A plethora of oral and topical treatments are available for patients, according to Stein Gold’s SCALE 2023 sessions.
Whether a patient needs an oral or topical treatment option, dermatology professionals have a vast armamentarium of medications to choose from for atopic dermatitis, psoriasis, and acne. At the 2023 SCALE meeting in Nashville, Tennessee, Linda Stein Gold, MD, the director of clinical research in the department of dermatology at Henry Ford Hospital, reviewed the numerous oral and topical options available to help patients achieve clear skin, whether they have atopic dermatitis, psoriasis, or acne.
Stein Gold: Hi, I'm Linda Stein Gold, I'm from the Henry Ford Health System in Detroit, Michigan. Today I talked about what's new in JAK therapy for atopic dermatitis and for psoriasis. In atopic dermatitis, we have a topical JAK, ruxolitinib, that's been FDA-approved. We saw really good efficacy. We use it twice a day and in clinical trials for 8 weeks, we saw over 50% of patients getting to clear or almost clear, and for a nonsteroidal topical, it had really very low incidence of local irritation. So that's good news. In terms of the oral JAKs, we have abrocitinib and upadacitinib. These drugs offer really good efficacy, they kick in very rapidly. And we see a very rapid reduction in itch. As long as you monitor appropriately, do baseline labs, and follow these patients either at month one or month 3, and then as needed. I think these are a really important addition to our treatment armamentarium. And then finally, for psoriasis, we have an oral TYK2 inhibitor, deucravacitinib. This drug is highly specific for TYK2, which is important for the inflammatory process of psoriasis. We saw nice efficacy with really good safety and tolerability. This drug doesn't have blood monitoring other than the TB tests at baseline, and in patients who have potentially liver disease. But otherwise, I think we have some wonderful treatments. And it's important to get educated on what treatments are available so we can do the best possible for our patients.
Dermatology Times®: What are the top highlights from your session, "The Treatment of Acne in 2023: How I Do It?"
Stein Gold: Today I talked about what's new in acne in 2023. And how I'm treating my patients. We have some great new topical approaches, we have a fixed combination that utilizes full-strength tretinoin in combination with benzoyl peroxide. And the way we can mix these unmixables is we have a silica shell that surrounds each of these actives, and very slowly and deliberately releases them onto the skin. So a nice fixed combination, once daily. We also have topical clascoterone which is the first drug to actually decrease sebum production in a topical treatment modality. So that's exciting. We can use it for both men and women. And I like to use it in combination with other treatments. We have oral sarecycline, which isn't so new, but it's important to remember that this drug has really great anti-inflammatory properties. It doesn't cross the blood-brain barrier. So it doesn't cause dizziness and has a lower GI side effect profile. And then we have some new data on oral isotretinoin. We have things hanging over our heads like does it cause depression? Does it cause inflammatory bowel disease? And 2 nice new studies that actually have shown that in fact, isotretinoin decreases a lot of the psychiatric problems that we see in our patients, and there did not seem to be a positive association with isotretinoin and inflammatory bowel disease. In fact, it appears that it's the acne itself that poses an increased risk. So, a lot is new in the treatment of acne and we're able to get our patients under better control than we have before.
[Transcript edited for clarity]