Abstract Highlights: Notable Research Presented at
Maui Derm 2021
Tapinarof cream 1% once daily for plaque psoriasis: favorable local tolerability in two pivotal Phase III trials
Stein Gold L, Kircik L, Lebwohl M, et al.
In Phase III of the PSOARING 1 and PSOARING 2 trials, patients with mild-to-severe plaque psoriasis applied tapinarof cream 1%, a topical therapeutic aryl hydrocarbon receptor modulating agent, or a vehicle cream once a day for 12 weeks. Physician Global Assessment scores and body surface area involvement were measured at baseline and Weeks 2, 4, 8, and 12; further, using a five-point scale, researchers evaluated the degree of application-site irritation (overall and in sensitive areas) throughout the course of the trials, and patients detailed any burning, stinging, or itching across the above sites as well. Overall, the patients tolerated tapinarof cream 1% well, even in sensitive areas, and low Physician Global Assessment scores were reported by the end of the study.
Perspectives on generalized pustular psoriasis treatment in North America: survey results from dermatologists in the Corrona Psoriasis Registry
Strober B, Lebwohl M, Kotowsky N, et al.
Due to the limited published literature on acute generalized pustular psoriasis flares, Strober et al analyzed survey responses from 29 dermatologists who treated generalized pustular psoriasis within the last five years from a survey conducted by The Corrona Psoriasis Registry. The survey included questions regarding flare diagnoses, frequency, duration, management, and therapies. Amid the gathered data, they found that treatment course was dependent on patient symptoms, and most patients claimed that treatment response was slow, though the therapies ultimately helped manage symptoms. Based on the data, Strober et al concluded an “unmet need in GPP treatment guidelines,” and future treatments should aim for a faster treatment response and complete resolution of the condition.
Long-term safety of tildrakizumab in patients over 65 years of age with moderate-to-severe plaque psoriasis: pooled analysis through five years from the reSURFACE 1 and reSURFACE 2 Phase III trials
Van de Kerkhof PC, Daudén E, Schoenenberger A, Pau-Charles I.
Here, Van de Kerkhof et al analyzed the safety and efficacy of tildrakizumab in patients with moderate-to-severe plaque psoriasis, aged 65 or older, after five years of treatment, based on data from the reSURFACE 1 and reSURFACE 2 trials. Occurrence of serious adverse events, such as infection requiring antibiotics, and major adverse cardiovascular events, as well as exposure-adjusted incidence rates (reported as events per 100 patient-years [P100PY]) were monitored and evaluated. Nasopharyngitis, arthralgia, and urinary tract infection were the most common infections, and the exposure-adjusted incidence rates were 2.70 P100PY for those who received 200mg of tildrakizumab and 2.99 P100PY for those who received 100mg. The exposure-adjusted incidence rates of major adverse cardiovascular events were 1.35 P100PY for those who received 200mg of tildrakizumab and 0.50 P100PY for those who received 100mg. Van de Kerhof et al concluded both dosages of tildrakizumab were well tolerated in patients 65 and older.
Efficacy and safety of tildrakizumab, a high-affinity anti–interleukin-23p19 monoclonal antibody, in patients with active psoriatic arthritis
Mease PJ, Chohan S, García Fructuoso FJ, et al.
Mease et al evaluated the safety and efficacy of tildrakizumab over the course of 52 weeks, with five groups of patients with PsA receiving either: 1) 20mg of tildrakizumab every 12 weeks until Week 24, then switched to 200mg every 12 weeks; 2) 100mg of tildrakizumab every 12 weeks; 3) 200mg of tildrakizumab every four weeks; 4) 200mg of tildrakizumab every 12 weeks; or 5) placebo every four weeks until Week 24 then 200mg of tildrakizumab every 12 weeks. The authors analyzed changes in patient Psoriasis Area and Severity Index scores and observed any treatment-emergent adverse events throughout the study. According to the researchers, all the treatment dosage groups tolerated the drug well and experienced improved joint and skin symptoms; treatment-emergent adverse events occurred in 64.5 percent of patients.
Calcipotriene and betamethasone dipropionate cream combines high efficacy, favorable safety, and treatment preference in a single product for topical treatment of psoriasis
Stein Gold L, Green LJ, Dhawan S, Præstegaard M, Selmer J.
Here, Stein Gold et al compared the safety and effectiveness of combination calcipotriene 0.005% and betamethasone dipropionate 0.064% (CAL/BDP) cream with CAL/BDP topical suspension (CAL/BDP TS). Patients with mild-to-moderate plaque psoriasis applied either CAL/BDP cream, CAL/BDP TS, or vehicle cream once a day for eight weeks. Researchers observed changes in physician global assessment and modified Psoriasis Area and Severity Index scores, as well as the occurrence of treatment-emergent adverse events, throughout the study. The authors determined that the patients who applied CAL/BDP cream achieved greater treatment success compared to the CAL/BDP TS and vehicle cream groups and was the safest treatment; only one percent of patients experienced application site irritation.
Halobetasol propionate 0.01%/tazarotene 0.045% lotion for the treatment of plaque psoriasis in patients with mild scaling and mild plaque elevation
Stein Gold L , Tanghetti EA, Leonardi C, Kwatra SG, Jacobson A.
To test the effectiveness and safety of combination tazarotene 0.045% and halobetasol propionate 0.01%, researchers gave 276 patients with plaque psoriasis and mild scaling and plaque elevation the combination lotion and 142 patients with the same condition a vehicle lotion once a day for eight weeks, monitoring Investigator’s Global Assessment scores, changes in affected body surface area, and the occurrence of treatment-emergent adverse events. By the end of the study, the patients who received the combination therapy experienced notable reduction in affected body surface area percentage and greater rates of treatment, erythema, and plaque elevation success, compared to those given the vehicle lotion. Additionally, most treatment-emergent adverse events were mild or moderate.
Safety of tildrakizumab 100mg and 200mg through five years of exposure in reSURFACE 1 and reSURFACE 2
Han G, Fernández-Peñas P, Albrecht L, et al.
In Phase III of the reSURFACE 1 and reSURFACE 2 trials, participants with moderate-to-severe plaque psoriasis were given either 100mg or 200mg of tildrakizumab or placebo at baseline, Week 4, and every 12 weeks after for 64 and 52 weeks, respectively. Here, Han et al evaluated the safety of both doses by examining the exposure-adjusted incidence rates (as cumulative incidence per 100 patient-years) of drug-related and serious adverse events, as well as any adverse events that led to discontinuation or death after five years of use. The authors found that all exposure-adjusted incidence rates and occurrences of discontinuation were low, indicating “no dose-dependent safety effects.”
Tapinarof cream 1% once daily for the treatment of plaque psoriasis: efficacy and safety in two pivotal Phase III trials
Lebwohl M, Stein Gold L, Strober B, et al.
In Phase III of the PSOARING 1 and PSOARING 2 trials, patients with mild-to-severe plaque psoriasis applied tapinarof cream 1%, a topical therapeutic aryl hydrocarbon receptor modulating agent, or a vehicle once a day for 12 weeks. Lebwohl et al monitored changes in Physician Global Assessment scores and Body Surface Area involvement from baseline to evaluate the safety and effectiveness of the topical treatment. When compared with those who received the vehicle, the tapinarof cream 1% group exhibited more improved scores and body surface area involvement, with only mild-to-moderate adverse events occurring in less than five percent of patients. Lebwohl et al concluded that “tapinarof cream has the potential to provide physicians and patients with a novel non-steroidal topical treatment option that is effective and well-tolerated.”
Cardiovascular events, serious infections, and neoplasia through five years of tildrakizumab exposure in two Phase III clinical trials
Song EJ, Trickett C, Gebauer K, et al.
Based on data from the reSURFACE 1 and reSURFACE 2 trials, Song et al examined the exposure-adjusted incidence rates of cardiovascular events, infections, and neoplasia (cumulative incidence per 100 patient-years [100PY]) between the two dosages (100mg and 200mg) in patients who received tildrakizumab for five years. For major and extended adverse cardiovascular events, the exposure-adjusted incidence rate was 0.5/0.3 per 100PY in patients who received 100mg of tildrakizumab and 0.4/0.6 per 100PY for those who received 200mg of tildrakizumab. For infections, the exposure-adjusted incidence rate for those who received 100mg was 0.8/0.9 per 100PY and 1.0/1.0 per 100PY for those who received 200mg. For neoplasia, the exposure-adjusted incidence rate was 1.6/0.8 per 100PY for those who received 100mg and 0.8/1.1 per 100PY for those who received 200mg.
Five-year efficacy of tildrakizumab 100 and 200 mg in achieving and maintaining PASI 75/90/100 and PGA 0/1 in reSURFACE 1 and 2
Blauvelt A, Farberg AS, Sinclair R, et al.
In Phase III of the reSURFACE and reSURFACE 2 trials, participants with moderate-to-severe plaque psoriasis were given either 100mg or 200mg of tildrakizumab or placebo at baseline, Week 4, and every 12 weeks after for 64 and 52 weeks, respectively. Those who achieved a Psoriasis Area and Severity Index score of at least 50 by the end of the study were moved to the extension trial of this therapy. Using the extension data, Blauvelt et al analyzed the long-term safety and effectiveness of tildrakizumab. Of the total patients from the initial studies, 525 out of 638 (from reSURFACE 1) and 731 out of 756 (from reSURFACE 2) were included in the subsequent extension trial. By Week 256, the researchers concluded that tildrakizumab was well tolerated, had consistent rates of adverse events that were similar to the initial studies, and maintained improved Psoriasis Area and Severity Index scores over the course of five years.
ACTNOW: Therapeutic Inertia in management of psoriasis & its impact on patients
Murlidhar, Dogra S, Godse K, et al.
To better understand patient experience and impact on quality of life in patients with psoriasis, researchers evaluated and compared interview answers from ACTNOW, a survey that aimed to identify gaps between physician knowledge and patient expectations and impact to improve psoriasis management. According to Murlidhar et al, 207 patients with moderate-to-severe psoriasis and 13 medical experts were interviewed from September 2020 to November 2020. Some of the findings indicated that most patients were not satisfied with their physician’s attempt at reassurance when expressing grief due to other people believing their skin condition was contagious. Additionally, only 23 percent of patients were satisfied with their physician’s explanations of coping strategies, lifestyle modifications, and treatment options.
Tildrakizumab 100 mg efficacy and safety by metabolic syndrome status in psoriasis: Post-hoc analysis of 5-year data from the Phase III reSURFACE 1 and reSURFACE 2 studies
Fernandez AP, Dauden E, Rivera R, et al.
Based on Phase III data from both the reSURFACE 1 and reSURFACE 2 studies, Fernandez et al analyzed the safety and efficacy of tildrakizumab in patients with moderate-to-severe psoriasis and metabolic syndrome after five years of treatment. Of the 44 patients receiving 100mg of tildrakizumab in the initial studies, 26 had metabolic syndrome and were included in the updated, five-year post-hoc analysis. Regardless of higher risk of cardiovascular- and obesity-related events, the safety outcomes of patients with metabolic syndrome were consistent and similar to patients without metabolic syndrome by Week 244. To boot, patients with metabolic syndrome maintained their improved Psoriasis Area and Severity Index scores for five years, with little to no variances between the patients without metabolic syndrome.
Maui Derm for Dermatologists 2021: January 29, 2020
Infectious Disease Update 2021—Ted Rosen, MD; Sheila Fallon-Friedlander, MD; Aditya Gupta, MD, PhD, MBA
The Maui Derm faculty covered essential updates in viral, bacterial, fungal, parasitic, and arthropod infections. Dr. Rosen discussed new data and updates on several infectious diseases. He began with a discussion of racial disparities in COVID-19, then moved on to reviewing the detriments of zoonotic diseases, with a special focus on the Seoul virus which he noted could be the source of a next pandemic. He then moved on to case studies of other types of diseases, such as recurrent cellulitis of the leg, the new presentation of genital lymphogranuloma venereum, necrotizing fasciitis, and leishmaniasis. To conclude, Dr. Rosen provided key points for the identification and treatment of Lyme disease and shared reported rates of sexually transmitted diseases during the COVID-19 era.
Following Dr. Rosen, Dr. Fallon-Friedlander presented several studies on pediatric fungus, using these to discuss topics such as the “old dogma” surrounding tinea capitis and its treatments. Dr. Fallon-Friedlander dissected the shortcomings and risks of certain therapeutic methods and highlighted which treatments appear to be the most effective. Wrapping up this segment, Dr. Fallon-Friedlander shared prevention methods and the role of genetics in the development of tinea capitis.
To end this session, Dr. Gupta presented updates on the epidemiology, prevalence, and available oral and topical treatments for onychomycosis. Dr. Gupta also assessed PCR verses culture species identification when diagnosing for the above condition and the major advancements in related therapies.
Challenging Cases—Seemal Desai, MD, FAAD; Albert Yan, MD; Ted Rosen, MD; Matthew Zirwas, MD
Maui Derm’s faculty presented a wide array of challenging and complex cases that pushed their diagnostic and therapeutic skills to the limit. To begin, Dr. Rosen shared his diagnostic and patient confrontation approaches to challenging cases, which involved penile bruising linked to a psychodermatologic disorder, and, for another case, lipogranulomatosis from injected plastic.
Next, Dr. Yan focused on the therapeutic challenges in pediatric cases, starting with the treatment of a three-week-old with a vascular birthmark that developed pinpoint bleeding over time. Dr. Yan then used the case of the proliferating infantile hemangioma of a nine-week-old to describe the treatment benefits of beta blockers and other intensive courses of action.
Following Dr. Yan, Dr. Zirwas presented the case of a 71-year-old with stubborn hand atopic dermatitis and used this case to discusses the importance of checking patient treatment history and incorporating critical questioning when assigning an effective treatment regimen. The next case involved a 48-year-old with a painful trunk rash resulting from drug rash with eosinophilia and systemic symptoms (DRESS) syndrome from previous treatment.
To wrap up this presentation, Dr. Desai shared a collection of different cases
that depicted mysterious widespread areas of scalp hair loss and development of blotchy pigmentation all over the body that stemmed from lichen planus pigmentosus and related forms, as well as a case regarding an intense genital rash, scaling of the thigh, and blistering of the inner elbows due to tinea incognito. Dr. Desai shared the former case to bring attention to the over-the-counter availability of topical steroids in other countries that has led to abuse of these types of treatments.
Contact Dermatitis Update 2021—Matthew Zirwas, MD
In this informative session, Dr. Zirwas discussed the challenges of managing a wide range of dermatitis dilemmas. He shared many illustrative patient cases of common allergens that presented in somewhat uncommon ways and explained why identification of the allergen is just the beginning of the treatment process. Dr. Zirwas also reviewed his protocol for interpreting patch tests, courses of action for patch tests with positive results, and rationale behind diagnosing, treatment, and management methods for each featured case.
Maui Derm for Dermatologists 2021: January 28, 2020
Atopic Dermatitis and Pruritus: Current Concepts and Therapeutics for 2021—Eric Simpson, MD; Jonathan Silverberg, MD, PhD, MPH; Lawrence Eichenfield, MD; Gil Yosipovitch, MD, PhD
Maui Derm’s experts discussed the latest findings in the pathogenesis and co-morbidities of atopic dermatitis and itch. They provided their insight into the broadening list of topical, systemic, and biologic therapies for AD and itch that will become available to our clinics in 2021 and discussed where they all fit.
Dr. Simpson discussed data on systemic treatment for atopic dermatitis, including criteria for when to use these therapies, disease phenotyping, endotyping, and predictive biomarkers, available options, and updates on dupilumab.
Dr. Silverberg discussed notable literature on allergic contact dermatitis in patients with atopic dermatitis and when to patch test patients with this skin condition; further, Dr. Silverberg shared information on when to refer these patients to food allergy testing. Depression, anxiety, and cognitive dysfunction in patients with atopic dermatitis concluded his segment.
Following Dr. Silverberg, Dr. Eichenfield reviewed new information on pediatric atopic dermatitis through a discussion of exemplary patient cases and recent studies. Dr. Eichenfield covered how to assess early atopic dermatitis in children, the algorithm for step-up care, and setting up safe amounts of initial medications.
To conclude this session, Dr. Yosipovitch analyzed serval cases and data regarding itch in elderly patients. These studies clarified the mechanism of elderly dry-skin itch, neuropathies that cause itch, bullous pemphigoid and statis dermatitis itch, and itch therapeutics for elderly patients that do not cause rash.
Nail Disorders 2021: Diagnostic and Therapeutic Challenges—Phoebe Rich, MD
Dr. Phoebe Rich, one of the world’s leading nail experts, presented a series of cases that challenged our diagnostic and therapeutic acumen. Dr. Rich began this session by sharing literature on “COVID nails,” primarily nail manifestations of the virus, the role of nail hygiene in preventing transmission, and overall nail hygiene during the pandemic. Next, Dr. Rich thoroughly assessed patient cases of pseudomonas in the nail, chronic nail dystrophy, onychotillomania and related conditions, and squamous cell carcinoma of the nail unit. Ending this presentation, Dr. Rich reviewed videos of nail matrix biopsies that tested for some of the above conditions.
Lasers and Energy Devices Used to Treat Medical Problems: What’s New in 2021!— Suzanne Kilmer, MD; Rox Anderson, MD, PhD; Stuart Nelson, MD, PhD; E.Victor Ross, MD; Fernanda Sakamoto, MD, PhD
Maui Derm’s world-class experts discussed their approach to an array of challenging skin conditions and cutaneous lesions, vascular lesions and tumors, striae, scars, disorders of pigmentation, and more.
With the assistance of demonstrative footage and photos, Dr. Nelson discussed laser treatment of “medical” vascular lesions, including the mechanisms and types of lasers, proposed challenges of various skin disorders, and use in infants and children; further, Dr. Nelson focused on the optical advantages of early therapy, as well as various port wine stain and periorbital veins treatment responses. Dr. Nelson wrapped up this segment by exploring use of lasers in hemangioma cases.
Next, E. Victor Ross, MD, shared a series of cases demonstrating different skin conditions, including venous lake, sebaceous hyperplasia, scars, tattoo and hair removal adverse reactions, minocin hyperpigmentation, and osteoma cutis, and discussed the laser treatments that were used to manage each featured condition. Dr. Ross also highlighted his favorite lasers and the importance of adapting pigment endpoints per patient and case characteristics.
Following Dr. Ross, Dr. Kilmer focused on the use of fully and fractional ablative lasers. The discussed uses included resurfacing, skin texture improvement, and treatment of actinic keratosis, superficial basal cell carcinomas, rhinophyma, xanthelasma, neurofibromatosis, hair removal on skin grafts, and sarcoidosis.
After, Dr. Sakamoto shared clinical cases and therapy session photos of patients with nodule and recalcitrant acne treated with a pulsed dye laser.
To conclude, Dr. Anderson, presented the challenging case of a five-year-old with giant congenital melanocytic nevus. Throughout his segment, Dr. Anderson reported the treatment course and provided photos illustrating progress in appearance between therapy sessions. Dr. Anderson also explored the role of hair follicles in congenital melanocytic nevi.
Maui Derm for Dermatologists 2021: January 27, 2020
Wound Healing Advances in 2020—Robert Kirsner, MD, PhD
Dr. Kirsner, one of the leading experts in wound healing, presented the latest in wound healing science that will change the way we approach wound healing.In Wound Healing Advances in 2020, Dr. Kirsner presented a number of patient cases and related clinical studies to provide informative pearls for treating and healing wounds. Some of the featured cases depicted appropriate debridement of wounds, methods of scarless skin grafting, available therapies for healing venous ulcers, the effective use of topical beta blockers on wounds, replicating scarless embryotic healing, reducing tension on incision sites, and the healing influence of the gastrointestinal microbiome.
Update 2021: Acne and Rosacea—Guy Webster, MD, PhD; Lawrence Eichenfield, MD; Jim Leyden, MD; Richard Gallo, MD
New drugs, new data, and new insights into acne and rosacea. Maui Derm’s esteemed faculty shared their insights into the management of acne and rosacea. Dr. Webster began the session by explaining the relationship between polycystic ovary syndrome (PCOS) and acne and analyzing the current treatment strategies for PCOS-related acne, such as the use of metformin, spironolactone, or isotretinoin. Additionally, Dr. Webster provided clinical and safety data for new acne treatment drugs.
Next, Dr. Eichenfield discussed new pediatric acne literature and notable case reports, beginning with management of acne in children (and adults) caused by face masks and a discussion of examples of pseudo-acne. Then, Dr. Eichenfield assessed the evolution of pediatric data regarding many acne therapeutics, reviewing relevant case studies, safety profiles, and effectiveness of each featured treatment. To wrap up this segment, Dr. Eichenfield focused on methods for healing acne scarring.
After, Dr. Leyden discussed difficult patient cases that pertained to isotretinoin treatment, which involved relapse, acute inflammation, worsening of acne, sinus tracts, and the occurrence of inflamed keratinous cysts; further, Dr. Leyden reviewed the history of effective and ineffective isotretinoin dosing that contributed to above difficulties, as well as the impact age has on acne therapies and potential retreatment.
Finally, Dr. Gallo reviewed the fundamentals, common triggers, and comorbidities of rosacea. Dr. Gallo also focused on the recent understanding of the phenotype classification system for rosacea, assessing the innate immune dysfunction that describes phenotypes in rosacea. To conclude, Dr. Gallo shared new advances that can be used to better understand the biology of rosacea.
Hot Topic: Regeneration Will Replace Rejuvenation 2021 – The Science Behind Regeneration—Phil Werschler, MD
Dr. Werschler shared how the evolving science of “regeneration” will impact aesthetic and medical dermatology in the future. He reviewed the history, key concepts, and efficacy of regenerative aesthetic medicine (RAM) in dermatology. He also discussed FDA guidance for common RAM procedures and potential FDA oversight throughout this session. Additionally, he highlighted various 2021 RAM market trends, their influence on clinical direction, and current and emerging RAM therapies.
Maui Derm for Dermatologists 2021: January 26, 2020
Pediatric Dermatology 2021—Lawrence Eichenfield, MD, Sheila Fallon-Friedlander, MD, Iona Frieden, MD, James Treat, MD, Albert Yan, MD
Maui Derm’s faculty of expert pediatric dermatologists covered a wide array of topics in pediatric dermatology.
Dr. Yan began this session by highlighting the trending issues in pediatric viral skin diseases, focusing on cases exhibiting inflammation versus infection in children with molluscum contagiosum (MC), efficient and ineffective treatment options for particular manifestations of MC, and therapy data for the treatment of skin infections from atopic dermatitis and herpes viruses. To wrap up this segment, Dr. Yan shared three cases that contained examples of powassan virus infection from tick-borne encephalitis and reviewed the SARS-CoV2 (COVID-19) clinical phenotypes in children.
Following this, Dr. Fallon-Friedlander discussed how SARS-CoV2 affects children and adolescents by providing instructive cases and patient data. Additionally, Dr. Fallon-Friedlander shared examples of associated “COVID toes,” pernio, and purpura in children subsequent to presence of COVID-19. Next, Dr. Fallon-Friedlander evaluated immunotherapies for warts, including use of anti-interleukin agents and the human papillomavirus vaccine and a new, FDA-approved wartPEEL cream. To conclude, Dr. Fallon-Friedlander reviewed some recent literature on viral warts in children.
Using case reports, Dr. Frieden reviewed the histopathology, current treatments, and future strategies for vascular anomalies in children. Some cases included infantile hemangioma and pyogenic granuloma treated with beta blockers, timolol for EGFR inhibitor-induced paronychia, sirolimus for Sturge-Weber syndrome, tacrolimus for tufted angioma, the use of genomics to target mutant alleles, and potential targeted therapies for arteriovenous malformations.
Next, Dr. Treat discussed how dermatitis presents in children and various exposures, causes, and treatments for the skin condition. Dr. Treat also covered common contact allergens in everyday items, how to read patch tests for skin of color, essential oils causing and/or exacerbating dermatitis, and contact dermatitis caused by elastic bands on face masks. Additionally, Dr. Treat provided discussed two case reports—one patient who developed facial redness with dupilumab use and another patient who developed rash while on the ketogenetic diet.
The session ended with Dr. Eichenfield, who provided information on pediatric inflammatory skin diseases, reviewed pediatric psoriasis guidelines, discussed new and in-development treatments for atopic dermatitis and psoriasis in children, and listed newly approved biologics for pediatric psoriasis, specifically ixekizumab and ustekinumab. Dr. Eichenfield also assessed current pediatric vitiligo therapeutic approaches and new information on laser use for pediatric scars.
Psoriasis 2021—Bruce Strober, MD, PhD, Arthur Kavanaugh, MD, Linda Stein-Gold, MD, Joel Gelfand, MD, MSCE
Maui Derm’s panel of leading authorities discussed a number of topics, including: What’s in the pipeline? What’s coming? What topicals are trending? What are the head-to-head studies showing? How did COVID 19 affect our management of psoriasis and psoriatic arthritis and what were the “take aways” from the pandemic? What’s new in PsA?
Dr. Strober explored new and upcoming psoriasis therapies, beginning with a review of Phase III studies on apremilast for moderate-to-severe scalp plaque psoriasis, bimekizumab safety and tolerability data, and ixekizumab for pediatric psoriasis. Next, Dr. Strober moved on to drug survival and tailored dosing of newer and current treatments. Moreover, Dr. Strober compared certain interleukin (IL)-23 and IL-17 inhibitors, including mirikizumab, secukinumab, and guselkumab, and analyzed their long-term safety profiles. The mechanisms of select JAK-inhibitors, deucravacitinib, tofacitinib, and a TYK2-inhibitor, PF-06826647, were also covered. Ending this segment, Dr. Strober reviewed severity guidelines for the treatment of psoriasis.
Following this, Dr. Kavanaugh provided updates on psoriatic arthritis treatment options. Available adjunctives, DMARDs, biologics, JAK-inhibitors, and PDE4-inhibitors, and other therapies currently in development were examined throughout Dr. Kavanaugh’s presentation using head-to-head studies and clinical trial data.
Through the use of efficacy and tolerability data of psoriasis treatments, Dr. Stein Gold highlighted the key points of topical therapy use, such as vehicle significance, proactive treatments maintaining efficacy, opting for combination therapy, and the differences between various PDE4-inhibitors.
Finally, Dr. Gelfand discussed continuation of psoriasis treatment during the pandemic and related COVID-19 risks, while assessing comorbidities of psoriasis that are correlated to poor COVID-19 outcomes and the respiratory infections that might occur with IL-17, IL-23, and TNF-inhibitor use. Dr. Gelfand also discussed COVID-19 vaccines.
Update 2021: Disorders of Pigmentation—Pearl Grimes, MD
Dr. Grimes, one of the leading authorities on pigmentation disorders, is back by popular demand! She provided her “tour de force” of the latest in therapeutic strategies to treat vitiligo, melasma, postinflammatory hyperpigmentation, and more.
Throughout this instructive presentation, Dr. Grimes examined the pathogenesis, mechanisms, therapeutic interventions, and patient cases of pigmentation disorders; further, Dr. Grimes covered UV photoprotection, grafting, the impact of iron-oxide containing and tinted formulations on visible light-induced pigmentation in patients with skin of color, the mechanism of action of certain topical lighteners, and chemical peel and micro-needling patient responses. To conclude, Dr. Grimes focused on the clinical direction of vitiligo and vitiligo treatments.
Maui Derm for Dermatologists 2021: January 25, 2020
Dermatology in Review—Hensin Tsao, MD, PhD, and Sheila Fallon-Friedlander, MD
Sheila Fallon-Friedlander, MD, kicked off Dermatology in Review, providing current information and studies on COVID-19 and subsequent multisystem inflammatory syndrome and potential skin manifestations in adults and children. Next, Dr. Fallon-Friedlander shared updates in pediatric dermatology, beginning with data on malignancy in tacrolimus and recent care protocols and treatments for pediatric eczema and atopic dermatitis; dupilumab trial outcomes were thoroughly reviewed as well. To conclude this segment, Dr. Fallon-Friedlander analyzed the case report of a patient with pellagra, emphasizing the potential skin-related consequences of nutritional and vitamin deficiencies in eating patterns of children.
Next, Hensin Tsao, MD, PhD, highlighted COVID-19 reports and articles on PubMed, evaluating protein complexes and mechanisms of the virus and comparing COVID-19 against the common cold/seasonal coronaviruses. After an in-depth assessment of COVID-19 vaccines and clinical approaches, Dr. Tsao addressed the mechanisms and clinical and patient characteristics of “COVID toes.” Following this, Dr. Tsao shared data, outcomes, and adverse events from nemolizumab trials and for other topical agents used to treat atopic dermatitis and pruritis. The chronic effects of sun damage, the pathology of melanocyte mutations, and lymphatic microenvironments that promote tumor-cell growth were covered as well. After, Dr. Tsao reviewed the primary, secondary, and correlative trial endpoints of ruxolitinib treatment. To wrap up this presentation, Dr. Tsao assessed the role and shortcomings of app-based intervention in self skin examinations.
New Drugs and Therapies—Ted Rosen, MD, and Neal Bhatia, MD
Neal Bhatia, MD, and Ted Rosen, MD, began New Drugs and Therapies by presenting the mechanism, tolerability, and benefits of microencapsulated benzoyl peroxide for the treatment of rosacea and acne. They then switched gears to review future head lice therapies and clinical trial data, safety, and efficacy of various Janus kinase (JAK)-inhibitors, including ruxolitinib, deucravacitinib, baricitinib, upadacitinib, and abrocitinib. Following this, Dr. Rosen focused on ligelizumab, comparing its Phase II study results with existing standard of care for hives and itch in chronic spontaneous urticaria. Next, the presenters reviewed the mechanism and technologies of new Ebola therapies, Ebanga and Inmazeb. Drs. Rosen and Bhatia concluded their presentation with a review data on tirbanibulin, an actinic keratosis treatment.
Cutaneous Oncology, Part 1—George Martin, MD, and Chrysalyne Schmults, MD, MSCE
George Martin, MD, began the Cutaneous Oncology presentation with a review of the mechanism, tolerability, efficacy, and safety (especially for patients who are pregnant) of tirbanibulin for the treatment of actinic keratosis. Next, Dr. Martin addressed why ingenol mebutate was removed from the United States and European Union markets, using related study data and patient outcomes. Ending this segment, Dr. Martin discussed the LEIDA and LP0041-63 studies, focusing on the correlation between field therapies and squamous cell carcinoma, and shared the evolution and effectiveness of painless photodynamic therapy.
Following Dr. Martin, Chrysalyne Schmults, MD, MSCE, discussed field cancerization and its variances between actinic keratosis and poikiloderma. Dr. Schmults then covered how field cancerization impacts the quality of life, cancer risks, and cancer outcomes of patients with the condition. Using patient outcome data, Dr. Shmults evaluated the best treatments for field cancerization, primarily 5% 5-fluorouracil cream. Moreover, the risks and patient satisfaction of incorporating calcipotriol to 5% 5- fluorouracil treatment for a faster, more effective therapy were also analyzed. To conclude, Dr. Schmults highlighted the overall effectiveness of nicotinamide and retinoids, which are other field cancerization treatment options.