Initial Diagnostic Workup for Patients Presenting With Psoriasis Symptoms

This Peer Exchange opens by addressing persistent gaps in psoriasis care, despite the expanding therapeutic landscape. Linda Stein Gold, MD and her colleagues analyze patient- and provider-reported data from the ENCOMPASS and Stein Gold 2025 surveys, revealing that many patients remain dissatisfied with current therapies and that oral agents are overwhelmingly preferred over injectables. The experts discuss how patient lifestyle, comorbidities, and psychosocial burden influence shared decision-making and treatment adherence. They also interpret the International Psoriasis Council’s (IPC) new definition of “topical failure” and explore its implications for reducing “topical churn” and advancing systemic therapy earlier in the disease course

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The second section examines the investigational drug pipeline and its potential to close current gaps in care. The panel provides an in-depth review of the icotrokinra (ICO) clinical development program, summarizing the ICONIC-ADVANCE 1 and 2 trials, which demonstrated superior efficacy versus deucravacitinib at both 16 and 24 weeks, with favorable safety and tolerability. They also discuss new week 52 ICONIC-LEAD data showing sustained clearance and no new safety signals in adults and adolescents. The faculty reflect on ICO’s implications for adolescent psoriasis and how early, aggressive oral intervention may help prevent progression to psoriatic arthritis, marking a significant milestone in the evolution of oral IL-23–targeted therapy

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The final portion of the series shifts focus to managing active psoriatic arthritis (PsA). The experts discuss new findings from the APEX Phase 3b study, where guselkumab demonstrated the first clear evidence of IL-23–mediated inhibition of structural joint damage, reinforcing the rationale for early biologic use in high-risk patients. They compare APEX to prior IL-23 studies, discuss implications for therapy sequencing, and highlight other emerging data from Fall Clinical 2025, including the SPECTREM and PSOLAR studies. In closing, Dr. Stein Gold and colleagues emphasize a forward-looking approach that integrates personalized therapy selection, early detection of PsA, and cross-specialty collaboration to elevate standards of psoriasis care