PracticalDermatology

As 2022 draws to a close, Practical Dermatology® magazine’s Clinical Focus Editors reflected on the biggest breakthroughs, approvals, and advances of 2022, and by and large, 2022 ushered in many great therapies for patients with acne, rosacea, atopic dermatitis, and psoriasis.

Acne and Rosacea

Tretinoin is perhaps the most commonly used retinoid for acne, but also the most temperamental, says Joshua Zeichner, MD, an associate professor of dermatology and

Director of Cosmetic & Clinical Research in Dermatology at Mount Sinai Hospital in New York City.

“For the first time, tretinoin now can play nicely with benzoyl peroxide in the same prescription product,” he says. “Microencapsulation technology in Twyneo allows benzoyl peroxide and tretinoin to exist in the same formula. Think of it like socially distancing to keep both ingredients safe.”

Despite its prevalence, effective treatment for rosacea is still an unmet need for many patients. “While most dermatologists consider benzoyl peroxide to be a treatment only for acne, there is strong data showing its effectiveness in rosacea,” he says. “The problem with traditional formulations is the irritation potential, especially in a rosacea patient with sensitive skin.”

Enter Epsolay, an FDA-approved rosacea treatment that doesn’t cause the irritation traditionally associated with benzoyl peroxide. “The specialized encapsulation of the benzoyl peroxide allows slow, sustained delivery to the skin and improves tolerability,” he says. “This is not your grandmother’s benzoyl peroxide, and it offers quick onset efficacy in treating rosacea patients.”

Atopic Dermatitis

This has been an incredible time in the world of atopic dermatitis, too, adds 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. “We have seen the launch of a second biologic for adults in tralokinumab, two new oral JAK inhibitors with upadacitinib and abrocitinib, and another biologic, dupilumab, approved down to 6 months of age,” he says.

Toward the end of 2021, the topical JAK inhibitor, ruxolitinib, scored an FDA nod for atopic dermatitis, and it became more widely available in 2022, he says.

And the future looks bright, he says.

“The pipeline shows no signs of slowing down,” Dr. Lio says. “Another IL-13 inhibitor lebrikizumab is anticipated soon, as is an IL-31 receptor inhibitor nemolizumab, and there are new topical agents (tapinarof and roflumilast) approved for psoriasis that also have been studied or are being studied in atopic dermatitis as well.”

More than any individual agent is the fact that there are new therapies and a new understanding of atopic dermatitis. “I honestly believe that we are seeing the dawning of a more widespread acceptance of just how bad this condition can be and that these new tools in our toolbox empower us to change the discussion about what our treatment goals are.”

Psoriasis

Treating patients with plaque psoriasis has never been more rewarding than it is now, says Jennifer Soung, MD, FAAD, a dermatologist and director of clinical research at Southern California Dermatology in Santa Ana, CA, and a clinical professor at Harbor–UCLA.

“For patients who have moderate to severe plaque psoriasis, biologics targeting IL-17 (ixekizumab, brodalumab, and secukinumab) and IL-23 (risankizumab, guselkumab, and tildrakizumab) have brought clearer skin, improved safety, and durable skin responses,” she says. “A new oral option, deucravacitinib, that selectively targets TYK2 outperforms apremilast, and apremilast is now officially approved for psoriasis of all severity levels including mild to moderate.”

Two new topical non-steroidal medications were also approved for plaque psoriasis in 2022, offering patients who have localized disease in sensitive areas an effective treatment option without stinging and burning. “For a rare and potentially life-threatening form of psoriasis—generalized pustular psoriasis, the FDA recently approved the use of IV Spesolimab,” Dr. Soung says.

There have been other positive changes in how psoriasis is diagnosed and treated,

Increasingly, dermatologists are screening and treating for early psoriatic arthritis, she adds. “Instead of classifying psoriasis as mild, moderate, or severe, the International Psoriasis Council’s system recommends classifying patients as candidates for either topical or systemic therapy. Beyond the skin, my hope is that dermatologists emphasize the importance of screening for cardiovascular risk factors, obesity, and lifestyle habits because ultimately treating the psoriatic patient is an integrative approach by multiple specialties to improve the lives of psoriatic patients and lessen disease severity,” she adds.

Editors’ note: Stay tuned for exciting changes in Clinical Focus coming in 2023. We are adding more A-list experts to tackle even more types of skin diseases as well as the diagnosis and treatment of dermatological conditions in diverse populations.