Diversity of PA cohorts during the evolution to an entry-level master's degree.

OBJECTIVE: This study evaluated the racial and ethnic diversity of physician associate/assistant (PA) graduating cohorts during the profession's transition from a standard undergraduate degree to an entry-level master's degree. METHODS: Using all existing program reports from the Physician Assistant Education Association (1985-2019), we explored potential associations between changes in tuition, degree types offered, and racial/ethnic makeup of graduating cohorts. RESULTS: We observed a strong negative association between Black students and graduates versus increasing tuition and the rise of master's level programs. CONCLUSIONS: More equitable opportunities for joining the PA profession may be needed.

New Non-Steroidal Topical Therapies for Inflammatory Dermatoses-Part 3: Roflumilast.

Topical corticosteroids have remained the initial and long-term topical treatment option for inflammatory dermatitis conditions since the 1950s. A number of non-steroidal topicals for treatment of inflammatory dermatoses have been developed in the recent decades, such as topical calcineurin inhibitors (tacrolimus ointment and pimecrolimus cream), vitamin D analogues, and phophodiesterase-4 inhibitors (crisaborole), but none had the combination of broad therapeutic range, relatively rapid onset of action, tolerability, and wide-spread clinical success that allowed topical glucocorticosteroids to remain the mainstay of therapy. This situation has shifted dramatically with three non-steroidal new molecular entities, each with completely different mechanisms of action, receiving approval of the Food and Drug Administration (FDA) in the past year. Topical ruxolitinib, a Janus kinase (JAK) inhibitor, was the first to receive FDA approval, specifically for treating atopic dermatitis, and was the subject of the first report in this series. Subsequently, topical tapinarof, an aryl hydrocarbon receptor modulating agent, was approved by the FDA for treating plaque psoriasis in May 2022 and was the focus of the second report in this series. Finally, and most recently in July 2022, topical roflumilast, a highly potent phosphodiesterase-4 inhibitor, has received FDA approval for treating plaque psoriasis, and is the subject of the third and final report in this series. In addition to their unique mechanisms of action and spectra of activity, each of these agents has unique clinical characteristics, including degree of efficacy, rapidity of onset of efficacy, potential remittive effects, and safety and tolerability profiles. In this three-part series, we reviewed and summarized the data surrounding each agent, providing a comprehensive overview that would allow dermatologists to integrate them confidently and appropriately into treatment paradigms. Part three focuses on topical roflumilast, a highly potent phosphodiesterase-4 inhibitor.

New Non-Steroidal Topical Therapies for Inflammatory Dermatoses-Part 2: Tapinarof.

Since its introduction in 1952, topical glucocorticosteroids remain the initial and long-term treatment option for various forms of inflammatory dermatitis. A number of non-steroidal topicals for treating inflammatory dermatoses have been developed in the recent decades (such as topical calcineurin inhibitors, vitamin D analogues, and phophodiesterase-4 inhibitors), but none had the combination of broad therapeutic range, relatively rapid onset of action, high tolerability, and wide-spread clinical success; this allowed topical glucocorticosteroids to remain the mainstay of therapy. This situation has shifted dramatically, with three non-steroidal new molecular entities, each with completely different mechanisms of action, receiving approval of the Food and Drug Administration (FDA) in the past year. Topical ruxolitinib, a Janus kinase (JAK) inhibitor, was approved by the FDA in September 2021 for atopic dermatitis, and was the subject of the first report in this review series. Subsequently, topical tapinarof, an aryl hydrocarbon receptor modulating agent, was approved by the FDA in May 2022 for treating plaque psoriasis, and is the focus of this present report. Finally and the most recently, topical roflumilast, a highly potent phosphodiesterase-4 inhibitor, received FDA approval in July 2022 for treating plaque psoriasis, and is reviewed in the third and final report in this series. In addition to their unique mechanisms of action and spectra of activity, each of these agents has unique clinical characteristics, including degree of efficacy, rapidity of onset of efficacy, potential remittive effects, and safety and tolerability profiles. In short, in this three-part series, we reviewed and summarized the data surrounding each agent, providing a comprehensive overview which would allow dermatologists to confidently and appropriately integrate them into treatment paradigms.

Tapinarof, a Novel, First-in-Class, Topical Therapeutic Aryl Hydrocarbon Receptor Agonist for the Management of Psoriasis.

Topical treatments remain the foundation of psoriasis management. Tapinarof (VTAMA®; Dermavant Sciences, Inc.) is a first-in-class, non-steroidal, topical, aryl hydrocarbon receptor (AhR) agonist approved by the US Food and Drug Administration for the treatment of plaque psoriasis in adults and is under investigation for the treatment of psoriasis in children, and atopic dermatitis in adults and children down to 2 years old. Here, we review the mechanism of action of tapinarof and the PSOARING phase 3 trial program in mild to severe psoriasis. AhR is a ligand-dependent transcription factor involved in maintaining skin homeostasis. Tapinarof specifically binds to AhR to decrease proinflammatory cytokines, decrease oxidative stress, and promote skin barrier normalization. In two identical, randomized, 12-week pivotal phase 3 trials, PSOARING 1 and 2, tapinarof cream 1% once daily (QD) demonstrated significant efficacy versus vehicle and was well tolerated in adults with mild to severe psoriasis. In the PSOARING 3 long-term extension trial of repeated, intermittent tapinarof cream in eligible patients completing the pivotal trials, a high rate of complete disease clearance (40.9%) and a remittive effect of approximately 4 months off therapy were demonstrated over 52 weeks, with no tachyphylaxis. The most common adverse event, folliculitis, was mostly mild or moderate and resulted in a low trial discontinuation rate in PSOARING 1 and 2 (≤1.8%). Tapinarof cream 1% QD provides a novel, non-steroidal, topical treatment option for patients with psoriasis and is highly effective and well tolerated with long-term use including when applied to sensitive and intertriginous skin. Bobonich M, Gorelick J, Aldredge L, et al. Tapinarof, a novel, first-in-class, topical therapeutic aryl hydrocarbon receptor agonist for the management of psoriasis. J Drugs Dermatol. 2023;22(8):779-784. doi:10.36849/JDD.7317.

New Non-Steroidal Topical Therapies for Inflammatory Dermatoses-Part 1: Ruxolitinib.

For the twenty-year period from 2001 to 2021, only one new topical molecular entity for an inflammatory skin disease was approved in the United States. This situation has shifted dramatically, with three non-steroidal new molecular entities, each with completely different mechanisms of action, receiving FDA approval in the past year. As a three-part series, each non-steroidal molecule will be reviewed. We focus first on topical ruxolitinib, which received FDA approval in September of 2021 as the first Janus Kinase Inhibitor (JAK) for the treatment of atopic dermatitis. Other topical therapies covered in this review series include tapinarof, an aryl hydrocarbon receptor modulating agent, which was approved for the treatment of psoriasis in May 2022 and topical roflumilast, a highly potent phosphodiesterase-4 inhibitor, which was recently approved in July 2022 for treatment of plaque psoriasis. In addition to their unique mechanisms of action and spectra of activity, each of these agents have unique clinical characteristics - including degree of efficacy, rapidity of onset of efficacy, potential remittive effects, and safety and tolerability profiles. In this review series, we review and summarize the data surrounding each agent, providing a comprehensive overview which will allow dermatology providers to confidently and appropriately integrate them into treatment paradigms. As stated, this contribution focuses on topical ruxolitinib, the only topical JAK therapy FDA approved for treatment atopic dermatitis, and most recently, the first ever approved therapy for nonsegmental vitiligo.

Healthcare Provider Administration of Biologics for Patients with Plaque Psoriasis: Literature Review and Clinical Considerations.

Objective: Plaque psoriasis is a chronic, inflammatory, immune-mediated skin disease. Biologic therapies markedly improve skin disease severity and health-related quality of life for patients with moderate-to-severe plaque psoriasis. All but two of the biologics approved in the United States for moderate-to-severe plaque psoriasis may be self-administered by adult patients via subcutaneous injection. This review discusses rationales for choosing healthcare provider (HCP) administration over self-administration of biologics for patients with plaque psoriasis, including treatment adherence, patient preference, and practical considerations. Methods: PubMed was searched for "psoriasisAND biologic AND administration AND (office OR provider OR profession)." The most relevant results and additional papers identified from the references were included in the review. Results: Although many patients prefer self-administration, others may benefit from HCP administration. Key considerations in the choice between HCP vs. self-administration of biologics for plaque psoriasis treatment include adherence, patient preferences, and practical concerns. Patient characteristics that may make HCP administration of biologic therapies for treatment of plaque psoriasis preferable to at-home self-administration are discussed. Limitations: There are few published studies specific to HCP administration of biologics for treatment of psoriasis. Conclusion: Administration of biologics by an HCP may improve treatment adherence and clinical outcomes compared to self-administration in selected patients with plaque psoriasis.

A Review of Phase 3 Trials of Dupilumab for the Treatment of Atopic Dermatitis in Adults, Adolescents, and Children Aged 6 and Up.

Atopic dermatitis (AD) is a chronic pruritic skin disease that can have a profound negative impact on patients' quality of life, especially in cases of inadequate disease control. Dupilumab, a dual inhibitor of IL-4 and IL-13 signaling, is approved in the United States for the treatment of moderate-to-severe AD in adults (≥ 18 years old) and in children (≥ 6 years old). In this review, we present results from phase 3 trials evaluating dupilumab's efficacy and safety in adults, adolescents, and children. These trials demonstrate that dupilumab provides rapid improvements (in as little as 1 week) and sustained efficacy (up to 4 years) when used as a treatment for moderate-to-severe AD. Dupilumab not only improves skin signs and symptoms, but also provides multiple health benefits beyond the skin, including improvements in quality of life, itch, sleep disturbances, and pain/discomfort. Dupilumab is generally well tolerated, has a favorable safety profile in adults, adolescents, and children, has no serious drug-drug interactions, does not require routine laboratory testing, and is not an immunosuppressant. Taken together, phase 3 trials demonstrate that dupilumab provides rapid and sustained efficacy and is generally well tolerated for the treatment of moderate-to-severe AD across age groups.

Successful Management of Psoriasis and Treatment-induced Tinea Incognito: A Case Report.

This case report describes the management of a 64-year-old Hispanic male patient with a 20-year history of severe psoriasis who presented with a worsening of his condition, and topical corticosteroid-induced tinea incognito. The patient was initially treated with systemic and topical antifungals to clear the corticosteroid-induced tinea incognito. He was subsequently treated with broadalumab, an interleukin-17 receptor A antagonist. A combination of oral terbinafine and twice daily ciclopirlox cream to the pruritic lichenified patches on the patient's neck, upper chest, buttocks, and hip cleared the fungal tinea infection within one month, but well-demarcated plaques remained unchanged on nearly 35 percent of his body. Three weeks of after commencement of broadalumab, the pruritus resolved and the patient's psoriasis body surface involvement was less than three percent; at four months, it was less than one percent. Conclusion: PAs and NPs working in dermatology should monitor patients on long-term topical corticosteroid therapy to alert them to possible cutaneous complications. Tinea incognito and psoriasis often mimic each other and can occur concomitantly but require different treatment approaches. If tinea incognito is confirmed, topical corticosteroids should be discontinued and it should be treated with antifungals, while, if appropriate, systemic management of the psoriasis with an appropriate biologic may be initiated.