AAD 2023 Annual Meeting – 6 takeaways from Nola on trends in Dermatology innovation

This past weekend, people from every corner of the world descended upon New Orleans for the American Academy of Dermatology (AAD) Annual Meeting (official attendance numbers haven’t yet been released, but attendance in prior years has approached almost 20,000). Despite the surprisingly chilly weather, there was no shortage of fun to be had, with the city’s famed food scene, nightlife, and culture providing the backdrop for a plethora of dinners, social hours, reunions of long-time friends and colleagues, viral social media campaigns with @dudewithsign and @dudettewithsign, and of course endless opportunities for learning and exchange of ideas.

As is often the case with such conferences, both the discussion topics and the exhibit hall at the AAD New Orleans provided a glimpse into the current and future trends shaping the field of Dermatology and beyond. So without further ado, here are 6 of the biggest trends I saw at this year’s conference that could have implications for innovation in the field.

1. More than ever, the field has a significant appetite for innovation

As I discussed in my first post, Dermatology represents an incredibly broad field that not only touches nearly every aspect of medicine, but also provides avenues for innovation in technology, wellness, aesthetics, and care delivery. Increasingly, many Dermatologists themselves are looking for opportunities to participate in that process of innovation, whether it be through their basic science research, translational work, partnering with industry, or even startups of their own. Case in point, Thursday’s pre-conference event the Dermatology Innovation Forum – hosted by Advancing Innovation in Dermatology – was impressively well-attended, with a packed house consisting of attending Dermatologists, residents, and innovators in industry spending the full day discussing a broad range of topics related to emerging digital technologies, innovation in both systemic and topical medications, entrepreneurship in academic settings, and artificial intelligence, among other things. Throughout the weekend, I spoke with a number of Dermatologists and trainees who asked how to become more involved in the innovation pipeline, and I anticipate that over the coming years the combined clinician-innovator career path will become increasingly popular.

2. Artificial intelligence (AI) and augmented intelligence (AuI) in Dermatology are at an inflection point

With ChatGPT and artificial intelligence taking off in the technology world more broadly, it is unsurprising that the implications of AI for the field of Dermatology was a central recurring theme at this year’s AAD. The topics of artificial intelligence and augmented intelligence (the use of AI not to replace physicians, but rather to further support them) have certainly had a prominent presence in AADs prior…but this year felt different. Whereas previous years largely discussed AI and AuI as early-stage, theoretical, and/or research ideas being explored, this year’s AAD increasingly saw them discussed as a tangible reality being incorporated into the field as we speak. Nearly every facet of Dermatology is being touched by AI and AuI in one way or another. From precisely quantifying change in hair count and additional characteristics such as caliber and hair type on trichoscopy to monitor response to alopecia therapy, to determining melanomas more likely to recur, to supporting clinical decision-making both in well-resourced and particularly under-resourced regions, to wearable sensors with AI algorithms for itch and sleep, to streamlining administrative tasks such as documentation and billing, both Dermatologists and industry are using AI and AuI as tools to enhance the quality and efficiency of both care delivery and medical and technological discovery. I anticipate exponential growth in the number of AI and AuI innovations that will be presented at future AADs, but to me this felt like the first year where it truly hit its inflection point to drive this explosive growth.

3. Increased targeting and mechanistic understanding continue to provide new opportunities for therapeutic advancement

While certainly not a new trend, basic scientists continue to develop increasingly precise understandings of the pathways underlying both inflammatory and neoplastic processes, and translational scientists continue to leverage these discoveries into increasingly targeted therapies. In many ways psoriasis has served as the model disease for this type of innovation over the past decade, with increasingly targeted treatment options being introduced that allow for management of both psoriasis and even some of its comorbidities as discussed in the session titled “So Many Biologics, So Little Time”.

Unlike psoriasis, the management of other conditions is still in the earlier stages of this innovation curve – but this year’s AAD continued to provide of glimpse of the innovation pipeline to come. Dupilumab has certainly transformed the management of atopic dermatitis, and in a range of sessions we also heard about the potential role for JAK inhibitors and even novel inhibitors of IL-4Ra or IL-22R as newer tools in the Dermatologist’s future toolkit for this condition. In the session titled “Off-label Use of Biologics and New Medications”, we also learned about the promise of IL-17 and IL-23 inhibitors for hidradenitis suppurativa, dupilumab for bullous pemphigoid, and apremilast for seborrheic dermatitis and lichen planus. At the “Late-breaking Research” session, Johns Hopkins’ Dr. Shawn Kwatra presented the phase 3 findings of nemolizumab (an anti-IL-31RA antibody) for prurigo nodularis to a packed yet overflowing theater, underscoring the significant interest in advancements in treatment of itch and related conditions. Also at this session, new potential treatment of seborrheic keratoses via Akt inhibition and a potential oral IL-17 inhibitor were presented, again highlighting the significant room for continued innovation within targeting of neoplastic and inflammatory pathways. Common conditions with limited systemic treatment options to date – such as alopecia areata, vitiligo, and hidradenitis suppurativa – were particularly exciting topics given the recent approvals and current trials in process for these widely prevalent, significantly impactful conditions.

JAK inhibitors continued to remain a hot topic, particularly given the large number of FDA approvals in the class over the past 1-2 years across a range of conditions including not only psoriasis and atopic dermatitis but also alopecia areata and vitiligo. Newer drugs in the class – such as deucravacitinib (Sotyktu^TM), abrocitinib (Cibinqo^TM), and ritlecitinib (currently in phase 3 trials) – served as prime examples of potential innovation via increased targeting, with each aiming to build on the promise of their “pan-JAK” predecessors by targeting their specific JAK of choice. Given the targeted JAK inhibitors in the pipeline and the ongoing study of the drug class in various conditions, I anticipate this will continue to remain a hot topic at AADs to come.

4. There is ongoing innovation in therapeutics for rare diseases, with potentially life-changing implications

Rare diseases span an incredibly broad range of often life-altering conditions that have been historically challenging to treat. Unsurprisingly, then, rare diseases provide a nearly countless number of opportunities for innovations that can dramatically improve patients’ lives, particularly as new technologies help enable and accelerate discovery in the space. At this year’s AAD we learned about new therapeutics for rare diseases spanning inflammatory conditions (e.g., spesolimab for generalized pustular psoriasis), malignancy (e.g., trials in Merkel cell carcinoma), and genetic syndromes (e.g., QTORIN rapamycin for pachyonychia congenita).

In many ways, rare diseases represent the prime candidate for rapid advancement and discovery, given the sheer volume of conditions, their significant patient impact, their comparatively lower number of treatments to date, and their alignment with new treatment modalities such as gene therapy, DNA- and RNA-based therapeutics, and pathway-targeted therapies. I therefore expect a healthy number of rare disease-related therapeutic advancements to be presented at AADs in the foreseeable future.

5. Skin of color continues to receive significant attention as a major area of need in Dermatology

In recent years, the field has realized the significant underrepresentation of skin of color across Dermatology with regard to education, practitioners, diagnostics, and products / therapeutics. As I discussed in my original post, there has been significant attention paid to this gap more recently, which will dramatically grow the population that the field can more effectively serve. This year’s AAD saw continued emphasis on this important area through a range of topics. Examples of such topics ranged from a full 3 hour Skin of Color Symposium on a range of medical dermatology topics particularly important in skin of color (e.g., scarring alopecia, keloids, HS), to lasers in skin of color discussed by my Harvard mentor Dr. Mat Avram and Dr. Omar Ibrahimi,

to incorporating diverse representation of skin types into AI models of Dermatology discussed by Stanford’s Dr. Justin Ko, to management of pigmentary disorders in the “50 Shades of Brown” session led by Harvard’s Dr. Sandy Tsao and Dr. Rishi Chopra and the “Pigmentary Potporri” session led by USC’s Dr. Nada Elbuluk. Eucerin advertisements for its new sensitive tinted mineral sunscreen could be seen from the moment attendees arrived in the New Orleans airport to their time in the city and convention center, and this was just one of many products and technologies that could be found in the exhibit hall aiming to provide improved solutions in patients with skin of color. With the increased recognition of the need to expand such offerings, I anticipate this will remain an important area of focus across clinicians, researchers, and industry as we aim to improve our ability to care for all of our patients.

6. Academic-industry collaboration can accelerate innovation

In line with the growing recognition of the importance of translational work over recent years, the field of Dermatology – and medicine more broadly – increasingly appreciate the importance of bridging the gap between scientific discovery and clinical actualization of those discoveries. Many of the largest institutions in the country have launched or grown innovation accelerators in recent years, such as the MESH Incubator at my home institution Mass General Brigham.

Several talks at the AAD supported the importance of such programs to foster and harness innovation coming out of academic institutions. The keynote speech at Thursday’s Dermatology Innovation Forum was delivered by Dr. Emma Guttman-Yassky, Chair of Dermatology and Immunology at Mount Sinai who discussed the institution’s incredibly prolific clinical trials program that has been involved in nearly every significant novel biologic and therapeutic trial over the past decade. Massachusetts General Hospital’s Dr. Lilit Garibyan discussed the Magic Wand Initiative and Virtual Magic Wand – programs designed to support clinicians aiming to identify and address unmet needs – which has already produced a number of successful innovations and Dermatologist-entrepreneurs since its inception in 2013. And Dr. John Harris, Chair of Dermatology at UMass, discussed the Autoimmune Therapeutics Institute, an organization he founded which has already led to ongoing work and potential advancements in vitiligo therapy, topical drug and vaccine delivery, adeno-associated virus vectors for gene therapy, parasite products, and siRNA therapeutics, among others. Discoveries out of Dr. Harris’s group have already garnered significant attention from industry and investors, including an acquisition of Villaris Therapeutics announced by Incyte in October 2022, and separately $30M of funding by Medicxi for Aldena Therapeutics, announced the day before the conference.

As discussed by Dr. Harris in his speech to the Dermatology Innovation Forum, his group is able to ensure academic discoveries more effectively realize their true potential by navigating them through the “Valley of Death”, or the gap between discovery and commercial realization where many innovations fail. I strongly believe in the importance of such collaboration to help advance the field of medicine, and have personally enjoyed taking part in such innovation and commercialization through my role as Entrepreneur in Residence at Gore Range Capital. I expect that programs such as those discussed above will only further enhance the ecosystem for bench-to-bedside innovation, and am excited to see this trend continue to blossom in the years to come.

Dr. Hashemi is a final-year Dermatology resident at Harvard Medical School, and Entrepreneur in Residence at Gore Range Capital. He previously completed internship training at Memorial Sloan Kettering Cancer Center in New York City, and prior to medical school served as an Engagement Manager in management consulting and Director of Corporate Strategy at a Fortune 500 entertainment company. He holds an MD from the University of Pennsylvania, an MBA from the Stanford Graduate School of Business, a post-baccalaureate certificate from Johns Hopkins University, and an undergraduate degree in Economics Phi Beta Kappa from the University of Chicago. He has published numerous articles in such influential dermatology journals as JAMA Dermatology, JAAD, and Dermatologic Surgery, and has lectured on medical, surgical, and cosmetic dermatology. He has a particular interest in innovation within Dermatology and healthcare more broadly.

Photo by Rosie Kerr on Unsplash