Top Meeting Takeaways From the Fall Clinical Conference

In this exclusive Dermatology Times® 2-Minute Drill program, Zoe Diana Draelos, MD, of Dermatology Consulting Services; Lisa Swanson, MD, a pediatric dermatologist at Ada West Dermatology; Mark G. Lebwohl, MD, of Icahn School of Medicine at Mount Sinai; and Peter A. Lio, MD, of Northwestern University Feinberg School of Medicine discussed their takeaways from the recent Fall Clinical Dermatology Conference in Las Vegas, Nevada. With MJH Life Sciences® Vice President of Content Allie Ward moderating, these practitioners talked about which FDA approvals they are awaiting and what they are most excited about when it comes to the future of dermatologic interventions.

When asked about the biggest surprise coming out of the conference, Draelos remarked that she thought it was “the tremendous increase in the number of options we have in dermatology for treating common diseases. We have the approval of topical roflumilast, which can be used for psoriasis, but it’s also going for indications such as atopic dermatitis [(AD) and] hand eczema, and we also have a whole plethora of other topicals, orals, and injectables. Dermatology has really exploded and that’s exciting as a clinician because it allows our armamentarium to grow.” Added Swanson, “I would say the biggest surprise is that the black box warning on JAK [Janus kinase] inhibitors might not be as scary as we initially thought it was. There were numerous speakers that talked about that and addressed it. So I think the JAKs really had…a shining moment.” Lebwohl noted that among the new drugs discussed was “cantharidin for molluscum. Hopefully that will be coming soon. I will say one real surprise was that topical fluconazole was shown to be more effective than oral Lamisil for dermatophytosis. I was actually really surprised to see that in the meeting.”

Lio noted that when it comes to dermatology now, “We’re going to have to rewrite every chapter in the textbooks. There are now not only so many new treatments for each disease, but…diseases that have treatments for the first time with real FDA approval. So just hearing that at sessions, that something is actually an approved medication for an indication, is a sign that dermatology has really entered the modern era; we are finally off to the races here.”

What piece of information from the conference was most impactful for their own practices? Lio focused on personalized care: “I’m always looking to get better on individualized care for a patient. Of course we all want the most effective, efficacious treatments, but I also now realize, with this huge number of options, particularly in diseases like psoriasis and acne, it also might fit better to look at some of the [adverse] effect profiles to really personalize it, something many are calling precision medicine.” Draelos agreed, adding that personalized medicine for disease and aesthetics has become a game-changer. “Now we are seeing the ability to use your own endogenous growth factors or endogenous blood-derived products for cosmetic purposes. This science has not only bled into the medical world but also into the cosmetic world. Platelet-rich plasma has really taken over cosmetic dermatology.”

Lebwohl remarked on how JAK inhibitors have changed the way he practices. He marveled at how infrequent the adverse effects were, adding, “We now have a wealth of agents for those inflammatory skin conditions that we didn’t have before.” The boxed warnings on Advil, he pointed out, were worse than the boxed warnings on any of the current JAKs. For Swanson, the approval of cemiplimab for pustular psoriasis was most important: “Having an officially approved biologic to treat that scary and dangerous subtype of psoriasis is very exciting, [as is] low-dose oral minoxidil for various types of alopecia. And I think just gaining a comfort level with its use is an important thing that’s going to change my practice with patients who have alopecia.”

The clinicians were next asked which clinical presentation paved the way for the next big FDA approval in dermatology. Enthused, Swanson noted, “There is so much to look forward to. I’m really excited to see lebrikizumab approved for AD. And I am very excited to see roflumilast and tapinarof, currently approved for psoriasis, approved for AD, and very excited to see the official approval of cantharidin for molluscum.” Draelos expressed her enthusiasm for having an on-label drug for seborrheic dermatitis. “That’s a common, cradle-to-grave disease, and we don’t have anything on label to treat it. So the indication of roflumilast foam for seborrheic dermatitis is very exciting.”

Lio noted that the FDA might soon be approving drugs for the unmet need for itch. “We have…just had an approval for prurigo nodularis, but this is such a rich space. I have such a rich practice with patients [experiencing itch], I need all the help I can get.” Lebwohl mentioned a nitrous oxide–based product for molluscum that he hopes to see approval for soon, along with a triple-action acne product containing benzyl peroxide, adapalene, and clindamycin, “which I first heard about at this conference, and which sounds very impressive.”

Which trials discussed at the conference do practitioners need more information on? For Lebwohl, it was the Novan trial for molluscum, and “in addition, we really are at the infancy stage of alopecia [and] vitiligo; we need mores safe agents for these conditions. JAK inhibitors are so effective. All the JAK inhibitors and ritlecitinib specifically is what I’d like to hear more about.”

Lio noted that at the end of many recent trials, remission remains even after the medication has been stopped. “Often, after a medication is stopped, a condition will spike back up to baseline or worse. I am fascinated by those drugs and what that means to see this relative remission.”

Draelos observed that “What dermatologists need now is determining which biologics are best for which patients. Various companies, for example, are trying to look at interleukins and the interleukin profile, and picking a specific ‘mAb’ [monoclonal antibody] against a specific interleukin might be a way of personalizing psoriasis medication.” Swanson also is eager to see future trials and medications for hidradenitis suppurativa. Although she noted that intervention options exist for this devastating condition, there is no “gangbuster treatment for people who are really suffering. I can’t wait to see data from those studies.”

The biggest winner at the meeting? Lio gave that prize to everyone: “There was so much excitement and energy and so much connecting, which was definitely the most heartwarming part of the conference.” For Swanson it was simply that “JAK is the new black. JAK inhibitors were the winner of the meeting.” Lebwohl noted that Swanson herself was the biggest meeting winner––“Off the charts, the best speaker in a long time,”––and agreed that JAK is indeed the new black: “If we can get the story of the safety of these JAKs out, we will be helping our patients a ton.” For Draelos, the melanoma presentations were fascinating and deserved a call out, and she noted that melanoma is one of the most dangerous diseases dermatologists treat. “The options beyond surgery available now, the immunologic treatments, …were greatly insightful,” she explained.

Final thoughts and advice? Swanson said, “Don’t be afraid to treat kids with bad AD and psoriasis: they need our help. These medicines are safe and there are good data, so be bold, be brave, and treat those kids who need it.” Lio credited his colleague Lebwohl “who once told me that getting the message out to clinicians involves the 3 P’s: posters, presentations, and publications. Also, right now I am working with a company called Top Derm that is making video games for doctors for medical education. This is so exciting to think we can take modern video game concepts and allow people to take difficult ideas and put [them] into bite-sized packages, so stay tuned!” Draelos loved seeing the reintroduction of old drugs with new vehicles: “People are taking old drugs, and instead of a greasy ointment, creating…polymer emulsions. Dermatology has suffered from a lack of innovative excipients in the past, so these new vehicles are very exciting.” Lebwohl admitted, “As a co-director of this meeting, I felt it really was so packed with information that you can learn on a Monday and use on a Tuesday with your patients.”

All panelists agreed on one thing: the meeting offered information in a palatable way and left them feeling energized. And, as Lio observed, “Sometimes it feels like we are just surrounded by disease and terrible pain and insurance issues, but [this meeting proved] there is not a better bunch of people to fight the good fight with.”