2 Helpful Clinical Tips for Dermatologists, with Eingun James Song, MD

At the 44th Annual Fall Clinical Dermatology Conference in Las Vegas, the HCPLive editorial team spoke with Eingun James Song, MD, associate chief medical officer and director of clinical research at Frontier Dermatology, about his talk ‘20 Tips in 20 Minutes.’

Song specifically gave 4 clinical pearls, 2 of which were highlighted in this segment of his interview with the HCPLive team. First, he mentioned a tip for treatment of alopecia areata when a patient is not a candidate for an oral Janus Kinase (JAK) inhibitor.

“I actually shared a case of a patient that also had generalized vitiligo, so his entire body was depigmented,” Song explained. “So I warned a patient, if we put him on an oral JAK for his scalp, his color may re-pigment again, and that was not something he was interested in because he's lived for years without having any color in his skin. We had to pivot and look for a different treatment option.”

The option, Song noted, was DPCP also known as diphenyl cyclopropane. Song added that this form of contact immunotherapy can be useful.

“It's an oldie, but a goodie, and it's a form of contact immunotherapy, where we're trying to trick or distract the immune system so it doesn't pay attention to the scalp,” he said. “It pays attention to the dermatitis that we're causing by applying that product.”

Song commented that he begins such patients at the lowest dose, which is 0.01%, noting that he has the patient apply a small amount to the affected area, anywhere from once a week to 3 times a week.

“Then I will increase it by tenfold every couple of weeks, and I'll just be sending in a new prescription until they get to a point where they're getting a low grade dermatitis for about 4 - 5 days, and once we get to that point, they just continue to use it on a 1 - 3 times weekly maintenance dose,” Song said. “And it has worked extraordinarily well for some of my most recalcitrant patients, even in patients who failed oral JAK inhibitors.”

Song was asked about his second tip as well, which in this case referred to patients with refractory disco lupus erythematosus (DLE).

“We've tried traditional immunosuppressants on DLE, whether it's methotrexate, mycophenolate, azathioprine, and these medicines have a lot of side effects and, quite frankly, they don't work all that well either,” Song said. “So we've been using deucravacitinib, which is an allosteric TYK2-inhibitor, as kind of my treatment of choice now as a steroid-sparing agent in
DLE. That's because we know that there are higher levels of type 1 interferon signaling in patients with lupus erythematosus, and deucravacitinib happens to block TYK2, which also signals those key interferon type 1 interfering cytokines.”

For further information on this topic, check out the full interview segment posted above. To find out more about conference talks, view our latest coverage of this conference here.

The quotes contained in this summary description were edited for clarity.