Off-Label Approaches to Therapeutic Challenges in Dermatology, with Adam Friedman, MD

During the Dermatology Education Foundation (DERM) 2025 NP/PA CME Conference, Adam Friedman, MD, from the George Washington University School of Medicine & Health Sciences Department of Dermatology, spoke about off-label approaches to therapeutic challenges in conditions such as lichen planus.

Friedman spoke with HCPLive about the lack of US Food and Drug Administration (FDA)-approved treatments for lichen planus and other lichenoid dermatitides, advocating for off-label use of JAK inhibitors and other treatments like oral retinoids and doxycycline. He also highlighted the potential of JAK inhibitors in autoimmune skin disease treatment, noting conditions such as cutaneous lupus, dermatomyositis, and morphia, noting ongoing clinical studies and personal successes.

“Now, none of these diseases I mentioned have anything meant for them, so that's where we get to be ‘off-label bandits’ and be quite creative,” Friedman said. “I have found with tinkering and trying out different things that in my hands, JAK inhibitors have been the most effective. But historically, the go-tos were things like oral retinoids for moderate to severe disease; most notably, acitretin has the most evidence supporting its use. I've also, for oral lichen planus, low-dose doxycycline. It makes sense because if you think about the initial indication for doxycycline, 20 milligrams, twice a day, which was for chronic gingivitis, I can guarantee you that some of those patients had oral lichen planus, and it just wasn't distinguished. So I think that there are some low-hanging fruit, whether it be topical agents, …whether it be low-dose antibiotics, oral retinoids, or even immunosuppressants. But I think the age of JAK inhibitors in the utilization for lichenoid dermatitis is upon us.”

For dermatomyositis, Friedman emphasized the importance of malignancy screening. In morphia, he highlighted the need for physical therapy to prevent joint deformity. Overall, Friedman encouraged creativity and vigilance for new treatments to improve patient care.

View his full video interview posted above to find out more about these topics. For more from DERM2025, view the latest conference coverage.

The quotes used in this interview summary were edited for clarity.

Friedman has previously reported serving as a consultant to Dermira, Eli Lilly and Company, Encore Dermatology Inc, Exeltis, Galderma, IntraDerm, Johnson and Johnson, Oculus Innovative Sciences, Pfizer Inc, and Sanovaworks.