Exciting developments in the treatment and management of numerous dermatologic diseases are providing much-needed options to adult and pediatric patients with these conditions. New biologics and Janus kinase (JAK) inhibitors offer viable therapeutic choices for an increasing list of dermatologic diseases and conditions, including psoriasis, atopic dermatitis, alopecia areata, vitiligo, and other common dermatoses.

Although the scope of cutaneous conditions and diseases in dermatology is extensive, continued research and development have led to several breakthrough medications to address many common dermatologic diseases.

“In the last 20 years of being involved in dermatology, I have never seen so much innovation and so much of a deep understanding of diseases. I think we have entered the ‘virtuous cycle of drug development,’ where we innovate and make new medicines, learn more about the disease, and then make even better medicines with more targeted actions,” said Peter A. Lio, MD, FAAD, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine, founding director of Chicago Integrative Eczema Center, and founding partner of Medical Dermatology Associates of Chicago in Illinois.

This scenario has played out during the past decade in psoriasis with the availability of ever-improving treatments. According to Lio, this virtuous cycle has continued and expanded to include atopic dermatitis, alopecia areata, vitiligo, and acne.

Coverage Concerns

Although novel therapeutic agents and drug vehicles for dermatologic diseases have become available on a global scale, insurance providers and health care coverage remain a major obstacle.

“In the last couple of years, we have seen an explosion of new targeted drugs such as dupilumab, which is now the standard of care in most parts of the world,” said Maria Teresa Garcia-Romero, MD, MPH, SPD, chair of the International Outreach and Global Alliances Committee for the Society for Pediatric Dermatology and an attending physician and assistant professor at the National Institute of Pediatrics in Mexico City, Mexico. “However, in my region in Latin America, the introduction and approval of this agent as well as other breakthrough medications are still in their beginning stages, and it can be very challenging for patients to receive insurance coverage for these very effective therapies.”

Garcia-Romero said it usually takes 3 to 5 years for these medications, including the IL-17 blocker ixekizumab and IL-12/23 blocker ustekinumab used for psoriasis, to become available in Mexico and other Latin American countries, significantly lagging behind the relatively quicker FDA approval for these medications in the United States. Once approved however, pediatric patients will still have difficulty attaining these agents due to lack of appropriate insurance coverage.

“The accessibility of these drugs is still very difficult, and most patients cannot pay for these medications themselves,” Garcia-Romero said.

“Only those patients who have medical insurance or visit hospitals where government-subsidized plans cover the costs of therapy have access to these drugs. As with other countries, [in Latin America,] unfortunately it is the regulatory environment that hinders patients from [receiving these drugs in a timely manner].”

What’s Next?

Lio noted that as more treatment options become available, it is of paramount importance that the decision-making process regarding treatment and management be shared with the patient. Lio explained that, ideally, clinicians should lay out the potential therapeutic options and carefully review them with the patient when deciding on a treatment plan. Lio said this becomes even more important when dealing with more serious medications because patients must be ready and willing to address any adverse effects that may occur during the treatment period.

“This is a very exciting time in pediatric dermatology and adult dermatology,” Garcia-Romero said. “There are many areas of research in inflammatory disorders and genetic disorders where in the past 10 years, we have seen more advances than in the previous decades. We are getting closer to being able to treat many of the conditions that we see on a daily basis, and we can provide a lasting improvement for patients.”

Lio agreed. “We are currently in an innovation phase of development, and it has been such an exciting bonanza of new ideas and therapies that have recently come forth,” he said. “The next 10 years should be very interesting, and surely our patients will benefit from continuing research in dermatology.”