New Drugs and New Concepts: Clinical Pearls

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Neal Bhatia, MD & Ted Rosen, MD

  1. New drug for papulo-pustular rosacea: QD 1% ivermectin cream (Soolantra®, 30g tube)
  • Better than placebo and superior to metronidazole 0.75% BID
  • “Clear” or “Almost clear” by IGA : 38-40%
  1. New HPV vaccine (Gardasil 9®)
  • Contains VLP to prior quadrivalent vaccine (HPV 6,11,16,18)
  • PLUS: contains VLP to immunize against HPV 31,33,45,52,58
  • Now 97% protective against genital SCCA due to 90% etiologic HPV
  • Also recommended for MSM, where ~75% protective against anal SCCA
  1. Miltefosine (Impavido®) for leishmaniasis
  • Both old world and new world organisms (more evidence for new world)
  • 100-150mg daily (higher dose if over 45kg weight)
  • AEs: anorexia, nausea, vomiting, diarrhea, H/A, mild ↑ LFTs, mild ↑Cr, and mild thrombocytopenia; but is Pregnancy category X (contraindicated): Do not take if pregnant, use adequate contraception during Rx and for five months after therapy has been discontinued
  1. Biologics are coming for atopic dermatitis
  • Duplilumab (anti IL4, IL13)
  • Lebrikizimab (anti IL13)
  • Mepolizumab (anti IL5)
  • Various anti IL31 monoclonal antibodies
  1. Watch for Vitamin D deficiency in various derm diseases: psoriasis, SLE, hidradenitis, alopecia areata; Not known if repletion of Vitamin D will be therapeutic
  2. Tofacitinib, a JAK3 janus kinase inhibitor, currently approved for RA, may be effective in psoriasis and psoriatic arthritis. A case report appeared showing benefit in alopecia totalis!
  3. Adalimumab appears beneficial for hidradenitis in a Phase III RCT.
    • Dosage 40mg weekly
    • Still not a miracle drug
  4. Tonsillectomy improved refractory psoriasis!
  5. Red henna tattoo does NOT affect pulse oximetry
  6. RUSHING to put on condoms leads to errors and failures, including increased STDs