In this comprehensive 5-part lecture, Linda F. Stein Gold, MD, April W. Armstrong, MD, MPH, Boni E. Elewski, MD, Dirk M. Elston, MD, and Theodore Rosen, MD, provided updates on important developments in dermatology, focusing on a range of topics from acne treatment controversies to the latest in systemic therapies for chronic skin conditions. 

Linda F. Stein Gold, MD, began the session by addressing the controversy surrounding benzoyl peroxide (BPO) use in acne treatment. BPO can break down into benzene, with higher breakdown rates correlated to more benzene production. Benzene is a known carcinogen and is associated with an increased risk of leukemia, particularly acute myeloid leukemia (AML). Independent laboratory tests revealed that BPO-containing products stored at room temperature or higher could have 800 to 1200 times the FDA- and EPA-approved benzene limit for long-term exposure. Thus, there was a concern that BPO-containing products could be dangerous to the public. However, a study conducted on 2.3 million patients with acne showed that there was no increased risk of AML associated with BPO use. A retrospective cohort study from the TriNetX US Collaborative Network also confirmed no link between BPO and increased cancer risk. Dr Stein Gold concluded by recommending that BPO products be stored in refrigerators and replaced every 3 to 6 months to minimize benzene formation, particularly avoiding exposure to high temperatures. 

Next, April W. Armstrong, MD, MPH, provided an overview of newly FDA-approved treatments for psoriasis, atopic dermatitis (AD), and prurigo nodularis. She discussed bimekizumab, a monoclonal antibody targeting IL-17A and F, which showed promising results with 54.5% of patients with psoriatic arthritis achieving ACR50 and 65% of patients with psoriasis reaching PASI100 after one year. In the realm of AD treatment, she presented data on lebrikizumab, an IL-13 inhibitor, which demonstrated long-lasting efficacy in the ADvocate 1 and 2 trials, with patients maintaining significant skin clearance and itch relief for 52 weeks. The ADore trial confirmed its safety, with mild- to-moderate adverse events and low rates of conjunctivitis (8%), comparable to dupilumab. Lastly, Dr Armstrong covered the approval of nemolizumab for prurigo nodularis with 37.6% of patients reporting significant reductions in itch and severity. 

Boni Elewski, MD, turned the discussion toward fungal infections, specifically focusing on the emergence of drug-resistant strains such as T. indotineae, T. rubrum, and T. mentagrophytes genotype VII. These infections pose significant treatment challenges. Itraconazole was suggested as the preferred choice for the treatment of resistant fungal infections. Dr Elewski also addressed the management of generalized pustular psoriasis (GPP), noting that high loading doses of biologics—600 mg followed by 300 mg every 4 weeks—were effective in reducing the risk of flares. 

Dirk M. Elston, MD, followed with a detailed review of psoriasis treatments, emphasizing the variety of options available and selection of treatment plans that best fit individual patient needs. He highlighted the effectiveness of proactive use of combination therapies like calcipotriene and betamethasone over reactive management. Dr Elston elaborated on the pros and cons of various psoriasis medications, highlighting the complex decision-making required for psoriasis treatment. In addition, the presentation provided practical guidance on selecting biologics based on patient comorbidities such as obesity, demyelinating diseases, and pregnancy. 

Theodore Rosen, MD, concluded the session by discussing JAK inhibitors and their potential uses beyond their current FDA approvals. Through case presentations, he demonstrated the effectiveness of various JAK inhibitors—such as tofacitinib, baricitinib, abrocitinib, upadacitinib, and ruxolitinib—in treating conditions like granuloma annulare, sarcoidosis, and lichen planus. Tofacitinib was shown to not only resolve cutaneous symptoms but also address systemic effects of these disorders, making it a valuable tool in treating complex dermatologic conditions.