One Hundred and second issue
JANUARY 21st, 2026
Risk models without immunosuppression? Bold choice.
Cutaneous squamous cell carcinoma (cSCC) is more frequent and aggressive in immunosuppressed patients, but whether immunosuppression (IS) itself predicts outcomes beyond tumor stage has been debated. This international, multi-center retrospective cohort included 11,930 patients with 18,760 primary cSCCs (12 institutions, 1991–2023), and tested whether IS independently predicts poor outcomes after adjustment for key clinical and pathologic factors.
What did they find?
Main Takeaway: For many Latine patients with HS, disparities extend beyond access to dermatology, but to whether care addresses the daily realities of the disease. This study identifies three actionable priorities: integrating wound care and pain management into HS care, reducing experiences that discourage care-seeking, and improving patient-centered communication, particularly with interpreters.
Cutaneous squamous cell carcinoma (cSCC) is more frequent and aggressive in immunosuppressed patients, but whether immunosuppression (IS) itself predicts outcomes beyond tumor stage has been debated. This international, multi-center retrospective cohort included 11,930 patients with 18,760 primary cSCCs (12 institutions, 1991–2023), and tested whether IS independently predicts poor outcomes after adjustment for key clinical and pathologic factors.
What did they find?
- Among 24 Latine adults with HS (median age 37.5 years; 71% female; 46% Spanish-preferring; 79% Hurley stage 2–3), three major themes emerged:
- Theme 1: Gaps in wound care and pain management
- Limited guidance from dermatology teams led patients to rely on trial-and-error self-care, with substantial burden managing supplies, drainage, and pain outside the clinic.
- Theme 2: Perceived discrimination drives avoidance of care
- Patients reported feeling dismissed or judged based on race/ethnicity, language, income, gender, or appearance, eroding trust and contributing to delayed follow-up or disengagement from care.
- Theme 3: Interpreter-mediated communication limits patient-centered care
- Use of phone or video interpreters reduced emotional nuance and clarity around pain and lived experience, leading some patients to limit dermatology visits or shift care to Spanish-speaking primary care clinicians.
Main Takeaway: For many Latine patients with HS, disparities extend beyond access to dermatology, but to whether care addresses the daily realities of the disease. This study identifies three actionable priorities: integrating wound care and pain management into HS care, reducing experiences that discourage care-seeking, and improving patient-centered communication, particularly with interpreters.
Safety and efficacy of ICP-332 for moderate to severe atopic dermatitis: A phase 2 randomized clinical trial
JAMA Dermatology
JAMA Dermatology
Not all JAKs are created equal — this one TYK2s the itch out early.
Atopic dermatitis (AD) is a chronic inflammatory skin disease driven by complex immune dysregulation, classically involving type 2 cytokines, but increasingly recognized to include type 1 and type 17 pathways as well. While oral JAK inhibitors are effective for moderate-to-severe AD, safety concerns and black box warnings have limited their use. Tyrosine kinase 2 (TYK2) inhibition offers a more selective immune-modulating approach that avoids broader JAK pathway suppression. This phase 2 randomized clinical trial evaluated the safety and efficacy of ICP-332, an oral TYK2 inhibitor, in adults with moderate-to-severe AD.
What did they find?
Atopic dermatitis (AD) is a chronic inflammatory skin disease driven by complex immune dysregulation, classically involving type 2 cytokines, but increasingly recognized to include type 1 and type 17 pathways as well. While oral JAK inhibitors are effective for moderate-to-severe AD, safety concerns and black box warnings have limited their use. Tyrosine kinase 2 (TYK2) inhibition offers a more selective immune-modulating approach that avoids broader JAK pathway suppression. This phase 2 randomized clinical trial evaluated the safety and efficacy of ICP-332, an oral TYK2 inhibitor, in adults with moderate-to-severe AD.
What did they find?
- Mean eczema area and severity index (EASI) improvement reduction at week 4 was -78.2% (80 mg) and -72.5% (120 mg) vs. -16.7% with placebo (P < .001).
- 64% of patients in both ICP-332 groups achieved EASI < 75 at week 4 compared with 4% in the placebo group (P < .001).
- Significant reductions in pruritus severity and frequency were seen as early as day 2 in ICP-332 patients (P < .001).
- No serious adverse events were reported; the most common adverse event was decreased fibrinogen (average of 44% with 80 mg, 21% with 120 mg dose).
Late-onset HS has higher risk of comorbidities but showed no difference in severity compared to early-onset HS
BJD
BJD
All this waiting for HS research is aging me…
Hidradenitis suppurativa (HS) is a chronic, inflammatory disease characterized by painful abscesses and draining tracts, typically within intertriginous areas. Current literature describes a bimodal distribution, but has yet to clearly characterize the disease based on age of onset. This retrospective study analyzed 404 HS patients diagnosed at National Taiwan University Hospital (2006–2022) to compare clinical features by age of onset.
What did they find?
Main Takeaway: HS shows a bimodal distribution. Late-onset disease differs in anatomic involvement and has higher cardiometabolic and renal comorbidity, but age at onset was not associated with greater disease severity by Hurley stage.
Hidradenitis suppurativa (HS) is a chronic, inflammatory disease characterized by painful abscesses and draining tracts, typically within intertriginous areas. Current literature describes a bimodal distribution, but has yet to clearly characterize the disease based on age of onset. This retrospective study analyzed 404 HS patients diagnosed at National Taiwan University Hospital (2006–2022) to compare clinical features by age of onset.
What did they find?
- Late-onset HS was less likely to involve axilla [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.39–0.98] and nuchal areas [OR 0.39; 95% CI 0.17–0.89].
- Late-onset HS was more likely to be associated with diabetes mellitus [OR 4.48; 95% CI 2.04–9.83], hypertension [OR 3.36; 95% CI 1.58–7.14], hyperlipidaemia [OR 8.42; 95% CI 3.41–20.79], chronic kidney disease [OR 6.69; 95% CI 1.30–37.22] and gout [OR 8.91; 95% CI 1.76–45.27].
- There were no significant differences in Hurley stage between age groups.
Main Takeaway: HS shows a bimodal distribution. Late-onset disease differs in anatomic involvement and has higher cardiometabolic and renal comorbidity, but age at onset was not associated with greater disease severity by Hurley stage.
Combining 308nm excimer laser with upper hair follicle transplantation to treat refractory vitiligo
Innovation/Scoop
Innovation/Scoop
New Year, New Treatment for Vitiligo
Vitiligo is an autoimmune disease in which melanocytes are destroyed, producing well-demarcated, depigmented patches. Hair follicle transplantation can restore pigment by supplying melanocyte progenitor cells, but new hair growth may not be desirable at some cosmetic sites. A newer approach combines upper hair follicle transplantation (UHFT) with a 308 nm excimer laser to trigger inactive melanocyte progenitor cells (MelPCs) to differentiate and migrate into the epidermis without transplanting the follicular bulb, minimizing unwanted hair growth. This study evaluates the UHFT plus 308 nm excimer protocol and reports repigmentation and safety outcomes in patients with stable vitiligo.
What did they find?
Main Takeaway: UHFT plus 308 nm excimer achieved high repigmentation rates without unwanted hair growth, supporting this as a promising, tissue-sparing option for vitiligo.
Vitiligo is an autoimmune disease in which melanocytes are destroyed, producing well-demarcated, depigmented patches. Hair follicle transplantation can restore pigment by supplying melanocyte progenitor cells, but new hair growth may not be desirable at some cosmetic sites. A newer approach combines upper hair follicle transplantation (UHFT) with a 308 nm excimer laser to trigger inactive melanocyte progenitor cells (MelPCs) to differentiate and migrate into the epidermis without transplanting the follicular bulb, minimizing unwanted hair growth. This study evaluates the UHFT plus 308 nm excimer protocol and reports repigmentation and safety outcomes in patients with stable vitiligo.
What did they find?
- 18 patients with 22 vitiligo lesions stable for greater than 1 year and Vitiligo Disease Score < 0 were included.
- UHFT harvested using a follicular unit extractor for the occipital or postauricular hairline donor site.
- The vitiliginous lesions received 0.6 mm punches at 0.3 cm intervals, with the donor extraction implanted into the punches.
- At 1 week, follicles were removed and 308 nm excimer started twice weekly for 12 weeks (initial 100–300 mJ/cm², increased 10–20% per session).
- At 24-week follow-up, 12 lesions had a repigmentation rate of >75%, 5 had 51-75%, 2 showed 26%-50%, and 3 showed < 25%.
Main Takeaway: UHFT plus 308 nm excimer achieved high repigmentation rates without unwanted hair growth, supporting this as a promising, tissue-sparing option for vitiligo.
What unmet needs are reported by dermatologists caring for underserved populations globally?
Global Derm
Global Derm
~Checking off~ the steps to improve global dermatologic care
The number of dermatology-trained providers varies significantly within countries, with a higher concentration typically present in urban areas. Consequently, communities in remote and underserved settings often experience disparities in access. Few studies have characterized global dermatologic care in under-resourced settings and the specific needs of these populations. This cross-sectional study surveyed 537 dermatology-trained providers across 83 countries who care for underserved populations, to characterize care delivery and unmet needs.
What did they find?
Main Takeaway: High-frequency and high-volume engagers, especially those working or living in LMICs, are pivotal in caring for underserved communities and call for systems-level solutions in workforce expansion, funding, education, and practical tools like teledermatology and AI.
The number of dermatology-trained providers varies significantly within countries, with a higher concentration typically present in urban areas. Consequently, communities in remote and underserved settings often experience disparities in access. Few studies have characterized global dermatologic care in under-resourced settings and the specific needs of these populations. This cross-sectional study surveyed 537 dermatology-trained providers across 83 countries who care for underserved populations, to characterize care delivery and unmet needs.
What did they find?
- 84% were board-certified dermatologists, 8% other healthcare providers, 2% medical students, and 1% industry professionals.
- Providers most often served low-income (60%), elderly (54%), and rural/remote/urban underserved (44%) groups, mainly through provider education (73%), patient education (66%), and outreach clinics (40%).
- Compared with high-income countries, providers from low- and middle-income countries (LMICs) were more likely to deliver care to rural/remote/urban underserved populations (P < 0.01).
- High-volume engagers caring for >1,000 underserved patients annually most commonly utilized patient education (P < 0.01), outreach clinics (P < 0.01), and teledermatology (P = 0.01).
- Most frequently reported needs were affordable care (75%), more dermatologists (50%), and educational resources for providers (43%).
- Most desired interventions included financial support (62%), patient education (48%), provider training materials (47%), access to AI tools (42%), and product donations (42%).
Main Takeaway: High-frequency and high-volume engagers, especially those working or living in LMICs, are pivotal in caring for underserved communities and call for systems-level solutions in workforce expansion, funding, education, and practical tools like teledermatology and AI.
Distinguishing features of lichen sclerosis and non-accidental trauma and recognizing co-occurrence
Peds Derm
Peds Derm
Clearing up the confusion and not making rash judgments
Lichen sclerosus (LS) is a chronic autoimmune inflammatory condition that predominantly affects the anogenital region and occurs in both prepubertal girls and postmenopausal women. In children, its nonspecific presentation can make diagnosis challenging and may be confused with non-accidental trauma (NAT), including suspected sexual abuse. Misdiagnosis can have serious emotional, social, and legal consequences. This systematic review aimed to identify distinguishing clinical features to improve diagnostic accuracy when pediatric LS and NAT are both considered.
What did they find?
Main Takeaway: LS and sexual abuse are not mutually exclusive. Recognizing differentiating clinical features, documenting carefully, and using multidisciplinary evaluation can reduce misdiagnosis and its consequences for children and families.
Lichen sclerosus (LS) is a chronic autoimmune inflammatory condition that predominantly affects the anogenital region and occurs in both prepubertal girls and postmenopausal women. In children, its nonspecific presentation can make diagnosis challenging and may be confused with non-accidental trauma (NAT), including suspected sexual abuse. Misdiagnosis can have serious emotional, social, and legal consequences. This systematic review aimed to identify distinguishing clinical features to improve diagnostic accuracy when pediatric LS and NAT are both considered.
What did they find?
- 25 studies, including 146 patients, met inclusion criteria. Eighty-nine percent had a final diagnosis of LS.
- Among those ultimately diagnosed with sexual abuse (11%), a known offender within the family was reported in 6 of 13 cases with available data, and withdrawn or hypersexualized behavior was reported in 5 of 16.
- Hymenal disruption or scarring consistent with trauma was more common in abused patients (8 of 13 with available examinations).
Main Takeaway: LS and sexual abuse are not mutually exclusive. Recognizing differentiating clinical features, documenting carefully, and using multidisciplinary evaluation can reduce misdiagnosis and its consequences for children and families.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.