Dermatology Off-Label Treatments – Adam Friedman, MD
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Adam Friedman, MD, of George Washington University School of Medicine & Health Sciences, highlights innovative approaches to treating conditions like lichen planus at the Dermatology Education Foundation (DERM) 2025 NP/PA CME Conference.
In the absence of readily available FDA-approved treatments for challenging dermatological conditions such as lichen planus and other lichenoid dermatitides, clinicians are increasingly turning to creative, off-label therapeutic strategies.Adam Friedman, MD, from the George Washington University School of Medicine & Health Sciences Department of Dermatology, shared his insights on these approaches during the recent Dermatology Education Foundation (DERM) 2025 NP/PA CME Conference, emphasizing the evolving landscape of autoimmune skin disease management.
The Off-Label Frontier: JAK Inhibitors and Beyond
Friedman articulated a pragmatic approach to managing these complex conditions, often necessitating a willingness to explore treatments beyond their primary FDA indications. “Now,none of these diseases I mentioned have anything meant for them,so thatS where we get to be ‘off-label bandits’ and be quite creative,” Friedman stated. He identified Janus kinase (JAK) inhibitors as a notably promising class of drugs in his clinical practice.
JAK Inhibitors: A Powerful Tool in the Dermatologist’s Arsenal
“I have found with tinkering and trying out different things that in my hands, JAK inhibitors have been the moast effective,” friedman explained. This class of medications, which modulate the immune system by blocking specific signaling pathways, has shown significant potential in treating a range of autoimmune skin diseases. Beyond lichenoid dermatitides, Friedman noted their efficacy in conditions such as cutaneous lupus, dermatomyositis, and morphea, citing both ongoing clinical studies and his personal successes with these agents. The growing body of evidence suggests that the era of JAK inhibitors for lichenoid dermatitis is indeed dawning.
Traditional Mainstays and Emerging Options
while JAK inhibitors are gaining prominence, Friedman also acknowledged the continued relevance of established treatments. “Historically, the go-tos were things like oral retinoids for moderate to severe disease; most notably, acitretin has the most evidence supporting its use,” he said. Oral retinoids,such as acitretin,have long been a cornerstone in managing severe inflammatory skin conditions due to their ability to regulate keratinocyte proliferation and differentiation.
Moreover, Friedman highlighted the utility of low-dose doxycycline for oral lichen planus. He posited that the initial indication for low-dose doxycycline (20 mg twice daily) for chronic gingivitis might have inadvertently captured patients with undiagnosed oral lichen planus. “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,” he commented, underscoring the availability of various therapeutic avenues.
Comprehensive Care for Autoimmune Skin Diseases
Beyond pharmacological interventions, Friedman stressed the importance of a holistic approach to patient care, particularly for conditions like dermatomyositis and morphea.
Addressing Specific Autoimmune Conditions
For patients with dermatomyositis, Friedman emphasized the critical need for thorough malignancy screening. This recommendation stems from the known association between dermatomyositis and underlying cancers, making early detection paramount for optimal outcomes.
In the management of morphea, a localized form of scleroderma, Friedman underscored the vital role of physical therapy.Proactive physical therapy is essential to prevent joint deformity and maintain functional mobility, which can be substantially impacted by the fibrotic changes characteristic of the condition.
A Call for creativity and Vigilance
Adam Friedman, MD, encouraged dermatologists to embrace creativity and maintain vigilance in their pursuit of novel treatments for challenging autoimmune skin diseases.By leveraging off-label strategies, staying abreast of emerging research, and adopting a comprehensive care model, clinicians can significantly improve patient outcomes and quality of life.
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.
The quotes used in this interview summary were edited for clarity.