Key Non-Medication Clinical Pearls for Dermatologists, With Matthew Zirwas, MD

Clinicians in the dermatology field can be aided by diagnostic strategies and overlooked environmental triggers if their aim is to more effectively evaluate patients with persistent or unexplained dermatitis, according to Matthew Zirwas, MD, of Bexley Dermatology, who spoke about several key non-drug pearls during the panel session, "Clinical Pearls for Optimizing Dermatologic Care," at the 2026 SDPA Summer Dermatology Conference.1,2

In an on-site interview with HCPLive following the session, Zirwas noted the use of a Wood's lamp for detecting scabies as one of his most valuable nonpharmacologic clinical insights during the talk. He described the diagnosing of scabies as having traditionally relied on skin scrapings or dermoscopy, both of which he described as challenging. This is because patients often harbor only a handful of mites.

Instead of searching a limited number of suspicious lesions, Zirwas noted clinicians may implement a Wood's lamp to rapidly assess an entire body in a darkened room, where scabies mites and their burrows fluoresce with a characteristic appearance. In his description, Zirwas referred to this technique as one of the most effective methods he has encountered for a clinician to confidently rule out scabies in individuals presenting with new-onset dermatitis.

Later in his interview, Zirwas emphasized the value of recognizing systemic nickel sensitivity. This sensitivity, he argued, is an underappreciated contributor to dermatitis and other inflammatory symptoms. While nickel allergy is known to be common, particularly among women, Zirwas highlighted a subset of nickel-allergic individuals as potentially consuming enough dietary nickel to trigger systemic reactions. Outside of dermatitis, Zirwas pointed to these patients as potentially experiencing gastrointestinal symptoms and other systemic complaints.

In a third pearl Zirwas focused on, he described hot tubs as a frequently overlooked source of widespread dermatitis. He further described some patients as allergic not to the disinfectants commonly used in hot tubs, but to ammonium persulfate-related compounds observed during shock treatments. He suggested clinicians routinely ask individuals showing levels of diffuse dermatitis whether they had been inside a hot tub and, if so, to urge their avoiding it for several weeks as a means to determine whether symptoms improve.

Disclosures: Galderma Laboratories, L.P, Regeneron Healthcare Solutions, GENZYME CORPORATION, Arcutis Biotherapeutics, Lilly USA, Novartis Pharmaceuticals Corporation, Dermavant Sciences, LEO Pharma, Verrica Pharmaceuticals, Incyte Corporation, AbbVie, and Pfizer.

References

1. Zirwas M. Clinical Pearls for Optimizing Dermatologic Care. Session presented at SDPA Summer 2026; June 10–14.

2. Zirwas M, Rosen T. No Label No Trouble: A Panel Review of Off-Label Medication Use. Session presented at SDPA Summer 2026. Jun 10-14, 2026.