New Drugs in 2013

Ted Rosen, MD & Neal Bhatia, MD

Drs Ted Rosen and Neal Bhatia discussed new drugs and devices in 2013.

Ted Rosen, MD

Modified release prednisone (Rayos) is now on the market. Why would this be a reasonable therapeutic choice? For many inflammatory diseases, the cytokines peak overnight; yet, steroid administration is often done in the morning. This treatment delays the bioavailability for about four hours. The idea is to take this at bedtime so that it releases overnight and; therefore, reduces morning symptoms associated with inflammatory diseases. Rayos is approved for steroid-responsive inflammatory disorders.  It is available in 1, 2 and 5mg doses.  Larger size tablets will be come available soon.

Cellulite is seen in 90 percent of women over the age of 40. Cellulaze Laser was approved in January 2012. It is a side-firing 1440nm wavelength laser that destroys fibrous bands and excessive fat. Dr Rosen feels that it may actually work and there may be a reasonable rationale for its use. However, there is not a lot of published data (n= 10) and it is rather costly ($5,000-$10,000 per treatment). There have also been instances of bruising, swelling, pain, and numbness associated with its use.

Vismodegib, a hedgehog pathway inhibitor, is a novel therapy for basal cell carcinoma (BCC). This treatment has dermatologists thinking a little more like oncologists, i.e. is the tumor stable? is it shrinking?  In other words, some response is a good thing even if it isn’t a complete response. It is important to remember that even with ongoing therapy, there may be a recurrence of BCC. This is a unique and outstanding therapy and has a place in the dermatological armamentarium. It really offers the small subset of BCC patients a new option.

Recent FDA Warnings that dermatologists should keep in mind

  • Minoxidil 15%- may cause hypotension
  • Vicrelis and Incivek (PIs for Hep C) Incivek- serious skin reactions (All patients who develop a skin reaction should receive urgent medical care)
  • Nature Relief-Recall because calcium oxide that burns the warts and moles can burn the skin
  • Bleaching creams- may contain mercury
Neal Bhatia, MD

Dermatology has become reliant on botany with regards to some of the newer therapies. These include:

  • Ingenol mebutate for AKs
  • Polypodium leucotomos (Heliocare) is an anti-inflammatory agent with antioxidant effects and an impact on photodamage
  • Sinecatechins (Veregin) for HPV-related dermatoses also has antioxidative effects, antiviral effects, and is immune-stimulatory.  This is probably not an option for AKs; could be used for Molluscum, maybe more so than genital warts.

Photodynamic therapy

What is the appropriate incubation time?  Two hours and maybe even one hour. This is not just treating spots, but also surface areas.

It is important to choose patients wisely and avoid overexposure.

 Atrapro versus Aurstat: Battle of the Hydrogels

  • Microcyn is the active ingredient in Atrapro. This causes stabilization of mast cells and leads to a direct anti-itch effect
  • Hypochlorous acid and sodium hydrochloride are the active ingredients Aurstat Hydrogel; therefore leading to the reduction of itching in mild to moderate atopic dermatitis
  • Both of these products may reduce the need for steroids and antibiotics and that may be where we see their potential utility

Nuvail was recently approved as a product for restoring the health of nails. Polyureaurethane is the active ingredient. Clinical data demonstrated 62% improvement after six months of treatment.