⚡Melanoma Imaging Miss, 100% Psoriasis Clearance, and Sofdra Works

Good morning. It's Saturday, Mar. 29, and we're covering 3D total-body photography for melanoma screening, a new IL-23 monoclonal antibody for psoriasis, and more.

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Need To Know

3D Total-Body Photography Falls Short in Melanoma Screening Trial

A randomized clinical trial published in JAMA Dermatology found that adding 3D total-body photography (3D TBP) and sequential digital dermoscopy imaging (SDDI) via teledermatology to routine skin checks may lead to more skin excisions but fewer detected melanomas in high-risk patients—a surprising outcome that raises questions about the technology’s clinical value.

The trial, conducted in Australia, randomized 314 adults at high risk of melanoma into two groups: a control group receiving usual care (including regular skin checks) and an intervention group receiving usual care plus 3D TBP-SDDI every six months. In the intervention group, concerning lesions identified by a junior clinician were reviewed remotely by a senior teledermatologist.

After two years, results were unexpected. The 3D TBP-SDDI group had significantly more skin excisions than the usual care group (average 5.7 vs. 4.0 per patient; P = 0.03) but detected fewer melanomas (24 vs. 43). Most melanomas identified in both groups were in situ; only 13 were invasive.

The intervention did identify substantially more keratinocyte carcinomas than usual care (256 vs. 146). However, the accompanying editorial noted that detecting more keratinocyte carcinomas may be a drawback of melanoma screening, as these tumors are rarely life-threatening.

The authors suggest future studies evaluate whether artificial intelligence can enhance the precision of 3D TBP in teledermatology—improving melanoma detection while reducing unnecessary procedures.

Quick Hits

> QX004N Hits 100% PASI 75 in Early Psoriasis Trial: QX004N, an IL-23 monoclonal antibody from Qyuns Therapeutics, demonstrated unexpectedly high clearance rates in a phase 1b trial for moderate to severe psoriasis. In the 30-patient study published in JAMA Dermatology, all patients treated with QX004N achieved at least a 75% reduction in disease severity (PASI 75) by weeks 12 and 24. Additionally, 100% reached clear or almost clear skin (IGA 0/1) by week 24. The drug was well tolerated, with mostly mild to moderate adverse events. However, interpretation is limited by the small sample size and a high placebo response—33% of placebo-treated patients reached PASI 75 at week 12 and 67% by week 24.

> Sofdra’s Efficacy Confirmed in Axillary Hyperhidrosis Trials: Pooled results from two Phase 3 trials published in JAAD support once-daily Sofdra (sofpironium) gel 12.45% for axillary hyperhidrosis. Among 701 participants, 56% of Sofdra-treated patients achieved at least a 2-point improvement on the Hyperhidrosis Disease Severity Measure-Axillary (HDSM-Ax-7) score (range of 0 to 4) at 6 weeks, compared to 37% in the vehicle group. Sofdra also significantly reduced gravimetric sweat production more effectively than placebo (median 138 mg vs. 115 mg). Most participants tolerated the gel well, experiencing only mild adverse events. Sofdra is the first FDA approved treatment for axillary hyperhidrosis in six years. It selectively blocks M3 muscarinic receptors—key mediators of sweat gland activation—while its retrometabolic design facilitates rapid metabolism, minimizing systemic absorption and side effects.

> Week 52 Data Reinforce Delgocitinib’s Benefits in Chronic Hand Eczema: Long-term results from the DELTA 3 extension study support the safety and sustained efficacy of delgocitinib cream for patients with moderate to severe chronic hand eczema (CHE) who are unresponsive to topical corticosteroids. In this open-label trial, 801 adults who completed the 16-week DELTA 1 and 2 studies received as-needed delgocitinib for an additional 36 weeks. Among those initially randomized to delgocitinib, the IGA-CHE 0/1 response rate—indicating clear or almost clear skin—was maintained from 25% at the start of DELTA 3 to 30% at Week 52. Encouragingly, 81% of patients who stopped delgocitinib after achieving clear or almost clear skin regained disease control upon retreatment for disease worsening. Participants originally assigned to placebo also showed substantial clinical improvement. Most adverse events were mild, with no new safety signals observed.

> Brepocitinib Curbs Inflammation in Scarring Alopecia Subtypes: Priovant’s TYK2/JAK1 inhibitor, brepocitinib, demonstrated encouraging results in a Phase 2a trial of patients with cicatricial alopecias. The study enrolled 50 adults diagnosed with lichen planopilaris, frontal fibrosing alopecia, or central centrifugal cicatricial alopecia. Compared to placebo, brepocitinib significantly reduced expression of CCL5—an IFNγ-associated inflammatory marker—highlighting its potential to disrupt Th1/IFNγ-driven follicular inflammation. Fibrotic marker expression remained stable in the brepocitinib group but worsened in the placebo group, suggesting the drug may help prevent fibrotic progression. Clinically, brepocitinib significantly reduced disease severity scores by 39% to 79% at 48 weeks, depending on alopecia subtype. While most adverse events were mild or moderate, four participants discontinued the drug due to side effects.

> TYK2 Efficacy Replicated in Cutaneous Lupus Trial: Deucravacitinib (Sotyktu), Bristol Myers Squibb’s oral TYK2 inhibitor, demonstrated significant clinical benefit in patients with discoid and subacute cutaneous lupus erythematosus (CLE), according to results from the Phase 2 PAISLEY CLE trial. The study enrolled 74 patients who were already receiving standard therapies such as oral corticosteroids, antimalarials, or immunosuppressants. At Week 16, deucravacitinib-treated patients achieved an average 50% reduction in CLE severity scores, compared to 28% in the placebo group. Over 50% of those on deucravacitinib reached at least a 50% improvement in disease severity, compared to only 19% on placebo. The drug’s safety profile was consistent with prior psoriasis trials. As a TYK2 inhibitor, deucravacitinib targets type I interferon signaling—a key driver of CLE pathogenesis.

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