Summaries of selected poster presentations from key dermatology conferences.
Highlights from: Maui Derm 2021 (January 25–29, 2021)
Dermatology in Review
Sheila Fallon-Friedlander, MD, kicked off Dermatology in Review, providing current information from research on COVID-19 and subsequent multisystem inflammatory syndrome and potential skin manifestations in adults and children. Next, Dr. Fallon-Friedlander shared updates in pediatric dermatology, beginning with data on malignancy in tacrolimus and recent care protocols and treatments for pediatric eczema and atopic dermatitis. Dupilumab trial outcomes were thoroughly reviewed as well. To conclude this segment, Dr. Fallon-Friedlander analyzed the case of a patient with pellagra to emphasize the potential skin-related consequences of nutritional deficiencies in children.
Next, Hensin Tsao, MD, PhD, highlighted COVID-19 reports and articles on PubMed, evaluating protein complexes and mechanisms of the virus and comparing COVID-19 against the common cold/seasonal coronaviruses. After an in-depth assessment of COVID-19 vaccines and clinical approaches, Dr. Tsao addressed the mechanisms and clinical and patient characteristics of “COVID toes.” Following this, Dr. Tsao shared data, outcomes, and adverse events from nemolizumab trials and discussed new topical agents used to treat atopic dermatitis and pruritis. The chronic effects of sun damage, the pathology of melanocyte mutations, and lymphatic microenvironments that promote tumor-cell growth were covered as well. After, Dr. Tsao reviewed the primary, secondary, and correlative trial endpoints of recent research on ruxolitinib. To wrap up this session, Dr. Tsao assessed the role and shortcomings of app-based intervention in self skin examinations.
New Drugs and Therapies
Neal Bhatia, MD, and Ted Rosen, MD, began New Drugs and Therapies by discussing the mechanism, tolerability, and benefits of microencapsulated benzoyl peroxide for the treatment of rosacea and acne. They then switched gears to review future head lice therapies and clinical trial data, safety, and efficacy of various JAK-inhibitors, including ruxolitinib, deucravacitinib, baricitinib, upadacitinib, and abrocitinib. Following this, Dr. Rosen focused on ligelizumab, comparing its Phase II study results with existing standard of care for hives and itch in chronic spontaneous urticaria. Next, the presenters reviewed the mechanism and technologies of new Ebola therapies, Ebanga and Inmazeb. Drs. Rosen and Bhatia concluded their presentation with a review data on tirbanibulin, an actinic keratosis treatment.
Maui Derm’s panel of leading authorities discussed a number of topics, including: What’s in the pipeline? What’s coming? What topicals are trending? What are the head-to-head studies showing? What’s new in psoriatic arthritis? How did COVID-19 affect our management of psoriasis and psoriatic arthritis, and what have been the most important takeaways from the pandemic?
Bruce Strober, MD, PhD, explored new and upcoming psoriasis therapies, beginning with a review of Phase III studies on apremilast for moderate-to-severe scalp plaque psoriasis, bimekizumab safety and tolerability data, and ixekizumab for pediatric psoriasis. Next, Dr. Strober moved on to drug survival and tailored dosing of newer and current treatments. Moreover, Dr. Strober compared certain interleukin (IL)-23 and IL-17 inhibitors, including mirikizumab, secukinumab, and guselkumab, and analyzed their long-term safety profiles. The mechanisms of select JAK-inhibitors, deucravacitinib, tofacitinib, and a TYK2-inhibitor, PF-06826647, were also covered. Ending this segment, Dr. Strober reviewed severity guidelines for the treatment of psoriasis.
Following this, Arthur Kavanaugh, MD, provided updates on psoriatic arthritis treatment options. Available adjunctives, DMARDs, biologics, JAK-inhibitors, PDE4-inhibitors, and other therapies currently in development were examined throughout Dr. Kavanaugh’s presentation using head-to-head studies and clinical trial data.
Through the use of efficacy and tolerability data of psoriasis treatments, Linda Stein Gold, MD, highlighted the key points of topical therapy use, such as vehicle significance, proactive treatments for maintaining efficacy, opting for combination therapy, and the differences between various PDE4-inhibitors.
Finally, Joel Gelfand, MD, MSCE, FAAD, discussed continuation of psoriasis treatment during the pandemic and related COVID-19 risks, while assessing comorbidities of psoriasis that are correlated to poor COVID-19 outcomes and the respiratory infections that might occur with IL-17, IL-23, and TNF-inhibitor use. Dr. Gelfand also discussed COVID-19 vaccines.
Pediatric Dermatology 2021
Albert Yan, MD, began this presentation by highlighting the trending issues in pediatric viral skin diseases, focusing on cases exhibiting inflammation versus infection in children with molluscum contagiosum (MC), efficient and ineffective treatment options for particular manifestations of MC, and therapy data for the treatment of skin infections from atopic dermatitis and herpes viruses. To wrap up this segment, Dr. Yan shared three cases that contained examples of powassan virus infection from tick-borne encephalitis and reviewed the COVID-19 clinical phenotypes in children.
Following this, Dr. Fallon-Friedlander discussed how COVID-19 affects children and adolescents by providing instructive cases and patient data. Additionally, Dr. Fallon-Friedlander shared examples of associated “COVID toes,” pernio, and purpura in children subsequent to presence of COVID-19. Next, Dr. Fallon-Friedlander evaluated immunotherapies for warts, including use of anti-interleukin agents and the human papillomavirus vaccine and a new, FDA-approved wartPEEL cream. To conclude, Dr. Fallon-Friedlander reviewed some recent literature on viral warts in children.
Using case reports, Ilona Frieden, MD, reviewed the histopathology, current treatments, and future strategies for vascular anomalies in children. Some cases included infantile hemangioma and pyogenic granuloma treated with beta blockers, timolol for EGFR inhibitor-induced paronychia, sirolimus for Sturge-Weber syndrome, tacrolimus for tufted angioma, the use of genomics to target mutant alleles, and potential targeted therapies for arteriovenous malformations.
Next, Jim Treat, MD, discussed how dermatitis presents in children and various exposures, causes, and treatments for the skin condition. Dr. Treat also covered common contact allergens in everyday items, how to read patch tests for skin of color, essential oils causing and/or exacerbating dermatitis, and contact dermatitis caused by elastic bands on face masks. Additionally, Dr. Treat provided discussed two case reports—one patient who developed facial redness with dupilumab use and another patient who developed rash while on the ketogenetic diet.
The session ended with Lawrence Eichenfield, MD, who provided information on pediatric inflammatory skin diseases, reviewed pediatric psoriasis guidelines, discussed new and in-development treatments for atopic dermatitis and psoriasis in children, and listed newly approved biologics for pediatric psoriasis, specifically ixekizumab and ustekinumab. Dr. Eichenfield also assessed current pediatric vitiligo therapeutic approaches and new information on laser use for pediatric scars.
Update 2021: Acne and Rosacea
This presentation delivered new drugs, new data, and new insights into acne and rosacea to meeting attendees. Maui Derm’s esteemed faculty shared their insights into the management of acne and rosacea. Guy Webster, MD, PhD, began the session by explaining the relationship between polycystic ovary syndrome (PCOS) and acne and analyzing the current treatment strategies for PCOS-related acne, such as the use of metformin, spironolactone, or isotretinoin. Additionally, Dr. Webster provided clinical and safety data for new acne treatment drugs.
Next, Dr. Eichenfield discussed new pediatric acne literature and notable case reports, beginning with management of acne in children (and adults) caused by face masks and a discussion of examples of pseudo-acne. Then, Dr. Eichenfield assessed the evolution of pediatric data regarding many acne therapeutics, reviewing relevant case studies, safety profiles, and effectiveness of each featured treatment. To wrap up this segment, Dr. Eichenfield focused on methods for healing acne scarring.
After, Jim Leyden, MD, discussed difficult patient cases that pertained to isotretinoin treatment, which involved relapse, acute inflammation, worsening of acne, sinus tracts, and the occurrence of inflamed keratinous cysts. Further, Dr. Leyden reviewed the history of effective and ineffective isotretinoin dosing that contributed to above difficulties, as well as the impact age has on acne therapies and potential retreatment.
Finally, Richard Gallo, MD, reviewed the fundamentals, common triggers, and comorbidities of rosacea. Dr. Gallo also focused on the recent understanding of the phenotype classification system for rosacea, assessing the innate immune dysfunction that describes phenotypes in rosacea. To conclude, Dr. Gallo shared new advances that can be used to better understand the biology of rosacea.
Wound Healing Advances in 2020
Robert Kirsner, MD, PhD, one of the leading experts in wound healing, presented the latest in wound healing science that will change the way we approach wound healing. In Wound Healing Advances in 2020, Dr. Kirsner presented a number of patient cases and related clinical studies to provide informative pearls for treating and healing wounds. Some of the featured cases depicted appropriate debridement of wounds, methods of scarless skin grafting, available therapies for healing venous ulcers, the effective use of topical beta blockers on wounds, replicating scarless embryotic healing, reducing tension on incision sites, and the healing influence of the gastrointestinal microbiome.
Atopic Dermatitis and Pruritus: Current Concepts and Therapeutics for 2021
Maui Derm’s experts discussed the latest findings in the pathogenesis and comorbidities of atopic dermatitis and itch. They provided their insight into the broadening list of topical, systemic, and biologic therapies for AD and itch that will become available to our clinics in 2021 and discussed where they all fit.
Eric Simpson, MD, discussed data on systemic treatment for atopic dermatitis, including criteria for when to use these therapies, disease phenotyping, endotyping, and predictive biomarkers, available options, and updates on dupilumab.
Jonathan Silverberg, MD, PhD, MPH, discussed notable literature on allergic contact dermatitis in patients with atopic dermatitis and when to patch test patients with this skin condition; further, Dr. Silverberg shared information on when to refer these patients to food allergy testing. Depression, anxiety, and cognitive dysfunction in patients with atopic dermatitis concluded his segment.
Following Dr. Silverberg, Dr. Eichenfield reviewed new information on pediatric atopic dermatitis through a discussion of exemplary patient cases and recent studies. Dr. Eichenfield covered how to assess early atopic dermatitis in children, the algorithm for step-up care, and setting up safe amounts of initial medications.
To conclude this session, Gil Yosipovitch, MD, PhD, analyzed serval cases and data regarding itch in elderly patients. These studies clarified the mechanism of elderly dry-skin itch, neuropathies that cause itch, bullous pemphigoid and statis dermatitis itch, and itch therapeutics for elderly patients that do not cause rash.
Lasers and Energy Devices Used to Treat Medical Problems: What’s New in 2021!
Maui Derm’s world-class experts discussed their approach to an array of challenging skin conditions and cutaneous lesions, vascular lesions and tumors, striae, scars, disorders of pigmentation, and more.
With the assistance of demonstrative footage and photos, Stuart Nelson, MD, PhD, discussed laser treatment of “medical” vascular lesions, including the mechanisms and types of lasers, proposed challenges of various skin disorders, and use in infants and children; further, Dr. Nelson focused on the optical advantages of early therapy, as well as various port wine stain and periorbital veins treatment responses. Dr. Nelson wrapped up this segment by exploring use of lasers in hemangioma cases.
Next, E. Victor Ross, MD, shared a series of cases demonstrating different skin conditions, including venous lake, sebaceous hyperplasia, scars, tattoo and hair removal adverse reactions, minocin hyperpigmentation, and osteoma cutis, and discussed the laser treatments that were used to manage each featured condition. Dr. Ross also highlighted his favorite lasers and the importance of adapting pigment endpoints per patient and case characteristics.
Following Dr. Ross, Suzanne Kilmer, MD, focused on the use of fully and fractional ablative lasers. The discussed uses included resurfacing, skin texture improvement, and treatment of actinic keratosis, superficial basal cell carcinomas, rhinophyma, xanthelasma, neurofibromatosis, hair removal on skin grafts, and sarcoidosis.
After, Fernanda Sakamoto, MD, PhD, shared clinical cases and therapy session photos of patients with nodule and recalcitrant acne treated with a pulsed dye laser.
To conclude, Rox Anderson, MD, PhD, presented the challenging case of a five-year-old with giant congenital melanocytic nevus. Throughout his segment, Dr. Anderson reported the treatment course and provided photos illustrating progress in appearance between therapy sessions. Dr. Anderson also explored the role of hair follicles in congenital melanocytic nevi.
Nail Disorders 2021: Diagnostic and Therapeutic Challenges
Phoebe Rich, MD, one of the world’s leading nail experts, presented a series of cases that challenged our diagnostic and therapeutic acumen. Dr. Rich began this session by sharing literature on “COVID nails,” primarily nail manifestations of the virus, the role of nail hygiene in preventing transmission, and overall nail hygiene during the pandemic. Next, Dr. Rich thoroughly assessed patient cases of pseudomonas in the nail, chronic nail dystrophy, onychotillomania and related conditions, and squamous cell carcinoma of the nail unit. Lastly, Dr. Rich reviewed videos of nail matrix biopsies that tested for some of the above conditions.
Maui Derm’s faculty presented an array of challenging and complex cases that pushed their diagnostic and therapeutic skills to the limit. To begin, Ted Rosen, MD, shared his diagnostic and patient confrontation approaches to challenging cases through a discussion of two cases: one which involved penile bruising linked to a psychodermatologic disorder and a case of lipogranulomatosis from injected plastic.
Dr. Yan discussed therapeutic challenges in pediatric cases, starting with the case of a three-week-old infant with a vascular birthmark that developed pinpoint bleeding over time. Dr. Yan then used the case of a proliferating infantile hemangioma in a nine-week-old infant to discuss the treatment benefits of beta blockers and other intensive courses of action.
Matthew Zirwas, MD, presented the case of a 71-year-old patient with stubborn hand atopic dermatitis and used this case to discuss the importance of checking patient treatment history and incorporating critical questioning when assigning an effective treatment regimen. The next case involved a patient with a painful trunk rash resulting from drug rash with eosinophilia and systemic symptoms (DRESS) syndrome from previous treatment.
Seemal Desai, MD, FAAD, shared a collection of different cases that depicted mysterious widespread areas of scalp hair loss and development of blotchy pigmentation all over the body that stemmed from lichen planus pigmentosus and related forms, as well as a case regarding an intense genital rash, scaling of the thigh, and blistering of the inner elbows due to tinea incognito. Dr. Desai shared the former case to bring attention to the over-the-counter availability of topical steroids that has led to abuse of these treatments.
Contact Dermatitis Update 2021
In this informative session, Dr. Zirwas discussed the challenges of managing a range of dermatitis dilemmas. He shared many illustrative patient cases of common allergens that presented in somewhat uncommon ways and explained why identification of the allergen is just the beginning of the treatment process. Dr. Zirwas also reviewed his protocol for interpreting patch tests, courses of action for patch tests with positive results, and rationale behind diagnosing, treatment, and management methods for each featured case.