Lisa Swanson, MD, FAAD: The Current Topical Landscape for Pediatric Patients

Lisa Swanson, MD, FAAD, is a dermatologist and pediatric dermatologist in Boise, Idaho, working at Ada West Dermatology and St Luke's Children's Hospital.

At the 2024 Society for Pediatric Dermatology (SPD) Annual Meeting in Toronto, Ontario, Canada, Swanson presented a sponsored (Arcutis Biotherapeutics), non-CME session titled, "Latest Innovation in Topical Therapies."

Swanson spoke with Dermatology Times to discuss the highlights of her talk, the exciting and changing landscape of topical therapies for young patient populations, and more.

"So much stuff is happening in peds derm," Swanson said. "It's a very exciting time."

Transcript

Lisa Swanson, MD, FAAD: Hi, I'm Lisa Swanson. I'm a dermatologist and pediatric dermatologist in Boise, Idaho. I work at Ada West Dermatology and at St Luke's Children's Hospital.

Dermatology Times: What are key highlights from your non-CME talk on innovations in topical therapies?

Swanson: I spoke about a medication that was just approved 4 days ago. It's topical roflumilast in a 0.15% cream that was approved for the treatment of mild to moderate atopic dermatitis for patients age 6 and up. This is very exciting, because it is a topical non steroid, once a day, excellent tolerability, no limitations on body surface area, that you can apply it to, and no limitations on combining it with a systemic agent. If a patient is on dupilumab and doing well, but not perfectly, this topical could be used in conjunction with that, and the patient could be on a completely steroid free regimen.

Dermatology Times: What is new or upcoming in pediatric dermatology that most excites you?

Swanson: So much stuff is happening in peds derm. It's a very exciting time in the world of atopic dermatitis. We just got the roflumilast 0.15% cream indicated. We are anticipating approval of tapinarof % cream as another non-steroid topical for once daily use. Very much looking forward to that. Their data is excellent, and so I can't wait to use it in real life. We are looking forward to a label expansion for topical ruxolitinib for atopic dermatitis. Currently, it's approved age 12 and up, but they have data going down to 2 that's been submitted to the FDA, and we're anxiously hoping for a label expansion. It would be lovely to be able to use that topical cream in our younger patients.

In the world of psoriasis, we have topical roflumilast 0.3% cream approved for once daily use for plaque psoriasis in patients as young as 6 years old. That's a wonderful steroid-free option. It would be nice to see tapinarof 1% cream with a label expansion, because currently they're approved age 18 and up for plaque psoriasis. We got the approval of roflumilast 0.3% foam for seborrheic dermatitis for patients age 9 and up, so that is super fantastic. We got the approval of a topical at home for molluscum called berdazimer gel that was approved late last fall, but won't be available for prescribing until probably this fall, so we're anxiously awaiting the use of that. We have 2 topical medications for epidermolysis bullosa, which, I mean, EB has been a difficult condition to manage, because we really have had nothing besides wound care. Now we have 2 therapies: one that delivers it uses an inactivated herpes simplex virus to deliver collagen into the skin. Wow, the powers of science. The other is a birch bark extract that's designed to be used basically as often as you need it with each dressing change, and the 2 can even be used together. To have not one but 2 topical agents to treat such a devastating condition is just super exciting stuff.

One exciting thing in the world of pediatric dermatology is the treatment of infantile hemangiomas. The use of propranolol was discovered almost 20 years ago, and pediatric dermatologists have been prescribing it every single day for hemangiomas with astounding results. It revolutionized everything for us in the world of treating hemangiomas. About 3 years ago, there was an article published based on a study out of right here Canada that showed that nadolol was superior to propranolol in the treatment of hemangiomas and peds derms everywhere were just shocked. We couldn't believe it. Something better than propranolol? During the conference, they had a bit of a debate: propranolol versus nadolol, and so they had a peds derm arguing both sides. Both sides made very valid points, but I think the use of nadolol is something that we need to consider in the treatment of infantile hemangiomas.

For me personally, in practice, I will always start with propranolol, but if I'm not seeing the kind of results that I want to see, or if it's a hemangioma that I'm very worried about, ulcerating hemangioma, lip, eyelid, and I'm not making strides towards making it better pretty rapidly, I have switched my patients to nadalol, and I would agree with the study that was published 3 years ago. It works better; it works faster. I think they're both great, and I still to this day, start with propranolol, but I think peds everywhere should be open to the idea of a switch to nadolol if inadequate response is seen.

[Transcript has been edited for clarity.]

Note: Dr Swanson's talk was sponsored by Arcutis Biotherapeutics and was considered a non-CME session.