Emerging Therapies, Innovations Highlight the Evolving Dermatology Treatment Landscape

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Experts kicked off the third day of the 2026 American Academy of Dermatology (AAD) Annual Meeting in Denver, Colorado, by sharing high-yield updates on emerging therapies, evolving disease management, and innovative tools transforming care across common dermatologic conditions.¹

True to its name, experts throughout the session, titled “Bread n’ Butter with a Side of Nutella: Short n’ Sweet, High-Yield Updates on Management of Bread n’ Butter Dermatologic Diseases,” delivered quick briefs on treatment strategies for common dermatologic conditions, including hair loss, itch, and skin cancer.

To round out the session, they also discussed the use of artificial intelligence (AI), as it continues to permeate more of the specialty, regardless of the condition.

Emerging Therapies and Expanding Options in Hair Loss Management

Sarah Lonowski, MD, MBA, FAAD, of the University of Nebraska Medical Center, provided updates on hair loss treatment, beginning with androgenetic alopecia (AGA). Despite remaining off-label, low-dose oral minoxidil is seeing rapidly expanding use in clinical practice. She noted that research is increasingly exploring its role beyond traditional male and female pattern hair loss, with growing interest in new formulations that may improve both efficacy and safety.

One such innovation is extended-release oral minoxidil (VPHL01), currently in phase 3 trials for men and women. The formulation is designed to maintain serum drug levels above the threshold needed for hair growth while avoiding peaks associated with cardiovascular risk. Early phase 2 data suggest improved efficacy due to these sustained levels, and the treatment has the potential to become the first FDA-approved treatment for male and female pattern hair loss. Lonowski noted that phase 3 results are expected in the coming months.

On the topical front, she highlighted PP405, a novel agent developed by researchers at UCLA that reactivates dormant follicular stem cells through inhibition of the mitochondrial pyruvate carrier. In a phase 2 trial, 31% of men with advanced AGA achieved greater than a 20% increase in hair density at week 8 after 4 weeks of once-daily treatment, compared with 0% in the placebo group.

Additionally, 3 oral Janus kinase (JAK) inhibitors are now approved for alopecia areata (AA): ritlecitinib (Litfulo; Pfizer), baricitinib (Olumiant; Eli Lilly), and the newest agent, deuruxolitinib (Leqselvi; Sun Pharma).² Lonowski noted that deuruxolitinib, which is dosed twice daily, appears to have a rapid onset of action, with nearly one-third of patients achieving meaningful hair regrowth early in treatment.¹ Patients with less severe baseline disease appear to respond better, suggesting a benefit to earlier intervention. However, she said the drug requires CYP2C9 genotyping before initiation and is contraindicated in poor metabolizers.

Management of scarring alopecias is also evolving. A retrospective study comparing low-dose vs high-dose doxycycline for conditions such as lichen planopilaris, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia found similar efficacy between dosing strategies but fewer adverse events with low-dose regimens. These findings support the use of anti-inflammatory rather than antimicrobial dosing, Lonowski said.

Lastly, recent research supports low-dose oral minoxidil as an adjunctive therapy across a range of hair disorders, including scarring alopecias and AA, highlighting its expanding role. Overall, Lonowski emphasized that the hair loss treatment pipeline is rapidly evolving, with several emerging agents showing promising efficacy and favorable safety profiles.

Rethinking Itch Management

Daniel C. Butler, MD, FAAD, of the University of Arizona, discussed the evolving understanding of itch. Traditionally, clinicians divided patients into those with itch accompanied by a visible rash, diagnosed based on morphology, and those without a rash, who underwent laboratory workups to identify an internal cause. He noted that when labs were negative, itch was often labeled as psychogenic.

This framework reinforced an overly narrow view of itch as primarily allergy-driven and led to heavy reliance on antihistamines. Even clinical signs like the “butterfly sign,” once thought to indicate nonorganic itch, are now recognized as outdated, reflecting how far the field has evolved.

Today, Butler explained, itch is understood as a complex neuroimmune phenomenon involving interactions among the skin barrier, immune system, and nervous system. Rather than fitting patients into rigid categories, clinicians now recognize that most individuals experience overlapping contributions from barrier dysfunction, immune activation, and neural sensitization.

“No longer are we just looking for immunologic or neuropathic itch,” he said. “…We're looking for immunologic itch with a little bit of nerves. Barrier function repair, if needed, with a little bit of immunologic inactivity, and that will be the future driving our treatments.”

Treatment approaches have evolved alongside this understanding. Many newer therapies, across conditions like atopic dermatitis and chronic urticaria, demonstrate strong efficacy in reducing itch. While rapid symptom relief is appealing, Butler warned against overvaluing speed alone. Instead, he emphasized that the primary clinical goal should be durable, long-term control. Importantly, itch is increasingly recognized not just as a symptom but as a coexisting disease process warranting direct treatment.

This perspective supports earlier, more proactive management rather than delaying treatment while searching for a single underlying cause. Butler concluded that advances in targeted therapies are not only improving patient outcomes but also deepening understanding of the neuro-immune-barrier network driving chronic itch.

Improving Outcomes With Evolving Skin Cancer Care

Vanessa Voss, MD, FAAD, of the University of Nebraska Medical Center, reviewed new skin cancer treatment advances. Recent studies have clarified the role of nicotinamide (niacinamide) in skin cancer prevention, addressing earlier safety concerns.

While a 2024 report suggested a possible link to major adverse cardiac events (MACE), dermatology-specific research in about 13,000 patients found no increased cardiovascular risk after adjusting for baseline factors. Meanwhile, a larger cohort of roughly 33,000 patients confirmed that nicotinamide reduces nonmelanoma skin cancer risk. She highlighted that the greatest benefit is seen when started early, before patients accumulate a high skin-cancer burden, supporting earlier initiation.

Additionally, risk assessment in cutaneous squamous cell carcinoma (cSCC) is evolving beyond traditional staging. Although frameworks like the Brigham and Women’s staging capture many high-risk tumors, poor outcomes still occur in lower-stage lesions. Voss noted that “intermediate” risk factors, such as moderate differentiation, 1 to 2 cm tumor size, subcutaneous fat invasion, and perineural or lymphovascular invasion (LVI), can elevate recurrence and metastasis risk.

LVI, in particular, strongly predicts poor outcomes and occult nodal disease. Therefore, she noted tumors with LVI or multiple intermediate features warrant more aggressive management, including imaging, closer follow-up, and adjuvant therapy consideration.

Surgical strategies are becoming more nuanced, as Mohs micrographic surgery is being increasingly recommended for select melanomas. These include lentigo maligna and cosmetically sensitive sites like the head and neck, where subclinical spread is common. She explained that Mohs offers improved margin control and lower recurrence compared with standard excision. At the same time, routine prophylactic antibiotics for lower-extremity dermatologic surgery are being reconsidered, with studies showing no significant reduction in infection; attention is shifting to antiseptic preparation and meticulous wound care.

Voss also highlighted how immunotherapy is changing the landscape for advanced cSCC. Neoadjuvant PD-1 inhibitors show high rates of pathologic response in locally advanced or node-positive disease. Trials report substantial complete and major responses, with encouraging long-term outcomes, including high recurrence-free and overall survival. She said these findings suggest that neoadjuvant immunotherapy can reduce tumor burden, improve surgical outcomes, and enhance durable disease control, representing a major shift in high-risk cSCC management.

“Just know that this is kind of up and coming, and if you have an advanced cSCC, really think about adding in that neoadjuvant PD-1 [inhibitor] for 4 weeks if the patient is a candidate, because it could really shrink down that tumor burden and hopefully improve surgical outcomes but also then you trigger that immune surveillance and hopefully lead to remission for these patients,” Voss concluded.

Integrating AI Across Dermatology Practice

Yevgeniy Semenov, MD, MS, FAAD, of Massachusetts General Hospital, wrapped up the session by discussing AI use in dermatology, a topic relevant to all disease states. AI in dermatology is not new, but advances in computing power and data have rapidly accelerated its capabilities. Semenov explained that modern deep learning enables highly accurate image analysis, with studies showing performance that can match or exceed dermatologists in distinguishing benign from malignant lesions.

Consequently, AI is being increasingly used as a diagnostic support tool, with evidence showing modest improvements in accuracy when combined with physician judgment. Several FDA-cleared tools are available, which are designed for high sensitivity to avoid missing cancers, but this comes at the cost of more false positives. He noted these tools are best used as adjunctive triage aids rather than stand-alone decision-makers.

Beyond diagnosis, AI is advancing prognostication and clinical operations. Semenov highlighted that machine learning models analyzing digitized histopathology and clinical data can generate risk scores that may outperform traditional staging and predict both recurrence risk and patterns.

At the same time, AI is already transforming workflows. Ambient documentation tools are reducing time per visit, increasing same-day note completion, and cutting after-hours charting burden. Additional applications, like AI-assisted scheduling, previsit intake, and tailored patient education, are improving efficiency and patient engagement.

While diagnostic capabilities continue to evolve, he concluded by emphasizing that the operational gains are already enhancing clinician experience and pointing toward a future of integrated, AI-supported dermatologic care.

References

1. Barrett E, Butler DC, Hirner JP, et al. “Bread n’ butter with a side of Nutella”: short n’ sweet, high-yield updates on management of bread n’ butter dermatologic diseases. Presented at: 2026 AAD Annual Meeting; March 27-31, 2026; Denver, CO.
2. Santoro C. FDA approves deuroxolitinib for alopecia areata. AJMC^®. July 26, 2024. Accessed March 29, 2026. https://www.ajmc.com/view/fda-approves-deuruxolitinib-for-alopecia-areata