This month’s news from across the specialty
What’s hot
September 1, 2025
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
News flash: As of June 20, 2025, dupilumab is officially FDA-approved as the first targeted treatment for bullous pemphigoid (BP)! I’ve been using it off-label for years, telling each patient I was hoping and praying for approval — and now, that prayer has been answered (joyously, one day before my birthday!).
Back in 2001, a Journal of Investigative Dermatology study identified elevated IL-4 and IL-13 cytokine levels in BP patients’ blood and blisters, pointing to a Th2-mediated pathway (J Invest Dermatol. 2001. 117(5):1097-102). Nearly 20 years later, case reports emerged highlighting dupilumab’s effectiveness in BP.
Now, based on the LIBERTY-BP ADEPT study (Adv Ther. 2024. Jul;41(7):2991-3002), the FDA has granted approval. This is especially meaningful for our elderly patients, for whom traditional treatments like systemic steroids, methotrexate, mycophenolate, rituximab, and IVIG pose significant risks or burdens.
In the ADEPT trial — a multicenter, double-blind, placebo-controlled study of 106 adults with moderate-to-severe BP — patients received dupilumab or placebo plus a protocol-driven standard of care systemic steroid taper. Sustained remission (off systemic steroids by week 16 with no relapse by week 36) occurred in 18.3% of dupilumab patients vs. 6.1% of placebo. Itch reduction was achieved in 38.3% vs. 10.5%, and responders used lower median cumulative steroid doses (2.8g vs. 4.1g). Side effects included joint pain, conjunctivitis, blurred vision, herpes infections, and keratitis.
While the primary endpoint rates weren’t striking, the criteria were stringent. In real-world practice, I expect dupilumab will offer meaningful, safer relief for many of our BP patients.
DermWorld Insights & Inquiries
There is an abundance of new immunomodulatory medications in our armamentarium. The impact of these medications on patch testing remains a topic of discussion. The North American Contact Dermatitis Group (NACDG) has updated their 2012 expert opinion paper (Dermat Contact Atopic Occup Drug. 23(6):301-3, 2012; JAAD. 92(6):1383-5, 2025).
The NACDG updated guidelines note that studies demonstrate the ability to elicit positive patch test reactions while on these medications, however, false negatives are possible (JAAD. 2025, 92(6):1383-5; Dermat Contact Atopic Occup Drug. 2021. 32(6):365-74). The recommendation remains that patch testing is performed off all immunosuppressants whenever possible.
The updated guidelines recommend a seven-day wash-out period for low- and mid-potency topical steroids, topical calcineurin inhibitors, topical JAKi, and topical PDE4 inhibitors. High-potency topical steroids should be held for 14 days, and intramuscular steroids should have a 30-day wash-out period. Oral steroids, methotrexate, azathioprine, cyclosporine, mycophenolate mofetil, oral JAKi, and UVB phototherapy should be held for seven days prior to patch testing. Biologics for atopic dermatitis should be held for 14 days. Psoriasis biologics and antihistamines do not need to be held.
If immunosuppressants cannot be held without flaring disease, patch testing can be performed on the lowest dose possible. However, patch test interpretation needs to be done carefully as false negatives may occur. Larger research studies are needed to determine the effect of these medications on the patch testing process and individual allergens. Until this occurs, the NACDG has provided updated guidelines.
More What’s Hot!
Check out more What’s Hot columns from the DermWorld Editorial Advisory Workgroup.
