Fall Clinical 2025: Clinical Innovation and Precision Care

Dermatology clinicians from across the country arrived in Las Vegas, Nevada, from October 23 to 26, 2025, for the 25th Annual Fall Clinical Dermatology Conference. Dermatology Times was live onsite, interviewing presenters to discuss the key takeaways from their session. Some of the key themes from this year’s meeting included raising therapeutic targets, precision medicine through molecular diagnostics, advancements in oral therapies, and an increased understanding of the immune pathways associated with chronic itch.

New Standards in AD Management

Brad Glick, DO, MPH, a practicing dermatologist at Glick Skin Institute in Margate and Wellington, director of the Dermatology Residency at the Larkin Health System Palm Springs Campus, and clinical assistant professor of dermatology at the Florida International University Herbert Wertheim College of Medicine in Miami, all in Florida, discussed the significance of the Aiming High in Eczema/Atopic Dermatitis (AHEAD) recommendations.

According to Glick, new evidence-based approaches, along with the introduction of innovative systemic therapies, are redefining what treatment success means for chronic, relapsing AD. Glick noted that the AHEAD recommendations encourage health care providers to aim for high levels of skin clearance—up to 90% improvement—and a near-complete reduction in itch. This reflects a broader shift in dermatology toward treat-to-target strategies that focus on measurable, patient-centered results rather than symptom minimization alone.

“Much like we raised the bar in psoriatic disease, we are doing it in atopic dermatitis,” Glick said.

GEP Testing and Risk Stratification

Harrison Nguyen, MD, MBA, MPH, managing director and chief investigator at Harrison Dermatology & Research Group in Houston, Texas, discussed the evolving clinical role of gene expression profile (GEP) testing in skin cancers. According to Nguyen, GEP assays such as the 31-GEP for invasive melanoma and 40-GEP for high-risk cutaneous squamous cell carcinoma (cSCC) provide independent prognostic information that can refine clinical decision-making.

For high-risk cSCC, Nguyen typically employs the 40-GEP test following biopsy results confirmation, though in some cases, it may be performed postoperatively, such as after Mohs surgery or wide local excision, if high-risk histologic features are identified intraoperatively.

“There are some really exciting emerging data for prospectively studying the risk of a positive sentinel lymph node biopsy using the GEP test,” Nguyen said.

Emerging Pediatric Psoriasis Therapies

Lisa Swanson, MD, a pediatric dermatologist at Ada West Dermatology in Boise, Idaho, shared her insights on the evolving treatment landscape for psoriasis, particularly about IL-23 inhibition and its emerging role in pediatric and oral therapy.

“They said we could never experience biologic mechanism of action in a pill because the molecules were simply too big,” Swanson explained. “But science is wonderful and amazing.”

Although injectable IL-23 inhibitors have been mainstays in moderate to severe plaque psoriasis for years, Swanson and her copresenters, Tiffany Mayo, MD; and Linda Stein Gold, MD, discussed a new novel agent, an oral peptide IL-23 inhibitor, icotrokinra (Johnson & Johnson).

Phase 3 data have shown durable Psoriasis Area and Severity Index responses and minimal adverse effects, primarily nasopharyngitis and mild headache, a safety profile comparable to injectable biologics.

OX40 Ligand Pathway and Chronic Itch

Shawn Kwatra, MD, professor and chair of dermatology at the University of Maryland School of Medicine in Baltimore, discussed a range of chronic itch presentations and novel immune-based mechanisms. His sessions emphasized diagnostic precision in prurigo nodularis (PN) and chronic pruritus of unknown origin along with the promising therapeutic implications of OX40 ligand inhibition in AD.

Kwatra first highlighted that PN often presents with diverse morphologies, ranging from nodules and papules to excoriated plaques, and is frequently misdiagnosed as neurotic excoriations. He noted that recognizing the characteristic “itch-driven” phenotype is crucial, as these patients may respond dramatically to biologic therapy.

Regarding AD, Kwatra described the OX40 ligand pathway as “the prequel to inflammation”—a pivotal upstream event that precedes cytokine signaling (IL-4, IL-13, IL-31).

“Since atopic dermatitis is such a heterogeneous disease, we'll be hearing a lot more about OX40 ligand in the future of dermatology,” Kwatra said.