South Beach Symposium: Dr. Neal Neal Bhatia Maps a Fragmented but Promising Pipeline

At the 2026 South Beach Symposium, Neal Bhatia, MD, FAAD, delivered a wide-ranging and opinionated overview of the current dermatology therapeutic landscape, arguing that

Innovation is uneven across disease states and increasingly driven by mechanism-based extrapolation rather than traditional US Food and Drug Administration (FDA) trial pathways, Neal Bhatia, MD, FAAD, said during an overview of the therapeutic pipeline at the 2026 South Beach Symposium.

Dr. Bhatia's presentation, “Dermatology Pipeline 2026: Do We Need Anything Else?”, blended analysis with practical clinical commentary on where dermatology is advancing and where it is stalling. He emphasized that many inflammatory and rare dermatologic diseases will never be supported by large, registrational trials, leaving clinicians reliant on mechanistic rationale and smaller datasets. Conditions such as pyoderma gangrenosum, granuloma annulare, morphea, vasculitides, and graft-versus-host disease were highlighted as areas of persistent unmet need, where off-label use remains unavoidable. 

Among areas of optimism, he pointed to a renewed role for intralesional therapies in nonmelanoma skin cancer, citing high reported clearance rates with intralesional methotrexate or 5-fluorouracil in selected cutaneous squamous cell carcinomas and keratoacanthomas, while stressing variability in protocols and the need for careful patient selection. Photodynamic therapy was also framed as underutilized, with blue- and red-light modalities viewed as complementary rather than interchangeable, particularly for actinic keratoses. 

In contrast, Dr. Bhatia described the topical therapy pipeline as “dry,” warning that overreliance on biologics and systemics risks marginalizing foundational dermatologic treatments. He highlighted emerging interest in novel topical mechanisms, including fatty acid synthase inhibitors for acne, topical JAK inhibitors for select off-label indications, and photodynamic agents such as topical hypericin for early-stage cutaneous T-cell lymphoma. 

The latter portion of the talk focused on pipelines for inflammatory diseases, particularly hidradenitis suppurativa and chronic spontaneous urticaria, where JAK inhibitors, BTK inhibitors, IL-1–targeted agents, and KIT-directed therapies may reshape management. Dr. Bhatia concluded that therapies that “turn off the faucet rather than mop up the mess” best reflect the future of dermatologic drug development.