J Clin Aesthetic Dermatol 2022;15(12 Suppl 1):S13–S15
Matthew T. Reynolds, MS, MPAS, PA-C, a native of Arkansas, received his physician assistant training at the University of Arkansas for Medical Sciences (UAMS) in Little Rock. In 2015, after completing his Master of Science degree in Physician Assistant Studies, he joined Arkansas Dermatology, where he completed a one-year physician assistant fellowship in dermatology and where he continues to practice dermatology to this day. Matt enjoys treating a wide variety of general and surgical dermatologic conditions—from psoriasis and acne to atopic dermatitis and skin cancer.
In addition to his clinical practice, Matt serves as a guest lecturer for the UAMS Physician Assistant Program, as well as a national speaker and educator for nurse practitioners and physician assistants. Over the last seven years, Matt has authored several published articles on a variety of dermatological topics, including atopic dermatitis, melanoma and nonmelanoma skin cancers, and psoriasis, and has coauthored book chapters on squamous cell skin cancer.
Matt is also the cofounder of the Arkansas Research Trials Center in North Little Rock, Arkansas, where he currently serves as a subinvestigator for many ongoing clinical studies.
What inspired you to pursue a career in dermatology?
Matt: I was initially inspired to pursue a career in dermatology when I came to the realization that nearly every systemic disease has some sort of skin manifestation, whether it is heart failure, diabetes, an autoimmune disorder, or other chronic condition. This impressed me most, and as I continue to expand my own knowledge, I often find I am humbled by the ever-expanding wealth of knowledge the dermatology field gains year after year on the many diseases we treat in the specialty. I now, more than ever, am most intrigued by the number of discoveries continually being made in immune pathway research. The number of biologic compounds that have been or are being developed that can target these pathways and disrupt the pathogenesis of these skin diseases has greatly expanded our treatment options for our patients. I continue to be inspired by not only how far we’ve come in recent years in our knowledge of skin diseases, but also by where we are heading in the future.
What clinical areas in dermatology interest you the most?
Matt: I am passionate about preventing and managing nonmelanoma and melanoma skin cancer. In our beautiful state of Arkansas, we have a high incidence of these types of cancers, and at Arkansas Dermatology, where I practice dermatology, we prioritize these patients so they can access high-quality care as quickly as possible for optimal outcomes.
I also enjoy treating inflammatory skin disorders, such as atopic dermatitis, plaque psoriasis, and urticaria. The ever-expanding landscape of therapies for these diseases is very promising, and I am thankful to have such a wide variety of tools available to effectively treat these patients. For example, when I initially began practicing dermatology, there were only two biologics available for the treatment of plaque psoriasis— alefacept and efalizumab; now, there are numerous therapeutic options available to patients. For atopic dermatitis, I’ve seen the launch of dupilumab, and now JAK inhibitors have made their debut, creating more therapeutic options for all patient types. In 2019, my colleagues and I founded a dedicated research facility for patients with inflammatory skin conditions; we are currently investigating several agents that will eventually be on the market.
Being involved in several clinical trials, you’ve got your finger on the pulse of new and emerging therapies in dermatology. What emerging therapies or areas of research are you most excited about?
Matt: One area of research/drug discovery that I’m very excited about is the use of oral IL-17 and-23 agents as therapeutic options for plaque psoriasis. I believe if we can get a handle on the potency and safety of these agents, we could potentially move completely away from the injectables. I’m also interested in the next generation of medication delivery systems; currently, there are several companies working on highly effective, continuous drug delivery systems that go beyond the patient having to self-inject or remember to take a daily pill. I’m very excited to see what happens over the next 10 years in this area of research.
Targeted therapy, or precision medicine, has definitely become an important aspect of drug develpment for the treatment of skin cancer, psoriasis, and other chronic skin conditions. What types of targeted therapy do you utilize in skin cancer management? How do you integrate these treatments into clinical practice?
Matt: One of the greatest gifts to derm practitioners is the number targeted therapies that are availble for many skin diseases. Specifically, for nonmelanoma skin cancer, I believe the Hedgehog inhibitors have been the biggest game changer. The ability to give your patients another option for treatment besides surgery or radiation is very rewarding to me as a provider. We have patients with too many lesions to treat or who have lesion recurrence following surgery or radiation that do really well on a Hedgehog inhibitor. We manage these patients with a specialized pulse dosing regimen and L-Carnitine 1500mg daily for muscle cramps, and they typically do very well. In addition to Hedgehog inhibitors, we also heavily utilize PD-1 blockers in our practice to treat patients with advanced squamous cell carcinoma. When it comes to optimal outcomes, the more advanced the disease, the more you need to have advanced tools in your armamentarium. I can’t encourage the advanced practice provider (APP) community enough to become educated and proficient in prescribing these types of therapies.
How do you keep your patients engaged in and adherent to their treatment plans?
Matt: Certainly, I try to give my patients a lot of extra attention. I will follow up with them every week or two when they are first starting an injectable for their psoriasis or eczema. I will often give away more samples than I’m probably supposed to (and without my clinic manager knowing) just so my patients can start treatment sooner. I firmly believe that if you sit down with your patients and set realistic expectations, provide adequate counseling, and follow up with them often, they will be much happier and more adherent to therapy. One consistent comment we see on our patient surveys is, “They truly care about my skin condition.” I love hearing that my patients feel well cared for.
What do you love most about being a PA in the field of dermatology?
Matt: I can say safely that I love what I do because I can see visible progress as I manage my patients’ skin conditions. It is very rewarding to see a patient’s psoriasis plaques melt away. I enjoy finding and implementing creative and innovative treatment strategies that are different from those of my colleagues, and then ultimately sharing those pearls with them so that their patients can also benefit. For example, for advanced basal cell carcinoma, I’ve found that pulse dosing patients with vismodegib (Erivedge®, Genentech, San Francisco, California)—a Hedgehog inhibitor—10 days per month helps them better tolerate their medicine without losing efficacy (Figures 1–2). Another example is using a combination Blu-light/daylight therapy for the treatment of actinic keratosis in patients who previously swore they would never undergo this type of treatment again. Often these patients will have had a bad experience with previous Blu-light treatment they received at another clinic. At our clinic, however, we will change a few treatment settings, such as incubation time or light exposure, to provide good results without any pain or discomfort, making these patients believers again in this type of treatment.
Over my career, I’ve also developed a passion for educating others. I can say wholeheartedly that the APP dermatology community is composed of eager, motivated, knowledge-hungry individuals that are advancing the dermatology specialty at an incredible rate. I am very humbled to be a part of this community of professionals.
How do you find balance between your personal life and your career? How do you avoid burnout
Matt: I try to focus on the tasks at hand. In order to be efficient, I find it helpful to compartmentalize and prioritize my day. I’ve found the most efficient way to be balanced, if there is truly such a thing, is to simply schedule everything—whether its exercise, sleep, or time with my wife and children—it’s just easier for me if I have my time preplanned. I wasn’t always this way, and certainly balancing career with family, personal health, and well-being will always be something I have to work on, but I know that I cannot hope to make progress in areas where I have taken no action.
What advice would you give NPs and PAs just beginning their dermatology careers?
Matt: Find someone who will train you, and really train you, to become a specialist in dermatology. Realize that you are held to high standards and are expected to perform at a high level—you have to always be more than people expect you to be. You are not going to be great in 90 days, and seeing 100+ patients every day is not good for you, your patients, or anyone else. I cannot stress enought how important well-rounded training is. In my practice, we train PAs and NPs for 12 months, sometimes longer. I believe you are ready to see patients when you can treat anything that walks through the clinic’s doors. If your supervising MD/DO does not want to train you, find another practice to work for. Lastly, as you become proficient in your career, learn to be a fighter for your patients—always try to put yourselves in their shoes. Continually ask yourself, “What kind of care would I want?” Keep that mentality when treating all patients and you will do well in your career.