Dr. James Del Rosso Reviews Emerging Topical Therapies

Advances in photoprotection, sebum-targeted acne treatment, and nonsteroidal topical therapies are expanding the range of topical options available to dermatologists, according to James Q. Del Rosso, DO, in one of his annual presentations at the 2026 Fall Clinical Dermatology Conference, titled "What's New in the Medicine Chest (From the Outside)? Topical Therapies, Personalized Methods, and Beyond."

Dr. Del Rosso's wide-ranging review addressed established products, emerging clinical data, and investigational treatments, while distinguishing routine practice from potential future applications.

Dr. Del Rosso began with a call for a more deliberate approach to skincare. Complicated regimens can create problems for patients, he said, particularly when products contain ingredients that irritate the skin or introduce avoidable adverse effects. He singled out topical diphenhydramine because of contact dermatitis concerns, capsaicin because it may cause burning, and prolonged hydrocortisone use because even low-potency corticosteroids carry risks with chronic application.

Photoprotection, he added, has evolved beyond preventing sunburn in people with fair skin. Current considerations include protection across skin tones and against longer-wavelength ultraviolet A and high-energy visible light. Dr. Del Rosso discussed bemotrizinol, a photostable ultraviolet filter, as a potential addition to existing sunscreen combinations rather than a replacement for other filters. He also emphasized that mineral labeling alone does not establish whether a sunscreen addresses every relevant exposure.

New Acne Treatments Target Sebum Production

In acne, Dr. Del Rosso highlighted clascoterone as a topical antiandrogen with a mechanism distinct from benzoyl peroxide and retinoids. He described a study involving 40 adults with mild to moderate acne in which twice-daily treatment was associated with an approximately 50% reduction in sebum production over one year, alongside patient-reported reductions in oiliness and facial shine. He also discussed preliminary laboratory compatibility work involving clascoterone and other topical acne agents, including benzoyl peroxide, retinoids, azelaic acid, and dapsone.

Another potential approach is denifanstat, an investigational oral fatty acid synthase inhibitor intended to reduce sebum production. Dr. Del Rosso summarized a phase 3 study conducted in China that evaluated 50 mg once daily for 12 weeks against placebo, followed by an open-label extension in which participants received active treatment. He described sustained lesion-count improvements through 1 year but cautioned that replication in US studies remains necessary.

He also discussed trifarotene 0.005% cream, noting research on postinflammatory hyperpigmentation and early acne-related scarring. He distinguished potentially modifiable early changes from longstanding, deep scars, which should not be expected to respond similarly.

Nonsteroidal Topicals Expand the Discussion

For atopic dermatitis, Dr. Del Rosso reviewed real-world findings involving ruxolitinib 1.5% cream that he said were consistent with earlier clinical trial experience. He noted that the topical Janus kinase 1/2 inhibitor retains boxed warnings and discussed exploratory off-label applications, including superficial hidradenitis suppurativa lesions and genital lichen sclerosus.

Dr. Del Rosso also covered phosphodiesterase 4 inhibitors and the aryl hydrocarbon receptor agonist tapinarof. He described reports of off-label roflumilast use in conditions including perioral dermatitis, lichen planus pigmentosus, and early hidradenitis suppurativa lesions. In the latter setting, he referenced a four-patient case series. He additionally reviewed pediatric plaque psoriasis and atopic dermatitis data, emphasizing the importance of formulation, concentration, and indication-specific labeling.

Tapinarof, he explained, acts through the aryl hydrocarbon receptor, a pathway involved in inflammatory signaling, barrier-related proteins, and responses to environmental exposures. He discussed studies examining sleep outcomes in children with atopic dermatitis, along with preliminary off-label reports in other inflammatory dermatoses.

Closing the presentation, Dr. Del Rosso contrasted two approaches to molluscum contagiosum: patient- or caregiver-applied berdazimer gel, a nitric oxide–releasing treatment, and clinician-administered cantharidin solution. The broader message of the session was that familiar therapeutic pathways are being studied across additional conditions, but clinicians need to separate established indications from preliminary reports and investigational applications.