What's New in Topical Dermatology Drugs, With Brad Glick, DO, MPH

Advances in topical dermatologic medications are quickly reshaping how clinicians manage chronic inflammatory skin diseases, providing them with new options designed to extend beyond the long-standing reliance on corticosteroids.

In a new interview, Brad Glick, DO, MPH, a board-certified dermatologist and the director of the dermatology residency training program at the Larkin Health System Palm Springs campus in Florida, reflected on this topic in light of data he presented in his recent presentation at the American Academy of Dermatology (AAD) Annual Meeting.1

In this session and in his subsequent Q&A interview with HCPLive’s editorial team, Glick highlighted emerging nonsteroidal therapies and their growing role in clinical practice:

HCPLive: What were some of the topical therapies you elected to discuss in this talk, titled ‘What’s New in Dermatology’?

Glick: First of all, it's such an honor to be able to be at the podium at the Academy, and I've had that opportunity the last few years to do so. But one of my favorite sessions at virtually the end of the meeting is this. When my colleague, Dr. Mark Lebwohl, invited me last year to be at the podium to do this very same topic. One of the things he told me was to make sure everything is pretty brand spanking new. So I tried to do that. What did I talk about?...I spoke on steroidal topical therapies, which are really in Vogue now. We still need our topical corticosteroids, but we can use them more effectively, even more now than we did before.

Now we have three topical non steroidal therapies, roflumilast, ruxolitinib, and tapinarof, which was the first one to be approved down to the age of 2 for treating our kiddos with atopic dermatitis. Roflumilast has multiple indications: psoriasis, seborrheic dermatitis, atopic dermatitis. And we have things in our toolbox now that we can use for our recommendations for our patients once or twice a day where they don't have what I like to call that ‘saw-tooth’ pattern that we get with corticosteroids. Someone has a bad rash, we still prescribe topical corticosteroids, but for something that is chronic, what is the solution for them?

When we tell them, ‘Okay, use it for 2 or 3 weeks and then take a break,’ we have to have some substantive substitute for that particular product so that they can continue with their therapy. Otherwise, we run into what I talked about in my lecture, which was not only the common side effects that we're concerned about with the chronic use of topical corticosteroids…and not just atrophy of the skin and broken blood vessels, telangiectasias, and maybe steroid acne and steroid rosacea, particularly when topical steroids are used in the face, but what has become a topic of significant discussion. There've been multiple articles published in this last year…steroid withdrawal syndrome. We have hundreds of thousands of patients that have been using topical steroids for many years, some of them for reasonably moderate periods of time, but many of them have this phenomenon over longer periods of time because that's what they were given, or that's what they found successful, transiently.

But [for some] it then seems to backfire, where they get this rebound type of change, worsening of their rash and profound involvement of their face. It may not always be where the corticosteroid is being utilized. So all that told we've had this need for topical, non-steroidals and I talked a lot about newer ones like delgocitinib, which was recently approved for chronic hand eczema. It will have some other uses. I talk a lot about off-label uses of all of these new non-steroidals, so whether it's tapinarof for things like seborrheic dermatitis, there is some data around that for vitiligo that's in progress.

JAK inhibitors [too] are becoming like the Windex of dermatology. We can use them for almost anything right now, although there are obviously FDA-approved indications, such as those for ruxolitinib 1.5% cream for atopic dermatitis down to the age of two, and also for adolescents and adults for non-segmental vitiligo. But there are off-label uses for these therapeutics as well. Palmoplantar postulosis is being studied with a number of these topical non-steroidals.

The punchline is, for our cutaneous, inflammatory, immune-mediated diseases, we now can shift our therapy to more long-term solutions, because patients can use these therapies for longer periods of time compared to, for instance, higher potency corticosteroids. Hopefully, that was an exciting part of my talk. But there are new things that are coming as well, that are exciting for disease states that have been very difficult to treat. Let's talk about one of them, frontal fibrosing alopecia. We've largely used hydroxychloroquine orally and intralesional corticosteroids, but now we may be able to use some of these topical, for instance, Janus kinase inhibitors, to treat that condition. We also have some therapies that may be coming for treatment.

In certain conditions, like cutaneous T-cell lymphoma, and from a topical perspective, we have a certain topical like hypericin gel, which may be beneficial in combination with photodynamic therapy, meaning we use a light source to allow this particular substance, which appears to work just about as well as one of our topical nitrogen mustards. And then this is a fairly uncommon condition, CTCL, cutaneous T cell lymphoma. Nevertheless, the toolbox is not there and is very full. We'll mostly use phototherapy and topical corticosteroids. And of course, for advanced disease, we've had to either use topical retinoids in combination with phototherapy or even systemic retinoids. And so this is a unique and novel agent that's still under study.

Its mechanism of action is to downregulate a lot of these inflammatory changes that are leading to the chronic inflammatory change that we see in CTCL, which leads to the development of these atypical lymphocytes that we see in this particular condition. So stay tuned on that. But hyperson gel, in combination with photodynamic therapy, a light source used with this agent, may have some benefit in the treatment of CTCL, so that's particularly exciting. And actually, there's some thought that maybe even some of the topical Janice kinase inhibitors that I talked about may play some role in the treatment of CTCL, albeit a little bit controversial, and we have to stay tuned there.

HCPLive: Would you go a bit more in depth about JAK inhibitors covered in your talk? Do you feel clinicians are more open to their use now that some of the JAK safety data has been cleared up?

Glick: Let's answer question number one first. There's really three reasonable, reasonably accessible topical Janus kinase inhibitors. So let's start with topicals first, and then I'll answer part, part two of the question second, because your question involves the orals and the topicals, which is pertinent. There are 3 topical therapies. Two of them are FDA approved, one that we can get from compounding pharmacies that are primarily used. There are others that are on the horizon. I gave a talk about some of them, providing a list. I mentioned the pan-JAK inhibitor in delgocitinib. It's a pan-JAK inhibitor that's approved for chronic hand eczema first and only, currently approved for adults only. But I can tell you, there was the DELTA-TEEN study that was done. I did talk about it in one slide in my talk…We saw treatment success versus vehicle in the clinical trials for chronic hand eczema, and hopefully it will be approved soon down to the age of 12. That's one to highlight.

The second one, which is the originator topical JAK that was first approved for atopic dermatitis, now approved down to the age of 2, is ruxolitinib 1.5% cream. Use it twice daily. That's also one to highlight, highly effective in the treatment of atopic dermatitis in that age spectrum of 2 years and above. And then finally, for topical tofacitinib…[It] has been evaluated topically for the treatment of various forms of alopecia, including alopecia area and frontal fibrosine alopecia. Our audience will know that the initial discovery for the benefits of JAK inhibitor started with oral tofacitinib, and so many of us have used it for many years in a variety of different settings.

…Question two was that you asked about the risk adverse nature of some of our colleagues where JAK inhibitors are concerned, because the systemic agents of which there are now 3 that are approved for alopecia areata in baricitinib, ritlecitinib, and now deuruxolitinib, and then also our originator products in baricitinib for alopecia areata, but also upadacitinib for atopic dermatitis down to the age of 12, of getting those approvals correctly. Abrocitinib is also approved for adolescents. These are unique therapies, but all of them, and including one of the topical therapies, which is ruxolitinib cream…The point is that I think with more use, yes, we're starting to see a steady uptake of the use of the orals and certainly the topicals. I think that our expert dermatology colleagues feel quite comfortable that these topical therapies, unless someone is swimming in it and using all over their body, 100%.

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

Glick has served as an adviser, consultant, speaker, or investigator for Amgen, AbbVie, AstraZeneca, Almirall, Arcutis, Bausch Health/Valeant, Ortho Dermatologics, Boehringer Ingelheim, Bristol-Myers Squibb, Brickell Biotech, Cara, ChemoCentryx, Dermavant, Dermira, Eli Lilly, EPI/Novan, Incyte, Janssen Pharmaceuticals, LEO Pharma, Galderma, Nimbus Lakshmi, Inc, Novartis, Sun Pharma, Pfizer, Sanofi, Regeneron, UCB and the CorEvitas AD, CorEvitas PSO, and PROSE Registries and is a shareholder of Top MD

References

1. Glick B, et al. S065 What's New in Dermatology. Session presented at: 2026 American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, CO.