What Derm NPs and PAs Will Tackle at Horizons in Advanced Practice

Small-group case discussions at the third annual Dermatology Times Horizons in Advanced Practice meeting in Atlanta, Georgia, are designed to support dermatology nurse practitioners (NPs) and physician assistants (PAs) in applying recent trial data on nonsteroidal topicals for atopic dermatitis (AD), oral and targeted therapies for plaque psoriasis, and type 2 inflammatory disease to real clinical scenarios. To anchor the discussions and make them more robust, Horizons faculty shared peer-reviewed papers as suggested pre-reading materials.

The collection supports 4 main topic areas that will be highlighted in the case discussions, each of which will be led by Horizons faculty: Omar Noor, MD, FAAD, Lakshi Aldredge, MSN, ANP-BC, DCNP, FAANP, and Douglas DiRuggiero, DMSc, MHS, PA-C. As at prior meetings, attendees will leverage recent data to work through patient cases in small breakout groups and decide how the evidence applies to their own patients. The discussions also allow attendees to ask questions and learn from the faculty’s experience in the field.

Allowing a free flow of ideas and discussions in small groups is the foundation of the meeting. The chairs previously noted how rewarding these sessions can be. At the inaugural meeting in Las Vegas, Nevada, Aldredge reflected on what attendees took away from the meeting. “One of the best things about this meeting was seeing the illumination in their eyes, [realizing] ‘I didn’t know I could practice that way;’ ‘I didn’t know I could order this drug this way’,” she said in an interview with Dermatology Times.

Choosing Among Nonsteroidal Topicals for Young Children With AD

The studies selected to review for Noor’s session, “Personalizing Topical Therapy: Case-Based Discussions on Nonsteroidal Topicals in Atopic Dermatitis,” reflect a practical shift. Nonsteroidal topicals with 3 different mechanisms now have phase 3 data in children as young as 2 years:

• INTEGUMENT-PED evaluated roflumilast cream 0.05% (Zoryve), a phosphodiesterase 4 inhibitor, in children aged 2 to 5 years.¹
• TRuE-AD3 studied ruxolitinib cream (Opzelura), a Janus kinase inhibitor, in children aged 2 to 11 years.²
• The ADORING trials tested tapinarof cream 1% (Vtama), an aryl hydrocarbon receptor agonist, in patients down to age 2.³

Beyond mechanism, the agents differ in dosing frequency and in what happens after clearance. Roflumilast and tapinarof were applied once daily in their trials, and ruxolitinib twice daily. In the 48-week open label ADORING 3 extension, patients who reached complete clearance and stopped tapinarof remained treatment-free for a mean of nearly 80 consecutive days.⁴

Where Oral Therapies Now Fit in Plaque Psoriasis

The suggested reading for Aldredge and DiRuggiero’s “Oral Therapies in Plaque Psoriasis: Case-Based Insights on an Evolving Landscape” breakout discussion spans 3 oral mechanisms, starting with the ESTEEM trials of apremilast (Otezla), a phosphodiesterase 4 inhibitor, which established its efficacy in moderate to severe plaque psoriasis.⁵,⁶

The list then moves to deucravacitinib (Sotyktu). In POETYK PSO-1 and PSO-2, it outperformed both placebo and apremilast.⁷,⁸ PSORIATYK SCALP evaluated it in moderate to severe scalp psoriasis.⁹

The newest agent on the list is icotrokinra (Icotyde), an oral peptide that selectively blocks the interleukin (IL)-23 receptor. The icotrokinra papers cover 3 study settings:

• Phase 3 results in adults and adolescents (ICONIC-LEAD)¹⁰
• Head-to-head comparisons with deucravacitinib in adults (ICONIC-ADVANCE 1 and 2)¹¹
• 1-year results in scalp, genital, and hand/foot psoriasis (ICONIC-TOTAL)¹²

Together, the papers give attendees data on 3 distinct oral approaches to plaque psoriasis.

Looking Past Body Surface Area in Psoriasis

For the session “Tailoring Treatment in Plaque Psoriasis: Matching Therapy to the Individual Patient,” the suggested reading focuses on patients whose psoriasis involves high-impact sites. SPECTREM evaluated guselkumab (Tremfya) in patients with moderate psoriasis covering 2% to 15% body surface area (BSA) plus at least 1 high-impact site, such as the scalp, face, genitals, or intertriginous areas; the investigators noted that patients with low BSA have been underrepresented in clinical studies.¹³ Separate phase 3b trials of tildrakizumab (Ilumya) and secukinumab (Cosentyx) focused specifically on moderate to severe scalp psoriasis.¹⁴,¹⁵ The secukinumab investigators pointed out that scalp disease had not previously been studied prospectively in patients without moderate to severe body psoriasis.¹⁵

The suggested reading also covers nails. In the PHOENIX 1 trial of ustekinumab (Stelara), 71% of patients with moderate to severe psoriasis had nail involvement.¹⁶ Together, the papers address scalp, facial, genital, intertriginous, and nail disease.

Following Type 2 Inflammation Beyond Atopic Dermatitis

Noor will also lead a discussion in a session, “From Mechanism to Management: Case-Based Perspectives on Type 2 Inflammation in Dermatology.” Its suggested reading extends beyond AD to 2 conditions:

• Chronic spontaneous urticaria: Phase 3 data for dupilumab (Dupixent), which blocks IL-4 and IL-13 signaling, and for remibrutinib (Rhapsido), an oral Bruton tyrosine kinase inhibitor.¹⁷,¹⁸
• Prurigo nodularis: Phase 3 data for dupilumab and for nemolizumab (Nemluvio), an IL-31 receptor alpha antagonist.¹⁹,²⁰

One paper looks beyond the skin. A post hoc analysis studied children aged 6 to 11 years with severe AD. At baseline, these children were overrepresented in lower height percentiles. The investigators then tracked linear growth and a bone mineralization biomarker through week 52, with all children receiving dupilumab after week 16.²¹ The analysis adds growth and bone health to the evidence attendees will bring into the session.

A full recap and video discussions will be published after the meeting. For those interested in learning more and engaging with other dermatology NPs and PAs, join us for Derm Nexus.

References

1. Eichenfield LF, Serrao R, Prajapati VH, et al. Efficacy and safety of once-daily roflumilast cream 0.05% in pediatric patients aged 2-5 years with mild-to-moderate atopic dermatitis (INTEGUMENT-PED): a phase 3 randomized controlled trial. Pediatr Dermatol. 2025;42(2):296-304. doi:10.1111/pde.15840
2. Eichenfield LF, Stein Gold LF, Simpson EL, et al. Efficacy and safety of ruxolitinib cream in children aged 2 to 11 years with atopic dermatitis: results from TRuE-AD3, a phase 3, randomized double-blind study. J Am Acad Dermatol. 2025;93(3):689-698. doi:10.1016/j.jaad.2025.05.1385
3. Silverberg JI, Eichenfield LF, Hebert AA, et al. Tapinarof cream 1% once daily: significant efficacy in the treatment of moderate to severe atopic dermatitis in adults and children down to 2 years of age in the pivotal phase 3 ADORING trials. J Am Acad Dermatol. 2024;91(3):457-465. doi:10.1016/j.jaad.2024.05.023
4. Bissonnette R, Stein Gold L, Kircik L, et al. Skin clearance, duration of treatment-free interval, and safety of tapinarof cream 1% once daily: results from ADORING 3, a 48-week phase 3 open-label extension trial in adults and children down to 2 years of age with atopic dermatitis. J Am Acad Dermatol. 2025;93(3):707-714. doi:10.1016/j.jaad.2025.05.1391
5. Papp K, Reich K, Leonardi CL, et al. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1). J Am Acad Dermatol. 2015;73(1):37-49. doi:10.1016/j.jaad.2015.03.049
6. Paul C, Cather J, Gooderham M, et al. Efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with moderate-to-severe plaque psoriasis over 52 weeks: a phase III, randomized controlled trial (ESTEEM 2). Br J Dermatol. 2015;173(6):1387-1399. doi:10.1111/bjd.14164
7. Armstrong AW, Gooderham M, Warren RB, et al. Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: efficacy and safety results from the 52-week, randomized, double-blinded, placebo-controlled phase 3 POETYK PSO-1 trial. J Am Acad Dermatol. 2023;88(1):29-39. doi:10.1016/j.jaad.2022.07.002
8. Strober B, Thaçi D, Sofen H, et al. Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: efficacy and safety results from the 52-week, randomized, double-blinded, phase 3 Program fOr Evaluation of TYK2 inhibitor psoriasis second trial. J Am Acad Dermatol. 2023;88(1):40-51. doi:10.1016/j.jaad.2022.08.061
9. Duffin KC, Griffiths CEM, Hoffmann M, et al. Deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 (TYK2) inhibitor, in patients with moderate to severe scalp psoriasis: efficacy and safety results through week 16 in a phase 3b/4, multicenter, randomized, double-blinded, placebo-controlled trial (PSORIATYK SCALP). JAAD Int. 2025;25:28-40. doi:10.1016/j.jdin.2025.09.022
10. Bissonnette R, Soung J, Hebert AA, et al. Oral icotrokinra for plaque psoriasis in adults and adolescents. N Engl J Med. 2025;393(18):1784-1795. doi:10.1056/NEJMoa2504187
11. Stein Gold L, Armstrong AW, Bissonnette R, et al. Once-daily oral icotrokinra versus placebo and once-daily oral deucravacitinib in participants with moderate-to-severe plaque psoriasis (ICONIC-ADVANCE 1 & 2): two phase 3, randomised, placebo-controlled and active-comparator-controlled trials. Lancet. 2025;406(10510):1363-1374. doi:10.1016/S0140-6736(25)01576-4
12. Warren RB, Gooderham M, Lain E, et al. Durability of response to icotrokinra for high-impact site psoriasis: 1-year ICONIC-TOTAL findings. J Eur Acad Dermatol Venereol. 2026;40(9):1502-1514. doi:10.1111/jdv.70471
13. Stein Gold L, Gottlieb AB, Armstrong AW, et al. SPECTREM phase IIIb clinical trial results through week 16: guselkumab efficacy and safety for the treatment of low body surface area, moderate psoriasis with high-impact site involvement. Br J Dermatol. 2026;194(1):25-36. doi:10.1093/bjd/ljaf327
14. Sofen HL, Gebauer K, Spelman L, et al. Efficacy and safety of tildrakizumab for the treatment of moderate-to-severe plaque psoriasis of the scalp: week 52 results from a phase 3b, randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 2025;92(4):816-824. doi:10.1016/j.jaad.2024.12.018
15. Bagel J, Duffin KC, Moore A, et al. The effect of secukinumab on moderate-to-severe scalp psoriasis: results of a 24-week, randomized, double-blind, placebo-controlled phase 3b study. J Am Acad Dermatol. 2017;77(4):667-674. doi:10.1016/j.jaad.2017.05.033
16. Rich P, Bourcier M, Sofen H, et al. Ustekinumab improves nail disease in patients with moderate-to-severe psoriasis: results from PHOENIX 1. Br J Dermatol. 2014;170(2):398-407. doi:10.1111/bjd.12632
17. Maurer M, Casale TB, Saini SS, et al. Dupilumab in patients with chronic spontaneous urticaria (LIBERTY-CSU CUPID): two randomized, double-blind, placebo-controlled, phase 3 trials. J Allergy Clin Immunol. 2024;154(1):184-194. doi:10.1016/j.jaci.2024.01.028
18. Metz M, Giménez-Arnau A, Hide M, et al. Remibrutinib in chronic spontaneous urticaria. N Engl J Med. 2025;392(10):984-994. doi:10.1056/NEJMoa2408792
19. Yosipovitch G, Kim BS, Kwatra SG, et al. Dupilumab improves pruritus and skin lesions in patients with prurigo nodularis: pooled results from 2 phase 3 trials (LIBERTY-PN PRIME and PRIME2). JAAD Int. 2024;16:163-174. doi:10.1016/j.jdin.2024.03.025
20. Kwatra SG, Yosipovitch G, Legat FJ, et al. Phase 3 trial of nemolizumab in patients with prurigo nodularis. N Engl J Med. 2023;389(17):1579-1589. doi:10.1056/NEJMoa2301333
21. Irvine AD, Paller AS, Siegfried EC, et al. Dupilumab treatment improves linear growth and bone biomarkers in children with atopic dermatitis: post hoc analysis of a phase 3 randomized, placebo-controlled clinical trial and an open-label extension study. J Am Acad Dermatol. 2026;95(5):1324-1334. doi:10.1016/j.jaad.2026.07.006