practicaldermatology.com
The development of new therapeutics for dermatologic conditions in recent years has been so prolific that Hensin Tsao, MD, PhD, used a “Maui Journal of Medicine” theme for his conference-opening presentation at the Maui Derm Hawaii 2025 meeting in Maui, Hawaii.
Following the traditional Hawaiian blessing and introduction from host George Martin, MD, Dr. Tsao and Sheila Fallon Friedlander, MD, presented “Dermatology in Review” to kick off the meeting.
“One of the biggest and most explosive areas of growth over the last 10 years has been the search for new drugs,” Dr. Tsao said.
Dr. Tsao first discussed scalp psoriasis, noting that 40% to 90% of psoriasis patients have this difficult-to-treat type. He highlighted research on tildrakizumab, an anti-IL-23 (p19) monoclonal antibody for psoriasis.1
“It’s effective and generally safe for scalp psoriasis,” he said, “which is good because, in general, scalp psoriasis has been difficult to treat.”
Dr. Tsao also spoke about the new oral IL-23 receptor antagonist peptide icotrokinra.2
“It joins other oral peptide antagonists,” Dr. Tsao said, “so this is an exciting sort of new approach … getting away from injections.”
Moving on the hidradenitis suppurativa, Dr. Tsao talked about bimekizumab, a dual IL-17A/F antibody shown to improve HS in a phase 2 study.3
Dr. Tsao referred to chronic hand eczema as “sort of a new frontier.”
“[It is] really quite challenging to treat, and here we’re looking into JAK inhibitors,” he said. “Topical steroid right now is the mainstay, but I think that’s moving away.”
In particular, he highlighted delgocitinib, a pan-JAK inhibitor formulated in a cream.4
“This is effective for moderate-to-severe chronic hand eczema,” Dr. Tsao said, “[and it] is a cream, so we’re not expecting a large number of systemic side effects.”
In atopic dermatitis, a new antibody against IL-13 worth noting is cendakimab, Dr. Tsao said, noting that there are only two FDA-approved IL-13 antibodies for treatment of atopic dermatitis (tralokinumab and lebrikizumab).
“Activation of this pathway is known to be a driver for atopic dermatitis,” he said.
Cendakimab has demonstrated significant benefits for moderate-to-severe atopic dermatitis,5 but Dr. Tsao cautioned that it is becoming important to differentiate which biologics perform better than others as more become available.
“The real question I raise with this one is … when does it become just another biologic inhibitor?” Dr. Tsao said.
Moving on to skin cancer, Dr. Tsao noted that advanced squamous cell carcinomas are a frequent cause of mortality in patients with kidney transplants. Cemiplimab for advanced squamous cell carcinoma had not been studied much, he said, until recently.6
“This drug, in this sort of regimen … can lead to some anti-SCC responses,” Dr. Tsao said. “Remember, most of these patients would have been dead with the advanced SCC … this was a pretty good advance in trying to tackle these patients.”
Dr. Tsao also discussed public response to drugs and accumulating strong data,7 the possibility of converting non-volar skin to pressure-responsive volar skin in ectopic dermatitis,8 detecting a “fingerprint in the blood via liquid genome,9 and the promise of artificial intelligence (AI) for predictive purposes.10
“It’s the idea that they will get better and better and better,” Dr. Tsao said of AI. “We can use these to help educated your patients. And they’re good for event predictions. … [There is] a lot in your hands now that you can use to try to inform your patients of outcome.
Dr. Friedlander provided pediatric updates. The most important article impacting the world of pediatric dermatology, she said, involved interfering with the natural course of chronic disease.
Two important articles she discussed involved reducing atopic march risk in atopic dermatitis patients prescribed dupilumab11 and evaluating dupilumab on the disease burden.12
She stressed, as well, that while dupilumab has the most data, “if we were looking at JAK inhibitors, we might be seeing the same thing.”
“It appears to me that early intervention in atopic children may help,” she said.
Dr. Friedlander said the “big excitement drug” for both adolescents and adults is ritlecitinib, noting that it provides hope for patients with alopecia areata.13 She noted that clinicians need to reinforce to patients the importance of patience with this drug, however.
“Data shows that up to a year, more and more patients respond, so I think it’s important not to give up early with ritlecitinib,” she said.
Dr. Friedlander also noted that several studies have shown that vaccinations are safe for patients on dupilumab.14
“But you want to talk to families about it,” she said.
Finally, Dr. Friedlander talked about AI. The human element is still necessary, she said, but AI can be a useful tool. ChatGPT, she said performs just as well as pediatric dermatologists on case-based questions, though not quite as well on board exam type questions.
“We are still winning, but by just a hair,” she said. “Do not take everything that ChatGPT tells you at face value. Double check. But it’s a great way to start differential diagnosis.”