Research improves understanding of complex dermatologic diseases

Advances in Medical Dermatology (S002)

Several complex diseases with cutaneous presentations are benefiting from advances in evaluation and treatment and are leading to better outcomes for patients. Treatments now entering clinical practice and promising research into several of these diseases will be examined Friday during “Advances in Medical Dermatology.”

“It is important to use systemic approaches to treat severe patients. There are many new developments that can be applied either now or in the near future that will make a big difference for our patients,” said Victoria P. Werth, MD, symposium director.

Conditions that will be discussed in the symposium are autoinflammatory diseases, hidradenitis suppurativa, dermatomyositis, atypical pyoderma gangrenosum, and lupus.

“Because there are many new biologic and small molecule therapies being developed, we now are beginning to have tools to improve the ability to treat patients who have manifestations of complex diseases,” said Dr. Werth, professor of dermatology and internal medicine at the University of Pennsylvania, Philadelphia, and chief of dermatology at the Philadelphia VA Medical Center. “The goal is to go through areas where there have been developments and improvements in understanding pathogenesis and exacerbators, and also where there are ongoing or new therapies.”

The discussion of autoinflammatory diseases will focus on the mutations and pathways involved. This better understanding has helped clarify disease etiology and led to new therapies. The presentation will touch on anti-cytokine therapies that are being used to target specific abnormalities, as well as therapies in development, she said.

New information about pathways linked to atopic dermatitis has led to the development of a promising treatment, which will be discussed in one of the presentations.

“We know there are Th2 cells that are very important in driving the inflammation and itch,” Dr. Werth said. “With a new monoclonal antibody that blocks anti-IL-4 and anti-IL-13, there is really a hope that we can be able to control the disease much better than we have been able to in the past. There are also new oral and topical JAK inhibitor therapies that are being studied, as well therapies that block IgE.”

The treatment of hidradenitis suppurativa has improved because of a better understanding of this chronic skin condition. The presentation on hidradenitis suppurativa will look at the promise of surgical and medical approaches, including specific cytokine blockade.

The first double-blind placebo-controlled interventional study for amyopathic dermatomyositis is underway, raising hopes of learning more about the inflammatory disease that is linked to muscle weakness and a rash, Dr. Werth said. There are new insights into disease phenotypes associated with specific autoantibodies in dermatomyositis.

“We are getting better at knowing how to measure the disease on the skin and its impact on quality of life,” she said. “We are also aware we need better therapies because our current therapies are not as effective as we would like.”

Atypical presentations of pyoderma gangrenosum highlight the “huge need” for more information about the condition, Dr. Werth said. The presentation on pyoderma gangrenosum will focus on understanding the condition and look at potential new therapies.

The final presentation will explore lupus, which has been the focus of several studies that led to the development of new treatments. There is increased understanding of complex cytokine loops and the genetics of cutaneous lupus.

“There are a large number of interesting biologics and small molecules in the pipeline. There are several exciting studies that have been done with antibodies that block type I interferon. There are numerous other ongoing studies with anti-cytokine antibodies, antibodies that target pathogenic inflammatory cells, and new oral small molecules that block transcription factors genetically linked to the risk of lupus that could have a huge impact on the ability to manage these patients,” Dr. Werth said.

To learn more about new treatments for atopic dermatitis, check out Dermatology World’s December cover story at aad.org/dw/monthly/2016/december/playing-the-angles.

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