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In this SDPA Summer Dermatology Meeting interview, Zirwas speaks on treatment gaps for dermatologic conditions and off-label alternatives.
At the 2026 Society of Dermatology Physician Associates (SDPA) Annual Summer Dermatology Conference, dermatologist Matthew Zirwas highlighted several practical off-label treatment strategies during the session ‘No Label No Trouble: A Panel Review of Off-Label Medication Use,’ emphasizing the continued importance of affordable and versatile therapies in dermatology.1,2
Speaking in an interview with HCPLive following the presentation, Zirwas noted, despite the growing number of targeted therapies entering the field, clinicians will continue to face notable treatment gaps for many dermatologic conditions that lack US Food and Drug Administration (FDA)-approved options.
“I think the most important thing I'd like to get across to people is a drug called oral roflumilast,” Zirwas said. “So, this is a PDE4 inhibitor, just like apremilast, that we use for psoriasis, but it is substantially more effective.”
Zirwas pointed to the presence of oral roflumilast as 1 of the most important takeaways from the session, describing the phosphodiesterase-4 (PDE4) inhibitor as an underappreciated option with efficacy approaching that of some biologic therapies while maintaining a favorable safety profile similar to that of apremilast. According to Zirwas, oral roflumilast offers a unique combination of effectiveness, accessibility, and affordability, with a cash price of only a few dollars per month.
Although psoriasis is 1 potential use case, he suggested the medication may be even more valuable in a variety of inflammatory dermatologic diseases that have limited treatment options, including granuloma annulare, cutaneous lupus, cutaneous dermatomyositis, and palmoplantar pustulosis. He also highlighted its utility as an adjunctive therapy for patients already receiving biologics, noting that it can provide an additional clinical benefit without significantly increasing treatment-related risk.
Zirwas also discussed the off-label use of linezolid (Zyvox), an antibiotic more commonly associated with treatment of resistant bacterial infections. He noted that short courses of linezolid can be highly effective for difficult-to-treat cases of hidradenitis suppurativa (HS) and chronic folliculitis, particularly in patients who continue to experience disease activity despite other therapies. Limiting treatment to approximately 10 days, he explained, helps preserve the medication’s favorable safety profile while providing meaningful clinical improvement.
Looking ahead, Zirwas predicted that off-label prescribing will remain an important component of dermatologic practice, largely because many rare or less common skin diseases are unlikely to receive dedicated FDA-approved therapies. He also identified generic tofacitinib as a development worth watching in the coming years, suggesting that lower-cost JAK inhibition could eventually expand treatment options across a broad range of dermatologic conditions.
Disclosures: Galderma Laboratories, L.P, Regeneron Healthcare Solutions, GENZYME CORPORATION, Arcutis Biotherapeutics, Lilly USA, Novartis Pharmaceuticals Corporation, Dermavant Sciences, LEO Pharma, Verrica Pharmaceuticals, Incyte Corporation, AbbVie, and Pfizer.
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