What therapies have you found most effective for managing patients with Darier disease?

Because of the amazing bench-to-bedside paper below, my most severe Darier's patient started on an IL17 inhibitor, and it is the closest thing I've seen to a miracle in ages. She was refractory to everything we tried, and is now 80+% clear. What a joy to see science change people's lives!

Ettinger et...

A patient of mine with extensive disease involvement, an NRS 10, using a pound of triamcinolone every few days, unable to tolerate systemic retinoids, has completely cleared on Dupixent. He is thrilled to have clear, itch-free skin for the first time in decades!

I typically like to always start by educating and addressing local factors (friction, heat, sweating, etc.). Topical retinoids such as tretinoin, adapalene, and tazarotene can be sufficient for some. If secondary infection is present, obviously, that has to be addressed appropriately with topical or...