WCM 2024 Conference Highlights

A much-anticipated session with Drs Del Rosso, Lebwohl, and Zeichner reviewed the hottest new trends and therapeutics for multiple common dermatoses. Starting with acne, results from a clinical trial with the triple-combination gel with clindamycin, adapalene, and benzoyl peroxide were shown, touting a dramatic reduction in inflammatory and noninflammatory lesions by week 4. For psoriasis, 3-year safety data has been published on bimekizumab, noting 18.5 events per 100 person years in the first year on the IL-17A and F inhibitor. Spesolimab has been shown to decrease flares in generalized pustular psoriasis with those who were started on high-dose spesolimab with a GPPGA score of 0 or 1 remaining flare-free for 48 weeks after week 4 of dosing. Deucravacitinib also has long-term efficacy data from clinical trials, with patients who achieved a PASI75 and PASI90 generally maintaining response for 3 years. The speakers moved on to discuss updates in atopic dermatitis including delgocitinib cream for chronic hand eczema, which tripled those obtaining IGA treatment success by week 8 when compared to placebo. For standard atopic dermatitis, response to abrocitinib may be predicted by week 4, and, for those who don’t achieve an EASI-50 reduction by this time point, dose-escalation to 200 mg should be considered. Tapinarof 1% cream has significant efficacy in children 2 years and up all the way to adults in atopic dermatitis. In a review of novel medications for a few other conditions, the efficacy of roflumilast foam for seborrheic dermatitis, which allowed 79% to obtain IGA success by week 8 compared to 48% using vehicle alone, was covered, along with the improvements of eyelash and eyebrow growth in patients with severe alopecia areata on baricitinib. Deuruxolitinib is another JAK inhibitor undergoing clinical trials for this condition. For chronic spontaneous urticaria, dupilumab improves itch and omalizumab improves sleep. Other advances in dermatology that were covered in this presentation centered around the improvements in gene expression tests. This may lead to advances in difficult-to-diagnose conditions like mycosis fungoides. The 2-GEP assay has a negative predictive value of 99.7%, indicating it can be used to rule out melanoma.

Joslyn Kirby, MD, walked us through how to manage patient expectations and social perceptions when “prescribing” over-the-counter products in practice. She started with evidence-based treatments for itch, specifically the use of second-generation antihistamines for chronic spontaneous urticaria. While hydroxyzine and lorazepam require prescriptions prior to procedures, diphenhydramine can be kept in the office and used 30 minutes prior at 25-mg to 50-mg dosages for anxiety. She also gave us the recipe for orange juice mixed with 10 x 50 mg naltrexone tablets, which can be dosed in 1-tsp (5-mL) quantities for various pruritus-inducing dermatoses, though patients should be counseled on vivid dreams and headaches. Dr Kirby had even more hacks for our patients as she presented a study from JAAD that demonstrated that salicylic acid improves the penetration of topical steroids. N-acetyl cysteine functions as a glutamate modulator and antioxidant but has demonstrated efficacy for treatment of picking disorders at 600 mg to 2400 mg daily. If picking becomes pimples, an alternative to antibiotics is zinc gluconate at 90 mg daily for more conservative patients with acne. Pimple patches are also remarkable at keeping hands away from these lesions. Her last pearls are to try out adapalene for acanthosis nigricans, which has more evidence than calcipotriol, and don’t forget to recommend compression stockings, which can be layered at lower strengths for ease of application.