Research has improved care; more advances are on the way

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Alexandra Boer Kimball, MD, MPH

In the past decade, dermatology has been a leader among medical specialties with groundbreaking advances in the treatment of patients with diseases such as melanoma and psoriasis. That growth will continue, first by therapeutic advances, then by enhanced research advances in a variety of areas, said Alexandra Boer Kimball, MD, MPH.

“The good news is that I also see this revolution occurring in a number of other areas, including atopic dermatitis and hidradenitis suppurativa. Those are two areas where we had a limited armamentarium for moderate to severe disease. I think that in the next five years we will see these blow open as well,” Dr. Kimball said while discussing her Plenary address, “Dermatology Research Advances that Will Shape Your Practice.”

Driving those changes are advances in three areas — precision medicine, technology, and big data — which will all lead to the development of more novel therapeutics, said Dr. Kimball, professor of dermatology at Harvard Medical School and director of the Clinical Unit for Research Trials and Outcomes in Skin.

“We are seeing development in both the small molecules and in biologic target therapy,” she said. “One of the interesting things about psoriasis is that it was an example of the epidemiology, bench-to-bedside, bedside-to-bench, and clinical observation studies feeding each other simultaneously.

“When we developed some of these drugs, we didn’t even know the immunologic pathways that were actually being affected, and in the process of seeing how effective they were, we elucidated a lot of new things about the biology. I think the paradigm of bench-to-bedside is completely upended.”

Precision Medicine

Targeted therapies are on the upswing as the accessibility of genetic profiling has reduced its cost. That change could usher in the long-awaited era of personalized medicine, now known as precision medicine.

“Tests used to cost thousands of dollars and would only test for one thing,” Dr. Kimball said. “Now, for a couple hundred dollars, we can evaluate a lot of things for people. I see that as helping us diagnostically, and ultimately, therapeutically. We are just a few steps away from that.”

Some of that data is already in use, with testing that shows how patients with psoriasis and specific genotypes will respond to treatments such as ustekinumab.

“We will increasingly be able to do point-of-care testing in our offices, and it will be a much more efficient way to manage our patients,” Dr. Kimball said.

Technology

Dermatology has long held the promise of using digital photography to help examine lesions, but the cost and reliability of diagnostic technologies have been impediments. Research, though, is progressing to make digital diagnoses a possibility.

“It opens up a lot of possibilities for clinicians and patients to more efficiently manage things,” Dr. Kimball said. “The research element is to define what the appropriate venue is in which to use these technologies while allowing you enough sensitivity and specificity to help patients. There are computer-based algorithms that are going to be useful in helping with diagnoses.”

Pattern-recognition software is improving, but it still needs to be determined what kind of photos should be accepted and how they should be managed.

“What other information do people need to make good therapeutic decisions? We need to study that to make sure we are correct, because if you see a mole in isolation, you may be off-base,” Dr. Kimball said.

Big Data

Clinical data registries, such as the AAD’s DataDerm™, are on the rise, adding to other data collected in studies and giving health care more information to improve treatments.

“This has altered the landscape of how we think about a lot of our diseases, their associated comorbidities, and their risk factors,” Dr. Kimball said. “We are going to see that information continue to evolve. The level of sophistication will improve as the data sets get bigger, better, and more long-term.

“DataDerm is a great example of what we need to do to move the field forward. We need this to help with our patients and to demonstrate to the health care system that we are doing effective and important work.”

Despite all of these changes, the core of health care remains centered on doing what is best for the patients, but the advances of the last decade are improving patient outcomes, Dr. Kimball said.

“These major strides forward in the past 10 years have profoundly affected everything we do today, and it is going to evolve,” she said. “It is tremendously rewarding to think about the progress we have already made.”

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