Getting a diagnosis of systemic mastocytosis takes about 8 years on average. The symptoms aren't specific, many doctors rarely see it, and each test tells only part of the story.

Kortney and Dr. Payel Gupta are joined by Dr. Tony Hunter, a hematologist at Winship Cancer Institute of Emory University. This episode builds on our first episode (#67) about testing. We walk through each test, what it can and cannot tell you, and what happens once you have a diagnosis.

What we cover in this episode about diagnosing systemic mastocytosis

• Why would I see a cancer doctor? Systemic mastocytosis is technically a blood cancer, but the indolent type is a long-term condition. It does not usually shorten your life or damage your organs.
• What does a high tryptase level mean? It can point to mastocytosis. But the most common cause is hereditary alpha-tryptasemia (HAT), an extra copy of the tryptase gene that a simple blood test can now find.
• What if my KIT test came back negative? Most people with mastocytosis have the KIT D816V gene change, but some tests aren't sensitive enough to detect it. Newer, more sensitive tests are still being studied.
• Do I really need a bone marrow biopsy? It is the main test to confirm the diagnosis. Dr. Hunter explains what doctors look for and what the procedure actually feels like.
• What happens after a diagnosis? Urine tests can show mast cell activity, but they do not confirm the diagnosis. Once you are diagnosed, Dr. Hunter makes sure you have epinephrine and get a bone density scan.

More resources on systemic mastocytosis

• The Itch guide to diagnosing mast cell disease
• What is Mastocytosis?
• Mast Cell Disease Toolkit

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Made in partnership with The Allergy & Asthma Network.

Thanks to Blueprint Medicines for sponsoring today’s episode.

This podcast is for informational purposes only and does not substitute for professional medical advice. Always consult with your healthcare provider for any medical concerns.

Many parents worry about using eczema creams on young kids for a long time. In this episode of The Itch Review, we look at a study of roflumilast cream.

Kortney and Dr. Payel Gupta are joined by allergist Dr. Michael Blaiss to review "Long-Term Safety and Efficacy of Once-Daily and Proactive Twice-Weekly Roflumilast Cream 0.05% for Mild-to-Moderate Atopic Dermatitis in Children Aged 2-5 Years From a 52-Week, Phase 3 Trial (INTEGUMENT-OLE)," published in Pediatric Dermatology, March 2026.

The FDA approved roflumilast cream 0.05% (Zoryve) for mild to moderate atopic dermatitis in kids ages 2 to 5 in October 2025.

• The study design and what OLE means.
• Why parents stop eczema creams early. Warnings on eczema creams can scare families. Many stop treatment too soon, even when their doctor says to keep going.
• How roflumilast works. Dr. Blaiss explains it as easing off the gas pedal for inflammation. Young kids use a lower strength because their skin soaks up more.
• Safety over a year. Only 2.5% of kids had cream-related side effects. Stinging or burning happened in less than 1% of kids.
• Secondary endpoint. Kids whose skin cleared moved to twice-weekly use. Half of them stayed clear for close to 8 months or longer.

DOWNLOAD THE INFOGRAPHIC

Ep. 106: The Risks and Realities of Steroid Overuse for Eczema

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Made in partnership with The Allergy & Asthma Network.

Thanks to Arcutis for supporting today’s episode.

This podcast is for informational purposes only and does not substitute for professional medical advice. Always consult with your healthcare provider for any medical concerns.

Atopic dermatitis is the most common type of eczema. It is not just dry skin. A weak skin barrier and an overactive immune system work together to cause dry, itchy, inflamed skin.

Kortney and Dr. Payel Gupta are joined by Dr. Ted Lain, a board-certified dermatologist and host of the Science of Skin podcast. We go back to the basics: what atopic dermatitis is, why it itches so much, what it looks like, and what really sets off a flare.

• Eczema vs. atopic dermatitis. Eczema is an umbrella word for itchy, scaly rashes. Atopic dermatitis is the most common type. Either word is fine at the doctor's office.
• What is happening in the body to cause atopic dermatitis. Dr. Lain explains the skin barrier as water balloons held together by mortar. In atopic dermatitis, water gets out, and things like dust, pollen, and germs get in.
• Is eczema just dry skin? The immune system overreacts like “a train without brakes.” That is why moisturizer alone is not enough, and why newer treatments target the immune system.
• The itch, scratching, and sleep. Scratching hurts the skin even more, but “just don't scratch” is not real advice. Itch often feels worse at night, when there is less to distract you.
• Flares, triggers, and food. Fragrances, harsh products, scrubbing, and rough fabrics can trigger flares. Food rarely causes eczema, so strict diets and online food tests usually do more harm than good.

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Made in partnership with The Allergy & Asthma Network.

Thanks to Evommune for supporting today’s episode.

This podcast is for informational purposes only and does not substitute for professional medical advice. Always consult with your healthcare provider for any medical concerns.