What's New in Technology (Predicting the Future) Christopher Zachary, MD
Dr. Christopher Zachary led us through an exciting look at the future of technology in dermatology. Micro-coring is a new technology for scarless skin removal without the use of thermal energy for treatment of loose skin and wrinkles. Nano-Pulse Stimulation (NPS) uses ultra-short electrical energy pulses to cause non-thermal regulated cell death in treatment of both benign and malignant skin tumors. Studies have demonstrated efficacy in treating sebaceous hyperplasia, acne, seborrheic keratoses, and recalcitrant warts with NPS. Additional emerging treatments for acne include selective destruction of sebaceous glands using the 1726nm laser device, and selective photothermolysis of sebaceous follicles with topically delivered light-absorbing gold nanoparticles with 800nm diode laser. Treatment of basal cell carcinomas using a controlled hyperthermic and modulated protocol (CHAMP) for the 1064 nm Nd:YAG laser allows precise energy delivery to limit undesired side effects. The Clarity II 1064/755nm laser is a new device that improves upon current technology for treatment of laser hair removal, vascular lesions, and pigmented lesions. A new protocol for treating vascular conditions such as port-wine stains, rosacea, and poikiloderma utilizes the DermaV 532nm KTP laser. Multiphoton microscopy (MPM) allows the ability to image skin structures and tumors in vivo, label-free and non-invasively. Finally, rapid acoustic pulse technology (Soliton) and Synchronous Ultrasound Parallel beam technology (Sofwave SUPerb) are promising new treatments for patients with aging skin.
Finessing Fillers and Toxins Arisa Ortiz, MD
In her second talk of the day, Dr. Arisa Ortiz shared her expertise on the use of fillers and toxins. She emphasized the importance of proper counseling and setting realistic expectations, advising to “under-promise, over-deliver.” There are many hyaluronic acid fillers currently on the market, as well as several non-HA fillers. Tips for using dermal filler include having a strong knowledge of anatomy, the ability to recognize complications, being conservative with the volume injected in one session, a focus on volumizing the face rather than filling the lines, and showing patients their improvement periodically during treatment. There are currently 5 botulinum toxins with FDA approval in the US (Botox, Xeomin, Jeuveau, Dysport, and most recently Daxxify). Tips for using botulinum toxin include using a “less is more” approach, injecting high on the forehead, and avoiding injecting the upper forehead without glabella in women. She discussed specific injection techniques including brow lift, filler for temples, bunny lines, dynamic periorbital rhytides, perioral lines, gummy smile, nasal tip droop, lower eyelid, tear trough, depressor anguli oris, chin bunching, platysmal bands, jawline filler, necklace creases, hypertrophic masseter, and hand rejuvenation. Lastly, she focused on methods for treating male patients with fillers and toxins while preserving their male characteristics. Complications such as eyelid ptosis, bruising, and blindness from fillers are rare and can be prevented by avoiding high-risk areas and knowing the anatomy.
Telemedicine: Where Are We Now? Ivy Lee, MD
Dr. Ivy Lee provided us with an illuminating discussion of telemedicine optimization in our current age. She described both synchronous modalities of telehealth, such as audio (telephone) and videoconferencing, as well as asynchronous (store-and-forward) modalities such as email/portals, SMS text, and third-party platforms. This is of importance as the modalities that are covered and reimbursed may vary widely, and there are pros and cons of both types. Hybrid telehealth involves the combination of asynchronous and synchronous telehealth, and hybrid care involves the combination of telehealth and in-person, “brick-and-mortar” care. With the beginning of the Covid-19 pandemic in March 2020, the use of telehealth grew dramatically and rapidly. During this time, previous barriers to telehealth were removed almost overnight. The dermatology community created resources such as the AAD Teledermatology Toolkit, with helpful tools such as a coding workflow and clinical workflows for both outpatient and inpatient diverse customization. Through this experience, dermatologists have been able to experiment with how telehealth can be used in the field, with opportunities for quality improvement and optimization as well as personalization of care for patients. Potential uses for telehealth may include chronic conditions, medication management/monitoring, triage of new lesions, skincare discussions, pre-procedure consultation, post-procedure follow up, and patients who are traveling. One of Dr. Lee’s favorite uses of telehealth is for isotretinoin. Customization of telehealth to both diverse practice settings and patient populations allows for improved efficiency, patient access and experience, and physician well-being. However, challenges remain with the uncertain reimbursement and regulatory landscape of telehealth.
Poster of the Day
Deucravacitinib long-term efficacy and safety in plaque psoriasis: 2-year results from the phase 3 POETYK PSO program Richard B Warren, Howard Sofen, Shinichi Imafuku, Jacek C Szepietowski, Andrew Blauvelt, Lynda Spelman, Joannee Zumkehr, Jessica Toms, Alex Buck, Subhashis Banerjee, Alan Menter
Deucravacitinib is an oral, selective, allosteric tyrosine kinase 2 (TYK2) inhibitor that uniquely binds to the regulatory domain and is FDA-approved for treatment of adults with moderate to severe plaque psoriasis. The objective of this analysis was to characterize the safety and tolerability of long-term deucravacitinib use and the maintenance of efficacy responses. A total of 1519 patients enrolled in the POETYK PSO-1/PSO-2 and the POETYK long-term extension (LTE) trials were included in the analysis. Overall, the 2-year safety profile was consistent with Weeks 0-52 of the POETYK PSO-1/PSO-2 trials with predominantly mild to moderate adverse effects, most commonly nasopharyngitis, upper respiratory tract infection, diarrhea, arthralgia, and headache. An increase in serious infections observed was attributable to the Covid-19 pandemic and consistent with background epidemiologic rates. There were no serious cases of disseminated herpes zoster, and there was low incidence of cardiovascular events. Clinical efficacy was maintained for up to 2 years with deucravacitinib treatment as measured by PASI 75, PASI 90, and sPGA 0/1. The findings of this long-term study support the use of deucravacitinib as an efficacious and well-tolerated treatment for moderate to severe plaque psoriasis. See the full poster here.