<p>The rapidly evolving plaque psoriasis landscape took center stage at <strong>Maui Derm Hawaii 2026</strong>, with discussions highlighting updated management strategies that include treatment sequencing of systemic therapies in challenging clinical scenarios.</p> <p><br></p> <p><em>Following these presentations, featured expert Eingun James Song, MD, FAAD, was interviewed by </em>Conference Reporter<em> Associate Editor-in-Chief Rick Davis, MS, RPh. Clinical perspectives from Dr Song on these findings are presented here.</em></p>

Route of administration is a key factor when choosing between oral and injectable therapies for plaque psoriasis. Until recently, a strong preference for an oral option meant acknowledging a trade-off in efficacy compared with biologics. In selected clinical scenarios, particularly in patients with mild to moderate disease, the convenience and simplicity of a pill may outweigh the more modest efficacy of currently available oral therapies.

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That conversation may soon change with the anticipated availability of additional oral agents, including icotrokinra, zasocitinib, and envudeucitinib. Top-line data for the latter 2 were presented at the recent Maui Derm Hawaii 2026 meeting, while a network meta-analysis presented by April W. Armstrong, MD, MPH, suggested that icotrokinra performs on par with many of the newer biologics.

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Also at the meeting, I participated in a panel led by Bruce E. Strober, MD, PhD, on therapy selection and sequencing for different psoriasis clinical scenarios. The first case was a 45-year-old male patient with extensive body surface area involvement (ie, 42%) with no signs or symptoms of psoriatic arthritis. My copanelists recommended both IL-23 and IL-17 inhibitors as preferred first-line options, although I did give a slight nod to bimekizumab, given the depth and speed of response.

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The second case was a 45-year-old female patient with limited body surface area involvement (ie, 6%) but with predominantly scalp disease. She was systemic treatment naive without any notable comorbidities. The panelists unanimously agreed that IL-17 inhibitors would be the preferred option, although IL-23 inhibitors would be a reasonable second choice. There was also a discussion on using oral JAK inhibitors such as upadacitinib and tofacitinib, both of which are US Food and Drug Administration (FDA) approved for psoriatic arthritis, to treat refractory scalp psoriasis. A similar preference for IL-17 inhibitors was expressed for nail psoriasis.

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The third case discussed during Dr Strober’s presentation at Maui Derm Hawaii 2026 sparked the most debate among the panelists. The 45-year-old female patient had palmoplantar psoriasis limited to the palms. While there was consensus that biologics offer only modest efficacy and that oral JAK inhibitors provide the strongest efficacy in this subtype, opinions were more divided regarding other options, including methotrexate, acitretin, and apremilast.

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One of the final cases involved a patient with plaque psoriasis with significant skin involvement and mild psoriatic arthritis. Most panelists favored either an IL-17 or IL-23 inhibitor over other options, citing superior skin efficacy and favorable safety profiles. The key differentiator was the presence of axial disease, which would favor the use of an IL-17 inhibitor. Speed of response was also discussed, with IL-23 inhibitors generally taking longer to reach peak efficacy.

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The panel also briefly reviewed retrospective analyses from claims databases and registries suggesting a lower incidence of new-onset psoriatic arthritis among patients treated with IL-23 inhibitors compared with those treated with other classes. While intriguing, the panel agreed that these findings are best viewed as hypothesis generating, given the inherent limitations of such studies, and that longer prospective trials are needed for confirmation.