Therapy-Guiding Measures, Treatment Options, and Decision-Making Strategies in Psoriasis: James Song, MD

Incorporating patient-reported outcome measures, such as quality of life, as well as looking into real-world data, is important when assessing how to treat a patient with psoriasis, says James Song, MD, chief medical officer and director of clinical research, Frontier Dermatology, in this interview from Maui Derm Hawaii 2026.

This transcript was lightly edited; captions were auto-generated.

Transcript

What role do patient-reported outcomes and quality of life measures play in guiding therapy selection in complex cases?

With psoriasis clinical trials, we've often relied on the body surface area and the IGA [Investigator’s Global Assessment] as a measure of success. 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 Questionnaire 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, which drives home the point that patient-reported outcomes like itching, burning, and pain, even if we can't visibly see [them], still impacts patients quite a bit, which is why this should be included in our assessment of patient severity.

Are there any approved topical or systemic therapies that you feel are underutilized in practice?

In the last maybe 2 or 3 years, we've made significant advancements with our topicals, specifically nonsteroidal topicals. And so, we have now tapinarof as well as roflumilast cream. These are wonderful nonsteroidal options that give us additional options beyond just using steroids. And so, while I don't want to say you can't or you should never use a steroid, we always want to make sure that we are transitioning these patients off of steroids after we get them to clear. I think these have a lot of potential, [but] still [are] not being utilized as much as I would like, but hopefully that's going to change with just more time and education.

As far as systemic therapies, we have pretty much the same ones that we've had for the last couple of years. But as far as newer therapies, we do have now 3 oral therapies for psoriasis that are under study; we may get one here, which is an IL-23 peptide called icotrokinra, hopefully approved in the first quarter of this year. And then we have several second-generation TYK2 inhibitors that are under study that might get approved next year as well.

How do you approach treatment decisions when clinical trial data for a therapy are strong, but real-world experience is still limited?

Clinical trial data is important for the FDA as they decide whether they're going to approve a drug or not. We have to remember patients that are in clinical trials is almost like a best-case scenario. Patients are doing everything they should be doing. They're following their protocol. You're seeing them at certain time points. But real-world data doesn't always reflect clinical trial data, so I would agree; sometimes we need to give it more time to see, is this drug as effective? Is it as safe and well-tolerated in the real world as it is from our randomized controlled trials? That being said, it's the best that we have, so it's going to take time just to learn more about these therapies.