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Marie Bosslett is the assistant editor of 

 and joined the MJH Life Sciences team in October 2024. She attended Loyola University Maryland in Baltimore and earned a Bachelor of Arts in Communication with minors in marketing and writing. When she’s not writing, Marie enjoys going to concerts, reading on the beach, and spending time with friends and family.

Articles

The innovative 21-item Hair & Scalp CARE questionnaire is designed to evaluate the psychological impact of hair and scalp conditions on quality of life.

Newly Developed Questionnaire Evaluates Quality of Life for Patients with Hair and Scalp Conditions

Maddi Hebebrand is an associate editor of 

and joined the MJH Life Sciences team in May 2024. She attended Baldwin Wallace University, studying Media Production and Film, and received her Masters in Digital Media from Ohio University. When she's not writing, Maddi loves to read, attend concerts and spend time with her family. 

The FDA approved pz-cel, a groundbreaking gene therapy for recessive dystrophic epidermolysis bullosa, transforming treatment options for patients.

FDA Approves First Gene Therapy for RDEB

JAK inhibitors show promise in treating alopecia areata among Black patients, highlighting the need for inclusive clinical research and equitable access to therapies.

Subgroup Case Series Reveals JAKi Efficacy for Black Patients With AA

and joined the MJH Life Sciences team in February 2023. She attended Kent State University and earned a Bachelor of Science degree in journalism with minors in public relations and creative writing. She enjoys making and listening to music, reading, and spending time with her cats, Astrid and Marceline.

Catch up on dermatology news, highlights, and insights from the past 24 hours.

Daily Derm Times: April 28, 2025

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Final Thoughts: The Importance of Comparative Studies in AD

Panelists offer concluding insights and emphasize the critical role of comparative studies in advancing atopic dermatitis treatment strategies.

clinical

Video Series

A recent study study aimed to assess the efficacy and safety of Botulinum toxin type A (BTX-A; Botox) in treating this condition. The research, following PRISMA guidelines, reviewed 6 studies encompassing open-label, controlled trial, double-blind placebo-controlled, and observational designs. The results consistently indicated that BTX-A effectively reduced symptoms of hyperhidrosis with no significant side effects. The treatment significantly improved QoL, decreased sweat rate and production, and did not adversely affect grip strength. Additionally, the prolonged antisudorific effect suggested the potential for long-term management of palmar hyperhidrosis with BTX-A.

However, this treatment may not be effective in many cases.

Other treatment options, including topical agents, medical devices, systemic therapies, and surgical interventions, are available for palmar hyperhidrosis, given its significant impact on quality of life. Nonsurgical approaches, such as topical antiperspirants, iontophoresis, and systemic agents, are supported by current literature, with topical therapies often beneficial for mild to moderate cases. 

As the disease severity increases, systemic oral medication, like anticholinergic drugs, may become necessary, and surgical approaches are considered last-line for severe refractory cases. Recent therapeutic advancements are emerging as promising alternatives in clinical trials. However, the selection of treatment modalities should consider disease severity, benefit-to-risk profile, cost, patient preference, and clinician expertise, with the review providing insights to help clinicians optimize decision-making in managing excessive hand sweating.

Do you use all or any of these in combination? We want to know. Email us at 

1. Rashaan R, Arkoumanis PT. The efficacy of Botulinum Toxin A in treating palmar hyperhidrosis - a literature review. 

. 2023;18(4):712-717. doi:10.26574/maedica.2023.18.4.712

2. Gregoriou S, Sidiropoulou P, Kontochristopoulos G, Rigopoulos D. Management strategies of palmar hyperhidrosis: challenges and solutions. 

. 2019;12:733-744. Published 2019 Oct 4. doi:10.2147/CCID.S210973

Botox? Iontophoresis? Let us know what you most often recommend to your patients with severe palmar hyperhidrosis.

Polls 

POLL: What Is Your Go-to Treatment for Severe Palmar Hyperhidrosis?

As clinicians look ahead to the upcoming 

Revolutionizing Atopic Dermatitis (RAD) conference

, scheduled for June 6 to 7 in Nashville, Tennessee, one of the much-anticipated lectures is set to be delivered by Christopher Bunick, MD, PhD, associate professor of dermatology and translational biomedicine at Yale University School of Medicine and 

' 2025 editor in chief. His session, titled "Assessing the Evidence for OX40-OX40L Axis Inhibition for the Treatment of Atopic Dermatitis," will explore a promising immunologic pathway that may shift the treatment paradigm for patients with moderate to severe disease.

, Bunick shared his enthusiasm for the RAD conference and highlighted the critical role such events play in advancing clinical knowledge and improving patient outcomes. 

“One of the most important things that a meeting like RAD can do is to teach dermatologists about all of the components needed to elevate the standard of care of atopic dermatitis patients,” he said.​

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

Christopher Bunick, MD, PhD, Previews RAD 2025: Raising the Bar in Atopic Dermatitis Care

Atopic dermatitis (AD) management continues to evolve rapidly with a growing number of targeted therapies in development and already approved. Bunick emphasizes the RAD conference as a key educational moment for clinicians to stay abreast of emerging treatment goals and benchmarks. 

“Going to a meeting like RAD allows a learner to really understand how there are new benchmarks, how to achieve optimal treatment targets and minimal disease activity,” he explained.​

The upcoming talk by Bunick will explore the scientific rationale and therapeutic potential of targeting the OX40-OX40L pathway—a T-cell co-stimulatory axis implicated in the chronic inflammation of AD. Bunick noted the session aims to help clinicians critically assess clinical trial data and pipeline therapies. 

“All the therapies that we're using and how those therapies are trying to get those patients to that optimal treatment target” will be part of the discussion, he said.​

With more therapeutic choices comes greater responsibility for clinicians to make nuanced decisions based on disease severity, patient comorbidities, and long-term outcomes. Bunick sees RAD as essential to this process: “A meeting like RAD is essential for learning how to better manage our atopic dermatitis patients and hit those optimal treatment targets with the therapies that we have and to learn about all the therapies that are in development for atopic dermatitis.”​

Bunick also made a compelling case for why dermatologists should prioritize attending this year's RAD meeting:


“It’s in an incredibly fun city, Nashville, Tennessee,” he said, adding a personal note: “I was born and raised in Tennessee, and I can tell you Nashville is a fun place to be.”


Attendees can expect expert-led sessions from the leading voices in AD research and clinical care. “You're going to have some of the top experts in atopic dermatitis education there teaching, and so you're bound to learn more than you ever could have hoped for about atopic dermatitis,” Bunick shared.


Ultimately, RAD is about translating cutting-edge science into better outcomes. “The best reason to attend is it's all about the patient. This is about making the patients better, and you will take home pearls that help you help your patients better than ever,” he concluded.

As the treatment landscape for AD becomes increasingly complex, conferences like RAD provide clinicians with an invaluable opportunity to refine their knowledge, exchange ideas with peers, and engage directly with thought leaders like Bunick. His lecture on the OX40-OX40L axis will be a key session for those looking to understand the next frontier in AD immunotherapy.​

To hear more about OX40 inhibition from Bunick,

register to attend the 2025 Revolutionizing Atopic Dermatitis (RAD) Annual Meeting

in Nashville, Tennessee, held June 6-7. Use code DT40 for 40% off your registration.

A recent study indicates that patients with metastatic melanoma who discontinue adjuvant immunotherapy before 12 months due to toxicity do not experience worse outcomes compared to those who complete the full course. The study highlights the importance of optimizing treatment duration to mitigate toxicity risks and financial burdens. Data from a multicenter skin cancer database showed that early termination of nivolumab or pembrolizumab did not significantly affect recurrence-free survival. However, limitations exist due to the multicenter registry's data constraints and lack of detailed reasons for treatment discontinuation.

Interview conducted at Global Aesthetic Conference 2019.

The surgical eyelid procedure is used to improve the appearance of the eyelids by removing and/or repositioning excess skin, muscle and fat. But what should you do when there’s an additional underlying defect that also contributes to eyelid appearance?

Blepharoplasty and ptosis: Correct or refer

Richard Gentile, M.D., a board-certified facial plastic surgeon in Boardman, Ohio, spoke this weekend at the 

 2019, Miami Beach, about minimally invasive neck lifting.

“It's been an area that I've been intensely involved with in both the development of technologies and techniques to do more to get good results without extensive surgery because that's what our patients tend to be very interested in,” he says.

Dr. Gentile has been practicing in Northeast Ohio for 32 years.

While neck lifting techniques began with isolated surgery, and perhaps, some liposuction, he says, today’s approaches have evolved to include the use of energy devices for skin tightening results.

“In about 45 minutes we can transform a neck without substantial surgery,” notes Dr. Gentile.

The evolution from isolated surgical procedures to today’s energy-based techniques began about 12 years ago with the use of fiber lasers, according to Dr. Gentile.

“These are small lasers that are introduced through a stainless steel cannula. Through a number of small entrance incisions, we could… use these to heat the fat, melt the fat and tighten the skin. In addition to this, occasionally, we would do some muscle tightening and other things that we could do through small incisions.”

Notably, these techniques limited the need for larger incisions around the ears and neck that result from traditional neck lifting, he says.

“These devices included the original SmartLipo laser, which then became Thermi RF. Now, we're into devices such as FaceTite [inMode] and AccuTite."

Plasma device Renuvion is the latest one, he says. "And I'm very pleased to have been actively involved in designing some of the new hand pieces for Renuvion.”

He describes the plasma device technology as “a very hot stream of plasma that can melt fat and tighten skin. And we've had some truly remarkable results with Renuvion... We’ve had really outstanding results with FaceTite as well,” he says.

 (FFAS) meeting in New Orleans, Dr. Gentile says he saw the plasma technology on exhibit by 

“Bovie had the original cautery unit, and they're not known for new technology. So they had this new thing and I'm kind of laughing thinking, Oh, what is this going to be? And sure enough, it was novel technology, and now everybody's heard about it. And it’s really cut some traction, which is good for the company [because if they aren’t] commercially successful, then we lose this whole technology.”

Minimally invasive neck lifting has evolved significantly, incorporating energy devices for skin tightening and fat melting, reducing the need for extensive surgery. Dr. Richard Gentile, a facial plastic surgeon, has been instrumental in developing these techniques, which began with fiber lasers and have progressed to advanced devices like FaceTite, AccuTite, and Renuvion. These technologies offer transformative results in a short time, with minimal incisions. Dr. Gentile's involvement in designing new handpieces for Renuvion highlights the ongoing innovation in this field, enhancing patient outcomes and commercial viability.

“In about 45 minutes we can transform a neck without substantial surgery.” That’s according to Dr. Richard Gentile who spoke about the evolution from surgery to energy-based solutions for skin tightening at this year’s Global Aesthetics Conference in Miami Beach.

Lasers for necklifting

The landscape of plaque psoriasis treatment is evolving, particularly in how physicians think about disease severity, treatment goals and the timing of systemic therapy use or initiation.

 Recent guidance has redefined how we classify psoriasis severity, recognizing that even patients with limited skin involvement may experience substantial disease burden and could benefit from systemic therapy.

 Emerging research continues to enhance our understanding of treatment approaches for these patients and may help inform optimal management strategies.

A recent large-scale, real-world evidence study has provided important insights into the impact of timing of initiating a systemic therapy in plaque psoriasis treatment.

 To explore these findings, we spoke with two leading experts in the field: Dr. Linda Stein Gold, Division Head of Dermatology at Henry Ford Health System and former vice president of the American Academy of Dermatology, and Dr. April Armstrong, Chief of Dermatology at University of California, Los Angeles. Both doctors were investigators on the real-world study discussed below.

How to Approach Plaque Psoriasis Treatment in Patients with Limited Skin Disease

Considerations When Treating Plaque Psoriasis with Topical Therapy

Clinical Considerations For Evaluating the Potential Benefits of Systemic Treatments

Navigating Patient Conversations Around Potential Systemic Use


Otezla® (apremilast) is indicated for the treatment of adult patients with plaque psoriasis who are candidates for phototherapy or systemic therapy.

Otezla® (apremilast) is contraindicated in patients with a known hypersensitivity to apremilast or to any of the excipients in the formulation.

Please see additional Important Safety Information further below.

Otezla Clinical Evidence: The ADVANCE Trial

Before examining the real-world evidence, it's important to understand the foundational clinical data that preceded it. The pivotal Phase 3 ADVANCE trial was a multicenter, randomized, placebo-controlled, double-blind study evaluated Otezla® (apremilast) in 595 adult patients with mild to moderate plaque psoriasis.

The study population had a mean baseline body surface area (BSA) of 6.4%, with inclusion criteria requiring BSA involvement of 2%-15%, a Psoriasis Area and Severity Index (PASI) score of 2-15, and a static Physician's Global Assessment (sPGA) score of 2-3. These were patients who had been inadequately controlled with or intolerant to topical therapy and were allowed unmedicated emollients for body lesions and nonmedicated shampoos for scalp.

 Patients were randomized 1:1 to receive either Otezla 30 mg twice daily (n=297) or placebo (n=298) for the first 16 weeks, followed by an open-label extension phase through week 32.

The trial met its primary endpoint, with 21.6% (n=297) of patients receiving Otezla achieving an sPGA

 response at week 16 compared to 4.1% (n=298) with placebo (p<0.0001). The study also demonstrated statistically significant improvements in key secondary endpoints at week 16, including Whole Body Itch Numeric Rating Scale response

 (43.2% versus 18.6%) and Scalp Physician's Global Assessment response

 (44% versus 16.6%) compared to placebo. The safety profile remained consistent with the safety profile in patients with moderate to severe plaque psoriasis, with the most commonly reported treatment-emergent adverse events (≥5%) being diarrhea, headache, nausea, nasopharyngitis, and upper respiratory tract infection.

"The ADVANCE trial addressed a critical gap in our understanding," explains Dr. Stein Gold, who was also an investigator on this trial. "The five-fold improvement in response rates demonstrated the potential for systemic therapy in this patient population, with 21.6% of patients taking Otezla achieving an sPGA response at week 16, compared to just 4.1% with placebo."

While ADVANCE demonstrated how Otezla can help patients with mild to moderate plaque psoriasis, an important question remained: what impact could the timing of initiating Otezla have on patients? A subsequent real-world study helped shed light on this critical question.

Real-World Evidence: Examining Timing of Initiating Otezla

A recent real-world study has provided insight into the impact of the timing of initiating Otezla in patients with mild to moderate plaque psoriasis. "Real-world data really complement the clinical trial data," explains Dr. Armstrong. "In clinical trials, you often have a very curated population of patients. Whereas in the real world, in our clinical practice, dermatologists have a heterogeneous population of patients that we manage and treat every day. Therefore, real world data that reflect the realities of our daily practice can help inform certain treatment decisions.

The retrospective, observational analysis examined electronic medical record and claims data from the OM1 database, including over 13,000 U.S. adults with mild to moderate plaque psoriasis. The study focused on patients whose first available BSA value after diagnosis was between ≥1% to ≤10% -- designated as the index date. These patients were new to systemic treatment, had no prior psoriatic arthritis diagnosis, had at least a year of baseline data, and either initiated Otezla or started a second topical prescription between 2014 and 2023.

Note: Patients on topicals could either have switched or added a new topical. Notably, patients had a mean BSA of 5.5% at baseline, and in the Otezla arm, about 50.5% used concomitant topical therapy during the study.

A total of 3,589 patients had started Otezla, with 2,073 starting Otezla within 6 months of their index date and 1,516 starting at least 6 months after their index date. Early initiators had a median time to Otezla start of just 2 weeks after their index date, while late initiators didn't initiate treatment until a median of 16 months after their index date.

The studies showed that the early initiator group (n=2,073) experienced a 2% BSA increase from index date to Otezla start (≤6 months; median 2 weeks). In the late initiator group (n=1,516) there was a 49% BSA increase from index date to Otezla start (>6 months; median 16 months).

The study also demonstrated that in the group that initiated Otezla early, 6.0% mean BSA at index date slightly increased to 6.1% mean BSA at Otezla initiation. In the late initiation group, however, 4.9% mean BSA at index date increased to 7.3% mean BSA at Otezla initiation.

The study also revealed important insights about treatment history. "What's particularly noteworthy," Dr. Stein Gold points out, "is that before starting Otezla, 54% of early initiators and 75% of late initiators had tried three or more topicals. This highlights the varying treatment journeys patients may experience before initiating systemic therapy.”

"These findings underscore the timing of systemic therapy," notes Dr. Stein Gold. "Patients who were late Otezla initiators (n=1,516) saw an average of 49% increase in BSA from index date."

Of note, this real-world study had several important limitations to consider. While prescription data was available, actual medication adherence couldn't be confirmed. Additionally, while the study was anchored on the first observed BSA value, this may not have been the patient's first BSA measurement, and disease duration before the index date was unknown. For the topical group, it wasn't possible to distinguish between treatment switching and adding a new topical to an existing regimen.

It's also worth noting that patients with disease severity measures (BSA values) may be different from patients that don't have these measures, though a database comparison suggested no major differences in patient characteristics between these groups.

 Finally, since this is real-world evidence and not a clinical trial, conclusions about statistical or clinical significance cannot be drawn.

Looking Forward: Evolving Approaches to Treating Plaque Psoriasis

The treatment landscape for limited plaque psoriasis continues to evolve, informed by both clinical trials and real-world evidence. The ADVANCE trial demonstrated the efficacy and safety of Otezla in mild-to-moderate disease, while real-world evidence has now highlighted the impact of the timing of initiating Otezla.

 Moving forward, a key opportunity lies in better identifying which patients with limited disease might benefit from systemic therapy before cycling through multiple topicals.

Hypersensitivity: Hypersensitivity reactions, including angioedema and anaphylaxis, have been reported during postmarketing surveillance. If signs or symptoms of serious hypersensitivity reactions occur, discontinue Otezla and institute appropriate therapy

Diarrhea, Nausea, and Vomiting: Cases of severe diarrhea, nausea, and vomiting were associated with the use of Otezla. Most events occurred within the first few weeks of treatment. In some cases, patients were hospitalized. Patients 65 years of age or older and patients taking medications that can lead to volume depletion or hypotension may be at a higher risk of complications from severe diarrhea, nausea, or vomiting. Monitor patients who are more susceptible to complications of diarrhea or vomiting; advise patients to contact their healthcare provider. Consider Otezla dose reduction or suspension if patients develop severe diarrhea, nausea, or vomiting

Depression: Carefully weigh the risks and benefits of treatment with Otezla for patients with a history of depression and/or suicidal thoughts/behavior, or in patients who develop such symptoms while on Otezla. Patients, caregivers, and families should be advised of the need to be alert for the emergence or worsening of depression, suicidal thoughts or other mood changes, and they should contact their healthcare provider if such changes occur

: Treatment with Otezla is associated with an increase in depression. During clinical trials in adult patients with moderate to severe plaque psoriasis, 1.3% (12/920) of patients reported depression compared to 0.4% (2/506) on placebo. Depression was reported as serious in 0.1% (1/1308) of patients exposed to Otezla, compared to none in placebo-treated patients (0/506). Suicidal behavior was observed in 0.1% (1/1308) of patients on Otezla, compared to 0.2% (1/506) on placebo. One patient treated with Otezla attempted suicide; one patient on placebo committed suicide

: Treatment with Otezla is associated with an increase in depression. During clinical trials, 1.0% (10/998) reported depression or depressed mood compared to 0.8% (4/495) treated with placebo. Suicidal ideation and behavior was observed in 0.2% (3/1441) of patients on Otezla, compared to none in placebo-treated patients. Depression was reported as serious in 0.2% (3/1441) of patients exposed to Otezla, compared to none in placebo-treated patients (0/495). Two patients who received placebo committed suicide compared to none on Otezla

: Treatment with Otezla is associated with an increase in depression. During the clinical trial, 1% (1/104) reported depression or depressed mood compared to 1% (1/103) treated with placebo. No instances of suicidal ideation or behavior were reported in patients treated with Otezla or treated with placebo

Weight Decrease: Monitor body weight regularly; evaluate unexplained or clinically significant weight loss, and consider discontinuation of Otezla

Recent advancements in plaque psoriasis treatment have shifted the focus towards understanding disease severity, treatment goals, and the timing of systemic therapy initiation. New guidelines suggest that even patients with limited skin involvement may benefit from systemic therapy. The ADVANCE trial demonstrated the efficacy of Otezla in mild-to-moderate cases, while a real-world study highlighted the importance of early systemic therapy initiation. Early treatment with Otezla was associated with better disease control compared to delayed initiation. These findings emphasize the need for timely systemic therapy in managing plaque psoriasis effectively.

This content is sponsored by Amgen and was developed in conjunction with Linda Stein Gold, MD, April Armstrong, MD, both of whom were compensated by Amgen for their participation. 

Jessica Hergert

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