SATURDAY

November 8

SESSION 1

8:05 – 8:20

REVIEW OF DRUGS FOR THE TREATMENT OF SKIN DISEASE (2003)

Stuart Maddin

In spite of the glacial speed exhibited by Canadian regulators, a number of new drugs have made their appearance this year and several more should become available in 2004. Never before has so much pharmaceutical effort been directed toward one skin disease – psoriasis. Dermatologists are awaiting the regulatory approval of four systemic antipsoriatic immunomodulators – alefacept will likely be the first, followed by etanercept, infliximab and efalizumab. In addition, at least five or six other antipsoriatic systemic agents are in late-stage clinical trials.

Several of these new antisporiatic agents are already being used in the U.S. and have demonstrated efficacy and safety profiles comparable to existing therapies. They are not only able to provide sustained improvement, but also allow for months of relief from psoriasis without treatment. These advantages may encourage the many psoriatic patients who are disenchanted with existing treatments to once again seek the care of dermatologists.

Topical formulations such as calcipotriol and betamethasone dipropionate combination – which are presently used alone or in combination with U.V. radiation – have been found to play a beneficial role when used in combination with the immunomodulators.

Current information will also be provided on another class of immunomodulators that is being used topically to manage atopic dermatitis – tacrolimus and pimecrolimus. Credible reports concerning the positive response for skin diseases exhibiting sclerosis and depigmentation will be included.

One of the earliest immunomodulators, imiquimod, which was introduced in the late 1990s and proved to be successful in treating venereal warts, is presently awaiting a new indication for the management of actinic keratoses and basal cell cancer. Other established drugs such as mycophenylate mofetil, acetretin, thalidomide and ciclopiroxolamine have been shown to provide added therapeutic benefit for other unlabelled diseases such as psoriasis, pemphigus, erythema nodosum leprosum, lupus erythematosus, Beçhets syndrome, aphthous stomatitis, seborrheic dermatitis and onychomycosis. Although they have been available for 50 years, corticosteroids are still recognized as the gold standard for inflammatory skin disease and have proven useful for managing bullous pemphigoid, chronic paronychia and recurrent mucosal lesions.

As so often happens, drugs that have long been in clinical use – such as permethrin, erythromycin (oral) and lindane – are no longer as effective, or, in some cases, cause safety concerns.

When treating moderate and severe acne, dermatologists continue to support drugs such as isotretinoin (still the gold standard after 20 years) and the hormonal combination cyproterone and ethinyl estradiol, despite the negative reports that circulate concerning their use.

The newer topical acne combinations – clindamycin phosphate and benzoyl peroxide – are very popular. Reports on the two new topical drugs that are undergoing clinical trials for mild to moderate acne – MBI 594AN and dapsone – will also be included.

Finally, therapeutic advances for treating photoaging, wrinkles, hyperpigmentary changes and hyperhidrosis will be also be included in this review.