Is it hot in here, or just the topics?

Can emollients prevent the first onset of atopic dermatitis in high-risk newborns? That was the first of many exciting questions answered in Saturday’s S038 – Hot Topics, led by David Eric Cohen, MD, FAAD. Eric Simpson, MD, MCR, FAAD, professor of dermatology at Oregon Health & Science University, kicked off the session by presenting information on atopic dermatitis pathogenesis and evidence suggesting that it can’t be prevented from the outside in.

“So far, it hasn’t panned out. But I’m not giving up,” Dr. Simpson said. Still, evidence shows you can reduce the severity of the atopic disease progression in infants with proactive therapy started within four months of diagnosis.

Who should use JAK inhibitors?

“JAK inhibitors are potent therapies for biologic failures,” Dr. Simpson said. They are not recommended for patients with a history of clotting risks, cancer, serious infection, severe renal or liver disease, or significant cardiovascular disease. Avoid prescribing a JAK inhibitor to patients who are pregnant or breastfeeding, but pick patients carefully, engage in shared decision-making, and do not use during pregnancy or lactation. Patients should review the medication guide. JAK inhibitors provide amazing results if used properly in the right patient,” he said.

New help for hair loss

Does low-dose oral minoxidil work better than topical minoxidil? Since 2015, low-dose oral minoxidil — 10 mg or less daily — has become almost routine for dermatologists to use for various hair conditions, said Jerry Shapiro, MD, FAAD, professor at NYU Grossman School of Medicine. Dr. Grossman presented evidence that low-dose oral minoxidil can benefit patients with androgenetic alopecia and alopecia areata. Dr. Shapiro also presented new evidence on the efficacy of baricitinib. “This will become the first FDA-approved medication for alopecia areata,” Dr. Shapiro said. Doses of 4 mg and 2 mg show significant results in clinical trials, compared to placebo, with low side effects. Ritlecitinib is another JAK inhibitor on the horizon. There is no cure for alopecia areata. “But these JAK inhibitors will be game changers. Eyelashes and eyebrows regrew in many people,” Dr. Shapiro said. “I tell patients: ‘Your hair is not dead. It’s sleeping. We need something to wake it up.’ These JAK inhibitors seem to wake it up in many patients.”

Lasers and energy-based therapies

Highlighting new technologies on the horizon, “there’s a lot in the pipeline,” said Murad Alam, MD, FAAD, vice chair in the department of dermatology at Northwestern University in Chicago. “Many use AI and other similar technologies to improve the targeting of lasers. It’s a matter of zapping exactly what you want,” Dr. Alam said. New laser devices on the horizon include combination C02157 nm ablation and tightening and imaging-directed selective dermal laser treatment. “The device uses next-generation 3D precision laser and high-resolution imaging,” Dr. Alam said. Be on the lookout for non-laser devices as well, such as nitrogen-derived plasma technology — plasma that can cause epidermal and dermal remodeling. Robotics will also be a big part of the future, such as the robotic no-contact 1064 nm diode for lipolysis. It’s laser technology that doesn’t touch the skin or cause pain like contact 1064 nm lasers can. But don’t worry that robots will replace dermatologists. “We will still be the leaders to use the technologies to help our patients get better outcomes,” Dr. Alam said.