practicaldermatology.com
The current landscape of therapeutics for dermatologic conditions is dramatic, with new groundbreaking drugs continuously becoming available.
Matching that level of drama, Neal Bhatia, MD, FAAD, and Ted Rosen, MD, took the stage dressed as a zombie and the grim reaper, respectively, and used a horror movie theme to present “New Drugs and Therapies in 2025” at the Maui Derm Hawaii 2025 meeting in Maui, Hawaii.
Dr. Bhatia and Dr. Rosen first talked about immediate/extended release minocycline for rosacea, approved last November and launching this spring.
“We can deliver minocycline in a dose that’s safe, and we can reduce the cumulative dose,” Dr. Bhatia said, noting as well that many rosacea patients are eager to switch to an oral option.
For prurigo nodularis, Dr. Rosen noted the significance of nemolizumab joining dupilumab as another approved option.
“Dupilumab works just fine … but like every disease, it’s always important to have more than one option, because no drug is 100% effective on 100% of people,” Dr. Rosen said.
Nemolizumab inhibits signaling of the IL-31 receptor A.
“If you block the effects of IL-31,” Dr. Rosen said, “you are in effect blocking neuronal proliferation.”
While one reported side effect of nemolizumab is atopic dermatitis, Dr. Rosen noted that this is probably because those patients already had underlying atopic dermatitis.
Speaking of atopic dermatitis, Dr. Rosen talked about roflumilast for that disease, stressing that it is used in a different concentration than for psoriasis but that results can be dramatic.
“If you get clear—and I would stretch that definition a little bit, if you’re pretty close to clear—you can drop down your dosing to twice weekly,” Dr. Rosen said.
Tapinarof, meanwhile, was recently approved for age 2 and older, and the latest studies showcase long-term results.
“These extension studies aren’t just for the purpose of having another publication or another poster,” Dr. Rosen said. “Think about it. These are chronic diseases. We are managing; we are not curing. So, you don’t want something that is going to work for a couple of months and then they’re all just going to go back to where they were.”
Another new option for atopic dermatitis is lebrikizumab, and Dr. Rosen noted the potential benefit of decreasing dosing.
“If after or at week 16, the patient is having good clinical response, you can maintain that with the same 250 mg, but instead of every 2 weeks you can do every 4 weeks,” Dr. Rosen said.
Even more recently, nemolizumab also was approved for atopic dermatitis. Dr. Rosen noted that there is no weight discrimination for this application, unlike with nemolizumab for prurigo nodularis, and similar to lebrikizumab, dosing can be decreased.
“Does it work? Yes,” Dr. Rosen said, showing the results of the ARCADIA studies. “So, now we have four derms—dupi, tralo, lebri, and now nemolizumab.”
Dr. Bhatia added that the future is even more promising.
“As good as we’re going to get, we still have a lot of good things coming,” he said.
Perhaps the most promising drugs involve the OX40 pathway. The anti-OX40-L monoclonal antibody amlitelimab has shown promising results in trials.
“What their binding does is stimulate a high level of T cell proliferation on all counts,” Dr. Bhatia said, also mentioning rocatinlimab.
“If you can block these long-lasting memory cells,” Dr. Rosen said, “there’s possibility for infrequent dosing, there’s possibility for therapeutic rest periods, maybe even a cure.”
Moving on to hidradenitis suppurativa (HS), Dr. Rosen called bimekizumab “basically revolutionary.”
“We all have hidradenitis patients who responded to something … except 6 months later, a year later, they don’t respond anymore,” Dr. Rosen said, emphasizing the importance of the 2-year data for bimekizumab.
Dr. Bhatia noted that the speed with which bimekizumab takes effect is another major benefit.
“They got better quickly,” he said. “To get them that relief quickly, they will stay on the treatment, which is the best part.”
Dr. Bhatia also discussed ruxolitinib cream 1.5% for mild-to-moderate HS.
“Again, look at that sprint effect,” he said of the fast results.
Dr. Bhatia also mentioned that phase 3 data is on the way for povorcitinib for HS, and Dr. Rosen noted that brepocitinib for HS may eventually be revisited.
In other disease states, Dr. Bhatia noted the “amazing” data on TYK2 inhibitors for lupus.
“We’re going to see a lot for lupus,” he said.
For chronic spontaneous urticaria (CSU), Dr. Bhatia noted that omalizumab is used more by allergists now, but that dupilumab could soon be used for CSU.
“There’s no way dupilumab won’t get approved for treating chronic spontaneous urticaria,” Dr. Rosen said.
Meanwhile, remibrutinib offers an exciting new option for CSU.
“This is amazing, and this is oral,” Dr. Rosen said. “We can take back hives and tell the allergists to just give a bunch of shots to their patients.”
Dr. Bhatia added, “I think we’re going to learn a lot more about how safe it is for all these patients.”
For vitiligo, Dr. Rosen spoke about the potential of ruxolitinib cream.
“This is now long-term, 2-year data, and look what happens: It keeps getting better,” Dr. Rosen said. “If you’re using ruxolitinib topical to treat vitiligo, you need to tell your patients, this might take time.”
Dr. Rosen noted that some oral JAK inhibitors should be available for vitiligo soon as well.
For skin cancer, Dr. Rosen and Dr. Bhatia talked about tirbanibulin, lifileucel, and cosibelimab, and looking ahead, they discussed intralesional VP-315 and intralesional cemiplimab.
They discussed several new device approvals, with Dr. Rosen focusing on Enspectra’s VIO system for biopsy-free skin imaging and diagnosis based upon AI interpretation of multiphoton laser scanning with reflectance confocal microscopy.
“That combines two different ways of looking at lesions, down to the cellular level, so you can tell what it is, how deep it is, where it is, and where it isn’t,” Dr. Rosen said.