Scholarly Activity

OBJECTIVES: Understanding patient priorities in nonsegmental vitiligo is essential for developing therapies that address unmet needs. This study used a modified Outcome-Driven Innovation approach to quantify unmet need by considering patients' perspectives on the importance of, and their satisfaction with, treatment attributes.

METHODS: A cross-sectional survey of 522 patients with nonsegmental vitiligo in the United States quantified the relative importance participants placed on 26 treatment attributes. Participants also rated their satisfaction with how well available treatments performed on those attributes. K-means clustering was used to segment participants based on priorities.

RESULTS: Three segments, focusing on efficacy, administration and dosing, or safety, were identified. The two most underserved attributes, identified by >10% of participants as important for which satisfaction was low, were improvement in emotional well-being from repigmentation (15.6% of participants) and access to systemic therapy (15.1% of participants). Participants with ≥5% body surface area affected, including the face, more often identified efficacy and systemic treatment that targets the entire body as unmet needs than did those reporting facial involvement only.

CONCLUSIONS: These findings highlight substantial unmet needs in nonsegmental vitiligo treatment, underscoring the importance of developing systemic therapies that align with patients' priorities to deliver meaningful repigmentation that improves emotional well-being.

What is this summary about? Treatments for seborrheic dermatitis include over-the-counter products (medications that do not need to be prescribed by a healthcare professional) and prescription shampoos, foams, creams, oils, and solutions. These treatments can be time-consuming to apply, have bothersome side effects, cannot be used long-term, and/or do not work for everyone. Researchers are looking for better ways to treat seborrheic dermatitis. Roflumilast foam is a new prescription treatment applied to the skin that decreases inflammation and is not a steroid. This article is a summary of published research that describes the results of the STRATUM study of roflumilast foam in patients with seborrheic dermatitis. What are the key takeaways? Patients aged at least 9 years, with seborrheic dermatitis, were randomly assigned to treatment with roflumilast foam or vehicle foam (foam portion of the drug treatment with no prescription medicine) for 8 weeks. A greater proportion of patients who applied roflumilast foam had improvements in the severity of their seborrheic dermatitis and symptoms of itching, scaling, and/or skin redness, compared with patients who applied vehicle foam. Of patients who applied roflumilast foam, 80% had clear or almost clear skin and an improvement of seborrheic dermatitis severity by at least two points (on a 4-point scale) at the end of 8 weeks. Rates of side effects related to treatment were low and were similar between patients who applied roflumilast foam compared with those who applied vehicle foam. What were the main conclusions reported by the researchers? Adults, adolescents, and children aged at least 9 years with seborrheic dermatitis who applied roflumilast foam once daily had improved seborrheic dermatitis signs and symptoms after 8 weeks compared with patients who used vehicle foam.

BACKGROUND: Adalimumab is widely used for hidradenitis suppurativa (HS), but treatment durability varies and predictors of sustained benefit remain uncertain.

OBJECTIVE: To identify clinical and laboratory factors associated with adalimumab treatment durability in HS.

METHODS: We retrospectively studied 135 adults with HS who initiated adalimumab as first biologic therapy across three academic centers from 2013 to 2023. Outcomes were categorized as primary failure (12-24 weeks), secondary failure (24 weeks-2 years), or sustained response (>2 years) based on discontinuation for inefficacy. Predictors of treatment durability were evaluated using ordinal logistic regression.

RESULTS: In univariable analyses, Hurley stage 3, higher body mass index, diabetes, and lower hemoglobin were associated with lower adalimumab durability. In the multivariable model, Hurley stage 3 remained independently associated with less favorable durability (adjusted odds ratio 0.37, 95% confidence interval 0.17-0.81). Comorbid psoriasis was not significantly associated with durability (adjusted odds ratio 2.84, 95% confidence interval 0.96-8.39). Baseline laboratory parameters, including leukocyte and monocyte counts and albumin, did not predict outcome. Age at disease onset, disease duration, and other demographic characteristics were also not associated with durability.

CONCLUSION: Hurley stage 3 was independently associated with lower adalimumab durability, while routinely available laboratory measures did not identify additional predictors of long-term treatment outcome.

OBJECTIVES: Non-segmental vitiligo (NSV) is a chronic skin disease characterized by progressive, bilateral skin depigmentation that can impact health-related quality of life and psychosocial well-being. To assess emerging and new NSV treatments, patient-reported outcomes (PROs) that capture patient-valued treatment outcomes and meaningful changes are needed. Two common aspects of NSV are vitiligo noticeability and sun sensitivity. Thus, PRO items assessing vitiligo noticeability and sun sensitivity were developed. This study aimed to evaluate the content validity and interpretability of the NSV noticeability and sun sensitivity PRO items. METHODS: In this cross-sectional, qualitative interview study, the NSV noticeability and sun sensitivity PRO items were tested in iterative hybrid concept confirmation and cognitive debriefing interviews with 24 adults (≥18 years) and 13 adolescents (12 to ≤17 years) with confirmed NSV. RESULTS: Among the participants, approximately 73% stated noticeability was an important aspect of their vitiligo. Of those who reported sun sensitivity (n = 23), 73.9% noted this symptom was important. Following cognitive debriefing, item wording was simplified, and each item was split to separately assess facial vitiligo and body vitiligo. CONCLUSIONS: Combined, these findings underscore the importance of vitiligo noticeability and sun sensitivity among patients with NSV. The revised noticeability and sun sensitivity items, separately assessing the face and body, may provide a more comprehensive assessment of these outcomes experienced by people with NSV.

Sunlight is an important environmental determinant of human physiology, though its effects on health have been studied predominantly in the context of skin disease. While ultraviolet (UV) radiation is a well-established risk factor for skin cancer, evidence suggests that it may also have beneficial systemic effects. This narrative review synthesizes evidence from the past decade on the associations between sunlight and UV radiation exposure and mortality-related outcomes, with a focus on internal malignancies, cardiovascular disease and infectious diseases. A comprehensive search of PubMed and Embase was conducted for English-language articles published between January 2015 and June 2025. Of 148 articles identified, two duplicates were removed. After title and abstract screening, 64 full-text articles were assessed for eligibility; a total of 28 studies met the inclusion criteria and were included in the final review. Among the included studies, four examined cardiovascular outcomes, 12 evaluated infectious diseases, six focused on malignancies and six assessed all-cause mortality. Overall, most studies reported inverse associations between UV exposure and adverse health outcomes, suggesting potential protective effects. For example, a large cohort study found that individuals with 2000 kJ/m(2) higher annual solar radiation exposure had a 12% lower risk of all-cause mortality. The comparator group had an average of 26 days of life lost over the 15.7-year follow-up period. This review identifies a pattern of potential beneficial associations between UV radiation exposure and systemic health outcomes, although confounding by various parameters including the healthy user effect and socioeconomic differences. When the benefits are considered alongside the well-established deleterious cutaneous effects of UV exposure, these findings underscore the need for balanced public health messaging that acknowledges the risks and potential benefits of sunlight exposure.

INTRODUCTION: Icotrokinra, a first-in-class targeted oral peptide, precisely blocks the interleukin (IL)-23 receptor and inhibits IL-23 pathway signaling. In phase 3 studies (ICONIC-LEAD, ICONIC-TOTAL, ICONIC-ADVANCE 1 and 2), icotrokinra provided superior skin clearance versus placebo and deucravacitinib in adults and adolescents with moderate-to-severe psoriasis and psoriasis affecting high-impact sites. This analysis evaluates icotrokinra safety through 1 year using pooled data from these four studies.

METHODS: Icotrokinra-randomized participants received 200-mg pills once daily, and placebo-randomized participants crossed over to icotrokinra at week 16; participants randomized to deucravacitinib 6 mg (ICONIC-ADVANCE 1 and 2 only) switched to icotrokinra at week 24. Pooled safety data are summarized for the placebo-controlled period (week 0-16, all studies), active-controlled period (week 0-24, ICONIC-ADVANCE 1 and 2), and through week 52 (all studies).

RESULTS: During the placebo-controlled period across all studies, 568 participants received placebo and 1296 received icotrokinra. From week 0 to 24 in the ICONIC-ADVANCE studies, 632 participants received icotrokinra and 634 received deucravacitinib. Through week 52, 2400 icotrokinra-treated participants contributed 1840 participant-years [PY] of follow-up. Through week 16, in the icotrokinra and placebo groups, respectively, exposure-adjusted incidence rates/100 PY of adverse events (AEs; 232 and 269), serious AEs (5.2 and 6.6), infections (91 and 104), and AEs leading to discontinuation (6.6 and 10.0) were comparable between groups. Through week 24, in the ICONIC-ADVANCE studies, rates/100 PY with icotrokinra versus deucravacitinib were as follows: AEs, 204 vs 265; serious AEs, 6.4 vs 7.2; infections, 81 vs 119; AEs leading to discontinuation, 5.7 vs 6.8. Through week 52, event rates/100 PY in icotrokinra-treated participants were as follows: AEs, 167; serious AEs, 4.6; infections, 76; AEs leading to discontinuation, 3.0.

CONCLUSION: In this analysis of 2400 icotrokinra-treated participants with psoriasis followed through 1 year, icotrokinra demonstrated favorable safety; event rates through week 16 were similar to placebo and remained consistent through week 52.

CLINICALTRIALS: GOV: NCT06095115, NCT06095102, NCT06143878, NCT06220604. Infographic available for this article. INFOGRAPHIC.

BACKGROUND: Icotrokinra, a targeted oral peptide, precisely blocks the interleukin-23 receptor. In two phase III moderate-to--severe plaque psoriasis trials, ICONIC-ADVANCE 1 (NCT06143878) and ICONIC-ADVANCE 2 (NCT06220604), icotrokinra provided significantly higher skin clearance rates vs. placebo at week 16 and deucravacitinib at weeks 16 and 24.

OBJECTIVES: To evaluate the clinician- and patient-reported outcomes (PROs) for participants who received icotrokinra in the ICONIC-ADVANCE 1 and ADVANCE 2 phase III clinical trials.

METHODS: ICONIC-ADVANCE 1 and 2 randomized (2 : 1 : 2 and 4 : 1 : 4, respectively) adults with moderate-to-severe plaque psoriasis to icotrokinra 200 mg, placebo (transition to icotrokinra at week 16) or deucravacitinib 6 mg once daily (transition to icotrokinra at week 24). Outcomes assessed through week 52 included proportions of participants achieving Investigator Global Assessment (IGA) 0/1 (with ≥ 2-grade improvement from baseline), Psoriasis Area and Severity Index (PASI) 90, IGA 0, PASI 100, scalp-specific IGA (ss-IGA) 0/1, several well-established PROs, and adverse events (AEs).

RESULTS: ICONIC-ADVANCE 1 and 2 randomized 1505 participants (774 and 731, respectively). Skin clearance rates among participants randomized to icotrokinra increased through week 24 and were durable through week 52, with approximately 70-75% exhibiting clear/almost clear skin (IGA 0/1, PASI 90) and approximately 50% demonstrating completely clear skin (IGA 0, PASI 100) during weeks 24-52. Among participants achieving clear/almost clear skin at week 16, around 85-90% maintained response at week 52. Response rates for ss-IGA 0/1 and PROs were also durable through week 52. Participants who transitioned from placebo or deucravacitinib to icotrokinra exhibited increasing response rates that were comparable to participants randomized to icotrokinra through week 52. The AE profile was similar to placebo through week 16 and showed lower AE rates than deucravacitinib through week 24; no safety signals were observed through week 52.

CONCLUSIONS: Once-daily icotrokinra provided robust, durable skin clearance and symptom improvement, with no safety signals, through week 52 in adults with moderate-to-severe plaque psoriasis. Participants transitioning from placebo or deucravacitinib to icotrokinra achieved similar increased response rates to participants who were randomized to icotrokinra through week 52. Our findings support icotrokinra as a systemic therapy with long-term robust disease control and a favourable safety profile.

Introduction: Protective hairstyles (PHS) for Afro-textured hair require minimal manipulation and are worn to prevent damage.1 However, there is a dearth of literature regarding risks of PHS.1 As many rely on social media for education, it is imperative to understand the quality of information being shared.2,3 This study aims to analyze the quality of YouTube videos discussing risks of PHS. Methods: A cross-sectional analysis of YouTube videos was performed in December 2024 using a previously validated method.4 Eligibility included being posted January 2020–December 2024, in English, 4–20 minutes, ≥ 1,000 views, and discussed PHS for natural hair. Two reviewers assigned DISCERN scores (DS) from a 16-item validated tool to assess quality of consumer health information.5 DS range from 16–29 (very poor), 30–40 (poor), 41–51 (fair), 52–63 (good), and 64–80 (excellent). Discrepancies were resolved by two additional reviewers. Results: Twenty-six videos were included, mostly by laypersons (n=20) and beauticians (n=2). Discussed styles included box braids, twists, faux locs, wigs, and crochet braids. Risks included breakage, tension, hair loss, dryness, and scalp buildup. The mean DS was 40.8, indicating videos were of poor to fair quality. Nonparametric testing demonstrated no significant difference in DS between personal and educational videos (W=43, p=0.972) or poster types (χ 2 =5.74, df=3, p=0.125). Conclusion: PHS were linked to various types of hair damage in the videos analyzed. The low DS highlights a need for more accurate, high-quality social media content to educate about risks of protective hairstyles and promote safer haircare practices.

Seborrheic dermatitis (SD) is a chronic inflammatory skin condition commonly affecting the scalp, face, and intertriginous areas. It has been reported as a frequent comorbidity among patients with scarring alopecia (SA), a group of disorders characterized by permanent hair loss due to follicular destruction and fibrous replacement. Using the TriNetX US Collaborative Network, which includes approximately 65 million deidentified patients, we evaluated the association between SD and subsequent SA. Patients with SD were identified using ICD-10 code L21 and compared with a control cohort without SD. SA was identified using ICD-10 code L66, which includes pseudopelade, lichen planopilaris, folliculitis decalvans, perifolliculitis capitis abscedens, folliculitis ulerythematosa reticulata, and other nonspecified cicatricial alopecias. A 1:1 greedy nearest-neighbor propensity score matching algorithm controlled for baseline demographics including age, sex, and race/ethnicity. Statistical analyses included chi-square tests and odds ratios (OR) with 95% confidence intervals (CI). After matching, 878,678 patients with SD were compared to 881,049 controls. The mean age was 34.0 years, with most patients female (51%), White (57%), and non-Hispanic/Latino (70%). Patients with SD had significantly greater odds of developing SA (OR 2.674, 95% CI 2.571–2.781, p < 0.001). Findings suggest SD may be a risk factor for SA, potentially through Malassezia-associated inflammation leading to follicular damage and fibrosis. Limitations include diagnostic coding variability, inability to assess disease severity, and lack of subtype specificity. These results highlight the importance of recognizing SD as a possible precursor to SA, warranting further mechanistic and clinical investigation.

Introduction: Lutikizumab, an interleukin-1α/1β antagonist, improved International Hidradenitis Suppurativa Severity Score System (IHS4) in patients with moderate-to-severe hidradenitis suppurativa (HS) who failed anti-TNF therapy in a phase 2b study. Here, we dynamically characterized IHS4 responses to lutikizumab in biologic-naïve adults with moderate-to-severe HS. Methods: In this multicenter, phase 2, open-label study, 47 biologic-naïve adults with moderate-to-severe HS received lutikizumab 300 mg every week (EW) for 16 weeks. Post-hoc efficacy assessments included improvement from baseline in IHS4, percent change from baseline in IHS4 among patients with IHS4 score ≥ 4 at baseline, percent change from baseline in abscess and inflammatory nodule (AN) count ( ≥ 3 AN at baseline), and percent change from baseline in draining tunnels ( ≥ 3 draining tunnels at baseline). Mixed model for repeated measures was used to handle missing data for continuous endpoints. Results: Overall, 47 patients (70.2% female; mean [SD] age 34.4 [9.1] years; mean [SD] IHS4 24.4 (26.26) were enrolled across 20 sites. At Week 16, patients receiving lutikizumab showed improvement from baseline in IHS4 (-19.3) and improvement in percent change from baseline in IHS4 (-71.3%). The proportion of patients with severe HS (IHS4 ≥ 11) decreased from 74.5% at baseline to 22.5% at Week 16. At Week 16, patients receiving lutikizumab showed improvement in percent change from baseline in AN count (-70.8%) and draining tunnels (-84.8%). Conclusions: In biologic-naïve adults with moderate-to-severe HS, lutikizumab 300 mg EW improved IHS4, as well as AN and draining tunnel counts over 16 weeks. These results support further investigation of lutikizumab in HS.

Background: Delgocitinib, a non-steroidal topical pan-JAK inhibitor for moderate to severe CHE, has been shown to improve patients’ HRQoL within 16 weeks. Methods: In the phase 3 open-label DELTA 3 (NCT04949841), patients completing the 16-week DELTA 1 and 2 trials were treated on an as-needed basis with twice-daily delgocitinib cream for an additional 36 weeks. EQ-5D-5L, Dermatology Life Quality Index (DLQI), Hand Eczema Impact Scale (HEIS) and the Work Productivity and Activity Impairment (WPAI) questionnaire were assessed over a total of 52 weeks. Data was reported as observed in patients receiving delgocitinib in the parent trials. Change from baseline in parent trials was reported in those that completed the 52 week trials. Results: Patients (n=560) had a mean age of 45.8 years (SD 14.4), and 63.4% were female. At baseline in the parent trial, average scores for EQ-5D-5L, DLQI, and HEIS were 0.64 (SD 0.23), 12.6 (6.1), and 2.49 (0.76), respectively. At end of parent trials, these scores had improved to 0.83 (0.18), 4.5 (5.0), and 0.89 (0.88), respectively. At week 36, improvements remained stable; 0.86 (0.16), 3.9 (4.1), and 0.81 (0.82), respectively. For patients who completed the study, mean improvements from baseline were significant (P< .0001): EQ-5D-5L improved by 0.20 (95% CI: 0.18, 0.22), DLQI improved by 8.5 (-9.1, -7.9), and HEIS improved by -1.66 (-1.75, -1.57). Furthermore, work productivity loss and daily activity impairment scores improved: -25.4 (-29.0, -21.9) and -33.3 (-35.8, -30.7), respectively. (P< .0001). Conclusion: Improvements in HRQoL, work productivity and daily activity impairment demonstrated after 16 weeks of continuous twice-daily treatment with delgocitinib cream were maintained after an additional 36 weeks of as-needed treatment. Acknowledgements: The DELTA 3 (NCT04949841) trial and analyses were sponsored by LEO Pharma A/S.

Sarecycline, a narrow-spectrum oral antibiotic approved for treatment of inflammatory lesions in moderate-to-severe acne vulgaris (AV), has been evaluated in three phase 3 trials that have been reported separately. This pooled analysis of results from these trials provided information from a cohort of patients with moderate-to-severe facial AV (Investigators’ Global Assessment [IGA] 3 or 4) treated with this agent. Each trial had a 12-week duration and followed a randomized (1:1 sarecycline vs placebo in two studies and 2:1 in one study) double-blind design in which patients received sarecycline (1.5 mg/day) or placebo. Endpoints assessed included IGA success (score of 0 [clear] or almost clear [1] and a reduction from baseline >/=2), percent reduction in inflammatory lesions, and absolute reduction in the number of non-inflammatory lesions. The trials enrolled 2,393 patients (9-45 years old, 57.4% female; 64.9% white, 12.6% black, 19.0% Asian, 2.2% multiracial, and 1.3% other). At Week 12, IGA success was achieved by 25.9% of patients treated with sarecycline vs 13.3% for placebo (P<0.0001). Percent reductions in inflammatory lesions were –58.5% vs –41.2% (P<0.0001), respectively; and those for non-inflammatory lesions were –40.4% vs –29.2% (P<0.01). Pooled results from the three studies indicated a rapid onset of action for sarecycline. At 3 weeks after treatment initiation (first post-baseline evaluation), percent reductions in inflammatory lesions were –30.5% for sarecycline and –22.4% for placebo (P=0.0001). This pooled analysis demonstrates that sarecycline improves IGA and inflammatory lesions in moderate-to-severe AV, with improvements evident as early as week 3 and sustained over time.

CAB gel—the only approved triple-combination acne topical—was efficacious/safe in 12-week clinical trials and in a 24-week study.1-4 Acne presentation and sequelae vary by skin type, requiring long-term management strategies to account for differences in skin pigmentation.5,6 This post hoc analysis assessed long-term CAB use in participants with darker Fitzpatrick skin phototypes IV-VI. Data were pooled from 2 identical, 24-week, single-center, open-label studies of once-daily CAB in 50 participants ≥ 12 years with moderate/severe acne (Investigator’s Global Assessment [IGA] score=3/4). Endpoints included changes from baseline in IGA score and inflammatory/noninflammatory lesions. Skin appearance (dryness, postinflammatory hyperpigmentation [PIH], postinflammatory erythema [PIE]), tolerability (itching, burning, redness, swelling), scarring, and adverse events were evaluated. Of 24 participants with Fitzpatrick skin types IV-VI, 22 completed the studies. At week 24, 73% of participants achieved treatment success ( ≥ 2-grade reduction from baseline in IGA score and clear/almost clear skin), with reductions in inflammatory and noninflammatory lesions of 90% and 66%, respectively. PIH, PIE, and scarring improved from baseline by 71%, 87%, and 32%, respectively. No participants reported tolerability issues at week 24 and all had skin dryness scores of 0 (none). One treatment-related adverse event (BPO allergy) occurred, leading to study discontinuation. In participants with darker skin phototypes, 6 months of once-daily CAB use led to 73% treatment success and inflammatory lesion reductions of 90%. These improvements are higher than those seen at week 12 in the pivotal trials and support the long-term use of CAB in patients with darker skin phototypes.

Background: Gene Expression Profiling (GEP), like the integrated 31-GEP by Castle Biosciences, and clinicopathologic nomograms, like the Melanoma Institute Australia (MIA) and Memorial Sloan Kettering Cancer Center (MSKCC), were developed to assess risk of sentinel lymph node biopsy (SLNB) positivity in patients with thin-melanomas. Direct head-to-head comparisons of their performance remain limited. Methods: We retrospectively reviewed charts of all melanoma patients who underwent i31-GEP testing at a single institution and calculated MIA and MSKCC nomogram scores. Sensitivity, specificity, AUC, and Net Reclassification Index (NRI) were calculated for SLN positivity prediction at 5% and 10% risk thresholds. Recurrence discrimination was evaluated using AUROC for MIA prognostic score and GEP. Results: Among 20 patients (18 SLN–, 2 SLN+) with results from all tools, MIA and MSKCC achieved perfect sensitivity for SLN positivity at 5% threshold, but low specificity (0.17 and 0.22). i31-GEP showed lower sensitivity (0.50) and moderate specificity (0.44). Among 31 patients (7 recurrences) with MIA and i31-GEP results (MSKCC does not calculate recurrence), the MIA prognostic score (AUROC 0.87, 95% CI 0.74–1.00) demonstrated stronger discrimination for recurrence than i31-GEP (AUROC 0.82, 95% CI 0.66–0.99). i31-GEP positivity was significantly associated with recurrence in non-T1a tumors (Fisher’s exact p = 0.0238; OR = ∞ [ 1.06–∞]) but showed no significant link in T1a tumors (p = 0.111; OR = ∞ [ 0.21–∞]). Conclusions: Clinicopathologic nomograms outperform i31-GEP at predicting SLN sensitivity and disease recurrence. Larger prospective studies are needed to validate these findings.

Introduction: Access to pathologic review by a trained dermatopathologist is an integral component of skin disease diagnosis management. [1,2] There is currently no worldwide assessment of access to dermatopathology. [3]. Methods: The Global Access to Skin Health Observatory (SkinObservatory) Study is a cross-sectional, Delphi-developed, survey of national-level dermatologic leaders in all 194 WHO member states. Participants reported number of dermatopathologists, presence of specialty board, training programs, and access to dermatopathology slide review. Responses were compared across World Bank Income (WBI) levels with Chi-squared and Kruskal-Wallis analyses. Results: Out of 157 countries responding, 139 reported on dermatopathology. Presence of dermatopathologists is associated with WBI level (p=0.024), with dermatopathologists present in 80% of high-income and 41% of low-income countries. Seventy-five percent of lower-income countries rank their access to dermatopathology as either “extremely poor” or “inadequate,” while 67% of higher-income countries report their access as “adequate” to “excellent.” Dermpatopathologist density is significantly associated with WBI (p=0.0001), with median dermatopathologists per 1,000,000 people of 0.0318 in low-income, 0.222 in lower-middle-income, 0.376 in upper-middle-income, and 2.45 in high-income countries. The presence of dermatopathology boards (p=0.026) and training programs (p=0.013) is more common in higher-income countries. Forty-seven countries have no dermatopathologists. In areas without dermatopathologists, dermatopathology is primarily done by: 1) general/surgical pathologists, 2) dermatologists, and 3) referrals to regional/national centers. Conclusion: Our data illustrates a global dearth of access to dermatopathology that disproportionately burdens lower-income countries. By providing a granular assessment of global access to dermatopathology, we aim to define avenues to improve access to this vital resource.

Introduction: Among adults with moderate-to-severe plaque psoriasis in ICONIC-ADVANCE 1 (NCT06143878) and ICONIC-ADVANCE 2 (NCT06220604), the targeted oral peptide icotrokinra (ICO) demonstrated significantly higher rates of skin clearance vs placebo (PBO) at Week (W)16 and vs deucravacitinib (Deucra) at W16&W24, with adverse event (AE) rates similar to PBO and numerically lower than Deucra.1 Here, ICO findings through W52 of ICONIC-ADVANCE 1&2 are reported. Methods: ICONIC-ADVANCE 1&2 participants (pts) were randomized (2:1:2/4:1:4) to once-daily oral ICO 200mg, PBO (PBO→ICO at W16), or Deucra 6mg (Deucra→ICO at W24). Investigator’s Global Assessment (IGA)/Psoriasis Area and Severity Index (PASI) responses and AEs were assessed through W52. Results: In ICONIC-ADVANCE 1&2, 774/731 pts with moderate-to-severe psoriasis received ICO (311/322), PBO (156/82 [PBO→ICO=141/74]), or Deucra (307/327 [Deucra→ICO=283/301]). Skin clearance rates achieved with ICO through W24 of ICONIC-ADVANCE 1&2 (IGA0/1: 74/68%, PASI90: 66/65%, IGA0: 48/40%, PASI100: 41/33%) were maintained or increased through W52 (IGA0/1: 74/73%, PASI90: 69/71%, IGA0: 52/50%, PASI100: 49/48%). PBO→ICO pts achieved consistent rates of skin clearance at W52 (IGA 0/1: 75/80%, PASI 90: 71/74%, IGA0: 56/47%, PASI100: 50/43%). In Deucra→ICO pts, skin clearance rates at W24 (IGA0/1: 52/55%, PASI90: 41/43%, IGA0: 21/21%, PASI100: 16/16%) increased substantially after transitioning to ICO (W52 IGA 0/1: 75/79%, PASI 90: 71/77%, IGA0: 45/56%, PASI100: 42/51%). ICO safety through W52 was consistent with that observed through W16/W24. Conclusion: ICO provided robust and durable skin response rates through 1 year of treatment; skin clearance rates increased in Deucra-randomized pts after transitioning to ICO. No ICO safety signals were identified.