Highlights from Sunday, January 26, 2020
Pediatric Dermatology 2020
Maui Derm’s expert panel of pediatric dermatologists covered a wide range of topics in pediatric dermatology, including presentations from Lawrence Eichenfield, MD, Sheila Fallon-Friedlander, MD, Ilona Frieden, MD, and Jim Treat, MD.
Lawrence Eichenfield, MD, in his presentation, titled, “Pediatric Inflammatory Skin Disease Update,” reviewed the new joint American Academy of Dermatology-National Psoriasis Foundation Pediatric Psoriasis Guidelines, specifically, psoriasis triggers, pediatric psoriatic arthritis, tips for monitoring and management, severity assessments, guidelines for topical use, and systemic monitoring. Also discussed were approved and emerging biologic therapies for pediatric psoriasis, with special focus on ustekinumab and apremilast. Dr. Eichenfield went on to review characteristics of pediatric patients under the age of four years with alopecia areata (AA) and a proposed algorithm to treat AA, with a focus on oral and topical Janus kinase (JAK) inhibitors in children and tofacitinib for preadolescent patients with AA. Next up, Dr. Eichenfield discussed treatments for pediatric patients with vitiligo, including research that compared topical therapy combined with 308-nm excimer laser to excimer laser monotherapy.
Sheila Fallon-Friedlander, MD, in her presentation titled, “Where have all the viruses gone?” discussed the recent outbreaks of measles in the United States, the zika virus, the increased incidence of neonatal herpes simplex virus in a Medicaid population over a seven-year period, and updates in research on a single-use cantharidin applicator for molluscum contagiosum, common warts, and other indications.
Ilona Frieden, MD, in her presentation titled, “The Spectrum of Spitz,” reviewed phenotypes of Spitz nevi and clinical features and histopathological attributes of classic Spitz nevi versus that of atypical Spitz tumors. In addition, Dr. Frieden reviewed results from a study that evaluated beliefs, behaviors, and experiences of pediatric dermatologists with regard to Spitz nevi as well as research that found clear differences between Spitz nevi and melanoma via molecular cytogenetic analysis.
Jim Treat, MD, discussed off-label uses of systemic medicines for rare and common diseases. Therapies reviewed by Dr. Treat included dupilumab for systemic contact dermatitis, chronic urticaria, itch, alopecia areata, and eosinophilic annular erythema, omalizumab for mastocytosis, ustekinumab for atopic dermatitis, papulosquamous disease, deficiency of interleukin (IL)-36 receptor antagonist, hidradenitis suppurativa, and acne, IL-17 blockade for ichthyosis, tofacitinib for vitiligo, etanercept for Stevens-Johnson syndrome, and methotrexate for alopecia areata.
Maui Derm’s panel of leading authorities discussed a number of topics, including the metabolic impact of psoriasis, new topical and systemic drugs in 2020, psoriatic arthritis, and the immunology and genetics of psoriasis.
In his presentation, Craig Leonardi, MD, discussed new developments in treatments for moderate-to-severe psoriasis. Dr. Leonardi discussed developments in therapies for pediatric psoriasis, including:
- A Phase II open-label safety and efficacy study of apremilast
- A Phase III trial of ixekizumab
For moderate-to severe-plaque psoriasis, Dr. Leonardi provided details on the following studies:
- A head-to-head trial of ixekizumab versus guselkumab
- A Phase III trial of netakimab, an anti-IL-17 antibody
- A Phase II randomized, placebo-controlled trial of BMS-986165, a highly selective oral TYK2 inhibitor
- A Phase IIb, dose-ranging study of dual IL-17A and IL-17F neutralization with bimekizumab
Other developments reviewed by Dr. Leonardi included:
- A Phase III, double-blind, placebo-controlled trial of apremilast for severe plaque psoriasis of the scalp
- A Phase I study evaluating the safety and efficacy of BI655130, an anti-IL-36 receptor antibody, for acute generalized pustular psoriasis
Arthur Kavanaugh, MD, reviewed treatment options for psoriatic arthritis, focusing on new research on etanercept and methotrexate as monotherapy or in combination. Dr. Kavanaugh also discussed newer therapeutic agents for systemic inflammatory autoimmune disease, including research evaluating ustekinumab versus tumor necrosis factor inhibition on enthesitis, research investigating the differences between ustekinumab and etanercept in the modulation of inflammatory gene transcripts in psoriasis, and five-year results from the Phase III FUTURE 1 study on secukinumab for psoriatic arthritis. Dr. Kavanaugh closed his presentation with some future directions for psoriatic arthritis, discussing treatment optimization, personalized medicine, prediction, and prevention.
Linda Stein Gold, MD, presented on innovations in topical therapy for psoriasis. Dr. Stein Gold discussed the effects that layering topical drugs can have on efficacy, including altered permeation and penetration and incompatibility. She also touched upon maintaining results in patients with psoriasis through proactive treatment and enhanced vehicles that lead to improved drug efficacy, citing a halobetasol propionate and tazarotene lotion as an example of this. New molecules were also reviewed, including tapinarof for psoriasis and topical roflumilast for plaque psoriasis. Dr. Stein Gold concluded by emphasizing the importance of vehicle selection in topical therapy and vitamin D as an important addition to topical steroid treatment.
Joel Gelfand, MD, MSCE presented an update on the rapidly expanding knowledge surrounding psoriasis comorbidities, including updates on gum disease and how periodontal treatment might improve psoriasis, the risk of liver disease in patients with psoriatic disease treated with methotrexate, updates on psoriasis and cancer and psoriasis and heart disease, and taking comorbidities into consideration when selecting treatments for psoriasis.
Andrew Blauvelt, MD, MBA, presented an update of psoriasis pathogenesis. Dr. Blauvelt answered important clinical questions pertaining to psoriasis, including:
- Why does the Koebner phenomenon occur?
- Is the skin and gut microbiome important in psoriasis?
- What comes first: skin inflammation or systemic inflammation?
- What does the latest data tell us about biologic therapies and decreasing the risk of cardiovascular disease?