Lisa Swanson, MD, On Emerging Pediatric Psoriasis Therapies

At Fall Clinical Dermatology 2025, pediatric dermatologist Lisa Swanson, MD, Ada Dermatology, Boise, Idaho; affiliated with St. Luke’s Children’s Hospital, shared insights on the evolving treatment landscape for psoriasis — particularly around IL-23 inhibition and its emerging role in pediatric and oral therapy.

“They said we could never experience biologic mechanism of action in a pill because the molecules were simply too big,” Swanson explained. “But science is wonderful and amazing.”

From Needles to Pills: A New Era in IL-23 Blockade

While injectable IL-23 inhibitors have been mainstays in moderate-to-severe plaque psoriasis for years, Swanson and her co-presenters, Drs. Tiffany Mayo and Linda Stein Gold, discussed a new frontier: an oral peptide IL-23 inhibitor, icotrokinra (Johnson & Johnson) (also referenced as JNJ-2113 in published trials).

“This is an oral peptide that inhibits IL-23,” she emphasized. “This pill packs a punch … and then to add to it, it has tremendously clean safety.”

Phase 3 data have shown durable PASI responses and minimal adverse effects, primarily nasopharyngitis and mild headache, a safety profile comparable to injectable biologics. For clinicians, the convenience factor is significant: once-daily oral dosing, no refrigeration, and the potential to reach patients reluctant or unable to use injections.¹

Swanson illustrated a common scenario: A college student transitioning from home to dorm life who struggled with refrigeration and storage of injectables. For these patients, she notes, an oral option could improve adherence and quality of life.

Pediatric Patient

Swanson also expressed excitement about the PROTOSTAR trial, which evaluated guselkumab (Tremfya; Johnson & Johnson) in children aged 6 to 17 years. Results exceeded expectations, with efficacy outcomes even higher than those seen in adults.

“We found excellent efficacy that was even higher than in the adult patients previously approved for guselkumab,” Swanson noted, calling the results “a home run.”

PROTOSTAR data, published in The British Journal of Dermatology, demonstrated robust PASI 90 and 100 responses with no new safety signals, making guselkumab the first IL-23 inhibitor approved for pediatric psoriasis. For clinicians treating children, this expands therapeutic flexibility beyond older biologics like etanercept or ustekinumab.²

Looking Beyond Psoriasis

Swanson also pointed to ongoing unmet needs in hidradenitis suppurativa, alopecia areata, and vitiligo, where early intervention is critical but pediatric approvals remain limited. She expressed optimism that biologic and small-molecule expansion into these areas, including potential JAK inhibitors and IL-17/IL-23 blockers, will continue to improve outcomes for younger patients.

Conclusion

As the psoriasis treatment landscape continues to evolve, oral IL-23 inhibition represents a meaningful step toward greater personalization and patient-centered care. For clinicians, these advances promise to bridge the gap between efficacy, safety, and convenience, offering more flexibility for patients of all ages and preferences. With ongoing innovation in both adult and pediatric dermatology, the future of inflammatory skin disease management looks more accessible and adaptable than ever.

References

1. Icotrokinra shows superiority to deucravacitinib in first reported head-to-head trials reinforcing promise of novel targeted oral peptide for treatment of plaque psoriasis. Press release. Johnson & Johnson. Published September 17, 2025. Accessed September 17, 2025. https://www.jnj.com/media-center/press-releases/icotrokinra-shows-superiority-to-deucravacitinib-in-first-reported-head-to-head-trials-reinforcing-promise-of-novel-targeted-oral-peptide-for-treatment-of-plaque-psoriasis
2. Prajapati VH, Seyger MMB, Wilsmann-Theis D, et al. Guselkumab for the treatment of moderate-to-severe plaque psoriasis in paediatric patients: results of the phase III randomized placebo-controlled PROTOSTAR study. Br J Dermatol. 2025;192(4):618-628. doi:10.1093/bjd/ljae502