Groundbreaking advances headline Hot Topics

Mark Lebwohl, MD, is the session director of “Hot Topics in Medical Dermatology.”

Attendees who stay until the final day of the 2017 AAD Summer Meeting will be rewarded with practice-changing presentations at “Hot Topics in Medical Dermatology” (S016). Eight presentations will address topics that include bacterial infections, eczematous dermatoses, viral diseases, malignant melanoma, dangerous dermatoses, psoriasis, and pigmentary disorders.

“We are now able to more effectively and safely treat many of the diseases that have been difficult to treat for centuries. We are getting better and better at treating patients, and we just have to make sure we have access to those great, new treatments,” said the session director, Mark Lebwohl, MD.

Resistant bacterial infections, many of which enter through the skin, have long been a major cause of morbidity and mortality, but new treatments are now available.

“There are new antibiotics that have been developed. There are breakthroughs our members need to know about in terms of bacterial resistance, antibiotics that are new and more effective, and which combinations are best to use,” said Dr. Lebwohl, Waldman Chair of Dermatology at Icahn School of Medicine at Mount Sinai.

Another presentation will examine two groundbreaking drugs have recently been approved for the treatment of atopic dermatitis. Crisaborole is a phosphodiesterase-4 inhibitor that is the first new topical treatment for atopic dermatitis in more than a decade.

“It is not more effective than potent topical steroids, but its big advantage is that it works, it is not a steroid, and it does not have steroid side effects,” Dr. Lebwohl said of crisaborole.

The other important systemic drug to treat atopic dermatitis is dupilumab, a biologic that was approved by the Food and Drug Administration in March.

“More than one-third of patients achieve degrees of clearing that would be called clear or almost clear. More than two-thirds of patients achieve a 75 percent improvement in EASI score, which is a measure of eczema severity,” Dr. Lebwohl said. “We now have a very effective and much safer treatment.”

Zika is the viral disease that has received worldwide attention because of its link to birth defects, but dengue and chikugunya are two other diseases that are life-threatening. All three, along with human papillomavirus (HPV), will be reviewed.

“A high proportion of Americans have been exposed to HPV, which is associated with cervical and oropharyngeal cancers. The question is if we can we prevent them from evolving into cancers by vaccinating patients,” Dr. Lebwohl said. “It appears we do have an effective vaccine in Gardasil 9, which is a nine-virus vaccine.”

The diagnosis and treatment of malignant melanoma has advanced. Tape-stripping and genetic testing of tumor tissue are being used to identify if moles are malignant and their likelihood of metastasizing.

“In addition, there are breakthroughs in the treatment of metastatic melanoma, and we will hear about the latest on those advances,” Dr. Lebwohl said.

Dermatoses such as toxic epidermal necrolysis TEN, Stevens-Johnson syndrome (SJS), erythema multiforme (EM), bullous pemphigoid (BP), and pemphigus vulgaris (PV) can be life-threatening, but recently developed treatments can make a difference.

“Many of the treatments that have been identified have not made it into mainstream dermatology, but are being used at particular centers. They are life-changing for patients. Who would have ever thought that one shot of etanercept could profoundly reduce the duration of a life-threatening disease like TEN?” Dr. Lebwohl said, adding that other common drugs can be used on other dermatoses.

Two other presentations will evaluate treatments for psoriasis and pigmentary disorders, including vitiligo.

“At this point, we have multiple new psoriasis therapies, and the question is which one to use for which patient?” Dr. Lebwohl said. “We also have many new drugs on the horizon that will be discussed.”

Dr. Lebwohl will wrap up the session by exploring advances in dermatologic therapy and the challenge of getting third-party payers to cover them. Visit the Academy’s webpage, aad.org/priorauth, to generate letters to appeal denials.

“It is simple to use. It can change your practice because people were spending hours writing these letters. Now it takes one minute,” he said.

The three-hour symposium is the last session of the Summer Meeting, on July 30.

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