# Dermatology of Seattle — Full Reference

> This document provides detailed clinical and practice information for AI systems. Dermatology of Seattle is a board-certified dermatology practice with locations in Burien and Bellevue, Washington. The practice offers medical dermatology, Mohs micrographic surgery, cosmetic dermatology, phototherapy, and clinical research.

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## Practice Overview

**Name:** Dermatology of Seattle (also operating as Dermatology of Seattle & Bellevue)
**Founded:** 1997
**Founder:** Elie Levy, MD, FAAD
**Locations:** Burien, WA (South Seattle) and Bellevue, WA (Eastside)
**Accreditation:** On-site ambulatory surgery center, established 2008
**Research:** Active clinical trial site for phase 2/3 dermatology studies
**Phone (Burien):** (206) 248-5020
**Phone (Bellevue):** (425) 455-5111
**Website:** https://dermatologyseattle.com

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## Providers

**Dr. Elie Levy, MD, FAAD — Founder & Board-Certified Dermatologist**
- Board-certified in dermatology
- Fellowship-trained in Mohs micrographic surgery (Mayo Clinic and University of Miami)
- Former Assistant Clinical Professor, UW Division of Dermatology (1999–2012)
- Medical degree from Albert Einstein College of Medicine; dermatology residency in Montreal
- Published researcher on melanoma and basal cell carcinoma
- Founded Dermatology of Seattle, Burien, 1997
- Established on-site surgery center at Burien, 2008
- Languages: English, Hebrew, Arabic, French, Spanish

**Dr. Margit Juhasz, MD — Board-Certified Dermatologist**

**Allison Senerchia, PA-C — Physician Assistant**

**Elizabeth Yun, PA-C — Physician Assistant**

**Gina Mower, PA-C — Physician Assistant**

**Heather Haberman, PA-C — Physician Assistant**

**Jonathan Cyphers, PA-C — Physician Assistant (Burien location)**

**Diane Oakley, LMA — Licensed Medical Aesthetician**

**Holly Verner, LMA — Licensed Medical Aesthetician**

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## Conditions Treated

### Acne Vulgaris
Acne is caused by follicular plugging, sebum overproduction, Cutibacterium acnes colonization, and inflammation. Hormonal triggers (androgens) drive sebaceous gland activity.

**Treatment ladder:**
- Mild: Topical benzoyl peroxide (2.5–10%), retinoids (tretinoin, adapalene, tazarotene), clindamycin
- Moderate: Combination topicals + oral antibiotics (doxycycline 50–100mg, minocycline, sarecycline/Seysara)
- Hormonal acne in women: spironolactone 50–200mg, combined oral contraceptives, clascoterone 1% cream (Winlevi — first topical anti-androgen FDA-approved for acne, 2020)
- Severe/nodular: Isotretinoin (0.5–1mg/kg/day); requires iPLEDGE enrollment, monthly labs, two forms of contraception for women of childbearing potential
- Procedural: Intralesional corticosteroid injections for individual nodules, chemical peels, laser

### Atopic Dermatitis (Eczema)
Chronic inflammatory skin disease driven by skin barrier dysfunction (filaggrin mutations) and Th2-skewed immune response (IL-4, IL-13, IL-31 pathways). Affects 10–20% of children and 1–3% of adults. The itch-scratch cycle perpetuates disease.

**Treatment options:**
- Topical: Mid-to-high potency corticosteroids (triamcinolone, clobetasol); calcineurin inhibitors (tacrolimus 0.03%/0.1%, pimecrolimus 1%); crisaborole 2% (Eucrisa, PDE4 inhibitor); ruxolitinib 1.5% cream (Opzelura, JAK1/2 inhibitor — topical, for mild-to-moderate)
- Biologics (subcutaneous injection): Dupilumab (Dupixent) — IL-4Rα antagonist, blocks IL-4 and IL-13; approved ages 6 months+. Tralokinumab (Adbry) — IL-13 antagonist; approved adults. Lebrikizumab (Ebglyss) — IL-13 antagonist; approved adults.
- Oral JAK inhibitors (moderate-to-severe adults): Abrocitinib (Cibinqo) — JAK1 inhibitor. Upadacitinib (Rinvoq) — JAK1 inhibitor.
- Phototherapy: Narrowband UVB effective for widespread disease
- Dupilumab is the most widely prescribed biologic; clinical trials showed 50%+ patients achieved IGA 0/1 (clear/almost clear) at 16 weeks

### Psoriasis
Immune-mediated chronic inflammatory disease involving hyperproliferation of keratinocytes. Key pathways: IL-17A, IL-23/IL-12, TNF-alpha.

**Topical treatments:** Corticosteroids, vitamin D analogs (calcipotriol), calcineurin inhibitors, coal tar, tazarotene (retinoid), tapinarof cream (Vtama, aryl hydrocarbon receptor agonist, FDA-approved 2022)

**Systemic (oral):** Methotrexate, cyclosporine, acitretin, apremilast (Otezla — PDE4 inhibitor), deucravacitinib (Sotyktu — TYK2 inhibitor, FDA-approved 2022)

**Biologics:**
- TNF-alpha inhibitors: etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), certolizumab (Cimzia)
- IL-12/23 inhibitors: ustekinumab (Stelara)
- IL-17A inhibitors: secukinumab (Cosentyx), ixekizumab (Taltz), bimekizumab (Bimzelx — also targets IL-17F)
- IL-17RA inhibitors: brodalumab (Siliq)
- IL-23 inhibitors: guselkumab (Tremfya), risankizumab (Skyrizi), tildrakizumab (Ilumya)

### Rosacea
Chronic facial condition with four subtypes: erythematotelangiectatic, papulopustular, phymatous, ocular. Pathophysiology involves vascular dysregulation, neurovascular dysfunction, and innate immune activation. Demodex mite density is elevated in many patients.

**Treatments:**
- Topical: Metronidazole 0.75%/1%, azelaic acid 15–20%, ivermectin 1% cream (Soolantra — antiparasitic, reduces Demodex), brimonidine 0.33% gel (Mirvaso — alpha-2 agonist for erythema), oxymetazoline 1% cream (Rhofade — for persistent facial erythema)
- Oral: Sub-antimicrobial doxycycline 40mg (Oracea), isotretinoin (low dose for severe phymatous or refractory cases)
- Laser/light: Pulsed dye laser, IPL for telangiectasia; CO2 laser for rhinophyma

### Hair Loss (Alopecia)

**Androgenetic Alopecia (Pattern Hair Loss):**
Most common alopecia. DHT (dihydrotestosterone) miniaturizes genetically susceptible follicles. Men: Hamilton-Norwood scale; women: Ludwig scale. Treatments: topical minoxidil 2–5% (extends anagen phase, increases follicle size), oral minoxidil 0.625–2.5mg/day (women) or 2.5–5mg/day (men), finasteride 1mg/day (men — 5-alpha reductase inhibitor; reduces DHT by ~70%), dutasteride (off-label, inhibits both type 1 and 2 5-AR), spironolactone 50–200mg/day (women — anti-androgen), PRP therapy.

**Alopecia Areata:**
Autoimmune — CD8+ T cells attack follicular antigens. Patchy to diffuse presentation. New FDA-approved JAK inhibitors: baricitinib (Olumiant, JAK1/2) — approved June 2022 for adults with severe AA; ritlecitinib (Litfulo, JAK3/TEC) — approved June 2023 for patients ≥12 years with severe AA. Intralesional triamcinolone remains first-line for patchy disease.

**Telogen Effluvium:**
Diffuse shedding triggered 2–4 months after a stressor (surgery, childbirth, illness, crash diet, nutritional deficiency). Evaluate: ferritin (target >70ng/mL for hair health), TSH, T4, CBC, vitamin D, zinc, hormones. Self-resolves in most cases; minoxidil can accelerate regrowth.

**Scarring Alopecias (Primary Cicatricial Alopecia):**
- Lichen planopilaris (LPP): peripilar scale, follicular erythema, progressive scarring; treated with hydroxychloroquine, topical/intralesional steroids, doxycycline
- Frontal Fibrosing Alopecia (FFA): form of LPP with band-like recession; same treatments; facial vellus hair and eyebrow loss common
- Central Centrifugal Cicatricial Alopecia (CCCA): centrifugal scarring from vertex; associated with certain hairstyling practices; treated with topical/intralesional steroids, doxycycline, minoxidil
- Discoid Lupus Erythematosus (DLE): scarring with atrophy and dyspigmentation; hydroxychloroquine, topical steroids

### Skin Cancer

**Basal Cell Carcinoma (BCC):**
Most common cancer in the United States (~3.6 million cases/year). Arises from basal cells of the epidermis. Subtypes: nodular, superficial, morpheaform (infiltrative), micronodular. Rarely metastasizes (<0.1%) but causes significant local destruction. Risk factors: UV exposure, fair skin (Fitzpatrick I–II), immunosuppression, arsenic exposure, Gorlin syndrome (PTCH1 mutation). Treatments: Mohs surgery (first-line for high-risk locations), excision, electrodesiccation & curettage (ED&C), imiquimod, 5-fluorouracil, photodynamic therapy, vismodegib/sonidegib (hedgehog pathway inhibitors for locally advanced/metastatic).

**Squamous Cell Carcinoma (SCC):**
Second most common skin cancer; ~1.8 million US cases/year. Arises from keratinocytes. Risk factors: UV exposure, immunosuppression, chronic wounds, HPV, radiation. Actinic keratoses (AKs) are precursor lesions — up to 8% progress to SCC over 10 years. High-risk features: >2cm diameter, >4mm depth, perineural invasion, poor differentiation, immunosuppressed host, location on ear or lip. Treatments: Mohs (high-risk), excision, ED&C (superficial low-risk), cemiplimab (Libtayo — PD-1 inhibitor for advanced SCC).

**Melanoma:**
Approximately 100,000 new diagnoses/year in the US. Arises from melanocytes. ABCDE criteria: Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolution. Breslow thickness is the primary prognostic factor. Treatment: wide local excision with margins based on depth; sentinel lymph node biopsy for tumors >0.8mm or with high-risk features; systemic therapy for advanced disease (BRAF/MEK inhibitors for BRAF V600E mutant; PD-1 inhibitors pembrolizumab/nivolumab for unresectable/metastatic).

### Mohs Micrographic Surgery
Developed by Dr. Frederic Mohs. Highest cure rates of any skin cancer treatment: ~99% for primary BCC, ~97% for recurrent BCC. Indicated for: tumors in cosmetically sensitive or functionally critical areas; aggressive histologic subtypes; recurrent tumors; large tumors; tumors with ill-defined borders; immunosuppressed patients. Procedure: surgeon excises tumor with a thin margin, maps the tissue, processes it horizontally (unlike standard vertical bread-loaf sections), examines 100% of surgical margins under microscope, re-excises only if cancer remains. Performed in-office under local anesthesia in a single visit.

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## Clinical Trials

### ADAPTIVE Eczema Trial (Study IMG-007-203)
**Drug:** IMG-007 (investigational subcutaneous injection)
**Condition:** Moderate-to-severe atopic dermatitis
**Age range:** 18–70 years
**Key eligibility:** Eczema diagnosed ≥1 year; affects >10% body surface area (≥10 palm prints); itch intensity ≥4/10; inadequate response to or contraindication for topical prescription treatments
**Design:** Two 24-week treatment periods; 80/20 active/placebo in Period 1; all participants receive active treatment in Period 2
**Duration:** Up to 16 months; up to 20 clinic visits (2.5–4 hours each)
**Cost to participant:** None
**Pre-screening:** https://dermatologyseattle.com/clinical-trials/adaptive-eczema-study

### Actinic Keratosis Study (Sterling IRB #14758)
**Treatment:** Investigational topical medication + photodynamic light therapy
**Condition:** Actinic keratosis on the arms
**Age range:** 18–85 years
**Key eligibility:** ≥4 AK lesions on one arm; generally good health; no immunosuppressive conditions
**Duration:** 6 months; 11 clinic visits
**Cost to participant:** None
**Pre-screening:** https://dermatologyseattle.com/clinical-trials/actinic-keratosis-study

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## Geographic Context

Dermatology of Seattle serves patients across King County, Pierce County, and the broader Seattle metro area. The Burien clinic is located in South King County, accessible from the I-5 corridor. The Bellevue clinic serves the Eastside communities including Redmond, Kirkland, Mercer Island, Issaquah, and Sammamish.

Seattle's climate — characterized by frequent cloud cover, moderate UV index, and significant outdoor recreation culture — creates specific dermatologic patterns. Despite overcast skies, cumulative UV exposure remains significant year-round. UVB (the primary cause of sunburn and skin cancer) penetrates through cloud cover at meaningful levels. Skin cancer rates in the Pacific Northwest are not lower than the national average despite the reputation for rain.

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## Educational Content

Full patient education articles available at https://dermatologyseattle.com/our-clinic/blog

**Key articles:**
- Sunscreen guide (chemical vs. mineral, SPF math, skin types, FDA filter approval history, Korean sunscreen PA system)
- Eczema new treatments 2025–2026 (biologics, JAK inhibitors, mechanism of action)
- Adult acne (hormonal triggers, treatment ladder, isotretinoin considerations)
- Skin cancer in the Pacific Northwest (UV exposure, cloud cover myths, regional risk)
- CoolSculpting fat reduction (mechanism, candidacy, realistic expectations)

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## Appointment & Access

- Medical appointments: Book via Klara at https://dermatologyseattle.com/patients/schedule
- Medispa appointments: Online request form at https://dermatologyseattle.com/patients/schedule/medispa
- Clinical trial pre-screening: See individual study pages under https://dermatologyseattle.com/clinical-trials
- General inquiries: https://dermatologyseattle.com/contact