Scholarly Activity

BACKGROUND: Ostomates suffer from multiple comorbidities and social stigma, which can be especially debilitating in young patients. TikTok has become a popular platform for this population to establish a community and gain resources. This study aims to characterize intestinal ostomy videos on TikTok.

METHODS: The top 50 videos for search terms "ileostomy," "colostomy," "ostomy," and "stoma" were queried on TikTok. Information was compiled regarding the videos' creators, content type, overall sentiment, and viewer engagement.

RESULTS: A total of 113 videos amongst 38 creators garnered 52,021,700 likes and 370,983 comments. Most videos focused on education (45.5%) and personal stories (22.7%). Creators were predominantly young females (82.0%), with minimal input from healthcare professionals (3% of videos). Sixty-nine (61%) of videos had responses with further questions.

CONCLUSIONS: Our study reveals a gap between interest and availability of professional educational material regarding intestinal ostomies. Addressing this deficiency may improve patient acceptance, bystander understanding, and its negative stigma.

Adenoid cystic carcinoma (ACC) is a rare cancer that most commonly occurs in the salivary glands, making up approximately 2-4% of all head and neck malignancies. Treatment for ACC varies, with combinations of surgical excision, adjuvant radiotherapy, and chemotherapy reported in the literature. In this study, we aim to assess ACC recurrence rates with Mohs Micrographic Surgery (MMS) treatment compared to traditional wide local excision (WLE). In June of 2024, a comprehensive review of the literature was performed using the following keywords: "Adenoid Cystic Carcinoma" and/or "Mohs Micrographic Surgery" and/or "MMS" and/or "excision." Between the two databases, 25 articles were identified which included a total of 30 patients. Among all the articles, 30 procedures were documented - 8 MMS and 22 WLE. Patients with ACC treated with WLE had a higher rate of recurrence (40.9%) compared to those treated with MMS (12.5%). Limitations include a small number of tumors treated and reporting bias. MMS for the treatment of ACC demonstrated a decreased recurrence rate compared to WLE. Further studies with larger sample sizes are needed to confirm the benefit of MMS over WLE.

Itch is a prominent symptom in many cutaneous disorders, including atopic dermatitis (AD), prurigo nodularis, and psoriasis. Itch is also a common but overlooked concern in patients with hidradenitis suppurativa (HS). Currently, the mechanisms underlying itch in HS remain unclear. To gain a better understanding, we reviewed the literature on pruritus in HS and other itch-predominant disorders, AD, and psoriasis. In HS, psoriasis, and AD, we found that itch often co-localized with pain and occurred more frequently at night. Furthermore, itch was found to negatively affect sleep and increase the risk for comorbid psychiatric disorders in HS, psoriasis, and AD. However, HS-, psoriasis-, and AD-related itch differ in temporality. Itch in AD is often described as chronic, while itch in HS and psoriasis is often described as episodic. HS-associated itch is likely multifactorial, and several mechanisms have been proposed including peripheral sensitization, central sensitization, and neuroinflammation. Prior studies in HS highlight enhanced IgE production and a dense infiltration of mast cells, along with a variety of cytokines and chemokines. Furthermore, alterations in the skin microbiome may contribute to itch in HS. To date, few therapies have been studied to treat itch in HS. Given the efficacy of several biologics and small molecules in treating itch in AD and psoriasis, similar agents may be explored in future HS studies. Alternative therapies to target neurological and psychiatric contributions to itch may include anticonvulsants, cannabinoids, and nonpharmacological treatments. In conclusion, pathomechanisms of itch in HS remain to be fully elucidated. However, we can draw on lessons from other pruritic disorders to begin addressing the symptom of it and identify important questions for future study.

Few studies discuss the co-management of vitiligo and acquired hyperpigmentation disorders (AHD) such as melasma, erythema dyschromicum perstans, post-inflammatory hyperpigmentation, drug-induced hyperpigmentation, and lichen planus pigmentosus. This review discusses clinical studies examining co-management strategies and identifies current practice gaps. Dermatology Life Quality Index scores are higher in individuals with vitiligo or melasma. It is plausible that populations experiencing both conditions may exhibit worsened psychological outcomes because of stigmas and perceived social beauty standards. Standard treatments for vitiligo aim to increase pigmentation, while AHD treatments target decreasing pigmentation, causing potential worsening of contrast between multiple skin tones for patients experiencing both disorders. Tretinoin may prevent narrowband ultraviolet B (NBUVB)-induced hyperpigmentation in patients with vitiligo without altering treatment response and is also beneficial for managing AHD. In addition, the use of oral tranexamic acid to treat melasma does not diminish the response to NBUVB phototherapy. Platelet-rich plasma (PRP) injections and oral Polypodium leucotomos extract may also be beneficial for comanaging vitiligo and AHD. However, practice guidelines are needed to optimize care for this patient population.

Background: Tapinarof cream 1% once daily (QD) demonstrated significant efficacy in patients down to age 2 years with atopic dermatitis (AD) in the ADORING 1 and 2 phase 3 trials. We report local tolerability outcomes.

Methods: Patients received Tapinarof or vehicle cream QD for 8 weeks. Tolerability was evaluated using patient/parent/caregiver and investigator 5-point Local Tolerability Scales (LTS). Investigators assessed tolerability for sensitive skin areas, including face/neck.

Results: 813 patients were randomized (∼80% pediatric). Mean pretreatment baseline overall LTS scores were similar across groups and trials: 1.0-1.9 (patient-assessed) indicating slight burning/stinging and itching; and 0.3-0.6 (investigator-assessed) indicating no-to-minimal irritation. Tapinarof was well tolerated with improvement from pretreatment baseline and no-to-minimal burning/stinging and itching from first application through Week 8 (patient-reported): mean Week 8 LTS scores were 0.2-0.4 (burning/stinging) and 0.6-0.8 (itching). Investigators reported improvement from pretreatment baseline with no-to-minimal irritation (dryness/erythema/peeling) from first Tapinarof application through Week 8 (mean LTS scores: 0.2 and 0.1 in ADORING 1 and 2, respectively). Across sensitive skin, investigators reported no-to-minimal irritation from first application through Week 8 (mean scores [Tapinarof versus vehicle]: 0-0.3 versus 0-1.0).

Conclusion: Tapinarof was well tolerated locally from first application through Week 8, including on sensitive skin areas. Clinicaltrials.gov numbers NCT05014568, NCT05032859.

BACKGROUND: Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition with a greater prevalence and disease burden in patients who identify as African American and those with a family history of HS, suggesting a strong genetic component to its pathogenesis.

OBJECTIVE: To evaluate the relationship between plasma inflammatory protein expression, HS disease severity, and genetic ancestry in a diverse cohort of patients with Hidradenitis Suppurativa.

METHODS: We performed a case-control study of patients with HS compared to age-, sex-, and ethnicity-matched healthy controls. We profiled circulating inflammatory proteins using Olink High-throughput proteomics and determined genetic ancestry from whole-genome sequencing data.

RESULTS: Using linear regression, we identified novel proteins associated with HS after adjusting for age, sex, and ethnicity. Our analysis also revealed differences in the inflammatory proteome linked to disease severity. Specifically, we found that plasma IL6 levels can distinguish between different Hurley stages, indicating that IL6 may serve as a marker of disease severity. Additionally, we observed variations in inflammatory protein levels based on genetic ancestry: patients with predominantly African ancestry exhibited higher levels of inflammatory proteins associated with neutrophilic inflammation, while those with predominantly European ancestry showed increased levels of Th1-related inflammatory proteins.

LIMITATIONS: Single-center study. Limited sample size. Unable to account for treatment status or comorbidities that may influence the level of inflammatory cytokines.

CONCLUSION: Genetic ancestry and disease severity influence the plasma inflammatory profile in patients with HS.

BACKGROUND: Ruxolitinib cream has demonstrated anti-inflammatory and antipruritic activity and was well tolerated in a phase 3 study in patients aged 2-11 years with mild to moderate atopic dermatitis (AD).

OBJECTIVE: This study examined the safety, tolerability, pharmacokinetics, efficacy, and quality of life (QoL) with ruxolitinib cream under maximum-use conditions and with longer-term use.

METHODS: Eligible patients were aged 2-11 years with moderate to severe AD [Investigator's Global Assessment (IGA) score 3-4], and ≥ 35% affected body surface area (BSA). Patients applied 1.5% ruxolitinib cream twice daily to all baseline-identified lesions during the 4-week maximum-use period, then to active lesions only up to week 52 (patients with ≤ 20% affected BSA from week 8). Safety was assessed by frequency and severity of adverse events. Pharmacokinetic parameters were assessed as secondary endpoints, and efficacy and QoL were exploratory endpoints.

RESULTS: Overall, 29 patients (median age 5 years) were enrolled. Treatment-emergent adverse events were reported in 9/29 patients (31.0%); there were no adverse events of special interest (i.e., no serious infections, malignancies, major adverse cardiovascular events, or thromboses) during the study period. Mean steady-state plasma concentration during the maximum-use period was below the known half-maximal inhibitory concentration of Janus kinase-mediated myelosuppression in adults. Reductions in affected BSA and IGA observed at week 4 were sustained with as-needed use through 52 weeks. Improvements in patient-reported outcomes and QoL measures were consistent with efficacy results.

CONCLUSION: These results support the safety of ruxolitinib cream in children (2-11 years) with AD, including those with extensive disease, and are consistent with previous efficacy findings.

GOV IDENTIFIER: NCT05034822, first registered 30 August 2021.

Objectives: To quantify treatment priorities and unmet need among adults and adolescents with vitiligo in the United States (US). Methods: An adaptive self-explicated preference-elicitation survey was administered to adults (age ≥18 years) and adolescents (age 12-17 years) with non-segmental vitiligo. The preference-elicitation included 26 attributes related to treatment efficacy, safety, and mode of administration. Relative importance (RI) of each attribute was estimated using latent class analysis (LCA). Satisfaction with the 10 most important attributes for each patient was elicited using rating scales. RI and satisfaction were combined to estimate unmet need using a modified outcome-driven innovation approach which defines unmet need as high RI combined with low satisfaction. Results: The sample comprised adults (N=321) and adolescents (N-201) who received vitiligo care from 83 sites across the US. They had a mean (SD) age of 26 (9.1) and 14 (1.6) years, respectively. More than 50% of participants self-identified as non-White; 50% were female. Fitzpatrick skin types were 23.9% Type I-II (pale white, fair), 43.6% III-IV (darker white, light brown), and 32.4% V-VI (brown, black). LCA identified three preference segments: Efficacy (N=182,34.9%), most important attributes were amount of repigmentation on the entire body (RI=5.16) and reducing the emotional burden of vitiligo (RI=5.00); Mode of Administration (MOA) (N=159,30.5%), most important attributes were having an oral (RI=4.80), systemic (RI=5.03) treatment; Safety (N=181,34.7%), most important attributes were avoiding cardiovascular events (RI=4.53), cancer (RI=4.38), or shingles (RI=4.42). Among the full sample, the greatest areas of unmet need were reducing the emotional burden of vitiligo and having access to an oral systemic (rather than topical) treatment. Conclusions: Treatment preferences among people with vitiligo are heterogeneous. In addition to repigmentation, reducing the emotional burden of vitiligo is a key treatment goal for patients. An effective oral systemic treatment could help address unmet need in this patient population.

Background: Acne-induced post-inflammatory hyperpigmentation (PIH) is a common, long-lasting sequela of acne with a significant psychosocial impact. To assess its impact on sufferers, interviews were conducted in a phase IV study of trifarotene treatment of acne and PIH. Methods: Cross-sectional blinded qualitative interviews as a sub-study of a 6-month phase IV randomized controlled study of patients (n=123) with acne and moderate-to-marked PIH treated with trifarotene or vehicle. Semi-structured interviews conducted by trained interviewers with patients (n=30, 18-34 y). Results: Patients had a mean age of 24.8 years, 73.3% had Fitzpatrick skin types IV-VI, and 40% (12/30) were treated with trifarotene. More than half (60%) rated their PIH severity at ≥7 at study entry, and 57% said PIH disturbed their daily life at a level of 7 (0=no disturbance to 10=worst disturbance). Improvement in PIH was reported by 100% of the trifarotene group vs 83% in the vehicle group and those in the trifarotene group had a greater reduction in self-reported PIH severity (-5.5 vs -3.5 vehicle). Patients reported lack of treatment success with prior treatments but noticeable improvements in uniformity of skin color during this study: “my skin got brighter, lighter, the dark spots have faded,” and “at first it was very, very noticeable … it just faded.” Other patients reported increased self-confidence and reduced reliance on makeup and lengthy cover-up daily routines. AEs were more common with vehicle vs trifarotene (30.2% vs 16.7%). Conclusions: Patients described noticeable and meaningful changes in the appearance of PIH and daily life impacts.

Background: Trifarotene belongs to a new generation of topical retinoids for acne. Data indicate multiple mechanisms through which trifarotene may interrupt acne pathogenesis and improve acne-related scarring and pigmentation. Acne sequelae impact patients’ lives and frequently outlast the causative acne lesion. Thus, treatment addressing both acne lesions and sequelae is likely to improve long-term outcomes. Methods: Two vehicle-controlled, 24-week phase 4 studies evaluated trifarotene treatment (with appropriate skin care regimen) and 1) atrophic acne scarring and 2) acne-related hyperpigmentation. The scarring study (Study 1) utilized a split-face design (N = 121) while the pigmentation study (Study 2) randomized patients 1:1 to active or vehicle arms (N = 123). Results: In study 1, trifarotene treatment resulted in significant improvement in scar counts, with differences from vehicle apparent as early as week 2 (W2) and progressively improving through W24. There was also a significant difference between trifarotene and vehicle in scar global assessment (SGA) success from W12 through W24. Study 2 enrolled a diverse population of patients with a range of skin tones. In study 2, trifarotene treatment accelerated pigment reduction at week 12 vs vehicle. Active and vehicle were similar at week 24. Although not a defined study endpoint, reduction in macular erythema was also observed. Trifarotene was well tolerated in both studies, with tolerability scores higher than vehicle but mild in severity. Conclusions: Management of atrophic acne scarring and hyperpigmentation is an important consideration in acne therapy. Trifarotene achieved rapid improvements in these acne sequelae along with efficacious acne control.

Background: Acne is highly visible andone of the most common skin diseases. Healthcare professionals should have a reliable first-line approach that is efficacious and suited for a broad range of patient skin types, ages, and demographics. Methods: Including the Phase 3 program, trifarotene has been studied in thousands of acne subjects in clinical trials. Most recently two vehicle-controlled, 24-week phase 4 studies evaluated trifarotene treatment of acne and 1) atrophic acne scarring (4-1) and 2) acne-related hyperpigmentation (4-2). The scarring study 4-1) utilized a split-face design (N = 121) while the pigmentation study (Phase4-2) randomized subjects 1:1 to active or vehicle arms (N = 123). Results: The studies were international, with men and women in the studies ranging from 9 to 58 years of age. The phase 3 studies were majority White, but included substantial diversity, including 74 Black/African-American and 195 Latino subjects treated with trifarotene. In 4-2 <50% of subjects were White. Additionally, 30.6% of subjects in 4-1 and 61.7% of subjects in 4-2 had type IV-VI skin. Approximately 35% of subjects in 4-1 and 2 identified as Hispanic/Latino. In Study 2, 18.2% of subjects in the trifarotene group were Asian. In all studies, trifarotene was significantly superior to vehicle in improving acne. In 4-1, trifarotene rapidly improved atrophic acne scars and in 4-2 trifarotene reduced hyperpigmentation. In all studies, trifarotene had a positive risk/benefit ratio. Conclusions: Across a broad range of subject types, trifarotene had good efficacy for improving acne, atrophic scars, and hyperpigmentation, and safety.

Background: Atopic dermatitis (AD), a highly pruritic inflammatory skin disease, typically begins in childhood and affects up to 23% of children globally. Ruxolitinib cream was effective and well tolerated in adults/adolescents (TRuE-AD1/TRuE-AD2 [NCT03745638/NCT03745651]) and children 2–<12 years old (y/o; TRuE-AD3 [NCT04921969]). Here, efficacy by baseline clinical characteristics in children 2–<12 y/o enrolled in TRuE-AD3 is reported. Methods: Patients 2–<12 y/o with AD for ≥3 months, Investigator’s Global Assessment (IGA) score of 2/3, and 3%–20% affected body surface area (BSA) were randomized (2:2:1) to apply twice-daily ruxolitinib cream (0.75%/1.5%) or vehicle for 8 weeks. Results: Patients 2–<12 y/o (N=330) had a median (range) age of 6 (2–11) years; AD duration, 4.8 (0.3–11.3) years; mean (SD) affected BSA was 10.5% (5.40%). At Week 8, 49/134 (36.6%) children applying 0.75% ruxolitinib cream and 74/131 (56.5%) applying 1.5% ruxolitinib cream vs 7/65 (10.8%) applying vehicle achieved IGA treatment success (IGA-TS; score 0/1 with ≥2-grade improvement from baseline); 69/134 (51.5%) and 88/131 (67.2%) vs 10/65 (15.4%) achieved ≥75% improvement in Eczema Area and Severity Index (EASI75), respectively. IGA-TS was observed regardless of baseline AD severity measure. For IGA-TS: IGA score of 2 and 3, 32.3%/48.4% vs 0% and 37.9%/59.0% vs 14.3%, respectively; EASI score ≤7 and >7, 41.7%/58.8% vs 17.2% and 30.6%/55.0% vs 5.6%. Ruxolitinib cream was well tolerated; no serious treatment-emergent adverse events were reported. Conclusions: Ruxolitinib cream is a well-tolerated and effective treatment for AD in children 2–<12 y/o, independent of baseline clinical characteristics.

Introduction: High frequency ultrasound (HFU) has been shown to be useful for Hidradenitis Suppurativa (HS) evaluation along with physical examination.1 Sonographic features of HS include dermal thickening, widening of hair follicles, anechoic or hypoechoic fluid deposits and fistulous tracts.2,3 Pre-surgical margin mapping with HFU, prior to CO2 laser surgery – an effective treatment for HS, may reduce recurrence rates; however, there is little existing literature on margin mapping methodology.4 Methods: This work describes methodology for HFU margin mapping of HS lesions prior to CO2 laser surgery. Results: Unlike traditional US imaging, skin imaging requires utilization of transducers with high frequency (15 MHz and above). A 1-2 mm gel bed is required for better visualization of changes in superficial features.5 For margin mapping, dermal thickening was found to be the most relevant HFU feature of HS. Skin marker was used to mark the border at the transition point between normal and thickened dermis every 1-2 cm around the HS lesion to demarcate the area of excision. Isolated lesions within 2-3 cm on the surrounding skin were evaluated for the presence of any sinus tracts connecting them to the main lesion as that would impact the area to be excised. Conclusion: Change in dermal thickening was the most pertinent HFU feature of HS when performing preoperative margin mapping. Future studies are needed to evaluate if preoperative margin mapping of HS lesions with HFU correlates with lower recurrence rates.

Introduction: Hidradenitis suppurativa (HS), a chronic, systemic inflammatory skin disease characterized by deep, painful, and difficult-to-treat lesions, often requires rescue interventions alongside conventional treatment.[1] Here, we investigate the impact of bimekizumab (BKZ), a monoclonal IgG1 antibody that inhibits interleukin (IL)-17F and IL-17A, on the need for concomitant rescue interventions in patients with moderate to severe HS. Methods: We report pooled, post hoc analysis from the initial treatment period (Weeks 0–16) of the BE HEARD I&II trials.[2,3] Adult patients with moderate to severe HS were randomized to BKZ (320mg every 2 weeks [Q2W] or Q4W) or placebo (PBO). The incidence of concomitant rescue interventions for HS, including medical (antibiotics, analgesics) and procedural (incision/drainage, intralesional triamcinolone injection), and time to first procedural intervention, are reported. Results: Overall, 1,014 patients were randomized to BKZ (n=868) or PBO (n=146) across BE HEARD I&II. In BKZ-treated and PBO-treated patients, 4.1% (n=36) and 8.9% (n=13) received ≥1 rescue analgesic; 4.0% (n=35) and 5.5% (n=8), received ≥1 rescue systemic antibiotic. Incidence of ≥1 incision/drainage intervention was 2.1% (n=18) in BKZ-treated and 3.4% (n=5) in PBO-treated patients; 1.6% BKZ-treated (n=14) and 3.4% PBO-treated (n=5) received ≥1 intralesional triamcinolone injection. Time to first procedural intervention was 65.3±36.2 (mean days±standard deviation) in BKZ-treated and 30.4±17.0 in PBO-treated patients. Conclusions: Over 16 weeks, the incidence of concomitant interventions for HS was low in BKZ-treated patients; low levels of rescue analgesic use in BKZ-treated patients may indicate reduced pain burden. Time to first procedure was numerically longer for BKZ- versus PBO-treated patients.

Roflumilast is a nonsteroidal, highly potent phosphodiesterase 4 inhibitor developed as once-daily cream and foam formulations being studied in patients for long-term treatment of atopic dermatitis and seborrheic dermatitis (SD). Roflumilast cream 0.3% is approved as a once-daily, nonsteroidal cream for patients with chronic plaque psoriasis, including sensitive areas such as intertriginous, face, and genital areas. Efficacy and safety of once-daily roflumilast foam 0.3% in patients ≥9 years old with at least moderate SD from this phase 3 randomized controlled trial (NCT04973228) were reported previously. Roflumilast foam 0.3% (n=304) demonstrated statistically significant improvements in efficacy compared with vehicle (n=153) with low rates of adverse events, which were similar between treatment groups. Here we report the patient-reported outcomes: Worst Itch Numeric Rating Scale (WI-NRS), Scalpdex, and Dermatology Life Quality Index (DLQI)/Children’s DLQI (CDLQI), and local tolerability. Among patients with baseline WI-NRS score ≥2, more roflumilast-treated than vehicle-treated achieved WI-NRS score 0/1 at Week 8 (70.7% vs. 52.9%; P=0.0085), with improvements in itch compared to vehicle as early as 48 hours after first treatment (mean percent change from baseline [CfB]: -27.87% vs. -13.11%; nominal P=0.0024). Roflumilast-treated patients reported greater improvements in least squares (LS) mean CfB DLQI score (-3.8 vs. -2.7; nominal P<0.001), while those with scalp involvement, had greater improvements in LS mean CfB Scalpdex score (-23.21 vs. -15.42; nominal P<0.001) at Week 8. Local tolerability and safety were favorable. Treatment with once-daily roflumilast foam 0.3% reduced pruritus and improved quality of life with favorable tolerability. Sponsored by Arcutis Biotherapeutics, Inc.

Tapinarof cream 1% once daily (QD) demonstrated significant efficacy versus vehicle and was well-tolerated in adults and children down to 2 years of age with moderate to severe atopic dermatitis (AD) in two pivotal phase 3 trials (ADORING 1 and 2). Here, we present baseline characteristics and outcomes from the prespecified interim analysis of ADORING 3, the long-term extension trial assessing safety and efficacy of up to 48-weeks’ open-label tapinarof. 728 patients enrolled in ADORING 3, representing a large, diverse AD population comprising a high proportion (91%) of eligible patients from the pivotal ADORING trials, 28 patients from a 4-week maximal usage pharmacokinetic trial, and an additional 76 tapinarof-naive patients aged 2-17 years with various disease severities (mild; or moderate or worse with body surface area [BSA] ≥40%), who were ineligible for preceding trials. The majority of patients in ADORING 3 were pediatric; 26.6% were aged 2-6 years; 27.1% 7-11 years; 29.3% 12-17 years; and 17.0% were adults. Overall, 46.6% were male, 52.6% White, 11.1% Asian, 30.1% Black/African American, and 4.4% other race categories. Patients with AD present different phenotypes and treatment responses. A high proportion of primarily pediatric patients elected to rollover from previous trials, and the diverse population enrolled in ADORING 3 is representative across the broad spectrum of disease severity, BSA affected (up to 95%), and demographics. No new safety signals were reported with long-term treatment in this interim analysis. The full analysis in 2024 will report further safety and efficacy data with tapinarof cream 1% QD.

Introduction: New topical treatments were recently FDA approved for patients with plaque psoriasis. This study was designed to assess the effect of education on knowledge, competence, and confidence regarding new topical psoriasis treatments. Methods: Dermatologists (n= 76) participated in an online CME activity that featured video with synchronized slides. A repeated-pair design with pre/post-assessment including 3 multiple choice questions that assessed knowledge or competence and one confidence assessment question assess effectiveness, with each participant serving as his/her own control. A McNemar’s test was conducted to assess question level statistical significance (P <.05). The activity launched 3/10/23 and data were collected approximately 60 days post-launch. Data are presented as %improved (%pre/%post) correct responses. Results are presented by learning theme. New Topical Psoriasis Treatments: • 11% improved (58%/54%; P = NS) change in knowledge regarding calcipotriene/ betamethasone data • 34% increase in confidence in identifying patients who would benefit from new topical psoriasis treatments Psoriasis in Sensitive Areas: • 18% (49%/63%) increase in knowledge about the suitability of roflumilast in difficult to treat areas Psoriasis in Patients with Skin of Color: • 18% improved (53%/67%) competence in counseling patients with diverse skin tones on pigmentary changes associated with healing psoriasis. Discussion: Online CME resulted in improved knowledge, competence, and confidence among dermatologists regarding new topical psoriasis treatments. Baseline and post-education results suggest that there are remaining gaps regarding new topical treatments, managing psoriasis in difficult areas, and in treating psoriasis in patients with diverse skin tones.