An oral IL-23 blocker holds up in psoriasis, and a warning on stopping biologics

The edition in brief

Today's dermatology edition is weighted towards psoriasis, where the strongest evidence sits. Icotrokinra, an oral peptide that blocks the interleukin-23 receptor, showed durable one-year results across two phase 3 trials (1505 adults): about 70 to 75% reached clear or almost clear skin and roughly half reached complete clearance during weeks 24 to 52, with 85 to 90% of week-16 responders maintaining response at a year and a safety profile that beat the oral comparator deucravacitinib through week 24. A multicentre study warns of a distinct, painful pustular flare after biologic withdrawal, occurring in 7.2% of discontinuation episodes and more likely with repeated withdrawal-relapse cycles, psoriatic arthritis, a family history, a prior such flare, or slow initial response. A JAMA Dermatology Delphi consensus sets best practice for pseudofolliculitis barbae, centring on changing hair-removal behaviour, targeted topical and systemic treatment, and laser hair removal. A clinic pearl restates first-line topical therapy for acne. The practice-changer is OptIMMize-1: risankizumab gave high skin clearance in children with moderate-to-severe psoriasis, comparable to ustekinumab at week 16 and maintained to 52 weeks, extending an effective option to a group with few.