Eingun James Song, MD, is the director of clinical research for Frontier Dermatology. 

Eingun James Song, MD, FAAD 

Discussing Psoriasis Treatment Updates for 2026, With Eingun James Song, MD

 at the Grand Wailea hotel, a session titled ‘Psoriasis Update 2026’ was presented by several notable leaders in the field of dermatology, 1 of which was Eingun James Song, MD.

Song, known for his role as director of clinical research for Frontier Dermatology, provided an interview to the 

 editorial team regarding this talk and its most notable takeaways related to psoriasis treatment options and approaches to decision-making. He was asked in this discussion about patient-reported outcomes and their role in therapeutic decisions.

“With psoriasis clinical trials, we've often relied on the body surface area and the IGA as a measure of success,” Song explained. “But what the data tells us is that even in patients who get 100% skin clearance, if you were to do what we call a DLQI, which is a [Dermatology Life Quality Index], still a significant number of these patients are saying that their psoriasis bothers them despite having completely clear or almost near complete skin clearance.”

Song highlighted this finding as evidence suggesting patient-reported outcomes such as pruritus, burning, and pain, even if they cannot be visibly observed, still impact patients. Due to this, Song believes the DLQI should be included in assessments of patient severity. He was also asked several other questions, including regarding helpful topical or systemic therapies available in the treatment armamentarium for psoriasis.

“In the last maybe 2 or 3 years, we've made significant advancements with our topicals, specifically non-steroidal topicals,” Song said. “So we have now tapinarof as well as roflumilast cream. These are wonderful non-steroidal options that give us additional options beyond just using steroids.”

To find out more about these topics and related information, view Song’s full interview posted above.

The quotes contained in this summary were edited for clarity.

Disclosures for Song include the following: Arcutis Biotherapeutics – Advisory Board(Honoraria), Investigator(Grants/Research Funding).

Stein Gold L, Song E, Gordon K, et al. Psoriasis Update 2026. Presented at: Maui Derm Hawaii 2026; January 25-29, 2026; Maui, Hawaii.

Arcutis Announces Positive Topline Results for INTEGUMENT-INFANT Phase 2 Trial of ZORYVE® (roflumilast) Cream 0.05% in Infants with Mild to Moderate Atopic Dermatitis. Arcutis Biotherapeutics. February 3, 2026. 

https://www.globenewswire.com/news-release/2026/02/02/3230196/0/en/Arcutis-Announces-Positive-Topline-Results-for-INTEGUMENT-INFANT-Phase-2-Trial-of-ZORYVE-roflumilast-Cream-0-05-in-Infants-with-Mild-to-Moderate-Atopic-Dermatitis.html

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This interview at Maui Derm 2026 highlights notable takeaways regarding psoriasis treatment strategies and emerging therapies.

Key Takeaways on Inhibiting Structural Damage in Psoriatic Arthritis

In the management of psoriatic arthritis, preventing structural damage and long-term disability is a crucial goal. However, formal treatment guidelines typically emphasize the elimination of active inflammation rather than structural damage inhibition as a primary target. The current treat-to-target approach focuses on controlling swollen joints, reducing inflammatory markers, and managing clinical symptoms. Incorporating advanced imaging techniques such as ultrasound to detect synovitis and enthesitis could provide more sensitive and earlier indicators of disease activity, potentially improving patient outcomes by guiding timely therapeutic adjustments before irreversible damage occurs.

Structural damage assessment is recognized as important but is often considered a secondary domain within clinical trials and treatment strategies. This is partly due to the slow and gradual progression of joint damage in psoriatic arthritis, which can make it difficult to measure within the time frame and size of typical early-phase studies. Although larger and longer trials attempt to evaluate radiographic progression, challenges remain in interpreting these outcomes due to minimal change in placebo groups and ethical constraints on prolonged placebo use. Nonetheless, there is an expectation that structural damage should be evaluated as part of the overall clinical development and management of the disease, albeit not necessarily as a routine treat-to-target end point.

The current era offers unprecedented therapeutic options for psoriatic arthritis, with many treatments providing both efficacy and improved safety profiles. This has transformed patient care, moving away from older, less targeted therapies toward more precise and tolerable interventions. The continued evolution of treatment strategies calls for better surrogate outcome measures, such as imaging-based markers of inflammation and early damage, to be recognized by regulatory agencies. Early identification and intervention remain key to preventing irreversible joint damage, highlighting the importance of educating health care providers and patients alike about timely diagnosis and treatment initiation.

Experts discuss the evolving management of psoriatic arthritis, emphasizing that while current treat-to-target guidelines prioritize controlling inflammation over structural damage, integrating advanced imaging for earlier detection and advocating for structural damage assessment as a key outcome could enhance long-term patient outcomes amid expanding therapeutic options.

Differentiating Between IL-23 Inhibitors in Psoriatic Disease

From a clinical and mechanistic standpoint, both medications target the IL-23 p19 subunit but differ structurally, which may influence their clinical effects. One is fully human with a wild-type Fc backbone that can bind to CD64, a high-affinity receptor found on myeloid cells producing IL-23. This binding potentially allows the drug to localize directly to inflamed sites, enhancing its ability to neutralize IL-23 where it is most active. The other drug is humanized with an Fc region mutation designed to silence immune recognition, which might reduce immune system engagement but may limit its ability to concentrate at inflammation sites. These differences could explain variations in clinical efficacy, such as stronger effects on structural damage or symptom improvement seen in some study data.

Clinically, these mechanistic distinctions translate into potential practical benefits. For example, one medication’s dosing flexibility—with options to shorten intervals for heavier or biologically experienced patients—may help manage breakthrough symptoms more effectively. Although head-to-head trials are lacking, numerical trends suggest subtle differences in outcomes such as ACR scores and fatigue, with radiographic inhibition being a key differentiator. Meanwhile, the other agent’s radiographic data have not shown statistical significance, partly due to minimal disease progression in the trial population, leaving some uncertainty about its effectiveness in preventing joint damage.

Assessing structural progression in psoriatic arthritis is inherently challenging because changes are slow and may not appear in placebo groups over typical trial durations. Moreover, evolving ethical standards limit the length of placebo-controlled phases, complicating data collection. In this context, innovative imaging tools such as ultrasound—which can detect erosions earlier and more sensitively—may offer valuable surrogate end points to better evaluate treatment effects on joint damage moving forward.

Experts discuss the structural and mechanistic differences between 2 IL-23 p19 inhibitors, exploring how variations in Fc region design may influence their localization to inflamed sites and clinical efficacy—particularly in preventing structural damage—and highlight challenges in assessing progression in psoriatic arthritis trials, suggesting that advanced imaging such as ultrasound could improve future evaluations.

Guselkumab and Structural Damage Inhibition in Psoriatic Arthritis: Insights from the APEX Trial

Recent advances in clinical research have provided critical clarity around the ability of IL-23 inhibitors to inhibit structural damage in psoriatic arthritis, a key concern for clinicians considering long-term outcomes. Early trials such as DISCOVER-2 initially suggested promise, but the approved every-8-week dose of one agent narrowly missed statistical significance in halting radiographic progression. This uncertainty led to the development of a larger, more targeted study—the APEX trial—which focused on bio-naive patients with evidence of existing joint damage. Results showed that both dosing regimens significantly inhibited structural progression, providing much-needed reassurance for clinicians.

For years, many prescribers hesitated to consider IL-23 inhibitors first line for joint disease, despite their clear effectiveness in skin clearance. With the APEX data now confirming structural protection, clinicians can confidently consider these agents even for patients with more aggressive or erosive disease. This is particularly impactful given that IL-23 inhibitors offer notable advantages in safety and dosing convenience. The ability to protect joints while minimizing serious adverse effect concerns and maintaining a low-frequency dosing schedule has the potential to shift prescribing patterns, especially for patients prioritizing long-term joint function and quality of life.

The favorable safety profile of IL-23 inhibitors also streamlines patient counseling. Discussions can often be shorter and more reassuring, as concerns commonly associated with other biologic classes—such as TB reactivation, depression, or cancer risk—are not prominent in the IL-23 data. Although some safety protocols such as TB testing remain in place for insurance reasons, clinical experts increasingly see these agents as both effective and low risk. As dermatologists and rheumatologists gain more confidence from robust evidence, the role of IL-23 inhibitors as a legitimate first-line option for both skin and joint involvement is expected to grow substantially.

Experts discuss recent clinical evidence confirming that IL-23 inhibitors effectively inhibit structural damage in psoriatic arthritis—particularly highlighted by the APEX trial’s findings in bio-naive patients—reinforcing their emerging role as a safe, convenient, and increasingly preferred first-line treatment for both joint and skin manifestations.

Eingun James Song, MD, FAAD

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