A Glimpse at the Future of Podiatric Dermatology

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Janus kinase inhibitors (JAK) are a hot topic in dermatology and physicians will be encountering patients who are on these agents, Tracey Vlahovic, DPM, noted at yesterday’s APMA National presentation. She notes JAK inhibitors are effective for conditions including atopic dermatitis and vitiligo.
 
The advantages for JAK inhibitors are that they can be given orally since the process starts on the surface of the cell, which is particularly helpful for patients who do not want injections, said Dr. Vlahovic. She cited several recently developed JAK inhibitors: ruxolitinib, abrocitinib, and upadacitinib.
 
Ruxolitinib is indicated for mild to moderate atopic dermatitis as well as non-segmental vitiligo, and Dr. Vlahovic noted it is the first JAK inhibitor approved by the Food and Drug Administration (FDA). While it does carry an FDA black box warning, she noted ruxolitinib is not associated with the systemic issues seen in other JAK inhibitors.
 
Adverse effects of JAK inhibitors include upper respiratory infections, nasopharyngitis, nausea, headaches and acne, said Dr. Vlahovic. She noted the need for more long-term safety data.  
 
Will artificial intelligence (AI) replace podiatrists? No, said Richard Scherer, DPM, MS, DABFAS, but AI does have its uses in podiatry. He noted applications for AI include general skin disorders, skin cancers, psoriasis and in the diabetic foot.
 
Dr. Scherer demonstrated that AI can be useful in image recognition, as the technology can present a range of possible diagnoses for patients who upload photos of suspected malignancies. However, there are limitations, as he noted AI is not as useful in skin of color and cannot replace the need for a skin or nail biopsy. He also noted weaknesses in AI diagnosing onychomycosis, saying AI cannot be used to confirm pathology. Dr. Scherer added he was able to fool an AI program by drawing a dot with a Sharpie on his foot, which the AI could not recognize as artificial.
 
Mpox, the disease formerly known as monkeypox, emerged in humans in the 1970s, and was declared a health emergency last year by the World Health Organization. Leland Jaffe, DPM, FACFAS, notes that cases in the United States peaked in August 2022 and appear to be declining.
 
Dr. Jaffe noted that the disease can be sexually transmitted and has been more prevalent in men, with 98% of those men identifying as gay or bisexual. He advised that the differential diagnosis includes conditions such as varicella zoster virus, herpes simplex, molluscum contagiosum, and secondary syphilis. Dr. Jaffe advised that there is no specific treatment for mpox, saying therapy is supportive and that most patients will recover.
 
Christina Bui, DPM, MPH, discussed melanoma in the military, pregnant people, and people of color. As she noted, melanoma is more prevalent in the military than the general population—highest in the Air Force and lowest in the Army. She said the high incidence is due to increased ultraviolet exposure from more time spent outdoors. Although sunscreen is critical to melanoma prevention, she said only about 30% in the military wear it.
 
About one-third of women diagnosed with melanoma are of childbearing age, noted Dr. Bui, and more people getting pregnant at older ages equals more cases of melanoma. She said there are no guidelines for melanoma in pregnant patients, although an excision biopsy would be safe in that population.
 
In patients with skin of color, Dr. Bui said melanoma has lower rates of incidence but higher mortality, due to challenges in detecting melanoma in darker skin. She also noted some patients of color have a worse prognosis due to less awareness of risk, a decline in sun safety, and less access to health insurance. She advised recognizing atypical melanoma presentations in skin of color and promoting sun safety.