Learn more about what treatments are on the rise for plaque psoriasis, the latest management advice and what trends are shaping the future of the disease. 

The changing treatment landscape of plaque psoriasis

and joined the MJH Life Sciences team in April 2021. She graduated from Kent State University in 2018 with a bachelor's degree in journalism and a minor in sociology. Linda used to work as a creative writer for 

 and was a technical writer/regulatory specialist/purchasing agent at GM Industrial before coming on to the team. She enjoys reading, traveling, and learning new perspectives. You can reach her at 

It has been 25 years since the launch of Galderma’s Restylane line of hyaluronic acid (HA) fillers in Europe.

Since becoming the first HA filler approved by the FDA in 2003, Restylane’s portfolio has continued to grow with 13 dermal filler product approvals and launches. They offer 2 complementary gel technologies—Nasha and XpreHAn (globally referred to as the OBT technology (Optimal Balance Technology)—to help patient satisfaction.

 for chin augmentation and correction for mild to moderate chin retrusion for adults over 21 years old and in June of this year, 

 was approved for cheek augmentation and correction of midface contour deficiencies in adults over the age of 21. It became the first and only product in the US to use proprietary XpresHAn technology for the cheeks, according to Galderma.

"The depth of experience from Restylane over the last 25 years has enabled us to build upon our expertise to innovate and develop new formulations and treatments," said Flemming Ørnskov, MD, MPH, chief executive officer at Galderma, Fort Worth, Texas. "With over 30 ongoing pipeline projects in aesthetics alone, we will continue to enhance our diverse and broad portfolio of sophisticated brands to advance dermatology for every skin story."

1. Restylane celebrates 25 years of natural-looking results with its signature line of hyaluronic acid fillers. Cision PR Newswire. Press release. Published September 30, 2021. Accessed October 13, 2021. https://www.prnewswire.com/news-releases/restylane-celebrates-25-years-of-natural-looking-results-with-its-signature-line-of-hyaluronic-acid-fillers-301388779.html

Articles

On September 30, 2021, Galderma celebrated its 25th anniversary of its Restylane line of hyaluronic acid fillers. 

Galderma Celebrates Restylane’s 25th Anniversary

Morgan Petronelli is an associate editor for 

and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

She enjoys working out, listening to music, and playing with her dog Scout. You can reach her at 

Adelaide Hebert, MD, chief of pediatric dermatology at the McGovern Medical School at UTHealth Houston, Texas drilled down into the intricate details of eczema, sharing her experience of the disease in pediatric patients.

To listen to what she had to say, watch the video below. 

 Well thank you so much for joining me today. My name is Morgan Petrelli, Associate Editor with dermatology times and today I'm joined by Dr. Adelaide Hebert, Dr. Hebert if you want to introduce yourself and any of the research that you're currently conducting.

 I'm Dr. Adelaide Hebert. I work at the University of Texas Medical School in Houston, Texas. I've been chief of pediatric dermatology here for 37 years, and have been actively engaged in clinical research for the past 36 years. The research interests that I have include atopic dermatitis, psoriasis, hyperhydrosis, acne, rosacea, skin, soft tissue infections, and diaper dermatitis. We really will study almost anything that deals with skin in both pediatric and adult realms. I don't typically do IV antibiotics studies, but we're very interested in biologic therapy and the new Janus kinase (JAK) inhibitors. We do the full scope we feel of research within the adult and pediatric realm.

 How does the prevalence of eczema differ based on age, gender, and race and or ethnicity?

 We see a vast difference in atopic dermatitis (AD) in different groups. One of the examples that I often use is that if the parents have eczema, asthma, or hay fever, the child is more prone to developing this skin condition. We do see a trend in families, but we do see children who have no family history who can develop severe eczema as well.

We certainly see different characteristics [in different demographic groups]. Asian people tend to have very severe eczema; they really suffer with this disease state. In the Black population, we may or may not have the genetic basis influencing the skin findings and the barrier effect, but we can still see profound AD.

Asthma is often associated with eczema. In the state of Texas, the number 1 drug written for children is an asthma drug. We also see eczema in patients if, for example, 1 or both parents have been born overseas and they immigrated to the United States. That child can have worse eczema. It's not just immigrating to the United States. This is known in other countries as well. It's about immigrating to a country where the skin has not been accommodated to, and then the eczema can be more profound. 

That’s something I make parents aware of. I don’t suggest that they go home to their country of origin, but they will often relay to me that, if they go home for a holiday and come back, the eczema goes away magically. That's not something they observed while in the United States. 

So, we do see very variations in the amount of eczema across the different ethnicities, but also against the against the different Fitzpatrick skin types.

 What is eczema’s impact on quality of life? What about its effect on comorbidities?

 We feel that eczema is 1 of the most impactful disease dates in terms of quality of life [QoL]. It impacts not just the child but also the family. One of the impacts in terms of QoL is itching. These patients don't sleep well, and their parents don't sleep well. There's co-sleeping where the child gets in bed with the parent and the parent’s sleep is disrupted by the child's itching. 

The concern we have with this is aging status. Not only do the children disrupt the skin barrier by scratching, they also disrupt their deep sleep so their growth hormone is not secreted, and their linear growth can be impacted unfavorably. There are many arenas in QoL that are affected.

These children have a difficult time going out during very hot summers as the protein and sweat serves as a trigger for furthering the condition. Also, dust mites can play a role. Unfortunately, because we have a very moist environment, they can survive even in the cleanest of homes. There can be associated conditions such as metabolic syndrome. There also may be a slight increase of cardiovascular events in our more aged patients. All these things impact QoL.

The QoL is greatly impacted because we have difficulties in controlling this ongoing relapsing disorder that is visible for patients with psychosocial development, even when they are adults. We know because it's such a visible disorder, and the patients have concurrent scratching, it can be extremely problematic. Another factor that we should consider is these patients get more cutaneous infections, both bacterial and viral. 

There's not a realm of the patient’s life that AD doesn't touch upon. This is 1 of the discussions we often have with patients and their parents when they come in for their initial or ongoing evaluations for this disease.

Make sure to stay tuned for the other 2 parts in this 3 part series. 

Videos

In this episode of DermView, Adelaide Hebert, MD, explains how eczema can lead to growth issues in pediatric patients, how environmental factors may play a role in flare ups, and more. 

DermView Episode 1: Environmental Factors and Ezcema

Cynosure, a medical aesthetics company, recently announced the clearance of its Potenza radiofrequency (RF) microneedling system by Health Canada.

The Potenza devices’ 4 modes—monopolar or bipolar, delivered at either 1 MHz or 2 MHz frequency—offers more customized microneedling treatments for patients and allows physicians to deliver both shallow and deep treatments on a single system. The device's monopolar RF mode delivers energy across a large area of tissue for deep heating and skin tightening through soft tissue coagulation for the whole body and in all skin types.

The bipolar RF mode offers a more concentrated delivery of energy to treat superficial tissue and provides skin revitalization results. The device is also equipped with Tiger Tip technology, the first semi-insulated needles of its design which allows practitioners to expand the treatment zone and address more tissue per treatment, leading to faster sessions for patients without consequences, according to the company. The device also has a single-needle handpiece designed to target and improve active acne.

The Fusion Tip is the newest addition to the Potenza system. It uses a dual-air chamber design to capture and release air toward the skin with every pulse. This design allows the penetration of topicals into the skin at a 67% better rate, according to Cynosure. Practitioners can maximize topical penetration while tightening the skin through soft tissue coagulation with the use of the tip.

"We're constantly challenging ourselves to drive innovation forward and deliver differentiated technologies that allow our customers to provide better, more customizable treatments for their patients," said Todd Tillemans, CEO of Cynosure, Westford, Massachusetts. "The Fusion Tip is the first and only RF microneedling tip on the market designed to enhance the penetration of topicals deeper into the dermis, improving the quality of your skin. This is a real game-changer for RF microneedling, and we're proud to be at the forefront of this next-level technology."

Additionally, Deanne Mraz Robinson, dermatologist, Modern Dermatology in Westport, Connecticut said: "Potenza's new Fusion Tip enables me to confidently deliver topicals deeper in the dermis, allowing me to reach where it matters most. By enhancing the penetration of topicals into the skin, I am able to maximize patient results." 

Procedures are recommended to be done with 3 to 5 treatments at roughly 4 to 6 weeks apart but, patients may notice improvements in their skin after the first or second treatment and will continue to see improvements 6 to 12 months post-treatment. 

Potenza RF Microneedling System is commercially available in Canada and only compatible with Cynosure's Potenza device. 

1. Cynosure launches best-in-class Potenza RF microneedling system with new fusion tip for enhanced topical penetration in Canada. Cision PR Newswire. Press release. Published October 6, 2021. Accessed October 14, 2021. 

https://www.newswire.ca/news-releases/cynosure-launches-best-in-class-potenza-tm-rf-microneedling-system-with-new-fusion-tip-tm-for-enhanced-topical-penetration-in-canada-884755918.html

Potenza, Cynosure’s RF microneedling system, has been cleared by Health Canada. 

Cynosure RF Microneedling System Cleared in Canada

 tells the story of 6 people with psoriasis who had biologics change their life and 

explains the newest sunscreen regulations from the FDA. Also, 

explores if consumers really need a skincare fridge and 

asks the question should I see an Esthetician or Dermatologist. Finally, 

features a dermatologist who explains who face toner should or should not be used and 

identifies the difference between acne on the lip and a cold sore. 

6 People With Psoriatic Arthritis Share How Their Lives Changed After Finding the Right Biologic

The FDA Just Updated Its Sunscreen Regulations, and This Is Everything a Consumer Should Know

Esthetician or Dermatologist: Who Should I See?

Are the Pimples on Your Lip Actually a Cold Sore?

This week’s edition of The Mainstream Patient features stories about how biologic treatments changed 6 psoriasis patients lives, updated sunscreen regulations, and more!

The Mainstream Patient: October 18, 2021

A preview at what to expect from Dermatology Times this week.

Coverage from the 2021 Fall Clinical Dermatology Conference happening October 21-14;

What's New on Dermatology Times: October 18-22

 podcast, Gary Linkov, MD, board-certified facial plastic and hair surgeon and founder and medical director of 

 in New York, New York sits down with to discuss the world of hair loss. He describes not only how to treat and prevent the condition, but how his own experience with hair loss helps him treat patients. 

If you would like to hear more from Linkov, you can follow his Youtube channel linked 

Podcasts

This episode of The Cutaneous Connection podcast, Gary Linkov, MD, dives into the topic of hair loss. 

The Cutaneous Connection: Hair Loss Trends, Challenges, and Prevention

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho.

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho, explains what keratosis pilaris (KP) is and how to improve the condition. After going through his best tips to try to show improvement, he describes when it would be best to go to the dermatologist.

To hear what he has to say, watch the video below.

Opinions expressed are that of Portela and do not express the views or opinions of Dermatology Times®.

In this week’s Pointers with Dr Portela, the 208SkinDoc explains what keratosis pilaris is and whether or not it can be cured.

Pointers With Dr Portela: Can Keratosis Pilaris Be Cured?

Armand Butera is the assistant editor for 

. He attended Fairleigh Dickinson University and graduated with a degree in communications with a concentration in journalism. Prior to graduating, Armand worked as the editor-in-chief of his college newspaper and a radio host for WFDU. He went on to work as a copywriter, freelancer, and human resources assistant before joining 

. In his spare time, he enjoys reading, writing, traveling with his companion and spinning vinyl records. Email him at 

Investigators in France developed and validated a dermatologic specific burden score called the Vitiligo Impact Treatment (VIT) score.

 population and patient acceptable symptom state (PASS) was calculated and defined to help identifying patients overwhelmed by the treatment.

Investigators led by Julien Senechal, MD, PhD, Service de Dermatologie, Centre de Référence des Maladies Rares de la Peau, Hôpital Saint André, CHU de Bordeaux, believed the questionnaire would be used to develop patient-centered approaches to vitiligo management involving the personalized adaptation of treatment regimens to find a balance between treatment benefit and burden.

They also noted the “devastating” impact on the quality of life and self-esteem and psychiatric comorbidities vitiligo can have on the 0.1% to 2% of the world’s population who are affected by the disease, and the challenges regarding appropriate treatment.

Their study occurred in the framework of an ongoing e-cohort project called ComPare. In it, the investigators aimed to develop and validate a patient reported measurement of the burden of treatment in vitiligo patients.

Senechal and colleagues utilized a multistep method to develop a questionnaire to measure the burden of patients with vitiligo.

The investigators initially conducted a literature search on PebMEd to identify published questionnaires or scoring systems related both to the quality-of-life impact and burden of treatment of vitiligo.

Among vitiligo quality of life scales, several instruments such as the vitiligo impact scale, the vitiligo impact patient scale, and the vitiligo life quality index related to treatment burden.

As of December 2020, the ComPaRe cohort consisted of 42,000 patients with chronic conditions. A total of 343 adult patients with vitiligo from the cohort were included in the current study.

Each participant from the cohort was tasked with answering an online survey with open ended questions that explored the different aspects of vitiligo. Their responses would be analyzed and used to identify 24 themes related to the burden of the disease.

Each theme was transformed in a questionnaire and evaluated with a 4-point Likert scale: "Disagree" (1), “Slightly agree" (2), "Agree" (3), "Strongly Agree" (4) and "Not concerned" (0).

Construct validity of the instrument was assessed by comparing the instrument’s score to the Dermatology Life Quality Index (DLQI), Vitiligo Impact Patient score (VIPs) and Treatment Burden Questionnaire (TBQ) scores.

By the end of the study, a 19-item questionnaire was developed that assessed the burden of treatment in patients with vitiligo through 4 pertinent dimensions: finding a doctor, topical treatments, light treatment, and impact on outdoor activities and photoprotection.

The team noted that their instrument complemented existing measures of dermatologic quality of life such as the DLQI and VIP, and that they believed their score fulfilled an unmet need in the clinical research of vitiligo by defining the burden of treatment as the core outcome.

Additionally, they believed it could be used in clinical practice as a validated global score that is easy to calculate to identify patients overwhelmed by their treatment and demonstrated that patients with a VITs score above 48.5 (PASS) were at risk of being overwhelmed.

Though the study was conducted based on the burdens of vitiligo, Senechal and investigators stated that “future studies could explore how our patient reported instrument could be generalized to other chronic inflammatory skin diseases.”

“Vitiligo Treatment Impact score (VITs): development and validation of a vitiligo burden of treatment questionnaire using the ComPaRe Vitiligo e-cohort,”

 was published online in the Journal of The European Academy of Dermatology and Venereology.

This article was initially published by our sister publication

Investigators believe the new instrument could be generalized to other chronic inflammatory skin diseases in future studies.

Investigators Develop New Vitiligo Impact Treatment Score

Cash balance plans (CBPs) are often referred to as today’s “modern retirement plans” because their use has grown rapidly in closely held businesses, including medical practices, during recent years. CBPs are a solution for high-income practice owners looking for tools that can provide them with significant short-term tax deductions along with strong long-term economics.

A CBP is a qualified retirement plan (QRP) that can provide dermatologists with a way to increase tax deductions and simultaneously boost retirement savings.

In a CBP, a participating employee will have access to a certain sum upon reaching retirement. Let’s use $100,000 as an example. To get to $100,000 at retirement, the plan assumes a combination of employer contributions and compound interest overtime. When the employee retires, they can take the $100,000 either as a lump sum or as an annuity that pays a portion of the $100,000 in periodic payments.

CBPs are like traditional defined benefit plans in terms of the funding and reporting requirements. Minimum funding standards apply; there is a minimum annual employer contribution that is reported on the CBP’s tax form 5500. An actuary is required to calculate this contribution amount using a reasonable actuarial funding method and actuarial assumptions specified by the IRS. The employer can decide to con- tribute an amount between the minimum funding requirement and the maximum permitted deduction but should attempt to fund to the actuary’s recommended contribution level to meet the plan’s current benefit liability.

On the other hand, CBPs are different from traditional defined benefit plans that promise a specified monthly benefit amount at retirement (ie, 3% of pay per year of employment, payable at the retirement age of 67). CBPs define benefits in the form of an account balance, rather than a periodic amount. This can be helpful because employees always understand what they are entitled to under the CBP because it is a specific amount. Owners and employees both know what is going into the plan on their behalf and what will come out when they leave.

CBPs and 401(k)s are not mutually exclusive. In fact, a dermatology practice can typically utilize both types of plans simultaneously, “layering” a CBP on top of its existing 401(k).

There are 4 compelling reasons why dermatology practices are inter- ested in CBPs:


In 2021, 401(k)s are subject to maximum deductible contribution limits of $19,500, with profit-sharing plan limits at $58,000. (The catch-up contribution for those over age 50 is an additional $6,500 annually.) These limits increase slightly each year. Properly structured CBPs, on the other hand, can allow business owners to make tax-deductible contributions of $200,000 or more, potentially saving them $80,000 to more than $100,000 in income taxes annually.

2. Additional Costs Are Much Lower Than Additional Tax Savings


CBPs usually involve higher annual administration costs and higher employer contribution amounts for employees than 401(k)s and/or profit-sharing plans. Nonetheless, the tax savings typically dwarf these additional expenses, making the CBP extremely attractive.

3. Possible Second Level of Tax Deduction


For those whose income puts them above the new tax code’s 

qualified business income (QBI) threshold limits, a CBP can be a tool to reduce taxable income enough to qualify for the QBI deduction, creating 1 deduction that leads to a second deduction

CBPs are powerful planning tools that provide larger contribu- tions than the QRPs most medical practices use today. CBPs can be attractive to practice owners who are looking for greater tax deduc- tions, asset protection, and superior retirement savings.

4. Greater Access to Top (+5) Asset Protection Level

As an exempt asset under federal law and most state laws, ERISA-qualified QRPs are protected at the highest (+5) level. Unless a CBP is put in place for only 1 owner, with no other employees, this ERISA protection will usually also apply to the CBP. With larger contribution levels allowed in the CBP, this means more wealth can be protected in the CBP than in most other QRPs.

OJMGroup,LLC(OJM) is an SEC registered investment adviser with its principal place of practice in the state of Ohio. SEC registration does not constitute an endorsement of OJM by the SEC nor does it indicate that OJM has attained a particular level of skill or ability. OJM and its representatives are in compliance with the current notice filing and registration requirements imposed upon registered investment advisers by those states in which OJM maintains clients. OJM may only transact practice in those states in which it is registered or qualifies for an exemption or exclusion from registration requirements.

For information pertaining to the registration status of OJM, please contact OJM or refer to the Investment Adviser Public Disclosure web site www.adviserinfo.sec.gov. For additional information about OJM, including fees and services, send for our disclosure brochure as set forth on Form ADV using the contact information herein. Please read the disclosure statement carefully before you invest or send money. This article contains general information that is not suitable for everyone.

The information contained herein should not be construed as personalized legal or tax advice, or as a recommendation of any particular security or strategy. There is no guarantee that the views and opinions expressed in this article will be appropriate for your particular circumstances. Tax law changes frequently, accordingly information presented herein is subject to change without notice. You should seek professional tax and legal advice before implementing any strategy discussed herein.

O’Dell is the managing partner with OJM Group in Cincinnati, Ohio, a financial consultant, and the author of more than a dozen books on wealth management for doctors. Foos is a partner and lead tax consultant with OJM Group in Cincinnati, Ohio.

Tap the Tax, Savings Potential of Cash Balance Plans

Last week, Boehringer Ingelheim announced that the US Food and Drug Administration (FDA) approved the supplemental Biologics Liscense Application for adalimumab-adbm (Cyltezo), which will become the first interchangeable biosimilar with adalimumab (Humira).

Adalumumab-adbm was originally approved by the FDA for the treatment of multiple chronic 

back in 2017, but the latest approval will deem it as interchangeable across all of these indications.

Approval for interchangeability was prompted by the positive data seen in the phase 3 randomized VOLTAIRE-X clinical trial, which studied the effects of multiple switches from adalimumab to adalimumab-adbm.

The study found that adalimumab-adbm was equivalent to adalimumab, with no clinically meaningful differences in pharmacokinetics, efficacy, safety, and immunogenicity recorded between the switching and continuous treatment groups.

In a statement made by Boehringer Ingelheim, Martin Menter, MD, chairman of the Division of Dermatology at Baylor University Medical Center, stated that the approval represented “an important step” towards offering more affordable treatment options for complex and expensive biologic reference products to patients in need.

“This is incredibly important for patients, who can be confident that once available, citrate-free Cyltezo® has the same efficacy and safety as the originator medicine with the added benefit of cost savings,” Menter said.

Additionally, senior vice president of Medicine and Regulatory Affairs at Boehringer Ingelheim Thomas Seck said that the interchangeability status of the biosimilar “reinforces (the company’s) goal of expanding overall treatment options and contributing to the quality and sustainability of the US healthcare system.”

Though it is not commercially available in the US, the commercial license of adalimumab-adbm will begin on July 1, 2023.

The approval was supported by promising phase 3 data of the VOLTAIRE-X clinical trial.

The Cutaneous Connection: Hair Loss Trends, Challenges, and Prevention

Pointers With Dr Portela: Can Keratosis Pilaris Be Cured?

Investigators Develop New Vitiligo Impact Treatment Score

Tap the Tax, Savings Potential of Cash Balance Plans

FDA Approves Adalimumab-adbm as First Interchangeable Biosimilar with Adalimumab

The changing treatment landscape of plaque psoriasis