Dr. Shawn Kwatra, MD — chair of dermatology at the University of Maryland School of Medicine and director of its dedicated itch center — joins hosts Joseph Merola, MD, MMSc, FAAD, FACR and Alice Gottlieb, MD, PhD to break down the neuroimmune biology of chronic itch, why pruritus persists even after skin clears, and what to do about it in your next clinic.

Topics covered:

• Why chronic itch is a neuroimmune disorder — not just a downstream symptom of inflammation
• The cytokine players: IL-4, IL-13, IL-31, TSLP, and how they directly sensitize sensory neurons
• Disease control redefined: the IEC consensus statement on low disease activity and remission in AD (published in JAMA Dermatology)
• What to do when skin clears but itch doesn't — JAK inhibitors, IL-31 inhibition, and neuromodulators
• Bispecific and trispecific approaches: why AD's biological redundancy may require layered targeting
• OX40 and OX40 ligand: the upstream "prequel to inflammation" and its potential for off-therapy remission
• Phenotype-driven treatment: TH17/TH22 involvement, skin of color presentations, and where the field is heading
• Device-based modalities: phototherapy, TENS units, cold plasma — what the evidence actually supports

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The discussion covers why standard CV risk calculators underestimate risk in this patient population, how the PREVENT calculator improves on the pooled cohort equation by incorporating lifetime risk and younger-age calibration, and what a practical screening workflow looks like across different practice settings — from academic medical centers to community dermatology. Dr. Weber also breaks down when to manage risk in-house, when to refer to primary care, and when to send directly to a preventive cardiologist.

The episode closes with a forward-looking discussion on imaging: coronary artery calcium (CAC) scoring, coronary CT angiography, cardiac MRI, and the emerging use of AI algorithms to identify unrecognized cardiovascular burden in CT scans already sitting in the medical record.

Hosted by Masterclasses in Dermatology Saturday Morning Live — a free virtual education series for dermatologists, nurse practitioners, and physician associates produced by HMP Global.

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The conversation covers the NPF's recently published on-treatment remission criteria for plaque psoriasis, the concept of the molecular scar — what's still happening under visibly clear skin — and why tissue-resident memory T cells may be the reason patients who stop therapy don't always get back to where they were. Dr. Merola also presents new AAD data applying remission definitions to real-world trial outcomes with bimekizumab and guselkumab, including how many patients sustained on-treatment remission at three and five years.

From there, the discussion expands to atopic dermatitis, where Dr. Merola led the International Eczema Council consensus on low disease activity and remission — now in press at JAMA Dermatology — and to psoriatic arthritis, where a similar framework is actively in development. Dr. Gottlieb draws on her rheumatology background to examine what dermatology should borrow from RA and PsA remission models, and where the analogy breaks down.

The episode closes on the question of cure — what it would actually require, what early-intervention data in guttate psoriasis suggests, and how far off a true immune reset really is.

Hosted by Masterclasses in Dermatology Saturday Morning Live, a free virtual education series for dermatologists, nurse practitioners, and physician associates.

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