James Del Rosso, DO, on What’s New in the Medicine Chest

James Del Rosso, DO, a clinical dermatologist and research leader based in Las Vegas, Nevada, recently shared his expertise in an interview with Dermatology Times. During this discussion, he provided key insights from his presentation titled’ “What’s New in the Medicine Chest?” at the 2025 Winter Clinical Miami Meeting, held at the Fontainebleau Hotel. Del Rosso emphasized, “this is an all-inclusive meeting, medical, surgical, cosmetic dermatology, a variety of different areas covered,” noting the variety of topics addressed in both clinical practice and research.

Innovations in Acne Treatment

Del Rosso highlighted groundbreaking research in acne management, particularly focusing on the combination of topical clascoterone 1% cream and a triple-combination gel containing clindamycin, adapalene, and benzoyl peroxide. “The adage is to first of all be thinking about optimizing our topical therapy, addressing all 4 pillars of the pathophysiology, which we can now do with clascoterone, and really hit the acne as hard as possible,” Del Rosso said. Clascoterone, a topical anti-androgen, is unique in targeting androgen receptors and the androgen-sebum pathway. The study underscored the importance of addressing all 4 pillars of acne pathophysiology for optimal results.

Refractory Pediatric Vitiligo

Next, Del Rosso discussed the use of ruxolitinib cream (1.5%) for refractory pediatric vitiligo. While approved for adults and adolescents, he pointed out the efficacy of off-label treatments such as topical roflumilast 0.3% cream. “A case report series showed that phosphodiesterase-4 inhibition with topical roflumilast was very effective and very safe in these patients that had refractory disease,” he noted, emphasizing the importance of individualized treatment plans and real-world results. He also highlighted successful outcomes with oral and topical therapies for vitiligo affecting the dorsal hands, traditionally a challenging area to treat.

Off-Label Uses in Dermatologic Disorders

Addressing other conditions, Del Rosso explored off-label treatments for seborrheic dermatitis, granuloma annulare, and palmoplantar psoriasis:

Seborrheic Dermatitis: Topical tapinarof 1% cream showed efficacy in small case studies, despite being primarily approved for plaque psoriasis and atopic dermatitis.

Granuloma Annulare: Janus kinase (JAK) inhibitors, including oral upadacitinib, demonstrated potential in resistant cases, providing a new avenue for managing generalized granuloma annulare.

Palmoplantar Psoriasis: Injectable biologics, such as bimekizumab, rapidly resolved severe cases with extensive involvement.

Atopic Dermatitis and Ocular Complications

Del Rosso emphasized the need for comprehensive care in atopic dermatitis (AD) patients, particularly regarding ocular health. He described ocular surface disease and conjunctivitis as common comorbidities, noting a recent study that showed, “85% of patients with AD, not on these treatments, just with the disease, have ocular surface disease that they don’t necessarily know about.” He advised regular ophthalmologic evaluations to detect and manage these issues proactively; “Every patient with AD that comes into our office has a good chance of having some type of ocular disease that we as dermatologists are not going to know about.” For patients experiencing adverse ocular effects with dupilumab, he suggested alternative therapies, including IL-13 inhibitors such as tralokinumab and lebrikizumab, as well as nemolizumab, an IL-31 inhibitor.

The Role of Emerging Therapies

Del Rosso concluded with optimism about the future of dermatology. He celebrated the role of JAK inhibitors, IL inhibitors, and other targeted therapies in expanding treatment possibilities across a range of dermatologic conditions. However, he also reminded practitioners to balance clinical trial data with real-world evidence, stating, “The proof is in the pudding sometimes in the real world.”

By sharing these insights, Del Rosso underscored the importance of advancing patient care through innovation and collaboration, while always tailoring treatments to individual needs.

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