You’re busy. Between patients, prior authorizations, inbox messages, and everything else on your plate, keeping up with the literature is the first thing that slips. Dermatology Times NP/PA Connect is here to make sure it doesn’t. Each week, we pull the most clinically relevant news from across dermatology and bring it straight to your inbox — what’s new, what it means, and what’s worth watching. This week: an oral pill closes in on biologic-level psoriasis clearance, povorcitinib holds up in patients who've already failed a biologic for HS, precision tools are reshaping how AD and CSU get treated, and we sort the hype from the evidence on probiotics for HS.

An Oral Pill Is Approaching Biologic-Level Skin Clearance in Psoriasis

Alumis reported topline results from the ongoing ONWARD3 long-term extension study of envudeucitinib, an investigational oral TYK2 inhibitor, in patients with moderate to severe plaque psoriasis. Among 773 patients who received up to 48 weeks of continuous treatment across the phase 3 ONWARD1, ONWARD2, and ONWARD3 program, 75% achieved PASI 90 and 54% achieved PASI 100, a rate the company describes as the highest reported among oral therapies for psoriasis.¹

Durability looked strong. Among patients who entered ONWARD3 already at PASI 90 or PASI 100, about 90% and 80%, respectively, held that response through the reported duration of the extension. A separate integrated analysis that included patients who did not continue into ONWARD3 showed lower but still substantial rates, 66% PASI 90 and 47% PASI 100 at 48 weeks, a reminder that responder-only figures can look stronger than intention-to-treat analyses. Safety over the extension remained consistent with earlier phase 3 data, with no new signals reported. Alumis is targeting a new drug application filing in the fourth quarter of 2026.

▶ Why it matters: Complete clearance has traditionally been a high bar for oral psoriasis therapy. If these results hold through regulatory review and real-world use, envudeucitinib could narrow the efficacy gap between oral and biologic options.

MORE ON PSORIASIS

For HS Patients Who've Already Failed a Biologic, an Oral Option Holds Up

New data from the phase 3 STOP-HS1 and STOP-HS2 trials add to the case for povorcitinib, an oral, selective JAK1 inhibitor, as a potential first approved oral targeted systemic therapy for hidradenitis suppurativa (HS). Through 54 weeks, up to 71.4% of patients achieved HiSCR50, and up to 29% reached complete clearance of abscesses and inflammatory nodules with no increase in draining tunnels.²

What stands out for practice is the biologic-experienced subgroup, nearly 40% of the combined trial population and substantially higher than in prior HS phase 3 programs, who achieved efficacy comparable to biologic-naive patients. Because povorcitinib works through a different pathway than the TNF-α and IL-17 inhibitors already approved for HS, it may offer a meaningful next step for patients who've had a suboptimal response to a biologic rather than requiring another injectable. Acne was the most common adverse event and appeared dose dependent; serious adverse events stayed low through week 12 and rose modestly, to 5% to 6%, by week 54, with no new safety signals reported. Regulatory submissions are expected in the US and Europe.

▶ Why it matters: Comparable responses in biologic-experienced and biologic-naive patients suggest povorcitinib could offer a different treatment pathway after inadequate biologic response — without requiring another injectable.

LEARN MORE ABOUT HS

Precision Medicine Is Reshaping How You Choose Biologics for AD and CSU

A broader look at the AD and CSU biologic landscape underscores how far individualized treatment selection has come, and how much further it has to go. In AD, dupilumab, tralokinumab, and lebrikizumab target IL-4 and IL-13 signaling, nemolizumab addresses IL-31–driven itch, and oral JAK inhibitors work further downstream, giving NPs and PAs a genuinely differentiated toolkit rather than a single default choice.³

Even so, many patients on current biologics fall short of stringent targets such as EASI-90, leaving residual itch or intermittent flares, a gap driving interest in bispecific and trispecific agents designed to hit multiple pathways at once. In CSU, omalizumab remains a key option after antihistamine failure, while dupilumab and emerging agents such as remibrutinib and barzolvolimab are expanding the treatment landscape for patients who don't respond adequately to existing therapy. Research into IgE levels, basophil activity, and gene expression profiles may eventually help clinicians predict treatment response, but validated biomarkers for routine treatment selection remain limited.

▶ Why it matters: As treatment options multiply, understanding the pathways driving disease can help clinicians make more individualized choices. The goal is increasingly to match the right mechanism to the right patient rather than simply cycling through therapies by trial and error.

Where Compounded Topical Isotretinoin Could Fit Into Acne Care

Aaron Farberg, MD, a board-certified dermatologist in Dallas, discussed Isoclear, a compounded topical isotretinoin regimen built around a 3-phase system: clear for active breakouts, fade for post-inflammatory hyperpigmentation, and renew for long-term maintenance. Farberg said patients typically notice reduced oil production and calmer skin within the first several weeks, with full effect by 6 to 8 weeks.⁴

Because the formulation is compounded and applied topically rather than taken orally, it falls outside the FDA's iPLEDGE Risk Evaluation and Mitigation Strategy program. Farberg said this could shift the clinical conversation, particularly for women of childbearing potential, away from the requirements associated with oral isotretinoin and toward a topical approach. However, the product is not FDA approved, and no Isoclear-specific safety or adverse event data were presented in the interview.

▶ Why it matters: For patients hesitant about oral isotretinoin and its REMS requirements, compounded topical isotretinoin introduces another concept clinicians may hear about from patients. Its compounded status and lack of FDA review should remain central to that discussion.

Probiotics for HS Have a Good Story, Just Not Good Data Yet

HS's link to cutaneous dysbiosis has fueled interest in probiotics as an adjunctive treatment, and a new review lays out the biologic rationale clearly. 16S rRNA sequencing studies consistently show altered microbiome composition and metabolic pathways in HS-affected skin, and TNF-α and IL-17 inhibitors already used in HS appear to shift the microbiome toward a more balanced state as inflammation resolves, suggesting a plausible two-way relationship between microbial composition and disease activity.⁵

Proposed microbiome-directed strategies include topical antiseptics, oral or topical probiotics, bacteriophage therapy, and fecal microbiota transplantation for patients with concurrent gut dysbiosis. The catch, and it is a real one, is that clinical evidence for probiotics specifically remains thin. The approaches are still largely experimental, and the review stops well short of recommending probiotics for routine use.

▶ Why it matters: Watch this space if you're fielding post-GLP-1 skin-quality complaints that fillers alone aren't solving. Regenerative ECM approaches are still investigational, but they're aimed squarely at that gap.

References

1. Heaning S. Envudeucitinib achieves 54% PASI 100 rate at 48 weeks in phase 3 extension. Dermatology Times. August 12, 2026. Accessed August 12, 2026. https://www.dermatologytimes.com/view/envudeucitinib-achieves-54-pasi-100-rate-at-48-weeks-in-phase-3-extension
2. Bosslett M. How povorcitinib may expand treatment options for challenging HS populations. Dermatology Times. August 12, 2026. Accessed August 12, 2026. https://www.dermatologytimes.com/view/how-povorcitinib-may-expand-treatment-options-for-challenging-hs-populations
3. Bosslett M. Biologic therapies in AD and CSU: progress and the push for precision medicine. Dermatology Times. August 12, 2026. Accessed August 12, 2026. https://www.dermatologytimes.com/view/biologic-therapies-in-ad-and-csu-progress-and-the-push-for-precision-medicine
4. Farberg AS, Heaning S. Three-phase topical isotretinoin strategy extends acne care beyond active breakouts. Dermatology Times. August 10, 2026. Accessed August 12, 2026. https://www.dermatologytimes.com/view/three-phase-topical-isotretinoin-strategy-extends-acne-care-beyond-active-breakouts
5. Bosslett M. Probiotics in hidradenitis suppurativa: biologic rationale vs clinical evidence. Dermatology Times. August 12, 2026. Accessed August 12, 2026. https://www.dermatologytimes.com/view/probiotics-in-hidradenitis-suppurativa-biologic-rationale-vs-clinical-evidence