Staying on top(icals)
The dermatology drug pipeline faces innovation gaps as experts push for renewed focus on topical therapies.
P010 – Pipeline Therapies in Dermatology
1-3 p.m. | Saturday, July 18
Sutton North
The future of dermatologic therapeutics is drawing increased scrutiny as physicians warn of a shrinking pipeline for new topical therapies, even as demand for safer, targeted approaches to treatment continues to grow.
The debate over what’s currently rich in potential and what’s at risk of extinction will serve as the foundation for the July 18 session, P010 – Pipeline Therapies in Dermatology. According to Neal Bhatia, MD, FAAD, who will lead the session, this gap is further widened as big pharmaceutical companies new to dermatology fund more research trials that focus on systemic and biologic treatments, and start-up companies take risks with proof of concept and early phase studies. Dr. Bhatia is director of clinical dermatology at Therapeutics Clinical Research in San Diego.
“The issue is that there’s not a lot coming down the pipeline and we’re losing our edge as dermatologists because we’re going to be without novel vehicles, having already lost branded topical steroids,” Dr. Bhatia said. “There are few innovations coming because nobody wants to support them. Sponsors don’t want to develop new topicals anymore because they think it’s a losing effort, and we’re going to get stuck with generics if we’re not careful.”
Impact on practices
Dermatology has long relied on topical treatments as a core part of patient care. The decline is already affecting clinical practice, Dr. Bhatia said. Physicians report that even when they prescribe specific formulations — such as foams or sprays for scalp conditions — these are often substituted with less effective or less acceptable options like ointments.
Despite these headwinds, Dr. Bhatia said several emerging and recently approved therapies are generating excitement for their potential versatility and safety compared with traditional steroids.
Among them:
- Ruxolitinib cream, which shows promise for multiple off-label uses beyond its approved indications
- Roflumilast (a PDE-4 inhibitor), which has potential applications across a wide range of inflammatory skin conditions
- Delgocitinib, which is currently indicated for hand eczema but is being explored for broader use
- Tapinarof cream, which is approved for atopic dermatitis and psoriasis
These newer agents provide options for dermatologists to reduce reliance on topical steroids, which are effective but carry risks with long-term use. Experts suggest that many of these therapies may be particularly valuable for conditions that are unlikely to ever receive large clinical trials, opening the door to expanded off-label use.
“Take ruxolitinib cream for example. There are so many potential off-label uses for it. There’s a lot of potential to use it for diseases that will never have a phase 3 trial,” Dr. Bhatia said. “It’s a golden opportunity for dermatologists to expand their horizons with what’s already available. But again, access is a deterrent.”
Innovation challenges
Neal Bhatia, MD, FAAD
In addition to fewer new molecules, dermatologists are also facing a decline in innovation around drug delivery systems, he said. Newer formats such as foams, sprays, and tapes — once critical for treating difficult areas like the scalp or nails — are becoming increasingly rare.
This lack of variety limits treatment flexibility and may reduce adherence, as patients often prefer lighter, more convenient formulations over traditional creams and ointments.
“We’re stuck with creams, gels, and ointments, so we don’t have the versatility to treat the scalp and other areas that are harder to treat,” Dr. Bhatia said. “There are new skin care sprays for itching, so there is some novelty there.”
Mounting pressure and call to action
The slowdown in dermatologic innovation could have broader implications. Dr. Bhatia warned that if dermatologists do not maintain leadership in treatment development, other specialties like rheumatology and allergy may increasingly inherit care of skin diseases, particularly for systemic therapies.
Topical treatments, he argued, are central to the specialty’s identity — making continued investment in this area critical for maintaining its clinical role.
To address these challenges, Dr. Bhatia encourages dermatologists to support dermatology-focused research, emphasizing the importance of staying current with pipeline developments. Balancing innovation, access, and reimbursement challenges will be key to ensuring that patients continue to benefit from effective, modern treatments.
For now, he said, the path forward will require a mix of leveraging existing therapies in new ways and advocating for renewed investment in the next generation of dermatologic drugs.
“Dermatologists need to stay in tune with what’s in the research pipeline because if they don’t, they’re going to get stale.”
