James Song, MD

2025 Fall Clinical Dermatology Conference

 in Las Vegas included a variety of sessions, with a notable example being the ‘30 Tips in 30 Minutes’ presentation.

Eingun James Song, MD, one of the talk’s presenters, spoke with the 

 editorial team about Song’s own contribution to this list of tips for dermatologists. In Song’s 3 tips for managing 

, he first recommended taking Janus kinase (JAK)-inhibitors at night to coincide with the peak of cytokines, citing a study showing rheumatoid arthritis patients taking it in the evening were nearly twice as likely to achieve ACR 20.

3 Tips for Managing Skin Disease in Dermatology Practice, With Eingun James Song, MD

“I used to tell patients to just take it whenever it is convenient for you,” Song said. “Maybe take it with food, because it can help with nausea. But it turns out that, just like how our bodies have a natural circadian rhythm and how certain hormones will spike at certain times of the day or night, like cortisol…so do the cytokines that cause the diseases that we treat, like TNF-alpha, IL-1, IL-6, even IL-13. They tend to peak at night.”

Song highlighted the ease and lower cost of this recommendation for patients. In his second tip for clinicians, Song cautioned against underestimating the role of diet in inflammatory skin disease.

“There really isn't good data behind diets and inflammatory skin diseases, but there are some recent publications that have shown the role of sodium in triggering various different inflammatory pathways,” Song said. “Specifically, amplifying Th-17 and Th-2 inflammation, which we know are central to psoriasis and atopic dermatitis, respectively. We've seen this in in vitro studies. But also in humans, where patients who have higher PASI scores, for example, actually have higher amounts of sodium in their dermis.”

Lowering the salt intake in one’s diet was recommended by Song. His third tip involved ways to deal with insurance companies denying a prescription due to a service being labeled as cosmetic.

“We've seen this with vitiligo or alopecia areata with certain insurance payers,” Song explained. “So my tip is knowing when to add a secondary diagnosis to add legitimacy to a condition. What I often would do is, if a patient has, let's say, alopecia areata, I will add on an anxiety code. I will add on a depression code, or the one that I think carries the most weight. If you use the disorder involving immune mechanism code that is a D89.9, that shows the payer that this is truly an autoimmune medical condition, not a cosmetic condition. So I will just tack that on to the original diagnosis, and I have found that to help sometimes in getting certain medications or services covered.”

To learn more information about this topic, view Song’s full video above.

The quotes used in this video summary were edited for the purposes of clarity.

Song has reported serving as an investigator, consultant, and/or speaker for AbbVie, Alphyn Biologics, Amgen, Apogee, Arcutis, Bristol Myers Squibb, Boehringer Ingelheim, Dermavant, DermBiont, Galderma, Incyte, Janssen, LEO Pharma, MoonLake, Novartis, Ortho, Pfizer, Regeneron, Sanofi, Sun Pharmaceutical Industries, Timber Pharmaceuticals, and UCB.

Elewski B, Alexis A, Glick B, Kaufmann M, Lio P, Song J. 30 Tips in 30 Minutes. Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

Videos

In this interview at Fall Clinical, Song highlights takeaways from his portion of the session ‘30 Tips in 30 Minutes.’

A session titled ‘Clear Skin, Clarity in Care: Emerging IL-23 Data Highlights for Psoriasis’ was presented at the 

To discuss some of the data and takeaways from this session on interleukin (IL)-23 inhibition for 

 team spoke with Eingun James Song, MD, one of the session’s presenters. Song emphasized several themes from the talk on new IL-23 inhibitors, including expanding systemic therapy to patients with lower body surface area (BSA) and high-impact areas.

New IL-23 Inhibitor Data Highlights for Psoriasis, With Eingun James Song, MD

“I'm talking about patients with maybe lower body surface area, or patients that maybe just have high impact areas, but are not being adequately addressed with topicals,” Song explained. “So to really get around some of the limitations that we have with using body surface area as the only measure of disease severity, the [International Psoriasis Council], under the guidance of Dr. Bruce Strober, actually recommended that we recategorize disease severity, move away from just mild or moderate or severe, based on BSA alone, and just simply put patients into two different buckets: Are you a topical patient or a systemic patient?”

Song highlighted the criteria for these 2 categories, noting qualification to receive systemic agents, one needs to have greater than 10% BSA, have a high-impact area affected by psoriasis, or have failed a topical therapy.

“Now the first two criteria are pretty black and white,” Song said. “It's pretty self-explanatory, but it's the third criterion that wasn't as well-defined, because topical failure can mean a lot of different things. Is it because you didn't get better? Is it because you don't like the vehicle? Is it because you just had a hard time being compliant? The IPC recently published its definition of a treatment or a topical treatment failure. According to these guidelines, if you've tried two consecutive four-week courses of a topical therapy, and you fail to get to a body surface area of 1% or less, or a [Physician's Global Assessment] of clear or almost clear, then you should be deemed a topical failure.”

Another theme highlighted in this session at Fall Clinical was that of drug persistence, or what is also known as ‘drug survivability.’ Song described this as a great surrogate for how well a drug works, how well a drug is tolerated, a drug’s safety, but also that it is helpful for insurance coverage and compliance.

“It's a good measure of all of these things combined in one, and we have various different ways that we can do real-world drug persistence studies,” Song said. “Whether that's coming from registries or claims data. We reviewed several of the larger studies that have been done in the space, and what we've seen very consistently is that, number one, patients discontinue their first biologic for all sorts of different reasons. That number could be fairly high, anywhere from maybe 20 to 40% of patients will stop because of inadequate efficacy, safety, tolerability, or sometimes because of insurance reasons.”

What these data sets have shown, Song explained, is that the IL-23 class, whether it's risankizumab or guselkumab, has the highest levels of drug persistence over the course of 3 years. If 1 of these 2 drugs is started, Song noted patients are far more likely to stay on those 2 medications than any other medications for psoriasis.

For any additional information on this topic, view Song’s full interview above.

The quotes contained in this summary were edited for clarity.

Song E, Del Rosso J, Strober B. Clear Skin, Clarity in Care: Emerging IL-23 Data Highlights for Psoriasis. Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

Song interviewed with the team regarding his session, discussing recent data on IL-23 inhibition in patients with psoriasis.

2025 European Academy of Dermatology and Venereology (EADV) Congress

 in Paris, Eingun James Song, MD, of Frontier Dermatology, touched on the topic of treatment sequencing, in light of his recent phase 4 data on risankizumab for those with moderate to severe scalp and genital 

Song’s team recently authored the UnlIMMited study, a multicenter, randomized, double-blind, placebo-controlled trial evaluating risankizumab. The team designed the study to address a historically underrepresented patient population in clinical research: patients with limited body surface area (BSA) involvement but with psoriasis affecting high-impact regions of the body such as the scalp and genitals.

Risankizumab and Treatment Sequencing in Scalp and Genital Psoriasis, With Eingun James Song, MD

“In the risankizumab studies, there were some patients who were on a prior systemic agent before,” Song explained. “So for the genital cohort, over 10% of these patients were on ixekizumab, an IL-17a inhibitor, with actually really good data for the genital scan, and then for the scalp group, we saw over 10% of these patients were either on adalimumab, a TNF alpha inhibitor, or apremilast, an oral PDE4 inhibitor. While we don't necessarily know how those patients responded to those prior therapies, what we can say is that people who've been exposed to those other biologics or DMARDs in the past, even if they didn't necessarily achieve a certain level of response, we are still seeing very high levels of response with risankizumab.”

Song noted that a caveat to his comments is that the numbers in this research are smaller and the data on these prior therapies are not known.

“My feelings on this, just based on my anecdotal experience, are that patients who don't do well with one particular agent, if they have very little response, we generally will switch out of the class,” Song said. “So if a patient was on an IL-17 or a TNF inhibitor before, and they had very little movement in their skin clearance, then we probably would move to an IL-23 inhibitor.”

In his discussion of treatment sequencing, Song highlighted the necessity of balancing risks and benefits.

“Purely from that standpoint, it is really hard to argue against the fact that an IL-23 inhibitor makes a very compelling case to be a first-line agent for patients if they've never been on anything before,” Song said. “Even for patients who've been on a systemic and maybe didn't get the result that they wanted…If there's maybe one thing I want you to take away from this study, it's that even in patients who have lower body surface areas, if they have a higher impact area that affects their quality of life [in a way that is] comparable to patients with much more extensive body surface area. So please don't under-treat these patients with just topicals. If they're not responding, at least consider escalating these patients to a systemic agent.”

Song has been a consultant, speaker or investigator for the following companies: AbbVie, Janssen, Amgen, Lilly, SUN, UCB, Incyte, Novartis, Sanofi & Regeneron, Castle Biosciences, and Pfizer.

Song J, et al. Safety and Efficacy of Risankizumab in Genital and Scalp Psoriasis in the UnlIMMited Phase 4 Randomized Clinical Trial at Week 16. Presented at the 2025 European Academy of Dermatology and Venereology (EADV) Congress, Sept 17-20, 2025.

Song J. Spotlighting New Data on Risankizumab for Scalp and Genital Psoriasis, With Eingun James Song, MD. HCPLive. September 17, 2025. 

https://www.hcplive.com/view/spotlighting-new-data-risankizumab-scalp-genital-psoriasis-eingun-james-song-md

This interview segment highlights Song’s risankizumab data covered during the 2025 EADV Congress in Paris.

, Eingun James Song, MD, director of clinical research at Frontier Dermatology, spoke with 

 about his team’s recent phase 4 findings on risankizumab for patients with moderate to severe scalp and genital psoriasis.

The UnlIMMited study was a phase 4, multicenter, randomized, double-blind, placebo-controlled study assessing risankizumab in individuals with moderate-to-severe scalp and/or genital psoriasis. The trial was created to address a historically underrepresented patient population in clinical trials: those with limited body surface area (BSA) involvement but with disease in “high-impact areas” such as the scalp and genitals, known to disproportionately impact quality of life.

Spotlighting New Data on Risankizumab for Scalp and Genital Psoriasis, With Eingun James Song, MD

“You could have one or two patches of psoriasis affecting these areas, and it can affect your quality of life as much as someone who has 25% body surface area,” Song explained. “What this study was trying to do was look at a population that was historically underrepresented or just flat out excluded from clinical trials to see [if] this medicine works in this population, and is it safe?”

Traditional psoriasis trials have required ≥10% BSA and a Psoriasis Area and Severity Index (PASI) score ≥12, but in this study, participants with <10% BSA were included if they had significant scalp or genital involvement. The study randomized patients 1:1 to receive either risankizumab 150 mg or placebo, administered at the 0 and 4-week mark, with the primary endpoint assessed at Week 16.

Song highlighted that the team’s findings demonstrated that nearly 70% of those treated with risankizumab attained clear or almost clear skin in the genital region, and that approximately 60% attained such an outcome in the scalp. Patient-reported outcomes (PROs) also improved significantly, including noted reductions in patients’ reports of itch, redness, burning, and scaling.

In addition, those taking part were shown to have improvements in sexual health, with decreased disease-related impact on sexual frequency following risankizumab treatment. Safety findings also aligned with prior data.

“One can make a very compelling argument that a medicine like risankizumab may very well be your first-line option for a patient who has a scalp or genital psoriasis that does not adequately respond to a topical therapy,” Song said. “That would very much be in line with the International Psoriasis Council recommendations, which state that we should not just refer or use a mild, moderate, or severe category anymore, but we should simply state a patient is a topical or systemic candidate. And if they have a higher impact area and they don't respond to a topical, that makes them eligible for a systemic therapy.”

Eingun James Song, MD, highlights recent phase 4 data on risankizumab for patients with moderate to severe scalp and genital psoriasis.

James Song, MD

Articles