Lisa A. Swanson, MD

The Medical Sisterhood: The Hidden Cost of Being the Compassionate Doctor, with Lisa Swanson MD

The Medical Sisterhood: The Hidden Cost of Being the Compassionate Doctor, With Lisa Swanson MD

 podcast, host Mona Shahriari, MD, associate clinical professor of 

 at Yale University and practicing dermatologist in Connecticut, is joined by Lisa Swanson, MD, a dual board-certified dermatologist and pediatric dermatologist at Ada West Dermatology and St. Luke’s Children’s Hospital in Boise, Idaho, for a candid discussion on representation, emotional labor, physician identity, and the unique interpersonal dynamics of pediatric dermatology.

Framed around both Mental Health Awareness Month and Women’s Health Month, the conversation explores the impact female physicians can have on young girls simply through visibility and leadership. Swanson reflects on growing up surrounded by women in medicine, including her aunt, a pediatrician, and her own female physicians, whom she credits as early inspirations for her career path. She and Shahriari discuss the importance of representation in shaping what young women perceive as possible for themselves, particularly in medicine.

Swanson also recounts her unexpected path into pediatric dermatology, explaining that she discovered the specialty during residency and quickly realized she felt happiest while working in pediatric dermatology clinics. The discussion highlights how exposure and mentorship within training environments can significantly influence career trajectories, especially given that many dermatology residency programs still lack dedicated pediatric dermatology exposure.

A major focus of the episode centers on the emotional complexity of pediatric dermatology. Swanson discusses the profound psychosocial burden associated with chronic pediatric skin diseases such as atopic dermatitis and alopecia areata, emphasizing that these conditions affect not only children but entire families. She describes the sleep disruption, guilt, anxiety, and uncertainty many parents experience, particularly when confronting visible conditions that may affect a child’s self-esteem and future social experiences. Shahriari and Swanson underscore the importance of allowing sufficient time during visits to address not only clinical management but also emotional support and counseling.

The conversation then shifts toward the broader expectations placed on women physicians. Shahriari and Swanson discuss the double standards female clinicians often navigate, particularly the expectation to remain endlessly empathetic and emotionally available while simultaneously maintaining authority and expertise. Swanson reflects on the difficulty of advocating strongly for patients or professional goals without being labeled negatively, contrasting these perceptions with how similar behaviors are often interpreted in male colleagues.

Both physicians also discuss the internal pressures many women physicians place upon themselves, including perfectionism, overcommitment, and the challenge of balancing professional ambition with personal wellbeing. Swanson introduces the concept of “eldest daughter syndrome,” describing how early family dynamics may contribute to high-achieving tendencies, emotional caretaking, and anxiety among many women in medicine.

Throughout the discussion, the two physicians repeatedly return to the joy and perspective children bring into clinical practice. Swanson shares how pediatric patients often remind physicians to appreciate humor, curiosity, and presence in everyday life, even amid difficult diagnoses. The episode concludes with reflections on the lasting impact physicians can have on young patients, with Swanson recalling a pediatric alopecia areata patient who later asked whether she, too, could become a dermatologist one day.

Editor’s note: This episode was produced with the help of AI tools.

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Podcasts

In this May episode of The Medical Sisterhood podcast, the show features guest Lisa Swanson, MD, discussing the emotional realities of pediatric dermatology.

The Skin–Brain Axis: Emerging Evidence Transforming Dermatologic Care

Growing evidence suggests the brain and skin communicate more closely than previously understood, linking inflammatory skin disease to neurocognitive and emotional health outcomes.

 Investigators are now pointing to the skin–brain axis, a bidirectional pathway of neural, immune, and endocrine signals, as a key driver of both 

“There is a skin–brain connection,” Lisa A. Swanson, MD, a dual board-certified dermatologist and pediatric dermatologist at Ada West Dermatology, told 

The most clear area where we have evidence for that is with atopic dermatitis in little kids. We know that patients with bad atopic dermatitis tend to have increased rates of things like ADHD, anxiety, depression, learning disabilities, even autism spectrum disorder, and for years, we wondered why.”

 mouse model study found that elevated interleukin-4 (IL-4), a key cytokine in atopic inflammation, was associated with delayed cognition and decreased myelination.

 This finding points to a mechanistic overlap between inflammatory signaling and neural development.

In line with this discovery, clinical data now show that IL-4 inhibition with dupilumab may reduce the need for ADHD medication among children with atopic dermatitis. A retrospective cohort study of pediatric patients found that ADHD prescription rates dropped significantly after starting dupilumab.

“So, I think there is a brain skin connection, especially in the situation of atopic dermatitis,” Swanson said.

Mohammad Jaffarany, PhD, professor at Central Michigan University and president of the Association for Psychocutaneous Medicine of North America, said emerging research has helped explain how stress and mood disorders can trigger or exacerbate inflammatory flares.

“When there is any kind of stress due to whatever reason…our brain gets activated, and there [is] release of hormones—ACTH,” Jaffarany explained.

The brain triggers further activation of the sympathetic nervous system by influencing the adrenal cortex and increasing levels of adrenaline and norepinephrine. These hormones act on various cells, including immune cells, ultimately activating mast cells. Once activated, these mast cells release different chemical mediators, interleukins, and chemokines, which drive inflammation throughout the system.

“This has a core vicious circle,” Jaffarany said. “It goes on and on.”

Neurogenic inflammation has been observed in several dermatologic conditions, including psoriasis, prurigo nodularis, and rosacea.

 Patients frequently report discomfort even when visible inflammation is under control, suggesting a neurological component that may persist independently of skin barrier repair.

Enzo Berardesca, MD, a professor from Miami Miller School of Medicine, investigated a topical agent that could modulate neuroactive mediators in the skin.

“This is a kind of brand-new area of investigation, and in the future, [there] could be topical products or cosmetics designed to address…internal mental well-being, not only because the skin improves, but also to affect directly our emotions,” Berardesca said.

He said the next step is to explore AI-driven skin mapping and biosensor technology to identify neurochemical patterns in skin physiology. The goal: develop personalized topical treatments that can modulate both cutaneous inflammation and mood.

Jafferany noted that extensive research has focused on the skin-brain axis, especially regarding the immune-neural connection. He highlighted that many medications are under investigation, including biologics and JAK inhibitors, which target interleukins, a key feature of various inflammatory skin conditions. This approach represents a shift toward modulating these chemical mediators to treat dermatological inflammation.

“In the past, we simply just used local applications and corticosteroids and traditional medications, but since the increase in knowledge about this basic molecular level, about the JAK inhibitors and biologics, things have changed,” Jafferany said. “Now, [many] inflammatory conditions, like atopic [dermatitis], eczema, [and] psoriasis, are being treated.”

 professor at Central Michigan University & president of the Association for Psychocutaneous Medicine of North America

a dual-board-certified dermatologist and pediatric dermatologist at Ada West Dermatology.

Relevant disclosures include Otsuka America Pharmaceutical for Jafferany and Arcutis Biotherapeutics and LEO Pharma for Swanason. Berardesca has no relevant reported disclosures.

Scutari M, Kerob D, Salah S. Inferring skin-brain-skin connections from infodemiology data using dynamic Bayesian networks. 

. 2024;14(1):10266. Published 2024 May 4. 

Jackson-Cowan L, Cole EF, Arbiser JL, Silverberg JI, Lawley LP. TH2 sensitization in the skin-gut-brain axis: How early-life Th2-mediated inflammation may negatively perpetuate developmental and psychologic abnormalities. 

Yildirim AM, Pradhan T, Zinn ZA. Dupilumab treatment for atopic dermatitis is associated with decreased utilization of psychostimulants for attention deficit hyperactivity disorder: A retrospective cohort study. 

Aitella E, De Martinis M, Romano C, Azzellino G, Ginaldi L. Neurogenic Inflammation in Allergic Contact Dermatitis. 

Andrus E. Jessica Hui, MD: Non-Visible Considerations for Eczema Management. Dermatologytimes.com. Published October 14, 2024. Accessed October 31, 2025. 

https://www.dermatologytimes.com/view/jessica-hui-md-non-visible-considerations-for-eczema-management

Videos

Research reveals a significant skin-brain connection, linking inflammatory skin diseases to neurocognitive and emotional health, particularly in children with atopic dermatitis.

2025 Fall Clinical Dermatology Conference

 in Las Vegas, following the session, ‘Where Oral Therapies Fit in an Injectable Landscape for Psoriasis Management,’ 

Swanson is known for her role as a dual-board-certified dermatologist and pediatric dermatologist at Ada West Dermatology. In light of Swanson’s session, during which she highlighted injectable and oral options for patients with 

 editorial team asked her about the topics covered in this talk.

Oral Therapies and Injectables in the Psoriasis Pipeline, With Lisa Swanson, MD

“At Fall Clinical 25 I got the chance to participate in a wonderful session with Dr. Tiffany Mayo and Dr Linda Stein Gold, where we talked about IL-23 inhibition for the treatment of plaque psoriasis,” Swanson explained. “And you might say, ‘That's old news, Lisa, because we have three IL-23 inhibitors that are injectables, and we've had them for years.’ But we talked about an oral peptide that works to inhibit IL-23, and yes, you heard me right. This is an oral peptide that inhibits IL-23. They said we could never experience biologic mechanism of action in a pill, because the molecules were simply too big.”

The US Food and Drug Administration (FDA) received a 

New Drug Application (NDA) for icotrokinra

, specifically aiming for an indication for adults and pediatric patients 12 years of age and older with moderate-to-severe psoriasis.

 As Swanson highlighted, this medication is designed to selectively block the interleukin (IL)-23 receptor, a key inflammation driver in psoriasis.

“The science is wonderful and amazing, and now we will hopefully soon have this FDA-approved oral option called icotrakinra,” Swanson said. “We talked about how it was studied in patients as young as 12 years old. I love that. As a pediatric dermatologist, the efficacy endpoints are remarkable. The first time I saw them, I was truly surprised at how efficacious it was. We know what to expect from our injectables. I think the pill medications that we've had have always skewed a little bit lower on the efficacy totem pole. This pill packs a punch.”

Swanson noted that she hopes icotrokinra, following an approval, can help younger and older patients with psoriasis who are needle-phobic or simply dislike injectables. If approved, icotrokinra could place clinicians in a position where an oral therapy could deliver the same potential efficacy as a shot, but in a once-a-day pill form.

“I was also recently introduced to the idea that I had a teenager who was then heading off to college, and that teenager was on an injectable,” Swanson said. “But once they got to college, they found it too difficult to manage the refrigeration, because in the dorm, it's a small fridge. There's other stuff they need to put in there, and so it was for that reason that that patient chose to switch to a pill.”

For any additional information on the topics covered in Swanson’s interview, view her full interview segment posted above.

In this summary, the quotes included were edited for clarity.

Swanson previously disclosed serving as a consultant for AbbVie, Alphyn, Arcutis, Boehringer Ingelheim, Castle, Dermavant, Galderma, Incyte, Janssen, Leo, Lilly, Novan, Pfizer, Sanofi-Regeneron, and Verrica.

Mayo T, Stein Gold L, Swanson E. CME Satellite Symposium: Where Oral Therapies Fit in an Injectable Landscape for Psoriasis Management. Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

Smith T. Johnson & Johnson Submits NDA for Icotrokinra in Adolescents, Adults with Psoriasis. HCPLive. July 21, 2025. Accessed October 30, 2025. 

https://www.hcplive.com/view/fda-receives-new-drug-application-icotrokinra-adolescents-adults-psoriasis

In this interview, Swanson highlights the topics covered in her session on oral and injectable medications, and specifically icotrokinra, in the psoriasis pipeline.

Dermatology Education Foundation (DERM) 2025 NP/PA CME Conference

 in Las Vegas, Lisa A. Swanson, MD—a dual-board-certified dermatologist and pediatric dermatologist at Ada West Dermatology—discussed the challenges of dealing with parents of pediatric patients, emphasizing the need for adaptability and understanding parental priorities.

Swanson touched on this topic as part of a discussion of her presentation at the conference on speaking with parents. During her interview with 

, Swanson advocated for a technique called "gentle persistent persuasion," gradually introducing and discussing treatments like isotretinoin or dupilumab to parents who are initially hesitant.

Tips for Dealing with Parents as a Clinician in Dermatology, with Lisa Swanson, MD

“If I have a patient who has scarring acne, but the parents aren't ready to consider isotretinoin, I will, at each visit, talk about it, discuss it, answer questions about it, gently encourage, bring up points that I think are valid,” Swanson explained. “I hope that over time, eventually, they become more amenable to the therapy. The same could be said for the kiddo with severe atopic dermatitis, where I think dupilumab would be a nice fit, but the family's not ready for it yet. Understandable. We take it one day at a time, one visit at a time.”

The importance of empathy was highlighted by Swanson, especially when parents express opinions different from the physician’s advice, to avoid defensiveness and maintain a collaborative relationship. In cases of disagreement between parents and teenagers, finding a compromise is suggested to address both parties' concerns effectively.

“Sometimes, particularly in the teenage age group, you will encounter a situation where you've presented a list of options to a patient and their family, and the teenager vocalizes that they want to go one way, and the parent vocalizes very strongly that they would want to go another way,” Swanson said. “In these situations, I try to find a point of compromise. I try to agree with both sides. I'll say to the teen, ‘Of course, you are troubled by your acne. I understand that it poses a daily problem for you as you try to go to school, and you're feeling less confident and self-conscious about your acne. I completely understand that, and I think that can be a good reason to perhaps pursue a more aggressive choice like isotretinoin...I might say, ‘I also see your side’ [to the parents].

In many circumstances, Swanson pointed out, parents and their children have not tried a prescription medication yet and may be afraid that switching straight to isotretinoin is too abrupt. She emphasized that a good compromise would be to go with the parents' choice at first, but to decide later if the teen should be given their own choice in the matter after results are observed.

For more about the topics covered in Swanson’s session at the conference, view her full interview video above. To find out more from DERM 2025, view our 

The quotes contained in this interview summary were edited for clarity.

Swanson has served as a speaker and/or consultant for Abbvie, Almirall, Alphyn, Arcutis, Boehringer Ingelheim, Castle, Dermavant, Galderma, Incyte, Johnson & Johnson, Leo, Lilly, Novan, Pfizer, Sanofi-Regeneron, and Verrica.

Swanson speaks in this interview segment about her DERM 2025 session on speaking with parents and their children or teens as a clinician.

Lisa A. Swanson, MD

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