Q&A: Current and future state of tumors and inflammatory skin diseases

George Han, MD, PhD, and Adam Friedman, MD, spoke with Dermatology World Meeting News to discuss some of the recent advances in treating tumors and inflammatory skin diseases and what could be coming next.

George Han, MD, PhD

What is the hottest new treatment area in inflammatory skin diseases?
Dr. Han: Biologic medications are now widely being used for a number of approved indications, such as psoriasis and psoriatic arthritis. However, there is considerable opportunity to use these agents for other inflammatory dermatoses, particularly for those too rare to have gotten an indication or where numerous first-line treatments have failed. Biologics can help transform patients’ quality of life in conditions such as pyoderma gangrenosum, sarcoid, vitiligo, and other less common inflammatory skin diseases if you go off-label. Some of these biologic medications may have only a few indications on the label, but they can be used effectively for a lot more in a safe and rational manner.

How far have we come in treating autoimmune skin diseases?
Dr. Friedman: Targeting cyclic AMP and the enzyme that breaks it down, phosphodiesterase 4 (PDE4), has taken center stage in treating psoriasis, atopic dermatitis, alopecia areata, and other diseases. There may also be a role for immunotherapy in some of the horrific autoinflammatory conditions being studied at the NIH.

What is the latest in treating dermatologic tumors?
Dr. Han: We have new biologics for melanoma, which are giving us much more effective treatment options through immunotherapy. There is still considerable work being done in determining which patients may be the best candidates for each approach, with new treatment targets being identified as well. The hope is that we’ll be able to offer our patients who have had their melanomas excised numerous options with regard to both treatment and prevention of recurrence.

Adam Friedman, MD

What surprises are in the development pipeline?
Dr. Friedman: There is tremendous potential for the utilization of cannabinoids in dermatology. Cannabinoids represent a broad class of chemical compounds originally comprised only of phytocannabinoids — cannabinoids produced by the cannabis plant. Now we have access to endocannabinoids and synthetic cannabinoids in addition to phytocannabinoids. Cannabinoids act as agonists on cannabinoid receptor-1 (CB1) and cannabinoid receptor-2 (CB2), which have distinct distributions throughout the body. CB1 is seen predominantly in the peripheral and central nervous system and therefore is a good target for pain and itch. CB2 is expressed by immune cells and keratinocytes, making it a great target for inflammatory and neoplastic diseases. Depending on the indication, you may want one to target one receptor or the other, or a mix of the two for the ideal clinical result.

Dr. Han is chairman of the department of dermatology at Mount Sinai Beth Israel in New York. Dr. Friedman is associate professor of dermatology, director of translational research, and director of supportive oncodermatology at George Washington School of Medicine and Health Sciences in Washington, D.C.

 

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