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and joined the MJH Life Sciences team in February 2023. She attended Kent State University and earned a Bachelor of Science degree in journalism with minors in public relations and creative writing. She enjoys making and listening to music, reading, and spending time with her cats, Astrid and Marceline.

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Catch up on dermatology news, highlights, and insights from the past 24 hours.

Daily Derm Times: April 23, 2025

Paller discusses the promising phase 3 trial SELVA trial results for Qtorin 3.9% rapamycin gel, an investigative treatment for microcystic lymphatic malformations.

Amy Paller, MD, MS, Discusses Phase 3 Trial Results for Qtorin 3.9% Rapamycin Gel

Raj Chovatiya, MD, PhD, MSCI, is a clinical associate professor at Rosalind Franklin University Chicago Medical School, founder and director of the Center for Medical Dermatology and Immunology Research in Chicago, and 

Raj Chovatiya, MD, PhD, MSCI, provides insights on the clinical advantages of JAK inhibitors for atopic dermatitis.

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Omar Noor, MD, FAAD, explores the complex immune and cellular mechanisms behind CHE and highlights its significant physical and emotional toll on patients.

Understanding Chronic Hand Eczema: Cellular Mechanisms and Therapeutic Implications

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Getting to Know BC Educators: Biologic Coordinators Services  

Final Thoughts: The Importance of Comparative Studies in AD

Panelists offer concluding insights and emphasize the critical role of comparative studies in advancing atopic dermatitis treatment strategies.

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The landscape of plaque psoriasis treatment is evolving, particularly in how physicians think about disease severity, treatment goals and the timing of systemic therapy use or initiation.

 Recent guidance has redefined how we classify psoriasis severity, recognizing that even patients with limited skin involvement may experience substantial disease burden and could benefit from systemic therapy.

 Emerging research continues to enhance our understanding of treatment approaches for these patients and may help inform optimal management strategies.

A recent large-scale, real-world evidence study has provided important insights into the impact of timing of initiating a systemic therapy in plaque psoriasis treatment.

 To explore these findings, we spoke with two leading experts in the field: Dr. Linda Stein Gold, Division Head of Dermatology at Henry Ford Health System and former vice president of the American Academy of Dermatology, and Dr. April Armstrong, Chief of Dermatology at University of California, Los Angeles. Both doctors were investigators on the real-world study discussed below.

How to Approach Plaque Psoriasis Treatment in Patients with Limited Skin Disease

Considerations When Treating Plaque Psoriasis with Topical Therapy

Clinical Considerations For Evaluating the Potential Benefits of Systemic Treatments

Navigating Patient Conversations Around Potential Systemic Use


Otezla® (apremilast) is indicated for the treatment of adult patients with plaque psoriasis who are candidates for phototherapy or systemic therapy.

Otezla® (apremilast) is contraindicated in patients with a known hypersensitivity to apremilast or to any of the excipients in the formulation.

Please see additional Important Safety Information further below.

Otezla Clinical Evidence: The ADVANCE Trial

Before examining the real-world evidence, it's important to understand the foundational clinical data that preceded it. The pivotal Phase 3 ADVANCE trial was a multicenter, randomized, placebo-controlled, double-blind study evaluated Otezla® (apremilast) in 595 adult patients with mild to moderate plaque psoriasis.

The study population had a mean baseline body surface area (BSA) of 6.4%, with inclusion criteria requiring BSA involvement of 2%-15%, a Psoriasis Area and Severity Index (PASI) score of 2-15, and a static Physician's Global Assessment (sPGA) score of 2-3. These were patients who had been inadequately controlled with or intolerant to topical therapy and were allowed unmedicated emollients for body lesions and nonmedicated shampoos for scalp.

 Patients were randomized 1:1 to receive either Otezla 30 mg twice daily (n=297) or placebo (n=298) for the first 16 weeks, followed by an open-label extension phase through week 32.

The trial met its primary endpoint, with 21.6% (n=297) of patients receiving Otezla achieving an sPGA

 response at week 16 compared to 4.1% (n=298) with placebo (p<0.0001). The study also demonstrated statistically significant improvements in key secondary endpoints at week 16, including Whole Body Itch Numeric Rating Scale response

 (43.2% versus 18.6%) and Scalp Physician's Global Assessment response

 (44% versus 16.6%) compared to placebo. The safety profile remained consistent with the safety profile in patients with moderate to severe plaque psoriasis, with the most commonly reported treatment-emergent adverse events (≥5%) being diarrhea, headache, nausea, nasopharyngitis, and upper respiratory tract infection.

"The ADVANCE trial addressed a critical gap in our understanding," explains Dr. Stein Gold, who was also an investigator on this trial. "The five-fold improvement in response rates demonstrated the potential for systemic therapy in this patient population, with 21.6% of patients taking Otezla achieving an sPGA response at week 16, compared to just 4.1% with placebo."

While ADVANCE demonstrated how Otezla can help patients with mild to moderate plaque psoriasis, an important question remained: what impact could the timing of initiating Otezla have on patients? A subsequent real-world study helped shed light on this critical question.

Real-World Evidence: Examining Timing of Initiating Otezla

A recent real-world study has provided insight into the impact of the timing of initiating Otezla in patients with mild to moderate plaque psoriasis. "Real-world data really complement the clinical trial data," explains Dr. Armstrong. "In clinical trials, you often have a very curated population of patients. Whereas in the real world, in our clinical practice, dermatologists have a heterogeneous population of patients that we manage and treat every day. Therefore, real world data that reflect the realities of our daily practice can help inform certain treatment decisions.

The retrospective, observational analysis examined electronic medical record and claims data from the OM1 database, including over 13,000 U.S. adults with mild to moderate plaque psoriasis. The study focused on patients whose first available BSA value after diagnosis was between ≥1% to ≤10% -- designated as the index date. These patients were new to systemic treatment, had no prior psoriatic arthritis diagnosis, had at least a year of baseline data, and either initiated Otezla or started a second topical prescription between 2014 and 2023.

Note: Patients on topicals could either have switched or added a new topical. Notably, patients had a mean BSA of 5.5% at baseline, and in the Otezla arm, about 50.5% used concomitant topical therapy during the study.

A total of 3,589 patients had started Otezla, with 2,073 starting Otezla within 6 months of their index date and 1,516 starting at least 6 months after their index date. Early initiators had a median time to Otezla start of just 2 weeks after their index date, while late initiators didn't initiate treatment until a median of 16 months after their index date.

The studies showed that the early initiator group (n=2,073) experienced a 2% BSA increase from index date to Otezla start (≤6 months; median 2 weeks). In the late initiator group (n=1,516) there was a 49% BSA increase from index date to Otezla start (>6 months; median 16 months).

The study also demonstrated that in the group that initiated Otezla early, 6.0% mean BSA at index date slightly increased to 6.1% mean BSA at Otezla initiation. In the late initiation group, however, 4.9% mean BSA at index date increased to 7.3% mean BSA at Otezla initiation.

The study also revealed important insights about treatment history. "What's particularly noteworthy," Dr. Stein Gold points out, "is that before starting Otezla, 54% of early initiators and 75% of late initiators had tried three or more topicals. This highlights the varying treatment journeys patients may experience before initiating systemic therapy.”

"These findings underscore the timing of systemic therapy," notes Dr. Stein Gold. "Patients who were late Otezla initiators (n=1,516) saw an average of 49% increase in BSA from index date."

Of note, this real-world study had several important limitations to consider. While prescription data was available, actual medication adherence couldn't be confirmed. Additionally, while the study was anchored on the first observed BSA value, this may not have been the patient's first BSA measurement, and disease duration before the index date was unknown. For the topical group, it wasn't possible to distinguish between treatment switching and adding a new topical to an existing regimen.

It's also worth noting that patients with disease severity measures (BSA values) may be different from patients that don't have these measures, though a database comparison suggested no major differences in patient characteristics between these groups.

 Finally, since this is real-world evidence and not a clinical trial, conclusions about statistical or clinical significance cannot be drawn.

Looking Forward: Evolving Approaches to Treating Plaque Psoriasis

The treatment landscape for limited plaque psoriasis continues to evolve, informed by both clinical trials and real-world evidence. The ADVANCE trial demonstrated the efficacy and safety of Otezla in mild-to-moderate disease, while real-world evidence has now highlighted the impact of the timing of initiating Otezla.

 Moving forward, a key opportunity lies in better identifying which patients with limited disease might benefit from systemic therapy before cycling through multiple topicals.

Hypersensitivity: Hypersensitivity reactions, including angioedema and anaphylaxis, have been reported during postmarketing surveillance. If signs or symptoms of serious hypersensitivity reactions occur, discontinue Otezla and institute appropriate therapy

Diarrhea, Nausea, and Vomiting: Cases of severe diarrhea, nausea, and vomiting were associated with the use of Otezla. Most events occurred within the first few weeks of treatment. In some cases, patients were hospitalized. Patients 65 years of age or older and patients taking medications that can lead to volume depletion or hypotension may be at a higher risk of complications from severe diarrhea, nausea, or vomiting. Monitor patients who are more susceptible to complications of diarrhea or vomiting; advise patients to contact their healthcare provider. Consider Otezla dose reduction or suspension if patients develop severe diarrhea, nausea, or vomiting

Depression: Carefully weigh the risks and benefits of treatment with Otezla for patients with a history of depression and/or suicidal thoughts/behavior, or in patients who develop such symptoms while on Otezla. Patients, caregivers, and families should be advised of the need to be alert for the emergence or worsening of depression, suicidal thoughts or other mood changes, and they should contact their healthcare provider if such changes occur

: Treatment with Otezla is associated with an increase in depression. During clinical trials in adult patients with moderate to severe plaque psoriasis, 1.3% (12/920) of patients reported depression compared to 0.4% (2/506) on placebo. Depression was reported as serious in 0.1% (1/1308) of patients exposed to Otezla, compared to none in placebo-treated patients (0/506). Suicidal behavior was observed in 0.1% (1/1308) of patients on Otezla, compared to 0.2% (1/506) on placebo. One patient treated with Otezla attempted suicide; one patient on placebo committed suicide

: Treatment with Otezla is associated with an increase in depression. During clinical trials, 1.0% (10/998) reported depression or depressed mood compared to 0.8% (4/495) treated with placebo. Suicidal ideation and behavior was observed in 0.2% (3/1441) of patients on Otezla, compared to none in placebo-treated patients. Depression was reported as serious in 0.2% (3/1441) of patients exposed to Otezla, compared to none in placebo-treated patients (0/495). Two patients who received placebo committed suicide compared to none on Otezla

: Treatment with Otezla is associated with an increase in depression. During the clinical trial, 1% (1/104) reported depression or depressed mood compared to 1% (1/103) treated with placebo. No instances of suicidal ideation or behavior were reported in patients treated with Otezla or treated with placebo

Weight Decrease: Monitor body weight regularly; evaluate unexplained or clinically significant weight loss, and consider discontinuation of Otezla

: Body weight loss of 5-10% occurred in 12% (96/784) of adult patients with moderate to severe plaque psoriasis treated with Otezla and in 5% (19/382) of patients treated with placebo. Body weight loss of ≥10% occurred in 2% (16/784) of adult patients treated with Otezla compared to 1% (3/382) of patients treated with placebo. Body weight loss of 5%-10% occurred in 12% (19/163) of pediatric patients with moderate to severe plaque psoriasis treated with Otezla compared to 2.5% (2/80) with placebo. Body weight loss of ≥ 10% occurred in 1% (1/163) of pediatric patients treated with Otezla twice daily compared to 0% (0/80) of patients with placebo. Closely monitor growth (height and weight) in Otezla-treated pediatric patients. Pediatric patients who are not growing or gaining weight as expected may need to have their treatment interrupted

: Body weight loss of 5-10% was reported in 10% (49/497) of patients taking Otezla and in 3.3% (16/495) of patients taking placebo

: Body weight loss of >5% was reported in 4.9% (5/103) of patients taking Otezla and in 3.9% (4/102) of patients taking placebo

Drug Interactions: Apremilast exposure was decreased when Otezla was co-administered with rifampin, a strong CYP450 enzyme inducer; loss of Otezla efficacy may occur. Concomitant use of Otezla with CYP450 enzyme inducers (e.g., rifampin, phenobarbital, carbamazepine, phenytoin) is not recommended

: The most common adverse reactions (≥ 5%) are diarrhea, nausea, upper respiratory tract infection, and headache, including tension headache. Overall, the safety profile of Otezla in adult patients with mild to moderate plaque psoriasis and pediatric patients with moderate to severe plaque psoriasis was consistent with the safety profile established in adult patients with moderate to severe plaque psoriasis

: The most common adverse reactions (≥ 5%) are diarrhea, nausea, and headache

: The most common adverse reactions (≥ 10%) are diarrhea, nausea, headache, and upper respiratory tract infection

Otezla has not been studied in pregnant women. Advise pregnant women of the potential risk of fetal loss

Adult patients with plaque psoriasis who are candidates for phototherapy or systemic therapy

Pediatric patients 6 years of age and older and weighing at least 20 kg with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy

Adult patients with active psoriatic arthritis

Adult patients with oral ulcers associated with Behçet’s Disease

*sPGA response was defined as the percentage of patients who achieved sPGA score of 0 (clear) or 1 (almost clear) and ≥2-point reduction from baseline.

†Patients achieving a ≥4-point reduction in WBI-NRS from baseline

‡In patients with ScPGA ≥2 at baseline. ScPGA score of clear [0] or almost clear [1] with at least a 2-point reduction from baseline.

Strober B, Caitriona R, van de Kerkhof P, van der Walt J, Kimball A, 

. Recategorization of psoriasis severity: Delphi consensus from the International Psoriasis Council, 

. Presented at: 7th World Psoriasis and Psoriatic Arthritis Convention; June 27-29, 2024; Stockhom, Sweden

Lebwohl M, Langley RG, Paul C, Puíg L, Reich K, van de Kerkhof P, Wu HL, Richter S, Jardon S, Gisondi P. Evolution of Patient Perceptions of Psoriatic Disease: Results from the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) Survey. 

Stein Gold L, Papp K, Pariser D, Green L, Bhatia N, Sofen H, Albrecht L, Gooderham M, Chen M, Paris M, Wang Y, Callis Duffin K. Efficacy and safety of apremilast in patients with mild-to-moderate plaque psoriasis: Results of a phase 3, multicenter, randomized, double-blind, placebo-controlled trial. 

. Presented at: Maui Derm Hawaii; January 22-26, 2024; Maui, HI

Menter A, Gelfand JM, Connor C, Armstrong AW, Cordoro KM, Davis DMR, 

. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. 

Recent advancements in plaque psoriasis treatment have shifted the focus towards understanding disease severity, treatment goals, and the timing of systemic therapy initiation. New guidelines suggest that even patients with limited skin involvement may benefit from systemic therapy. The ADVANCE trial demonstrated the efficacy of Otezla in mild-to-moderate cases, while a real-world study highlighted the importance of early systemic therapy initiation. Early treatment with Otezla was associated with better disease control compared to delayed initiation. These findings emphasize the need for timely systemic therapy in managing plaque psoriasis effectively.

This content is sponsored by Amgen and was developed in conjunction with Linda Stein Gold, MD, April Armstrong, MD, both of whom were compensated by Amgen for their participation. 

Latest Clinical Considerations for Timing of a Systemic Treatment in Plaque Psoriasis Patients with Limited Skin Disease

I have not considered the role of AI technology in Mohs surgery

I'm sorry, but it seems there is no article text provided for me to summarize and extract key takeaways from. Could you please provide the text of the article

A poster session and ACMS keynote speaker Anant Madabhushi, MS, PhD, both delve into the use of AI in Mohs surgery. 

POLL: Do You Think AI Technology Can Enhance the Mohs Surgery Workflow?

In a groundbreaking initiative that bridges science and creativity, John Zampella, MD, FAAD, associate professor of dermatology at NYU School of Medicine, and Mitchell Hanson, an MD/MPH candidate at the Medical College of Georgia, have introduced an innovative art showcase at the American Academy of Dermatology (AAD) Annual Meeting. The program seeks to explore how art can deepen connections within the dermatological community and enhance the understanding of identity, illness, and healing.

The project, with this year’s theme of “Self-Identity, Medicine, and Dermatology,” originated from a simple idea: incorporating artistic expression into the professional landscape of dermatology. Inspired by an AAD initiative called The Art of the Skin, spearheaded by Susan Taylor, MD, the AAD’s current president, Zampella and Hanson saw an opportunity to create something new. “This is the first year it’s ever happened,” Zampella said in a recent interview with 

. “I thought, how could we integrate art into some of the stuff that we’re doing?”

Hanson, who is not only a medical student but also an artist and LGBTQ+ advocate, took the idea and ran with it. Drawing on his past experience illustrating posters and even crafting original visuals for a TEDx talk, Hanson designed a submission-based art show inviting medical students and residents to express their identities and experiences through visual media.

The result was a compelling collection of over 20 diverse submissions—including paintings, textiles, mixed media, digital art, and photography. “I was really impressed with the talent that exists in our students and residents,” Zampella reflected. “There was some really high-quality, robust artwork with real thought and real talent.”

Hanson emphasized the inclusive, welcoming tone of the exhibit. “I wanted everyone to feel like they had a space there to talk and be seen,” he said. He noted that showcasing identity in dermatology is particularly powerful, as the skin is such a visible, personal part of the human body. “I wanted to leave it open to interpretation what that meant for medicine and dermatology.”

The impact extended beyond the artistic experience itself. Many students and attendees who might otherwise have felt intimidated by the scale of the AAD conference found a place to connect. “It lets everyone feel more like they are a part of the community,” said Hanson. “They have something to contribute, which I love.”

Clinically, the initiative is supported by research that links art exposure with improved diagnostic and communication skills. “It’s been shown in prior studies, at least with residents, to enhance visual diagnostic skills,” Hanson noted. “It’s also helped with cultural competency… and with students being able to display empathy and check their own biases.”

Zampella highlighted another critical dimension: preventing physician burnout. “Medical training and the practice of medicine beat a lot of the life out of you… People don’t have a lot of time to do hobbies or work on themselves. We want to encourage people here to maintain those other hobbies and skills outside of medicine.”

One particularly poignant piece showcased a sponge wiping away a surface to reveal a vibrant LGBTQ+ pride flag underneath—symbolizing the interplay between skin disease, identity, and visibility. “Instead of removing the dirty skin, it’s like, ‘This is who I am,’” Zampella said. “It hit all the things—what patients feel, how the artist feels, and how skin disease is not something necessarily to be washed away, but part of you.”

Looking ahead, both Zampella and Hanson hope the initiative continues to grow, potentially becoming a formal session at future AAD meetings. “If it stayed the way it is and still existed in 5 years, I’d be thrilled,” said Zampella. Hanson echoed the sentiment, but both expressed an ambition to expand the model across specialties: “I would like to see this on a broader display… I think art could be such a powerful tool to actually help students practice empathy, perspective-taking, and meaning in ways never done before.”

By elevating art in a medical context, this program not only humanizes dermatology but redefines how medicine itself can be practiced—with creativity, vulnerability, and vision.

An innovative art showcase at the American Academy of Dermatology Annual Meeting, led by John Zampella, MD, and Mitchell Hanson, MD/PhD candidate, integrates art into dermatology to enhance understanding of identity, illness, and healing. The initiative, inspired by The Art of the Skin, features diverse submissions from medical students and residents, fostering community and inclusivity. It also supports improved diagnostic skills, cultural competency, and empathy. The program aims to prevent physician burnout and hopes to expand across medical specialties, redefining medicine with creativity and vision.

Spearheaded by John Zampella, MD, FAAD, and Mitchell Hanson, the project highlights how art can foster community and empathy in dermatology.

Art Meets Medicine in Bold New AAD Showcase

A recent study reviewed cosmeceutical trends on social media and discovered that retinol is the most searched cosmeceutical on several platforms.

Investigators used analytics from TikTok and Google Trends. It is estimated that between 45% and 50% of adults turn to social media for skin care advice.

The authors conducted a Google Trends search from January 2004 to December 2023 in the United States. Trend lines were created for terms like retinol, bakuchiol, salicylic acid, glycolic acid, azelaic acid, hydroquinone, niacinamide, vitamin C serum, and hyaluronic acid. Then, the yearly perfect differences in relative search volume index (SVI) were calculated. The SVI is the ratio of the frequency a term is searched within a specific time relative to peak search volume during that time frame. An SVI of 100 is the peak popularity of the term. These trends were then graphed on scatterplots and compared to the total number of TikTok views for each search term.

The largest twofold increase in cosmeceutical search volume occurred from 2020 to 2021, due to the COVID-19 pandemic. Here, the average SVI doubled or tripled, with some increasing by 40% or more. Between 2022 and 2023, search volume rose by over 18%. This search interest in trends will continue to increase over time, according to the data.

Retinol was the most popular on both platforms followed by hyaluronic acid, salicylic acid, glycolic acid, vitamin C, niacinamide, hydroquinone, and azelaic acid. Retinol had an interest rank of 1 based on both Google SVI and TikTok views, the highest of all the cosmeceuticals. Bakuchiol was the least popular search term. Interestingly, niacinamide had much more TikTok views than Google searches. Conversely, salicylic acid had a higher Google SVI and a lower amount of TikTok viewership.

“Although not perfectly aligned, these data results collectively reveal that cosmeceutical appeal is constantly increasing, and that interest correlates with consumer viewership on social media,” the authors wrote.

The data may not accurately characterize all of the public interest due to some study limitations, including the lack of Internet access for older populations or those with lower socioeconomic status. Additionally, although Google Trends can be localized to certain geographic regions, TikTok cannot. Future literature could further evaluate specific demographics.

These results emphasize patients’ public interest in skin care, specifically with cosmeceuticals. Clinicians are advised to stay informed on popular social media trends so that they can educate their patients on product usage and combat misinformation.

“Awareness of skincare trends and growth in cosmeceutical interest empower dermatologists to anticipate patient inquiries and develop targeted education on product efficacy, cost effectiveness, and potential adverse reactions,” the authors wrote.

Let us know your thoughts and experiences by answering our poll above and commenting on social media, or by writing to us at 

A study analyzed cosmeceutical trends on social media, revealing retinol as the most searched term on platforms like TikTok and Google. The research utilized Google Trends data from 2004 to 2023, showing a significant increase in search volume during the COVID-19 pandemic. Retinol, hyaluronic acid, and salicylic acid were among the top searched terms. The study highlights the growing public interest in cosmeceuticals and suggests that clinicians should stay informed about social media trends to educate patients effectively and address misinformation.

Google search trends and TikTok view counts were used to analyze the public popularity of cosmeceutical ingredients like retinol, hyaluronic acid, and niacinamide.

Kaitlyn Bader, Senior Editor

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