Skin, Pills, and Shots: The Cutting Edge of Dermatology

The 2026 Elevate Derm Rapids Conference brought together some of the brightest minds in dermatology to discuss where the field is heading.

Victoria Garcia Albea, a dermatology NP,  sat down with Dr. Jason Hawkes from Oregon to discuss the latest clinical science. From the hidden cells driving chronic disease to groundbreaking oral peptides and the reality of GLP-1s in skin health, here are the major breakthroughs shifting the dermatology landscape.

1. Resident Memory T Cells: The Brains Behind Chronic Plaques

Ever wonder why a patient’s psoriasis plaques keep reappearing on the exact same elbows or knees, or why a fixed drug reaction strikes the identical spot every time?

The answer lies in Resident Memory T Cells.

• The Evolution: Historically, these cells were our skin’s frontline defense. In the era before modern housing and clothing, high type 2 (atopic dermatitis) or type 3 (psoriasis) inflammation protected us from harsh environments and pathogens.
• The Modern Pathogenesis: While evolutionary selection factors have changed, these long-acting cells remain anchored in the tissue. Even when systemic inflammation is suppressed,  T cells remain primed to re-trigger disease locally.

The Takeaway: To achieve true, long-term disease remission, future therapies will need to move beyond general immune suppression and directly target these stubborn, tissue-resident memory cells.

2. Closing the Efficacy Gap: The Rise of Oral Peptides

For years, the systemic dermatology conversation was polarized: you either chose a highly effective but expensive injectable biologic or an oral small-molecule option that was easier to take but often had more side effects or lower efficacy.

Enter Icotrokinra, a new oral small peptide targeting the IL-23 receptor.

Why Icotrokinra is Shaking Up Treatment:

• Biologic Efficacy in a Pill: Because it is roughly 10 times larger than a standard small molecule, it binds tightly to its target with the precision of a biologic, even showing superior potential in head-to-head data against Ustekinumab.
• No Heavy Monitoring: It features a clean safety profile with no liver metabolism, no drug-drug interactions, and no strict requirements for routine tuberculosis (TB) re-testing.
• Adolescent-Friendly: It can be dissolved in 4 ounces of water, making it a highly accessible option for patients aged 12 and up who struggle with swallowing pills or fear needles.

3. The GLP-1 Wave in Inflammatory Skin Disease

With the explosion of GLP-1 receptor agonists for weight loss, the intersections between obesity, metabolic syndrome, and psoriasis are becoming impossible to ignore.

While GLP-1 receptors are highly expressed within psoriatic plaques, science suggests they aren't the primary drivers of the skin disease itself. Instead, the connection is deeply systemic. Pediatric data show that over 90% of children with a strong family history of psoriasis develop obesity before their skin lesions manifest.

Should Derm Providers Prescribe GLP-1s?

Dr. Hawkes notes that while the dermatology specialty doesn't necessarily need to manage every comorbidity, providers shouldn't shy away from the conversation.

"I don't think it's any harder than medications like cyclosporine, methotrexate, or acitretin. These are pretty straightforward medications."

— Dr. Jason Hawkes

If a patient with severe psoriasis lacks a primary care provider to manage their metabolic risks, initiating GLP-1 therapy or using teledermatology networks can bridge a critical gap in holistic patient care.

4. Ultra-Long-Acting Biologics: Convenience vs. Control

The innovation pipeline is moving toward exceptionally long half-lives—potentially reducing dosing schedules to just once a year. While a "once-a-year psoriasis shot" sounds ideal, it introduces unique clinical hurdles:

• Unextractable Side Effects: If a patient experiences an adverse event (such as oral or esophageal candidiasis with IL-17 blockers), an ultra-long half-life means the side effect could linger for months.
• The Clinical Trial Bottleneck: Standard trial protocols require a 5-half-life washout period before enrollment in a new study. For a drug with a 75-day half-life, a patient would have to wait over a year to switch into a trial, complicating real-world clinical transitions.
• Psychological Control: Many patients simply prefer a "fast-on, fast-off" oral drug (like JAK inhibitors or Remibrutinib) because it gives them the autonomy to pause therapy ahead of a major surgery or illness.

Uping Our Game

The days of choosing blindly between Drug A, B, or C are over. As dermatology therapeutics become more sophisticated, clinicians must master the underlying basic science to navigate shared decision-making effectively.

We might not have a Matrix-style plug to download this data directly into our brains yet, but staying engaged with the latest clinical trials ensures patients get the personalized, cutting-edge care they deserve.

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