A newsletter that delivers the latest in dermatology research directly to you.
One Hundred and EIGHTEENTH issue
September 2nd, 2026
Brepocitinib: the key to rapid, durable skin control in dermatomyositis?
Cutaneous disease, including heliotrope rash, Gottron papules, and photosensitive poikiloderma, is a major cause of morbidity in dermatomyositis. Sustained remission is rare even with aggressive, multimodal standard therapy. This secondary analysis of the 52-week phase 3 VALOR trial (N = 241 adults with dermatomyositis, 90 sites in 20 countries) tested brepocitinib, a first-in-class oral TYK2 and JAK1 inhibitor, on cutaneous disease activity, itch, skin-related quality of life, and remission-level outcomes in patients with dermatomyositis.
What did they find?
Main Takeaway: Once-daily brepocitinib provided rapid and sustained improvement in dermatomyositis, with meaningful benefits noted in skin disease severity, itch, quality of life, and corticosteroid use.
Cutaneous disease, including heliotrope rash, Gottron papules, and photosensitive poikiloderma, is a major cause of morbidity in dermatomyositis. Sustained remission is rare even with aggressive, multimodal standard therapy. This secondary analysis of the 52-week phase 3 VALOR trial (N = 241 adults with dermatomyositis, 90 sites in 20 countries) tested brepocitinib, a first-in-class oral TYK2 and JAK1 inhibitor, on cutaneous disease activity, itch, skin-related quality of life, and remission-level outcomes in patients with dermatomyositis.
What did they find?
- By week 52, significantly more patients treated with brepocitinib had a clinically meaningful improvement in the severity of skin disease compared with placebo (61.7% vs 44.3%, p = 0.04). The treatment effect was also rapid, with benefits evident as early as week 4.
- Itch improved rapidly with brepocitinib, with twice as many patients achieving itch remission by week 4 compared with placebo (38.3% vs 19.0%). By week 52, most patients with moderate to severe itch had substantial improvement.
- Brepocitinib nearly doubled the proportion of patients who achieved clear or almost clear skin compared with placebo (45.7% vs 21.8%). Improvements in quality of life were also evident by week 4 and continued through week 52.
- Brepocitinib reduced corticosteroid use more than placebo, with more patients able to taper to low doses or discontinue corticosteroids entirely.
Main Takeaway: Once-daily brepocitinib provided rapid and sustained improvement in dermatomyositis, with meaningful benefits noted in skin disease severity, itch, quality of life, and corticosteroid use.
Nail unit squamous cell carcinoma: A multicenter, retrospective study of the clinical and morphologic characteristics of 261 patients
JAAD
JAAD
Not every abnormal nail deserves watchful waiting.
Nail unit squamous cell carcinoma (NSCC) is the most common nail malignancy, but its variable presentation can lead to delayed diagnosis and progression to invasive disease. In this large multicenter retrospective study, investigators evaluated 269 NSCC tumors in 261 patients to characterize the clinical features associated with in situ (NSCCis) versus invasive NSCC (iNSCC) and assess HPV associations, treatment patterns, and recurrence.
What did they find?
Main Takeaway: Nail unit SCC has distinct clinical features that may help distinguish in situ from invasive disease. Subungual oozing is an important predictor of invasion, while pain and loss of nail plate production should further raise suspicion for advanced disease.
Nail unit squamous cell carcinoma (NSCC) is the most common nail malignancy, but its variable presentation can lead to delayed diagnosis and progression to invasive disease. In this large multicenter retrospective study, investigators evaluated 269 NSCC tumors in 261 patients to characterize the clinical features associated with in situ (NSCCis) versus invasive NSCC (iNSCC) and assess HPV associations, treatment patterns, and recurrence.
What did they find?
- Nearly half of NSCCs were invasive (45.0%), and the mean time to diagnosis was 3.1 years.
- Subungual ooze independently predicted invasive NSCC, with approximately 4-fold higher odds of invasion (OR = 3.98, 95% CI = 1.19-13.2, p = 0.025).
- Pain and loss of nail plate production were more common in invasive disease (43.8% vs 27.0%, p = 0.022; 50.4% vs 32.4%, p = 0.004).
- Koilocytosis was identified in 32.2% of tumors with available HPV-related histology and was more common in NSCCis than iNSCC (p = 0.015); periungual tumors were also more likely to show koilocytosis (p = 0.049).
Main Takeaway: Nail unit SCC has distinct clinical features that may help distinguish in situ from invasive disease. Subungual oozing is an important predictor of invasion, while pain and loss of nail plate production should further raise suspicion for advanced disease.
The early bird gets the worm but also clearer skin!
Atopic dermatitis (AD) is the most common inflammatory disease of childhood and is often the initial manifestation of the "atopic march", preceding food allergy, asthma and rhinitis. This prospective Danish birth cohort (BABY study) followed 389 children (261 term, 128 preterm) from birth to age 4–5 years, comparing the prevalence, onset, severity and persistence of AD and allergic comorbidities.
What did they find?
Atopic dermatitis (AD) is the most common inflammatory disease of childhood and is often the initial manifestation of the "atopic march", preceding food allergy, asthma and rhinitis. This prospective Danish birth cohort (BABY study) followed 389 children (261 term, 128 preterm) from birth to age 4–5 years, comparing the prevalence, onset, severity and persistence of AD and allergic comorbidities.
What did they find?
- Preterm-born children had a markedly lower prevalence of AD than term-born children (19.2% vs. 39.8%, p < 0.001), with later onset (median 12.0 vs. 7.5 months, p < 0.01), milder severity (median EASI 1.4 vs. 4.8, p < 0.01), and less persistent disease (11.5% vs. 19.9%, p < 0.001).
- In adjusted Cox regression, preterm birth remained associated with a lower hazard of AD compared with term birth (HR = 0.37, 95% CI = 0.02-0.68, p < 0.01).
- Among children who developed AD, no preterm-born children (0%) developed food allergy, compared with 6.7% of term-born children with AD.
- Asthma was more common among preterm-born children with AD than term-born children with AD (36.0% vs. 17.3%, p = 0.05), while rhinitis prevalence was similar between groups (8.0% vs. 7.7%).
Not all responses to IL-17 are created equally in inflammatory skin disorders.
Psoriasis and hidradenitis suppurativa (HS) are both type 17 inflammatory skin diseases that respond to IL-17 and TNF blockade. Psoriasis is largely epidermal, whereas HS involves deep dermal inflammation with follicular occlusion, fibrosis, and tunnels. The authors developed two complementary mouse models then used single-cell transcriptomics, CellChat cell–cell communication analysis, and cell-type-specific IL-17RA deletion to compare the roles of fibroblasts versus keratinocytes in disease pathogenesis.
What did they find?
Main Takeaway: Inflammatory patterns and cell targets of IL-17 depend on the disease, as fibroblasts primarily drive dermal/HS-like inflammation, while both fibroblasts and keratinocytes are needed for epidermal/psoriasis-like inflammation, providing context for how IL-17 targeted therapies are treating distinct pathologies.
Psoriasis and hidradenitis suppurativa (HS) are both type 17 inflammatory skin diseases that respond to IL-17 and TNF blockade. Psoriasis is largely epidermal, whereas HS involves deep dermal inflammation with follicular occlusion, fibrosis, and tunnels. The authors developed two complementary mouse models then used single-cell transcriptomics, CellChat cell–cell communication analysis, and cell-type-specific IL-17RA deletion to compare the roles of fibroblasts versus keratinocytes in disease pathogenesis.
What did they find?
- Intradermal IL-17/TNF injection produced significantly greater neutrophil infiltration than topical IMQ across multiple measures, including percent neutrophils of CD45⁺ cells, percent of total live cells, and total neutrophil counts (p < 0.01 for all comparisons), with inflammation localized to the deep dermis (HS-like) rather than the epidermis (psoriasis-like, as with IMQ).
- Network analysis identified fibroblasts as the dominant communication hub in both human HS and IL-17/TNF-injected mouse skin, whereas both fibroblasts and keratinocytes showed strong network activity in human psoriasis and IMQ-treated mouse skin.
- In the IMQ (epidermal/psoriasis) model, deleting IL-17RA in either fibroblasts or keratinocytes equally reduced epidermal thickness and neutrophilia compared with controls (p < 0.05), while, in the intradermal IL-17/TNF (dermal/HS) model, only fibroblast-specific IL-17RA deletion significantly reduced epidermal thickening and neutrophilia (p < 0.01).
- Fibroblasts and keratinocytes activated largely non-overlapping, disease-specific gene expression patterns downstream of IL-17 activation, and this fibroblast-biased gene signature was selectively enriched in human HS skin compared with psoriasis (p < 0.0001).
Main Takeaway: Inflammatory patterns and cell targets of IL-17 depend on the disease, as fibroblasts primarily drive dermal/HS-like inflammation, while both fibroblasts and keratinocytes are needed for epidermal/psoriasis-like inflammation, providing context for how IL-17 targeted therapies are treating distinct pathologies.
Hepatitis B immunity in children on immunomodulators: Implications from a pediatric dermatology cohort and review of the literature
Peds Derm
Peds Derm
HBV titers, anyone? Going, going, gone!
Hepatitis B Virus (HBV) can progress to liver cirrhosis, failure, and cancer, with immunocompromised patients often experiencing poorer outcomes. Despite the HBV vaccine, prior research has found that HBV serologic immunity wanes over time in some individuals, posing concerns for those initiating immunomodulatory therapy. Although guidelines exist for HBV immunity testing in the adult population, pediatric guidelines for these circumstances are lacking. This study analyzed anti-HBV titers in a cohort of 23 pediatric dermatology patients on immunomodulatory therapies and characterized current evidence on screening and revaccination recommendations in this context.
What did they find?
Main Takeaway: HBV serologic immunity wanes over time in pediatric patients, with implications for screening standards prior to initiation of immunomodulatory therapies. Refined guidelines for screening and revaccination in this patient population are necessary to inform management.
Hepatitis B Virus (HBV) can progress to liver cirrhosis, failure, and cancer, with immunocompromised patients often experiencing poorer outcomes. Despite the HBV vaccine, prior research has found that HBV serologic immunity wanes over time in some individuals, posing concerns for those initiating immunomodulatory therapy. Although guidelines exist for HBV immunity testing in the adult population, pediatric guidelines for these circumstances are lacking. This study analyzed anti-HBV titers in a cohort of 23 pediatric dermatology patients on immunomodulatory therapies and characterized current evidence on screening and revaccination recommendations in this context.
What did they find?
- 10 of the 23 (43%) patients lacked evidence of HBV serologic immunity, though 0 patients had a history of HBV infection before or after starting immunomodulatory medication.
- Antimetabolite/folate antagonists were prescribed most commonly (8/23, 35%), followed by TNF-α inhibitors (7/23, 30%) and JAK inhibitors (4/23, 17%).
- The most prevalent dermatologic disorders treated with immunomodulators were psoriasis (9/23, 39%), hidradenitis suppurativa (6/23, 26%), atopic dermatitis (4/23, 17%), and alopecia areata/universalis (3/23, 13%).
- The current literature recommends screening for HBV prior to initiating immunomodulatory treatments via extrapolated adult guidelines, and studies on revaccination in pediatric patients without robust anti-HBV titers are inconsistent.
Main Takeaway: HBV serologic immunity wanes over time in pediatric patients, with implications for screening standards prior to initiation of immunomodulatory therapies. Refined guidelines for screening and revaccination in this patient population are necessary to inform management.
Turns out your odds of seeing a dermatologist depend a lot on your ZIP code.
Despite a heavy global burden of skin disease, little comprehensive data describe who actually provides dermatologic care and where those clinicians are located. This study aimed to characterize global dermatologist workforce density, training availability, and access to general and subspecialty dermatologic careacross WHO member states.
What did they find?
Main Takeaway: There are major global inequities in dermatologic care, with the greatest workforce, training, and infrastructure shortages concentrated in lower-income countries. Expanding regional training, improving rural retention, and equipping primary care and other frontline clinicians to manage common skin diseases will likely be essential to closing the gap.
Despite a heavy global burden of skin disease, little comprehensive data describe who actually provides dermatologic care and where those clinicians are located. This study aimed to characterize global dermatologist workforce density, training availability, and access to general and subspecialty dermatologic careacross WHO member states.
What did they find?
- Dermatologist availability differed dramatically by wealth and geography. Mean density was 5.05 dermatologists/100,000 people in high-income countries (HICs) vs 0.37/100,000 in low-income countries (LICs) (p < 0.001); Europe averaged 6.00/100,000 compared with just 0.26/100,000 in Africa (p < 0.001).
- The authors estimated 175,633 dermatologists worldwide (95% prediction interval = 173,598 - 177,668), but calculated that approximately 5.63 dermatologists/100,000 people were needed for adequate access. Only 17% of countries met this threshold, and HICs had nearly 9-fold greater odds of meeting it (OR = 8.84, 95% CI = 3.42 - 22.83).
- Access problems went beyond raw dermatologist numbers: 42% of countries reported inadequate or extremely poor general dermatologic access, 48% reported inadequate specialist access, and 79% of dermatologists worked in urban areas. Urban concentration increased as national income decreased, reaching 91% in LICs (p < 0.001).
- Training disparities may perpetuate the workforce gap: 21% of responding countries lacked dermatology training programs, including 46% of African-region countries. Training-program density was 0.004/100,000 in LICs vs 0.044/100,000 in HICs (p < 0.001).
Main Takeaway: There are major global inequities in dermatologic care, with the greatest workforce, training, and infrastructure shortages concentrated in lower-income countries. Expanding regional training, improving rural retention, and equipping primary care and other frontline clinicians to manage common skin diseases will likely be essential to closing the gap.
Effect of Golden Wanhong Ointment on wound microbiota in patients with diabetic foot ulcer
Integrative Dermatology
Integrative Dermatology
Traditional Chinese medicine is ready to take diabetic foot ulcers out
Diabetic foot ulcers are sustained in part by persistent inflammation and wound-microbiome dysbiosis, which can promote biofilm formation while impairing tissue repair. This prospective study evaluated the efficacy of a two-week treatment with Golden Wanhong Ointment, also known as Zi lian Gao, a topical formulation containing Lithospermum erythrorhizon, Coptis chinensis, Rehmannia glutinosa, Angelica sinensis, Scutellaria baicalensis, Polygonum cuspidatum, Sanguisorba officinalis, borneol, and other components for diabetic foot ulcers.
What did they find?
Main Takeaway: Two weeks of Golden Wanhong Ointment dressings were associated with reduced wound size and pain, modestly lower inflammatory marker levels, and measurable changes in the diabetic foot ulcer microbiome. Controlled trials are needed to determine whether the ointment itself improves healing.
Diabetic foot ulcers are sustained in part by persistent inflammation and wound-microbiome dysbiosis, which can promote biofilm formation while impairing tissue repair. This prospective study evaluated the efficacy of a two-week treatment with Golden Wanhong Ointment, also known as Zi lian Gao, a topical formulation containing Lithospermum erythrorhizon, Coptis chinensis, Rehmannia glutinosa, Angelica sinensis, Scutellaria baicalensis, Polygonum cuspidatum, Sanguisorba officinalis, borneol, and other components for diabetic foot ulcers.
What did they find?
- Wound area decreased over two weeks. Mean wound area declined from 30.25 ± 28.29 cm² to 19.00 ± 18.93 cm²—a reduction of approximately 37% (p < 0.001).
- Pain scores improved substantially. Mean visual analog scale scores decreased from 5.68 ± 1.05 to 3.35 ± 1.05, representing a 2.33-point reduction (p < 0.001).
- Inflammatory markers decreased, although the absolute changes were modest. Serum IL-6 declined from 42.66 ± 14.66 to 39.14 ± 15.77 pg/mL, while TNF-α decreased from 72.92 ± 35.60 to 67.53 ± 37.12 pg/mL (p < 0.001).
- The overall composition of the wound microbiome shifted. Among more than 4.5 million high-quality sequencing reads, the relative abundance of Proteobacteria decreased while Firmicutes increased. Bacteroidota and Actinobacteriota did not change significantly.
- Several infection-associated genera became less abundant. Relative abundances of Klebsiella, Proteus, Prevotella, and Escherichia–Shigella decreased after treatment, with particularly pronounced reductions in Prevotella and Escherichia–Shigella.
Main Takeaway: Two weeks of Golden Wanhong Ointment dressings were associated with reduced wound size and pain, modestly lower inflammatory marker levels, and measurable changes in the diabetic foot ulcer microbiome. Controlled trials are needed to determine whether the ointment itself improves healing.
Skin IMIDs can’t stop won’t stop
The societal impact of immune-mediated inflammatory diseases (IMIDs) of the skin can significantly affect individuals’ lives in multiple overlapping psychosocial and work domains. This systematic review synthesizes data from 196 studies spanning 45 different countries to examine the burden imposed on work productivity, work status, and work life of common skin IMIDs (psoriasis, atopic dermatitis, hidradenitis suppurativa, alopecia areata, and vitiligo) globally.
What did they find?
The societal impact of immune-mediated inflammatory diseases (IMIDs) of the skin can significantly affect individuals’ lives in multiple overlapping psychosocial and work domains. This systematic review synthesizes data from 196 studies spanning 45 different countries to examine the burden imposed on work productivity, work status, and work life of common skin IMIDs (psoriasis, atopic dermatitis, hidradenitis suppurativa, alopecia areata, and vitiligo) globally.
What did they find?
- The majority of studies (68.5%) suggest impaired work productivity through income, performance, and profits, which may increase with disease severity, as measured through validated tools.
- Some studies (12.8%) measured the unfavorable impacts on work status (days off work, access to labor market, discrimination), with higher unemployment rates in samples of patients with hidradenitis suppurativa and psoriasis compared to matched controls.
- Skin IMIDs directly affect occupational trajectories. Patients with atopic dermatitis and psoriasis report that their condition poses a moderate-to-strong professional burden, with unemployed patients citing it as the sole reason for being out of work. Notably, patients with severe psoriasis are 1.8 times more likely to be unemployed than those with mild disease.
- 10.7% of studies measured the impacts of skin IMIDs on work life, highlighting elevated burnout symptoms, diminished work-related quality of life, stigma, discrimination, and mental burden in work contexts, demonstrating the impact on psychosocial well-being in patients’ work lives.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.