Botulinum toxin in males with androgenetic alopecia
A study published in JAAD assessed the efficacy of treatment with botulinum toxin for male androgenetic alopecia. The study enrolled 13 men of whom half of the scalp was injected with 25 IU of botulinum toxin at weeks 0 and 12, and the other half of the scalp was injected with an equal volume of normal saline in mirrored injection sites. The authors found no statistically significant difference between the two sides of the scalp in terms of hair density. The authors concluded that botulinum toxin injection is not an effective treatment for androgenetic alopecia in males, although larger randomized controlled studies are needed.
DermWorld Insights and Inquiries: AESOP — The ants and the grasshopper
Unquestionably, AESOP (Adenopathy and Extensive Skin patch Overlying a Plasmactyoma) is rare — to date, fewer than 25 cases have been reported. Why write (or read) a commentary about AESOP when it is unlikely we will ever encounter a case? There are at least two valid reasons: 1) Because of its distinctive appearance, dermatologists should recognize it because of its potentially profound systemic associations; 2) Conceptually, it is a fascinating disorder. Dermatologists should consider the diagnosis of AESOP presented as predominantly truncal erythematous patches or sclerodermoid plaques. A significant number of cases are associated with polyneuropathy and/or POEMS syndrome. Keep reading!
FDA approves nemolizumab for prurigo nodularis
The FDA approved nemolizumab-ilto, an IL-31 inhibitor, to treat adults with prurigo nodularis. In two clinical trials, 56% and 49% of treated patients, respectively, achieved at least a four-point reduction in itch intensity by week 16 vs. 16% of placebo-treated patients. Itch reduction was also observed as early as week four, with 41% of patients in both trials achieving at least a four-point reduction in itch intensity vs. 6% and 7% in the placebo groups.
[Understanding and treating chronic itch. Read more.]
The FDA is currently reviewing the biologics license application for nemolizumab for the treatment of moderate-to-severe atopic dermatitis, with a decision expected this year.
What are the effects of nemolizumab treatment in prurigo nodularis patients? Read more.
On July 10, CMS released the 2025 Medicare Physician Fee Schedule proposed rule, which included important policy changes to fee-for-service payments and the Quality Payment Program (QPP). The AADA strongly opposes these cuts and demands that Congress reform the Medicare physician payment system by adding an annual inflation adjustment and modifying budget neutrality requirements. Medicare physician payment reform is the AADA’s sole federal congressional advocacy priority.
JAK inhibitor prescribing trends for alopecia areata
Authors of a research letter published in JAAD examined the impact of JAK inhibitors (JAKi) on overall alopecia areata (AA) prescribing trends in real-world use. Compared with 2010-2014, before the publication of the first JAKi case report, from 2015 to 2024, JAKi use increased from 0% to 26.4% among alopecia totalis (AT)/alopecia universalis (AU) patients, coinciding with the increased proportion of AT/AU patients receiving ≥1 treatment during this period (from 29.2% to 52.4%). Following FDA approval, among AT/AU patients, JAKi were less likely to be prescribed to women, those with nonprivate insurance, and the elderly.
The study suggests that the discovery of JAKi appears to have increased a return to care-seeking in AT/AU patients who were not regularly followed up for lack of efficacious treatment. Sex disparities in JAKi prescriptions may indicate undertreatment in women, possibly due to the disproportionate impact of unknown safety profiles during pregnancy, which is concerning as AA commonly affects women of childbearing age, the authors noted. Exclusion of elderly AA patients in JAKi trials may help explain prescriber/patient hesitancy due to the lack of safety data in this population.
Dermatologists discuss the influx of new JAK inhibitors in dermatology and how they are breaking new ground for the specialty. Read more.
Medicare reveals negotiated drug prices for dermatology drugs
The price negotiation program was passed in 2022 as part of the Inflation Reduction Act. The measure lowers prescription drug costs for seniors by empowering Medicare to negotiate the cost of prescription drugs. Medicare cut deals to lower the list prices of 10 widely used drugs between 38% and 79%, the Biden administration said, adding that seniors should save $1.5 billion in out-of-pocket costs when the price changes take effect Jan. 1, 2026.
Here are the negotiated prices for a 30-day supply of the drugs most commonly used by dermatologists:
Etanercept: $2,355.00 — a 67% discount
Ustekinumab: $4,695.00 — a 66% discount
Medicare administrators will select another 15 drugs for the next round of price talks by Feb. 1. Those negotiated prices would take effect in 2027.
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