A newsletter that delivers the latest in dermatology research directly to you.
One Hundred and FOURTEENTH issue
JULY 8th, 2026
GLP-1 receptor agonist use and clinical outcomes in patients with hidradenitis suppurativa
JAMA Dermatology
JAMA Dermatology
GLP-1s keep collecting new job titles...
Hidradenitis suppurativa (HS) is an inflammatory skin condition that carries an elevated risk of cardiovascular morbidity and mortality. GLP-1 receptor agonists (GLP-1RAs) have shown cardiometabolic benefits in type 2 diabetes and are suspected to be beneficial in related inflammatory conditions. This retrospective cohort study used the TriNetX federated EHR network to examine the effects of GLP-1RA on clinical outcomes for patients with HS. They specifically compared adults with HS who received at least two GLP-1RA prescriptions against a matched comparison group with no GLP-1RA use, examining mortality and systemic complications through 1 and 2 years of follow-up.
What did they find?
Hidradenitis suppurativa (HS) is an inflammatory skin condition that carries an elevated risk of cardiovascular morbidity and mortality. GLP-1 receptor agonists (GLP-1RAs) have shown cardiometabolic benefits in type 2 diabetes and are suspected to be beneficial in related inflammatory conditions. This retrospective cohort study used the TriNetX federated EHR network to examine the effects of GLP-1RA on clinical outcomes for patients with HS. They specifically compared adults with HS who received at least two GLP-1RA prescriptions against a matched comparison group with no GLP-1RA use, examining mortality and systemic complications through 1 and 2 years of follow-up.
What did they find?
- GLP-1RA use was associated with markedly lower all-cause mortality at 1 year (HR = 0.29; 95% CI = 0.23 - 0.37) and 2 years (HR = 0.36; 95% CI = 0.30 - 0.43).
- Major adverse cardiovascular events (MACE) were also reduced at 1 year (HR = 0.70; 95% CI = 0.59 - 0.81) and 2 years (HR = 0.79; 95% CI = 0.70 - 0.89).
- Consistent reductions were seen across both follow-up periods for cellulitis, sepsis, acute kidney injury, dialysis initiation, and suicidal ideation or attempts, with hazard ratios ranging roughly from 0.33 to 0.74 depending on outcome and timepoint.
- In patients without obesity, hazard ratios were directionally consistent with those in the primary analysis, but the associations did not reach statistical significance. This likely reflects limited statistical power within this smaller subgroup.
One visible clue. One potentially important diagnosis.
Androgenetic alopecia (AGA) has been linked to metabolic syndrome and cardiovascular disease, but its relationship with diabetes mellitus (DM) remains controversial. In this large population-based cross-sectional study, investigators evaluated 11,968 adults in Southern China to determine whether AGA is independently associated with DM and other cardiovascular risk factors, with a focus on age-specific differences.
What did they find?
Androgenetic alopecia (AGA) has been linked to metabolic syndrome and cardiovascular disease, but its relationship with diabetes mellitus (DM) remains controversial. In this large population-based cross-sectional study, investigators evaluated 11,968 adults in Southern China to determine whether AGA is independently associated with DM and other cardiovascular risk factors, with a focus on age-specific differences.
What did they find?
- AGA was independently associated with diabetes in adults < 45 years, even after multivariable adjustment (OR = 1.66, 95% CI = 1.21–2.27, p = 0.002).
- AGA was also associated with impaired fasting glucose (OR = 1.45, 95% CI = 1.11–1.89, p = 0.006) and elevated HbA1c ≥6.5% (OR = 1.65, 95% CI = 1.16–2.34, p = 0.006).
- The association between AGA and diabetes was age-dependent, with a significant age-diabetes interaction (p < 0.001) and no independent association observed in adults >45 years after adjustment.
- Although AGA was associated with obesity, hypertension, and dyslipidemia in unadjusted analyses, these associations were no longer significant after multivariable adjustment.
There's an app for that, but should there be?
Skin cancer is the most common cancer worldwide, and early detection is critical, particularly for melanoma. AI-based smartphone apps like SkinVision have been marketed as screening tools, but independent real-world validation data are sparse. This prospective single-center diagnostic accuracy study enrolled 1,458 adults presenting to a dermatology early-access clinic with a lesion of concern between February 2021 and June 2023, assessing the SkinVision app's convolutional neural network (CNN) against dermatologist-determined diagnosis across 1,904 lesions.
What did they find?
Main Takeaway: In the largest independent prospective validation to date, the SkinVision app showed moderate sensitivity and specificity under ideal conditions, with substantially worse performance in users' hands, missing nearly a third of melanomas overall. These findings underscore that rigorous independent clinical validation must precede widespread deployment of AI diagnostic tools.
Skin cancer is the most common cancer worldwide, and early detection is critical, particularly for melanoma. AI-based smartphone apps like SkinVision have been marketed as screening tools, but independent real-world validation data are sparse. This prospective single-center diagnostic accuracy study enrolled 1,458 adults presenting to a dermatology early-access clinic with a lesion of concern between February 2021 and June 2023, assessing the SkinVision app's convolutional neural network (CNN) against dermatologist-determined diagnosis across 1,904 lesions.
What did they find?
- Image capture failed in 16.6% of lesions (n/N = 317/1,904) under optimal conditions (90° angle, artificial light, researcher-taken), mostly due to hair, difficult anatomical locations, or hypopigmented lesions. Of these cases, 19 (6.0%, n/N = 19/317) were skin cancers (1 melanoma, 2 SCCs, 16 BCCs).
- The CNN achieved a sensitivity of 82.5% (95% CI = 75.9 - 88.0) and specificity of 76.8% (95% CI = 74.6 - 79.0) for skin cancer detection. False positives were most common among vascular lesions (54%) and inflammatory lesions (45%).
- Adding in-app teledermatology review increased specificity to 86.8% (95% CI = 85.0 - 88.6, p < 0.001) but reduced sensitivity to 75.3% (95% CI = 68.0 - 81.7, p < 0.05). 10 of 32 melanomas (31%) were ultimately missed.
- In a subgroup of 160 lesions, altering the photo angle from 90º to 45º decreased the rate of successfully captured lesions from 84.4% (n=135/160) to 56.3% (n=90/160) (p < 0.001). Diagnostic performance also varied significantly across smartphone models (p < 0.001 for specificity differences).
Main Takeaway: In the largest independent prospective validation to date, the SkinVision app showed moderate sensitivity and specificity under ideal conditions, with substantially worse performance in users' hands, missing nearly a third of melanomas overall. These findings underscore that rigorous independent clinical validation must precede widespread deployment of AI diagnostic tools.
Metformin's side hustle is calming down topical steroid withdrawal
Topical steroid withdrawal (TSW) is a controversial diagnosis describing adverse reactions following discontinuation of topical corticosteroid (TCS) treatment for atopic dermatitis (AD), with patient reports of severe, systemic adverse reactions. Recent studies have highlighted ways in which AD and TSW differ, but studies examining mechanistic differences between the two have been lacking. The authors re-analyzed survey data from 1,889 patients to clinically distinguish TSW from non-TSW, then conducted a pilot study of 16 TSW patients using skin biopsy multi-omics, cell and mouse models, and an open-label trial of mitochondrial complex I inhibitors.
What did they find?
Topical steroid withdrawal (TSW) is a controversial diagnosis describing adverse reactions following discontinuation of topical corticosteroid (TCS) treatment for atopic dermatitis (AD), with patient reports of severe, systemic adverse reactions. Recent studies have highlighted ways in which AD and TSW differ, but studies examining mechanistic differences between the two have been lacking. The authors re-analyzed survey data from 1,889 patients to clinically distinguish TSW from non-TSW, then conducted a pilot study of 16 TSW patients using skin biopsy multi-omics, cell and mouse models, and an open-label trial of mitochondrial complex I inhibitors.
What did they find?
- In a reanalysis of survey data from 1,889 patients with eczematous skin disease, patients with TSW reported burning, flushing, neuropathic pain, and thermodysregulation, clinically distinguishing them from atopic dermatitis patients.
- Metabolomics and transcriptomics of lesional skin biopsies from the 16-patient TSW cohort showed elevated NAD+ oxidation, driven by overexpression of mitochondrial complex I and increased conversion of tryptophan into neurotoxic kynurenine metabolites, compared to AD patients and healthy controls.
- Topical glucocorticoid methylprednisolone aceponate was applied to the arms of 19 healthy controls, and skin biopsies revealed upregulation of mitochondrial complex I just four hours after steroid application.
- Open-label treatment with mitochondrial complex I inhibitors metformin and berberine for 3–5 months resulted in TSW symptom improvement, including reduced itch, faded rashes, and shorter, less severe flares, with recovery occurring significantly faster than expected based on time since symptom onset (p = 0.012).
Spoiler alert: It’s not just a skin thing.
Among the dystrophic epidermolysis bullosa (EB) subtypes, recessive dystrophic epidermolysis bullosa inversa (RDEB-I) presents with blisters and erosions that primarily affect flexural skin sites and often persist on mucosal surfaces. Mucosal involvement contributes significantly to the clinical burden of RDEB-I, yet characterization of its overall impact in RDEB-I remains limited. This retrospective study of a multidisciplinary EB center assessed multisystemic mucosal disease, complications, and procedural interventions in ten patients with RDEB-I.
What did they find?
Main Takeaway: Multisystemic mucosal involvement is highly prevalent in RDEB-I and worsens disease morbidity, necessitating the incorporation of mucosal assessment in RDEB-I treatment approaches.
Among the dystrophic epidermolysis bullosa (EB) subtypes, recessive dystrophic epidermolysis bullosa inversa (RDEB-I) presents with blisters and erosions that primarily affect flexural skin sites and often persist on mucosal surfaces. Mucosal involvement contributes significantly to the clinical burden of RDEB-I, yet characterization of its overall impact in RDEB-I remains limited. This retrospective study of a multidisciplinary EB center assessed multisystemic mucosal disease, complications, and procedural interventions in ten patients with RDEB-I.
What did they find?
- Oral, esophageal, and anorectal involvement were observed in 100% (10/10) of patients, followed by otologic (80%, 8/10), genitourinary (70%, 7/10), and ocular disease (40%, 4/10).
- On average, patients had 13.2 mucosal complications across organ systems, most commonly recurrent dysphagia (100%, 10/10), radiographic strictures (90%, 9/10), dental loss (90%, 9/10), ankyloglossia (90%, 9/10), constipation (80%, 8/10), painful defecation (80%, 8/10), and bleeding during defecation (80%, 8/10).
- In total, patients required 124 procedures (mean = 12.4), including esophageal dilation (90%, 9/10), operative dental procedures (70%, 7/10), and various interventions for all affected organ systems, except ocular.
- 60% (6/10) of patients experienced procedural complications, notably post-esophageal dilation (50%, 5/10), where 70% (7/10) of episodes resolved without care escalation.
Main Takeaway: Multisystemic mucosal involvement is highly prevalent in RDEB-I and worsens disease morbidity, necessitating the incorporation of mucosal assessment in RDEB-I treatment approaches.
When your healthcare could have just been an email!
For patients with chronic diseases such as atopic dermatitis (AD), access to prompt dermatologic care remains a challenge. Researchers evaluated whether a team-based connected health (TCH) teledermatology model could provide outcomes similar to traditional in-person care. This randomized clinical trial included 300 adults and children with AD from 8 California dermatology clinics (2019-2024). Participants were randomized 1:1 to online TCH or in-person management, and outcomes were assessed over 12 months.
What did they find?
Main Takeaway: A structured teledermatology model achieved equivalent clinical outcomes to traditional office visits for atopic dermatitis. These findings support expanding team-based connected health programs as an effective strategy to improve access to dermatologic care without sacrificing quality.
For patients with chronic diseases such as atopic dermatitis (AD), access to prompt dermatologic care remains a challenge. Researchers evaluated whether a team-based connected health (TCH) teledermatology model could provide outcomes similar to traditional in-person care. This randomized clinical trial included 300 adults and children with AD from 8 California dermatology clinics (2019-2024). Participants were randomized 1:1 to online TCH or in-person management, and outcomes were assessed over 12 months.
What did they find?
- Online care was equivalent to in-person care for improvement in eczema severity measured by eczema area and severity index (EASI) (between-group difference = −0.01, 95% CI = −0.22 - 0.20).
- Patient-reported symptoms measured with the patient-oriented eczema measure (POEM) were also equivalent between groups (difference = 0.38, 95% CI = 0.03 – 0.73).
- Validated investigator global assessment (vIGA) showed equivalent clinical improvement with online care (difference = 0.06, 95% CI = 0.00 – 0.11).
- The findings suggest that a team-based teledermatology model can deliver comparable outcomes to in-person visits for chronic AD management while expanding access to specialty care.
Main Takeaway: A structured teledermatology model achieved equivalent clinical outcomes to traditional office visits for atopic dermatitis. These findings support expanding team-based connected health programs as an effective strategy to improve access to dermatologic care without sacrificing quality.
Momordin lc alleviates inflammation and skin barrier dysfunction of atrophic dermatitis in vitro and in vivo
Integrative Dermatology
Integrative Dermatology
When your skin barrier is held together by hopes, prayers… and plants
Atopic dermatitis (AD) is characterized by chronic inflammation, intense pruritus, and impaired skin barrier function. This preclinical study investigated Momordin Ic, a pentacyclic triterpenoid saponin isolated from Kochia scoparia L. (Kochiae Fructus), a traditional Chinese medicinal plant historically used to treat pruritic skin disorders. Researchers evaluated its effects in an MC903-induced mouse model of AD and in TNF-α/IFN-γ-stimulated HaCaT keratinocytes, assessing clinical severity, inflammatory signaling, and skin barrier proteins.
What did they find?
Main Takeaway: Momordin Ic, a bioactive constituent of Kochiae Fructus, demonstrated both anti-inflammatory and skin barrier-restoring effects through modulation of the JAK1/STAT3 and TRPA1 pathways. These findings support further investigation of this phytochemical as a potential therapeutic candidate for atopic dermatitis, although clinical studies are needed before translation to patient care.
Atopic dermatitis (AD) is characterized by chronic inflammation, intense pruritus, and impaired skin barrier function. This preclinical study investigated Momordin Ic, a pentacyclic triterpenoid saponin isolated from Kochia scoparia L. (Kochiae Fructus), a traditional Chinese medicinal plant historically used to treat pruritic skin disorders. Researchers evaluated its effects in an MC903-induced mouse model of AD and in TNF-α/IFN-γ-stimulated HaCaT keratinocytes, assessing clinical severity, inflammatory signaling, and skin barrier proteins.
What did they find?
- Oral Momordin Ic (12.5 or 25 mg/kg) significantly improved AD-like disease in MC903-treated mice, reducing ear swelling, dermatitis scores, scratching behavior, epidermal thickness, and mast cell infiltration, compared with untreated mice (all p < 0.05 to p < 0.001).
- Momordin Ic suppressed multiple Th2- and barrier-associated inflammatory mediators, including IL-4, IL-13, IL-6, TLR4, TSLP, and TRPA1, while also reducing JAK1 and STAT3 phosphorylation, suggesting inhibition of a central inflammatory signaling pathway (all p < 0.05 to p < 0.001).
- Treatment restored the tight junction proteins ZO-1 and occludin in both mouse skin and TNF-α/IFN-γ-stimulated HaCaT keratinocytes, indicating improved epidermal barrier integrity (all p < 0.05 to p < 0.001).
- In TNF-α/IFN-γ-stimulated HaCaT cells, Momordin Ic reduced iNOS and COX-2 expression without significant cytotoxicity at concentrations ≤25 μM, supporting both anti-inflammatory and barrier-protective effects.
Main Takeaway: Momordin Ic, a bioactive constituent of Kochiae Fructus, demonstrated both anti-inflammatory and skin barrier-restoring effects through modulation of the JAK1/STAT3 and TRPA1 pathways. These findings support further investigation of this phytochemical as a potential therapeutic candidate for atopic dermatitis, although clinical studies are needed before translation to patient care.
“Beauty is pain,” but is it worth it?
Skin bleaching is the use of chemical, botanical, or pharmacologic agents to inhibit melanogenesis to achieve a lighter complexion, often derived from colorist hierarchies that associated it with privilege, desirability, and opportunity, and is now amplified by media and marketing influences today. The prevalence of skin bleaching has risen, and many studies examine the multisystemic spectrum of complications from the early, late, and withdrawal phases of skin bleaching. This narrative review explores the evolving trends in skin bleaching, along with complications and potential interventions to address this persistent global health concern.
What did they find?
Main Takeaway: Skin bleaching is more than a cosmetic choice; it's a dangerous public health crisis fueled by deep-rooted colorism and a lack of regulatory oversight that can cause several multisystemic complications. Addressing this issue requires governments and clinicians to work together to combine strict policy enforcement against toxic agents with public awareness efforts to dismantle harmful beauty standards and protect global populations.
Skin bleaching is the use of chemical, botanical, or pharmacologic agents to inhibit melanogenesis to achieve a lighter complexion, often derived from colorist hierarchies that associated it with privilege, desirability, and opportunity, and is now amplified by media and marketing influences today. The prevalence of skin bleaching has risen, and many studies examine the multisystemic spectrum of complications from the early, late, and withdrawal phases of skin bleaching. This narrative review explores the evolving trends in skin bleaching, along with complications and potential interventions to address this persistent global health concern.
What did they find?
- A meta-analysis of 68 studies spanning 5 continents reported that 27.1% of African and 23.1% of Asian respondents used skin bleaching products regularly, and there had been a reported increase in use among African, Afro-Caribbean, and Asian populations in Europe and North America, with prevalence ranges of 15-30%.
- Traditional agents, including hydroquinine, mercury, and topical corticosteroids, are associated with well-documented cutaneous and systemic complications. Yet these remain the most widely used and available in online marketplaces despite regulatory restrictions in many regions.
- Skin bleaching causes dermatological complications, including exogenous ochronosis, steroid-induced atrophy, telangiectasia, acneiform eruptions, and more, which often result in irreversible disfigurement.
- Systemic complications include nephrotoxicity, hepatotoxicity, adrenal insufficiency, hypertension, diabetes, neurotoxicity, and menstrual irregularities.
Main Takeaway: Skin bleaching is more than a cosmetic choice; it's a dangerous public health crisis fueled by deep-rooted colorism and a lack of regulatory oversight that can cause several multisystemic complications. Addressing this issue requires governments and clinicians to work together to combine strict policy enforcement against toxic agents with public awareness efforts to dismantle harmful beauty standards and protect global populations.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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