Dr. James Del Rosso Presents ‘Medicine Chest’ at Winter Clinical 2026

James Q. Del Rosso, DO, delivered his annual “What’s New in the Medicine Chest” update at the 2026 Winter Clinical Dermatology Conference, covering new therapies, novel data, and practice-changing pearls spanning from molluscum and hyperhidrosis to vitiligo, lichen planus, and even mastocytosis.

“Skincare is our hobby and our calling,” Dr. Del Rosso said, setting the stage.

MOLLUSCUM CONTAGIOSUM: A NEW ERA WITH BERDAZIMER GEL

Dr. Del Rosso celebrated the long-awaited US Food and Drug Administration (FDA) approval of berdazimer gel, the first prescription home therapy for molluscum contagiosum. Approved for use in patients aged 1 year and older, the nitric oxide-releasing gel demonstrated strong efficacy in clinical trials:

• Week 4: Lesions reduced from ~20 to 10.
• Week 7: Down to 4 lesions.
• Week 12: 85% clearance of baseline lesions.

Dr. Del Rosso reminded clinicians that new lesion formation during trials likely underestimated true clearance rates.

“If you only measured baseline lesions, clearance would have been 95%,” he said.

TARGETED TREATMENT FOR AXILLARY HYPERHIDROSIS

Sofpironium gel, new hands-free topical anticholinergic for axillary hyperhidrosis, is now available to eliminate concerns of medication transfer to the face or eyes, which had plagued earlier therapies delivered via cloth wipes.

Approved for patients aged 9 and older, this precision applicator targets eccrine glands with improved safety and usability, offering relief for a burdensome and under-treated condition.

REIMAGINING LICHEN PLANUS MANAGEMENT

Once a topical steroid stronghold, lichen planus treatment is being reshaped by off-label innovations, Dr. Del Rosso said:

• Topical Ruxolitinib: Demonstrates improvement in inflammation, itch, and hyperpigmentation.
• Topical Roflumilast: In case reports, achieved rapid and sustained resolution in cutaneous LP.
• Oral Deucravacitinib: Delivered “impressive” results in off-label use, with formal publications pending.

“These drugs don’t know where they are FDA-approved; they work wherever the cytokines go,” Dr. Del Rosso said.

EXPANDING THE ROLE OF NON-STEROIDAL TOPICALS

Dr. Del Rosso shared several off-label success stories for topical roflumilast 0.3%, including:

• Vitiligo in children: Cases unresponsive to ruxolitinib or corticosteroids showed notable repigmentation.
• Perioral dermatitis: One case resolved in 5 days with remission lasting 11 months.
• Palmoplantar psoriasis: Significant improvement in stubborn lesions awaiting biologic approval.
• Hidradenitis suppurativa (mild): Four cases responded well without antibiotics or systemic therapy.

These anecdotes highlighted roflumilast’s anti-inflammatory versatility, even in tough-to-treat areas.

CHRONIC HAND ECZEMA

The investigational pan-JAK inhibitor delgocitinib, applied twice daily, shows promise for chronic hand eczema, regardless of atopic status.

Low systemic absorption and broad cytokine targeting make it a compelling option for this chronic, relapsing condition, Dr. Del Rosso said.

VITILIGO: COMBINING TOPICALS AND HOME PHOTOTHERAPY

Recognizing the challenges of extensive vitiligo, Dr. Del Rosso emphasized combination strategies such as topical ruxolitinib plus narrowband UVB to yield enhanced repigmentation.

He added that at-home UVB devices, now FDA-cleared and insurance-covered, offer access to phototherapy for patients without local clinics.

“This changes the game,” he said. “Even if you don’t offer phototherapy in-office, your patients can benefit from it.”

RECOGNIZING AND REFERRING MASTOCYTOSIS

Dr. Del Rosso made a passionate plea to Winter Clinical attendees: Be alert for systemic mastocytosis.

He recommended looking for urticaria pigmentosa, frequent flushing, anaphylaxis, or pruritus without lesions. Serum tryptase >20 ng/mL and a KIT D816V mutation test, he said, can flag high-risk patients.

“You don’t need to manage it, but you can change someone’s life just by catching it early,” he said.

RESHAPING WHAT WE CAN DO

Dr. Del Rosso emphasized that dermatologists should be capitalizing on the availability of all of these new therapies as soon as possible so their patients can reap the benefits.

“These are the therapies reshaping what we can do, not 5 years from now, but today,” he said.