The Latest in Dermatology With James Del Rosso, DO: Part 1

At the 44th annual Fall Clinical Dermatology Conference held in Las Vegas, Nevada from October 24 to 27, James Del Rosso, DO, presented “What’s New in the Medicine Chest” parts 1 and 2. Del Rosso, research director and principal investigator at JDR Dermatology Research in Las Vegas, Nevada, and clinical advisor of Fall Clinical, reviewed the latest updates in FDA-approved treatments for various skin conditions, as well as awaited new indications.

During his first session, Del Rosso discussed the mechanisms of action and benefits of topicals ruxolitinib (Opzelura; Incyte), roflumilast (Zoryve; Arcutis Biotherapeutics), tapinarof (Dermavant Sciences), crisaborole (Eucria; Pfizer), tirbanibulin (Klisyri; Almirall), and berdazimer gel (Zelsuvmi; Novan Inc).

Del Rosso’s Key Takeaways

1. Ruxolitinib cream

Ruxolitinib is a topical Janus kinase (JAK) inhibitor approved for the treatment of atopic dermatitis (AD) and vitiligo. For AD, ruxolitinib is approved for use in adolescents and adults with up to 20% body surface area involvement, with data extending to use in children as young as 2 years of age. Del Rosso explained that the efficacy of ruxolitinib is notable and provides rapid relief from pruritus, often within hours to days. Long-term data support sustained control with minimal safety concerns, particularly with the boxed warnings associated with oral JAK inhibitors. When used appropriately, the risk of adverse effects such as malignancies or serious infections is significantly reduced, making it a favorable option for managing AD. Ruxolitinib is also known for its efficacy in treating vitiligo, adding to its versatility.

2. Roflumilast cream

Roflumilast is a topical phosphodiesterase-4 (PDE-4)inhibitor available in various formulations and strengths for the treatment of atopic dermatitis and psoriasis. The 0.15% cream is approved for atopic dermatitis in patients aged 6 years and older, while the 0.3% cream is approved for psoriasis. The foam formulation, also 0.3%, is used for treating seborrheic dermatitis and may soon be approved for scalp and body psoriasis. Roflumilast is well-tolerated, with minimal adverse effects, making it a suitable non-steroidal option for patients with sensitive skin or long-term management needs. According to Del Rosso, roflumilast’s favorable safety profile and efficacy, especially in inflammatory skin conditions such as psoriasis and seborrheic dermatitis, have positioned it as an important non-steroidal therapy.

3. Tapinarof cream

Tapinarof is a topical aryl hydrocarbon receptor modulator that has shown efficacy in treating plaque psoriasis. It is applied once daily and has shown promising results in more challenging areas such as intertriginous, head, and neck psoriasis. Additionally, tapinarof has been submitted for FDA approval for treating atopic dermatitis, with studies showing favorable efficacy and tolerability. This non-steroidal cream offers a novel mechanism of action, adding diversity to the therapeutic options for both psoriasis and atopic dermatitis. According to Del Rosso, tapinarof’s ability to address specific anatomical challenges in psoriasis enhances its clinical utility.

4. Crisaborole ointment

Crisaborole is a topical PDE-4 inhibitor approved for atopic dermatitis in patients as young as 3 months. The recent update to its label allows for a reduction in application frequency from twice daily to once daily once the disease is under control. Although some patients experience a stinging or burning sensation, the topical is generally well-tolerated and provides a non-steroidal option for managing atopic dermatitis, especially in pediatric populations. Its role as a non-steroidal anti-inflammatory agent makes it a valuable treatment option for long-term disease management, said Del Rosso.

5. Tirbanibulin ointment

Tirbanibulin is an anti-proliferative topical approved for the treatment of actinic keratosis (AK) on the face and scalp. The drug is applied once daily for 5 days, offering high compliance due to the short duration of treatment. Tirbanibulin has shown favorable tolerability, with minimal erythema, scaling, or crusting. This mild side effect profile makes tirbanibulin a preferable option over more aggressive treatments such as 5-fluorouracil or imiquimod, which can cause significant inflammation. Additionally, tirbanibulin has demonstrated efficacy in field treatment of larger areas, further expanding its utility in clinical practice.

6. Berdazimer gel

Berdazimer gel is a nitric oxide-releasing topical approved for molluscum contagiosum. Nitric oxide has broad antimicrobial properties, making it effective against viruses, bacteria, and fungi. The gel formulation stabilizes nitric oxide, allowing for its topical application. This provides a convenient at-home treatment option for molluscum, an alternative to in-office procedures like cantharidin application. Although not yet on the market, berdazimer gel represents an innovative approach to managing molluscum contagiosum, offering patients a safe and effective topical solution.

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