Advances in Dermatology: 2024 in Review by Cather McKay, MD

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Advances in Dermatology: 2024 in Review 
By Cather McKay, MD

The past year has been another exciting one in the field of dermatology! New medications and expanded indications give us more options than ever to care for our patients.

 

Atopic dermatitis and prurigo nodularis

More topical options for atopic dermatitis (AD) became available this year with the approval of roflumilast 0.15% cream (Zoryve) in patients aged 6 years and up and tapinarof 1% cream (Vtama) in patients aged 2 years and up.1,2 Approval of the pan-JAK inhibitor delgocitinib cream for adults with chronic hand eczema is expected based on phase 3 trials.3 Ruxolitinib cream (Opzelura) is currently approved for ages 12 and up, but has shown safety and efficacy in patients as young as 2 years.4

IL-13 inhibitor lebrikizumab (Ebglyss) was approved in September for moderate to severe AD in patients 12 years and up who weigh at least 40 kg.5 Another IL-13 inhibitor, cendakimab, is in development.6

Indications for dupilumab (Dupixent) expanded to include AD of the hands and feet7 and eosinophilic COPD, with indications for chronic spontaneous urticaria and bullous pemphigoid likely in the future.

Rinvoq’s safety down to age 2 is supported by its approval for juvenile idiopathic and psoriatic arthritis; however, the AD indication remains age ³ 12 years while trials in younger children proceed.

Inhibition of the OX40 receptor and ligand involved in TH2 cell activation has shown efficacy in trials of amlitelimab8 and rocatinlimab9, respectively. Novel targets for AD including TYK2, IL-7 receptor, and PDE4 are also under early investigation.

IL-31 receptor inhibitor nemolizumab (Nemluvio) was approved in August for prurigo nodularis (PN) and just recently for AD in patients ³ 12 years of age.10 JAK inhibitors povorcitinib and abrocitinib (Cibinqo) are in trials for PN as well.11

 

Psoriasis

Pediatric patients have more options with expanded indications for apremilast (Otezla) to the age of 6 years for plaque psoriasis, and spesolimab (Spevigo) to 12 years for generalized pustular psoriasis.

An oral IL-23 inhibitor is on the horizon for plaque psoriasis,12 as may be TYK2 inhibitor zasocitinib, PDE4 inhibitor orismilast, and IL-23p19 subunit inhibitor picankibart.

In addition to psoriasis, IL-17 A and F inhibitor bimekizumab (Bimzelx) is now indicated for HS, psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis. Spesolimab was effective in a case of Sweet Syndrome,13 and is in early clinical trials for pyoderma gangrenosum.

When non-live vaccines are needed, the National Psoriasis Foundation recommends continuing treatment without interruption for most systemic psoriasis drugs, excluding methotrexate. Treatment should be interrupted for live vaccines for most drugs other than apremilast and acitretin.14 A retrospective study showed that IL-17 and IL-23 inhibitors may not reactivate latent TB.15

At-home phototherapy for psoriasis was shown to have improved adherence and was noninferior to office-based treatment.16

 

Acne and rosacea

The AAD released updated guidelines for the treatment of acne this year.17

Independent laboratory Valisure, who previously reported elevated levels of benzene in sunscreens, again caused a stir when they reported finding benzene in benzoyl peroxide products that were exposed to heat. Two studies have since shown no increase in blood benzene levels or malignancy in patients using benzoyl peroxide products for acne.18,19

Extended-release minocycline 40mg (Emrosi) was approved for rosacea in November.

 

Alopecia

The FDA approved a third oral JAK inhibitor, deuruxolitinib (Leqselvi), for adults with severe alopecia areata in July, however its release has been delayed due to patent litigation.

Low dose metformin showed benefit for central centrifugal cicatricial alopecia.20 TYK2/JAK1 inhibitor brepocitinib is also showing promise in treating cicatricial alopecia.21

Oral minoxidil 5mg daily compared to topical 5% minoxidil twice daily in male pattern hair loss did not show a difference in overall or frontal hair density, but the oral group did show increased density of the vertex.22 Another study showed no difference in pericardial effusion incidence among patients on low dose minoxidil and control.23

 

Hidradenitis suppurativa

Bimekizumab (Bimzelx) became the third biologic approved for moderate to severe hidradenitis suppurativa (HS) in November.24 TYK2/JAK1 inhibitor brepocitinib, IL-17A inhibitor Izokibep, IL-1 inhibitor lutikizumab and PDE4-inhibitor orismilast are also in varying phases of clinical trials.

Semaglutide was proven to reduce flares and improve outcomes in patients with HS and obesity.25


Other medical dermatology

Oral JAK inhibitors ritlecitinib and upadacitinib are under investigation for nonsegmental vitiligo. Secukinumab failed to meet proof of concept in treatment of lichen planus. The anticholinergic gel sofpironium (Sofdra) was approved for axillary hyperhidrosis in those 9 years and older. TYK2/JAK1 inhibitor brepocitinib is in phase 3 trials for dermatomyositis.26


Non-melanoma skin cancer

The FDA is reviewing the application for bemotrizinol, which would be the first new sunscreen ingredient since 1999.

A retrospective chart review of topical 5-fluorouracil and calcipotriene twice daily for a mean duration of 8.3 days resulted in a 92% response rate for 179 SCCIS and an 83% response rate for 30 superficial BCC, after a follow-up time of 15 months.27

The Dermatology Association of Radiation Therapy published new guidelines for appropriate use of image-guided superficial radiation therapy in the treatment of NMSC this year.28

Intralesional immunotherapy for NMSC may be on the horizon.29 PD-1 inhibitor cosibelimab (Unloxcyt) was approved in December for metastatic or locally advanced SCC.

Synthetic hypericin ointment photodynamic therapy using visible light proceeds in clinical trials for early stage CTCL.  The FDA approved denileukin, a novel immunotherapy, for refractory CTCL.

 

Melanoma

Lifileucel (Amtagvi), tumor-derived autologous T cell immunotherapy, received accelerated approval in February for advanced melanoma. In phase 2 trials, a personalized mRNA vaccine in addition to pembrolizumab improved relapse free and distant metastasis-free survival in patients with resected high-risk melanoma by 49% and 62% respectively, compared to pembrolizumab alone.30

PD-L1 inhibitor atezolizumab (Tecentriq) became the first of its class approved for subcutaneous injection for the same indications as the IV formulation, which includes melanoma. Nivolumab (Opdivo) is expected to follow.

In February, Quest Diagnostics released a 31-gene expression profiling (GEP) called MelaNodal Predict in conjunction with SkylineDx and Dermpath Diagnostics to classify patients at low vs. high risk of sentinel lymph node positivity. Personalized risk stratification testing remains a goal, although the NCCN guidelines do not currently recommend use of commercially available GEP testing to guide clinical decision making.

 

The WDS Editorial Committee hopes you enjoy this year-end review and wishes you very happy holidays!

 

 

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 References

  1. Simpson EL, et al. JAMA Dermatol. 2024; doi:10.1001/jamadermatol.2024.3121.
  2. Silverberg JI, et al. JAAD 2024; doi:10.1016/j.jaad.2024.05.023.
  3. Bissonnette R, et al. Lancet 2024 doi:10.1016/S0140-6736(24)01027-4.
  4. Bissonnette R et al. Bri J of Dermatology 2024; doi.org/10.1093/bjd/ljae266.003.
  5. Silverberg, et al. NEJM 2023; doi:10.1056/NEJMoa2206714.
  6. Blauvelt A, et al. JAMA Dermatol. 2024; doi:10.1001/jamadermatol.2024.2131.
  7. Simpson EL, et al. JAAD 2024; doi:10.1016/j.jaad.2023.12.066.
  8. Weidinger S, et al. J Allergy Clin Immunol. 2024; doi:10.1016/j.jaci.2024.10.031.
  9. Kyowa Kirin announces top-line data from rocatinlimab phase 3 ROCKET HORIZON trial for adults with moderate to severe atopic dermatitis. News release. Kyowa Kirin. September 25, 2024. https://www.prnewswire.com/news-releases/kyowa-kirin-announces-top-line-data-from-rocatinlimab-phase-3-rocket-horizon-trial-for-adults-with-moderate-to-severe-atopic-dermatitis-302258420.html.
  10. Silverberg JI, et al. Lancet 2024; doi:10.1016/S0140-6736(24)01203-0.
  11.  Kwatra SG, et al. JAMA Dermatol. 2024;doi:10.1001/jamadermatol.2024.1464.
  12. Ferris LK, et al. J Am Acad Dermatol. 2024;doi:10.1016/j.jaad.2024.10.076.
  13. Pang, et al. JAMA Dermatolog; 2024; doi:10.1001/jamadermatol.2024.4342
  14. Chat et al. J Am Acad Dermatol. 2024; doi: 10.1016/j.jaad.2023.12.070.
  15. Torres T, et al. Am J Clin Dermatol. 2024;doi:10.1007/s40257-024-00845-4.
  16. Gelfand JM, et al. JAMA Dermatol. 2024;doi:10.1001/jamadermatol.2024.3897.
  17. Reynolds et al. J Am Acad Dermatol. 2024: 10.1016/j.jaad.2023.12.017.
  18. Barbieri JS, et al. J Am Acad Dermatol. 2024;doi:10.1016/j.jaad.2024.05.093.
  19. Garate D, et al. J Am Acad Dermatol. 2024;doi:10.1016/j.jaad.2024.07.011.
  20. Bao A, et al. JAMA Dermatol. 2024;doi:10.1001/jamadermatol.2024.3062.
  21. David E, et al. J Am Acad Dermatol. 2024;doi: 10.1016/j.jaad.2024.09.073.
  22. Penha MA, et al. JAMA Dermatol 2024;doi:10.1001/jamadermatol.2024.0284.
  23. Kincaid CM, et al. J Drugs Dermatol. 2024;doi:10.36849/JDD.8029.
  24. Kimball AB, et al. Lancet. 2024;doi:10.1016/S0140-6736(24)00101-6.
  25. Lyons D, et al. Semaglutide for weight loss in obese patients as an adjunctive treatment for hidradenitis suppurative: Its impact on disease control and quality of life. Presented at: EADV Congress; Sept. 25-28, 2024; Amsterdam.
  26. Paik JJ, et al. Clin Exp Rheumatol. 2024;10.55563/clinexprheumatol/eeglsa.
  27. Loranger N, et al. Combined topical 5-fluoruracil and calcipotriene effectively treats superficial keratinocyte carcinomas. Presented at: American Society for Dermatologic Surgery Annual Meeting; Oct. 17-20, 2024; Orlando.
  28. Dermatology Association of Radiation Therapy. DART clinical guidelines for nonmelanoma skin cancer. https://dermassociationrt.org/guidelines/
  29. Patel VA. Intralesional therapy in cutaneous malignancies. Presented at: ODAC Dermatology, Aesthetic & Surgical Conference; Jan. 17-20, 2024; Orlando.Weber JS, et al. Abstract LBA9512. Presented at: ASCO Annual Meeting 2024; May 31-June 4, 2024; Chicago.
  30. Weber JS, et al. Abstract LBA9512. Presented at: ASCO Annual Meeting 2024; May 31-June 4, 2024; Chicago.

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