Psoriasis is a chronic condition of inflammation of the skin. There are many different types of psoriasis. The most common form, plaque psoriasis, appears as raised, red patches covered with a silvery white buildup of dead skin cells. The cause of psoriasis is unknown, but it is often associated with other serious health conditions such as psoriatic arthritis, diabetes, heart disease and depression.Read More
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As we start off the New Year I wanted to share a few emerging trends in dermatology. In my practice I treat patients for both medical and cosmetic concerns so I will highlight some developments in both areas.
On the medical side there are a number of exciting new treatments emerging for the treatment of psoriasis, eczema and acne just to name a few!
Eczema – This chronic condition can be challenging to treat, particularly since, to date, we have had limited effective systemic medications. Dupilumab is a new biologic that was approved by the FDA in 2017 and has been approved by Health Canada for roll out in 2018. Dupilumab is a human monoclonal antibody that is designed to inhibit overactive signaling of two key proteins (IL-4 and IL-13) that are believed to be major drivers of the underlying inflammation in atopic dermatitis (eczema). We dermatologists (and our patients) have all been awaiting the approval of this new medication as the data suggests it is quite effective and safe. A number of other biologics and topicals (including non-steroid options) are also in the pipeline, promising even more options to treat this condition.
Psoriasis – There are a number of new biologics being introduced for the treatment of psoriasis as well. New IL-17 inhibitors and IL-23 inhibitors, including risankizumab, guselkumab, tildrakizumab, ixekizumab and brodalumab (all a bit of a mouthful to say J), are either recently approved or in the final stages of gaining approval to be marketed in the US and Canada. If you suffer from psoriasis you can ask your dermatologist whether any of these new medications may be right for you. Topicals in newer formulations, such as spray foam (enstilar), also continue to gain popularity for treating mild to moderate psoriasis where a high-powered biologic medicine is not called for.
Acne – In terms of acne treatments there is new evidence that certain combination treatments, such as adapalene and benzoyl peroxide (TactuPump Forte) can help treat acne, including more severe acne, and can also prevent and treat acne scarring. There are number of new topicals in the pipeline for acne treatment as well, including topical sebum inhibitors that could act to reduce “oily skin” that may drive acne in some patients.
Moving on to cosmetic treatments, there are a number of themes influencing the way we treat patients.
Body Sculpting - Each year the American Society for Dermatologic Surgery (ASDS) surveys consumers to understand their views on cosmetic treatments. For the fourth consecutive year the treatment of excess fat ranked as the #1 thing that bothered people about their appearance. This has given rise to the popularity of treatments such as CoolSculpting. A number of new and faster CoolSculpting applicators have recently become available and I believe this treatment will continue to increase in popularity. In addition, Belkyra (Kybella in the US), which was originally approved as a treatment for double chins, is now being used (off-label) on different body sites as well to help treat stubborn fat.
Combination treatments – Increasingly you will find different cosmetic treatments, such as neuromodulators like botox, being used in combination with fillers, and lasers, for more effective results. We have moved away from simply treating a line or wrinkle to thinking of the face in 3-dimensions and focusing not only on the skin, but thinking about the underlying structures as well. The aging process is complex and while a patient may be bothered by one thing, we may approach this concern with a combination of treatments to address related concerns. Often a combination approach may provide the most effective and longest lasting improvement.
Natural looking outcomes – While this is not a new theme, it is definitely one that continues to be important. The desire to ensure a natural look has led to the rise in treatments like microneedling and thermage, skinboosters, and the use of more frequent, but smaller treatments with filler and neuromodulators such as botox. This also aligns with the goal of prevention and using cosmetic treatments to help preserve skin elasticity and collagen, so that your skin can stay looking healthy and vibrant longer.
Focus on men - Men have always represented a smaller proportion of the cosmetic patient population but they continue to grow each year. While men make up only about 10% of the total patient population for popular procedures like botox, the number of men seeking cosmetic treatments has increased dramatically over that past several years. Understanding the unique needs of men and developing customized treatment plans to emphasize masculine features continues to be a focus.
These trends will continue to play a big role in my practice in 2018 and beyond. I will continue to keep up-to-date on the latest in both cosmetic and medical dermatology. If you have any questions or want to book a consultation, please feel free to contact us.
I recently returned from the 2016 American Academy of Dermatology Conference in Washington D.C., where I had an opportunity to share some of my research and get updates on all the latest in the field of dermatology. It was a wonderful meeting with over 18,000 in attendance!
Once again there was much discussion of psoriasis and the new biologics available for treatment, as well as the importance of screening for other medical conditions such as high blood pressure and heart disease in these patients. Counseling psoriasis patients to stop smoking, minimize alcohol consumption and maintain a healthy weight was emphasized.
Another interesting topic was a review of treatment of pre-cancerous lesions such as actinic keratoses with topical chemotherapy creams. This can be combined with therapies such as liquid nitrogen for improved outcomes. Photodynamic therapy is another way to treat these lesions for both a medical and cosmetic improvement. As the population ages and there is an accumulation of sun damage, treatment strategies for both pre-cancerous lesions and skin cancers will become even more important.
On the cosmetic side there was a focus on combination therapy for rejuvenation of the aging skin and discussion on complications from treatments. I had the opportunity to present on facial vascular anatomy and strategies to prevent and treat vascular complications including blindness from filler. I also was invited to teach in a hands-on workshop where I educated other dermatologists how to inject filler in various areas of the face to get the best cosmetic result. Participants were able to practice injecting directly into a training model to practice their skills.
Overall it was a great meeting with lots of pearls shared. I'm looking forward to next year's meeting in Orlando.
I recently returned from the American Academy of Dermatology (AAD) Annual Meeting in San Francisco, where I had an opportunity to collaborate with and learn from many leaders in the field of dermatology. One of the areas I was interested to hear more about was the latest in treatment for psoriasis. This was a popular topic due in part to Novartis recently receiving approval from the FDA for its new treatment called Cosentyx (secukinumab). Secukinumab is the first in a new line of psoriasis drugs called interleukin inhibitors, which block interaction with the IL-17A receptor that triggers the inflammatory response in psoriasis.
Older treatments such as Enbrel, Remicade and Humira block a protein called TNF that signals the body to create inflammation. Stelara (ustekinumab) targets proteins known as IL-12 and IL-23, while secukinumab goes after IL-17A, which only recently has been linked to psoriasis. Similar IL-17 drugs are in development at Eli Lilly & Co. (ixekizumab) and in a partnership between Amgen and AstraZeneca (brodalumab). These IL-17 therapies are expected to be more effective for patients with moderate to severe psoriasis.
Dr. Mark Lebwohl presented summary data on all three IL-17 targeted therapies – secukinumab, ixekizumab, and brodalumab. Studies show a high response rate and improvement in plaque, scalp and nail psoriasis for all of these new class of drugs.
Data on secukinumab showed superior results to ustekinumab in delivering clear skin to subjects with moderate to severe plaque psoriasis over 16 weeks. Secukinumab has previously shown greater efficacy to placebo and to Etanercept. The study is ongoing and 52-week data will be reported at a later date. It will be interesting to see if the results hold but the early results are certainly encouraging.
Dr. Andrew Blauvelt presented additional data on the long-term benefits of secukinumab, showing sustained efficacy to two years with a favorable safety profile.
With approximately 9 million psoriasis sufferers in the US and Canada, it is exciting to see these new treatments coming to market. Like any systemic medication there are potential side effects, but if you are suffering from psoriasis and are interested in further treatment, consult your dermatologist.