3 Tips for Managing Skin Disease in Dermatology Practice, With Eingun James Song, MD

The 2025 Fall Clinical Dermatology Conference in Las Vegas included a variety of sessions, with a notable example being the ‘30 Tips in 30 Minutes’ presentation.1

Eingun James Song, MD, one of the talk’s presenters, spoke with the HCPLive editorial team about Song’s own contribution to this list of tips for dermatologists. In Song’s 3 tips for managing inflammatory skin disease, he first recommended taking Janus kinase (JAK)-inhibitors at night to coincide with the peak of cytokines, citing a study showing rheumatoid arthritis patients taking it in the evening were nearly twice as likely to achieve ACR 20.

“I used to tell patients to just take it whenever it is convenient for you,” Song said. “Maybe take it with food, because it can help with nausea. But it turns out that, just like how our bodies have a natural circadian rhythm and how certain hormones will spike at certain times of the day or night, like cortisol…so do the cytokines that cause the diseases that we treat, like TNF-alpha, IL-1, IL-6, even IL-13. They tend to peak at night.”

Song highlighted the ease and lower cost of this recommendation for patients. In his second tip for clinicians, Song cautioned against underestimating the role of diet in inflammatory skin disease.

“There really isn't good data behind diets and inflammatory skin diseases, but there are some recent publications that have shown the role of sodium in triggering various different inflammatory pathways,” Song said. “Specifically, amplifying Th-17 and Th-2 inflammation, which we know are central to psoriasis and atopic dermatitis, respectively. We've seen this in in vitro studies. But also in humans, where patients who have higher PASI scores, for example, actually have higher amounts of sodium in their dermis.”

Lowering the salt intake in one’s diet was recommended by Song. His third tip involved ways to deal with insurance companies denying a prescription due to a service being labeled as cosmetic.

“We've seen this with vitiligo or alopecia areata with certain insurance payers,” Song explained. “So my tip is knowing when to add a secondary diagnosis to add legitimacy to a condition. What I often would do is, if a patient has, let's say, alopecia areata, I will add on an anxiety code. I will add on a depression code, or the one that I think carries the most weight. If you use the disorder involving immune mechanism code that is a D89.9, that shows the payer that this is truly an autoimmune medical condition, not a cosmetic condition. So I will just tack that on to the original diagnosis, and I have found that to help sometimes in getting certain medications or services covered.”

To learn more information about this topic, view Song’s full video above.

The quotes used in this video summary were edited for the purposes of clarity.

Song has reported serving as an investigator, consultant, and/or speaker for AbbVie, Alphyn Biologics, Amgen, Apogee, Arcutis, Bristol Myers Squibb, Boehringer Ingelheim, Dermavant, DermBiont, Galderma, Incyte, Janssen, LEO Pharma, MoonLake, Novartis, Ortho, Pfizer, Regeneron, Sanofi, Sun Pharmaceutical Industries, Timber Pharmaceuticals, and UCB.

References

1. Elewski B, Alexis A, Glick B, Kaufmann M, Lio P, Song J. 30 Tips in 30 Minutes. Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.