Dr. April Armstrong Previews New Era for Oral Psoriasis Treatments
From wild chickens roaming Maui to a growing flock of groundbreaking psoriasis therapies, April W. Armstrong, MD, MPH, delivered an optimistic update on the future of plaque psoriasis treatment during her keynote presentation at the 2026 Winter Clinical Dermatology Conference in Hawaii.
“Psoriasis data are like the feral chickens on this island: everywhere and multiplying fast,” Dr. Armstrong said. “And in 2026, oral therapies are taking center stage.”
FDA APPROVALS IN 2025
Dr. Armstrong opened with recent US Food and Drug Administration (FDA) approvals, starting with roflumilast foam 0.3%, now indicated for plaque psoriasis of the body and scalp in patients 12 and older. Already used for seborrheic dermatitis, the once-daily foam formulation offers a valuable nonsteroidal topical alternative.
Next, she noted the expanded approval of guselkumab for pediatric patients as young as 6 who weigh at least 40 kg, adding an IL-23 inhibitor to the growing toolbox for children with moderate-to-severe plaque psoriasis.
The field also saw the approval of ustekinumab biosimilars, which may begin replacing originator prescriptions, depending on payer decisions. While biosimilars are generally comparable in efficacy and safety, Dr. Armstrong advised clinicians to be aware of potential differences in injection devices or excipient profiles.
REMISSION IS NOW A GOAL, NOT A DREAM
In a nod to the National Psoriasis Foundation’s 2025 campaign, Dr. Armstrong emphasized the shift from “Mission: Impossible” to “Remission: Possible.”
“We are redefining treatment goals,” she said. “Clear or almost-clear skin, once considered aspirational, is now an achievable and expected endpoint for many patients.”
ORAL THERAPIES LEAD THE 2026 INNOVATION WAVE
“2026 is the year of the pill,” Dr. Armstrong said, introducing a flurry of late-phase oral treatment candidates that are poised to rival biologics in efficacy:
1. Apremilast ER 75mg
A new, once-daily, extended-release formulation is now available for patients who previously used apremilast 30mg BID, potentially improving adherence. The ER version is approved for adults and pediatric patients (≥6 years, ≥50 kg).
2. Deucravacitinib (TYK2 Inhibitor)
With 5-year data showing 75% of patients maintaining PASI 75, deucravacitinib continues to demonstrate long-term efficacy. Phase 3 data in psoriatic arthritis (PsA) also support expanded use.
3. Zasocitinib and Invuducitinib: Next-Gen TYK2s
Two next-generation TYK2 inhibitors, both targeting the regulatory domain with higher specificity and potency, are making waves. On, zasocitinib, more than 50% of patients achieved PASI 90 by week 16; ~30% achieved PASI 100. With invuducitinib, by Week 24, 65% achieved PASI 90 and more than 40% PASI 100, putting it on par with biologics.
“These new TYK2 agents go after IL-23 signaling with surgical precision, and they are delivering the kind of clearance we usually associate with injections,” Dr. Armstrong said.
4. Icotrokinra: Oral IL-23 Receptor Blocker
Unlike TYK2 inhibitors, icotrokinra is a peptide that directly blocks the IL-23 receptor. In trials, it matched biologics in efficacy, with 65% achieving PASI 90 and 40% PASI 100 at Week 24.
Notably, adolescent patients responded as well or better than adults. In head-to-head trials with deucravacitinib, icotrokinra demonstrated approximately double the rate of complete clearance.
ORCA-001 COULD MEAN ONCE-YEARLY DOSING
The biologic pipeline also continues to evolve, with ORCA-001 (a modified version of risankizumab) showing potential for once-yearly dosing due to a YTE mutation that enables drug recycling via Fc receptor pathways.
“Imagine a psoriasis patient getting just one shot a year,” Dr. Armstrong said. “This is where we may be headed.”
IL-23 AND RADIOGRAPHIC PROGRESSION IN PSA
Addressing the Apex trial, Dr. Armstrong highlighted new data confirming that IL-23 inhibitors such ascoselicumab not only reduce skin symptoms but also inhibit radiographic progression in psoriatic arthritis, helping to preserve joint function and reduce erosion risk.