BACKGROUND:Psoriasis is a chronic inflammatory condition affecting approximately 3% of adults in the United States (US). While biologic therapies have transformed treatment for psoriasis, the speed and efficacy of response vary among biologics. This network meta-analysis (NMA) evaluates the efficacy and speed of response of interleukin (IL)-17 and IL-23, and tumor necrosis factor-alpha (TNF-alpha) inhibitors during the first 8 weeks of treating moderate-to-severe plaque psoriasis. METHODS:This Bayesian NMA used data from 53 phase 2b and 3 randomized controlled trials (RCTs). Efficacy was measured by Psoriasis Area and Severity Index (PASI) 75, PASI 90, and PASI 100 (≥75%, ≥90%, and 100% reduction in PASI score) at weeks 4 and 8. Absolute differences (absolute response minus placebo; AD) were calculated using a random-effects model. RESULTS:IL-17 inhibitors, specifically brodalumab, bimekizumab, and ixekizumab, had the highest AD in PASI 75, PASI 90, and PASI 100 at week 4 and week 8. DISCUSSION/CONCLUSION:IL-17 inhibitors, specifically bimekizumab, brodalumab, and ixekizumab, had a higher percentage of patients (measured as absolute difference in this study), achieving PASI 75, PASI 90, and PASI 100 at week 4 and week 8. However, there was no significant difference in absolute difference for the same endpoints and time points for patients treated with brodalumab, bimekizumab, and ixekizumab. IL-23 inhibitors, while effective, exhibited a slower onset; TNF-alpha inhibitors, except infliximab, generally showed slower responses. Indirect comparisons and differences in study design and populations may limit the generalizability of the results. &nbsp.

Dissecting cellulitis of the scalp (DCS) is a chronic inflammatory disorder of the scalp that manifests as inflamed nodules and abscesses, with subsequent patchy, scarring hair loss. While its exact pathogenesis remains unclear, follicular occlusion, inflammation, and sinus tract formation are thought to be key contributors. We present two patients, a 26-year-old male and a 33-year-old male, with refractory DCS and concomitant hidradenitis suppurativa and acne conglobata who were successfully treated with a combination therapy regimen of bimekizumab, isotretinoin, and oral antibiotics. &nbsp.

Atopic dermatitis (AD), is a chronic, relapsing inflammatory skin disorder that can pose a significant burden to patients and their caregivers and decrease their quality of life. Although substantial advances have been made in the safety and effectiveness of treatments for moderate to severe AD, opportunity for improvement remains. To better understand the patient journey and to consider the management of both current and emerging treatments, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in November 2025. This article provides a qualitative summary of the panel discussion. Key insights include that delayed diagnosis and limited access to dermatology specialists are top gaps in the provision of equitable care in moderate to severe AD and that despite treatment advances, more effective and affordable options are needed. Additionally, treatment adherence and positive outcomes in moderate to severe AD are multifactorial and may be affected by elements such as timely access, care coordination, disease severity and variability, and medication coverage and costs. Emerging agents show promise for a more durable response with less frequent dosing than current therapies, but payers are waiting for additional data to demonstrate long-term safety and efficacy and real-world outcomes. These findings can support informed clinical and coverage decisions, can offer practical actions for payers, and may inform future work.

Importance:Alopecia areata (AA) is an autoimmune hair loss disorder that affects more than 7 million people in the US. Before US Food and Drug Administration-approved trials of Janus kinase inhibitors, numerous treatments had been explored, with variable efficacy and quality of evidence. The absence of standardized treatment guidelines may lead to poor treatment outcomes and payer coverage. Objective:To establish a consensus on treatment for adults with severe AA in the US. Evidence Review:Systematic literature reviews for all known therapies used for treating AA were performed in PubMed from inception to December 2024. Inclusion criteria required studies to be randomized clinical trials or have an observational design, evaluate adult (≥18 years old) participants with moderate to severe AA (defined by Severity of Alopecia Tool scores >20%), and be published in English. Studies were excluded if they included patients with non-AA hair loss or if they exclusively evaluated pediatric participants or those with mild AA (Severity of Alopecia Tool scores ≤20%). Three rounds of anonymous, iterative online surveys were administered from May through November 2025. Consensus was predefined at an agreement threshold of 70% or greater. A definition of AA severity was proposed for determining patient eligibility. Experts with recent AA-related research and extensive clinical experience treating adults with severe disease indicated their agreement or disagreement with the use of 29 treatments for adults with severe AA. Treatments that reached consensus for inclusion were further explored with respect to therapeutic positioning, treatment regimens, and long-term management. Findings:Thirty-one US-based AA experts completed 3 rounds of iterative surveys. Consensus was achieved on treatment of adults with severe alopecia areata, as defined by the Alopecia Areata Scale. Oral Janus kinase inhibitors represented the primary, long-term therapy for all patients, with dupilumab as an alternative option for patients with comorbid atopy. Supplemental treatments included oral and topical minoxidil; intralesional, oral, and high-potency topical corticosteroids; and topical Janus kinase inhibitors and prostaglandins, with body site-specific indications. Patient support resources should be offered alongside medical treatment. Conclusion and Relevance:This study defines expert-established consensus on treatment of adults with severe AA in the US. Additional high-quality investigations are needed to establish the efficacy of existing therapies in subpopulations and enable head-to-head comparisons of new and existing interventions. These recommendations are not indicated for children, pregnant patients, patients with mild to moderate disease, or those with underlying comorbidities; additional research is needed to inform treatment guidelines for these specific patient populations.

BACKGROUND:Cutaneous squamous cell carcinoma (cSCC) represents a significant clinical challenge in patients with locally advanced (laCSCC) or metastatic (mCSCC) disease who are not candidates for surgery or radiation. In addition to PD-1 inhibitors, pembrolizumab and cemiplimab, cosibelimab, a PD-L1 inhibitor, has been recently approved by the US Food and Drug Administration (FDA) for laCSCC and mCSCC. Given its recent approval, practical guidance is needed to support clinician decision-making regarding cosibelimab's efficacy and safety. METHODS:A comprehensive literature review of PubMed and Google Scholar was completed for studies related to cosibelimab efficacy and safety in la and mCSCC. An expert panel of nine dermatologists with significant expertise in the treatment of cSCC gathered to review the articles and create consensus statements on the role of cosibelimab in managing laCSCC and mCSCC. A modified Delphi process was used to approve each statement, and the strength of recommendation was assigned using the Strength of Recommendation Taxonomy (SORT) criteria. RESULTS:The literature search produced over 200 articles that met the criteria, and a screening of the studies for relevance resulted in 13 articles. The panel developed six consensus statements, with five unanimously adopted with a strength of "A". CONCLUSION:Available data suggests that cosibelimab is an effective treatment for patients with laCSCC and mCSCC who are not candidates for surgery or radiation. Cosibelimab demonstrates a unique and favorable safety profile with no reported grade 4 or 5 immune-related adverse events after more than 2 years of follow-up.

Background:Deucravacitinib is a novel, allosteric, selective TYK2 inhibitor FDA-approved for the treatment of moderate-to-severe plaque psoriasis in adults. Currently, deucravacitinib is under investigation in numerous clinical trials to establish its efficacy and safety for other indications. Thus, this expert consensus panel was assembled to provide clinical guidance on the applications of and clinical considerations for deucravacitinib. Objective:The aim of this study was to assess the literature and formulate consensus statements covering the indications, safety, and efficacy of deucravacitinib. Methods:A comprehensive literature search of PubMed, Scopus, and Google Scholar was completed for English-language original research articles regarding deucravacitinib. The expert panel, which included eight dermatologists with advanced knowledge on both dermatologic and rheumatologic conditions, reviewed the pertinent literature and developed consensus statements regarding the additional indications, safety, and efficacy of deucravacitinib. Using a modified Delphi process, each statement had supermajority approval and was designated a strength of recommendation based on the Strength of Recommendation Taxonomy criteria. Key Findings:The panel unanimously voted to adopt 14 consensus statements and recommendations: 11 were a strength of "A", 1 was a strength of "B", and two were a strength of "C". The 14 consensus statements created by the expert panel provide expert recommendations regarding the efficacy, safety, and additional potential indications for deucravacitinib. Additionally, the expert panel notes that deucravacitinib is generally safe, as it can be safely combined with conventional synthetic DMARDs, immunosuppressants, and biologics and currently does not have data that support elevated malignancy risk, tuberculosis reactivation, increased risk for herpes zoster, or associated laboratory abnormalities. Conclusion:Deucravacitinib is an established treatment for plaque psoriasis that has shown strong evidence supporting safety and efficacy for psoriatic arthritis, cutaneous lupus, and systemic lupus erythematosus. Overall, deucravacitinib is a versatile and safe medication that may warrant further therapeutic consideration by clinicians. The expert panel concludes that deucravacitinib is an exciting medication that will likely have a larger role in the treatment of various conditions in the future.

People with plaque psoriasis are more likely to live with obesity relative to individuals without psoriasis, which can affect response to biologic treatment. This pooled analysis of the phase III reSURFACE 1 and reSURFACE 2 trials explored efficacy and safety of tildrakizumab 100 mg and 200 mg in patients with plaque psoriasis who were living with obesity for up to 244 weeks of treatment. Both doses of tildrakizumab were effective long-term, with comparable safety profiles in patients who were living with obesity and those who were not. Patients who were not living with obesity experienced more improvement with treatment than those with obesity, and those living with obesity had more long-term improvement after treatment with tildrakizumab 200 mg vs. tildrakizumab 100 mg.

BACKGROUND:Advanced topical nonsteroidal therapies are expanding options for atopic dermatitis (AD) by providing targeted anti-inflammatory control without many limitations of long-term topical corticosteroids. As these agents become more available, practical guidance is needed on their use as first-line therapy, proactive maintenance, combination regimens, safety, and long-term management. OBJECTIVE:To develop expert consensus statements defining the clinical role of advanced topical nonsteroidal therapies in AD. METHODS:A seven-dermatologist expert panel used a structured Delphi process informed by a literature review. Statements were drafted, iteratively refined, and voted on across multiple rounds. Evidence quality and strength of recommendations were assessed using the Strength of Recommendation Taxonomy (SORT). Consensus was predefined as ≥75% agreement. RESULTS:The panel reached unanimous consensus on seven statements regarding advanced topical nonsteroidal therapies, including topical ruxolitinib, tapinarof, roflumilast, crisaborole, tacrolimus, pimecrolimus, and delgocitinib. These therapies were considered effective in reducing AD signs and symptoms, including pruritus, and appropriate as first-line agents for many patients. Their use was associated with longer disease control, fewer relapses, and reduced cumulative topical corticosteroid exposure. The panel agreed that these therapies improve patient-reported outcomes, including quality of life and sleep, and can be safely incorporated into combination regimens with other topical or systemic treatments. They demonstrated favorable safety and tolerability profiles without the need for baseline or ongoing laboratory monitoring. Compared with topical corticosteroids, nonsteroidal therapies were preferred for long-term management to avoid steroid-associated adverse effects, with simplified dosing and suitability for sensitive and high-impact sites supporting adherence. CONCLUSION:Advanced topical nonsteroidal therapies represent an important evolution in AD management and are appropriate first-line options across disease severities, supporting sustained disease control and improved quality of life.

Alopecia areata (AA) is a chronic autoimmune disease characterized by a breakdown of immune privilege, resulting in an inflammatory response to hair follicles that can cause hair loss. Beyond its visible manifestations, AA imposes a considerable psychosocial burden and substantial economic impact due to increased health care utilization. There is no cure for AA, and management may be challenging due to the heterogeneic and recurrent nature of the disease. Attenuating the autoimmune response to hair follicles and stimulating hair regrowth in affected areas are key goals of AA treatment. Given its central role in mediating AA-related inflammation, the JAK-STAT pathway is a common target of current pharmacological strategies. Three JAK inhibitors are currently FDA-approved for severe AA: baricitinib, ritlecitinib, and deuruxolitinib. The safety and efficacy of these agents have been demonstrated in phase 3 trials. To support optimal outcomes for patients, there is an opportunity to recognize AA as a complex, immune-mediated condition rather than just a cosmetic concern. Aligning managed care coverage criteria with this clinical perspective and facilitating timely access to therapy may help mitigate the long-term clinical and economic consequences of the disease.

Cutis marmorata telangiectatica congenita (CMTC) is a rare congenital vascular disorder characterized by persistent, violaceous, reticulated skin changes that may be complicated by painful ulcerations. Although localized disease often improves with age, generalized CMTC can persist into adulthood and may be associated with limb asymmetry, ocular abnormalities, and neurologic sequelae. Diagnosis can be challenging in atypical adult presentations despite established major and minor criteria. We report a case of a 50-year-old woman with congenital livedo reticularis and Raynaud syndrome who presented with lifelong unilateral left lower-extremity hypoplasia and fixed lacy violaceous patches. Over the preceding decade, she developed recurrent, spontaneous, painful ulcerations exacerbated by cold exposure. Examination revealed a hypoplastic left leg with reticulated violaceous patches and tender, crusted erosions without venectasia; biopsy findings ruled out vasculitis, and the overall clinicopathologic picture met all three major and multiple minor Kienast-Hoeger criteria for CMTC. Multiple therapies targeting vasospasm and microvascular flow (including sildenafil, pentoxifylline, diosmiplex, nifedipine, and aspirin) failed to improve symptoms. Initiation of once-daily topical sirolimus (1 mg/mL) resulted in marked pain reduction within four weeks and cessation of new ulcerations, with visible improvement and healed erosions by two months. This case supports topical sirolimus as a promising off-label option for adult CMTC with chronic ulcerative disease.

Introduction Brodalumab is the only interleukin-17 (IL-17) receptor A blocker approved for moderate-to-severe plaque psoriasis and blocks downstream signaling of multiple IL-17 isoforms including IL-17A, IL-17F, IL-17C, IL-17E, and IL-17A/F. Here, we contextualize effectiveness and safety of brodalumab in adult patients in the Canadian Real-World Evidence (CARE) study alongside results from pivotal phase 3 trials. Methods CARE is a Canadian, 12-month, multi-center, prospective, observational phase 4 study (NCT05132231) in adult patients initiating brodalumab as part of routine clinical care. Results reported here reflect a prespecified interim analysis through month 6. In the AMAGINE-1, -2, and -3 phase 3 trials (NCT01708590, NCT01708603, NCT01708629), participants were initially randomized to receive brodalumab (140 or 210 mg) or placebo via subcutaneous injection every 2 weeks (Q2W) during a 12-week induction period. At week 12, brodalumab-treated patients were rerandomized to placebo or the same brodalumab dose (AMAGINE-1) or various brodalumab regimens (AMAGINE-2 and -3) through week 52. Brodalumab’s performance at the approved 210-mg dose was assessed with Psoriasis Area and Severity Index (PASI) scores and rates of adverse events (AEs). Real‑world effectiveness (3 and 6 months) and safety (6 months) are presented descriptively alongside pivotal trials efficacy and safety (3 months). No formal statistical testing was performed. Results In the CARE study, 351 patients (58% male, 74% Caucasian, mean age 51 y, baseline mean PASI score 14.1) completed the 6-month visit. At 3 months, PASI 75/90/100 were observed in 78.2% (265/339), 64.0% (217/339), and 43.4% (147/339) of patients, with improvements at 6 months to 82.1% (276/336), 72.6% (244/336), and 52.1% (175/336) of patients, respectively. Overall, 44.4% and 2.0% of patients reported AEs and serious AEs, respectively. In the phase 3 trials with brodalumab 210 mg (n=1458, 69%-73% male, 90%-91% Caucasian, mean age 45-46 y, baseline mean PASI score 19.4-20.4), PASI 75/90/100 were achieved in 83%-86%, 69%-70%, and 37%-44% of patients at 3 months (week 12). A total of 56.8%-59.0% and 1.0%-1.8% of patients experienced AEs and serious AEs, respectively. Conclusions Real‑world outcomes with brodalumab align closely with the efficacy and safety profile established in pivotal phase 3 trials. These results support the robustness and generalizability of brodalumab’s clinical profile across both controlled and routine‑care settings and its use as an effective treatment option for moderate‑to‑severe plaque psoriasis.

Deucravacitinib, an oral, selective, tyrosine kinase 2 inhibitor, is approved for adults with moderate to severe plaque psoriasis who are candidates for systemic therapy and for adults with active psoriatic arthritis. We evaluated deucravacitinib safety and efficacy over 5 years in the phase 3 POETYK PSO-1, PSO-2, and long-term extension (LTE) trials in patients with moderate to severe plaque psoriasis. PSO-1 and PSO-2 (parent trials) randomized patients 1:2:1 to oral placebo, deucravacitinib 6 mg once daily, or apremilast 30 mg twice daily. At 52 weeks, patients enrolled in the LTE trial received open-label deucravacitinib. Safety was reported as exposure-adjusted incidence rates (EAIRs) per 100 person-years (PY). Clinician- and patient-reported outcomes were analyzed using modified nonresponder imputation in patients receiving continuous deucravacitinib from day 1 (PSO-1/PSO-2) through 5 years. Overall, 1519 patients received one or more deucravacitinib dose; total exposure was 5046.7 PY through data cutoff (September 2, 2024). EAIRs/100 PY were comparable or decreased from the 1-year to 5-year cumulative period for adverse events (AEs) (229.23, 127.40, respectively), serious AEs (5.68, 5.06), discontinuation due to AEs (4.38, 2.09), deaths (0.20, 0.22), serious infections excluding coronavirus disease 2019 (COVID-19) (1.53, 0.94), malignancies (1.02, 0.92), major adverse cardiovascular events (0.30, 0.34), and venous thromboembolism (0.20, 0.06). Clinical outcomes were well-maintained in patients receiving continuous deucravacitinib (n = 513) from 1 through 5 years, including achievement of a ≥ 75

Importance:Overweight and obesity affect 60% to 78% of patients with psoriasis, affecting disease severity, treatment response, and clinical outcomes. However, no large, randomized, active-controlled clinical trial has evaluated a treatment strategy that addresses both diseases simultaneously. Objective:To evaluate the efficacy and safety of ixekizumab with or without tirzepatide in participants with psoriasis and overweight or obesity. Design, Setting, and Participants:This phase 3b, randomized, open-label, 52-week clinical trial was conducted at 72 sites in the US in adults with moderate to severe plaque psoriasis who have overweight with 1 or more weight-related comorbidities or obesity. The trial started on September 30, 2024, and completed the week 36 primary end point on January 8, 2026. Data were analyzed from January to February 2026. Interventions:Participants were randomized (1:1) to ixekizumab plus tirzepatide or ixekizumab as adjunct to diet and exercise in both treatment arms. Main Outcomes and Measures:At week 36, the primary end point was simultaneous achievement of Psoriasis Activity and Severity Index (PASI) 100 and 10% or greater weight reduction. Key secondary end points were PASI 100 and simultaneous PASI 75 and 5% or greater weight reduction, as well as 10% or greater weight reduction. Results:Among the 274 randomized participants (mean [SD] age, 45.6 [12.7] years; 123 [44.9%] women and 151 [55.1%] men; mean [SD] screening body mass index [calculated as weight in kilograms divided by height in meters squared], 39.2 [9.1]; mean [SD] duration of psoriasis, 14.6 [13.0] years; mean [SD] PASI, 19.7 [8.1]), 231 (84.3%) completed the treatment through week 36. Overall, 27.1% of participants simultaneously achieved PASI 100 and a 10% or greater weight reduction with ixekizumab plus tirzepatide vs 5.8% with ixekizumab (risk difference [RD], 21.2%; 95% CI, 12.8%-29.7%; P < .001). Also, 40.6% vs 29.0% of participants achieved PASI 100 (RD, 11.6%; 95% CI, 0.3%-22.9%; P = .04), 79.9% vs 17.9% simultaneously achieved PASI 75 and a 5% or greater weight reduction (RD, 62.0%; 95% CI, 51.7%-72.2%; P < .001), and 69.2% vs 9.1% achieved a 10% or greater weight reduction (RD, 60.0%; 95% CI, 50.4%-69.7%; P < .001), respectively. Adverse events were generally consistent with established drug safety profiles, the most common being gastrointestinal tract events and injection site reactions. Gastrointestinal tract events occurred more frequently with ixekizumab plus tirzepatide vs ixekizumab. Conclusions and Relevance:The trial results suggest that concomitant ixekizumab and tirzepatide produced clinically meaningful, statistically significant improvements in skin clearance and reductions in weight in participants with moderate to severe psoriasis, with no new safety concerns, while providing additional cardiometabolic benefits and a potential to elevate care. Trial Registration:ClinicalTrials.gov Identifier: NCT06588283.