The Changing Landscape of Topical Therapies

Linda Stein Gold, MD, MS, Cheri Frey, MD, FAAD, Peter Lio, MD, FAAD, and Bruce Strober, MD, PhD, led an expert discussion highlighting cutting-edge advances in topical dermatologic therapy that are transforming treatment safety, efficacy, and patient outcomes across acne, rosacea, atopic dermatitis, and psoriasis.

Dr Stein Gold opened with an evidence-based review addressing concerns regarding benzoyl peroxide (BPO) and potential benzene contamination. She summarized recent multicenter studies from 2024–2025 confirming that BPO use does not increase the risk of benzene-related malignancies, emphasizing that product stability depends on formulation chemistry and appropriate storage, specifically refrigeration, avoiding heat, and renewing products every few months. Dr Stein Gold also discussed the FDA approval of low-dose extended-release minocycline (DFD-29, 40 mg) for rosacea, presenting phase 3 data demonstrating strong efficacy, a favorable safety profile, and minimal microbiome disruption, supporting its role as a next-generation oral option for long-term rosacea management.

Dr Frey followed with an overview of advances in cosmeceutical science, focusing on novel retinoid analogues, peptides, and regenerative skincare. She explained how new retinoid derivatives such as retinyl retinoate and hydroxypinacolone retinoate enhance collagen and hyaluronic acid production while reducing irritation compared to traditional formulations. Dr Frey also described the therapeutic potential of bioactive peptides, palmitoyl tetrapeptide-7, oligopeptide-68, acetyl hexapeptide-3, and copper tripeptide-1 (GHK-Cu), in promoting skin repair, modulating pigmentation, and attenuating inflammation, though she noted that delivery optimization remains a clinical challenge. She concluded with an introduction to exosome-based regenerative skincare, which can promote wound healing and dermal rejuvenation through the Wnt/β-catenin and VEGF pathways, while underscoring the importance of regulatory oversight and controlled clinical validation.

Dr Lio then presented an update on the evolving therapeutic landscape for atopic dermatitis (AD), structuring his discussion around the practical goals of “Get Clear, Keep Clear, Keep It Up.” He reviewed new guideline-supported treatment algorithms incorporating topical corticosteroids, calcineurin inhibitors, and an expanding array of nonsteroidal options such as ruxolitinib, roflumilast, delgocitinib, and tapinarof. Comparative data demonstrated superior patient-reported outcomes with tacrolimus 0.03% versus crisaborole, while ruxolitinib and tapinarof provided durable disease control and favorable safety. Dr Lio emphasized the need for long-term maintenance strategies and barrier repair to sustain remission and improve quality of life.

Dr Strober concluded with a discussion of topical innovation in psoriasis and seborrheic dermatitis. He reviewed pivotal trial data showing that roflumilast 0.3% and tapinarof 1% achieve high rates of clearance, durable remission, and excellent tolerability, even in intertriginous and facial regions. Dr Strober highlighted the DERMIS and PSOARING programs, noting the remittive effects of tapinarof and the consistent tolerability of roflumilast across age groups. He positioned both agents as first- and second-line nonsteroidal options that deliver biologic-level efficacy through topical mechanisms. Collectively, the speakers illustrated how formulation science, molecular innovation, and patient-centered design are converging to usher in a new era of precision-driven topical therapy in dermatology.