⚡100% Response, Icotrokinra Gains, and Vitiligo Combination

Good morning — it's Saturday, Apr. 19, and we're covering an all-patient response to Qtorin, adolescent psoriasis results from ICONIC LEAD, and more.

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Need To Know

All Patients Respond to Qtorin in Microcystic Lymphatic Malformation Trial

Palvella’s investigational therapy Qtorin—an anhydrous 3.9% rapamycin gel—may become the first FDA-approved treatment for microcystic lymphatic malformations after demonstrating strong efficacy and tolerability in a Phase 2 trial.

At Week 12, 100% of patients treated with QTORIN achieved a clinician-rated response: 58% were rated as “Much Improved” and 42% as “Very Much Improved.” Patient-reported outcomes echoed these findings, with 83% reporting similar improvement. Safety was favorable, with only mild to moderate adverse events and no treatment discontinuations.

Microcystic lymphatic malformations are rare congenital vascular anomalies caused by dysregulation of the PI3K/mTOR pathway. They are marked by persistent lymphatic leakage, bleeding, and recurrent infections. The disease is progressive and does not resolve spontaneously.

Topical rapamycin inhibits mTOR activity locally in the skin, aiming to reduce endothelial hyperproliferation and VEGF signaling while minimizing systemic exposure.

The Phase 2 findings paved the way for SELVA, a 24-week, single-arm Phase 3 trial aiming to enroll 40 children with microcystic lymphatic malformations. The study recently expanded eligibility to include patients as young as 3 years old. Top-line data are expected in early 2026.

Quick Hits

> Icotrokinra Advances in Psoriasis With Adolescent Data From ICONIC LEAD: Just weeks after showing positive results at AAD 2025, icotrokinra—Johnson & Johnson’s oral IL-23 inhibitor—demonstrated strong efficacy in adolescents with moderate-to-severe psoriasis. In a subgroup analysis of 66 adolescents from the ICONIC-LEAD Phase 3 trial, 86% achieved clear or almost clear skin (IGA 0/1) at Week 24. Notably, 89% reached at least a 90% reduction in disease severity (PASI 90). Safety remained favorable, with fewer adverse events reported than in the placebo group. The subgroup analysis, presented at the World Congress of Pediatric Dermatology, strengthens icotrokinra’s emerging profile as a next-generation oral option. ICONIC-LEAD is the first Phase 3 trial to simultaneously evaluate a systemic psoriasis therapy in adolescents and adults. Recently, icotrokinra outperformed deucravacitinib, an oral TYK2 inhibitor, in the ICONIC-ADVANCE 1 and 2 trials.

> Ritlecitinib-Phototherapy Combination Boosts Repigmentation in Vitiligo: New data from a phase 2b extension trial published in JAAD suggest an additive benefit of narrowband UVB phototherapy when combined with ritlecitinib for treating nonsegmental vitiligo. Among 230 patients, 44% receiving combination therapy achieved at least a 75% improvement in facial vitiligo (F-VASI75) at week 24, compared to 27% on ritlecitinib monotherapy (P = 0.08). More patients on combination therapy also achieved a 50% or greater improvement in total vitiligo severity (T-VASI50) (33% vs 14%; P = 0.01). The regimen was well tolerated. Limitations included the small combination group (n = 43) and an FDA-mandated discontinuation rule, which required withdrawal of 9 patients in the combination group at week 12 for <10% improvement in total vitiligo severity. However, this dropout bias was addressed in the analysis. Ritlecitinib, a JAK3/TEC inhibitor, suppresses T cell–mediated melanocyte destruction, while phototherapy promotes melanocyte proliferation and differentiation.

> Xyngari Demonstrates Early Efficacy in Acne After Just Four Treatments: Xyngari—Dermata’s once weekly topical acne therapy—separated from placebo across all three primary endpoints after just four treatments in patients with moderate-to-severe acne. These findings come from the Phase 3 STAR-1 trial, which enrolled 520 patients aged 9 and older. At week 4, 12% of Xyngari-treated patients achieved clear or almost clear skin (IGA 0/1) compared to 6% with placebo (P < 0.05). Xyngari also drove larger reductions in inflammatory (-11.4 vs. -8.6) and non-inflammatory (-12.4 vs. -8.8) lesion counts (both P < 0.001). These early gains build on Dermata’s topline results, where Xyngari achieved statistically significant improvements over placebo across all primary endpoints at week 12. Derived from a freshwater sponge, Xyngari combines mechanical exfoliation with antimicrobial and anti-inflammatory activity to target acne.

> B-VEC Maintains Durable Wound Closure Through 112 Weeks: New long-term data published in AJCD reinforce the durability of topical beremagene geperpavec-svdt (B-VEC, Vyjuvek), the first FDA-approved gene therapy for dystrophic epidermolysis bullosa (DEB). In an open-label extension study, 47 patients received weekly treatment for up to 112 weeks (median of 81 weeks). B-VEC maintained wound closure, with 61–90% closure rates. Among early closures, 37% remained closed throughout the study, while most reopened wounds responded to retreatment. Patient satisfaction remained high. However, quality-of-life scores showed only modest gains. The authors attributed this to the treatment of limited body areas, persistent extracutaneous disease, and symptoms like pain or itch during wound healing. Safety was consistent with prior data, with no discontinuations due to treatment-related adverse events. Main limitations included a small sample size and early termination following product commercialization. B-VEC is a topical HSV-1-based gene therapy that delivers COL7A1 directly to wounded skin. View clinical images of wound improvement in Figures 5 and 6 of the full article.

> Autonomous Imaging Matches Standard Dermoscopy and Saves Time in Patients With High Lesion Counts: A prospective cohort study in JAMA Dermatology evaluated a fully autonomous total body photography and dermoscopic imaging device against manual handheld dermoscopy in 316 patients with atypical mole syndrome. The autonomous system captured standardized full-body and dermoscopic images without operator involvement. The device matched manual dermoscopy on image quality, scoring 9.8 vs 9.4 out of 10. Independent dermatologists achieved 92% agreement in diagnostic and management decisions across images obtained from both methods. While overall imaging time was only slightly lower with the autonomous device (519 vs 542 seconds), the time difference was more pronounced in patients with over 40 lesions (664 vs 802 seconds; P = 0.02). The device could serve as a front-end imaging platform for AI tools, enabling faster triage and improved diagnostic precision, while also supporting teledermatology by enhancing remote consultations. Watch the autonomous robotic system capture high-quality images in a streamlined workflow here (paywall restricted).

Derm Picks

Quizzes, cases, and perspectives to sharpen your clinical eye.

🖼️ Image Challenge

• A 66-year-old woman with submammary brownish hyperkeratotic plaques (View)

• An erythematous plaque on the forehead (View)

• A linear erythematous papulovesicular rash in a newborn (View)

🔎 Under the Dermatoscope

• Dermoscopic features of clear cell squamous cell carcinoma (View)

✂️ Cut & Close

• How to remove a stuck punch biopsy specimen with a formalin flush (Watch)

📚 Guides & Reviews

• Recommendations for the safe and effective use of topical and oral minoxidil (Read)

• New EADV task force recommendations for diagnosing and managing folliculitis decalvans (Read)

• Cosmetic dermatologists recommend skincare ingredients for common skin concerns in Delphi consensus study (Read)

• Practical expert guidance for managing challenging psoriasis scenarios (Read)

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