Dialing Into the Therapeutic Hotline with Gary Goldenberg, MD

The landscape of dermatology continues to witness remarkable advancements, as highlighted in the the 2024 Winter Clinical Hawaii session “Therapeutic Hotline: Psoriasis, Atopic Dermatitis, Acne, Actinic Keratoses & Other Common Practice Problems” with Gary Goldenberg, MD, assistant professor of dermatology and pathology at the Icahn Sinai School of Medicine at Mount Sinai in New York, New York.¹

Gary Goldenberg, MD (Photo courtesy: Mount Sinai)

Here are a few advancements catching Goldenberg’s eye. 

Acne Treatment Innovations

Goldenberg began by discussing advancements in acne treatment. He emphasized the effectiveness of clascoterone cream (Winlevi), the first topical androgen receptor inhibitor for acne in patients aged 12 and older. Photos displayed during the session showcased significant improvements in acne and post-inflammatory hyperpigmentation.²

Nutraceuticals were also introduced as a viable option for acne improvement, emphasizing the impact of dietary changes. The session delved into topical clindamycin, assuring attendees about its safety and efficacy for acne vulgaris, even addressing patient concerns about potential gastrointestinal side effects. “No, you don't need to worry about them [gastrointestinal side effects] because it doesn't get absorbed,” Goldenberg said.³

Cutting-Edge Acne Vulgaris Therapies

Triple combination therapy featuring adapalene benzoyl peroxide (A/BPO) emerged as a promising avenue. Goldenberg presented data demonstrating its safety and efficacy, with a specific focus on its positive outcomes in Black patients.In fact, one clinical trial (NCT02932267) showed that patients with skin of color and moderate or severe facial acne reported high satisfaction with 0.3% A/BPO treatment and experienced good tolerability, improved QoL, treatment efficacy, and improvement in postinflammatory hyperpigmentation.⁴

The presentation transitioned to antibiotics, highlighting the precision of saracycline in targeting P. acnes and showcasing its anti-inflammatory activity compared to traditional doxycycline. Intriguingly, micronized isotretinoin was discussed, emphasizing its efficacy whether taken with or without food, challenging conventional expectations. “So remember to absorb isotretinoin, you do need to have some fat on your stomach except for this product where it's not necessary. So if your patients are skipping meals while they're taking it, it still continues to work,” Goldenberg said.

Goldenberg also shared impactful data and personal experience treating patients withthe 1726-nanometer laser. “It'spretty simple [and] takes about 30 minutes, skin to skin after prep. The prep does take about 10 minutes. Andessentiallyit's a cold laser so you're just going through covering the entire skin surface,” he explained. “I've also treated patients backs and chests. With this. I think theyprobably need more treatments, especially for back at a higher energy level. But it's been a great tool on the practice for treating patients with acne vulgaris.”⁵

Revolutionary Psoriasis Treatments

Betamethasone dipropionate spray stood out to Goldenberg in psoriasis management, showcasing superior effectiveness compared to lotion formulations.⁶ The discussion extended to diethylene glycol monoethyl ether, emphasizing its superiority over propylene glycol for psoriasis treatment.⁷

Apremilast safety and efficacy data for patients with genital psoriasis was also noted. In the phase 3 DISCREET trial (NCT03777436), patients were randomized to apremilast (n = 143) or placebo (n = 146). Investigators wrote, “At Week 16, 39.6% and 19.5% of apremilast and placebo patients, respectively, achieved a modified static Physician Global Assessment of Genitalia response (primary endpoint; score of 0/1, ≥2-point reduction); treatment difference was significant (20.1%, P = .0003). Improvements in genital signs and symptoms, skin involvement, and quality of life were observed. Common treatment-emergent adverse events were diarrhea, headache, nausea, and nasopharyngitis.”⁸

Groundbreaking Advances in Atopic Dermatitis

Moving to atopic dermatitis (AD), Goldenberg kicked off the conversation with ruxolitinibcream (Opzelura), showcasing its approval and effectiveness in improving various measures of atopic dermatitis. Phase 3 data for tapinarof(Vtama) leaves Goldenberg optimistic. “It's[tapinarof] not FDA approved for AD yet. I've used it off label since the drug became available and the data supports using it for patients with AD as well.This is looking at definitive again for patients in the phase 3 trials,” he said.

The session also addressed the safety of long-term treatment with dupilumab (Dupixent) for young children, presenting data that reinforced its safety and effectiveness. ⁹ Janus kinase (JAK) inhibitors emerged as a breakthrough in atopic dermatitis treatment, with Goldenberg emphasizing their efficacy and safety. He said, “These [JAK inhibitors] are highly, highly effective and I know that all of us are scared of the safety, but you have to read between the lines because the safety warnings in the packages are have more to do with rheumatology patients who are sick and maybe other immunosuppressive as opposed to our patients in dermatology.” 

References

1. Goldenberg G. Therapeutic hotline: psoriasis, atopic dermatitis, acne, actinic keratoses & other common practice problems. Presented at: 2024 Winter Clinical Hawaii Dermatology Conference; January 12-17, 2024, Honolulu, HI.
2. Shields A, Ly S, Wafae B, et al. Safety and effectiveness of oral nutraceuticals for treating acne: asystematic review. JAMA Dermatol. 2023;159(12):1373-1382. doi:10.1001/jamadermatol.2023.3949
3. Emmerich VK, Purvis CG, Feldman SR. An overview of adapalene and benzoyl peroxide once-daily topical gel as a therapeutic option for acne. Expert OpinPharmacother. 2021;22(13):1661-1667. doi:10.1080/14656566.2021.1939678
4. DuBois J, Ong GCW, Petkar G, et al. Patient-reported outcomes in acne patients with skin of color using adapalene 0.3%-benzoyl peroxide 2.5%: a prospective real-world study. J Drugs Dermatol. 2019;18(5):514.
5. Scopelliti MG, Kothare A, Karavitis M. A novel 1726-nm laser system for safe and effective treatment of acne vulgaris. Lasers Med Sci. 2022;37(9):3639-3647. doi:10.1007/s10103-022-03645-6
6. Stein Gold L, Bagel J, Allenby K, Sidgiddi S. Betamethasone dipropionate spray 0.05% alleviates troublesome symptoms of plaque psoriasis. Cutis. 2020;105(2):97-E1.
7. Del Rosso JQ. Topical Corticosteroid Therapy for Psoriasis-A Review of Clobetasol Propionate 0.025% Cream and the Clinical Relevance of Penetration Modification. J Clin Aesthet Dermatol. 2020;13(2):22-29.
8. Merola JF, Parish LC, Guenther L, et al. Efficacy and safety of apremilast in patients with moderate-to-severe genital psoriasis: Results from DISCREET, a phase 3 randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. Published online October 16, 2023. doi:10.1016/j.jaad.2023.10.020
9. Kimball AB, Delevry D, Yang M, et al. Long-term effectiveness of dupilumab in patients with atopic dermatitis: results up to 3 years from the RELIEVE-AD study. Dermatol Ther (Heidelb). 2023;13(9):2107-2120. doi:10.1007/s13555-023-00965-5