2024 Expert Insights: More Options than Ever

Jason Hawkes, MD, MS: Looking Back on 2024, Ahead to 2025

Hawkes: “When I look back at 2024, what are the big themes that I see that have been exciting? What I see happening in dermatology in the last year, which has been really great, is that we are developing clinical trial programs for many dermatologic conditions that we often ignored or under studied, under treated.These are conditions like alopecia areata, vitiligo, hidradenitis suppurativa, and what I've been really excited about is chronic spontaneous urticaria.These are conditions that we're aware of. We tried a lot of off label treatments, but now we're getting dedicated clinical trial programs. We're seeing the versatility of similar classes of medication that can be used for many things. I think the JAK inhibitors have been a good example of their utility as broad acting agents. They're narrower than the cyclosporine methotrexate, for example, but they're broader than our biologic agents, allowing them to work in multiple diseases. We're seeing these extended, expanded clinical trial programs for a lot of different conditions. I think it's nice to be able to talk to our patients about specific, dedicated trials to medications that studied this drug for that particular disease, as opposed to saying we don't know if this will work or we think it might work, it's off label. This was really, I think, expanding the layers of treatment that we have. We also saw the parceling out aspects of diseases like atopic dermatitis. We saw treatments dedicated and trials dedicated just for hand dermatitis or chronic hand eczema. We saw trials dedicated to genital psoriasis, scalp psoriasis, palmer plantar psoriasis. The fact that we're getting closer to some of these unique subsets is getting us closer to what I always envisioned as true personalized medicine. We can choose the therapy that we know works for a particular disease. We can look at clinical trial data or a particular variant. I love this aspect, because we can really tailor treatment choices now to our patients as they're sitting before us with these often ignored variants or subsets of disease.”

“ARM Yourself with Knowledge": Emmy Graber, MD, MBA, Shares Insights on Acne, Rosacea, and More

Graber: "So one of the most exciting things to me about dermatology in 2024 was just seeing how much is new in dermatology. I went to a lot of meetings this year, including running my own virtual meeting, the "ARM Yourself with Knowledge" meeting. And it's just phenomenal to look back at 10 years ago and see what we have now and what everyone is talking about. And there's so many new pharmaceuticals and therapeutic modalities for many different diseases. And I think, in general, hearing about all of my colleagues speak about these different things in 2024 has been especially exciting for me."

“Don’t Touch This”: Contact Dermatitis Insights and Updates from Matthew Zirwas, MD

Zirwas: "The most exciting aspect of dermatology in the past year for me is an easy one, and it has nothing to do with anything else I've talked about today. It is the rise of the drug, oral roflumilast. If you are not using oral roflumilast on essentially a daily basis in your practice, you are behind the times. So oral roflumilast is an oral PDE-4 inhibitor. It costs $10 a month through some of the mail order pharmacies. So mechanistically, it is identical to Otezla. However, it is substantially more effective. One of the really good randomized, double-blind trials we have comparing it to methotrexate, showed that 50% of people got to passing 90 and about 70% of people got to passing 75. And this is with a drug that is non-immunosuppressive and requires no labs. It does cause GI upset in about 10% of patients. It does cause depression in about 1%, just like apremilast. But it's 10 bucks a month without insurance. So, it's a phenomenally good drug to use. Am I using it primarily in psoriasis and eczema? No, because I've got even better drugs for both of those. But where it's amazing? Number one, in psoriasis and eczema patients, when, for whatever reason, you can't get access to an FDA-approved therapy. But then the places where it's super good; lichen planus, lichen planopilaris, oral lichen planus, generalized granuloma annulare, even localized GA, cutaneous connective tissue diseases, pyoderma gangrenosum, and hidradenitis suppurativa. So, all of these inflammatory dermatoses, we now have a new agent that is super easy to use, is really cheap, and is broad spectrum, and it's especially good for a lot of things we haven't had good treatments for up till now."