Neal Bhatia, MD: What Clinicians Need to Know About Actinic Keratosis

At the Fall Clinical 2023 meeting in Las Vegas, Nevada, Neal Bhatia, MD, will be presenting new research on actinic keratosis and the use of tirbanibulin. “We've done a few trials on 100 square centimeters, which is great because that's the temples, forehead temples, including the ears, and a lot of surface area. And the pharmacokinetics are clear,” said Bhatia, the director of clinical dermatology at Therapeutic Clinical Research in San Diego, California, in an interview with Dermatology Times.

After his actinic keratosis session on October 19th, Bhatia will be speaking alongside Brittany Craiglow, MD, during “Discover a New Oral Treatment for Severe Alopecia Areata." Bhatia and Craiglow will be discussing key considerations of ritlecitinib for severe alopecia areata and how it can help change patient outcomes. Finally, Bhatia discusses what he’s looking forward to heading into 2024 after a busy year.

Transcript

Neal Bhatia, MD: This is Dr. Neal Bhatia. I'm the director of clinical dermatology at Therapeutics Clinical Research in San Diego, California. And I'll be speaking on actinic keratosis and some new updates in management.

Dermatology Times: What new research will you be presenting about actinic keratosis at Fall Clinical?

Bhatia: So the most recent and probably biggest update in topical treatment is the large field treatment with tirbanibulin 1% ointment. We've done a few trials on 100 square centimeters, which is great because that's literally the temples, forehead temples, including the ears, and a lot of surface area, which is great. And the pharmacokinetics are clear. There's still some good tolerability very little in terms of local skin reaction, an issue that would be bad for adherence. And it's still a 5-day course, but now we can cover a lot more surface area, which is great. Even more so, we're going to hear about some patient reported outcomes, especially in terms of what the patients are looking for in terms of not only topical management but also incorporation into combinations, what it does for their risk of skin cancer, and then even more so, where are we going to see some of these treatments fit into combinations down the road?

Dermatology Times: What is coming next for actinic keratosis regarding new research and trials?

Bhatia: So the next few trials, and really more adjustments would be with photodynamic therapy, I think we'll see some developments and some lights, both red and blue, if you will, there'll be larger surface lights as well as more potential for using them at different algorithms, including timings of incubation, timings of light, incorporations with daylight. And then of course, just putting PDT into context. I think more of an update would be just how to incorporate PDT into the practice as well as from the business end of things. Where does photodynamic therapy fit? I think, if you think about a sequence, we think about where do we use cryotherapy, topicals, photodynamic therapy; there's a good study out that I was part of years ago that showed you can freeze people on the first date, you can maintain them with topicals, prime their skin until they can get a chance to do photodynamic therapy. Studies have shown if you do photodynamic therapy every 2 months for 2 years, you can reduce skin cancer risk by almost 90% and keep it that way. So it's really an underutilized tool. And you have to start thinking in terms of "and" and "in combinations" rather than "or" and "what not to do." So that's really where dermatologists have to really focus on the larger management to keep skin cancer away.

Dermatology Times: What new advancements in alopecia areata will you be presenting?

Bhatia: On Friday of Fall Clinical, I'll be speaking with Dr. Brittany Craiglow, on some advances on treatments for alopecia areata, which will be sponsored by Pfizer. This will be focused on ritlecitinib, and some of its dosage strategy safety and clinical efficacy data, which is really pretty exciting. You think about alopecia areata, even vitiligo, and some of the other conditions that are now having treatments that match their mechanisms. We have some real opportunities to treat patients that really didn't have safe treatments or treatments that they could count on for efficacy. And I think now with alopecia areata being focused and ritlecitinib being launched at 50 milligrams a day, we can really treat these patients efficiently and safely for the long run.

Dermatology Times: What have you been working on this year? What are you looking forward to heading into 2024?

Bhatia: For me, it's been a busy year; 2023 has been a lot of fun. We've gotten into some new research trials. Fortunately, we've had a lot of meetings come back to normal, if you will. And I think you know, we're looking forward to 2024 to have some new advances and not only the new pharmacology trials and some new advances in biologics as well as JAK inhibitors, but just as a whole, trying to get the specialty reenergized back to topical management, back to treating outside in as well as inside out. And working on again, advocacy and scope of practice for a specialty so that we can all make sure our patients are covered by all of us who are well-trained. Even more so I think we look forward to a nice holiday season so that we can all unplug and take a breath because that's the best way to dodge burnout.

[Transcript edited for clarity]