From new medications with fewer side effects to a better understanding of comorbidities and risk factors, Practical Dermatology® magazine's Clinical Focus editors open up about what they would like to see more or less of in the next 12 months.

The Million Dollar Psoriasis Treatment Question

By and large, Jerry Bagel, MD, FAAD, director of the Psoriasis Treatment Center of Central New Jersey, is happy with today's psoriasis treatments as well as increasing attention to the systemic manifestations of this disease.

“I wish it didn't take so much extra work to get medications approved,” he says. In addition, some questions remain, such as whether biologic agents decrease cardiovascular events in psoriasis patients, and Dr. Bagel would like to see these questions answered definitively in 2019.

A New Standard of Care for AD

When it comes to atopic dermatitis (AD), Peter A. Lio, MD, a Clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University Feinberg School of Medicine and a partner at Medical Dermatology Associates of Chicago, wishes there was a better non-steroidal topical agent to prevent flare-ups and help avoid the need for stronger topical or systemic treatments.

“I wish we had better anti-itch treatments all around, both topical and oral, and I wish we had a better approach to normalizing the microbiota in atopic dermatitis,” Dr. Lio shares.

There's more: “I wish that we had deeper understanding of atopic dermatitis as a disease or diseases. We are beginning to get some clues that this is not one homogenous disease, but multiple similar conditions lumped together.”

The work of Roduit et al1 marks an important beginning of the journey to delve into the actual pathophysiology of this group of diseases, he says. “Critically, this also marks the beginning of hope for true precision medicine: once we understand the exact molecular pathways that are disrupted, it allows for the formulation of a therapy to right them! We are tantalizingly close, I think, or at least it feels that way at the start of 2019, and with newer therapies on the horizon, we will continue to be able to test these hypotheses in the real world.”

Dr. Lio also hopes for better ways to educate patients and providers. “There is so much information now and, sadly, so much misinformation and confusion, that it is hard to get the word out uniformly. The deep paradigm shift of thinking about ‘leaky skin' as a conduit for developing food allergies (i.e., transcutaneous sensitization) has truly turned the notion of eczema being caused by a food allergy upside down. Now more than ever we must get the word out that there is the potential to slow or even stop the development of certain food allergies by administering those ‘allergenic' foods early rather than delaying/avoiding them in the misguided notion that this will help.”

A new standard of care is emerging: much like in psoriasis, as better and safer therapies for AD emerge, he says.

Better Acne Treatments, Rosacea Answers

Joshua Zeichner, MD, FAAD, an Assistant Professor and Director of Cosmetic and Clinical Research in the Department of Dermatology at Mount Sinai Medical Center in New York, wants to see more effective treatments for acne: “I hope to see topical treatments in the future that help address excess oil production. We also will hopefully see new topical agents come to the market that are better tolerated even across our sensitive skin patients.”

New research has identified potential risk factors for rosacea including gastroesophageal reflux disease (GERD), hyperlipidemia, and migraines, as well as certain medications, such as proton pump inhibitors and laxatives, anxiolytic/sedative/hypnotics, and benzodiazepines. More studies are needed to better understand any causal relationships between potential risk factors and rosacea, according to Dr. Zeichner.

1. Roduit C, et al. Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood. JAMA Pediatr. (2017) Jul 1;171(7):655-662.