Eczematous Dermatitis: Dr. Zirwas

Dr. Matthew Zirwas:
Hi, I'm Dr. Matthew Zirwas here at Maui Derm. This year my session that I really want to talk about was an update on non-atopic dermatitis. And so this is the patients in particular, hand dermatitis and facial dermatitis are the two things I'd really like to talk about. And we're going to start with hand dermatitis. First, I'm going to give you the two-second summary. JAK inhibitors, topical JAK inhibitors are the best thing you are ever going to find for hand eczema. I think they're even better for hand eczema than they are for atopic dermatitis. Now, why? Well, hand eczema is a very heterogeneous disease. So everybody with hand eczema has a component of irritant contact dermatitis. Now, you might say, everybody, what the heck do you mean everybody? Well, think about it, even if you wash your hands five times a day, that is the equivalent of getting five showers a day.

If you got five showers a day, don't you think you would get dry, flaky, itchy skin? Yes, you would, right? So now if you put on top of that, you've also maybe got some allergic contact dermatitis, maybe you've got some atopic dermatitis as well. And then all three of those entities are immunologically different. So allergic contact dermatitis, primarily Th1, atopic dermatitis, primarily Th2, irritant contact dermatitis, really non-immunologic, more inflammatory. And so it's made it difficult to find drugs that would work really well. Well, it turns out JAK inhibitors are kind of the perfect drug, and especially there's a pan-JAK inhibitor coming. We just got some data on it. It's called delgocitinib. It's from our friends at LEO, and it is the first JAK we've got that really hits JAK1, JAK2, JAK3 in tick. And you really want the broad spectrum coverage of the JAKs for the anti-inflammatory and immunoregulatory effects.

So that's number one. With hand dermatitis, you still think about contact derm. You still think about atopic derm, but topical JAK inhibitors are absolutely the most effective thing I've ever seen. Now, let's jump over to facial dermatitis. Key thing with facial dermatitis. Your big differential there, again, atopic dermatitis, allergic contact dermatitis, but then seborrheic dermatitis. And again, we've got a fantastic drug here. So now face, I do want to talk, so first, what's the drug? The drug absolutely should be ZORYVE foam. So ZORYVE foam, phenomenally effective for seborrheic dermatitis. Also, a really good drug for allergic contact dermatitis or for atopic dermatitis. And so when I see facial dermatitis, that is my first go-to. Now, I'm still going to think, especially around allergic contact dermatitis, shampoo and conditioner are the two big things. And so my favorite brand there is called Cleure, C-L-E-U-R-E, Cleure. It's a mashup of clean and pure.

The other brand that I really like for hypoallergenic shampoo and conditioner, it's called VMV Hypoallergenics. So literally the letters, VMV Hypoallergenics. They're a little more bougie of a line than the Cleure. But so my standard, when I see facial dermatitis, I see it say and say, OK, allergic contact dermatitis, I'm going to change your shampoo and conditioner, make sure you're using a nice facial soap, CeraVe, Cetaphil. Those are very low-contact allergen things as well. But I'm going to change those things. I'm going to put you on ZORYVE because ZORYVE is going to work, whether it's seborrheic dermatitis, atopic dermatitis, or allergic contact dermatitis. So that is the two big takeaways. Hand dermatitis got a lot easier because we've got a topical JAK on the way. Opzelura is reasonable to use right now. And then for facial dermatitis, it's gotten a lot easier because we've got good low-allergenicity shampoo and conditioner. And we've got a drug in ZORYVE that really works for whatever the cause of the facial dermatitis is. So again, Matt Zirwas coming to you from Maui Derm this year. Really, if you're not here, you ought to be.