Risankizumab (RZB) and deucravacitinib (DEU) are both approved for the treatment of moderate-to-severe psoriasis. Physicians value head-to-head comparisons between available therapies to make evidence-based treatment decisions. This study evaluates the safety and efficacy of RZB compared with DEU for the treatment of patients with moderate psoriasis who have not previously received biologic treatment. Patients with moderate psoriasis, eligible for systemic treatment and without prior biologic exposure, were enrolled in a 1:2 ratio to RZB or DEU, respectively. The 52-week treatment was divided into two periods: period A (baseline to week 16) and period B (weeks 16-52). Results from period A are presented here. In period A, patients either received a single subcutaneous injection of RZB 150mg on day 1 and week 4 or oral DEU 6mg daily. The coprimary endpoints in period A were achievement of ≥ 90% improvement in Psoriasis Area and Severity Index (PASI 90) and achievement of sPGA 0 or 1 (sPGA 0/1) with at least a two-grade improvement from baseline. Ranked secondary endpoints for period A included the achievement of PASI 100 and sPGA 0 with at least a two-grade improvement from baseline at week 16. Additional endpoints were also assessed. Safety was based on assessment of treatment-emergent adverse events (TEAEs). A significantly higher proportion of patients treated with RZB achieved PASI 90 (57.3% versus 22.9%), sPGA 0/1 (80.2% versus 39.7%), PASI 100 (27.5% versus 6.5%), and sPGA 0 (27.5% versus 6.9%) compared with patients treated with DEU at week 16 (P < 0.0001). The proportion of patients with TEAEs was 33.6% (RZB) and 42.9% (DEU). Safety was consistent with the known profiles of RZB and DEU. In this 16-week analysis, treatment with RZB demonstrated superior efficacy compared with DEU in adults with moderate psoriasis. No new or unexpected safety signals were identified. ClinicalTrials.gov identifier: NCT06333860.

In pooled LIBERTY-PN PRIME/PRIME2 trials on prurigo nodularis (PN), at week24, the stringent composite endpoint of a ≥ 4-point reduction from baseline in Worst Itch Numeric Rating Scale (WI-NRS) score combined with an Investigator's Global Assessment for PN-Stage (IGA PN-S) score of 0/1 (clear/almost clear skin) was achieved by 35.3% of dupilumab versus 8.9% of placebo-treated patients. This optimal response may not capture the full experience of treatment in the remaining patients. This study assessed additional efficacy endpoints in the remaining dupilumab (64.7%) and placebo (91.1%) PRIME/PRIME2 recipients without optimal response at week24. Additional week24 endpoints included ≥ 9-point reduction from baseline in Dermatology Life Quality Index (DLQI) score, Patient Global Impression of Severity (PGIS) score of "none"/"mild," ≥ 75% healed lesions from Prurigo Activity and Severity (PAS-75), and a concomitant reduction from baseline of ≥ 3 points in WI-NRS score and ≥ 1 point in IGA PN-S score. Data from 99 dupilumab-treated and 144 placebo-treated patients without optimal response were analyzed. Among dupilumab-treated patients, 61.1% achieved a ≥ 9-point reduction from baseline in DLQI score, 55.8% a PGIS score of "none" or "mild," 53.7% PAS-75, and 45.7% the less stringent itch and skin lesion composite endpoint (nominal P vs placebo significant for all). Dupilumab treatment versus placebo resulted in nominally significant improvements in signs, symptoms, and quality of life in patients with PN without optimal response by week24, supporting the benefits of continued treatment. These results highlight the need to develop a treat-to-target strategy for the long-term management of PN. ClinicalTrial.gov Identifiers: NCT04183335 and NCT04202679 (registered December 2019).

Obesity contributes to inflammation and may decrease psoriasis treatment efficacy. We investigated whether obesity affects the efficacy and safety of tildrakizumab, an anti-interleukin-23 p19 antibody approved for the treatment of adults with moderate-to-severe plaque psoriasis, for scalp psoriasis treatment. This was a subgroup analysis of a randomized, double-blind, placebo-controlled, Phase 3b trial in patients with moderate-to-severe plaque psoriasis affecting the scalp. Patients receiving tildrakizumab 100mg or placebo were analyzed by baseline obesity status (body mass index ≥ 30 versus < 30kg/m2). Efficacy outcomes included an Investigator Global Assessment (IGA) modified 2011 (scalp) (IGA mod 2011 [scalp]) score of "clear"/"almost clear" (0/1) with a ≥ 2-point reduction (IGA mod 2011 [scalp] response), ≥ 90% improvement in Psoriasis Scalp Severity Index (PSSI) score (PSSI 90 response), ≥ 4-point reduction in Scalp Itch-Numeric Rating Scale (Scalp Itch-NRS response; among patients scoring ≥ 4 at baseline), and percent change from baseline (%CFB) in affected scalp surface area (SSA). Safety was assessed from adverse events. The analysis was not prospectively powered to detect differences between subgroups. In the intention-to-treat population, 56/117 (47.9%) patients randomized to tildrakizumab and 57/114 (50.0%) to placebo had obesity (modified intention-to-treat population: tildrakizumab, 43/89 [48.3%]; placebo, 40/82 [48.8%]). At Week 16, significantly more patients treated with tildrakizumab versus those receiving placebo achieved IGA mod 2011 (scalp) (obesity, 21/43 [48.8%] versus 4/40 [10.0%], p = 0.0002; no obesity, 23/46 [50.0%] versus 2/42 [4.8%], p < 0.0001) and PSSI 90 responses (obesity, 27/43 [62.8%] versus 4/40 [10.0%], p < 0.0001; no obesity, 27/46 [58.7%] versus 0/42 [0.0%], p < 0.0001). Treatment effect was also maintained for Scalp Itch-NRS response (p < 0.0001) and mean %CFB in affected SSA (no statistical testing), regardless of obesity status. Results in patients treated with tildrakizumab were similar through Week 52. No new safety signals were identified. No statistically significant differences in efficacy or safety were observed between patients with and without obesity. NCT03897088.

Atopic dermatitis (AD) is a chronically relapsing, complex skin disease characterized mainly by skin lesions and itch. The first-line treatment for patients with AD includes topical therapy, such as topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI). Long-term use of topical medications can be burdensome for patients, and despite these burdens, topicals remain a frequent treatment option, not only in patients with mild-to-moderate disease, but also as concomitant therapy in patients with moderate-to-severe disease. Lebrikizumab is a novel monoclonal antibody that binds with high affinityand slow off-rate to interleukin (IL)-13,thereby blocking the downstream effects ofIL-13 with high potency. This review focuses on the use of topical medications in the lebrikizumab ADvocate1&2 monotherapy trials and ADjoin long-term extension study in the context of similar trials for interleukin (IL)-13/IL-4 inhibitors. In the first 16weeks of the ADvocate1 and ADvocate2 monotherapy clinical trials, topical therapy was not permitted, and patients receiving topicals were considered nonresponders in the primary analysis. In the subsequent 36-week maintenance period, concomitant therapy was permitted at investigator discretion; however, most patients did not use TCS (TCS use: 11.9% and 9.7% for lebrikizumab treatment every 4weeks [Q4W] and 2weeks [Q2W], respectively). Likewise, in the ADjoin long-term extension study, concomitant therapy was permitted at investigator's discretion; however, the majority of patients did not use TCS up to 2years of treatment (TCS use: 12.1% and 8.5% for lebrikizumab Q4W and Q2W in patients from ADvocate1&2, respectively). Treatment with lebrikizumab monotherapy improved clinical signs and symptoms of AD, and demonstrated stable long-lasting disease control with less frequent dosing (Q4W), with no or minimal use of topicals. Topical use across clinical trials for approved monotherapy biologics (dupilumab, lebrikizumab, and tralokinumab) was reported, and topical therapy was permitted in the maintenance period. For nemolizumab, there is no monotherapy data available in AD.

Chronic itch is the most burdensome symptom of atopic dermatitis (AD), yet its routine assessment and measurement remain inconsistent. This study aimed to characterise current practices for evaluating itch in AD among UK dermatologists and, through a narrative review,to summarise available itch assessment tools and inform practical recommendations for routine practice. This was a cross-sectional clinician survey and narrative literature review. A total of 394 dermatologists participated in the survey of itch and its assessment in AD during the 2024 British Association of Dermatologists Annual Meeting. Dermatologists reported itch as the most bothersome symptom in atopic dermatitis (78.68%, n = 310), and nearly half identified itch as the strongest predictor of disease severity (47.97%, n = 189). Only 28.68% of respondents (n = 113) reported assessing itch often or always using the peak pruritus numerical scale (PP-NRS) or visual analogue scale (VAS), while 45.18% (n = 178) assessed itch sometimes and 26.14% (n = 103) never assessed itch. Reduction of itch was selected as the most important treatment goal by 56.35% of respondents (n = 222). In addition, 94.16% (n = 371) agreed or strongly agreed that they routinely try to understand the impact of itch on their patients, and 74.11% (n = 292) agreed or strongly agreed that there is currently a lack of effective treatment options for itch relief. The narrative review identified validated unidimensional itch measures (numerical rating scale (NRS), VAS, verbal rating scale (VRS)) and multidimensional instruments (Patient-Oriented Scoring of Atopic Dermatitis (PO-SCORAD), Patient-Oriented Eczema Measure (POEM), 5-D itch scale, ItchyQOL), with clinical studies reporting that reductions of approximately 3-4 points on the itch NRS correspond to patient-perceived meaningful improvement. This large UK-based survey among dermatologists highlighted a gap between recognition of itch burden in atopic dermatitis and its systematic measurement in routine practice. The accompanying narrative review identified simple patient-reported measures, including the numerical rating scale (NRS), as feasible options to support more consistent itch assessment in routine care.

Laser resurfacing, with erbium-doped yttrium aluminum garnet (Erbium:YAG) lasers, is a leading treatment for photoaging owing to its relatively rapid healing profile. However, even with advanced technology, there remains a need for adjunctive topical treatments to enhance skin recovery, mitigate postprocedure pigmentation issues, and minimize postprocedure downtime. This randomized, evaluator-blinded, controlled study evaluated a regenerative cream's performance following laser treatment. The study utilized a mini-zone model on the volar forearms of healthy participants to compare the cream's efficacy against laser treatment alone. Clinical and instrumental assessments were utilized to assess the efficacy of the regenerative cream in accelerating skin healing post laser. Within 7days of treatment, the regenerative cream significantly improved skin hydration (76%, p < 0.05) and smoothness (10%, p < 0.05), reduced skin roughness, crusting/scaling (49%, p < 0.05), and visual skin uniformity (49%, p < 0.05), compared with laser treatment alone. In addition, the regenerative cream showed greater reduction in skin redness (-27%, p < 0.05) than laser alone at day 18 post laser. Moreover, the regenerative cream outperformed an anhydrous benchmark formula in hydration, skin smoothness, and roughness after just 7 days. These findings highlight the potential of the regenerative cream as a valuable addition to laser resurfacing procedures, promoting faster healing with improved aesthetic outcomes.

Psoriasis is a chronic inflammatory skin disease associated with significant physical and psychological burden. Tildrakizumab, an interleukin-23 p19 inhibitor, has demonstrated efficacy in treating moderate-to-severe plaque psoriasis both in clinical trials and real-world setting. However, limited data are available on the impact of the effective treatment of psoriasis on the psychological health of patients. The aim of this study was to assess changes in psychological well-being, as well as clinical and quality-of-life outcomes, in patients with moderate-to-severe plaque psoriasis treated with tildrakizumab in routine clinical practice in Italy. This was an interim analysis (IA) of a 52-week multicenter, prospective, observational study. Adults with moderate-to-severe plaque psoriasis initiating tildrakizumab were enrolled. Endpoints focused on well-being and psychological health and included changes, from baseline to week28, in Depression, Anxiety, and Stress Scale-21 (DASS-21) scores, Dermatology Life Quality Index (DLQI), European Social Survey (ESS) items, and World Health Organization-Five Well-Being Index (WHO-5). Effectiveness was also monitored via Psoriasis Area and Severity Index (PASI), and safety via treatment-emergent adverse event reporting. A total of 115 patients were included (mean age 52.5years, 60.8% male), 102 receiving ≥ 1 dose of tildrakizumab and completing DASS-21 evaluations at baseline and week28. At week28, improvements were observed in DASS-21 subscales [depression (-2.6, 95%CI -2.0 to -1.0), anxiety (-2.3, 95%CI -2.0 to -1.0), and stress (-3.4, 95%CI -4.0 to -2.0)], accompanied by marked PASI reduction (-13.7, 95%CI -12.8 to -10.1). DLQI, ESS, and WHO-5 scores also improved. Adverse events were generally mild or moderate, with no unexpected safety signals. In this real-world IA, tildrakizumab was observed to improve the psychological well-being of patients, reflected by a reduction in all items of the DASS-21 scale and, in parallel, confirmed its effectiveness in managing physical symptoms of psoriasis, establishing its role in the holistic management of psoriasis.

Abrocitinib, a selective Janus kinase (JAK)-1 inhibitor, is approved for the treatment of moderate-to-severe atopic dermatitis (AD). Although several real-world studies evaluated the safety and efficacy of abrocitinib, most have been limited by small sample sizes, and there are limited data on South Korean patients with AD. In addition, real-world comparative data across oral JAK inhibitors for AD remain limited. We conducted a retrospective, single-center cohort study at the National Medical Center in Seoul, Korea. Patients aged ≥ 12years with moderate-to-severe AD (baseline EASI ≥ 7) who initiated abrocitinib between September 2022 and April 2024 were included in the primary cohort; additional cohorts treated with upadacitinib or baricitinib during predefined periods were analyzed for between-drug comparisons. Efficacy was assessed at baseline, week2, and week16 using the Eczema Area and Severity Index (EASI) and patient-reported outcomes (PROs). Safety was evaluated by adverse events (AEs), physical examinations, and laboratory tests. Of the 66 patients enrolled, 57 patients completed 16weeks of abrocitinib treatment in the analysis. The mean EASI score significantly decreased after 16weeks. At week16, 94.4%, 72.2%, and 25.9% of patients with AD achieved EASI-50, -75, and -90, respectively. Additionally, of the 21 patients who had previously experienced biologics or other JAK inhibitors, 95.5%, 72.7%, and 22.7% achieved EASI-50, -75, and -90, respectively. Further analysis of the EASI breakdown showed improvements of more than 80% across all body regions, with the lower extremities showing the greatest reduction (87.5%) and lichenification exhibiting the highest symptom improvement (89.7%). In descriptive, unadjusted comparisons, abrocitinib showed numerically higher EASI-50 and EASI-75 response rates at week16 than upadacitinib and baricitinib. Acne was the most frequent adverse event with abrocitinib (43.9%), followed by urticaria (24.6%) and herpes simplex infection (12.3%); no dose reductions or treatment discontinuations due to adverse events occurred. Abrocitinib demonstrates real-world efficacy and safety in moderate-to-severe AD, including patients with inadequate responses to other dupilumab or JAK inhibitors, including those with prior exposure to biologics or other JAK inhibitors.

Hidradenitis suppurativa (HS) is a highly disabling chronic inflammatory disorder affecting up to 1% of the Spanish population. It is a complex disease that requires significant resources and imposes a considerable economic burden. The aim of this study was to assess the economic burden of diagnosed HS in Spain both at patient and population level. The study was conducted from a societal perspective using a bottom-up, prevalence-based approach. We evaluated publicly financed direct healthcare costs (consultations, diagnostic tests, inpatient admissions, surgery, comorbidities, treatment), direct nonhealthcare costs (formal and informal care, out-of-pocket expenses), and indirect costs (absenteeism and productivity loss) incurred by patients diagnosed with HS. A sensitivity analysis was conducted to test the uncertainty of the model. The mean annual cost of treating all severities of patients with HS in Spain was €39,535.10. The largest cost components across all categories were informal care (46.05%), treatment (18.24%), out-of-pocket expenses (12.76%), loss of work productivity (10.82%), and surgery (5.62%). Moderate and severe patients cost 64.05% (€34,221.92) and 170.53% (€56,432.77) more than mild patients (€20,860.35), respectively. Assuming a prevalence of 1% and a diagnostic rate of 10%, the total economic burden of diagnosed HS in Spain was estimated at €1587 million. HS has a significant economic impact on patients, their families, the healthcare system, and wider society. This is particularly evident among patients with moderate-to-severe HS. To reduce the economic burden and improve quality of life, efforts should be made to prevent the disease from progressing and to ensure that patients remain in the milder stages.

Atopic dermatitis (AD) involving special areas such as the hands, head and neck, and genital region poses important therapeutic challenges owing to distinct barrier fragility, environmental exposure, and mixed Th1/Th2/Th17 activation. These sites often drive treatment escalation despite limited overall body surface involvement. Evidence on the real-world effectiveness of upadacitinib in these anatomical locations remains limited. A retrospective, observational multicenter study was conducted across five Spanish dermatology departments (November 2024 to November 2025). Adults and adolescents with moderate-to-severe AD and involvement of at least one special area treated with upadacitinib (15 or 30 mg) for ≥ 16 weeks were included. Disease severity was assessed using the Eczema Area and Severity Index (EASI), body surface area (BSA), pruritus numeric rating scale (NRS), Dermatology Life Quality Index (DLQI), Investigator's Global Assessment (IGA), and local 0-4 Physician Global Assessment (PGA). Minimal disease activity (MDA) was defined as EASI ≤ 3 plus pruritus-NRS 0-1. Descriptive statistics were applied. Distribution-shift plots were used to analyze categorical changes in special areas. Overall, 57 patients were included (mean age 47.9 ± 17.6 years, 59.6% women). Facial/neck, hand, and genital involvement were present in 73.7%, 61.4%, and 21.1% of patients, respectively; 31.9% had ≥ 2 special areas affected. Upadacitinib induced rapid improvement, with EASI decreasing from 18.9 to 2.7 at week 16 and 2.4 at week 52. MDA was reached by 61% at week 16 and 69% at week 52. Special-area PGA improved markedly across all sites. Upadacitinib provided rapid, sustained, and clinically meaningful improvement in AD involving special areas, supporting its use in anatomically sensitive areas.