Key Diagnostic and Therapeutic Pearls in Dermatology, With Brad P. Glick, DO, MPH

The number of innovative approaches to an array of both common and uncommon dermatologic diseases has grown in recent years, and many dermatologists have sought to share clinical pearls related to these approaches with other clinicians in the field.

During the 2026 American Academy of Dermatology (AAD) Annual Meeting in Denver, a session on these topics titled ‘Pearls: Diagnostic and Therapeutic’ was given by several notable speakers, 1 of whom was Brad P. Glick, DO, MPH, a board-certified dermatologist and the director of the dermatology residency training program at the Larkin Health System Palm Springs campus in Florida.1,2

Glick spoke with the HCPLive editorial team about his portion of this session, describing several key insights on treating conditions appearing on patients’ nails, designed to help dermatology clinicians:

HCPLive: Your portion of this session on diagnostic and therapeutic pearls covers nail disease within dermatology. Why did you feel the topic was important to pursue?

Glick: In our training in dermatology, I think one of the areas that doesn't necessarily get a ton of attention. While I didn't necessarily talk about a particular publication, because there are publications on this topic, I don't think nails get a lot of attention on our training. [This is] because there's just so much else going on. We have to learn about the basement membrane zone, then we apply that clinically to blistering diseases and immune mediated skin diseases. So we learn about how it treats psoriasis and eczema and lichen planus and this multitude of over 3000 diseases that we take care of in dermatology that I think probably the nails get a little neglected.

Deborah Lin, who is a resident University of Miami under the tutelage of Dr. Brian Morris, and her residency program director, a couple of years ago, published a really nice paper just vetting this, [noting] that even in programs where they have nail knowledge…our dermatology residents coming out of training and, if there's an area where they maybe feel a little bit uncomfortable, it's with nails. [This is] not only with assessment, but also with just how to do a biopsy, where to look, how to assess. So I think that was one of the main reasons why I like to provide tips.

Most of my tips are literature based, whether this relates to various topics like, let's say, the impact of biologic therapies and systemic therapies on nail diseases, whether it relates to the technique of doing an intra-lesional injection, and what that actually means. Where you're doing the injection depends largely on how you assess the nail. So those were the primary reasons, because I think we need more in our residency training programs.

HCPLive: Would you highlight some of the biggest takeaways that you mentioned within the session?

Glick: I think that one of the things that I talked about was the use of systemic small molecules and biologic therapies in the treatment of psoriatic disease, specifically psoriasis. You know, one of the things I highlighted is that when we're evaluating patients who have psoriatic disease, we really need to look at, first and foremost, as confirmed by some of the recent international psoriasis Council and AAD guidelines, high impact areas. The nails are critically important. So I think, as I tell my residents, if someone's there for psoriasis and their shoes and socks are still on, they need to take them off. They always need to look at all 20 nail units, because patients with nail psoriasis are three to four times more likely to develop psoriatic arthritis compared to those that really don't have nail changes associated with their psoriasis.

I think that's important, because in addition to seeing that, we also need to be screening our patients for psoriatic arthritis. Of course, we do a test called the PEST test, which is the psoriasis epidemiology screening tool, and it's all intertwined. One of the things I talked about is not only assessing the nails in the setting of an immune mediated skin disease like psoriasis…but also, there is significant impact by a number of our biologic therapies on psoriatic nail disease. So I think a we need to hone in on that assess accordingly, not just look at it from the standpoint of making the nails look or feel better, because a lot of times we don't ask, and a lot of our patients with nail changes in psoriatic disease.

They're uncomfortable, they have mechanical issues. It impacts their quality of life, but moreover, they may be one of those 30% of individuals who actually may either have or move on to develop psoriatic arthritis. I think rapid assessment is important, and realizing that we have specific biologic therapies that hadn't been studied directly for nail diseases, including tumor necrosis factor inhibitors, which are older therapies now they're mostly biosimilars…There are other post hoc analyses from our more modern day IL-17 and IL-23 inhibitors that demonstrate not only improvement in nail disease, but perhaps we are either pre-treating or treating their active psoriatic arthritis. That was really one very important area of discussion that I discussed in my my presentations on nail tips and tricks.

One of the things I also did for the audience was spend maybe 15 of my 30 minutes just going over nail terminology and different nail findings, because they are either common signs of normal health or aging, or they may be visible markers for systemic disease. I talked a lot about nail signs in general, not specific references to literature, although I did that in my remaining time, because there are some key journal articles that have been published just in the last year that I think are critical for us in our assessments for patients with nail diseases. I did talk a lot about nail terminology and nail signs of systemic disease. One other thing that I also talked about that I thought was important, because there are some new, if you will, data or information on how we assess certain nail signs of systemic disease, and one of them is the yellow nail syndrome.

Yellow nail syndrome is not particularly common, but on the other hand, it is a potential skin sign of systemic disease, where all 20 nails take on a yellow or sometimes a yellowish green color. And one of the hallmarks the presentation of patients who have yellow nail syndrome are complete absence of their cuticles. It's very, very unique presentation. And there's a wide differential diagnosis. It can look like fungus…But what's important about this particular condition is that it involves all 20 nails. Typically, the patients will present with a yellow discoloration, or yellow green discoloration of their nails. It's important to recognize this because it may be a nail sign of systemic problem, like cardiovascular disease, pulmonary disease, and more important malignancies such as bronchogenic carcinoma.

The quotes used in this Q&A interview summary were edited for clarity.

Glick had no relevant disclosures to highlight for this session.

References

1. Glick B, et al. S005 Pearls: Diagnostic and Therapeutic. Session presented at: 2026 American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, CO.

2. Lee DK, Lipner SR. Optimal diagnosis and management of common nail disorders. Ann Med. 2022 Dec;54(1):694-712. doi: 10.1080/07853890.2022.2044511. PMID: 35238267; PMCID: PMC8896184.