Christopher G. Bunick, MD, PhD

Christopher Bunick, MD, PhD, explains why composite endpoints are now critical for evaluating patient outcomes in AD therapy.

Data from the Level Up study shows that switching from dupilumab to upadacitinib enables more patients to achieve optimal targets of skin clearance and itch relief.

In his May letter, Christopher Bunick, MD, PhD, reflects on his journey as a physician-scientist and advocates for supporting foundations dedicated to rare skin diseases.

Christopher Bunick, MD, PhD, discusses the evolving role of OX40-targeted biologics in atopic dermatitis treatment ahead of the upcoming RAD conference.

Acting upstream of cytokines may hold the key to improving biologic efficacy and itch relief in AD.

Discover how the RAD conference in Nashville enhances atopic dermatitis care, featuring expert insights and patient-focused strategies for clinicians.

Panelists discuss how the future of generalized pustular psoriasis (GPP) diagnosis and management looks promising with emerging genetic testing for IL36RN mutations, development of multiple targeted biologics beyond IL-36 inhibitors, potential personalized treatment algorithms, improved disease classification, and enhanced multidisciplinary care approaches to better address this rare but severe dermatological condition.

Panelists discuss how a high-risk patient with generalized pustular psoriasis requires a carefully tailored treatment approach that balances aggressive intervention to control acute flares with consideration of comorbidities, medication interactions, and long-term safety concerns, often necessitating multidisciplinary collaboration between dermatologists, intensivists, and other specialists.

Panelists discuss how medical professionals anticipate new IL-17 inhibitor data, particularly from head-to-head trials like BE BOLD. Interest is growing in sonelokimab, an IL-17A/F nanobody (Papp, 2021). Further research is needed on long-term efficacy, safety, and optimal patient selection.

Panelists discuss how head-to-head trials in psoriasis provide direct efficacy and safety comparisons between IL-17 inhibitors and other drug classes. Studies like BE RADIANT, BE VIVID, and IXORA-R highlight bimekizumab’s and ixekizumab’s superiority over secukinumab and ustekinumab. CLARITY and COBRA compare IL-17 to IL-23 inhibitors, while IMMerge and BE BOLD explore risankizumab’s role. These trials inform treatment decisions by guiding biologic selection based on efficacy, durability, and safety.

Panelists discuss how poorly managed generalized pustular psoriasis (GPP) flares can lead to recurrent hospitalizations and significant morbidity, while reviewing Effisayil 2 trial results that demonstrated the effectiveness of maintenance therapy in preventing flares and sustaining long-term disease control through targeted inhibition of the IL-36 pathway.

Panelists discuss how a generalized pustular psoriasis (GPP) emergency case highlights the rapid onset, systemic complications, and treatment challenges of this condition, while reviewing Effisayil 1 trial results that demonstrated spesolimab’s efficacy in quickly resolving pustulation through IL-36 pathway inhibition, representing a significant advancement in targeted therapy for acute flares.

Panelists discuss how long-term data confirm the sustained efficacy and safety of IL-17 inhibitors in psoriasis. Secukinumab (Bissonnette, 2018; Langley, 2022) and ixekizumab (Blauvelt, 2021) show durable PASI responses over 5 years. Brodalumab’s 5-year pharmacovigilance (Lebwohl, 2024) and 120-week data (Puig, 2020) support its long-term use. Bimekizumab’s 4-year data (Blauvelt, 2024; Gordon, 2024) demonstrate continued efficacy, with 5-year results anticipated at AAD 2025.

Panelists discuss how when prescribing an IL-17 inhibitor, key safety considerations include infection risk (particularly tuberculosis and fungal infections), inflammatory bowel disease exacerbation, allergic reactions, neutropenia, immunogenicity, vaccination timing, pregnancy/breastfeeding status, malignancy history, and monitoring requirements for adverse events.

Dermatology Times' Editor in Chief Christopher Bunick, MD, PhD, discusses patient safety in the wake of AAD 2025, focusing on BPO recalls, corticosteroid risks, and JAK inhibitor innovations.

Panelists discuss how prior and current treatments for patients with generalized pustular psoriasis (GPP) have evolved from traditional systemic therapies with significant limitations to newer targeted biologics and small molecules that specifically address the underlying IL-36 pathway dysregulation, offering improved efficacy and safety profiles for this rare but severe condition.

Panelists discuss how recognizing the flares and triggers of generalized pustular psoriasis requires vigilant monitoring for warning signs such as fever, malaise, and spreading erythema, while understanding that common precipitating factors include medication withdrawals, infections, pregnancy, and certain drugs that can rapidly transform stable disease into acute, potentially life-threatening episodes requiring immediate intervention.

Panelists discuss how IL-17 inhibitors are generally well-tolerated, but common adverse effects include infections, particularly candidiasis, and potential increased suicidal ideation risk. Patients should be informed of candidiasis risk, especially with bimekizumab (Gordon, 2022), and monitored for mood changes, as IL-17s and IL-23s may impact mental health (Blauvelt, 2023). Open discussions help assess risks while ensuring treatment benefits.

Panelists discuss how IL-17 inhibitors are considered for plaque psoriasis based on disease severity, comorbidities, and patient preference. Selection factors include efficacy, safety, access, and cost. Clinical trial data guide choices, but real-world factors impact use. Dosing varies: secukinumab (300 mg weekly for 5 weeks, then monthly), ixekizumab (160 mg at week 0, then 80 mg biweekly for 12 weeks, then monthly), brodalumab (210 mg weekly for 3 weeks, then biweekly), and bimekizumab (320 mg every 4 weeks for 16 weeks, then every 8 weeks). Dosing and device options influence prescribing decisions.

Panelists discuss how generalized pustular psoriasis (GPP) profoundly impacts patients’ quality of life through physical pain, psychological distress, social isolation, and functional limitations, necessitating comprehensive support systems that address both medical management and psychosocial well-being.

Panelists discuss how the diagnosis and management of generalized pustular psoriasis present significant challenges due to its rarity, complex presentation, potentially life-threatening complications, limited treatment options, and the need for multidisciplinary care approaches.

Panelists discuss how inhibition of IL-17 in psoriasis treatment significantly improves quality of life by reducing inflammation, skin lesions, itching, and pain. Patients report better psychological well-being, increased social confidence, and improved daily functioning as inflammatory pathways are interrupted.

Panelists discuss how IL-17 inhibitors are biologics that target the inflammatory cytokine IL-17 pathway. They demonstrate rapid onset of action, with measurable improvement in most patients within 2 to 4 weeks and peak efficacy by 12 to 16 weeks. They achieve high rates of skin clearance in psoriasis patients and maintain efficacy with long-term use.

Panelists discuss how clinical experience in diagnosing generalized pustular psoriasis (GPP) requires recognizing its hallmark features of widespread sterile pustules on inflamed skin, distinguishing it from other pustular conditions, and understanding the genetic mutations and triggers that can precipitate this rare but potentially life-threatening form of psoriasis.

Panelists discuss how generalized pustular psoriasis (GPP), while rare, presents with distinctive widespread sterile pustules on erythematous skin, requires prompt medical intervention, and differs significantly from more common plaque psoriasis in its clinical presentation, triggers, and treatment approaches.

Panelists discuss how IL-17 inhibitors differ in their targets within the IL-17 pathway. Secukinumab and ixekizumab block IL-17A, reducing inflammation in psoriasis and arthritis. Brodalumab inhibits IL-17RA, affecting multiple IL-17 cytokines, but carries suicide risk warnings. Bimekizumab targets IL-17A and IL-17F, potentially enhancing efficacy but with added risk of infections. These differences impact efficacy, safety, and patient selection in inflammatory diseases.

Panelists discuss how IL-17 is a key pro-inflammatory cytokine in plaque psoriasis pathogenesis. It stimulates keratinocyte proliferation, promotes neutrophil recruitment, induces antimicrobial peptides, and up-regulates other inflammatory mediators, creating a self-perpetuating inflammatory cascade in lesional skin.

Christopher Bunick, MD, PhD, shares concluding remarks with colleagues at AAD 2025.

Christopher Bunick, MD, PhD, reviewed the evolving role of antibiotics, emphasizing antibiotic stewardship, the gut-skin connection, and the importance of narrow-spectrum antibiotics at AAD 2025.

Christopher Bunick, MD, PhD, discussed how to interpret recent benzene research as clinicians await regulatory guidance for benzoyl peroxide.