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Recently approved drugs manipulate immune response




Dr. Bhatia
Wailea, Hawaii — A handful of recently approved drugs target actinic keratoses (AKs), systemic lupus erythematosus (SLE) and hereditary angioedema (HAE), and Neal Bhatia, M.D., discussed the new therapeutic options at MauiDerm 2012: Advances in Cosmetic and Medical Dermatology.

When imiquimod 2.5 percent (Aldara, Medicis) is released commercially, "The real question will be, where does it fit?" Dr. Bhatia says. It might fit best as a step-down for maintenance treatment after treatments that capitalize on the field effect of imiquimod 3.75 percent.

"And there will be questions about whether imiquimod 2.5 percent is easier for treating broad surface areas, to minimize aggressive responses that result from stronger concentrations," says Dr. Bhatia, a Long Beach, Calif., dermatologist in private practice.

"The problem with 5 percent imiquimod was, where could it go without the treatment becoming too aggressive? When imiquimod 3.75 percent came out, its indication had more surface area. But it does not have any indication for solid tumors or warts," he explains.

Although he doesn't envision any additional clinical trials or indications for imiquimod, "There's a lot of potential for making imiquimod 3.75 percent work for solid tumors of the skin, such as basal cell carcinoma (BCC) and warts, as imiquimod 5 percent did," Dr. Bhatia says. "As long as imiquimod augments the targeted immune response against the specific antigen, it's going to do its job."


In February, the Centers for Medicare and Medicaid Services released a notice of proposed rulemaking titled Medicare and Medicaid Programs; Electronic Health Record Incentive Program — Stage 2. The proposal, which was issued in the Federal Register, outlines CMS' recommended guidelines for Stage 2 of meaningful use for the government's Electronic Health Records (EHR) Incentive Program.

Techniques to decrease the pain of botulinum toxin injections include mixing the toxin with bacteriostatic saline, using special cannulas designed for diabetics and injecting through follicles or pores wherever possible, says David M. Ozog, M.D.

A recent clinical trial on the use of adapalene and benzoyl peroxide gel 0.1 percent/2.5 percent (Epiduo, Galderma) for acne vulgaris in the pediatric population, demonstrated that it was a safe and effective treatment for preadolescents, according to Lawrence F. Eichenfield, M.D., principal investigator of the study, chief, pediatric and adolescent dermatology, and professor of pediatrics and medicine (dermatology), Rady Children's Hospital and University of California, San Diego.

Creams and emollients are relatively ineffective in treating ichthyosis, but vitamin A derivatives do prove to create responses in patients, according to the chief of pediatric dermatology at Phoenix Children's Hospital.

With conflicting evidence regarding the true risk of nonmelanoma skin cancers (NMSCs) in patients taking biologic drugs for psoriasis, Oscar Colegio, M.D., says physicians should consider treatment options for patients in this category on a case-by-case basis.