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Hottest Topics in Dermatology: Experts Weigh In

Saturday morning’s hot topics session at the American Academy of Dermatology Summer Meeting featured the latest evidence on conditions like psoriasis, as well advances in the fields of infectious, pediatric, and general dermatology. Mark Lebwohl, MD, led the panel on hot topics. Highlights included:

Psoriasis—Bruce Elliot Strober, MD, PhD, FAAD

The number of treatments for psoriasis will continue to grow, with the possibility of 13 biologics approved for psoriasis within the next year. BMS-986165, an TYK2 inhibitor, is under investigation and showing similar efficacy to biologics without the effects on biomarkers associated with Janus kinase inhibitors. Bimekizumab is an IL-17 A and IL-17F inhibitor that completed phase 2 trials and showed higher percentage of patients achieving clearance with fast response. A small study demonstrated the potential for targeting IL-16 in pustular psoriasis.

In addition, Dr Strober reviewed the results of studies that showed guselkumab had long-term efficacy compared with secukinumab, comparison of risankizumab with ustekizumab, safety data of certolizumab among women who are pregnant, showing no presence of drug in umbilical cord blood and neonatal blood, as well as no presence of drug in breast milk. The effects of apremilast on hemoglobin A1c and weight loss, as well as the potential safety and efficacy of this oral molecule in children, were also discussed, along with phase 3 results of an oral TYK2 inhibitor.

Dr Strober recommended clinicians always consider psoriatic arthritis when selecting treatment, noted that a stepwise approach is not always necessary, and added that combination therapy is sometimes needed.

Atopic Dermatitis—Emma Guttman, MD, PhD, FAAD

According to Dr Guttman, the therapeutic drought in atopic dermatitis is ending. One important contribution to this is the increased understanding of the pathogenic molecules involved in the disease. Personalized medicine will play an important role in the coming years, she said.

Several new therapies she discussed include IL-13 inhibitors lebrikizumab, which showed similar efficacy to dupilumab and suggests IL-13 maybe an important cytokine; nemolizumab, which targets the itch cytokine, IL-31, and showed improvement of pruritis; KPL716, which targets the OSM receptor beta, showed promise for pruritis and improvement on EASI in a phase 1 study, as well as OX40 mAB, KHK4083, MOR-106, and ANB020.

There is a lot of excitement in the field of AD, particularly with JAK inhibitors, said Dr Guttman, Upabicitinib showed 50% of participants achieved EASI 90 after 16 weeks in phase 2b study, but more studies are needed to determine safety and blood monitoring, she said. A few topicals under investigation include ruxolitinib cream and tapinarof, as well as delocitinib for hand eczema.

Skin Cancer—Darrell S. Rigel, MD, FAAD

Advances in the detection and treatment of skin cancer have impacted disease rates and mortality. Dr Rigel reviewed options for treating advanced nonmelanoma skin cancer (NMSC), such as PD-1 inhibitors, CTLA-4, Mohs surgery, nivolumab, and cemiplimab, which have demonstrated efficacy.

Early detection and treatments with gene targeted therapy have had some impact on mortality rates. Reporting melanoma to state cancer registries is required, Dr Rigel said. Patients with secondary melanomas have an increased risk for NMSC, lentigos, and elevated risk for other cancers, as well as for more melanoma. Dr Rigel emphasized that this latest data suggests patients with a history of melanoma should be followed regularly.

Dr Rigel reviewed the FDA’s new sunscreen recommendations and noted that more data regarding the environmental impact of sunscreens is needed to determine the impact of these ingredients in a real-world setting.

He concluded his presentation on the potential for computer-aided diagnoses, electrical impendence spectroscopy, as well as findings that showed volume was better than thickness for determining prognosis.

Dangerous Dermatoses—Jonathan Ungar, MD, FAAD

Nonpharmacological interventions involve ceasing the offending medication and supportive care, which includes wound care, fluid electrolyte balance, and transfer to appropriate center, preferably a burn center, said Dr Ungar. Glucocorticosteroids and IVIg, although used for SJS and TEN, have not been found to benefit patients, while cyclosporine showed some benefits. TNF inhibitors may also benefit patients and also reduced time to skin healing. Thalidomide has been found to increase mortality, said Dr Ungar. He recommended IVIg as an option for patients in whom cyclosporine and etanercept are contraindicated.

Therapies for bullous pemphigoid include high-potency steroids and systemic steroids, said Dr Ungar. Studies showed doxycycline does not perform as well as steroids. However, data suggests rituximab should be first-line therapy, as 93% of patients achieved complete remission, he added. Other possible therapies under investigation include bertilimumab and BIVV009. Certain medications such as DPP-4 inhibitors, anti-PD-1, and PD-L1 therapies cause BP.

For pemphigus, rituximab was approved last year and is more effective than steroids. According to Dr Ungar, the time to treatment matters as failure to achieve remission is associated with longer time of disease activity prior to initiating treatment. He recommended treating early with rituximab. Rituximab followed by azathioprine showed longer remission, he added.

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