The "Topical Therapy Forum" lecture series presented an in-depth look at advancements in topical treatments across several dermatologic conditions, with each expert delving into the latest innovations and their clinical applications. 

Dr James Q. Del Rosso started this series by focusing on treatments for seborrheic dermatitis (SD). SD is an inflammatory skin disorder that has a multifactorial pathogenesis caused by skin barrier dysfunction, Malassezia infection, host immunity dysregulation, sebaceous gland activity and skin microbiome changes. SD is highlighted as a distinct condition, rather than a continuation of atopic dermatitis or psoriasis, because of its unique clinical markers and distinct skin barrier disruption. Continued studies show evidence of skin barrier dysfunction due to ceramide composition and microbiome and microbial shifts and indicate a need to proactively prevent and protect the skin barrier as a means of treating SD. Treatment for seborrheic dermatitis includes corticosteroids, antifungal agents, calcineurin inhibitors, zinc and selenium-based shampoos. There are also emerging treatments for SD such as roflumilast (FDA approved in 2023 in foam form) and crisaborole (off-label). Roflumilast in both the foam and cream vehicles offers a promising nonsteroidal alternative for moderate-to-severe cases, demonstrating efficacy in reducing symptoms like redness, scaling, and itch, with a favorable safety profile. 

Next, Dr Linda Stein Gold delivered a detailed presentation on the latest topical treatments for psoriasis, focusing on 2 major breakthroughs: tapinarof and roflumilast. Tapinarof, a topical aryl hydrocarbon receptor modulating agent (TAMA), has shown significant efficacy in treating plaque psoriasis and intertriginous plaque psoriasis. Fifty-eight percent of patients achieved clear or almost clear skin within 4 months and a lasting effect of 115 days after treatment discontinuation. Dr Stein Gold also discussed roflumilast cream, a PDE4 inhibitor, for plaque psoriasis. Roflumilast has demonstrated strong results in reducing itch and improving skin clearance, particularly in areas like the scalp and intertriginous zones. 

Dr Lisa Swanson continued the discussion by covering new developments in the treatment of atopic dermatitis (AD). Swanson emphasizes the need for more treatments beyond the common combinations of topical corticosteroids and calcineurin inhibitors. She introduced the Aron regimen, a compounded mixture of betamethasone, mupirocin, and moisturizer, which has shown great success in treating persistent eczema in young children. She also discussed newly approved nonsteroidal topical therapies, including ruxolitinib cream, a topical JAK inhibitor, roflumilast 0.15% cream, a PDE-4 inhibitor, and tapinarof cream, an aryl hydrocarbon receptor modulator. Ruxolitinib is approved for patients aged 12 and older and has demonstrated rapid and sustained efficacy in reducing AD symptoms, particularly itch and inflammation, without stinging/burning or the side effects associated with steroids. Phase 3 studies are exploring the potential for ruxolitinib use down to the age of two. . Roflumilast 0.15% cream, approved for patients aged 6 and up, has also shown significant promise in treating mild-to- moderate AD, offering long-lasting effects (average: 281 days without treatment) with minimal irritation. Tapinarof, which has been previously approved for psoriasis, is now being studied for patients ages 2 and above for moderate-to-severe AD, and trials have shown significant efficacy over vehicle.