This month’s news from across the specialty

March 1, 2026

In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.  

Injectable biologics remain the gold standard for achieving optimal clinical responses in psoriasis, but fear of injections leads many patients to choose less-effective therapies. Against this backdrop, oral icotrokinra — a targeted peptide that selectively binds the interleukin-23 receptor — is a compelling development.

A recent manuscript reported 24-week results from the phase 3 ICONIC-LEAD trial, which enrolled 684 patients aged ≥12 years with moderate-to-severe plaque psoriasis (BSA ≥10%, PASI ≥12, IGA ≥3) across 138 international sites (doi: 10.1056/NEJMoa2504187). Participants were predominantly male (65%) and Caucasian (72%); only 1% were Black, and 10% were adolescents. Approximately 95% completed the trial.

Patients were randomized 2:1 to receive once-daily oral icotrokinra 200 mg or placebo, with placebo patients crossing over to active treatment at week 16. Clinical efficacy was robust: at week 16, IGA 0/1 responses were achieved in 65% of icotrokinra-treated patients versus 8% on placebo. PASI 90 responses occurred in 50% versus 4%, and PASI 100 in 27% versus <1%, respectively. Improvements were observed as early as week four, with sustained gains in patient-reported outcomes including Psoriasis Symptoms and Signs Diary (PSSD) and DLQI scores.

Safety profiles were comparable between groups, with adverse events reported in 49% of patients. Nasopharyngitis and upper respiratory infections were the most common (~7%). Thankfully, no concerning signals emerged regarding serious adverse events, malignancy, or tuberculosis. All in all, the exciting developments in psoriasis treatment keep coming!

The North American Contact Dermatitis Group (NACDG) reports the results of patch testing across the 12 sites in North America evaluating a standard series of 80 allergens which are beyond the standard FDA-approved series available in the U.S. During the current 2021-2022 reporting cycle, 3,056 patients were tested and 72% had at least one positive reaction with 46.6% having a primary diagnosis of allergic contact dermatitis (Dermatitis. 36(5): 464-76). Nickel remains the most common allergen followed by methylisothiazolinone (MI), hydroperoxides of linalool, cobalt chloride hexahydrate, and methylchloroisothiazolinone/MI.

One of the notable findings is the slow decline of MI as a contact allergen. The positivity of this allergen has dropped from its peak in 2017-2018 of 15.3% to 11.5% in the current 2021-2022 cycle. This may be a result of restrictions in concentration of MI and MCI/MI in leave-on products in Canada. According to the data, the rate of MI is 9.9% in Canada and 13.5% in the U.S. The pattern of positive reactions to fragrance markers also decreased with fragrance mix I and II. This may be due to changes in fragrance usage in other countries. Regardless, five of the top 15 allergens with the highest significance-prevalence index number were still fragrance markers.

Using this cycle data, a hypothetical detection rate of the standard FDA series suggests that almost half of positive reactions would have been missed with the 36-allergen panel. This highlights the need for expanded testing that is routinely adjusted and updated to consider current allergens used in products. Additionally, 21% of patients had at least one clinically relevant reaction to an allergen not on the NACDG 80 standard panel reinforcing the need for detailed history and patch testing for special series based on patient avocational, personal, and vocational exposures.

Dealing with prior authorizations (PAs) and medication/treatment denials is a major challenge in medical dermatology. Cost often deters coverage, but some insurers unfairly classify certain dermatologic conditions as “cosmetic,” denying coverage for visits, tests, and treatments.

A recent JAAD article highlights the highly commendable effort by the authors who worked to successfully reverse discriminatory policies by one of the largest health insurers in Michigan that selectively chose to not cover alopecia, lupus, keloid and sarcoidosis, dermatologic conditions that disproportionately affect African Americans and other skin of color patients (doi: 10.1016/j.jaad.2025.08.078).

The lack of coverage and classification as “cosmetic” skin conditions by the insurer was presumed to be because the treatment options for these conditions included corticosteroid injections. In reality, these are challenging, chronic, progressive, sometimes extremely disfiguring, and irreversible medical dermatologic conditions, requiring timely intervention. Denying coverage or requiring PAs for routine visits, biopsies, and one of the lowest-cost procedures in dermatology (corticosteroid injections) is what makes it appear discriminatory. Ironically, corticosteroid injections are used in rheumatology, orthopedic surgery, neurology, and interventional pain management, without being considered “cosmetic” treatments.

When policies restrict or delay access — by requiring PAs or denying coverage — patients’ conditions worsen and disparities broaden. These policies also hinder access to emerging therapies in clinical trials for lupus, scarring alopecia, and others, potentially delaying advanced treatments, similar to the continued lack of coverage for the FDA-approved treatments for alopecia areata by some major insurers.

In 2018, a dermatologic addendum to the 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides was published to standardize the names and definitions of cutaneous vasculitis and provide a framework for clinicians and investigators in the development of classification and diagnostic criteria for cutaneous vasculitis (Arthritis Rheumatol. 2018; 70:171-84).

The European Academy of Dermatology and Venereology Vasculitis and Vasculopathy Task Force recently convened an international panel of experts and used the Delphi method to publish a position statement for the diagnostic workup of cutaneous small vessel vasculitis (CSVV) (doi: 10.1111/jdv.70249). Forty-two statements regarding diagnostic workup of CSVV achieved expert consensus, with consensus items categorized into six sections: cutaneous findings raising suspicion for CSVV; medical history; physical examination; diagnosis; biopsy procedures and histopathology; and etiological work-up or laboratory investigation. The authors emphasized that the diagnosis of cutaneous vasculitis requires careful clinicopathologic correlation based on the clinical presentation and histopathology and recommend that all patients with suspected CSVV undergo skin biopsies for routine light microscopy and direct immunofluorescence (DIF) microscopy.

The position statement also provides a step-wise algorithm for differentiating various forms of CSVV in patients who present with “round, bilateral, macular, or palpable purpura” of the lower extremities, including: IgA vasculitis, IgM/IgG vasculitis, ANCA-associated vasculitis, cryoglobulinemic vasculitis, urticarial vasculitis, recurrent macular vasculitis, and vasculitis associated with autoimmune connective tissue disease. Hopefully, the consensus principles are helpful when evaluating patients with suspected CSVV.

Additional DermWorld Resources