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and joined the MJH Life Sciences team in February 2023. She attended Kent State University and earned a Bachelor of Science degree in journalism with minors in public relations and creative writing. She enjoys making and listening to music, reading, and spending time with her cats, Astrid and Marceline.

Articles

The phase 3 clinical trial investigating delgocitinib cream for adolescents with moderate to severe CHE met its primary and key secondary endpoints.

DELTA TEEN Highlights Potential of Delgocitinib in Adolescents With Chronic Hand Eczema

Marie Bosslett is the assistant editor of 

 and joined the MJH Life Sciences team in October 2024. She attended Loyola University Maryland in Baltimore and earned a Bachelor of Arts in Communication with minors in marketing and writing. When she’s not writing, Marie enjoys going to concerts, reading on the beach, and spending time with friends and family.

The combination treatment safely and quickly reduced laser-induced hyperpigmentation, especially on darker skin tones.

Low-Fluence Q-Switch Laser and Tranexamic Acid Can Quickly Treat Postinflammatory Hyperpigmentation

Maddi Hebebrand is an associate editor of 

and joined the MJH Life Sciences team in May 2024. She attended Baldwin Wallace University, studying Media Production and Film, and is now finishing her Masters in Digital Media through Ohio University. When she's not writing, Maddi loves to read, attend concerts and spend time with her family.

A study found that vitiligo patients had a higher incidence of COVID-19 than those with psoriasis or atopic dermatitis.

Patients with DIMIDs and Pandemic Risks

Catch up on dermatology news, highlights, and insights from the past 24 hours.

Daily Derm Times: February 20, 2025

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Older adults with higher genetic risk for HS show increased risks for coronary artery disease and diabetes, according to UK Biobank data.

Study Reveals Potential Genetic Connection Between Hidradenitis Suppurativa and Increased Risk of CAD and Diabetes

Investigators compared these outcomes due to limited research in the space, with previous surveys suggesting care disparities.

Eczema Prevalence Varies by Race and Ethnicity, With Overall Increase Seen

Final Thoughts: The Importance of Comparative Studies in AD

Panelists offer concluding insights and emphasize the critical role of comparative studies in advancing atopic dermatitis treatment strategies.

clinical

Video Series

Hyperhidrosis is not rare. According to the 

, approximately 385 million people worldwide live with hyperhidrosis.

In fact, they note that the amount of people living with chronic, excessive sweating is even higher than the amount of people living with other dermatologic conditions like psoriasis.

Just how common is hyperhidrosis in real-world comparisons?

The prevalence of hyperhidrosis is much higher in younger populations than in the general population, with 8.8% of individuals between the ages of 18 to 39 years old living with the condition. 

When comparing these statistics to everyday, common occurrences like hair color, the number of people with hyperhidrosis is greater than the 1% of individuals with natural red hair and 2% of individuals with natural blond hair. 

Despite how common hyperhidrosis is, it is estimated that 27% of those with the condition never receive a diagnosis.

 wants to hear from you. What percentage of the global population is estimated to have hyperhidrosis?

 to share your hyperhidrosis insights or research.

Albert. Fact check: Hyperhidrosis - International Hyperhidrosis Society: Official site. Home - International Hyperhidrosis Society. October 24, 1970. Accessed November 16, 2023. 

https://www.sweathelp.org/home/news-blog/542-fact-check-hyperhidrosis.html

Hyperhidrosis affects approximately 385 million people globally, surpassing the prevalence of other dermatologic conditions like psoriasis. It is notably more common in younger populations, with 8.8% of individuals aged 18 to 39 experiencing the condition. Comparatively, hyperhidrosis is more prevalent than natural red or blond hair, which affects 1% and 2% of the population, respectively. Despite its prevalence, 27% of those with hyperhidrosis remain undiagnosed. The article encourages engagement during Hyperhidrosis Awareness Month to share insights and research on the condition.

Click here to answer this week's poll for Hyperhidrosis Awareness Month.

Polls 

POLL: What Percent of the Global Population is Estimated to Have Hyperhidrosis?

At the 2024 Revolutionizing Alopecia Areata, Vitiligo, and Eczema (RAVE) conference in Chicago, Illinois, Nanette Silverberg, MD, chair of the Revolutionizing Vitiligo (ReV) portion of RAVE, chief of pediatric dermatology for the Mount Sinai Health System, and site director of pediatric and adolescent dermatology at Mount Sinai West and Mount Sinai Beth Israel in New York, presented 2 sessions on topical therapeutic considerations for vitiligo and how to achieve clinical excellence while treating patients with vitiligo.

In her topical therapeutics discussion, Silverberg reviewed the social determinants model of vitiligo, which included genetic susceptibility, environmental triggers, the recognition of diagnosis and initiation of therapy in a timely manner, and access to care. According to data Silverberg shared, there is still a 2.4-to-4-year gap before patients with vitiligo receive a diagnosis, and 40% of patients have previously been misdiagnosed. Additional barriers to care include challenges with prior authorizations, failure of inferior regimens, co-pays, and location of dermatologic care of physicians.

Considerations for Topical Therapeutics and Clinical Excellence in Vitiligo

When considering topical treatments, Silverberg first reviewed topical calcineurin inhibitors (TCIs) of topical tacrolimus and pimecrolimus that can be used as first-line therapy for children and adolescents aged 2 to 18 years with vitiligo, as TCIs are off-label use for vitiligo. Additional topical therapeutics that can be considered for the off-label treatment of vitiligo include topical corticosteroids and topical calcipotriene. The current FDA-approved first-line treatment for patients aged 12 years and older with vitiligo is topical ruxolitinib.

“However, we have no FDA-approved products for patients under the age of 12. Essentially everything we do with kids under the age of 12 is off-label, and that is a real problem because about 25% of vitiligo starts before the peak of 11,” said Silverberg.

Silverberg also stressed the importance of counseling patients about the realistic expectations of when patients may begin to see repigmentation. In many cases, it can take up tp 6 months to see meaningful repigmentation, and “6 months is a long time for patients to wait,” said Silverberg.

She added, “If patients really understand what’s waiting for them at the end of the 6 months, they can keep up. Sometimes, bringing patients back in the middle of that 2- or 3-month visit and looking for early repigmentation with them can help give them that sense that it’s working.”

In her second session, Silverberg discussed how to establish clinical excellence in your practice when treating patients with vitiligo. Treating patients is more than handing them a prescription, it’s about treating them in a holistic manner and coming up with a tailored treatment approach, according to Silverberg.

Being aware of both on- and off-label therapeutics for vitiligo is crucial for clinicians, however. Silverberg also encouraged attendees to consider combination therapies by including devices.

“How we incorporate all of these options together is what creates excellence in care. Caring for your patients is the most important first step in excellence in care; you have to think of them as individuals,” concluded Silverberg.

1. Silverberg N. Topical therapeutics for vitiligo. Presented at: 2024 Revolutionizing Alopecia Areata, Vitiligo, and Eczema; June 8-10, 2024; Chicago, IL.

2. Silverberg N. Excellence in vitiligo clinical practice. Presented at: 2024 Revolutionizing Alopecia Areata, Vitiligo, and Eczema; June 9-10, 2024; Chicago, IL.

Nanette Silverberg, MD, highlighted the challenges and strategies in treating vitiligo at the 2024 RAVE conference. She emphasized the social determinants affecting diagnosis and treatment, noting significant delays and misdiagnoses. Silverberg reviewed topical treatments, including off-label options for children under 12, as no FDA-approved treatments exist for this age group. She stressed the importance of setting realistic expectations for repigmentation timelines and advocated for a holistic, individualized approach to care. Silverberg also encouraged the use of combination therapies to achieve clinical excellence in vitiligo management.

Nanette Silverberg, MD, shares data on the efficacy of on- and off-label therapeutics for vitiligo, as well as the importance of communication with patients to promote clinical excellence. 

Considerations for Topical Therapeutics and Clinical Excellence in Vitiligo 

“The ability to bring science to the clinic—to our patients—is getting better and faster and much more gratifying as time goes on. I think the next 10 years will be amazing for dermatology,” Brian S. Kim, MD, MTR, FAAD, told 

Kim, vice chair of research in dermatology at the Icahn School of Medicine at Mount Sinai and Director of the Mark Lebwohl Center for Neuroinflammation and Sensation, received the Marion B. Sulzberger Award at the 2024 American Academy of Dermatology Annual Meeting in San Diego, California.

 about the latest research in understanding the etiology of itch, the implications for treatment, and what the future might hold.

Brian S. Kim, MD Advances in Itch

“We know that there are molecules on your sensory nervous system that trigger itch. We know that there are neuropeptides within your sensory nervous system that trigger itch, we know about a lot of factors, inflammatory and otherwise, that now are lock and key with these molecules,” he explained. “We have already done it. A lot of therapies are already doing it. The future is bright, because we now know a number of targets and we can go after them systematically.”

Kim noted the research and understanding is already being used in the clinic to help guide treatment decisions. “We're already doing it. I mean, we know that when we have agents like dupilumab that have long term effect on itch. The Jak inhibitors have a very rapid effect on itch—very, very rapid—so you can shut down triggers very quickly,” he told 

. I think you'll see with newer agents that are emerging, like with nemolizumab, you'll have now a monoclonal antibody, not a Jak inhibitor, and a rapid effect on itch. There's difelikefalin that is being developed for notalgia paresthetica, rapid improvement in itch, and neuropathic itch.”

“So what we're doing is aligning all of these molecules with diseases of high probability of success, and then directing them out to those diseases—in development, but now also post-development,” Kim said. “We know, for instance, probably a lot of these agents are going to work for many conditions beyond atopic dermatitis, and prurigo nodularis as well. And I know we're hearing a lot about that at this conference.”

How does Kim choose a treatment strategy? “Well, the first thing you want to do is make sure that you are treating the patient appropriately,” he said. “So the idea is if they have very generalized itch, you probably want to use more of a systemic treatment. If they have more localized itch, ideally, you would use more of topical routes of delivery and such. And that's the general idea.”

“You want to start with safety as your primary concern, but you also don't want to disregard efficacy,” Kim added. “You don't want to be so avoidant of [certain agents due to] safety concerns, and then you don't treat the itch at all. I think that has to come from in a very informed conversation with the patient, for them to understand what the risk/benefits are.”

“For a subjective disease, sometimes we minimize it. And that's a big problem with that. We think, ‘Oh, there's not a rash. There's not a lot going on. I don't think we really need to treat this aggressively.’ But the patient might want to treat it very aggressively. That's been my experience in the clinic.”

“Those are all the considerations. You have to take into account safety, efficacy, and all that, but there's a different lens you have to consider: It as a patient experience that you're really getting; it's not a provider experience. It's not objective,” Kim explained.

“I don't say when patients come in at the first visit ‘Let's do this—the big gun out of the gate,’” Kim said. “’The idea is we're going to start here, this is easier: safety-wise, ease of use, maybe even price point. We'll start there; we'll get this going. We'll see how you respond. We'll learn a little bit about your itch along the way. But here are other options that I want you to consider. I'll give you the kind of the highs and lows of that you can go home and Google it and think about it.’”

“Contemplation in medicine is very important. There's some patients that say out of the gate, ‘I'm never going to do that. I don't want to. I don't want to go on that therapy.’ And that's fine. That's totally fine,” he said. “But after a month, 2, 3, 6 months, 9 months—their feelings about that might change, often change. Living with itch becomes less bearable and their risk tolerance may change.

“I also feel it's my job as a physician to take certain risks with them, hand in hand. To say I'm not going to ever do that—I don't think works in medicine, right?”

“A lot of my patients come in having seen many other physicians and providers. They want relief. I have to be willing to go there, but they also need to be very informed if we're going to do that,” he told 

Watch the video to hear more from Dr Kim.

Advancements in dermatology are accelerating, with significant progress in understanding and treating itch through targeted therapies. Dr. Brian S. Kim highlights the role of molecules and neuropeptides in triggering itch and the effectiveness of treatments like dupilumab and Jak inhibitors. He emphasizes the importance of personalized treatment strategies, balancing safety and efficacy, and engaging patients in informed decision-making. Dr. Kim advocates for a patient-centered approach, recognizing the subjective nature of itch and the evolving risk tolerance of patients over time.

Kim, who received the Marion B. Sulzberger Award at the 2024 American Academy of Dermatology Annual Meeting, discussed itch research an implications for clinical practice.

Advances in Itch: Brian S. Kim, MD, Shares Insights and Treatment Tips 

2024 Society for Investigative Dermatology Annual Meeting

 last month in Dallas, Texas, Alice Gottlieb, MD, PhD, spoke to attendees about the importance of multidisciplinary care in psoriatic disease, monitoring patients with psoriasis for symptoms of arthritis, and easing pain and preventing disability.

Gottlieb is a clinical professor and medical director at the Icahn School of Medicine at Mount Sinai in New York, New York, and has conducted extensive research in the fields of dermatology and rheumatology.

"I was first to show, actually, that monotherapy with a TNF blocker cleared psoriasis, which I believe opened up the field to biologics for psoriasis," she said. "I would argue that if there weren't successful biologics for psoriasis, we wouldn't be talking about biologics for atopic dermatitis or alopecia areata."

Alice Gottlieb, MD, PhD: Multidisciplinary Care for Psoriatic Disease

I'm Alice Gottlieb. I'm a dermatologist and rheumatologist. I run the program at Mount Sinai Union Square. I was first to show, actually, that monotherapy with a TNF blocker cleared psoriasis, which I believe opened up the field to biologics for psoriasis. I would argue that if there weren't successful biologics for psoriasis, we wouldn't be talking about biologics for atopic dermatitis or alopecia areata.

The subject of my talk with the critical role of the dermatologist in preventing disability and pain due to psoriatic arthritis. Why do I feel it's so important? Because psoriatic arthritis is common in about 25 to 30% of psoriasis patients. In most cases, it's not difficult to diagnose, and if we make a mistake and send a fibromyalgia or rheumatoid arthritis patient to the rheumatologist, they still need to be seen by a rheumatologist. However, if we miss the diagnosis of psoriatic arthritis, we may be causing increased disability and pain. A delay in 6 months or more of diagnosis means a worse prognosis in terms of X ray findings, mutilating arthritis, a poorer quality of life. It's important to diagnose early, because psoriatic arthritis is potentially disabling. It is a real shame that in up to 41% of cases, the diagnosis of psoriatic arthritis is frequently missed by dermatologists, and we have a long enough time to think about it, because the cutaneous disease precedes the arthritis in most cases, in adults, by 10 to 12 years. We're the first who can detect psoriatic arthritis. 

Why does it matter? Because we have multiple TNF blockers, interleukin 17 blockers, a JAK inhibitor, which not only controls signs and symptoms, but inhibits radiographic progression, so we can prevent disability by initiating treatment early on. Frankly, I don't know how you can tell how to treat a psoriasis patient if you don't know whether they have psoriatic arthritis. Many psoriatic arthritis patients present with very little skin disease. If the dermatologist doesn't ask, they're going to give them a topical medication and miss the point that they have joint disease, because the presence of psoriatic arthritis is really independent of presenting psoriasis severity. Having said that, clearly, people with more severe skin disease are more likely to get psoriatic arthritis, but about 25% of people with psoriasis and mild disease have psoriatic arthritis. Ask every patient, and ask every visit. To me, that's the most important message I gave in the talk.

In order to address the issue of making it as easy as possible for dermatologists to at least ask about psoriatic arthritis, I spoke about what one could do. If one wants to do a mini physical exam, it's as easy as PSA, which is a algorithm developed by Dr Joseph Merola and his colleagues. P is pain in the joints. S is prolonged stiffness of greater than 30 minutes or inactivity. Or it could stand for swelling or sausage digging called dactylitis. The A is for inflammatory axial or spine involvement, which is back pain associated with stiffness that improves with activity.

Many dermatologists don't want to do that, so we developed an idiom, the International Dermatology Outcome Measures Group, that I founded and and president of, we developed an algorithm where the patient tells the doctor not only whether it's likely they have psoriatic arthritis, but whether they're in target. We do this with a free available test instruments that are available on the GRAPPA app for free. One of them is the PEST screening tool, which is a 5-question screening tool that if somebody answers 3 or more positive answers, it's likely they have psoriatic arthritis. Then there's the PsAID-12, which is a 12-question instrument which measures impact and symptoms of psoriatic arthritis, and there's a target. If the score is calculated, and if you're above that score, you're not in good control. These are available for free on any gizmo anybody could have: iPhone, iPad, Android, in many, many different languages.

We developed an idiom through a OMERACT process, highly rigorous process of developing and working with outcome measures, is when a patient comes or at a portal, as defined by their code, if their PEST score is 3 or more, or if they come with a rheumatologist's diagnosis of psoriatic arthritis, the patient, before they see the doctor, is given the PsAID. If the PsAID score is less than or equal to 4, then one can continue what one is doing, because the psoriatic arthritis is in acceptable control. If, however, the score is greater than 4, then one has to do something different or refer.

What we did as part of our quality project at Mount Sinai Union Square is we put both the PEST and the PsAID into our electronic medical record, which is Epic. When the patient opens their portal, or they're sitting in the
waiting room, if they have a psoriasis code, they are given the PEST and the PsAID. When the doctor opens up their chart, if the patient is not in good control, a yellow notice will come up, and it will say, "Your patient's PEST score of 3 or more indicates the patient may have psoriatic arthritis. If you are uncomfortable treating psoriatic arthritis, please refer this patient to our rheumatologist. Click here." It's a click away. You can't make it easier. The patient does the work, and the doctor should click the button. Then, if the if the PsAID score is greater than 4, then it also says, "Your patient's psoriatic arthritis may not be well controlled. Click here to get a rheumatology consult." I also maintain a list on that website of FDA-approved drugs for psoriatic arthritis. 

How well does this work? We've submitted this to the 

 and presented it for the first time in my guest lectureship. In an 18-month period, we had 2341 psoriasis patients. Of those patients, the response rate to completing the PEST was almost 40%. Yes, it could be better, but it's incredibly good for a patient questionnaire. Of those patients, 25% of the patients had a PEST score of greater than or equal to 3, indicating they could have psoriatic arthritis. Almost all of them took the PsAID, and over the 18-month period, we found that using this algorithm, 62% of patients actually were in acceptable control. 

This contrasts with an NPF non-interventional survey, where they just did the PEST and PsAID, and there was no action based on it, where only a third of the patients are in acceptable control. Using the PEST and the PsAID with an idiom developed algorithm, the patient does the work, and the doctor basically clicks a few buttons. With having the doctor made aware of the potential of psoriatic arthritis and potential for help in treating, 62% of patients were actually in target range, which I think is excellent for a dermatology practice.

Then I went over a comparative table with the domains of psoriatic arthritis, that is peripheral arthritis, skin and nail disease, axial disease, dactylitis, enthesitis, and with other factors, which may not be domains, but are confounding, such as inflammatory bowel disease, and I went over all of the FDA-approved treatments and which one does what, so that the audience could make a decision for their patient which would be an optimal choice. I also went over all the side effects from all of these treatments, too.

Then I discussed whether mute biologic use can actually decrease the risk of psoriatic arthritis. There's some hypothesis-generating data from registries, and I presented some of those, but we really don't have the answer to that yet. 

I highlighted, for those folks who are interested in interdisciplinary teaching in an intimate and very high degree of interchange between KOLs and attendees, I suggested that they come to Masterclass in Dermatology, which is unique in that it is interdisciplinary teachers, in February 2025 in Sarasota next year. For the PAs and NPs of both rheumatology and dermatology training, we have for free attendance a meeting of similar quality November 1-3 at the Ritz Las Colinas in Dallas, Texas.

[Transcript has been edited for clarity.]

Multidisciplinary care is crucial in managing psoriatic disease, emphasizing early diagnosis of psoriatic arthritis to prevent disability and pain. Dermatologists play a key role, as psoriatic arthritis often follows psoriasis by a decade. Tools like the PEST and PsAID help identify and manage psoriatic arthritis, integrated into electronic medical records for streamlined care. Early treatment with TNF blockers and other biologics can inhibit disease progression. The integration of these tools has shown improved patient outcomes, highlighting the importance of proactive screening and interdisciplinary collaboration in dermatology and rheumatology.

Gottlieb reviews her lecture from the Society for Investigative Dermatology Annual Meeting.

Alice Gottlieb, MD, PhD: Preventing Pain and Disability in Psoriatic Disease

 at the 2023 Fall Clinical Dermatology Conference for PAs and NPs to discuss his best acne treatment pearls during the “15 Tips in 15 Minutes” session. Zeichner, associate professor of dermatology and director of cosmetic and clinical research at the Icahn School of Medicine at Mount Sinai Hospital in New York City, presented alongside Mark Lebwohl, MD, the dean for clinical therapeutics, chairman emeritus of the Kimberly and Eric J. Waldman department of dermatology at the Icahn School of Medicine at Mount Sinai.

As a leading acne treatment expert, Zeichner reviewed his best treatment pearls for achieving cleared skin among his patients, as well as the importance of listening to his patient’s concerns to determine what treatment option will benefit them most.

: My name is Josh Zeichner. I'm an associate professor of dermatology at Mount Sinai Hospital in New York City.

: What are 3 acne treatment pearls from your session, "15 Tips in 15 Minutes?"

: I just gave a session at the Fall Clinical Meeting for NP and PAs here in Orlando, on tips in treating our acne patients. So I'll give you 3 of our top tips. Number one, you want to make sure that you're treating patients with combination therapies using different ingredients that have complementary mechanisms of action. The goal of treating our acne patients is to address as many pathogenic factors at the same time. Next, you want to hit patients hard from the beginning using multiple agents. If you start with one product, and then add another product later, it's not as effective as giving the patients all of those different ingredients right from the get-go. And finally, you want to involve patients in decision-making. You want to make sure that the patient is on board with your treatment regimen. If the patient is not interested in taking an oral medication, you need to find that out and you don't want to push that on a patient. If a patient agrees with the plan, and is willing to participate in the plan, ultimately, they're going to have better outcomes.

: What is the value of a meeting like Fall Clinical that brings together dermatologists, physician assistants, and nurse practitioners?

: I think there's huge value in bringing NPs and PAs to educational meetings alongside dermatologists so we can educate all health care providers who are treating our patients with skin conditions.

Joshua Zeichner, MD, shared his top acne treatment strategies at the 2023 Fall Clinical Dermatology Conference. He emphasized the importance of using combination therapies with complementary mechanisms to address multiple acne pathogenic factors simultaneously. Zeichner also highlighted the need to start treatment aggressively with multiple agents from the outset for better efficacy. Additionally, he stressed the significance of involving patients in treatment decisions to ensure adherence and improve outcomes. The conference's value lies in educating a diverse group of healthcare providers, including dermatologists, physician assistants, and nurse practitioners.

Zeichner reviewed his top 3 acne treatment pearls at the Fall Clinical Dermatology Conference for PAs and NPs.  

Maggie L. Shaw

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