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January 2021

Grab a Fork and Knife: An Approach to Treating Rosacea

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ODAC Dermatology Conference Highlights Rosacea

Source: Next Steps in Derm

For most dermatologic conditions, my mantra for treatment tends to be “less is more”. I prefer to use the fewest number of creams, pills, and steps to achieve the best results. However, after watching this year’s ODAC Sneak Peek Inflammatory Diseases Symposium, I may have a new mantra for treating my rosacea patients – “forks, spoons, and knives”.

At the ODAC 2021 Pre-Conference Sneak Peek Inflammatory Diseases Symposium, Dr. Julie Harper, dermatologist at the Dermatology and Skin Care Center of Birmingham and Founding Director of the American Acne and Rosacea Society, built a case for use of combination therapy for rosacea.  It is well known that there are four subtypes of rosacea – erythematotelangiectatic, papulopustular, phymatous, and ocular. However, most patients don’t fall into one subtype, but rather, many experience subtype overlap. This is why Dr. Harper believes that clinicians should “start subtyping lesions” and treat all the lesions that are observed, even if that means use of multiple therapeutic agents.

Not only are there multiple targets clinically, but treatment for rosacea can also be targeted on a cellular level. The role of innate immunity including cathelicidins, specifically LL-37, and toll-like receptor 2 induction via demodex has been described in the pathogenesis of rosacea. But did you know that many of the well-known triggers of rosacea such as heat, stress, exercise, and spice have been implicated to affect rosacea on a cellular level? I certainly didn’t! Dr. Harper explained that common triggers of rosacea cause neurogenic inflammation via induction transient receptor potential channels to release substance P and calcitonin gene-related peptide, which cause vasodilation.

Forks, Spoons, and Knives

To better understand therapeutic options, Dr. Harper compares the various treatments to utensils, categorizing them into forks, spoons, or knives. She states that treating rosacea is like eating a meal – you can’t get by with just one utensil. While a spork would be a plausible loophole to this one-utensil-meal challenge, we don’t quite have a spork for treating rosacea (yet!).  So what exactly are the utensils that Dr. Harper explained?

Forks are medications that treat papules and pustules, including:

Spoons should be utilized for persistent background erythema, such as:

    • Brimonidine
    • Oxymetazoline

Finally, knives are device-based treatments:

    • Pulsed dye laser
    • KTP
    • IPL
    • Electrosurgery

Why Combination Therapy?

Before showing us the evidence that combination therapy works, Dr. Harper described the goals of combination therapy:

    • Achieve clear skin
    • Achieve treatment goals more quickly
    • Maximize remission periods
    • Minimizing burden of disease

First, she reviewed a JDD article (Fowler J. J Drugs Dermatol. 2007;6(6)641-646) that combined two forks: modified release doxycycline and metronidazole gel. This 16-week study compared combination modified-release doxycycline with metronidazole 1% gel to metronidazole 1% gel with placebo. Metronidazole was discontinued at week 12 and doxycycline or placebo continued through week 16. At week 4, patients who received combination therapy had greater reduction of inflammatory lesion counts and were generally better faster. Then after week 12, those who continued on modified release doxycycline had better sustained results.

Next, Dr. Harper reviewed another JDD study (Stein Gold L, Papp K, et al. J Drugs Dermatol. 2017;16(9):909-916) that combined a fork and a spoon – ivermectin and brimonidine – to treat both moderate to severe erythematotelangiectatic and papulopustular rosacea. Three groups were identified in this study – one receiving vehicle only, one receiving ivermectin for 12 weeks with addition of bromonidine at week 4, and one receiving both ivermectin and brimonidine for 12 weeks. The most striking result from this study was that those who used combination therapy for 12 weeks had double the rate of improvement of redness in the three hours after brimonidine use. Dr. Harper explained that despite the use of a really good fork (ivermectin), there was still enough residual redness that the spoon (brimonidine) could make a meaningful impact. Thus, targeting inflammation and pustules alone will not lessen background erythema.

Read More….

Thank You to ODAC Virtual Supporters

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This year, due to the global pandemic, we are hosting ODAC Dermatology, Aesthetic and Surgical conference, virtually. ODAC is committed to providing high-quality education in an engaging virtual format with top speakers and important topics.

With nearly 1,000 US attendees registered, ODAC will provide a unique virtual experience that will continue to drive dermatology education and networking forward.

We appreciate all the effort that it takes to change direction and to make such an important and impactful event happen. We are deeply grateful to our sponsors, faculty and attendees.

Please take a moment to acknowledge and thank our gracious supporters by visiting their sponsor page in ODAC Virtual app.

Platinum and Featured Sponsors  

 

Amgen logo

Please see the resources below to discover our data and explore our resources in our sponsor page.

 

Cassiopea, Inc. is a specialty pharmaceutical company developing and commercializing prescription drugs with novel mechanisms of action to address long-standing and essential dermatological conditions such as acne, androgenetic alopecia and genital warts. Learn more about our company at www.cassiopea.com.

Our commitment to dermatology is built around a senior leadership team with deep roots and experience in the specialty. The management team is focused on providing unique treatment options, and to drive continued research and development in Dermatology, moving us to the forefront of the U.S. market.

We are excited to support dermatology healthcare professionals by contributing to the ODAC 2021 Conference.

Galderma, the world’s largest independent global dermatology company, was created in 1981 and is now present in over 100 countries with an extensive product portfolio of prescription medicines, aesthetics solutions and consumer care products. The company partners with health care practitioners around the world to meet the skin health needs of people throughout their lifetime. Galderma is a leader in research and development of scientifically-defined and medically-proven solutions for the skin. For more information, please visit www.galderma.com/us.

 

Incyte is a global biopharmaceutical company that is focused on finding solutions for serious unmet medical needs through the discovery, development and commercialization of novel medicines.

Since 2002, Incyte has remained committed to the relentless pursuit of science that can improve the lives of patients, make a difference in healthcare and build sustainable value for our stakeholders. The Company is advancing a diversified portfolio of clinical candidates across Oncology and Inflammation & Autoimmunity. Our research and development efforts in Dermatology are focused on a number of immune-mediated dermatologic conditions with a high unmet medical need, including atopic dermatitis, vitiligo, and hidradenitis suppurativa.

Headquartered in Wilmington, Delaware, Incyte has operations in North America, Europe and Asia.

For more information, visit Incyte.com and follow @Incyte.

Visit the Incyte Dermatology Virtual Booth.

 

Neutrogena Logo

At Aveeno®, groundbreaking science transforms nature’s ingredients into clinically proven products that help soothe, strengthen, and restore the moisture barrier. Our oat, soy, and feverfew ingredients—derived from nature and uniquely formulated to optimize skin health and beauty—are supported by 75 years of published data, demonstrating the scientific rigor behind every result. Visit AveenoMD.com to learn about our new products, plus access clinical resources, patient resources, and product samples.

The #1 dermatologist recommended skincare brand continually elevates the science of skincare, delivering new products and innovations that support your treatment guidance. Visit NeutrogenaMD.com to learn what’s new, plus access clinical resources, patient resources, and product samples. NeutrogenaMD.com – dedicated to dermatology professionals.

 

La Roche-Posay logo

Our brands are dedicated to dermatology with offerings in professional skincare and cosmetics. Each brand is created by dermatologists or works in partnership with dermatologists to meet the health and safety standards for patients. Please visit the L’Oréal booth.

 

Novartis logo

Novartis is a leading global medicines company, using innovative science and digital technologies to create treatments in areas of great medical need. In our quest to find new medicines, we consistently rank among the world’s top companies investing in research and development. Novartis products reach more than 800 million people globally and we are finding innovative ways to expand access to our latest treatments. About 109,000 people of more than 145 nationalities work at Novartis around the world. Find out more at www.novartis.com.

We hope you will take a moment to visit the COSENTYX® (secukinumab) Virtual Booth Experience to learn more about the Complete Cosentyx Approach.

 

Ortho Dermatologics is a specialty pharmaceutical business with the number one prescribed acne franchise and a portfolio of dermatology treatments in additional therapeutic areas including atopic dermatitis, fungal infections and psoriasis. Led by a team with deep experience in dermatology, we are dedicated to building meaningful connections with healthcare providers and their patients. Our ongoing commitment to the dermatology community shows through our pipeline of novel compounds and focused philanthropic activity here and around the globe.

 

Regeneron is a leading biotechnology company that invents medicines for people with serious diseases. Founded and led for over 30 years by physician-scientists, our unique ability to repeatedly and consistently translate science into medicine has led to seven FDA-approved treatments and numerous product candidates in development, all of which were homegrown in our laboratories.

Sanofi is dedicated to supporting people through their health challenges. We are a global biopharmaceutical company focused on human health. We stand by the few who suffer from rare diseases and the millions with long-term chronic conditions. With more than 100,000 people in 100 countries, Sanofi is transforming scientific innovation around the globe.

Please click the link below to visit our virtual booth!
https://www.dupixenthcp.com/virtualcongress

 

At UCB, we come together every day to work, laser-focused, on a simple question: How will this create value for people living with severe diseases? Patient value is not just what we say, but how we how we live. It is our culture of care, embodied by our patient value strategy. That’s because how we do business – from discovery to development to delivery – has been transformed and redesigned around the patient and their individual experience. Patients are at the heart of everything we do, inspiring us, driving our scientific discovery, and leading us to rethink the patient experience. By fulfilling our commitment, driving innovation, and providing patients a meaningful experience, more impactful solutions are on the horizon.

With a team of approximately 7,500 employees and operations in nearly 40 countries, we are a global biopharmaceutical company investing more than a quarter of our revenue in cutting-edge scientific research to meet unmet patient needs. Global headquarters are in Brussels, Belgium, with U.S. headquarters in Atlanta, Georgia. Additional U.S. UCB sites include global clinical development in Raleigh, North Carolina, research supporting UCB’s pipeline in Boston, Massachusetts (Bedford and Cambridge), Seattle, Washington, and Durham, North Carolina as part of our acquisition of Element Genomics, as well as an office in Washington, D.C.

CLICK to ENTER Virtual Experience