In the second part of his insightful dialogue, Dr. James Del Rosso, DO, delved into significant therapeutic innovations that are transforming the management strategies for conditions such as chronic hand eczema (CHE), chronic spontaneous urticaria (CSU), and vitiligo.
Dr. Del Rosso shed light on how these newer therapeutic agents are addressing persistent gaps in care for patients who have not achieved satisfactory results with traditional treatments. Among these conditions, CSU remains particularly challenging, especially for those individuals who do not respond adequately to high doses of H1 antihistamines.
As noted by Dr. Del Rosso, CSU is characterized by ongoing urticaria that persists for a minimum of six weeks, even with escalated standard therapeutic interventions. The treatment landscape for CSU is rapidly evolving, moving beyond merely antihistamines to include targeted biologics and small-molecule therapies.
One of the promising treatments is dupilumab, an injectable therapy administered bi-weekly, which has shown effectiveness when used in conjunction with antihistamines for adults suffering from CSU. Dr. Del Rosso emphasized that the onset of relief can vary significantly; while some patients may notice improvement shortly after starting therapy, others may take weeks before they see substantial benefits.
This variability highlights the necessity for healthcare providers to set realistic expectations for patients right from the outset of treatment. Recently, attention has also turned to remibrutinib, an oral Bruton tyrosine kinase inhibitor, which was evaluated in the REMIX trials at a dosage of 25 mg taken twice daily.
Dr. Del Rosso described the clinical performance of remibrutinib as remarkable due to its quick response time, stating, “Most of the patients are going to see a very rapid—sometimes in a few days—significant reduction in the hives and the itching.” This rapid action can be especially beneficial for patients experiencing severe symptoms that greatly affect their quality of life.
In terms of safety, the side effects associated with remibrutinib appear to be manageable. Instances of mild petechiae have been reported; however, Dr. Del Rosso classified these as clinically insignificant. A warning on the product label advises caution during surgical procedures, which is similar to precautions taken with nonsteroidal anti-inflammatory medications.
Beyond systemic therapies, Dr. Del Rosso also highlighted significant advancements in topical treatments. The introduction of delgocitinib, a topical pan–Janus kinase inhibitor, offers a novel treatment avenue for CHE, addressing various underlying causes, including atopic, allergic, and irritant types.
Clinical studies have substantiated the efficacy and tolerability of delgocitinib when applied to the hands and wrists. Additionally, topical ruxolitinib continues to play an essential role in managing conditions like atopic dermatitis and vitiligo, although treatment protocols may vary based on the specific condition being treated.
In the context of vitiligo, its use is generally restricted to areas covering up to 10% of body surface area, often focusing on cosmetically sensitive regions such as the face, which Dr. Del Rosso noted tends to respond most consistently to treatment. He also referenced emerging research on the combination of topical ruxolitinib with home-based narrowband UVB therapy, a strategy made more practical by the advent of new monitored phototherapy devices.
Collectively, these advancements signify a broader shift towards targeted, mechanism-driven therapies in dermatology. This evolution empowers clinicians with greater flexibility to tailor treatment plans, ultimately leading to improved outcomes for patients facing historically challenging skin conditions.
