Scholarly Activity

BACKGROUND: Deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 inhibitor, is approved in multiple countries for adults with moderate to severe plaque psoriasis who are candidates for systemic therapy.

OBJECTIVE: The 52-week, phase 3b/4 PSORIATYK SCALP (NCT05478499) trial evaluated deucravacitinib efficacy and safety in scalp psoriasis, including patients with more limited overall psoriasis. Here, we report week 16 results.

METHODS: Adults with moderate to severe scalp psoriasis and body surface area involvement ≥ 3% were randomized 1:2 to placebo (n = 51) or deucravacitinib 6 mg once daily (n = 103) through week 16. The primary efficacy endpoint was scalp-specific Physician Global Assessment score of 0/1; key secondary endpoints were Psoriasis Scalp Severity Index 90, scalp-specific numeric rating scale itch score, and static Physician Global Assessment (sPGA) 0/1.

RESULTS: In the overall population, scalp-specific Physician Global Assessment score of 0/1 (48.5% vs 13.7%; P < .0001), Psoriasis Scalp Severity Index 90 (38.8% vs 2.0%; P < .0001), and mean change from baseline in scalp-specific numeric rating scale itch (-3.2 vs -0.7; P < .0001) were superior with deucravacitinib versus placebo. In the sPGA ≥ 3 subpopulation, sPGA 0/1 was superior with deucravacitinib (51.0% vs 4.3%; P < .0001). Adverse events were comparable between groups.

LIMITATIONS: 16-week analysis.

CONCLUSION: Deucravacitinib was efficacious and well tolerated in patients with moderate to severe scalp psoriasis.

BACKGROUND AND OBJECTIVES: Vitiligo is challenging to treat and may have a substantial impact on quality of life. Despite the exponential growth in the development of new "traditional" vitiligo treatments, many vitiligo patients choose to employ medical products and practices that are used with or instead of standard medical care (complementary and alternative medicine or CAM). In this study, CAMs and camouflage were discussed together and referred to as over-the-counter products (OTCs). Using an observational cross-sectional study, we aimed to investigate the motivations and demographic factors of individuals with vitiligo who use OTCs, to identify the most utilized OTCs in this population, and to assess side effects and perceived efficacy of the utilized OTCs.

METHODS: We performed an international observational cross-sectional study between July 2021 and June 2022. An anonymous digital questionnaire was distributed to adults (aged ≥ 18 years) who had been diagnosed with vitiligo by a healthcare provider via e-mails from the Global Vitiligo Foundation to vitiligo support groups and through postings on the MyVitiligoTeam social media network. Participants were presented with a predefined list of OTC products and an open-ended option was also provided.

RESULTS: Of the 224 respondents, half were aged 45-64, most were female (69.6%), and the majority were White (56.3%). A total of 41.1% of participants used OTCs, either exclusively (19.2%) or with prescribed therapies (22%), while 58.9% used only prescribed therapies. The top reasons for using OTCs were dissatisfaction with conventional therapy, concerns about side effects, inconvenience, and cost. The most commonly used OTCs were camouflage, Vitamin B12, Vitamin D, zinc, ginkgo biloba, and vitamin C. Camouflage was reported as the most helpful OTC. Mild side effects were reported by 6.3% of users.

CONCLUSION: This study highlights the widespread use of OTCs in managing vitiligo, emphasizing the need for healthcare providers to be familiar with commonly used OTCs. Patients using OTCs raised concerns about conventional treatments, which should be considered in management discussions and drug development. Camouflage was the most beneficial OTC in this study, and it should be included in management plans. A better understanding of OTCs could improve treatment strategies and patient satisfaction.

The loss of major histocompatibility complex class I (MHC-I) molecules has been proposed as a mechanism for cancer immune evasion. Nevertheless, the mechanism is poorly understood. We report here that membrane-associated RING-CH-type finger 8 (MARCHF8), upregulated by human papillomavirus (HPV), ubiquitinates and degrades MHC-I in HPV-positive head and neck cancer (HPV+ HNC). Inhibiting MARCHF8 restores MHC-I levels on HPV+ HNC cells, suppresses tumor growth, and increases the infiltration of natural killer (NK) and T cells in the tumor microenvironment. Furthermore, Marchf8 knockout markedly increases cross talk between cytotoxic NK cells and CD8(+) T cells with macrophages and enhances the tumor-killing activity of CD8(+) T cells. Interestingly, Marchf8 knockout, in combination with anti-PD-1 treatment, further enhances tumor suppression and increases NK and T cell infiltration in mice bearing immune checkpoint inhibitor-refractory tumors. Our findings suggest that MARCHF8 could be a promising target for immunotherapy for HPV+ HNC patients.

This cross-sectional study analyzed the top 100 bestselling "baby" sunscreens on Amazon to evaluate ingredient composition, formulation types, and marketing claims of popular products. Among the 94 products evaluated, 100% were broad-spectrum and at least SPF 30, 76.6% were mineral-based, and 92.6% were water-resistant, consistent with American Academy of Dermatology's recommendations. Marketing labels such as "pediatrician tested," "dermatologist tested," and "non-nano" were common but lacked standardized definitions or regulatory oversight. These findings highlight the need for greater regulation in sunscreen labeling and marketing.

Erythropoietic protoporphyria (EPP) and X-linked protoporphyria (XLP) cause severe photosensitivity, resulting in significant quality of life (QoL) impairment. This study aims to evaluate the safety and efficacy of Polypodium leucotomos extract (PLE) as an adjunctive therapy in patients with persistent symptoms despite standard dosing of afamelanotide. In this prospective single-center cohort study, eight adults with confirmed EPP or XLP and ongoing symptoms despite regular afamelanotide implants every 2 months were enrolled. Participants received 480 mg oral PLE daily for 4 months. QoL and symptom severity were measured using questionnaires at baseline, Day 60, and Day 120. Six participants completed the study. Statistically significant improvements in QoL were observed on Day 60 (p = 0.014), but not at Day 120 (p = 0.152). Half of participants reported reduced reaction severity. No adverse events occurred. Adjunctive PLE improved short-term QoL in participants with incomplete symptom control on afamelanotide alone and was well tolerated. Larger studies are warranted.

Post-inflammatory hyperpigmentation (PIH) is a common complication following trauma or cutaneous inflammation, particularly affecting individuals with skin of color. Tranexamic acid (TXA) is a lysine analogue with antifibrinolytic properties and has been used as an off-label agent for melasma and procedural PIH. This pilot study evaluated the efficacy of oral TXA in the prevention and treatment of PIH using a validated in-vivo model. A baseline site was treated with 30% trichloroacetic acid (TCA) to induce PIH (control). After PIH developed, another site was induced and patients started oral TXA 650mg for 4 weeks. Both sites were assessed for pigmentation changes at day 56 using standardized photography, Investigator Global Assessment (IGA), colorimetry, and digital reflectance spectroscopy. While trends toward reduced pigmentation were observed in the TXA-prevention group, none reached statistical significance. Oral TXA may play a role in preventing PIH, but did not significantly reduce pigmentation in established PIH lesions.

Introduction: In the ADORING 1 and 2 Phase 3 trials, tapinarof cream 1% (VTAMA®, Dermavant Sciences, Inc.) once daily (QD) demonstrated significant efficacy and was well tolerated in patients down to age 2 years with atopic dermatitis (AD). We present efficacy, safety, and tolerability outcomes from ADORING 3. Methods: Eligible patients from ADORING 1, ADORING 2, from a four-week maximal usage pharmacokinetics trial, and tapinarof-naive patients with mild AD, or moderate or severe AD, that did not meet inclusion criteria for ADORING 1 or 2, received tapinarof cream 1% QD for up to 48 weeks. Efficacy endpoints included achievement of complete disease clearance (Validated Investigator Global Assessment for Atopic Dermatitis™ [vIGA-AD™] score=0 [clear]), and clear or almost clear skin (vIGA-AD™=0 or 1). Safety and tolerability were assessed. Patients entering with vIGAAD™ ≥ 1 were treated with tapinarof until complete clearance (vIGA-AD™=0). Those entering with or achieving complete clearance discontinued tapinarof and were assessed for maintenance of clear or almost clear skin off-treatment (duration of treatment-free interval). Patients whose AD returned to mild (vIGA-AD™ ≥ 2) were re-treated until complete clearance was achieved. Results: In total, 728 patients enrolled; 83.0 percent were pediatric (2–17 years). Overall, 51.9 percent (378/728) achieved complete disease clearance, and 81.6 percent achieved clear or almost clear skin at least once in the trial. Mean duration of first treatment-free interval was 79.8 consecutive days (standard deviation: 81.4 days). No tachyphylaxis on either continuous or intermittent therapy was observed for up to 48 weeks. Most frequent adverse events were folliculitis (12.1%), nasopharyngitis (6.9%), and upper respiratory tract infection (6.9%). Follicular events and contact dermatitis were mostly mild or moderate and associated with low discontinuations (1.0% and 0.4%, respectively). Tapinarof was well tolerated locally, even when applied on sensitive skin. Conclusion: Tapinarof cream monotherapy demonstrated a high rate of complete disease clearance in patients down to age 2 years with AD. After discontinuing tapinarof, patients maintained clear or almost clear skin for 79.8 consecutive days. Tapinarof was well tolerated over 48 weeks.

Introduction: Acne vulgaris is a common dermatologic condition and a leading dermatologic diagnosis in Black and Hispanic patients. Topical clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (CAB) gel is the only fixed-dose, triple-combination formulation approved for the treatment of acne. In three published clinical studies of participants with moderate-to-severe acne, CAB gel demonstrated superior efficacy to vehicle and component dyads, with good safety/tolerability. The objective of these analyses was to determine the efficacy, safety, and tolerability of CAB in Hispanic participants of these studies. Methods: In one Phase 2 (NCT03170388) and two Phase 3 (NCT04214652, NCT04214639) randomized, double-blind, 12-week studies, participants aged nine years or older with moderate-to-severe acne were randomized to once-daily CAB or vehicle gel. Endpoints included percentage of participants achieving treatment success (≥2-grade reduction from baseline in Evaluator's Global Severity Score [EGSS] and clear/almost clear skin) and least-squares mean percent change from baseline in inflammatory/noninflammatory lesion counts at Week 12. Treatment-emergent adverse events (TEAEs) and cutaneous safety and tolerability were also assessed. Pooled data across all three studies were analyzed for participants who self-identified as Hispanic/Latino (herein referred to as Hispanic; n=90 CAB; n=57 vehicle gel). Results: At Week 12, over half of Hispanic participants achieved treatment success with CAB versus less than one-quarter with vehicle gel (56.2% vs. 18.4%; p<0.001). CAB treatment provided more than 75-percent reductions in inflammatory/noninflammatory lesion counts at Week 12 vs 56.4 percent and 45.0 percent, respectively, with vehicle (p<0.001, both). TEAE rates with CAB in the Hispanic population were similar to those in the overall study populations (27% vs. 24.6–36.2%). Most TEAEs were of mild-to-moderate severity, and discontinuations due to AEs were low (<4%). Mean cutaneous safety and tolerability scores (0=none to 3=severe) with CAB at all visits were less than one (mild), similar to the overall study populations. Hyperpigmentation scores decreased from baseline (0.6) to Week 12 (0.3) following CAB treatment. Conclusion: In Hispanic participants with moderate-to-severe acne treated with CAB, over half achieved treatment success and acne lesion reductions were reduced by more than 75 percent by Week 12, without any additional safety signals. These results, combined with those of previous post-hoc analyses in Black study participants, demonstrate that CAB is an efficacious, safe, and tolerable acne treatment for patients of different racial and ethnic groups.

Introduction: Treatments with fast and substantial acne clearance are highly desirable. While a three-pronged approach can increase treatment efficacy versus monotherapy or dual-combination therapy, it is unknown if triple-combination provides more rapid improvement. CAB gel—clindamycin phosphate (clin) 1.2%/adapalene 0.15%/benzoyl peroxide (BPO) 3.1%—is the first fixed-dose, triple-combination acne topical. Since rapid/substantial acne improvements and fewer side effects can increase adherence, the efficacy and safety of CAB in the first four weeks of treatment was evaluated. Methods: In a Phase 2 (N=741; NCT03170388) and two Phase 3 (N=183; N=180; NCT04214639; NCT04214652), double-blind, 12-week studies, participants aged nine years or older with moderate-to-severe acne were randomized to once-daily CAB or vehicle gel; the Phase 2 study included three additional dyad arms: BPO/adapalene; clin/BPO; and clin/adapalene. Efficacy assessments included least-squares mean percent change from baseline in inflammatory and noninflammatory lesions. Cutaneous safety/tolerability assessments were graded from 0=none to 3=severe. Post-hoc analyses included percentages of participants with one-third and one-half acne lesion reductions. Results: At Week 4, CAB led to approximately 55 percent reductions from baseline in inflammatory acne lesions in the ph2 and pooled ph3 studies, significantly greater than vehicle (~40%) and its three dyads (ph2 range: 44.2-47.6%; p<0.05, all). The percentages of participants with one-third and one-half reductions of inflammatory lesions were significantly greater with CAB than vehicle and dyads (p<0.05, all). Similar trends were observed for noninflammatory lesions, though reductions were less pronounced. As expected for retinoids, transient increases from baseline to Week 2 in scaling, erythema, itching, burning, and stinging were observed for CAB, BPO/adapalene, and clin/adapalene, with mean scores ≤ 0.6 (1=mild); no trends in dyspigmentation were observed. Mean scores for all cutaneous assessments were highest for BPO/adapalene, indicating that adding a third product in the fixed-dose CAB gel formulation did not worsen tolerability. Conclusion: Acne lesion reductions were significantly greater with clin 1.2%/adapalene 0.15%/BPO 3.1% gel versus its dyads and vehicle gel as early as Week 4. More rapid efficacy with this first fixed-dose triple-combination acne product—coupled with its optimized formulation, once-daily dosing, and tolerability—might positively impact treatment adherence.

Introduction: Deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 inhibitor, is approved in multiple countries for treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy. Deucravacitinib was efficacious versus placebo and apremilast and was well tolerated in the global, 52-week, Phase 3 POETYK PSO-1 (NCT03624127) and POETYK PSO-2 (NCT03611751) parent trials. At Week 52, patients could enroll in the ongoing POETYK long-term extension (LTE) (NCT04036435) trial and receive open-label deucravacitinib. Changes in blood laboratory parameters known to be associated with Janus kinase (JAK) 1,2,3 inhibitors were evaluated through four years of deucravacitinib treatment. Methods: Changes from baseline in lipid (cholesterol, triglycerides), chemistry (alanine aminotransferase [ALT], aspartate aminotransferase [AST], creatinine, creatine phosphokinase [CPK]), and hematology (hemoglobin, lymphocytes, neutrophils, platelets) parameters in the blood known to be affected by JAK1,2,3 inhibitors in clinical trials were evaluated through Week 208 (4 years; data cutoff, November 1, 2023). Treatment discontinuations due to laboratory abnormalities were assessed. Results: A total of 1,519 patients received at least one deucravacitinib dose (total exposure, 4392.8 person-years); 1,203 (79.2%) had at least 52 weeks and 542 (35.7%) had at least 208 weeks of continuous deucravacitinib exposure (median, 185 weeks). No trends or clinically meaningful mean changes from baseline were observed in any of the above laboratory parameters. In total, three patients discontinued treatment due to increased CPK, and one patient each discontinued due to lymphopenia, abnormal hepatic function, increased ALT, and increased AST. Discontinuations due to triglyceride elevations were not observed. Conclusion: In PSO-1/PSO-2/LTE, no trends or clinically meaningful mean changes from baseline were observed in lipid, chemistry, or hematology parameters, in contrast to signature changes (eg, increased cholesterol, creatinine, serum transaminases, CPK, cytopenias) observed with JAK1,2,3 inhibitors. Discontinuations due to laboratory abnormalities noted above were rare (n=7 events) through four years of deucravacitinib treatment. Results suggest deucravacitinib treatment does not warrant routine laboratory testing for all patients, in contrast with the requirements for JAK1,2,3 inhibitors, reflecting its selectivity for TYK2.

Introduction: ADapt (NCT05369403), an open-label, Phase 3b, 24-week study, evaluated the efficacy and safety of lebrikizumab (LEB) in patients with moderate-to-severe atopic dermatitis (AD) previously treated with dupilumab (DUPI). Patients must have discontinued DUPI due to inadequate response (non-response, partial response, or loss of response), intolerance or an adverse event (AE), or other reasons. Methods: Four or more weeks after discontinuing DUPI, patients received a 500mg LEB loading dose at baseline and at Week 2 followed by 250mg every two weeks through Week 16 (Q2W). At Week 16, responders (IGA 0 or 1 with ≥ 2-point improvement [IGA0,1] or EASI75 [primary endpoint]) received LEB 250mg once every four weeks (Q4W); other patients continued with 250mg Q2W. Q2W and Q4W data were pooled and analyzed as-observed and with nonresponder/multiple imputation (NRI/MI). Results: Among 86 enrolled patients, 56 percent discontinued DUPI due to inadequate response, 16 percent due to intolerance/AEs to DUPI, and 28 percent for other reasons. For all patients, at Weeks 16 and 24, respectively, proportions of patients achieving: 1) EASI75: 57.4 percent and 60.0 percent, as-observed; 50.7 percent and 52.8 percent NRI/MI; 2) IGA0,1: 38.7 percent and 38.2 percent, as-observed; 35.6 percent and 36.8 percent, NRI/MI; 3) Face-IGA 0: 42 percent and 49 percent, as-observed; 4) Pruritus NRS ≥ 4-point improvement 53.2 percent and 61.5 percent as-observed; 48.8 percent and 47.9 percent NRI/MI; and 5) DLQI ≥ 4-point improvement 83.0 percent and 83.0 percent as-observed. The safety profile was consistent with other LEB Phase 3 trials. Four patients who discontinued DUPI due to conjunctivitis did not report conjunctivitis with LEB. Additionally, 3.5 percent of patients reported treatment-emergent conjunctivitis. Conclusion: In DUPI-experienced patients, treatment of moderate-to-severe AD with LEB resulted in meaningful improvements in skin clearance, itch, and quality of life.

Hidradenitis Suppurativa (HS) is a chronic inflammatory disease characterized by painful nodules and sinus tunnels which significantly impacts quality of life. Diagnosis of HS is difficult and often delayed due to the lack of diagnostic tests, relying on clinical observation and patient history. The average diagnostic delay is between 7-10 years. The literature lacks substantial evidence on the impact of insurance status, family history, and comorbidities on diagnostic delays. Our study evaluated these and other previously studied factors' association with HS diagnostic delay at Henry Ford Hospital in Detroit. Data including age of HS onset, age of HS diagnosis, first degree family history, comorbidities and tobacco use history was extracted from the new patient intake forms at the HS specialty clinic from (January 2020 – March 2024) with demographics from chart reviews. Data from 228 records were analyzed. Diagnostic delay was defined as diagnosis over one year post-onset. A generalized additive model with non-linear regression was used to assess the association between each variable and average diagnostic delay. 228 records were reviewed, out of which 196 complete records were included in the analysis. Increased age (p=0.0329) and positive family history (p=0.0135) were associated with longer diagnostic delays after adjusting for confounders. Tobacco use revealed the longest delay (eight years). Sex was not significantly associated with diagnostic delay. Final analyses will include results for covariates including insurance status, comorbidities and average delay in years. This study will offer key insights into factors contributing to HS diagnostic delay.

Background: Optical Polarization Imaging (OPI) exhibits potential for indirectly determining basal cell carcinoma (BCC) margins via detection of peri-lesional dermal collagen disruption. Although the capability of OPI in BCC margin assessment prior to Mohs surgery was recently published, challenges remain in image acquisition and analysis leading to discrepancies between OPI and histopathology findings. This pilot study was to identify key aspects for optimal OPI image acquisition and analyses. Methods: OPI images were collected from 27 BCC lesions enrolled in an IRB approved study. Images were reviewed for quality and comparisons were made between OPI and histopathology, after the first Mohs layer, to identify limitations and areas of improvement to increase consistency. Results: The following were identified to improve image quality: avoidance of bubbles within the gel by applying gentle pressure, selecting relatively flat areas as curvature was resulting in pressure gradient, application of uniform pressure, and using appropriate exposure time. To improve image analysis, the following were identified: utilization of skin marker with color transparent in the blue channel, avoidance of, or adjustment to image processing algorithm to account for excessive vascularization, photodamage, or hair in the field of view. Conclusion: OPI remains a promising modality for indirect detection of BCC margin and could potentially be added to other direct tumor imaging modalities for increased specificity. OPI is a user-friendly, non invasive and time efficient imaging technique; however, further refinement of image acquisition and analysis methods, incorporating the respective criteria above in future studies are warranted to optimize its capabilities.

Introduction: Deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 (TYK2) inhibitor, is approved in multiple countries for treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy. In the phase 3b/4, PSORIATYK SCALP (NCT05478499) trial, deucravacitinib was superior to placebo at Week 16 in patients with moderate to severe scalp psoriasis, including those with more limited overall psoriasis.1 This analysis reports efficacy in overall body psoriasis by baseline total body surface area (BSA) involvement. Methods: Outcomes at Week 16, analyzed by BSA involvement of 3%-10% or >10%, included static Physician Global Assessment score of 0 (clear) or 1 (almost clear) with a ≥2-point reduction from baseline (sPGA 0/1) and adjusted mean change from baseline in PASI. Nonresponder imputation (binary outcomes) and modified baseline observation carried forward (continuous outcomes) were used for patients who had missing data. Analyses are post hoc; P values are nominal. Results: Baseline BSA-defined subgroups were 3%-10% (n=70 vs n=38) and >10% (n=33 vs n=13) for deucravacitinib vs placebo, respectively. Week 16 sPGA 0/1 response rates were comparable in 3%-10% and >10% BSA subgroups, with higher proportions among patients treated with deucravacitinib versus placebo (42.9% vs 5.3% and 57.6% vs 0%, respectively; P<0.001 for both). Similarly, decreases in adjusted mean PASI were greater with deucravacitinib than with both 3%-10% (−3.7 vs −1.0, respectively) and >10% (−13.2 vs −2.2) BSA subgroups (P<0.0001 for both). Conclusion: Deucravacitinib was efficacious in improving psoriasis in patients with a wide range of total BSA involvement.

Per-protocol response criteria can have limited ability to inform patient–healthcare provider dialogue as individual patient experiences may vary in the same responder population. This analysis aimed to assess individual patient trajectories of response to lebrikizumab using data from the ADvocate monotherapy trials. This analysis included patients with moderate-to-severe atopic dermatitis treated with 250-mg lebrikizumab every 2 weeks from the pooled ADvocate1 and ADvocate2 trials (modified intention-to-treat populations) during the induction period (weeks 0-16). A machine learning growth mixture model (GMM) was used to cluster patients by longitudinal trajectory of percent change in the Eczema Area and Severity Index (EASI). Proportions and rates of patients achieving EASI thresholds were evaluated. The GMM clustered patient response trajectories (N=564) into 2 groups. Cluster 1 (EASI responders) comprised 85% of patients (n=477), and on average achieved an EASI50 response at week 4 and with a continued response trajectory beyond EASI75. Cluster 2 (EASI nonresponders) comprised 15% of patients (n=87), with a mean EASI reduction of 24% at week 16. A GMM on Cluster 1 identified 3 subclusters (Clusters 1A/1B/1C), which varied by depth of and time to response and represented 38%, 32%, and 15% of patients, respectively. Patients in Clusters 1A, 1B, and 1C achieved mean EASI reductions of 93%, 84%, and 67%, respectively, at week 16. All clusters, including nonresponders in Cluster 2, had notable improvements in itch and quality of life. This analysis identified distinct EASI response patterns to lebrikizumab, which may help guide patient and healthcare provider expectations.

Background: Despite the growing minority population in the United States, there is no standardized method for incorporating skin color and its characteristics into clinical practice or research1. Skin classification aids in risk stratification, disease severity assessments, and monitoring adverse events, but most existing systems are limited (1). This study aims to identify components for an inclusive tool to diagnose and assess the severity of inflammatory and infectious conditions, evaluate disease course and treatment response, and classify participant categories in clinical research. Methods: A Delphi technique was utilized to transform expert opinion into group consensus through three survey rounds, meetings, and individual voting. A 66-item questionnaire scored with a 5-point Likert scale and 3 open-ended questions was distributed to a panel of SOCS dermatologists to gather opinions on skin type/color classification and assessment tools. Consensus for tool inclusion was defined as ≥80% agreement. Results: Twenty-two SOCS experts were invited to participate. Of these, twenty-one completed all three rounds and reached consensus on 21 statements. Critical consensus (≥70-79% agreement) was achieved for 7 statements, while 17 statements were excluded due to <70% agreement. 7 statements were selected for review based on panel members selecting “I don’t know/needs to be reviewed.” 100% consensus was reached on the need to validate the scale. Conclusions: Reliable tools for assessing dermatologic conditions in all skin types are essential. This study confirms that current classification tools are inadequate, and experts strongly agree on the need for a validated, inclusive tool for both clinical practice and research.