In this session, Matt J. Zirwas, MD discussed the challenges of managing a range of contact dermatitis dilemmas, including:
- When to patch test and when to treat empirically
- Non-allergenic topicals
- Low allergenicity personal care products
- Allergen updates
- The explosion of contact dermatitis from essential oils
- Change in which formaldehyde releasers are most common
- New or up-and-coming allergens, including long lasting nail polish, glucosides, and ammonium persulfate
- Effects of L-histidine supplementation in atopic dermatitis
- Oral management of xerotic dermatitis
Session moderator Ted Rosen, MD provided a thorough overview of the latest in infectious disease. Dr. Rosen discussed the arbovirus threat in the United States, including chikungunya and zika. Dr. Rosen also mentioned ongoing research on the potential oncolytic effects of the zika virus for neuroblastoma and glioblastoma. Yellow fever outbreak in Brazil and West Nile Virus in the US was reviewed, as well as the rising incidence of syphilis gonorrhea in the US. Dr. Rosen discussed his own research on ozenoxacin cream for the treatment of adult and pediatric patients with impetigo. Other research on 15% and 10% potassium hydroxide for Molluscum contagiosum was also reviewed. Other topics discussed include the possibility of a two-drug regimen for stable HIV, evidence for oral antibiotic exposure and increased risk of kidney disease, E. coli resistance to antibiotics after exposure to fluoxetine, tecovirimat for smallpox, leptospirosis associated with contaminated water from floods and the use of chemoprophylaxis after floods to reduce outbreaks, antibiotic links to increased risk of death in heart disease patients and cancer relapse, and hypoglycemia in patients taking fluoroquinolone.
- Invasive mold disease in immunocompromised children
- Eczema herpeticum
- A study showing a lack of significant efficacy of cyclosporine in pediatric cases of Stevens–Johnson syndrome/toxic epidermal necrolysis.
- The case of a three-day-old boy with diffuse superficial skin erosions and brown crusts on the back
- Perianal pseudoverrucous papules and nodules
- Ivermectin and permethrin for treating scabies
Aditya K. Gupta, MD, PhD, FAAD, FRCP (C) provided attendees with updates on onychomycosis and tinea. Regarding onychomycosis epidemiology, Dr. Gupta addressed the role of the immune system in conferring protection or susceptibility to dermatophyte infections, the increased risk of Candida or Aspergillus onychomycosis in elderly individuals or those with renal transplants, HIV, or diabetes, and the increasing prevalence of onychomycosis. Dr. Gupta also compared diagnostic strategies and reviewed strain typing for onychomycosis. In addition, Dr. Gupta reviewed optimal regimens for oral drugs such as terbinafine, itraconazole, and fluconazole. He also discussed research on posaconazole and albaconazole. Topical therapies including ciclopirox 8% HPCH nail lacquer, efinaconazole, and tavaborole were reviewed. In addition, Dr. Gupta discussed a critical review of laser studies. Dr. Gupta finished his presentation with strategies to prevent onychomycosis recurrence and learning objectives for the future.
- The many conditions associated with destructive chronic inflammation and disrupted skin barrier
- In vitro data as an inadequate method for predicting human success
- The requirements for “active ingredients” to remain effective at varying concentrations and formulations, and methods for determining whether these ingredients actually work
- Manufacturing and packaging specifics to protect ingredient efficacy
- Precedents for ensuring cosmeceutical efficacy and safety
- The benefits of using herbs in cosmeceuticals
- The effects on climatic and seasonal conditions, time of harvest, storage site and duration, and extraction method on the active ingredients in herbal extracts
- Results from studies comparing herbal blends with prescription products for the treatment photoaging and eczema
Henry W. Lim, MD used his presentation to discuss the latest in photoprotection. He began with the results of a survey on photoprotective habits including using sunscreen, seeking shade, and wearing hats and other protective clothing. Survey respondents who reported engaging in all four habits showed the lowest likelihood of sunburn. Dr. Lim discussed another study comparing users of sun protection factor (SPF) 16 sunscreen with a control group that observed decreased squamous cell carcinoma, basal cell carcinoma, photoaging, and melanoma among the users of sunscreen. Dr. Lim went on to review the public health and environmental detriments of organic filters such as oxybenzone and octinoxate as well as the merits of inorganic (mineral) filters such as zinc oxide and titanium oxide. Dr. Lim finished his presentations with the benefits of photolyases and stabilized, biologically active antioxidants in sunscreens.
Andrew Blauvelt, MD, MBA, presented attendees with an update on the AD pipeline. Dr. Blauvelt reviewed recent research on biologics such as tralokinumab, an anti-IL-13 monoclonal antibody (mAb), lebrikizumab, an anti-IL-13 mAb, and nemolizumab, an anti-IL-31 receptor A mAb. Dr. Blauvelt discussed other studies on monoclonal antibodies for AD targeting IL-5, IL-22, TSLP, IL-17C, IL-1alpha, IL-33, and OX40. In addition, Dr. Blauvelt discussed research on the JAK1 Blockers Baricitinib, upadactinib, and PF-04965842. Additional potential therapies discussed include ASN002, ZPL-389, and apremilast. Dr. Blauvelt also covered new topical drugs for AD, including JAK inhibitors, PDE4 inhibitors, and tapinarof.
Eric Simpson, MD, MCR, provided an update on dupilumab. Topics discussed by Dr. Simpson include:
- When to use systemic therapy
- What to tell patients to expect with systemic therapy
- Are there patients who should not be put on dupilumab?
- Should we check labs?
- How to treat dupilumab conjunctivitis
- How to treat facial resistance or flares
- How long will patients stay on dupilumab?
- Other uses for dupilumab
- Combination treatment
Lawrence F. Eichenfield, MD, provided attendees with an update on pediatric AD.
In this session, Sonja Ständer, MD and Gil Yosipovitch, MD, two of the world’s leading authorities on pruritus, discussed the pathophysiology and management of a wide variety of itch disorders.
Important questions to ask an itchy patient
- Simple tools for assessing itch for the dermatologist and allergist
- Cases of chronic itch without rash
- Treatment regimen for pruritus of undetermined origin
- Ending the antihistamine era for atopic dermatitis
- Addressing the neural system in connection with itch treatment
- Central nervous system targets for itch treatment by reducing neural sensitization
- Mature aging itch immunosenescence in the elderly
Guy Webster, MD, PhD began his presentation by reviewing the case of a 17-year-old patient who experienced myalgia while taking isotretinoin, then elaborated on isotretinoin and muscle damage and how he handles these cases. He also reviewed the very uncommon problem of resistance to isotretinoin and how to address this issue, then discussed the case of one isotretinoin-resistant nodule in a 20-year-old patient. Dr. Webster also discussed adalimumab for the treatment of hidradenitis suppurativa. Additional treatments for acne were reviewed, including topical minocycline, topical androgen inhibitors, sarecycline, and a new tetracycline.
Richard L. Gallo, MD, PhD, used his presentation to provide an update of the pathophysiology of acne. Dr. Gallo covered such topics as:
- The age of the microbiome and acne
- Name change of Propionibacterium acnes to Cutibacterium acnes (C. acnes)
- How to detect C. acnes
- The specific types of C. acnes that are associated with acne
- C. acnes global epigenetic inflammatory response
- Model of epigenetic control of acne pathogenesis
- Therapy by targeting acne metabolites
- Updates to the diagnosis, classification, and assessment of rosacea
- The complex pathology of rosacea and how this differs greatly from acne
James Leyden, MD presented on treating acne without antibiotics. He began with a review of the history of antibiotic therapy for acne, starting in 1950 with the discovery of the anti-acne effects of tetracycline and erythromycin, to today with antibiotic effects on P. acnes being greatly compromised. Dr. Leyden went on to discuss non-antibiotic options for treating acne, including methods for sebum suppression such as spironolactone, oral contraceptives, isotretinoin, and topical clascoterone, anti-microbials such as benzoyl peroxide, addressing comedogenesis with topical retinoids, and anti-inflammatory treatments such as dapsone.
Andrew Blauvelt, MD, MBA, focused his presentation on new translational psoriasis research. Dr. Blauvelt discussed important clinical questions in psoriasis, including:
- Why does skin disease recur at the same anatomic sites when relapsing?
- Can we cure patients with currently available biologic therapies?
- Do biologic therapies decrease the risk of cardiovascular disease?
Arthur Kavanaugh, MD presented attendees with a psoriatic arthritis (PsA) update. PsA treatment options discussed by Dr. Kavanaugh include adjunctive treatments, DMARDs, biologics, JAK inhibitors, PDE4 inhibitors, and experimental treatments.
Linda Stein-Gold, MD, educated attendees on how to optimize treatment approaches with topical therapies. Dr. Stein-Gold discussed the importance of vehicles and how they affect the potency, and as a result, the efficacy of topical treatments. She pointed to different vehicles used with betamethasone dipropionate 0.05% to illustrate the concept. Dr. Stein-Gold discussed other ways to enhance topical treatment penetration, including hydration and heat as well as topical vitamin D3. She also discussed the prevention of steroid-induced atrophy using combination therapies. Also discussed was a phase 3 clinical study to assess the safety and efficacy of halobetasol propionate and tazarotene lotion in plaque psoriasis. Dr. Stein-Gold also reviewed new topical molecules including PDE4 inhibitors, JAK inhibitors, and aryl hydrocarbon receptor agonists.
Bruce E. Strober, MD, PhD presented interesting psoriasis data from 2018. He discussed apremilast, specifically changes in weight and A1c after 16 weeks of apremilast in patients with psoriasis and PsA. Dr. Strober also discussed cardiovascular risk in psoriasis, reviewing research on the effect of systemic and biologic drug treatment on carotid intima-media thickness in patients with moderate-to-severe psoriasis as well as vascular and systemic inflammation following treatment with ustekinumab in patients with psoriasis. Finally, Dr. Strober discussed pediatric psoriasis and reviewed research on the efficacy and safety of apremilast for pediatric patients with moderate-to-severe plaque psoriasis. Another treatment discussed included ixekizumab and ustekinumab for the treatment of nail lesions in patients with plaque psoriasis.