Strata Skin Sciences Q1 2024 Earnings Report

Strata Skin Sciences EPS Results

• Actual EPS: -$1.00
• Consensus EPS: N/A
• Beat/Miss: N/A
• One Year Ago EPS: N/A

Strata Skin Sciences Revenue Results

• Actual Revenue: $6.75 million
• Expected Revenue: N/A
• Beat/Miss: N/A
• YoY Revenue Growth: N/A

Strata Skin Sciences Announcement Details

• Quarter: Q1 2024
• Date: 5/15/2024
• Time: N/A
• Conference Call Date: Wednesday, May 15, 2024
• Conference Call Time: 4:30PM ET

Strata Skin Sciences (NASDAQ:SSKN) is a medical technology company headquartered in Edison, New Jersey, that specializes in developing and commercializing dermatological devices and therapies. The company’s flagship offering is the XTRAC® excimer laser system, an FDA‐cleared, 308-nanometer ultraviolet light device used to treat skin conditions such as vitiligo and psoriasis. Strata’s product suite also includes associated accessories and disposables, as well as clinical services and training programs designed to support dermatology practices and improve patient outcomes.

Strata Skin Sciences expanded its portfolio and market presence through the strategic acquisition of PhotoMedex in 2019, bringing together complementary phototherapy and energy-based technologies under one roof. This integration enabled the company to widen its geographic footprint, serving physicians and clinics across the United States and through select international distribution partners in Europe and Asia. Strata continues to invest in clinical research, product enhancements and next-generation platforms aimed at addressing a range of dermatologic disorders with noninvasive treatment modalities.

Under the leadership of Chairman and Chief Executive Officer David J. Peskin, Strata Skin Sciences maintains a direct sales force of clinical specialists who provide installation, training and ongoing support for its laser and light‐based systems. The company’s operational strategy focuses on fostering long-term partnerships with dermatology practices, promoting the adoption of its technologies through peer-reviewed publications, educational initiatives and real-world evidence studies. As a result, Strata has positioned itself as a focused provider of advanced phototherapy solutions within the skin disease market.

Strata Skin Sciences Q1 2024 Earnings Call Transcript

Key Takeaways

• DTC marketing ramp: Expanded into six regions generating over 500 patient appointments at under $300 cost each and under $40 cost per lead, versus just 21 appointments in Q1 2023 with no DTC spend.
• Extract device optimization: Removed 32 underperforming units and added 16 placements, resulting in 907 devices installed and targeting a jump in average gross recurring revenue per device from ~$21,000 to $30,000 to drive ~$8 million incremental high-margin revenue.
• Improved Q1 performance: Domestic gross recurring billings declined only 3% year-over-year—the smallest drop in seven quarters compared with 12–15% declines in prior periods.
• TheraClear X growth: Installed base grew from 92 to 104 clinics, with 47 submitting insurance reimbursement charts at a rate of 65 charts/week, tapping into a 50 million+ patient acne market.
• Cost control achievements: Reduced cash burn by 41% (~$1.1 million) and operating expenses by 14% (~$1 million) year-over-year, extending the company’s cash runway for its turnaround strategy.

Presentation

[Operator]

Good afternoon and welcome to the STRATA Skin Sciences, Inc. first quarter of 2024 financial results and corporate update conference call. At this time, all participants are in a listen-only mode. Should you need any assistance during the call, please signal a conference specialist by pressing the star key followed by 0. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press * then 1 on your telephone keypad, and to withdraw a question, please press * then 2. Participants of this call are advised that the audio of this conference call is being broadcast live over the internet and is also being recorded for playback purposes. A webcast replay of the call will be available approximately one hour after the end of the call through November 15, 2024.

[Operator]

With that, I'd like to turn the call over to Joey Delahoussaye. Please go ahead.

[Joey Delahoussaye, Head of Investor Relations at STRATA Skin Sciences, Inc.]

Good afternoon and thank you for participating in today's conference call. Earlier this afternoon, the company released its financial results for the quarter ended March 31, 2024. A copy of that press release can be found on the company's website at www.strataskinsciences.com under the Investors tab. Joining me on today's earnings call from STRATA Skin Sciences management team are Dr. Dolev Rafaeli, Chief Executive Officer, and Chris Lesovitz, Chief Financial Officer. During this call, management will be making forward-looking statements, including statements that address STRATA Skin Sciences' expectations for future performance or operational results. Forward-looking statements involve risks and other factors that may cause actual results to differ materially from those statements.

[Joey Delahoussaye, Head of Investor Relations at STRATA Skin Sciences, Inc.]

For more information about these risks, please refer to the risk factors described in STRATA Skin Sciences' most recently filed annual report on Form 10-K and subsequent periodic reports filed with the SEC and STRATA Skin Sciences press release that accompanies this call, particularly the cautionary statements in it. The content of this call contains time-sensitive information that is accurate only as of today, May 15, 2024. Except as required by law, STRATA Skin Sciences disclaims any obligation to publicly update or revise any information to reflect events or circumstances that occur after this call. It is now my pleasure to turn the call over to CEO Dr. Dolev Rafaeli.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

Thank you, Joey, and good afternoon for everyone on the call. During the first quarter, we continued to execute on the multifaceted turnaround strategy introduced when I was appointed CEO late last year. Clinical results using XTRAC are proven across the hundreds of thousands of patients treated for psoriasis, vitiligo, and eczema, and our strategy primarily focused on adjusting our XTRAC device placements and increasing our DTC marketing to drive XTRAC device utilization and recurring revenue per device over the coming quarters across our domestic installed base of approximately 900 devices. During my previous tenure here at STRATA, we have been successful with these strategies, and we feel comfortable driving similar results in 2024 and beyond.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

We started our DTC spend ramp-up at the beginning of the first quarter in a limited region of the country and expect to increase our marketing allocation to DTC in the coming quarters to drive patient appointments and expand the program into additional geographical areas. During the first quarter, we have expanded from our original four targeted areas to six and generated over 500 patient appointments at a cost per appointment of under $300 and a cost per lead of under $40. These metrics are in line with our previous DTC campaigns from my previous tenures and in stark contrast to the 21 appointments scheduled by STRATA in the first quarter of 2023 when the company did not apply DTC.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

These metrics are in line with those achieved in the first quarters of each 2019 and 2021 in which, with a full DTC spend budget across the nation, we achieved 1,900 and 1,800 appointments respectively after three quarters of ramp-up. The first quarters in each of those years followed periods of no DTC spend, and as a reminder, domestic gross recurring revenue in both 2019 and 2021 experienced strong double-digit growth. Another strategic initiative is optimizing our XTRAC device placements. We have some underperforming dermatology partners, so instead of staying saddled with underperforming assets, we constantly consider removing these devices from such clinics and placing the devices in other dermatology clinics that have demonstrated the potential for higher utilization. Higher utilization is a benefit for both the clinic and STRATA Skin Sciences, so we are always looking to optimize our install base of XTRAC placements.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

The opportunity to increase utilization of our XTRAC devices from both increased DTC spend and a repositioning of underperforming devices is significant. Successful execution of our strategy could increase the average gross recurring revenue per device from approximately $21,000 in 2023 to $30,000, which we last enjoyed in fiscal 2019 right before the COVID pandemic. This transition will take some time, as a similar turnaround that started in mid-2018 resulted in the fourth quarter of 2019 reaching nearly $8,000 in gross recurring revenue per device. A return to these efficiencies across our installed base of over 900 devices could mean an incremental $8 million in high-margin revenue, allowing us to reach profitability and positive cash flow in the process. We have seen evidence that our domestic business may have already been positively impacted by our strategic initiatives and are encouraged by that we are on the right path.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

In the first quarter of 2024, our gross domestic recurring billings were down just 3% year over year, making that the smallest year-over-year decline in the past seven quarters since the end of the second quarter of 2022. During the most recent three quarters, from second quarter of 2023 to the fourth quarter of 2023, this metric was down 15%, 12%, and 14% respectively. Thus, this much smaller decline in gross domestic recurring billing of 3% in the first quarter of 2024 was a marked improvement, providing some optimism that this metric can turn positive in the upcoming quarters, further cementing the business turnaround.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

As part of our strategic turnaround, we successfully removed 32 XTRAC devices in the first quarter of 2024 and placed 16 devices into new accounts, including six that were placed into comeback accounts that represent clinics with existing excimer laser business that opted to re-engage with STRATA through our partnership model. These changes have resulted in a domestic recurring install base of 907 XTRAC devices at the end of the first quarter, down from 923 at the end of 2023. We expect this optimization to continue in the upcoming quarters. Beyond XTRAC, we continue growing our domestic install base of TheraClear X device through the implementation of our recurring revenue model. In the first quarter, we successfully grew the TheraClear X install base from 92 at the end of 2023 to104 at March 31, 2024.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

We are encouraged by the uptake of clinics beginning to use the Acne Surgery CPT code. The first quarter ended with 47 of the 104 clinics submitting Rx insurance reimbursement charts at a rate of 65 charts per week as compared to none in the same period previous quarters. There are over 50 million patients with acne in the U.S., and the unique and reimbursable underlying photopneumatic approach with TheraClear X can address limitations of existing acne treatments and drive reimbursable recurring revenue for our dermatology partners similar to the XTRAC model. Lastly, continued penetration in key international markets is also an objective for us. In late December 2023, we've extended our exclusive distribution agreement with our distributor in Korea, and in early April, we did the same with our exclusive distributors in China and Japan.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

International revenue typically accounts for approximately 30%-35% of our total revenue, and these three territories alone account for over 50% of those revenues. So to extend these long-lasting relationships is mutually beneficial for both sides. Going forward, we expect to see continued growth in our DTC marketing efforts, driving XTRAC utilization and gross domestic recurring billings, each of which are key components for us to demonstrate improved operating leverage and reaching profitability. A key initiative in this turnaround is our focus on cost controls. Notably, in the first quarter, we've reduced our cash burn by $1.1 million or 41% and our operating expenses by $1 million or 14% compared to last year.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

We talked about these collective strategies, strategic initiatives before, and we will continue discussing them in the future calls in future calls, as these tangible financial changes and results are proof of our commitment to narrowing our losses, extending the cash runway of the company, and becoming profitable. Now I'd like to turn the call over to Chris, who will review our financial results in much more detail. Chris?

[Christopher Lesovitz, CFO at STRATA Skin Sciences, Inc.]

Thank you, Dolev. Our total revenue for the first quarter of 2024 was $6.8 million versus $7.6 million in the first quarter of 2023. Revenue was negatively impacted by the deferred gross billings, lower domestic equipment revenue, and the discontinuation of StrataPen. Global recurring revenue for the first quarter of 2024 was $4.7 million versus $5.2 million in the first quarter of 2023. Excluding deferred billings and other GAAP adjustments, XTRAC gross domestic recurring billings were $4.6 million in the first quarter of 2024, down 3% from $4.7 million in the first quarter of 2023. Equipment revenue was $2.1 million in the first quarter of 2024 versus $2.4 million in the first quarter of 2023. International sales of XTRAC and VTRAC devices comprised the majority of the equipment revenue in both periods.

[Christopher Lesovitz, CFO at STRATA Skin Sciences, Inc.]

Gross profit decreased to $3.1 million for the three months ended March 31, 2024, from $4.4 million during the same period in 2023. As a percent of revenues, the gross profit was 45.6% for the three months ended March 31, 2024, as compared to 58% for the same period in 2023. The decrease in gross profit percentage was primarily the result of lower recognition of Q4 deferred revenue and Q1 from the prior year in the same period, higher depreciation costs due to more XTRAC lasers and new TheraClear X devices placed into service, higher material and production costs, and the write-off of obsolete Pharos inventory assets. Total operating expenses in the first quarter of 2024 were $6 million versus $7 million in the first quarter of 2023.

[Christopher Lesovitz, CFO at STRATA Skin Sciences, Inc.]

The decrease in operating expenses is a direct result of our right-sizing efforts and a purposeful leaner cost structure implemented in late 2023. Sales and marketing declined by approximately $725,000 year-over-year, and G&A declined by approximately $200,000 year-over-year. The goal is to return to a leaner cost structure last seen in 2019. Our cash, cash equivalents, and restricted cash position of $6.6 million at March 31, 2024, along with our modified credit facility with MidCap Financial, supports our growth initiatives and leaner cost structure. We continue to believe we can execute on our strategic goals for 2024 given our current financial position. As of March 31, 2024, the company had 35,060,920 common shares outstanding. That concludes my prepared remarks, and I'd like to turn the call back over to Dolev for any remaining comments.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

Thank you, Chris. With both XTRAC and TheraClear X, we have two solutions for the dermatology market that benefit patients, the dermatology clinics, and healthcare systems through reimbursed treatments, and of course, STRATA Skin. Our turnaround strategy is starting to take root, and some of the metrics in the first quarter, including narrowing decline in recurring revenues and a significant reduction in operating expenses, point to that. We have successfully right-sized our operating and corporate overhead, reemphasized the DTC growth engine domestically to drive device utilization, and anticipate adjusting our domestic XTRAC device footprint on a routine basis to remove devices from underperforming accounts and placing them with more promising accounts. We expect to be successful with our multi-pronged strategy, but as I've said before, it will take some time to reach the finish line and complete the turnaround.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

Our team and strategies are proven, and we are resolute in our drive. We thank our investors for their support and look forward to reporting continued corporate progress. Now I'd like to turn the call over to the operator so that we can begin the question-and-answer session. Operator?

[Operator]

We will now begin the question-and-answer session. To ask a question, you may press star, then one, on your telephone keypad. If you're using a speakerphone, please pick up your handset before pressing the keys. To withdraw a question, please press star, then two. At this time, we will pause momentarily to assemble our roster. Our first question here will come from Jeffrey S. Cohen with Ladenburg Thalmann & Company. Please go ahead.

[Jeffrey S. Cohen, Director of Research and Managing Director at Ladenburg Thalmann & Co. Inc.]

Hi, Dolev. And Chris, how are you?

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

Hi, Jeff. Good afternoon.

[Jeffrey S. Cohen, Director of Research and Managing Director at Ladenburg Thalmann & Co. Inc.]

I guess firstly, could you talk about or identify the region of the country you're referencing in DTC, and then maybe give us a sense of number of regions that you'll have in place, say, by the end of 2024?

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

Good question. So we anticipate to be covering all regions by the end of the year. We hope to get there by the middle of the third quarter in terms of DTC spend. We moved the needle up in terms of DTC spend based on efficiencies. We need to see the cost per lead and the cost per appointment remain within these ranges. We also need to see the uptake of these patients into the funnel and converting into patients in XTRAC treatment. And as we do that, we grow gradually. So as I said, end of Q2 or the middle of Q3 to be fully deployed.

[Jeffrey S. Cohen, Director of Research and Managing Director at Ladenburg Thalmann & Co. Inc.]

You're saying all regions this year?

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

Yes. I'm saying that by the end of this year, we're going to be advertising in all regions. I refer the listeners to the investor deck presentation that we have online, which shows the outcome of the first quarter in terms of patient leads in the New York City area, which was one of the four areas we advertised. That page has both the placements, so the devices in the market, as well as the patient leads. We anticipate the same visual to be in all other regions. These advertisements, these leads that come in that are converted into an appointment, the appointments happen two, three weeks later as these are being scheduled in, and then patients start to be treated. Revenue follows that with a couple of weeks. But yes, by the end of this year, we're going to be covering all regions.

[Jeffrey S. Cohen, Director of Research and Managing Director at Ladenburg Thalmann & Co. Inc.]

Okay. Got it. So could you talk about for a bit in kind of in a perfect world and what you're planning for, give us kind of a guesstimate of where you think XTRAC placements could be through Q2 at the end of the year, and the same with TheraClear?

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

I'll start with TheraClear, which we have, as I've detailed in previous calls, we have an inventory on hand of just about 200 devices. We would like to be in a position where by the end of this year or the first quarter of next year, we're going to be at or close to deploying all of these devices, so utilizing the inventory we own. The deployment of these devices, as we've outlined before, is mostly with accounts that are going to be using reimbursement. I'm saying mostly because not all of them do. These accounts need the patient flow to go through. As I've presented in my prepared remarks, we are now up to 65 new patients a week, which is a run rate of over 3,000 new patients for this new technology. This is only coming from 47 of the 104 accounts.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

So the rest of the accounts, 57 accounts, are still based. These accounts are still based on cash-paying patients. So that's with the TheraClear. And as we move forward throughout the year, we do anticipate to start talking about account utilization. And the same is with XTRAC, the replacement of existing devices in the market if we cannot get the throughput and the utilization from any one of these devices. And there was a press release that came out this week that discussed the nature of the accounts we go into. We mostly target existing XTRAC accounts and mostly with private equity-owned group roll-up clinics where we can have a clear understanding on how they're going to be utilizing the devices and how they're going to be utilizing the reimbursement codes.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

Because once we put our devices out there, the utilization is the only way utilization of the device is the only way where we can make money as well as they can make money. So that's with TheraClear. On XTRAC, we've ended 2023 with 923 devices deployed in the market, just over $5,000 per device average revenue per device for every quarter in 2023. As you can see from the numbers we put out, we actually took that number down to 907. We will continue the process of redeploying these devices, of taking them out from non-productive accounts, redeploying them with more productive accounts, and using the existing inventory without having to expand or build more devices into our own balance sheet before we fully utilize these 923 devices.

[Jeffrey S. Cohen, Director of Research and Managing Director at Ladenburg Thalmann & Co. Inc.]

Okay. Got it. And then just tie that in lastly, Dolev, for us, as far as these new accounts, talk a little bit about the funnel or the trends with regards to XTRAC, more importantly, as far as utilization trends, the funnel, and the upside. Is it coming on the utilization side, and how does that funnel of leads or new placements looking? Thank you.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

Funnel is most sorry, the utilization is the biggest upside we have because placing more devices is easy. With the approach that says we place the technology free of charge, we charge a fee per use, and there's no minimum charge, we can place as many devices as we want. But the outcome of that is higher depreciation, which we've started experiencing in 2022 and more so in 2023. That's why I'm replacing, repositioning these assets before we expand the number of assets we have in the market. Expanding utilization, we ended 2023 with just over $5,000 per device per quarter. Just for reference, we ended 2019 with $7,500. So the upside is about 50% in the recurring revenue. That's where the team is focused, both with the and we break the accounts by tiers.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

So both by working on Tier 1 and Tier 2 accounts, which are the big utilizers, and seeing what we can do to help them grow with either serving them patients through DTC or training or training of their staff, as well as working on the lower tiers to see if we can move accounts from Tier 5 up to Tier 3 and 4. Or if we can't move them up, we move them out, and we cut out from the bottom. That's Tier 5. And we try to move them up the tier ladder, if you wish. And we've outlined this in a press release earlier this week by saying that our best result would come from someone that has or had an existing excimer laser franchise, and they've owned the device, whether this was our device, XTRAC, or it was a Pharos device.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

In the last quarter, we placed 60 new devices, six of which were into accounts that had previously owned an excimer laser and had a business. The reason we are mostly seeking these accounts, and there are about 250 of these in the market, is that they have an existing business. We don't need to build them from scratch. We come in, and we grandfather an existing business. What we need to do is provide them the technology, the training, the support, the reimbursement support, and so on. It gives us a head start on taking a new account and starting from scratch.

[Jeffrey S. Cohen, Director of Research and Managing Director at Ladenburg Thalmann & Co. Inc.]

Got it. Okay. Perfect. That does it for us. Thanks for taking the questions.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

Thank you, Jeff.

[Operator]

And again, if you have a question, you may press star, then one, to join the queue. This will conclude our question-and-answer session. I'd like to now turn the conference back over to Dr. Dolev Rafaeli for any closing remarks.

[Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.]

I want to thank all of you for participating in today's call and for your interest in STRATA Skin Sciences. We look forward to sharing our progress on our next quarterly conference call when we report our second quarter 2024 financial results, likely in July of 2024. Thank you, and have a good day.

[Operator]

The conference has now concluded. Thank you for attending today's presentation. You may now disconnect your lines.

Participants

Analysts

• Christopher Lesovitz, CFO at STRATA Skin Sciences, Inc.
• Dolev Rafaeli, CEO at STRATA Skin Sciences, Inc.
• Jeffrey S. Cohen, Director of Research and Managing Director at Ladenburg Thalmann & Co. Inc.
• Joey Delahoussaye, Head of Investor Relations at STRATA Skin Sciences, Inc.