WCM 2025 Conference Highlights

Kicking off the first day of lectures in Miami, David Cohen, MD, MPH, provided an insightful overview of contact dermatitis, focusing on allergens dermatologists should monitor in 2025. He highlighted shifting trends, noting that while nickel and methylisothiazolinone (MI) remained the top 2 allergens, fragrance mix components like hydroperoxides of linalool and benzisothiazolinone (BIT) moved up the rankings. Through patient case studies, Dr Cohen explored common offenders such as MI, lanolin, and fragrance, emphasizing the rising prevalence of MI sensitization, which increased from 2.5% in 2010 to 13.8% in 2023. Despite being a common test allergen, MI testing may miss up to 60% of BIT sensitizations, prompting the need for broader testing strategies. Lanolin, designated as the 2023 allergen-of-the-year and commonly manifesting as contact dermatitis on the lips or genitals, was noted to be more likely seen in patients with concurrent atopic dermatitis. Fragrance sensitivity was also prevalent, with nearly 1 in 4 patients with contact dermatitis reacting to allergens like hydroperoxides of linalool and limonene, which require specific inclusion in patch test panels.Dr Cohen also addressed systemic contact dermatitis, a condition triggered by systemic exposure to allergens and often misdiagnosed due to its varied presentations, such as baboon syndrome or dyshidrotic hand eczema. He concluded with a focus on sulfites, the 2024 allergen-of-the-year, found in cosmetics, food, beverages, and pharmaceuticals, including topical antifungals and local anesthetics. By emphasizing the importance of recognizing new trends, refining diagnostic tools, and expanding patch test panels, Dr Cohen underscored the evolving landscape of allergen detection and management in dermatology.

In this presentation, Amy McMichael MD, discussed the latest updates in the treatment of common types of non-scarring alopecia, including pattern hair loss and alopecia areata (AA). She began by highlighting FDA-approved treatments for pattern hair loss, such as topical and oral minoxidil, finasteride, and low-level laser therapy, while also addressing emerging therapies like bicalutamide, sublingual minoxidil, and mesotherapy. The presentation emphasized the superior efficacy of oral dutasteride for male pattern hair loss compared to other therapies.For AA, updates included the disproportionate prevalence in patients of color and the efficacy of JAK inhibitors like baricitinib, ritlecitinib, and deuruxolitinib, which are approved for severe AA in different age groups. A new tool, the Alopecia Areata Scale (AASc), was introduced to standardize the evaluation of AA severity and guide treatment decisions. The presentation also discussed combination treatments, side effects, and long-term safety data for JAK inhibitors.

Antimicrobial resistance (AMR) has become one of the most urgent global health crises, as highlighted by Theodore Rosen, MD, in his impactful session, "Topical and Systemic Antibiotic Therapy." Dr Rosen opened with a case of a Serratia marcescens infection following a cat bite, which ultimately led to a finger amputation despite aggressive antibiotic treatment, showcasing the severe consequences of resistant pathogens. He stressed that AMR is a present and growing challenge, driven by the overuse and misuse of antibiotics, the adaptability of microbes, and a stalled pipeline for new drug development. With 1.3 million deaths attributed to AMR in 2019 and projections reaching 2 million annually by 2050, the presentation shed light on resistance mechanisms, such as efflux pumps and enzymatic degradation, and the diminishing arsenal of effective therapies.Dr Rosen emphasized the necessity of antibiotic stewardship, urging clinicians to ensure accurate diagnoses, select appropriate therapies, and minimize treatment durations. He also explored innovative solutions to combat AMR, including bacteriophages, antimicrobial antibodies, AI-driven drug discovery, and vaccine development. Expanding beyond bacterial resistance, Dr Rosen highlighted the growing threats from resistant viruses, fungi, and parasites, such as acyclovir-resistant HSV and terbinafine-resistant dermatophytes. Concluding with a call to action, he underscored the need for global collaboration, innovation, and vigilance to avoid a post-antibiotic era where even routine infections could become life-threatening. This session served as a critical reminder of the pressing need to address AMR through multidisciplinary efforts and cutting-edge research.

Rounding out the first day, Elizabeth Swanson, MD, presented an engaging review of emerging trends and treatments in pediatric infections, offering updates across various dermatologic conditions. She began with herpes zoster, noting an increase in cases among children due to waning immunity from chickenpox vaccination and emphasized the importance of antiviral treatments like acyclovir and valacyclovir, along with precautions for unvaccinated individuals and pregnant women. Dr Swanson also highlighted the efficacy of intralesional HPV vaccines for recalcitrant warts, outperforming intramuscular approaches. For molluscum contagiosum, she discussed the recently FDA-approved cantharidin and other treatment options like topical retinoids and Candida antigen injections, introducing pseudofurunculoid molluscum as a marker of resolution and cautioning against drainage. She also reviewed Gianotti-Crosti syndrome, emphasizing its viral triggers, self-limiting nature, and the use of topical steroids for symptomatic relief.Dr Swanson continued with practical insights on distinguishing impetigo from HSV through bacterial cultures and PCR testing, addressing recurrent cases by identifying nasal carriers. She explored severe cases of hand, foot, and mouth disease, particularly eczema coxsackium caused by coxsackie A6, which requires targeted eczema management and supportive care. Updates on fungal infections included strategies for managing resistant strains like Trichophyton indotineae and pediatric-friendly treatments for onychomycosis. Concluding her session, Dr Swanson provided practical clinical pearls, offering actionable insights and highlighting the importance of evolving, patient-specific therapies in managing pediatric infections.

Gary Goldenberg, MD, opened day 2 with an extensive review of the latest research on a broad range of dermatologic conditions, including acne vulgaris, psoriasis, atopic dermatitis (AD), alopecia areata, vitiligo, hidradenitis suppurativa (HS), prurigo nodularis (PN), seborrheic dermatitis, actinic keratosis (AK), chronic spontaneous urticaria (CSU), melanoma, onychomycosis, and cosmetic treatments. He began with acne vulgaris, highlighting innovative treatments such as clindamycin phosphate 1.2%, adapalene 0.15%/benzoyl peroxide 3.1% gel (CAB gel), clascoterone, sarecycline, trifarotene cream, and 1726 nm laser. CAB gel, shown to outperform dual combinations and vehicle gel in Phase 2 and 3 trials, and clascoterone, which demonstrated improvement in acne lesions, pore size, and shine by week 12, were particularly noteworthy. Sarecycline, a new antimicrobial with better gut microbiome preservation, also stood out. Dr Goldenberg then transitioned to psoriasis, discussing biologic advancements such as risankizumab, guselkumab, and bimekizumab, as well as alternatives like the 308 nm excimer laser. He reviewed AD therapies, including roflumilast, dupilumab, and lebrikizumab, before covering alopecia areata treatments like ritlecitinib and baricitinib. For vitiligo, he presented promising data on ruxolitinib and upadacitinib, alongside preclinical studies of VY201. HS therapies featured novel agents such as MC2-32, while PN, seborrheic dermatitis, and AK saw advancements in dupilumab, roflumilast foam, and tirribanibulin ointment, respectively. He concluded with updates on CSU, melanoma diagnostics, and cosmetic innovations, showcasing the latest in cutting-edge dermatology research.

Mark Lebwohl, MD, addressed a common clinical dilemma: selecting appropriate treatment regimens for patients with psoriasis amidst an expanding array of biologics and small-molecule inhibitors. His presentation emphasized the integration of therapeutic strategies tailored to disease severity, comorbidities, and patient preferences. He discussed vaccine management for patients on systemic therapies, perioperative considerations for immunomodulators, and obesity interventions using GLP-1 receptor agonists, which not only support weight loss but also improve psoriasis outcomes. Short-term biologics were highlighted as effective options for guttate psoriasis, while rapid interventions for generalized pustular psoriasis, including IL-36 inhibitors, were underscored as critical to mitigating severe disease progression.A key focus was the utility of emerging therapies, such as risankizumab and bimekizumab, in achieving high clearance rates even in challenging cases like scalp and nail psoriasis. Dr Lebwohl also explored the management of refractory “mild” psoriasis, advocating for an individualized approach to care that improves patient-reported outcomes, including quality of life. His comprehensive discussion provided actionable insights into optimizing treatment plans to address both common and complex scenarios in psoriasis care.

Chronic spontaneous urticaria (CSU) is defined by recurring hives, swelling, or both, and lasting 6 weeks or more, without identifiable triggers such as allergies or external stimuli. Dawn Merritt, DO, Mark Lebwohl, MD, and Marc Serota, MD, examined the challenges of second-line antihistamine treatments, explored new therapies, and emphasized personalized treatment strategies for CSU. Current guidelines have not yet integrated emerging therapies like omalizumab, remibrutinib, and dupilumab. Omalizumab, the only biologic currently approved for CSU, has demonstrated strong efficacy, achieving good control in 51.9% of patients and complete control in 35.8% of patients at the highest dose (300 mg). However, concerns over its black box warning for anaphylaxis have contributed to underutilization, even though the risk is rare (0.09%-0.2%) and mostly occurs within 2 hours of initial injections in patients with prior anaphylaxis history.New treatments like remibrutinib, rilzabrutinib, and dupilumab offer hope for improved CSU management. In the REMIX-1 and -2 trials, remibrutinib achieved UAS7 scores of 6 or less in 11.9% more patients than placebo, demonstrating rapid onset and sustained response over 52 weeks, with additional improvements in sleep and weekly itch severity (AIS7). Its safety profile includes mild adverse events like nasopharyngitis (6.6%), headache (6.1%), and petechiae (3.8%). Dupilumab, evaluated in the phase 3 Liberty-CUPID Study C, showed significant benefits over placebo, including greater reductions in itch severity, UAS7 scores, and improved disease control, with 30% achieving complete response. Dupilumab's adverse events were primarily skin-related. These advancements, including ongoing FDA reviews, signal a new era in CSU therapy, with the potential for better disease control and enhanced quality of life for patients.

Rounding out the second day was a multispeaker session on clinical pearls by Gary Goldenberg, MD, Brad Glick, DO, Edward (Ted) Lain, MD, MBA, Elizabeth (Lisa) Swanson, MD, and Joshua Zeichner, MD. Dr Goldenberg opened the session with 5 practical clinical pearls to address common challenges in practice. He emphasized the importance of going beyond simply prescribing medications, urging providers to incorporate advanced tools like platelet-rich plasma for hair loss into their treatment strategies. Dr Goldenberg also posed a thought-provoking question about the future of regenerative medicine, highlighting how regulatory and practical challenges may hinder its progress. Additionally, he stressed the importance of managing patient anxiety and pain during procedures to optimize outcomes. He concluded by encouraging providers to discuss dietary habits with their patients to combat photoaging and manage common skin conditions effectively.Dr Glick emphasized the importance and criticality of early detection and diagnosis of psoriatic arthritis (PsA). Studies have shown that there is an average delay of 5 years in PsA diagnosis, but even a 6-month delay in diagnosis can have detrimental effects including irreversible joint damage, worse long-term physical function, and decreased quality of life (QoL). There are several QoL measures in PsA, one of which is designated as minimal disease activity (MDA), which consists of 7 criteria—5 of which need to be met to achieve MDA. While MDA primarily assesses clinical disease activity, studies have shown that achieving MDA is strongly associated with slowed or halted radiographic progression of joint damage. Because early detection and diagnosis is critical to patients with PsA, it is important to know that patients with plaque and scalp psoriasis have a 50% or greater chance of having PsA. The 5 major risk factors for development of PsA in association with psoriasis additionally include higher BSA involvement, obesity, intergluteal or perianal lesions, and nail dystrophy. Dr Lain continued the discussion by addressing the management of rosacea, focusing on strategies for handling flares in previously controlled cases. He emphasized using low-dose isotretinoin (20–30 mg every other day) as an option for recalcitrant rosacea. For patients experiencing a flare after being well-controlled, Dr Lain suggested evaluating for small intestinal bacterial overgrowth and considering treatment with rifaximin 550 mg twice daily for 10 days. He also highlighted the potential role of probiotics in rosacea management. Additionally, Dr Lain recommended the use of minocycline rather than doxycycline for addressing rosacea-related papules and pustules.Dr Swanson followed with clinical pearls for pediatric dermatology, sharing practical and innovative approaches to common challenges in this patient population. She highlighted the Aron Regimen as an effective compounded treatment for severe atopic dermatitis, especially in infants and toddlers. Dr Swanson also discussed eclipse nevi, commonly found on children's scalps, emphasizing that these lesions are benign and typically do not require biopsy. For pyogenic granulomas, she discussed the treatment option of topical timolol. She also provided insights into managing warts, advocating for an approach using salicylic acid and 5-fluorouracil, which has shown to be highly effective with minimal pain. Finally, she shared a lighthearted but meaningful tip to always provide a snack to teenage boys after a biopsy, ensuring a positive experience for young patients.Lastly, Dr Zeichner presented clinical pearls for acne management. Key takeaways included starting with combination therapy such as IDP-126, a fixed-dose triple-combination topical consisting of clindamycin, adapalene, and benzoyl peroxide. Simplifying regimens was highlighted as a way to improve adherence, with once-daily treatments showing higher compliance compared to more complex regimens. Dr Zeichner also underscored the importance of considering acne a chronic condition and continuing treatment beyond 12 weeks, involving patients in shared decision-making to enhance engagement and adjusting isotretinoin doses based on clinical evaluations to ensure effective absorption.

Mark Nestor, MD, PhD, provided an in-depth update on the science of botulinum toxin type A (BoNT-A), focusing on how to select the right toxin and optimize clinical results. Dr Nestor astutely points out that understanding the clinical science of BoNT-A) injections allows providers to more accurately assess properties and differences between commercially available products. Going through the mechanism of BoNT-A, he demonstrates how molecular potency (MP), receptor binding and the role of patient-specific factors like age, muscle mass, and genetics influence toxin efficacy, onset, and duration.Dr Nestor discussed the concept of the "Area of Clinical Effect (ACE)," which is defined by the spread of the toxin suspension multiplied by MP. He discussed how optimal injection techniques, reconstitution volumes, and the number of injection sites can maximize results while minimizing adverse effects. He concluded by emphasizing that while all type A toxins share a similar mechanism, efficacy of the BoNT-A injection depends on a range of factors that include patient attributes, MP, technique, toxin spread, optimal reconstitution, and number of injections.

While many systemic treatments are available for atopic dermatitis (AD), Dr Alexandra Golant focused her lecture on the latest advancements and evidence-based strategies for choosing the right therapy. She began with a series of cases and clinical images emphasizing the range of presentations that AD can take, which can create discrete endotypes within the AD population. Fortunately, scientific discoveries on the pathogenesis of AD and treatment targeting now mirror the range of clinical presentations, allowing for an individualized approach to selecting a systemic therapy. Dr Golant reviewed when to reach for systemic therapy guidelines but also emphasized the importance of documenting disease severity, quality-of-life impacts, and treatment targets. She presented data on key therapies, including dupilumab, which showed sustained efficacy over 2 years, and tralokinumab, which demonstrated effectiveness in patients with head and neck involvement. Emerging options like nemolizumab and lebrikizumab were discussed, showcasing their promising results in clinical trials for moderate-to-severe AD. Dr Golant concluded by stressing the importance of achieving optimal treatment targets within 3 to 6 months and tailoring therapy to each patient’s needs and disease characteristics to improve outcomes and quality of life.

Alopecia areata is a complex autoimmune condition with profound physical and emotional impacts on patients. Natasha Mesinkovska, MD, PhD, opened her presentation with a fascinating discussion on mortality rates in patients with alopecia areata and vitiligo, noting that these rates are lower than in the general population. She then delved into factors beyond autoimmunity that may contribute to alopecia areata, including stress, reduced antioxidant activity, low levels of vitamin D and zinc, associated celiac disease, and imbalances in serum Th1, Th2, and Th17 levels.Dr Mesinkovska provided updates on treatment innovations, particularly the expanding role of JAK inhibitors such as baricitinib, ritlecitinib, and deuruxolitinib, which have demonstrated significant efficacy in clinical trials. She highlighted the need for sustained, long-term treatment to maintain hair regrowth and emphasized the importance of weighing safety and side effect considerations. Additionally, she addressed challenges regarding the use of JAK inhibitors in pediatric patients and during pregnancy, as most JAK inhibitors cross the placental barrier (with deucravacitinib being a notable exception). Despite these challenges, she advocated for maintaining JAK inhibitors as an option for patients of reproductive age.The presentation also explored the strong association between alopecia areata and atopic dermatitis, the most common comorbidity in these patients. She reviewed treatment approaches for concurrent conditions, including dupilumab, tralokinumab, and lebrikizumab, each showing varying levels of success. Dr Mesinkovska concluded with an exciting potential treatment: localized injections of baricitinib-loaded mesenchymal stem cell exosomes, which may represent a novel approach for managing alopecia areata.

Darrell S. Rigel, MD, MS started this multi-part discussion highlighting significant advancements in dermatologic oncology. Key updates include the efficacy of tirbanibulin 1% for treating actinic keratosis (AK) over larger treatment fields, supporting its expanded FDA approval. In invasive squamous cell carcinoma (SCC), watchful waiting was found reasonable for clinically resolved low-risk lesions, although immunocompromised patients face higher recurrence risks. For basal cell carcinoma (BCC), consensus guidelines favor hedgehog inhibitors for advanced cases, with strategies to mitigate side effects enhancing compliance. Advances in gene expression profiling (GEP) aid risk stratification and treatment decisions for melanoma and SCC, improving outcomes with early detection and targeted interventions. Additionally, neoadjuvant therapies, including nivolumab and ipilimumab, show promise in stage III melanoma, emphasizing personalized care in skin cancer management.Brian Berman, MD, PhD followed with a review of key advancements in actinic keratosis (AK) and basal cell carcinoma (BCC) treatments, along with innovative technologies in dermatology. Highlights included FDA approval for expanded use of tirbanibulin 1% for larger AK treatment areas and its correlation with high patient satisfaction. Intralesional therapies like STP705 siRNA and AIV001 showed promise in achieving high histological clearance rates for BCC with minimal adverse effects. Additionally, augmented reality-guided facial injections and surgeries emerged as cutting-edge technologies, offering enhanced safety by visualizing anatomical structures in real-time. These developments underscore significant strides in dermatologic treatments and procedural safety.David Cohen, MD, MPH, concluded Part 1 with an insightful discussion on the latest data regarding contact dermatitis. He highlighted the significant overlap between the pathways of allergic contact dermatitis (ACD) and those driving atopic dermatitis (AD). These shared mechanisms involve a diverse range of helper T-cell pathways, including Th2, Th17, and Th22, as well as various interleukins. Given this overlap, he noted that dupilumab, a treatment for AD, has been shown to alter clinical outcomes and impact patch test reliability. This can complicate the interpretation of patch test results, as dupilumab has been associated with an increased false-negative rate.

In Part 2 of “What Did Dermatology Bring to the Table in 2024 that Impact Patient Care in 2025” series, Seemal Desai, MD, Mark Lebwohl, MD, Dawn Merritt, DO, Joshua Zeichner, MD presented new data on several key dermatological conditions from vitiligo to acne.Seemal Desai, MD presented exciting advancements in vitiligo treatment, starting with topical ruxolitinib, which showed significant efficacy, including 95% improvement in F-VASI by week 80, with 66% achieving 75% improvement and 33.9% reaching 90% by week 104. He highlighted promising oral therapies, such as upadacitinib and povorcitinib, for recalcitrant cases, along with phase 2b trial data on ritlecitinib for nonsegmental vitiligo. Dr. Desai also discussed innovative approaches like autologous skin cell suspension grafting for repigmentation and introduced thiamidol, a tyrosinase inhibitor that offers a targeted option for lightening hyperpigmented areas.Dr Lebwohl presented updates on treatments for psoriasis, psoriatic arthritis, hidradenitis suppurativa (HS), atopic dermatitis (AD), and bullous pemphigoid (BP). In psoriasis, the FRONTIER 2 trial showed icotrokinra achieved PASI75 and PASI90 in 76.2% and 64.3% of patients by week 51, while TAK-279 (zasocitinib) reached PASI75 in 67.5% by week 12, and bimekizumab maintained PASI90 and PASI100 in 87.5% and 62.7% by week 16. For HS, the BE HEARD trials confirmed bimekizumab’s efficacy. In AD, lebrikizumab achieved EASI75 and EASI90 in 81.9% and 61.4% of patients by week 52, with upadacitinib outperforming dupilumab in EASI90 and EASI100 rates at 16 weeks. The JADE COMPARE trial found abrocitinib achieved higher EASI75 rates than dupilumab, while roflumilast maintained disease control in 57% of patients through week 56. Dupilumab showed significant efficacy in BP and CSU, reducing itch and hives regardless of baseline IgE levels. Lastly, a JAMA study examined short-term cardiovascular risks with JAK-STAT inhibitors.Up next, Dr Merritt highlighted advances in the treatment of chronic spontaneous urticaria (CSU). Despite the historically low usage of omalizumab among dermatologists, there is renewed interest and promising developments in CSU therapies. Notable innovations include dupilumab, which has demonstrated significant improvement in itch and hive reduction during phase 3 trials, and remibrutinib, an oral medication showing remarkable efficacy in biologic-naïve patients. Additionally, barzolvolimab, a humanized monoclonal antibody targeting KIT, exhibits profound mast cell suppression and promising results from phase 2 trials. These emerging treatments, coupled with ongoing research and upcoming FDA submissions, signify a transformative period for managing CSU and enhancing patient outcomes.Dr Zeichner explored the controversy surrounding benzene contamination in benzoyl peroxide (BPO) acne treatments. Testing revealed benzene levels above FDA safety thresholds in 34% of over-the-counter BPO products, raising concerns due to benzene’s carcinogenic potential. However, studies using data from NHANES and a retrospective cohort of over 50,000 individuals found no evidence linking BPO use to increased benzene blood levels or long-term cancer risk, including leukemia and lymphoma. He emphasized balancing risks and benefits, with practical tips like proper storage and application to minimize exposure. The findings reassure that BPO remains a safe and effective acne treatment when used appropriately.

In this presentation, Gary Goldenberg, MD and Mark Nestor, MD, PhD, provided valuable insights into botulinum toxin (Botox) injections, collagen biostimulators, androgenetic alopecia (AGA) treatments, and innovative aesthetic devices for 2025. They began by discussing Botox injections, emphasizing that while all Type A toxins share the same mechanism of action, variations in results arise from differences in molecular potency, dosage, patient-specific factors (such as age, gender, and muscle mass), genetics, and injection technique. Using detailed diagrams, they highlighted optimal injection sites to achieve desired outcomes and noted how targeting the correct muscles not only influences facial aesthetics but may also impact mood through facial feedback.The discussion then moved to collagen biostimulators, including poly-L-lactic acid (PLLA), calcium hydroxyapatite (CaHA), and cross-linked hyaluronic acid (HA). The presenters reviewed clinical studies, case results, potential mechanisms, and possible side effects of these biostimulators. For AGA, a variety of treatment options were explored, ranging from platelet-rich plasma and stem cells/exosomes (often paired with microneedling) to red light therapy, topical medications, vitamins, and low-dose oral minoxidil.Lastly, the presentation introduced two cutting-edge aesthetic devices. RF microneedling was highlighted for its versatility in skin tightening and fat reduction, particularly in the infraorbital and submental regions. The Thulium 1928 nm laser was showcased as a promising tool for effectively treating pigmentary disorders, demonstrating excellent clinical results.

Watch highlights from the Winter Clinical Miami 2025 Opening Reception in Miami, Florida!