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SESSION HIGHLIGHTS
JAK Inhibitors
To begin this presentation, Jeffrey M. Sobell, MD, reviewed the pathophysiology of psoriasis and the methods of using JAK inhibitors. Further, Dr. Sobell discussed clinical trial programs for psoriasis treatments in accordance with particular targets, such as tofacitinib for JAK 1 and 3 targets, baricitinib and ruxolitinib for JAK 1 and 2, and itacitinib, abrocitinib, and solcitinib for JAK 1. A majority of this session was centered around comparing the Phase II and III safety and efficacy data of these treatments in patients with moderate-to-severe plaque psoriasis. Ending this segment, Dr. Sobell assessed the use of deucravacitinib in patients with psoriatic arthritis.
Using patient examples and case photos, Brittany Craiglow, MD, illustrated the use of JAK inhibitors in treating (severe/recalcitrant) alopecia areata, as well as their impact on hair growth. Additionally, Dr. Craiglow shared randomized, controlled trials that examined the efficacy of JAK inhibitors in alopecia areata, which included ruxolitinib, brepocitinib, CTP-543, and baricitinib. To conclude, Dr. Craiglow highlighted the clinical management criteria for using JAK inhibitors to treat patients with alopecia areata and how to taper medications after hair regrowth.
Next, Brett King, MD, PhD, described the functionality of JAK inhibitors in the dermatology field, specifically as potential therapies for dermatomyositis, alopecia areata, atopic dermatitis, lichen planus, pruritus, psoriasis, and vitiligo. Dr. King also provided an instructive inflammatory skin diseases therapeutic tool chart that categorized not targeted, somewhat targeted, and targeted treatments. Then, Dr. King ended his session with adverse events associated with JAK inhibitors.
The role of JAK inhibitors in atopic dermatitis was covered by Eric Simpson, MD, MCR. Here, Dr. King evaluated the safety data from clinical trials wherein patients with atopic dermatitis were treated with topical or oral JAK inhibitors, such as ruxolitinib cream, triamcinolone cream, upadacitinib, baricitinib, and abrocitinib. Patient demographics and characteristics and changes in itch severity from each trial were included in this presentation as well.
After, Matthew D. Vesely, MD, PhD, explored the potential of JAK inhibitors in the treatment of inflammatory skin diseases and sclerosing skin diseases and JAK inhibitors as rescue or combination therapy. Dr. Vesely reviewed drug reactions subsequent to treating generalized deep morphea and eosinophilic fasciitis, as well as JAK inhibitors serving as bleomycin-induced fibrosis prevention. Further, Dr. Vesely analyzed JAK inhibits as a progressive systemic sclerosis therapy, too. With the reminder of the session, Dr. Vesely highlighted the role of JAK inhibitors and IL-4/IL-13 signaling in keloid and keloid lesions.
For the final presentation, William Damsky, MD, PhD, discussed JAK inhibitors for sarcoidosis and granuloma annular. After reviewing the mechanisms, background, and prevalence of these conditions, Dr. Damsky reported long-term efficacy data of tofacitinib in patients with either sarcoidosis or granuloma annular, with the assistance of patient photos and progress reports. To conclude this presentation, Dr. Damsky listed the upcoming trials on JAK inhibitors for granuloma annular and discussed the potential importance of vehicle optimization.
Controversies in Melanoma Diagnosis
Ben J. Friedman, MD, started this presentation with the role of molecular methods in diagnosis and predication of melanoma by reviewing challenges in melanoma detection. Then Dr. Friedman highlighted the pros and cons of GEP (PLA), GEP (Decision X) Array CGH, FISH Multiprobe Assay, and testing. Further, Dr. Friedman offered methods for deciding when to perform the above tests.
The melanoma “epidemic” from a dermatopathologist’s perceptive was presented next by Earl Glusac, MD, assessing previously published literature about the direction and prevalence of melanoma. Dr. Glusac identified certain factors that contributed to this “epidemic,” and the surrounding misconceptions, such as lesion size in relation to histologic criteria, screening problems, “no mission” motivation, and melanoma reservoir.
Next, Jason B. Lee, MD, discussed melanoma diagnosis from a clinician’s perspective. Dr. Lee first assessed the efforts needed to detect melanoma early. Like Dr. Glusac, Dr. Lee also discussed the melanoma “epidemic,” submitting the steady increase in mostly Stage 0 and 1 melanoma would not be the only Stages to raise if it was a true epidemic. Further, Dr. Lee explained how incidence rates might be raising, but mortality rates are remaining low and steady. After, Dr. Lee highlighted the three 3 categories of melanoma: slow-growing melanomas with chronic sun on head and neck, slow-growing melanomas with intermittent sun exposure and melanocytic nevi, and fast-growing aggressive melanomas (not correlated to sun exposure or melanocytic nevi). To conclude, Dr. Lee provided clinical scenarios of overdiagnosis of melanoma.
Lastly, Chauncey McHargue, MD, offered more insight on the melanoma “epidemic” as well. Dr. McHargue presented information from the SHEER database for cancer statistics, several articles on melanoma prevalence, the trend of related mortalities rates over the years (and the “mortality curve” during the 1980s), and research on the discordance in incidence and mortality of melanoma. After analyzing the ample amount of information packed in this session, Dr. McHargue concluded with the medical advancements that have evoked a 100-percent reduction in excess mortality over the past 30 years and the increase in incidence rates were mainly due to aggressive screening. In short, “there is no melanoma epidemic,” Per Dr. McHargue.
Hand and Foot Psoriasis, Dermatitis, and Other Inflammatory Dermatoses
To begin, Robert Bissonnette, MD, FRCPC, discussed differential diagnosis for hand and foot psoriasis, chronic pustular eruption, and palmoplantar pustulosis, using photos from specific patient cases. Dr. Bissonnette provided general approaches to the above conditions, including assessment considerations, associations with non-dermatological disorders, and potential treatment strategies.
Following this, Bruce E. Strober, MD, PhD, reported on management methods for hand and foot psoriasis, starting with an overview of palmoplantar psoriasis phenotypic expression and prevalence. Throughout this session, Dr. Strober listed and evaluated the many available palmoplantar psoriasis treatments, including corticosteroids, UV phototherapy, retinoids, IL-17 and IL-23 inhibitors, apremilast, and tofacitinib, and compared their efficacy and safety profiles.
Next, a review of the occurrence and mechanisms of hand dermatitis and contract dermatitis were covered by David E. Cohen, MD, MPH. Here, Dr. Cohen utilized patient cases to demonstrate deciding optimal diagnoses and the benefits of patch testing. Then, the history of hand eczema in children from 2000 to 2016 was assessed. Dr. Cohen also listed the many allergens that could trigger contact dermatitis, such as rubber and common skin cleansers.
For the final presentation, Emma Guttman-Yassky, MD, PhD, focused on the new topical and systemic therapies for chronic hand eczema. First, Dr. Guttman-Yassky described the process of developing therapies for atopic dermatitis and therapeutic response. Dr. Guttman-Yassky then dedicated the remainder of the segment to analyzing clinical trial (safety and efficacy) data on topical delgocitinib, oral gusacitinib, dupilumab, and apremilast.
SESSION HIGHLIGHTS
Atopic Dermatitis
Aaron Drucker, MD, ScM, FRCPC, presented on the epidemiology of atopic dermatitis (AD), as well as the prevalence and impact of this skin condition. Since AD affects people of all ages, Dr. Drucker offered suggestions for parents who are concerned about their children outgrowing AD. Using clinical data, Dr. Drucker then illustrated disease activity in accordance with certain factors, such as severity and age. To conclude this segment, Dr. Drucker discussed how AD affects the senior (65 years or older) population and how seniors might be more at risk for adverse events from systemic medications for AD.
Next, Emma Guttman-Yassky, MD, PhD, covered how the “inside out versus outside in” hypothesis impacted the development of long-term atopic dermatitis treatments and treatment approaches. Dr. Guttman-Yassky also reviewed the various cytokines involved with atopic dermatitis development, specifically the downregulation of interleukin (IL)-4 and IL-13, and how Th2 cytokines could link skin barrier and immune defects to the skin condition. Additionally, Dr. Guttman-Yassky shared clinical data suggesting AD is a systemic disease, much like psoriasis, due to observed factors such as increased T-cell activation and circulatory cytokines and cardiovascular-related markers. Using more findings from clinical trials, Dr. Guttman-Yassky then explored targeted treatments, featuring patient outcomes after receiving dupilumab or upadacitinib.
Following this, Jonathan I. Silverberg, MD, PhD, MPH, described multimorbidity of AD, assessing previously published studies that examined the comorbid health disorders related to the skin condition. The associations for multimorbidity were extensively reviewed and demonstrated based on patient data from various case-control studies. Dr. Silverberg ended the presentation by analyzing multimorbidity in children with AD.
After Dr. Silverberg, Lawrence Eichenfield, MD, reported updates in topical therapies for AD and the expansion of available literature on the skin condition. These updates included criteria for the “Step-up Care” algorithm, Phase IV of crisaborole trials (which featured infant cohorts), and adverse events from topical tacrolimus usage. Dr. Eichenfield then focused on tolerability outcomes from topical ruxolitinib, beprocitinib, and roflumilast trials. Dr. Eichenfield briefly discussed research on microbial interventions in the realm of topical therapy for AD, including a study on the topical application of Roseomonas mucosa in children aged three years and older. To conclude, Dr. Eichenfield offered resources for clinicians seeking to improving topical care for AD.
Next, Lisa A. Beck, MD, thoroughly discussed the role of the epidermal barrier in AD, taking into consideration the structure of the skin and barrier defects. Further, Dr. Beck shared the impact of tight junctions in eczema and AD, and how they can lead to bacterial and viral infections. To wrap up this session, Dr. Beck analyzed current trials that suggest there is no link between early emollient usage and AD prevention or delay.
The current and future direction of adult AD systemic treatments were then covered by Eric Simpson, MD, MCR. Dr. Simpson first mentioned the decision-making process when prescribing either systemic or topical therapies to patients. After, Dr. Simpson discussed currently available systemic therapies, mainly dupilumab, cyclosporine, phototherapy, methotrexate, mycophenolate, and azathioprine. Lastly, Dr. Simpson discussed various emerging therapies, which included tralokinumab, baricitinib, and abrocitinib.
Psoriasis
To begin, Bruce E. Strober, MD, PhD, highlighted new psoriasis data, exploring apremilast use in patients with less than 10-percent BSA and reviewing safety and efficacy data. Dr. Strober then moved onto deucravacitinib and compared its results with apremilast. Further, Dr. Strober presented the risk of candida infections subsequent to IL-17 pathway antagonists. Before concluding the segment, Dr. Strober reported findings form the PSOARING 1 and 2 trials, which tested the safety and efficacy of tapinarof cream in patients with plaque psoriasis.
Next, Andrew Blauvelt, MD, MBA, focused on what is new in psoriasis research. This segment featured new clinical data involving differential changes in inflammation, guselkumab versus secukinumab treatment, multi-color flow cytometry, and IL-23 versus tumor necrosis factor (TNF)-alpha productions by cells in psoriatic lesions. Dr. Blauvelt also presented information on improvements in non-calcified plaque burden in patients with psoriasis following one year of biologic therapy.
After Dr. Blauvelt, April W. Armstrong reviewed the guidelines for monitoring biologic and oral therapies, which involved evaluating baseline and ongoing laboratory bloodwork and routine bloodwork for those who are treated with apremilast or cyclosporine. Dr. Armstrong then analyzed biologic dose escalation, specifically for TNF inhibitors (etanercept, adalimumab, certolizumab, and infliximab) and IL-12/23 inhibitors (ustekinumab, guselkumab, tildrakizumab, and risankizumab). Further, Dr. Armstrong covered management of pediatric psoriasis and how certain treatments, such as ustekinumab, perform in children. To end this session, Dr. Armstrong discussed AAD-NPF phototherapy guideline updates.
With the assistance of specific case reports and various clinical studies, Nehal N. Mehta, MD, MSCE, FAHA, examined the link between the effects of inflammation and cardiometabolic diseases. The first case that was featured pertained to hypertension and untreated psoriasis. Dr. Mehta described the laboratory data involved to further depict how psoriasis is often correlated to cardiovascular disease. However, Dr. Mehta explained that biologics can be utilized to reduce systemic inflammation from psoriasis, as well as coronary plaque burden. After providing data that included many patients treated with biologics, Dr. Mehta discussed the moderation of lipid-rich neurotic core after one year of treatment. By reverting to the first case, Dr. Mehta concluded that inflammation produces lipid streaks in the arteries that lead to non-calcified plaque and eventually high-risk plaque in such populations and why biologic therapies can decrease the occurrence and exacerbation of the above process.
The final presenter, Richard GB Langley, MD, examined the treatment of mild-to-moderate plaque psoriasis with modern systemic therapies, deconstructing psoriasis severity classification and when to suggest such therapies. To end, Dr. Langley offered physicians introspective questions when constructing a treatment plan for the patient.
What’s New in Dermatology
To begin this session, Darrell S. Rigel, MD, MS, assessed the epidemiology of certain skin cancers, mainly melanoma and nonmelanoma skin cancer, and reported the United States annual deaths from melanoma (general and sex-based). Then, Dr. Rigel shared outcome data of patients who were pregnant and diagnosed with melanoma. The incidence rates and diagnostic methods for skin cancers were also highlighted, such as electrical impedance spectroscopy and GEP testing. Other topics throughout this session included suboptimal application of high SPF sunscreen and the protection of the epidermis in vivo, T1 and T2 tumors, influence of cutaneous reactions on immune checkpoint inhibitor melanoma response, and how COVID-19 has affected skin cancer management.
Following Dr. Rigel, Erin Boh, MD, PhD, discussed the many factors that might contribute to lack of adherence to topical treatments (e.g., medication intolerance, lack of response, and insufficiency vehicle choice), the safety of and clinical updates for bath therapies, and the efficacy of moisturizers for patients with either AD or psoriasis. Using clinical data, Dr. Boh presented new topical therapies tapinarof, ruxolitinib, and various retinoids for the above skin conditions.
The next segment pertained to updates in acne, rosacea, and hidradenitis suppurativa. James Q. Del Rosso, DO, FAAD, FAOCD, began by reporting on the acne treatment, sarecycline. Throughout the presentation, Dr. Del Rosso also discussed its use for treating rosacea. Dr. Del Rosso then highlighted Phase III clinical data to evaluate the safety and efficacy of the above treatment (for both skin disorders). Next, the history of oral isotretinoin, while also including the general challenges of oral antibiotics, was explored. Further, Dr. Del Rosso compared lidose isotretinoin and conventional isotretinoin. To conclude this session, Dr. Del Rosso provided new data on the parthenogenic mechanisms of hidradenitis suppurativa.
After, Seemal R. Desai, MD, FAAD, shared new systemic therapies, starting with Janus kinase (JAK) inhibitors for the treatment of atopic dermatitis, alopecia areata, vitiligo, and psoriasis and how their efficacy is influenced by certain disease states. Using clinical trial data, Dr. Desai highlighted the safety and efficacy of abrocitinib, baricitinib, and deucravacitinib. For the remainder of this session, the IL-17 inhibitor bimekizumab and tranexamic acid (for the treatment of melasma) were reviewed.
Then, Sheila Fallon Friedlander, MD, packed this seven-minute presentation with seven novel breakthroughs in pediatric dermatology, including comorbidities associated with eczema, displaying evidence that disproves the link between increased cancer risk and use of topical tacrolimus in children with atopic dermatitis, and the effective use of encapsulated terbinafine hydrochloride gel in children with tinea capitis.
The final presentation was by Terrence A. Cronin Jr., MD, wherein dermatologic and cosmetic surgery updates were explored. Using patient examples, Dr. Cronin covered biopsy versus confocal microscopy, predicting metastasis of squamous cell carcinoma via gene expression, cemiplimab for squamous cell carcinoma and basal cell carcinoma, and Mohs surgery for lentigo maligna. For the cosmetic surgery portion, Dr. Cronin assessed inventive novel tools and surgical techniques, such as a lubricating jelly and BD safe-clip for needles, and the Sung-Tip stich. Further, Dr. Cronin evaluated cases of COVID-19 vaccines evoking dermal filler reactions. To end, Dr. Cronin listed upcoming injectable treatment, QWO, for cellulite, and EMSCULPT Neo, an electromagnetic therapy, for body sculpting, and more personal cosmetic surgery pearls.
SESSION HIGHLIGHTS
Acne and Rosacea Symposium
Presenters at the acne and rosacea symposium reviewed our current understanding of the pathogenesis of acne and rosacea and compared the added benefit of new treatment options, including pipeline drugs. Adam Friedman, MD, discussed the role of dysbiosis in acne and rosacea, including the many functions of C. acnes strains that impact skin and overall health, as well as their influence on the gut microbiome and skin flora. David Ozog, MD, provided tips on acne scarring. Next, Diane Thiboutot, MD, and Linda Stein Gold, MD, discussed the potential of utilizing “good” C. acnes bacteria and probiotics in acne and rosacea treatments. Following this, Hilary Baldwin, MD, reviewed current and upcoming topical therapies for acne and rosacea, focusing on the importance of their vehicles and tolerability. The appearance, mechanism, therapies, and common myths of hormonal acne were discussed by Julie Harper, MD; moreover, the presenters discussed how several factors, such as age and sex, influence hormonal treatment strategies. The presentation shifted to oral treatment for rosacea and acne, including a discussion of antibiotic resistance by Jim Del Rosso, DO, FAOCD. Using clinical trial data, Emmy Graber, MD, MBA, discussed optimal isotretinoin dosing needed to achieve skin clearance and modifying dosing per patient and skin condition characteristics. Seemal Desai, MD, FAAD, concluded this presentation with patient data regarding treatments for post-inflammatory hyperpigmentation, dyspigmentation updates, and chemical peel and retinoid use.
COVID-19 Symposium
Esther Freeman, MD, PhD, began this presentation with COVID-19 registries and their contributions over the past year, following with common skin reactions to COVID-19 and its vaccine(s). Next, Lindy P. Fox, MD, discussed the cutaneous manifestations of COVID-19, such as “COVID toes,” recurrent pernio, morbilliform, vesicular rashes, and purpuric pressure ulcers. Dr. Fox also discussed whether skin lesions are correlated to diagnosis or disease severity. Following, Elena B. Hawryluk, MD, PhD, reviewed COVID-19 in pediatric populations, starting with diagnostic challenges and multisystem inflammatory syndrome (MIS-C) as a post-virial repercussion of COVID-19. Then, Marlys Fassett, MD, PhD, shared literature and clinical data on COVID-19 immunology, from a dermatologist’s perceptive. Dr. Fassett also provided information on the role of T-cells and viral sensing. COVID-19 and how it affects skin of color was highlighted by Seemal Desai, MD, in the next segment. Dr. Desai highlighted racial and ethnic health disparities in COVID-19, the spectrum of dermatological manifestations seen in COVID-19, and the influence of vitamin D status in patients with darker skin tones on COVID-19 outcomes. Next, April W. Armstrong, MD, MPH, assessed COVID-19 and biologics, exploring respiratory infections, treatment disruptions of patients with psoriasis, and how these therapies potentially impact COVID-19 symptoms and outcomes. After Dr. Armstrong, managing a dermatology practice and how COVID-19 has impacted dermatology training were discussed by Dirk M. Elston, MD, and Misha Rosenbach, MD. To conclude this presentation, Dr. Freeman offered more data and reports on COVID-19 vaccines and skin manifestations.
What’s New in Skin of Color
To begin, Andrew F. Alexis, MD, MPH, provided acne updates for skin of color, focusing on essential considerations when treating acne in patients with darker Fitzpatrick Skin Types. Dr. Alexis also listed current and upcoming methods to enhance acne therapies for these patients. Next, Hye Jin Chung, MD, MMSc, reviewed the significant aspects of Asian skin and integral considerations when managing/treating skin conditions in Asian patients. Further, Dr. Chung described cosmetic concerns that are unique to Asian skin types, such as lower face contouring, neuromodulator injections, and leg contouring. Following, Pearl E. Grimes, MD, examined updates in vitiligo, beginning with incidence rates in lighter versus darker skin types. Dr. Grimes illustrated the various vitiligo therapies for stabilization, comparing their efficacy using patient and clinical trial data. With the assistance of specific case reports, Candrice R. Heath, MD, FAAP, FAAD, then described typical skin and hair disorders with various presentations in children with skin of color. These cases mainly pertained to pigmentation disorders, staphylococcal scaled skin syndrome, and traction alopecia. Next, Henry W. Lim, MD, shared photoprotection updates for skin of color, covering sun exposure and the typical types of skin cancer that occur in different patients of color, variances in UV absorption, sunless tanning, and the use of organic UV filters. Then, Dr. Lim discussed data for banned sunscreen ingredients and how they have impacted the overall health of many patients. In the next segment, Lucia Seminario-Vidal, MD, PhD, outlined racial disparities in cutaneous T-cell lymphomas and the identification of clinical appearance and diagnostic hints in patients with skin of color. Moreover, Dr. Seminario-Vidal used case reports to depict differential diagnoses and management methods in patients with skin of color.