The
annual meeting of the American Academy of Dermatology
was held from March 7 to 11 in Orlando, Florida, and attracted clinicians, academicians, allied health professionals, and others interested in dermatology. The conference highlighted recent advances in the diagnosis and management of dermatological conditions.
During one presentation, Joshua Cook, M.D., of the Columbia University Irving Medical Center in New York City, noted that targeting insulin resistance and hyperinsulinemia is important not only for the treatment of obesity and diabetes, but potentially also independently for improving metabolism-related inflammatory skin diseases like psoriasis and hidradenitis suppurativa.
Cook discussed the tight epidemiologic connection between obesity, type 2 diabetes, and inflammatory skin diseases, especially psoriasis. The mechanistic basis of this connection is likely due to insulin resistance and/or hyperinsulinemia. Cook noted that hyperinsulinemia likely drives excessive proliferation and inflammation of skin lesions in psoriasis and other inflammatory skin diseases, even in the setting of systemic insulin resistance.
"We are currently performing clinical studies to better understand the role of insulin action in psoriasis," Cook said. "Health care providers should strongly consider screening patients with overweight/obesity and inflammatory skin diseases with hemoglobin A1c, fasting glucose, and lipid profiles. Treatment of obesity and type 2 diabetes with glucagon-like peptide-1 receptor agonists may improve inflammatory skin disease activity (an area of active research). There may also be roles for metformin and pioglitazone in inflammatory skin disease treatment in select patients."
Abstract
During another presentation, Daniel Charles Butler, M.D., of the University of Arizona College of Medicine in Tucson, discussed the connection between itch and aging.
Butler discussed how itch is very common in the older adult population. He noted there are many etiologic contributors to itch, including the immune system, the skin barrier, and the cutaneous nerves, all of which are uniquely impacted by aging.
"As practicing clinicians, we need to substantiate itch as a real, impactful but targetable symptom and disease," Butler said. "The connection between age and itching allows us to target contributing etiologies with available treatments. For example, itch in older adults is often multifactorial with immunologic changes and neuropathic changes. This allows us to use treatment to target multiple contributors."
Butler disclosed financial ties to the pharmaceutical industry.
Abstract
Adam J. Friedman, M.D., of the George Washington School of Medicine and Health Sciences in Washington, D.C., discussed how food allergy is an extremely rare cause of chronic urticaria with no identifiable cause (CSU), and some food intolerances may contribute, but responses are highly individualized and elimination diets should only be done in a structured way.
Friedman provided insight into how urticaria, both acute and chronic, is a common condition, affecting as many as 80 percent of people at some point in their lives. For approximately 1 percent of individuals who develop chronic urticaria, this condition can last for years, significantly impacting quality of life. While patients often search for a clear trigger, more than two-thirds of cases occur without an identifiable cause. Although food allergies can trigger acute urticaria, particularly in children, when it comes to CSU, food allergy is rarely a culprit. Friedman noted that, instead, he often sees food intolerances or pseudoallergic reactions, which may contribute to symptoms in some individuals. This distinction is important because a true food allergy involves an immune response, and food intolerances tend to be more variable, harder to predict, and less understood. A number of studies have explored dietary interventions in CSU, but the results so far have been mixed at best.
"At the end of the day, lifestyle modifications are cost-effective, noninvasive, and worth exploring, but they require proper education and guidance -- both for patients and physicians. This remains an underfunded and underresearched area, but as interest grows, we may gain clearer insights into how diet influences CSU," Friedman said. "While it's tempting to believe that cutting out a few foods might be a silver bullet, CSU is a complex, multifactorial condition. And as with most things in dermatology, there's rarely a one-size-fits-all approach."
Friedman disclosed financial ties to the pharmaceutical industry.
Abstract
Peggy A. Wu, M.D., of the University of California Davis in Sacramento, discussed how systemic contact dermatitis (SCD) is a diagnosis to consider in the setting of a chronic, recalcitrant
rash
in the right clinical setting, although the diagnosis is not common.
Wu discussed how SCD represents a small subset of allergic contact dermatitis (ACD) diagnoses. Like ACD, SCD is thought to be a delayed hypersensitivity reaction, and as such, reactions follow exposures in hours to days. SCD can present in a myriad of ways, including, most commonly, vesicular bilateral hand dermatitis, generalized dermatitis, and periorificial dermatitis. Frequent causes of SCD include exposure to nickel, balsam of Peru, and fragrance. The diagnosis is usually made in the setting of a chronic rash with positive patch test results to an allergen with plausible, relevant dietary sources and following topical avoidance of identified allergens.
"Physicians should consider the diagnosis of SCD in the setting of a recalcitrant chronic rash with certain phenotypes (vesicular bilateral hand dermatitis, generalized dermatitis, periorificial) and positive patch test reactions to allergen(s) with a possible relevant dietary source," Wu said. "A recommended approach to SCD is to start with a one-month trial of dietary modification. Longer courses of dietary modification may benefit from working with a dietitian to maintain nutritional need."
Abstract
AAD:
Baricitinib
Efficacious for Hair Regrowth in Teens With Severe
Alopecia Areata
TUESDAY, March 18, 2025 -- For adolescents with severe alopecia areata, baricitinib is efficacious for hair regrowth, according to a study presented at the annual meeting of the American Academy of Dermatology, held from March 7 to 11 in Orlando, Florida.
Read Full Text
AAD: Maintenance of Low
Eczema
Activity Seen After About 80 Days Off Tapinarof
FRIDAY, March 14, 2025 -- Patients with atopic dermatitis who achieve completely clear skin with tapinarof (
Vtama
) cream maintain low disease activity after about 80 days off treatment, according to a study presented at the annual meeting of the American Academy of Dermatology, held from March 7 to 11 in Orlando, Florida.
Read Full Text
AAD: Ivarmacitinib 4 mg, 8 mg Efficacious for Adults With Severe Alopecia Areata
THURSDAY, March 13, 2025 -- For adults with severe alopecia areata, ivarmacitinib, a selective Janus kinase 1 inhibitor, at doses of 4 and 8 mg is efficacious and tolerable, according to a study presented at the annual meeting of the American Academy of Dermatology, held from March 7 to 11 in Orlando, Florida.
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