Tildrakizumab, a humanized monoclonal antibody targeting the p19 subunit of interleukin-23, has demonstrated durable efficacy and a favorable long-term safety profile in moderate-to-severe plaque psoriasis. However, patients encountered in clinical practice frequently have comorbidities, treatment barriers, and social circumstances that are underrepresented in randomized clinical trials. This case review describes 16 patients treated with tildrakizumab across clinically relevant populations, including older adults, patients with cardiometabolic disease or complex medical comorbidities, and individuals with unique treatment considerations. Across these cases, tildrakizumab was associated with substantial improvement in psoriasis, including involvement of high-impact sites such as the scalp, nails and intertriginous regions. Durable disease control was observed in patients with prior malignancy, chronic infection, hepatic disease, cardiovascular comorbidities, polypharmacy, and prior biologic failure, without treatment-limiting adverse events attributed to tildrakizumab. In-office administration and every-12-week maintenance dosing also offered practical advantages for patients facing Medicare-related access considerations, self-injection aversion, inconsistent healthcare access, or adherence challenges. These cases demonstrate how tildrakizumab may be integrated into individualized psoriasis management and highlight its potential as a practical, effective, and well-tolerated treatment option across diverse real-world clinical settings.

Ammonium lactate is a well-established, time-tested dermatologic therapy with a substantial body of clinical evidence supporting its use in xerotic and hyperkeratotic skin conditions. Although its use in routine practice has evolved over time, interest in ammonium lactate has been renewed by advances in the understanding of lactate biology and its role in skin physiology. Xerosis is characterized by reduced water content, impaired corneocyte turnover, and structural disruption of the stratum corneum, leading to scaling, roughness, and discomfort. As a pH-balanced source of L-lactic acid, ammonium lactate exerts biomimetic effects, aligning with physiologic skin processes. This pHdependent delivery allows effective lactic acid activity at clinically relevant concentrations while maintaining a favorable tolerability profile. Emerging insights into the role of lactate as both a natural moisturizing factor component and a regulator of epidermal function provide a more contemporary framework for understanding its clinical activity. Through combined humectant and desquamating activity, ammonium lactate boosts moisture balance, surface smoothness, and overall skin quality. Clinical evidence supports its use in conditions including ichthyosis, atopic dermatitis, psoriasis, keratosis pilaris, acanthosis nigricans, as well as visible "ashiness", a distinct clinical feature associated with xerosis in skin of color. Treatment outcomes are influenced by concentration, formulation, and disease severity, endorsing a tailored therapeutic approach. This review provides a clinically focused framework for the use of ammonium lactate, positioning it as a versatile and physiologically aligned treatment option within contemporary dermatologic practice. &nbsp.

The stratum corneum (SC) is essential for maintaining skin barrier integrity through coordinated interactions between corneocytes, intercellular lipids, and natural moisturizing factors (NMFs). Lactate is a key NMF component that contributes to hydration, pH regulation, and enzymatic activity within the SC. Recent advances in understanding the distinctions between lactate, lactic acid, and ammonium lactate have clarified their respective roles within the skin, providing a novel framework for their clinical use. The use of ammonium lactate, a pH-balanced source of L-lactic acid, in skincare offers a biomimetic approach to restoring skin barrier function. Its activity is governed by pH-dependent equilibrium and diffusion processes within the SC, enabling targeted availability of L-lactic acid in superficial layers where xerotic changes are most pronounced. Mechanisms of action include humectant effects, normalization of desquamation, and support of epidermal homeostasis. Clinical relevance extends across xerotic and hyperkeratotic conditions, including atopic dermatitis, ichthyosis, and psoriasis, as well as in skin of color, where xerosis may present as visible ashy skin. Benefit has also been shown in conditions such as acanthosis nigricans. This review summarizes the mechanistic and clinical rationale supporting ammonium lactate as a physiologically aligned and increasingly well-characterized therapeutic option. &nbsp.