Gina Mangin, PA-C

Top Clinical Insights from SDPA 2025: Eczema, Alopecia, Burnout, Vitiligo, JAK Inhibitors

In late June, physician assistants convened at the 

SDPA Annual Summer Dermatology Conference

 in Washington, DC, from June 25 – June 29th, to attend talks from other physician assistants and clinicians.

in people of color. This edition of HCPLive Five spotlights interviews on tips for treating chronic hand eczema, using trichoscopy to differentiate alopecia subtypes, preventing career burnout, breaking down vitiligo misconceptions, and the workup before initiating JAK inhibitors for alopecia.

Tips to Optimize Diagnosis, Management of Chronic Hand Eczema with Adam Friedman, MD

Adam Friedman, MD, professor, chair of dermatology, and director of the Supportive Oncodermatology Program at The George Washington University School of Medicine & Health Sciences, shared clinical insights on diagnosing and managing chronic hand eczema (CHE), emphasizing its diagnostic complexity. CHE has symptoms that overlap with conditions, such as psoriasis, lichen planus, and secondary syphilis. In his interview, Friedman underscored the importance of patient history, especially recurrence, duration, and occupational exposure, and highlighted visual cues to differentiate CHE from other dermatoses.

He also noted that CHE often lacks sharp demarcation, unlike palmoplantar psoriasis, which favors pressure-prone areas. Recognizing patterns like lichenification and confluence helps inform diagnosis.

Trichoscopy Provides Clearer Differentiation of Alopecia Subtypes, With Amy Spizuoco, DO, FAOCD

Amy Spizuoco, DO, FAOCD, a board-certified dermatologist at True Dermatology and a clinical instructor at Mount Sinai, highlighted how trichoscopy enhances diagnostic accuracy in alopecia by revealing key patterns such as black dots, yellow dots, exclamation hairs, and follicular loss. She explained that recognizing these visual cues, like exclamation hairs in alopecia areata or follicular plugging in telogen effluvium, can distinguish scarring from non-scarring forms and guide proper treatment.

Discussing Ways to Help Clinicians Facing Career Burnout, with Hope Cook, PA-C

Hope Cook, PA-C, a physician associate from Georgia Skin Cancer & Aesthetic Dermatology, shared strategies for addressing clinician burnout, emphasizing that burnout is not the end—it can mark a new beginning.

In her session and interview, she introduced her CPR framework: Cocooning (inner reflection and awareness), Planning (evaluating what needs to change), and Revamping or Resigning (deciding whether to reshape or leave one’s role). Using a controlled burn metaphor, Cook illustrated how burnout can clear space for growth and career renewal. Drawing from her book (“Healing Clinician Burnout: How to Revive Your Life and Career”) and podcast, she offered practical, realistic steps clinicians can take to move from feeling stuck to rediscovering purpose in their professional lives.

Breaking Down Vitiligo Misconceptions at SDPA 2025, With Gina Mangin, PA-C

Gina Mangin, MPAS, PA-C, from Sand Lake Dermatology Center, addressed common vitiligo misconceptions, underlining that treatment is possible, even after years of the disease. In an interview, she highlighted the importance of using a Wood’s lamp to confirm diagnosis, especially in patients with skin of color.

Mangin discussed when to escalate to systemic therapy, using markers like rapid progression, confetti depigmentation, and inflammatory borders to assess disease activity. She also said harder-to-treat areas like hands and feet may require both topicals and phototherapy. With new therapies emerging alongside narrowband UVB, Mangin shared her optimism about re-pigmentation and maintaining results through an aggressive, tailored approach.

The Workup Before Initiating a JAK Inhibitor for Alopecia, With David Cotter, MD, PhD

David Cotter, MD, PhD, an assistant clinical professor at the University of Nevada, outlined key steps in evaluating patients with alopecia areata before starting a JAK inhibitor. His recommended workup includes a CMP, fasting lipids, TB and hepatitis B screening, QuantiFERON gold, and often varicella zoster titers—even beyond guideline recommendations—to assess shingles risk. He also considers pregnancy and HIV testing when appropriate.

Cotter stressed that clinicians should feel confident prescribing JAK inhibitors, as long as baseline labs are clear. Follow-up labs are crucial at 12 weeks, with frequency adjusted by patient risk. While many patients see significant regrowth, safety monitoring remains essential throughout treatment.

Videos

Check out insights from SDPA 2025 on eczema, alopecia, vitiligo, burnout, and JAK inhibitor workups—key tips to improve dermatology care.

HCPLive Five at SDPA 2025

Vitiligo Pipeline and Practice Gaps, With Gina Mangin, MPAS, PA-C

2025 Society of Dermatology Physician Assistant (SDPA) annual summer meeting

 spoke with Gina Mangin, MPAS, PA-C, from Sand Lake Dermatology Center, on her approaches to treating 

 and advice she would give other physician assistants on treating this condition.

“The advice I'd [give] to my PA colleague’s [is] keeping up to date with vitiligo; attend as many conferences as you can right now,” Mangin said. “This is a hot topic, so we're going to be talking about vitiligo, and we're going to be talking about a lot of autoimmune diseases. That is where dermatology is going. Dermatology is going down the line of immunology.”

In the first part of the interview, she discussed the importance of using a wood lamp every time a patient expresses concern about white spots or discoloration. Thinking you can diagnose vitiligo without a wood lamp can lead you to miss cases. She also addressed a misconception that no treatment exists for vitiligo, which is not true.

In the latter half of the interview, she shared specific patient profiles or characteristics that would make a patient a strong candidate for a JAK inhibitor, how to navigate treatment expectations, underutilized strategies, strategies for long-term disease control, and gaps in the vitiligo treatment landscape.

Mangin said that all patients with vitiligo are a good candidate for the JAK inhibitor of the FDA-approved Ruxolitinib. This topical has great safety and efficacy. In the pipeline there are oral JAK inhibitors, and once they are approved Mangin will consider a patients’ age before prescribing those.

Mangin shared underutilized strategies for treating vitiligo, which is narrowband UBV.

“Where I am in Orlando, Florida, we are only 1 of 2 offices that have narrowband light to offer our patients,” Mangin said. “It's sad that there's only 2 offices that actually offer this treatment, and there's tons of data to support it with safety backing it up. It still is great that we have these new medications, but I do feel that the narrow band light treatments are underutilized.”

A gap in vitiligo treatment is that only one FDA-approved medication is available: Ruxolitinib. However, drugs in the pipeline focus on attacking memory T cells, which cause the relapse of deep pigmentation.

“One thing we need to do better with our patients is educating them [that], once they establish repigmentation, staying on some type of treatment,” Magnin said. “Do not stop your treatment cold turkey because that's where those memory T cells are going to come in, and they're going to attack again, and our patients are going to regress. Compliance, from our patient standpoint, is key.”

Mangin, G. Vitiligo in Practice: Clinical Insights and Management Supported by Incyte. Presented at the Society of Dermatology Physician Assistant (SDPA) 2025 meeting on Thursday, June 26th in Washington, DC.

At SDPA 2025, Mangin emphasized the importance of wood lamp use, JAK inhibitors, and phototherapy in managing vitiligo and preventing relapse.

 on Thursday, June 26th, in Washington, DC, Gina Mangin, MPAS, PA-C, from Sand Lake Dermatology Center, presented “Vitiligo in Practice: Clinical Insights and Management Supported by Incyte.”

at the meeting, Mangin discussed her approach to treating 

, particularly in patients with skin of color.

“I use my wood lamp every single time I have a patient that comes in with any type of concern, where it's white spots or discoloration,” Mangin said. “Years prior, I may have thought, ‘Oh, I can make this diagnosis of vitiligo without the Woods lamp.’ No, a Woods lamp is essential to evaluating your patients for vitiligo.”

She also addressed a common vitiligo misconception, which is that no treatment exists for vitiligo. A misconception patients often have is that since they have had this condition for years, it will not re-pigment. It does not matter if a patient has had vitiligo for 2 years or 20 years—there is still potential to re-pigment the skin.

“So, when I have patients coming into the office now, I'm excited, because we have FDA-approved medications for them,” Mangin said.

Alongside the gold standard of using narrowband UVB for vitiligo, new medications will reach the market soon.

Mangin determines a systemic therapy over a topical or phototherapy if the disease is active. Markers for an active disease include a 1% increase in body surface area within 4 weeks, confetti-style depigmentation, an active Kebner phenomenon or trichome, or an inflammatory border around the vitiligo.

She noted that some areas are harder to pigment, including the hand, feet, and ankles, because of the lack of hair follicles. In this case, she may prescribe a topical along with phototherapy to really help with the re-pigmentation.

“We want to stop that autoimmune attack against the melanocytes,” Mangin said. “We want to re-pigment the skin, and we want to maintain that pigmentation. So that's usually where the aggressive approach is going to come into play, where I am going to use topicals, narrow band, and then, for the active disease patients, those systemics as well.”

Mangin, G. Vitiligo in Practice: Clinical Insights and Management Supported by Incyte. Presented at the Society of Dermatology Physician Assistant (SDPA) 2025 meeting on Thursday, June 26th in Washington, DC

At SDPA 2025, Mangin discussed her vitiligo approach, misconceptions, and how to determine when the disease is active.

Gina Mangin, PA-C

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