Dr. James Del Rosso Presents 'Medicine Chest' at Fall Clinical

A curated overview of skincare fundamentals, treatment pearls, and emerging data across acne, rosacea, hyperpigmentation, hidradenitis suppurativa (HS), and more was on display as James Q. Del Rosso, DO, presented “What’s New in the Medicine Chest” at the 2025 Fall Clinical Dermatology Conference.

MOISTURIZATION: STILL FOUNDATIONAL

Daily moisturization is a critical intervention across dermatologic diseases, including in patients without overt dryness, Dr. Del Rosso said.

“By the time you see dry skin, there’s already been significant transepidermal water loss and barrier damage,” he said.

Recent data suggest that early, consistent moisturization in infants may modestly reduce the incidence of atopic dermatitis—not only in high-risk infants, but even in the general population. Though effect sizes are small, the intervention is safe, inexpensive, and sensible.

In older adults, skin aging manifests as dermatoporosis, a term gaining traction in both US and European literature, Dr. Del Rosso said.

“We talk about the epidermal barrier constantly, but we rarely discuss the dermal barrier,” he added, pointing to products such as DerMend (Ferndale) that target dermal support using agents that reinforce collagen and vascular integrity.

HYPERPIGMENTATION: NEW TARGETS, NEW ACTIVES

Addressing facial hyperpigmentation, particularly in skin of color, Dr. Del Rosso emphasized the expanding therapeutic arsenal. He characterized current ingredients by their “eviction” style mechanisms:

• Melanin production inhibitors: Hydroquinone, cysteamine, tranexamic acid
• Transfer blockers: Niacinamide, soy
• Emerging tyrosinase inhibitors: Thiamidol, which uniquely targets human tyrosinase rather than mushroom tyrosinase, long used in preclinical studies.

Thiamidol, available in over-the-counter formulations such as Eucerin Radiance Tone, has been shown in at least five studies to improve various forms of hyperpigmentation, including post-acne, UV-induced, and laser-induced types.

TOPICALS IN HS

Though evidence is limited, Dr. Del Rosso shared findings from small studies showing benefit from topical hypochlorous washes and barrier-supportive sprays (eg, CLn Body Wash, Vanicream Z-bar) in patients with early-stage HS. Patients reported decreased irritation and better disease control with consistent topical hygiene measures.

ACNE: COMBINATION THERAPY AND SEBUM SUPPRESSION

In acne, the fixed-dose combination of benzoyl peroxide, clindamycin, and adapalene continues to outperform dual combinations in lesion reduction and global assessment, Dr. Del Rosso said. It demonstrated superior efficacy even when compared against benzoyl peroxide + adapalene 0.3%, previously the most potent over-the-counter option.

Meanwhile, topical clascoterone (1% cream) with BID application remains the first and only topical androgen receptor inhibitor for acne. Recent admixture studies confirmed its chemical stability when layered or sequenced with retinoids and benzoyl peroxide, facilitating flexible regimens. Additionally, new 12-month data reveal a ~50% reduction in sebum production in users of clascoterone, reinforcing its role in long-term acne management, especially in patients with seborrhea or oil-related flares.

Dr. Del Rosso also previewed a forthcoming review in the Journal of Clinical and Aesthetic Dermatology evaluating oral antibiotic use in acne. Key takeaways include that only two oral antibiotics are FDA-approved for acne: extended-release minocycline and sarecycline. Sarecycline stands out for its narrow-spectrum activity, preferentially targeting Gram-positive C. acnes while sparing Gram-negative flora. Tetracycline-class antibiotics remain foundational but require awareness of resistance patterns and long-term adverse effects.

TAZAROTENE FOR SCARS AND HYPERPIGMENTATION

While tazarotene 0.005% lotion is FDA-approved for acne, mounting data support its off-label use in treating post-inflammatory hyperpigmentation (PIH) and early acne scars, Dr. Del Rosso said. Using the Post-Acne Hyperpigmentation Index (PAHI), studies have demonstrated clinically significant reductions in both pigment intensity and lesion size.

ROSACEA: TARGETING PAPULES, PUSTULES, AND PERSISTENT REDNESS

Dr. Del Rosso emphasized that rosacea is not a single disease, as papulopustular flares, background erythema, and perilesional edema require distinct approaches.

Despite limited marketing, the microencapsulated BPO 5% formulation is highly effective and well-tolerated in papulopustular rosacea, outperforming conventional BPO in lesion reduction with minimal irritation, Dr. Del Rosso said.

Meanwhile, a low-dose, modified-release minocycline was recently approved for rosacea and showed superior efficacy to subantibiotic-dose doxycycline in a head-to-head trial. Over 16 weeks, patients achieved greater lesion reduction and improved global assessment. A microbiome study found no changes in skin, GI, or vaginal flora over 16 weeks, supporting its favorable safety profile.