Kenneth B. Gordon, MD1; Craig L. Leonardi, MD2; Daniel E. Furst, MD3; Neal Bhatia, MD4; Lawrence F. Eichenfield, MD5; Katie Beleznay, MD, FRCPC, FAAD6
New therapies, recent pathophysiological findings, and updated guidelines combined to create compelling presentations at the Skin Disease Education Foundation’s 41st Annual Hawaii Dermatology SeminarTM. This educational supplement summarizes the highlights of clinical sessions presented during this CME/CE conference.
A growing understanding of the biology of psoriasis has facilitated the development of increasingly efficacious medications. Skin clearance used to be regarded as an impractical goal for psoriasis therapy. Now, some clinical trials of newer medications report more than half of participants attaining Psoriasis Area and Severity Index (PASI) scores of 90. Two leading investigators review the latest findings about the treatment of this condition. Recent evidence demonstrates that psoriasis and psoriatic arthritis share multiple pathological underpinnings. A T helper type 17 (Th17) lymphocyte-based pathogenesis, genes, and microbiome changes have been identified in both conditions. Many therapeutics used in psoriasis care are efficacious in psoriatic arthritis. An expert in psoriatic arthritis updates readers about this condition.
Cutaneous fungal infections, including onychomycosis, pose diagnostic and treatment challenges. New topical therapies and an investigational oral agent offer expanded options for management. The American Academy of Dermatology has issued new guidelines for the treatment of acne. Appropriate antibiotic use is a prominent theme. The US Food and Drug Administration has issued a communication about the risk of unintentional injection of soft tissue fillers into facial blood vessels—including blindness. The lead author of a recent review about this topic discusses how to prevent this serious outcome.
The volume of new information about pathophysiology, diagnosis, therapy, and safety challenges our ability to keep current while enabling us to improve patient care. We hope that the highlights of this seminar offer you information that can be applied to your busy practices. Semin Cutan Med Surg 36(supp3):S51-S59 © 2017 published by Frontline Medical Communications
Acne, adalimumab, adapalene, appropriate antibiotic use, apremilast, biosimilar, blindness, brodalumab, cosmetic dermatology, dapsone, diagnosis, DRM 01, filler injection, guidelines, guselkumab, gut microbiome, IL-17A antagonists, IL-17 inhibitors, IL-23 antago- nists, ixekizumab, onychodystrophy, onychomycosis, psoriasis, psoriatic arthritis, recurrence, reinfection, SB204, secukinumab, soft tissue augmentation, Th17 lymphocytes, ustekinumab
Participants should read the CE information below, review the activity in its entirety, and complete the online post-test and evaluation. Upon completing this activity as designed and achieving a passing score on the post-test, you will be directed to a Web page that will allow you to receive your certificate of credit via e-mail or you may print it out at that time.
The online post-test and evaluation can be accessed at http://tinyurl.com/HISupp2017.
Inquiries may be directed to Global Academy for Medical Education at [email protected] or 973-290-8225.
Physicians: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Louisville and Global Academy for Medical Education, LLC.
The University of Louisville is accredited by the ACCME to provide continuing medical education for physicians. The University of Louisville Office of Continuing Medical Education & Professional Development designates this enduring material for a maximum of 2.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education: Postgraduate Institute for Medicine (PIM) is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This educational activity for 2.0 contact hours is provided by the Postgraduate Institute for Medicine. Designated for 0.5 contact hour of pharmacotherapy credit for Advance Practice Registered Nurses.
Expanding knowledge about the biology of skin disease has led to new therapies, updated guidelines, and changes in treatment recommendations. The rapid pace of advancement challenges the clinician’s ability to remain current in the management of conditions faced often in practice.
Psoriasis affects about 2% of the population. Three new biologic agents, all interleukin (IL)-17 antagonists, have been approved for the treatment of psoriasis in the last 2 years. At least four IL-23 antagonists are in late-stage development. A biosimilar has been introduced to the US market within the last year. Alternative maintenance regi- mens have been studied. The new therapies are associated with improved efficacy rates and differing safety profiles with which clinicians must become familiar.
Roughly 20% to 30% of individuals with psoriasis develop psoriatic arthritis (PsA). In addition to the presence of comorbid skin disease, articular manifestations and patho- physiology differentiate PsA from other forms of arthritis. Clinicians would benefit from understanding how to distinguish PsA from rheumatoid arthritis and other rheumatic diseases. Many therapies for psoriasis also are efficacious in PsA.
New guidelines for the treatment of acne highlight the importance of appropriately limited antibiotic use. They also offer recommendations for the therapy of mild, moderate, and severe acne. New topical therapies have been approved for the treatment of this condition. A study about the patient-reported effect of hormonal contraceptives on acne has shed light on this important issue.
Onychomycosis is a common complaint in clinical practice. Laboratory confirmation of diagnosis is a crucial element of successful therapy. New topical therapies offer addi- tional options for patients; an oral therapy is undergoing clinical trials as well. Results acceptable to the patient require persistence with treatment as well as adherence to lifestyle measures intended to reduce the risk of recurrence and reinfection.
The increasing popularity of soft tissue augmentation for aesthetic reasons has been accompanied by reports of accidental injection of filler into facial vasculature. This has resulted in cases of blindness. Along with a thorough knowledge of facial anatomy, certain techniques may reduce the risk of this catastrophic outcome. A protocol for handling complications of injection also is crucial.
By reading and studying this supplement, participants should be better able to:
- Explain the mechanisms and roles of currently available biologic agents in the treatment of psoriasis and psoriatic arthritis
- Analyze the investigational biologics for psoriasis
- Distinguish the manifestations of psoriatic arthritis from those of rheumatoid arthritis
- Demonstrate knowledge of options for laboratory diagnosis of onychomycosis
- Evaluate current and emerging therapy for onychomycosis and acne
- Integrate techniques to prevent serious adverse events,such as blindness, when injecting soft tissue fillers
Individuals in a position to control the content of this educational activity are required to disclose:
1) the existence of any relevant financial relationship with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients with the exemption of non-profit or government organizations and non-health care related companies, within the past 12 months; and
2) the identification of a commercial product/device that is unlabeled for use or an investigational use of a product/device not yet approved.
Katie Beleznay, MD, FRCPC, FAAD
Neal Bhatia, MD
Lawrence F. Eichenfield, MD
Daniel E. Furst, MD
Kenneth B. Gordon, MD
Craig L. Leonardi, MD
Staff and Advisory Board Disclosures: The CME & PD staff pediatricians, family practitioners, and Advisory Board have nothing to disclose.
CME/CE Reviewers: Courtney R. Schadt, MD, Assistant Professor of Medicine, Chief of Dermatology, Robley Rex Veterans Affairs Medical Center, Director, University of Louisville Dermatology Residency Program, has no relevant financial relationships to disclose. The PIM planners and managers, Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CHCP; Judi Smelker Mitchek, MBA, MSN, RN; and Jan Schultz, MSN, RN, CHCP, have nothing to disclose.
Global Academy for Medical Education Staff: Sylvia H. Reitman, MBA, DipEd; Shirley V. Jones, MBA; and Eileen McCaffrey have no relevant financial relationships to disclose.
Off-Label/Investigational Use Disclosure
This CME/CE activity discusses the off-label use of certain approved medications as well as data from clinical trials on investigational agents. Any such material is identified within the text of the articles.
1 Professor and Chair, Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
2 Adjunct Professor of Dermatology, Saint Louis University; Central Dermatology, St. Louis, Missouri
3 Clinical Professor of Medicine, University of Washington, Seattle, Washington; Professor of Medicine, University of Florence, Florence, Italy; Professor of Rheumatology (Emeritus), David Geffen School of Medicine, UCLA, Los Angeles, California
4 Director of Clinical Dermatology, Therapeutics Clinical Research, San Diego, California
5 Professor of Dermatology and Pediatrics, University of California, San Diego, Rady Children’s Hospital, San Diego, California
6 Clinical Instructor, Department of Dermatology, The University of British Columbia, Vancouver, British Columbia, Canada
Publication of this CME/CE article was jointly provided by University of Louisville, Postgraduate Institute for Medicine, and Global Academy for Medical Education, LLC, and is supported by educational grants from Merz Pharmaceuticals, LLC, and Valeant Pharmaceuticals North America LLC. All of the faculty authors have received an honorarium for participation
in this activity. They acknowledge the editorial assistance of Eileen McCaffrey, medical writer, and Global Academy for Medical Education in the development of this continuing medical education journal supplement.
Kenneth B. Gordon, MD, Consultant, Grant Research Support: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly and Company, Janssen, Novartis, SunPharma.
Craig L. Leonardi, MD, Speakers Bureau, Consultant, Grant Research Support: AbbVie, Actavis, Amgen, Boehringer Ingelheim, Celgene, Coherus, Corrona, Dermira, Eli Lilly and Company, Janssen, Leo, Merck, Novartis, Pfizer, Sandoz, Stiefel, UCB, Wyeth.
Daniel E. Furst, MD, Consultant, Non-CME, Grant Research Support: AbbVie, Actelion, Amgen, Bristol-Myers Squibb, Cytori, NIH, Novartis, Pfizer, Roche/Genentech.
Neal Bhatia, MD, Speakers Bureau, Consultant, Non-CME, Grant Research Support: Actavis, Allergan, Anacor Pharmaceuticals, Inc./Pfizer Inc.,
Aqua, Bayer, Biofrontera, BiopharmX, Dermira, Dusa, Exeltis, Ferndale, Foamix, Galderma, Intraderm, ISDIN, LaRoche-Posay, Leo Pharma, Novan, Novartis, PharmaDerm, Promius, Regeneron, Sanofi, SunPharma, Valeant Pharmaceuticals North America LLC.
Lawrence F. Eichenfield, MD, Speakers Bureau, Consultant, Non-CME, Grant Research Support: Amgen, Anacor Pharmaceuticals, Inc./Pfizer Inc., Astellas Pharma US, Celgene, Eli Lilly and Company, Galderma Labs, Genentech Inc., Janssen, Leo, Novan, Otsuka/Medimetriks, Sanofi Genzyme/Regeneron, Stiefel, Taro, TopMD, Valeant Pharmaceuticals North America LLC.
Katie Beleznay, MD, FRCPC, FAAD, Speakers Bureau, Grant/Research Support: Allergan, Evolus, Revance, Zeltiq.
Address reprint requests to: Lawrence F. Eichenfield, MD, Rady Children’s Hospital, 8010 Frost Street, Suite 602, San Diego, CA 92123; [email protected] ucsd.edu