Medical dermatology update takes on systemic disease skin conditions

Jeffrey Phillip Callen, MD,

Jeffrey Phillip Callen, MD, discusses advances in recognizing and diagnosing key skin conditions during “Update Platform: Medical Dermatology.”

“Update Platform: Medical Dermatology” succeeded on every front in presenting the latest advances in recognizing and diagnosing key skin conditions associated with systemic disease. During the Aug. 1 session, the audience was treated to updates on everything from immunobullous blistering conditions to skin disease emerging from organ transplantation.

“In a three-hour session, we could not possibly cover the whole breadth of medical dermatology, but I did select topics quite relevant today within the broad spectrum of potential systemic manifestation of skin diseases,” said course director Jeffrey Phillip Callen, MD, professor of medicine, division of dermatology, University of Louisville School of Medicine, Louisville, Ky.

The Update Platform session featured faculty representing a blend of seasoned dermatologists and rising stars in the specialty, all experts in their fields of focus:

  • Immunobullous disease – John Joseph Zone, MD, professor and chairman, department of dermatology, University of Utah, Salt Lake City
  • Sarcoidosis – Misha Rosenbach, MD, assistant professor, dermatology and internal medicine, University of Pennsylvania, Philadelphia
  • Post-transplantation skin conditions – Fiona O’Reilly Zwald, MD, assistant professor of dermatology, department of dermatology, Emory University, Atlanta
  • Psoriasis – Mark Lebwohl, MD, professor and chairman, department of dermatology, Icahn School of Medicine, Mount Sinai Medical Center, New York
  • Vasculitis – David A. Wetter, MD, associate professor of dermatology, Mayo Clinic, Rochester, Minn.
  • Review of the hottest dermatology literature – Erik Joseph Stratman, MD, chairman and program director, department of dermatology, Marshfield Clinic, Marshfield, Wis.

Particularly hot topics in medical dermatology today are immunobullous disease and sarcoidosis.

“Neither of these disorders are necessarily as common as eczema or acne, but they are common and problematic enough in terms of therapeutic approach that we wanted to highlight them in this Update Platform,” Dr. Callen said. “There are new approaches we can use for both conditions.”

For immunobullous disease, the audience learned about the benefits of rituximab for bullous pemphigus and palivizumab for bullous pemphigoid. Rituximab is a chimeric monoclonal antibody that attacks CD20 on the surface of B cells and is used for autoimmune disorders such pemphigus, lymphomas, leukemias, and transplant rejection. Palivizumab is a humanized monoclonal antibody (IgG) that has typically been used to prevent the entry of respiratory syncytial virus into the cell and is now showing promise in treating pemphigoid.

The session on sarcoidosis featured a presentation about the development of a novel grading scale to determine the level of sarcoidosis in patients based on their cutaneous lesions. With this scale, clinicians can note at which point patients have or have not responded to therapy.

“With sarcoidosis, it’s another inflammatory disease where patients may respond well to some of the immunologic drugs that attack the immune system being developed for diseases such as psoriasis,” Dr. Callen said.

Another dermatology challenge involves skin conditions associated with organ transplantation. “I wanted to make sure we received an update about the organ transplant patient population and the skin diseases they tend to acquire, particularly talking about what we can do in treatment to prevent skin cancer,” Dr. Callen said. “They get a new organ, but they could end up dying of squamous cell carcinoma of the skin.”

This Update Platform also featured key updates about the safety of biologic therapies for psoriasis and other effective oral therapies that might be in the pipeline.

“According to the National Psoriasis Foundation, these patients are not getting treated as fully as they would like,” Dr. Callen said. “I believe that is true. In my office, it’s not uncommon for a patient to arrive who has been to other dermatologists not wanting to take the time or risks of prescribing something beyond topical therapy. Topical therapy is probably not the best means of treating our patients who have psoriasis, particularly those who have more than just a few localized plaques.”

The audience also received a treatment update on vasculitis and accompanying blistering lesions occurring as a result of weakened blood vessels that have become occluded or inflamed.

“All of these are relatively uncommon conditions, and they are problematic to treat,” Dr. Callen said. “It’s kind of an exciting time because we have new therapies that are available to us. We probably do understand the mechanism of action more clearly now, and that has given us some therapeutic targets that we can use. We want dermatologists to be able to treat their patients in a more efficient and effective manner for these key conditions, particularly the autoimmune blistering diseases.”


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