When Imagination Becomes Reality: Advances in Treatment and Medicine in Dermatology


The 25th European Academy of Dermatology and Venereology Congress in Vienna, Austria, began on Wednesday night with Stephen I. Katz, MD, PhD, director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and adjunct investigator in the Dermatology Branch of the National Cancer Institute. Calling his presentation “Past is Prologue," Katz embarked on a discussion of recent and future advances in treatment and medicine in dermatology. Through his overview of these advances, Katz demonstrated how improvements in patient care are become more attainable, and how they are the result of basic science discoveries.

“It is important to see how these fundamental discoveries have changed … the entire landscape of medical research,” Katz explained. This imbued the future of dermatological treatment—and his presentation—with a palpable optimism.
           
Katz opened his discussion with a simple yet poignant question: “Can you imagine a future, with the past that we have had?” From here, he demonstrated how over the past 15 years, advances in dermatological treatments have emerged in 5 areas, each one prefaced with an enthusiastic “Can you imagine?” These areas were: understanding of pathophysiological pathways in psoriasis and atopic dermatitis; treatments that prolong the life of patients with melanoma; treatments for newly-defined autoinflammatory diseases, many with characteristic skin manifestations; hope for gene, protein, or stem cell therapy for recessive dystrophic epidermolysis bullosa; and approaches to the treatment of patients with inherited structural disorders.

Each of these new advances was accompanied by a host of recent clinical discoveries, illustrating how these former speculations have actually come to fruition. For example, in the area of psoriasis, Katz commented on the recently developed anti-IL-12/anti-IL-23 treatments, and anti-P-19 treatments, which allow researchers and practitioners to better understand the pathways to inflammation and immunological events associated with psoriasis. He also highlighted approved drugs that block either IL-17 (eg, Cosentyx) or IL-17 receptors. Katz assured the audience that there are many more—“more than 50”—monoclonal antibodies and small molecules being investigated for treatment of psoriasis.

Another notable discovery was in the area of melanoma. Katz shared a recent study1 that found acquired resistance to PD-1 blockade immunotherapy in patients with melanoma was associated with defects in the pathways involved in interferon-receptor signaling and in antigen presentation.
          
After proving that past is, indeed, prologue, Katz then discussed how these advances reveal a promising future for treatments in dermatology. He touched on a multitude of prospects in treatment and patient care, among them, topical therapies for non-melanoma skin cancer, gene therapy for a number of single gene diseases, and personalized medicine for treating diseases beyond cancer. Katz ended his presentation with what he described as his most important message: the importance of basic science discoveries.

“Whether as clinical dermatologists, or as basic researchers, we rely on basic research to form the fundamentals of the advances that we see," he said.

Reference
1. Zaretsky JM, Garcia-Diaz A, Shin DS, et al. Mutations associated with acquired resistance to PD-1 blockade in melanoma. N Engl J Med. 2016;375(9):819-829.
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