Game Changers in Dermatology

Opening the session "What’s New in Dermatology" at the American Academy of Dermatology Virtual Meeting Experience 2021 (AAD VMX), session leader Mark Lebwohl, MD, pointed out that not even COVID-19 could stop innovation in dermatology.

“Despite the pandemic, there have been many breakthroughs in our specialty,” said Lebwohl, Dean for Clinical Therapeutics and Chairman emeritus at the Kimberly and Eric J. Waldman Department of Dermatology in the Icahn School of Medicine at Mount Sinai in New York, New York, and a member of Dermatology Times®’ editorial advisory board.

This year will build on that, he added. Lebwohl and other key opinion leaders across the specialty highlighted the research, treatments, and techniques that will continue to shorten the distance between skin disease management and cure during their presentations at the AAD’s annual meeting held virtually April 23-25, 2021.¹

Here is their list of top trends to watch.

• More biologics are being approved for pediatric patients with psoriasis. Most show safety and efficacy rates similar to those in adults, said Lebwohl. Among “the most exciting” new drugs for treatment in general, in his view, is bimekizumab (UCB), which blocks IL-17A and IL-17F. “It is dramatically effective for psoriatic arthritis and psoriasis,” he added. Currently, It is the only drug to inhibit 2 targets, but a second is on the horizon. Also making news are anti-IL-36 drugs, which inhibit a pathway that clearly has been identified as playing a major role in pustular psoriasis, according to Lebwohl. One of those inhibitors, spesolimab (Boehringer-Ingelheim) showed that two-thirds of patients in a clinical trial (NCT04399837) were clear or almost clear at week 1 after the first injection, and 100% were clear or almost clear by week 4. “With the tremendous number of treatments available, nearly any patient can be clear,” he said.
• Digital devices and genomics will evolve, providing access to more precise data to direct both skin cancer diagnosis and treatment management, said Darrell S. Rigel, MD, MS, FAAD, clinical professor of dermatology at the New York Grossman School of Medicine in New York, New York in his AAD VMX presentation.1 He sees a new generation of adjunctive digital dermoscopy tools such as the Demetra (Barco) imaging platform that can archive data, analyze, provide data for diagnosis and store all that in the cloud. “The ability of these devices to help distinguish between a benign and malignant lesion will lower the number of unnecessary biopsies and also help less experienced diagnosticians improve their overall performance.” The new electric impedance spectroscopy (EIS) method is a measure of the overall resistance in a tissue at alternating currencies of various frequencies. Rigel said a recent study showed EIS changed the biopsy 24% of time, improved accuracy and “significantly” reduced the number of benign biopsies. He also sees genomics becoming an adjunct to standard of care for prognosis, diagnosis and sentinel lymph nod biopsy, especially in light of studies exploring 40-gene expression testing.
• JAK inhibitors, combination therapies and drug holidays will be key areas to watch in atopic dermatitis, said Erin E. Boh, MD,PhD, in her AAD VMX presentation. Both oral and topical JAK inhibitors are in clinical trials for atopic dermatitis, including some that target all of pathways 1, 2, and 3, and others that focus on specific combinations of those pathways, according to Boh, Joseph Chastain professor and chair of dermatology at the Tulane University School of Medicine in New Orleans, Louisiana. She also sees drugs such as ruxolitinib (Jakafi, Incyte) showing promise for treating vitiligo. A recent study showed positive outcomes across all dosages, but 1.5% q day or BID dosing was most effective in repigmenting vitiligo.² Turning to retinoids, she pointed to the potential of combination therapies such as a fixed combination of halobetasol and tazarotene (Duobrii, Ortho Dermatologics) lotion in a novel polymeric emulsion. “This technology provides more efficient epidermal delivery of active ingredients with better tolerability,” she said. “It gets the active ingredient where it needs to be.” Boh sees topical steroids continuing to be a mainstay in atopic dermatitis treatment. However, “steroid sparing agents are very useful, and also better in combination. Moisturizers are helpful adjunct delivery systems of the new moisturizers and will improve efficacy and compliance in the long run. And also think about different topicals in the context of treating different people in different locations.”
• Some new systemic dermatological indications that are not yet FDA-approved could play an important role in treating melasma and hyperpigmentation, said Seemal R. Desai, MD, FAAD clinical professor in the department of dermatology, University of Texas Southwestern Medical Center in Dallas and founder of Innovative Dermatology in Dallas.6 “Specifically, I’m referring to tranexamic acid.”

Because this is a synthetic analogue of the amino acid lysine, it competitively inhibits the transformation of plasminogen to plasma, a molecule that degrades fibrin. “Via multiple steps, tranexamic acid blocks the production of inflammatory mediators like prostaglandins and arachidonic acid,” he said. “And guess what prostaglandins and arachidonic acid do in melasma pigmentation? They stimulate tyrosyl activity to make more melanin.”

While there are some contraindications to oral tranexamic acid for patients who are pregnant, nursing or breastfeeding, “young healthy male and female patients can use this for recalcitrant disease,” Desai said. “I use it frequently in 250 mg to 500 mg doses VID or BID. I typically do this to see improvement in 6 to 8 weeks.”

Disclosures:

Lebwohl receives research funds Abbvie, Amgen, Arcutis, Boehringer Ingelheim, Dermavant, Eli Lilly,Incyte, Janssen Research & Development, LLC,Leo Pharmaceutucals,Ortho Dermatologics, Pfizer, and UCB, Inc.and is a consultant for Aditum Bio, Allergan, Almirall, Arcutis, Inc., Avotres Therapeutics, BirchBioMed Inc., BMD skincare, Boehringer-Ingelheim, Bristol-Myers Squibb, Cara Therapeutics, Castle Biosciences, Corrona, Dermavant Sciences, Evelo, Facilitate International Dermatologic Education, Foundation for Research and Education in Dermatology, Inozyme Pharma, Kyowa Kirin, LEO Pharma, Meiji Seika Pharma,Menlo, Mitsubishi, Neuroderm, Pfizer, Promius/Dr. Reddy’s Laboratories, Serono, Theravance, and Verrica. Rigel mentioned Castle BioSciences, SciBase, Molesafe and DermTech. Boh reported financial disclosures from Ortho Dermatologics, Incyte, Corrona, UCB, Abbvie, Janssen, Pfizer. Desai reported no relevant or financial disclosures.

References:

1. Lebwohl M, Rigel D, Boh E. What’s new in dermatology. Presented at: American Academy of Dermatology 2021 Virtual Meeting Experience (VMX) annual meeting; April 23-25, 2021.

2. Rosmarin D, Pandya AG, Lebwohl M, et al. Ruxolitinib cream for treatment of vitiligo: a randomised, controlled, phase 2 trial. Lancet 2020; 396: 110–20