Recent Developments
Survey: Telederm Appointments Suitable Alternatives to Office Visits
The majority of dermatology patients find telehealth appointments to be a suitable alternative to in-person office visits, according to a survey in the Journal of Drugs in Dermatology.
“Teledermatology boasts a number of benefits, including increased access to care, cost savings for patients, convenience, and, with the current pandemic, avoids physical contact,” says Samuel Yeroushalmi, a third-year medical student at the George Washington University (GW) School of Medicine and Health Sciences and first author of the study, in a news release. However, virtual appointments do come with some drawbacks, including privacy and security concerns, appropriate image acquisition, and appropriate provider training or experience.
To evaluate patient satisfaction with teledermatology appointments, the team distributed an online survey to dermatology patients at the GW Medical Faculty Associates. The survey assessed the patients’ reasons for scheduling the telehealth visit, as well as any pandemic-related barriers to care and overall satisfaction with the appointment.
Of the respondents to the survey, 47 percent reported having a previous appointment cancelled due to COVID-19 and 17.7 percent were new patients who had not previously had an in-office appointment. Patients reported that they most liked their telehealth experiences because they were time efficient, did not require transportation, and effectively maintained social distancing. Reasons patients did not like their virtual appointments include lack of physical touch and feeling they received an inadequate assessment.
When asked if they would recommend telehealth services, only a small minority (6.9 percent) stated they would not.
The authors suggest that telehealth can and should continue to provide high-quality care for patients of dermatologists during the COVID-19 pandemic in tandem with proper education to ensure meaningful use.
NRS Survey Finds Rosacea Patients Lack Knowledge of Antibiotic Resistance
A majority of rosacea patients have never heard of antibiotic resistance, results of a recent survey by the National Rosacea Society (NRS) show. Yet topical or oral antibiotics are among the most commonly prescribed treatments for rosacea. The NRS’s recently published standard management options for rosacea note that oral and topical therapies are often initially prescribed in combination, followed by long-term use of a single therapy to maintain remission.
“Dermatologists and rosacea patients can both practice antibiotic stewardship to help protect against resistance,” says James Q. Del Rosso, DO, adjunct clinical professor of dermatology at Touro University College of Osteopathic Medicine. “It requires avoiding oral antibiotic dosing as much as possible and remaining aware of guideline suggestions that may be applied to patient care.”
A recent CDC study found dermatologists wrote more prescriptions for antibiotics than any other medical specialty; individual dermatologists wrote an average of 162 more such prescriptions per year than primary care physicians.
There is strong clinical evidence supporting the use of low-dose doxycycline to treat the papules and pustules of rosacea, including a 40mg doxycycline modified-release capsule developed specifically for rosacea. The 40mg dosage is subantimicrobial, avoiding antibiotic resistance while reducing the inflammation associated with this condition.
In severe cases, higher doses of oral antibiotics may be prescribed. However, since higher doses may also have an antimicrobial effect, Dr. Del Rosso recommends that such treatment be carefully managed and not used for long-term maintenance.
Allergan Aesthetics Introduces CoolSculpting Elite
Allergan Aesthetics, an AbbVie company, is launching CoolSculpting Elite, its next generation fat reduction system.
The system’s new applicator collection includes seven shapes and sizes. The new C-shaped applicators are designed to complement the body’s natural curves for improved fit and comfort during initial tissue draw and features up to an 18 percent larger cooling area as compared to previous generation CoolSculpting applicators. The clinical significance of these data has not been established.
CoolSculpting Elite is FDA cleared to treat visible fat bulges in nine areas including the thigh, abdomen, and flank, along with bra fat, back fat, underneath the buttocks, upper arm, and the submental and submandibular areas.
Take 5 with Jim Lee, MD, PhD, Incyte
Founded in 2002 by a group of 23 research scientists, Incyte has a basis in small molecule drug development. Company researchers discovered the JAK inhibitor class of molecules, and developed two JAK therapeutics already on the market. With more than half of its 1,600 employees in R&D, the company is staking a claim in the dermatology market. Jim Lee, MD, PhD, Group Vice President, Head, Inflammation and Autoimmunity at Incyte, spoke with Practical Dermatology® magazine about the company.
Incyte is committing to dermatology.
Jim Lee, MD, PhD: Incyte has allowed the science to drive decisions. We recognized that many dermatological diseases are impacted by many of the pathways where Incyte has developed drugs. JAK inhibitors are a classic example. Incyte has developed the JAK1/JAK2 inhibitor ruxolitinib into a cream that has been investigated for inflammatory skin diseases like atopic dermatitis (AD) and vitiligo. That’s really the genesis of Incyte, but also the expansion and pivot of Incyte into dermatology.
Adding dermatology experts on the R&D side has allowed us to expand and consider additional diseases, like hidradenitis suppurativa (HS). We’ve identified novel targets and developed molecules for those targets. We have molecules in our oncology pipeline that could also be evaluated in skin conditions.
There is still much room to improve treatments for skin conditions.
Dr. Lee: One of the things that really drives me personally, having interacted with a number of patients with vitiligo and atopic dermatitis, is that while there are much better treatments now, there’s still a lot of unmet need. Patients are really what motivates Incyte to develop these molecules. We look at the disease pathways, but we also look at the patients and their unmet needs.
In AD, we think ruxolitinib cream has shown benefits in endpoints that matter to patients and healthcare providers and recently submitted the NDA. We are doing Phase 3 studies in vitiligo, and we have a Phase 2 study with an oral JAK1 inhibitor in HS. We plan to continue to expand the dermatology portfolio for Incyte and are committed to the dermatology space for the long haul.
Incyte has a culture of science and collaboration.
Dr. Lee: We really are a science-driven company. We have to partner with dermatologists and the patients to figure out where the unmet need is and whether we have something we can provide that fulfills that unmet need. We have a lot of excitement about ruxolitinib cream, our oral JAKs, as well as our early pipeline portfolio, and we continually look for diseases where patients don’t have satisfactory treatments.
Dermatology presents unique challenges…and opportunities.
Dr. Lee: Incyte has a big presence in oncology, where patients have a life-threatening disease and are more willing to put up with a more severe side effect profile. In dermatology, you really need a drug that’s very safe but also very effective. That makes drug development a little bit more challenging. We recognize that that is one of the challenges, but it certainly doesn’t stop us from identifying pathways. There’s still a lot of pathogenesis that’s not completely understood in many of these diseases, whether it’s the itch, or the inflammation, or the triggers for the disease.
Understanding that you have different populations of patients within a disease, and then trying to figure out the best treatment for those patients, is important.
Incyte will partner with dermatologists.
Dr. Lee: We are the new kid on the block, but not really, because many of us have been in the dermatology space for many years, with deep expertise on both the R&D and commercial sides. We’re making a significant investment in R&D space in dermatology and are reaching down deep into our portfolio and early discovery efforts to partner dermatologists to identify new targets, as well as the diseases where there’s really a desire within the dermatology community to see new treatments.
Our ruxolitinib cream program illustrates how deeply committed we are. With AD, itch has remained a significant unmet need. We have a topical product for the milder, more moderate patients, where we see a rapid and significant reduction, not just in the inflammation, but the itch. That is something that is clearly not available to patients today. I hope dermatologists appreciate that this really has the potential to be a game changer for their patients.
Merz Aesthetis Rolls Out Belotero Balance(+)
Merz Aesthetics is launching Belotero Balance(+) with Lidocaine in the US.
Approved in 2011, Belotero Balance is an injectable filler used to smooth moderate-to-severe etched-in facial lines and wrinkles in the lower face. The hyaluronic acid (HA) in is specially formulated in a proprietary process to create a uniquely smooth and cohesive gel that blends into the natural structure of the skin.
CLOSE UP with Erica D. Dommasch, MD
Many transgender individuals are prescribed masculinizing hormone therapy to develop male-pattern hair growth and male body contours and to suppress secondary female sex characteristics. However, testosterone confers side effects, including acne, which can have profound effects on self-esteem. Erica D. Dommasch, MD, a dermatologist at Beth Israel Deaconess Medical Center in Boston, and colleagues aimed to get a better idea of the prevalence and incidence of acne in transgender patients. Here, Dr. Dommasch discusses the findings, which appeared JAMA Dermatologylast month, and their implications.
Why is this topic important to study?
Erica D. Dommasch, MD: Prior studies have suggested that testosterone use among transgender/gender minority patients may be linked to the development of acne, but they have been limited by small patient populations and have had varying conclusions. Acne can be a debilitating condition for many patients but may be especially harmful for transgender patients who already experience stigma and discrimination.
Describe the research and your findings.
Dr. Dommasch: We conducted a large, retrospective cohort study including 988 transgender patients who newly initiated testosterone to examine the incidence and predictors of acne in this population. We found that after two years, 25 percent of these patients developed a new diagnosis of acne. This risk was highest among the youngest age group in our study (18 to 20.75 years), with 29.6 percent of these patients developing acne over two years. Clinicians should counsel transgender and gender minority patients who are initiating hormone therapy with testosterone that there is a significant risk of developing acne. This risk may be highest among younger patients (<21 years of age). This patient population may be particularly susceptible to the psychological effects of acne, such as depression. Early coordination of care with dermatologists is needed for many of these patients to ensure that their acne is adequately treated.
What is the next step?
Dr. Dommasch: Future studies are needed to determine the safest and most effective treatment options for acne for transgender and gender minority patients.
FDA Approves Restylane Defyne for Chin
The FDA has approved Restylane Defyne for the augmentation and correction of mild to moderate chin retrusion in adults over the age of 21.
Results of a pivotal Phase 3 clinical trial showed that most patients (74 percent) experienced significantly improved chin projection for up to one year as measured by the Galderma Chin Retrusion Scale (GCRS). Positive aesthetic outcomes following treatment were demonstrated through high levels of subject satisfaction in FACE-Q and Global Aesthetic Improvement Scale (GAIS) questionnaires.
Fully 99 percent of patients reported improvement in the appearance of their chin projection (when asked at 12 weeks), while 96 percent of injectors said treatment improved the appearance of patients’ chin projection up to 1 year. In the Phase 3 clinical trial, Restylane Defyne had a proven safety and tolerability profile.
Inspire Insights with Practical Dermatology®
Your Patients Are Talking About…Topical Psoriasis Remedies
To help readers better understand the issues that patients with skin diseases face, Practical Dermatology® magazine partnered with Inspire to provide Inspire Insights. With more than 100 national patient organization partnerships and over two million members, Inspire is a vital social network that enables safe sharing of health experiences and social support.
Eight percent of Inspire psoriasis members search for topical treatments. From vitamin D analogs, corticosteroids, PDE4 inhibitors, and over-the-counter remedies, psoriasis patients are looking for relief from flare-ups. Topical treatments have the potential to provide quick relief from psoriasis irritation and inflammation, but what works for one psoriasis patient may not work for another. “I have been using topical treatments off and on for a couple of years with minimal results. Recently I have been using an ointment with hot wet wraps in combination with oral medications and it has helped tremendously,” said one Inspire member.
“Topicals are still a first-line treatment for psoriasis, especially for mild to moderate disease,” says Practical Dermatology® Clinical Focus-Psoriasis editor Jennifer Soung, MD, a dermatologist at Southern California Dermatology in Santa Ana, CA. She is also the director of clinical research at Southern California Dermatology in Santa Ana, CA, and clinical professor at Harbor–UCLA. “We look forward to the development of new nonsteroidal topicals that are currently in Phase 3 clinical trials such as topical tapinaroff and roflumilast.”
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