Carnac the Magnificent of new drugs and treatments

Dr. Rosen

In their novel presentation on new drugs and therapies in 2020 at the current Maui Derm for Dermatologists, Ted Rosen, M.D., Houston, Texas and Neal Bhatia, M.D., San Diego, Cali., tackled the up-and-coming treatments hitting the industry.

Dressed as Carnac the Magnificent from the Johnny Carson show, Dr. Bhatia took the stage with Dr. Rosen to answer questions and inform the audience, all while in character.

“[It’s] different than usual medical meeting talk, that's for darn sure,” says Dr. Rosen.

Talking about acne in 2020, Dr. Rosen says it “has been a banner year for new drugs.”

Trifarotene, the only topical retinoid that selectively targets retinoic acid receptor (RAR) gamma, has shown promising results, he says.

“We have a brand-new molecule, a new retinoid trifarotene in a cream, which not only studied facial acne but deliberately studied and showed good results in truncal acne,” he says.

Clascoterone, the first and only anti-androgen as a topical, was also highlighted in the presentation.

“It has to be used couple times a day, but it looks very, very promising, and it's different from all our other agents,” he says. “It's a competitive inhibitor of DHT for those androgen receptors.”

The last acne topical that was discussed, minocycline 4%, which Dr. Rosen says is interesting because of its formulation.

“This is going to be in a foam formulation, and you know people like foam,” he says.

Though it has been attempted in years past to make minocycline into a topical, he says that it’s only recently been possible due to new technology.

“This is a new technology with ultra-micronized minocycline,” he says. “It's only about three microns so it can easily get into the follicles which are about 60 microns more or less across.”

Interestingly, he notes that a lot of the new drugs are actually old drugs with new technologies.

Two of those drugs, betamethasone dipropionate, along with calcipotriene but it's in a new formulation, use PAD technology, “where the oil droplets are in a honeycomb matrix, which melts when it hits the skin.”

When tested in a head-to-head study, the drugs using pad technology beat the same ingredients in a suspension form.

For molluscum contagiosum, Dr. Rosen expressed his interest in a new 0.7% cantharidin product that has recently been FDA approved.

“It's in a precise applicator with a dye so you know which lesions you've treated, and which you haven't,” he says. “It's done once every 21 days, up to a maximum of four times and lesion clearance was quite good. Sixty-three percent to 83% of lesions in general disappeared. But even better if you looked at important sites like the head and neck, the face, the groin, the genitalia, you had over 80% completely clear by day 84.”

Highlighting one self-professed ‘oddball new drug,’ Dr. Rosen touched on the IV formulation of cetirizine for the treatment of acute urticaria.

“It’s a single dose every 24 hours and approved all the way down to six months of age,” he says. “Mostly it'll be used for adults and adolescence, but clearly a major advance in the treatment of bad urticaria because there are very few people have returned for any additional treatment.”