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Marie Bosslett is the assistant editor of 

 and joined the MJH Life Sciences team in October 2024. She attended Loyola University in Baltimore, Maryland, and earned a Bachelor of Arts in Communication with minors in marketing and writing. When she’s not writing, Marie enjoys going to concerts, reading on the beach, and spending time with friends and family.

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The LIBERTY-AD PED-OLE study showed clinical remission for moderate to severe atopic dermatitis. 

Off-Treatment Remission Achieved with Dupilumab for Pediatric AD

Maddi Hebebrand is an associate editor of 

and joined the MJH Life Sciences team in May 2024. She attended Baldwin Wallace University, studying Media Production and Film, and is now finishing her Masters in Digital Media through Ohio University. When she's not writing, Maddi loves to read, attend concerts and spend time with her family.

Researchers stated the dual-action therapy could offer a promising approach to treat progressive non-segmental vitiligo.

Study Underscores Safety and Efficacy of Baricitinib with NB-UVB in Vitiligo

Kaitlyn Bader is the assistant managing editor of 

 and joined the MJH Life Sciences team in June 2022. She attended Otterbein University in Westerville, Ohio, and earned a Bachelor of Arts degree in literary studies with minors in creative writing and film studies. Prior to health care news, Kaitlyn worked in industrial marketing. She enjoys cooking, reading, and tending to her house plants.

Learn more about the in-depth topics covered in the October 2024 acne supplement of Dermatology Times.

Acne Challenges: October 2024 Supplement Recap

The minocycline hydrochloride extended release capsules (40 mg) represent a new standard of care for patients with rosacea.

FDA Approves Journey Medical’s DFD-29 for Rosacea

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Egeberg discusses promising new treatments and insights from recent clinical trials, highlighting significant advancements in chronic hand eczema and atopic dermatitis care presented at the EADV 2024.

Alexander Egeberg, MD, PhD, Shares Key Findings on Chronic Hand Eczema and Atopic Dermatitis 

Final Thoughts: The Importance of Comparative Studies in AD

Panelists offer concluding insights and emphasize the critical role of comparative studies in advancing atopic dermatitis treatment strategies.

clinical

Video Series

 in Las Vegas, Nevada, from October 24 to 27, a poster was presented demonstrating the efficacy of the novel 

 treatment for active non-segmental vitiligo (aNSV)

. These results come from a phase 1b clinical trial testing the use of VYN201 at various dosage levels. According to the study team at VYNE Therapeutics, these findings confirm the safety and tolerability of the topical gel for aNSV.

VYN201 is a topical small molecule BET (bromodomain and extra-terminal domain) inhibitor that minimizes disease severity and encourages anti-inflammatory effects. Pre-clinical trials observed that the treatment inhibits CD8+ T-cell expansion without being cytotoxic and prevents detachment and melanin loss from the basal layers of tissue. Researchers saw a significant reduction in the release of MMP-9 (

 ≤ 0.01). These pre-evaluations were also presented through a poster at this year’s Fall Clinical.

“VYN201 represents a differentiated potential treatment for aNSV, as it down-regulates vitiligo markers, up-regulates melanogenesis factors, prevents continued depigmentation in patients, and shows evidence of re-pigmentation,” the investigators noted.

The phase 1b, open-label, multi-center study took place over 16+ weeks with 28 days of screening, 112 days of outpatient treatment, and 7 days of safety follow-up. Patients were split into 3 dose cohorts of 0.5% (

 = 9). The topical treatment was applied once daily on affected skin not exceeding 10% of body surface area.

The 29 participants were between the ages of 18 and 75 and had been clinically diagnosed with aNSV for at least 1 month. Eligibility also included having a Facial Vitiligo Area and Severity Index Score (F-VASI) of ≥ 0.5 with active vitiligo on the face. Active lesions were defined as having hypochromic borders, confetti-like depigmentation, peri-lesional inflammation, and/or Koebner phenomenon.

All 3 dosage cohorts had significant clinical response after 16 weeks of multiple-dose administration. Participants with the 0.5% dose experienced a -7.5% change in F-VASI scores while there was a -30.2% change in F-VASI for the 1% dosage group. Ultimately, the 2% dose group experienced the most drastic change in F-VASI score at -39.0%. The poster also featured patient photographs taken before and after treatment, including a participant with near-complete depigmentation.

Additionally, the mean scores of localized skin tolerance assessments (LSTA) did not increase over the course of the 16-week treatment. Although there were some mild to moderate adverse effects such as erythema, stinging, and dryness, no serious events occurred and none of these TEAEs led to treatment discontinuation. There were also no clinically relevant localized skin tolerability findings.

Through this study, researchers confirmed that patients treated with VYN201 saw a significant dose-dependent clinical response by the 16-week mark. The topical delivery enabled local anti-inflammatory effects and minimized systemic exposure while maintaining a strong safety profile.

"This disease state has had marked, marked unmet need for many, many years. It has been overlooked by industry with respect to new therapies, and even the therapies that are coming through now are all based on one pharmacology," Iain Stuart, PhD, the chief scientific officer at VYNE said in an 

. "We think that's unacceptable. We think the potential for BET inhibition could be very broad, and not just in vitiligo, but into all the dermatologic and immunologic diseases. We're looking forward to continuing the program and involving the dermatology community in the next steps for VYN201."

1. Stuart I. Phase 1b: Translational evaluation of VYN201, a pan-BD BET inhibitor, for the treatment of non-segmental vitiligo.Poster presented at the 44th Annual Fall Clinical Dermatology Conference. Las Vegas, Nevada. October 24 to 27, 2024.

2. Stuart I. Preclinical studies: Translational evaluation of VYN201, a pan-BD BET inhibitor, for the treatment of non-segmental vitiligo. Poster presented at the 44th Annual Fall Clinical Dermatology Conference. Las Vegas, Nevada. October 24 to 27, 2024.

3. Andrus E, Stuart I. VYN201 for vitiligo: promising data showcases potential of BET inhibition. Dermatology Times. May 22, 2024. Accessed November 1, 2024. 

https://www.dermatologytimes.com/view/vyn201-for-vitiligo-promising-data-showcases-potential-of-bet-inhibition

A phase 1b clinical trial presented at Fall Clinical 2024 demonstrated the efficacy and safety of VYN201, a topical BET inhibitor, for treating active non-segmental vitiligo (aNSV). The study involved 29 participants across three dosage cohorts, showing significant dose-dependent clinical responses in F-VASI scores over 16 weeks. VYN201 effectively down-regulated vitiligo markers, up-regulated melanogenesis factors, and prevented depigmentation. The treatment was well-tolerated with no serious adverse events. Researchers highlighted the potential of BET inhibition for broader dermatologic and immunologic applications.

VYNE Therapies announces that aNSV patients saw disease improvement without serious adverse effects.

VYN201 for Vitiligo: Phase 1b Study Confirms Safety

 Case-Based Roundtable® events, leading dermatologists and their local peers tackled some of the most challenging cases of acne. These gatherings provided an invaluable platform for collaborative discussion, innovative problem-solving, and the exchange of cutting-edge treatment strategies. Each session featured in-depth case presentations, allowing participants to delve into the complexities of acne presentations and explore various diagnostic and therapeutic approaches for diverse patient populations. These clinical insights from New York, Nevada, and Florida showcased the dermatology community’s collective expertise and dedication to improving patient care.

Hilary Baldwin, MD, medical director of the Acne Treatment and Research Center in Morristown, New Jersey, led a team of local colleagues in a detailed discussion about 2 particularly challenging cases of acne in younger patients. These cases emphasized the importance of combination therapies, adherence, and flexibility.

The first case presented was that of a 12-year-old boy with moderate acne on both his face and back. Baldwin described the patient as “quite overweight” and noted that his mother mentioned he was “a very picky eater,” implying a diet high in junk food and low in nutritional value. This was the patient’s first visit to a dermatologist, having only used some over-the-counter spot treatments before this consultation.

“This is his first time visiting a dermatologist. He’s used some over the counter stuff before, but it’s mostly just spot treatments—some of those spot pads, for example. No medications, not even any bona fide over the counter acne medications,” Baldwin explained. She highlighted that the acne was affecting his self-esteem, social interactions, and performance in school.

The team noted that it was unusual for someone so young to have such extensive acne, leading them to predict that he might eventually need isotretinoin. However, given his age, they aimed to try alternative treatments first to potentially postpone the use of isotretinoin, knowing that “the younger you start isotretinoin, the more likely patients are to relapse,” Baldwin explained.

The treatment plan involved a combination of benzoyl peroxide and adapalene (0.3%) to be applied every other day initially, then gradually increased to once daily. Baldwin stressed the importance of gradual introduction to minimize irritation. “We came up with a combination of benzoyl peroxide and adapalene 0.3%...starting out every other day and then gradually increasing to once a day, hoping that that slow onset of use would reduce any irritation that he might experience.”

The patient was advised to return in 6 weeks. Upon his return, his acne showed no significant improvement, largely due to questionable adherence to the medication regimen. Consequently, the team decided to prescribe 100 mg of doxycycline twice daily as a more effective and easier-to-use treatment. “We decided that it was time to put him on a medication that was a little bit easier to use and would be a little bit more effective and perhaps work more rapidly, and we started him on doxycycline 100 mg twice a day,” Baldwin said, adding that they also addressed concerns about antibiotic resistance with the patient’s mother.

When the patient returned 6 weeks later with little improvement, they opted to start him on isotretinoin, despite his young age. This decision was made after discussing the proper dosing and ensuring that he took the medication with a fatty meal to improve absorption. “Knowing that the younger you start isotretinoin, the more likely patients are to relapse,” Baldwin noted, they agreed on a starting dose of 0.5 mg/kg/day to prevent potential adverse events like pseudoacne fulminans. Despite these efforts, the patient’s condition did not improve significantly, leading to the realization that his low-fat diet was impairing drug absorption. The team switched him to a food-independent formulation of isotretinoin, which proved to be successful.

The second case involved a 17-year-old girl with moderate acne on her face and back, who was particularly concerned about clearing her skin in time for prom and graduation. This patient had been using makeup and TikTok remedies, such as toothpaste, to manage her acne, but had not tried prescription medications. Baldwin emphasized the importance of using non-comedogenic products, especially for young girls who experiment with various skin care products. “We want to make sure that our patients are using only topical products that actually say non-comedogenic on it,” she advised.

The patient’s treatment plan included a triple combination of clindamycin, adapalene, and benzoyl peroxide.

Baldwin noted the importance of setting realistic expectations for improvement, typically around 8 weeks, to prevent patient frustration and discontinuation of treatment.

Given the need for rapid improvement before prom, the team considered adding clascoterone to the regimen to address sebum production. “The key takeaways here were that we felt that with the triple combination, we were taking care of killing Cutibacterium acnes, helping to reduce follicular hyperkeratinization, and helping to reduce inflammation, but what we were lacking was a reduction in sebum production,” Baldwin explained.

When the patient reported no significant improvement after 4 weeks, despite good adherence, the team decided to add clascoterone twice a day. This addition aimed to provide comprehensive treatment covering all aspects of acne pathogenesis. “One of the key takeaways here was that it is very important to be using this drug twice a day,” Baldwin said, emphasizing the importance of patient education on the mechanisms of action of drugs and the need for consistent use.

The team also considered starting an oral antibiotic for the patient’s back acne but decided to give clascoterone more time to work before adding another medication. They highlighted the importance of continuous follow-up and patient education to ensure adherence and avoid treatment discontinuation.

The Dermatology Times Case-Based Roundtable® events facilitated discussions among dermatologists on challenging acne cases, emphasizing combination therapies, adherence, and flexibility. A 12-year-old boy with moderate acne was initially treated with benzoyl peroxide and adapalene, later switched to doxycycline, and finally isotretinoin due to poor response and adherence issues. A 17-year-old girl, concerned about prom, was treated with a combination of clindamycin, adapalene, and benzoyl peroxide, with clascoterone added for sebum control. Both cases highlighted the importance of patient education and tailored treatment plans.

In a Dermatology Times Case-Based Roundtable event, Hilary Baldwin, MD, shared pearls for challenging acne cases.

Addressing Challenging Cases of Acne: Part 1

Heather Woolery-Lloyd, MD, dermatologist and director of the skin of color division for the University of Miami Department of Dermatology in Florida, led a roundtable discussion with a team of dermatology clinicians. The conversation centered around 2 challenging acne cases, providing valuable insights into treatment approaches, patient adherence, and the nuances of personalized care.

Woolery-Lloyd introduced the first case involving a 12-year-old overweight boy with moderate facial and chest acne that began 2 years ago. The patient’s mother expressed concerns about his diet and the psychological impact of acne on his self-esteem and academic performance.” Because this patient had moderate to severe acne affecting both the face and trunk, one of the first things that the participants thought would be a good option was isotretinoin,” said Woolery-Lloyd. “We discussed the risks and benefits, but many felt that starting isotretinoin right off the bat was appropriate.”

Half of the participants were willing to consider isotretinoin at the first visit, whereas others preferred trying topical treatments or oral antibiotics first. They acknowledged the challenge of adherence to a complicated skincare routine, especially for a young patient. “Typically for this type of patient with moderate to severe acne, they may need to use a treatment in the morning, a treatment at night, certain skincare products, moisturizers, and maybe an oral antibiotic. This can be very complicated for a young male who may not be interested in such a routine,” Woolery-Lloyd explained.

During a follow-up visit, the patient admitted difficulty adhering to the prescribed combination therapy of topical benzoyl peroxide and clindamycin due to its complexity. The mother’s concern about long-term antibiotic use also emerged. “We discussed the issue of antibiotic resistance, which is a hot topic. Participants recommended probiotics to support the gut microbiome and emphasized limiting the use of long-term antibiotics,” Woolery-Lloyd noted.

Given these challenges, the dermatologists decided that isotretinoin was a more viableoption. They addressed the practicalities of isotretinoin, including the need to take it with fatty meals, which can be difficult for patients adhering to a low-fat diet. “Many participants suggested options like almond butter or peanut butter to ensure the medication is absorbed properly,” Woolery-Lloyd added. “However, the modern diet has changed, and people generally don’t consume fatty meals twice daily.” The patient was ultimately prescribed a micronized version of isotretinoin, which does not require consumption with fatty meals, significantly improving adherence. “This micronized version was considered a good option for improving adherence and outcomes, especially in young patients,” Woolery-Lloyd stated.

Managing Expectations on a Tight Timeline

The second case involved a 17-year-old high school student with moderate acne on her face and back. The patient was distressed, as her acne was impacting her self-esteem and social interactions, particularly with her upcoming prom night. “There is a lot of pressure for teenagers to look their best during significant life events like prom. We discussed the need to address acne effectively and quickly in such situations,” Woolery-Lloyd remarked.

The patient was started on a combination treatment of adapalene and benzoyl peroxide. She was counseled on proper application techniques and expected timelines for improvement. After 4 weeks, the patient reported no significant improvement. Upon confirming there were no adverse events, the treatment regimen was intensified. “We had a robust discussion about the order of application of skin care products and prescription medications,” Woolery-Lloyd said. “Written instructions were emphasized as crucial for improving compliance and minimizing side effects.”

Participants debated the integration of over-the-counter skincare products with prescription regimens, highlighting the importance of a clear and manageable skincare routine for patients. “Some participants felt it was best to discourage additional products, while others tried to incorporate them into the prescribed regimen,” Woolery-Lloyd noted. “The consensus was that clear, step-by-step instructions were vital.”

Leading dermatologists engaged in collaborative discussions to address challenging acne cases, focusing on personalized care, treatment adherence, and patient education. The first case involved a young boy with moderate to severe acne, where isotretinoin was considered after challenges with adherence to topical treatments. The second case featured a teenager seeking rapid acne improvement before prom, emphasizing the importance of clear instructions and managing expectations. These discussions highlighted the dermatology community's commitment to improving patient outcomes through innovative strategies and shared expertise.

In a Dermatology Times Case-Based Roundtable event, Heather Woolery-Lloyd, MD, shared pearls for challenging acne cases.

Addressing Challenging Cases of Acne: Part 3

In a roundtable discussion held in Las Vegas, Nevada, a group of dermatology clinicians, including dermatologists, dermatology nurse practitioners, and dermatology physician assistants, convened to tackle some of the most challenging cases in acne management. James Del Rosso, DO, of JDR Dermatology Research, led this discussion, presenting a particularly challenging case of an adolescent girl with persistent acne. The case highlighted the complexities of acne treatment and the necessity for personalized, patient-centered approaches.

Del Rosso introduced the case of a 14-year-old girl with persistent acne. “This patient had been treated with conventional therapies but remained dissatisfied with her progress,” he explained. Initially, she had been using various over the counter topical treatments without success. When she sought medical intervention, she was prescribed topical clindamycin combined with benzoyl peroxide and, subsequently, oral doxycycline.

“From the start, she disliked benzoyl peroxide,” Del Rosso noted. “She had a strong aversion to it even as an over the counter medication, so we had to discontinue its use.” The patient’s acne primarily consisted of closed comedones, open comedones, and superficial inflammatory papules and pustules scattered across her face. Despite not having nodular acne, her condition was persistent and did not improve to her satisfaction over several months of treatment.

Navigating Diet and Preference Challenges in Treatment

The patient’s dislike for benzoyl peroxide posed a significant challenge. “We had to respect her preferences and not push her to use something she was uncomfortable with,” Del Rosso emphasized. Instead, the patient was treated with clindamycin and tretinoin, and oral doxycycline was added because of insufficient improvement. However, concerns about antibiotic resistance and the patient’s strict vegan, low-fat diet added layers of complexity to her treatment.

“When discussing options, we considered different topical therapies,” said Del Rosso. “But she was adamant about not using benzoyl peroxide, even in potentially less irritating formulations.” The team had to navigate these preferences while aiming to optimize her treatment outcomes.

Introducing Isotretinoin With Contraceptive Considerations

Given the patient’s lack of response to initial treatments and her consistent use of an intrauterine device that released levonorgestrel, the decision was made to start her on oral isotretinoin. “She was motivated and already had contraceptive protection, which made her a suitable candidate for isotretinoin,” Del Rosso explained. “We used a branded generic formulation based on the original Accutane, which requires high-fat intake for optimal absorption.”

Despite the challenge of her low-fat diet, the patient initially responded well to isotretinoin, achieving clear skin for nearly 1.5 years. However, her acne recurred, necessitating further treatment. A second course of isotretinoin at a higher dose provided another period of remission, but the acne returned after 2 years.

Considering Patients With Polycystic Ovary Syndrome

As the patient’s acne continued to recur, the discussion among clinicians turned to the possibility of underlying conditions, such as polycystic ovarian syndrome (PCOS). “There was debate about whether to conduct hormonal testing for androgens,” Del Rosso recalled. “Most of the group was not familiar with PCOS presenting in patients of low body weight and smaller physical size.”

Despite the patient’s lack of classical PCOS symptoms like hirsutism or alopecia, laboratory testing was conducted. “We tested for testosterone, androstenedione, and dehydroepiandrosterone-sulfate,” Del Rosso said. “She had her blood drawn during her menstrual period, which is ideal for these tests.” The results revealed elevated androgen levels, and a transvaginal ultrasound confirmed the presence of ovarian cysts, leading to a diagnosis of PCOS.

With the new diagnosis, the treatment strategy needed adjustment. “We considered using an isotretinoin formulation that does not depend on high fat intake for absorption,” Del Rosso explained. “But obtaining coverage for these formulations can be challenging.” The patient was also started on oral spironolactone, an anti-androgen medication, and the team discussed the potential benefits of topical therapies.

“We now have a topical androgen receptor inhibitor, clascoterone, which is FDA-approved for patients 12 [years] and older,” Del Rosso noted. “This patient could have been using it all along. It might have provided additional benefits alongside conventional agents like retinoids and benzoyl peroxide, although she wouldn’t use the latter.”

This case underscored the importance of a personalized approach in acne treatment. “Working with the patient to utilize treatments they feel comfortable with is crucial,” Del Rosso emphasized. “Pushing treatments they are reluctant to use can lead to non-compliance and suboptimal outcomes.” The clinicians agreed that patient preferences and lifestyle factors, such as diet and strict veganism, must be considered when designing treatment plans.

“Many were surprised by the PCOS diagnosis, especially in a patient who did not fit the classical visual textbook picture.” The case illustrated the necessity of considering underlying conditions in patients with recurrent acne and highlighted the evolving landscape of acne treatment options. “This was a very instructive case. It brought together considerations of optimizing topical therapy and evaluating androgen levels in patients with persistent acne. It was a great meeting with valuable input from various individuals, and I was happy to be able to facilitate this roundtable discussion,” Del Rosso concluded.

A series of Dermatology Times Case-Based Roundtable® events facilitated discussions on challenging acne cases, emphasizing collaborative problem-solving and innovative treatment strategies. A notable case involved a 14-year-old girl with persistent acne, highlighting the need for personalized treatment approaches. Despite initial treatments, her condition persisted, leading to the use of isotretinoin and a subsequent PCOS diagnosis. The case underscored the importance of considering patient preferences, lifestyle factors, and potential underlying conditions in acne management, while showcasing the evolving landscape of treatment options.

In a Dermatology Times Case-Based Roundtable event, James Del Rosso, DO, shared pearls for challenging acne cases.

Addressing Challenging Cases of Acne: Part 2

Hyperhidrosis is not rare. According to the 

, approximately 385 million people worldwide live with hyperhidrosis.

In fact, they note that the amount of people living with chronic, excessive sweating is even higher than the amount of people living with other dermatologic conditions like psoriasis.

Just how common is hyperhidrosis in real-world comparisons?

The prevalence of hyperhidrosis is much higher in younger populations than in the general population, with 8.8% of individuals between the ages of 18 to 39 years old living with the condition. 

When comparing these statistics to everyday, common occurrences like hair color, the number of people with hyperhidrosis is greater than the 1% of individuals with natural red hair and 2% of individuals with natural blond hair. 

Despite how common hyperhidrosis is, it is estimated that 27% of those with the condition never receive a diagnosis.

 wants to hear from you. What percentage of the global population is estimated to have hyperhidrosis?

 to share your hyperhidrosis insights or research.

Albert. Fact check: Hyperhidrosis - International Hyperhidrosis Society: Official site. Home - International Hyperhidrosis Society. October 24, 1970. Accessed November 16, 2023. 

https://www.sweathelp.org/home/news-blog/542-fact-check-hyperhidrosis.html

Hyperhidrosis affects approximately 385 million people globally, surpassing the prevalence of other dermatologic conditions like psoriasis. It is notably more common in younger populations, with 8.8% of individuals aged 18 to 39 experiencing the condition. Comparatively, hyperhidrosis is more prevalent than natural red or blond hair, which affects 1% and 2% of the population, respectively. Despite its prevalence, 27% of those with hyperhidrosis remain undiagnosed. The article encourages engagement during Hyperhidrosis Awareness Month to share insights and research on the condition.

Click here to answer this week's poll for Hyperhidrosis Awareness Month.

Alexander Egeberg, MD, PhD

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