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Greetings, Dermatology E-News Readers! Next month is Medscape’s 2nd Annual Pigmentary Disorders Exchange Symposium, and in this issue, Medscape’s PDE faculty candidly share their thoughts and opinions on a variety of current topics, treatments, and debates in both the PDE space and in clinical and aesthetic dermatology more generally. Read on to see what they say when the microphone is off!

Check out this month’s Derm Resource section, with articles from Cutis, JAMA Dermatology, Dermatology News, Cutis, and NEJM—and don’t miss the MD-IQ quiz on treating vitiligo at the end of this issue—are you up to date before the PDE Symposium?

Thank you to our faculty featured in this issue. Please contact me at colleen@cmhadvisors.com with comments or suggestions. Thanks!—Colleen Hutchinson

Rapid Fire with Our PDE Thought Leaders…

The need for paradigm shifts in how we approach patients with pigmentary disorders:

Dr. Pearl Grimes: We are indeed in dire need of paradigm shifts for treatment of a spectrum of pigmentary diseases in all skin types. This is particularly important when using peels, lasers, and light sources. It is important to educate physicians regarding the dos and don’ts for treatment in different skin types.

Dr. Susan Taylor: Pigmentary disorders are not cosmetic disorders, but rather medical problems that must be accurately diagnosed and treated.

Dr. Seaver Soon: Start thinking of how the epidermis and dermis interact to initiate and sustain pigmentary disorders.

Dr. John Harris: So many novel therapies are being developed for skin diseases—we need pigmentary diseases to get on the radar, too!

Dr. Iltefat Hamzavi: Yes—these conditions have an unconscious bias against them that suggests they are medical problems, when the reality is they have tremendous impact on sense of wellbeing.

Favorite new treatment option of this decade:

Dr. Grimes: I love the spectrum of new non hydroquinone products.

Dr. Passeron: JAKi in vitiligo.

Dr. Harris: Have to say Opzelura, but I’m biased. . .

Dr. Hamzavi: Vitiligo surgery.

Dr. Taylor: JAK inhibitors (vitiligo, lichen planus pigmentosus, and also atopic dermatitis, psoriasis, alopecia areata) and also tranexamic acid for melasma.

Where we are at with treatments for melasma:

Dr. Grimes: We have made major new advances in photoprotection, topical agents, chemical peeling, and the use of lasers and light sources.

Dr. Soon: Melasma is still a challenge, but understanding the role of the dermis and of high energy visible light are steps forward.

Dr. Passeron: Very good depigmenting options but we still need a cure to prevent relapses.

Dr. Taylor: Emerging.

The evolution of the therapeutic landscape of pigmentary disorders:

Dr. Taylor: Extraordinary.

Dr. Passeron: Great advances for vitiligo (and the best is yet to come!). For hyperpigmentary disorders: better cosmetic depigmenting agents and great advances on the impact of visible light.

Dr. Grimes: We have made major advances in our understanding of the pathogenesis of melasma and vitiligo. This new knowledge is the magnificent foundation for therapeutic intervention. Melasma requires a multi-modality approach to optimize outcomes. The vitiligo landscape has changed substantially. Following the approval of ruxolitinib in 2022, there are multiple new topical and oral therapies in development, with several in phase 3 trials.

Dr. Harris: Rapidly improving in vitiligo with ongoing clinical trials.

Dr. Hamzavi: Better outcome measures with better treatments and awareness.

Where we are at with treatments for hyperpigmentation:

Dr. Grimes: Photoprotection, new sunscreens providing visible light protection, oral and topical antioxidants, oral and topical tranexamic acid, many new and effective non hydroquinone lighteners, and new and better resurfacing procedures.

Dr. Passeron: Significant advances for melasma (but still need approaches to provide long-term efficacy), but a long way to go for PIH.

Dr. Taylor: Progressing.

Industry-supported educational endeavors:

Dr. Grimes: VERY IMPORTANT for education, research, and advocacy.

Dr. Taylor: Exceptional.

Dr. Passeron: More information on vitiligo for patients, their family, and the physicians who are still undertreating and not considering this condition enough.

Where we are at with treatments for vitiligo:

Dr. Grimes: Photoprotection, new sunscreens providing visible light protection, oral and topical antioxidants, oral and topical tranexamic acid, many new and effective non hydroquinone lighteners, and new and better resurfacing procedures.

Dr. Passeron: JAKi (topical and oral) are a great advance but they are only the first generation. Combination approaches are mandatory and efforts must be made to enhance melanocyte differentiation to repigment resistant areas.

Dr. Harris: PUVAsol was being used in the iron age 3400 years ago, and light is still the mainstay of treatment. JAKi are effective for vitiligo, so new options are now available and more are coming. There are even more drugs on the horizon, so exciting time for sure!

Dr. Hamzavi: Making advances, but advocacy must be coupled with better options targeting melanocytes.

Dr. Taylor: Light years ahead with JAK inhibitors.

Need CME? We’ve got you covered!

Three meetings you can register for today: The upcoming 2nd Annual Pigmentary Disorders Exchange Symposium in June (more details below), the Skin of Color Update in September, and the Las Vegas Dermatology Seminar, also in September! Click on these meeting links to register and catch up on your CME!

The 2nd Annual Pigmentary Disorders Exchange Symposium

Register now by clicking here!

Loews Chicago Hotel • Chicago, Illinois, June 7-8, 2024

  • World-renowned dermatology experts spend two full days diving deep into pigmentary disorders in the full spectrum of skin tones.
  • Brought to you by MedscapeLIVE! and the producers of ODAC Dermatology, Aesthetic, and Surgical Conference and Skin of Color Update.
  • Participants will increase their understanding of:
    • The effects of pigmentary disorders on patients' quality of life.
    • The need for paradigm shifts in how we approach these individuals.
    • Pathogenesis, nuances in clinical presentation, and full range of therapeutic options (topical approaches, oral interventions, and procedural modalities)—from hyperpigmentation to hypopigmentation!

Dermatology Resource Section:

Cutis Clinical Review: An Update on Cutaneous Angiosarcoma Diagnosis and Treatment

JAMA Dermatology—Viewpoint: Emergency Contraception for Patients Taking Isotretinoin

NEJM Perspective: Learning to Say Goodbye

Dermatology News JAK Inhibitors for Vitiligo: Response Continues Over Time

Cutis Commentary: Sunscreen Safety: 2024 Updates

JAMA Dermatology Editorial: The Quest for a More Accurate Diagnosis of Cellulitis-In Dreams Begin Responsibilities

MEDSCAPE MD-IQ QUIZ: Treating vitiligo