A newsletter that delivers the latest in dermatology research directly to you.
seventy-Eight issue
February 5, 2025
Baricitinib or NB-UVB for severe vitiligo… Why not both?
Vitiligo, a chronic autoimmune disorder, causes skin depigmentation and reduced quality of life. Baricitinib, a Janus kinase (JAK) 1/2 inhibitor, shows promise in immune-mediated skin diseases. This multicenter, double-blind randomized clinical trial evaluated the efficacy and safety of baricitinib combined with narrowband UV-B phototherapy in 49 adults with severe, active, nonsegmental vitiligo. Patients were randomized 3:1 to baricitinib (4 mg/day) or placebo for 36 weeks. The first 12 weeks involved baricitinib or placebo alone, followed by baricitinib + NB-UVB twice weekly from weeks 12 to 36.
What did they find?
Main Takeaway: This proof-of-concept trial suggests baricitinib + NB-UVB may reduce disease activity and promote repigmentation in extensive, active vitiligo. Findings support baricitinib as a potential adjunct to phototherapy, offering a promising treatment for severe vitiligo.
Vitiligo, a chronic autoimmune disorder, causes skin depigmentation and reduced quality of life. Baricitinib, a Janus kinase (JAK) 1/2 inhibitor, shows promise in immune-mediated skin diseases. This multicenter, double-blind randomized clinical trial evaluated the efficacy and safety of baricitinib combined with narrowband UV-B phototherapy in 49 adults with severe, active, nonsegmental vitiligo. Patients were randomized 3:1 to baricitinib (4 mg/day) or placebo for 36 weeks. The first 12 weeks involved baricitinib or placebo alone, followed by baricitinib + NB-UVB twice weekly from weeks 12 to 36.
What did they find?
- Mean total VASI (Vitiligo Area Scoring Index) score decreased by 44.8% in the baricitinib + NB-UVB group vs. a 9.2% decrease in the placebo group.
- This reduction was not significantly greater than the 42.9% repigmentation threshold observed with NB-UVB alone.
- However, post hoc analyses showed a significant difference between baricitinib + NB-UVB and placebo + NB-UVB (P =0.02).
- Improvement in disease activity and quality of life was greater in the baricitinib group compared to placebo.
- Adverse events were comparable between groups, indicating an acceptable safety profile.
Main Takeaway: This proof-of-concept trial suggests baricitinib + NB-UVB may reduce disease activity and promote repigmentation in extensive, active vitiligo. Findings support baricitinib as a potential adjunct to phototherapy, offering a promising treatment for severe vitiligo.
Pityriasis versicolor epidemiology, disease predictors, and health care utilization: Analysis of 32,679 cases in a large commercial insurance database
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Pityriasis Versicolor: So common, it’s practically the ~chameleon~ of skin conditions!
Pityriasis versicolor (PV) is a common fungal skin infection caused by Malassezia, typically presenting as hypo- and hyperpigmented patches on the neck, trunk, and arms. Despite its prevalence, detailed epidemiological research on PV remains scarce. Given the widespread use of antifungals for PV, improved epidemiological insights are needed to guide antifungal stewardship. This study analyzed outpatient PV cases from 2022 in a commercial insurance database.
What did they find?
Main Takeaway: This large-scale study highlights the characteristics and prevalence of PV. While antifungal prescriptions were frequent, diagnostic testing for PV, as recommended by current American Academy of Dermatology guidelines, was low.
Pityriasis versicolor (PV) is a common fungal skin infection caused by Malassezia, typically presenting as hypo- and hyperpigmented patches on the neck, trunk, and arms. Despite its prevalence, detailed epidemiological research on PV remains scarce. Given the widespread use of antifungals for PV, improved epidemiological insights are needed to guide antifungal stewardship. This study analyzed outpatient PV cases from 2022 in a commercial insurance database.
What did they find?
- Among 11,805,800 outpatients in the insurance database, 32,679 were newly diagnosed with PV (incidence: 2.8 per 1,000 person-years), highest in 18- to 24-year-olds (5.0) and males (3.2).
- PV was strongly associated with acne (OR: 2.61), rosacea (2.44), anorexia nervosa (1.48), hidradenitis suppurativa (1.29), and immunocompromising conditions (1.24), while hypothyroidism (0.93) and diabetes mellitus (0.78) were inversely associated.
- Dermatologists saw almost half, 44.9%, of patients with PV, while 21.9% visited general practitioners, 15.4% nurse practitioners/physician assistants, and 5.7% pediatricians.
- Diagnostic testing occurred in 8.5% of cases, mainly biopsies (5.5%), with dermatologists conducting the most testing (13.5%) and pediatricians the least (0.7%).
- Antifungals were prescribed to 67.7% of patients, primarily by dermatologists (71.9%); 56.3% received topical treatments (ketoconazole: 47.9%, selenium sulfide: 4.0%, ciclopirox: 3.3%), while 23.7% received oral antifungals (fluconazole: 18.6%, ketoconazole: 3.0%, terbinafine: 1.2%).
Main Takeaway: This large-scale study highlights the characteristics and prevalence of PV. While antifungal prescriptions were frequent, diagnostic testing for PV, as recommended by current American Academy of Dermatology guidelines, was low.
Nevus subtypes and their respective melanoma risks
Journal of Investigative Dermatology
Journal of Investigative Dermatology
To excise, or not to excise...
Melanoma can develop from existing moles, prompting dermatologists to remove suspicious moles based on clinical and dermoscopic features. However, these techniques same techniques are typically not used in histopathologic examinations. Ex vivo dermoscopy and derm dotting (EVD-DD) enables the integration of dermoscopic features into histopathological assessment. Using EVD-DD, researchers analyzed 7,364 nevi, classifying them into 12 subtypes and examining their correlation with patient demographics, histopathological atypia, and melanoma association.
What did they find?
Main Takeaway: Ex vivo dermoscopy and derm dotting, a technique used to preserve dermoscopic features during histopathological examination, can be beneficial in assessing the melanoma risk in nevi.
Melanoma can develop from existing moles, prompting dermatologists to remove suspicious moles based on clinical and dermoscopic features. However, these techniques same techniques are typically not used in histopathologic examinations. Ex vivo dermoscopy and derm dotting (EVD-DD) enables the integration of dermoscopic features into histopathological assessment. Using EVD-DD, researchers analyzed 7,364 nevi, classifying them into 12 subtypes and examining their correlation with patient demographics, histopathological atypia, and melanoma association.
What did they find?
- Hypermelanotic nevus was the most common subtype (46%), while atypical lentiginous nevus was the least common (1%).
- Atypical lentiginous nevi were four times more likely to be associated with a positive melanoma history compared to other subtypes (OR: 3.61 95% CI [2.18-5.89]).
- Histopathological atypia varied by subtype, with severe atypia most common in atypical lentiginous (48%) and pulverocytic flat nevi (9%).
- Melanoma occurrence was highest in atypical lentiginous and pulverocytic flat nevi (OR: 14.26 95% CI [8.11-26.86] and 55.66 [24.1-158.75], respectively).
Main Takeaway: Ex vivo dermoscopy and derm dotting, a technique used to preserve dermoscopic features during histopathological examination, can be beneficial in assessing the melanoma risk in nevi.
Differential expression of p53 in Mycosis fungoides, Sezary syndromes, and their transformed forms
British Journal of Dermatopathology
British Journal of Dermatopathology
Transformation trepidation
Mycosis fungoides (MF) and Sezary syndrome (SS) are subtypes of primary cutaneous T-cell lymphoma, sharing similar histopathologic features. 25-30% of cases progress into MF/SS with large cell transformation (LCT), which is associated with a worse prognosis. Diagnosing MF/SS with LCT is challenging due to clinical heterogeneity and lack of specific immunohistochemical markers. However, previous studies have shown that TP53 is often mutated in MF and SS. Researchers retrospectively compared p53 expression in MF (n=25), SS (n=11), MF-LCT (n=7), and SS-LCT (n=5) skin biopsies to assess the utility of p53 as a diagnostic tool.
What did they find?
Main Takeaway: P53 overexpression with a 30% cut-off is a potential tool to distinguish MF/SS from MF/SS with large cell transformation and to differentiate untransformed MF from SS.
Mycosis fungoides (MF) and Sezary syndrome (SS) are subtypes of primary cutaneous T-cell lymphoma, sharing similar histopathologic features. 25-30% of cases progress into MF/SS with large cell transformation (LCT), which is associated with a worse prognosis. Diagnosing MF/SS with LCT is challenging due to clinical heterogeneity and lack of specific immunohistochemical markers. However, previous studies have shown that TP53 is often mutated in MF and SS. Researchers retrospectively compared p53 expression in MF (n=25), SS (n=11), MF-LCT (n=7), and SS-LCT (n=5) skin biopsies to assess the utility of p53 as a diagnostic tool.
What did they find?
- Receiver Operating Characteristic curve analysis identified a 30% cut-off to define p53 overexpression with a sensitivity of 83% and specificity of 89%.
- Overexpression of p53 was observed more often in MF-LCT and SS-LCT groups compared to MF and SS groups (47% vs 12%, P<0.01).
- Staining intensity of p53 was higher in MF/SS groups with LCT (average staining 2+) compared to untransformed MF/SS groups (average staining 1+).
- In untransformed samples, p53 overexpression was seen more often in MF compared to SS (23% vs 7%, P<0.01).
Main Takeaway: P53 overexpression with a 30% cut-off is a potential tool to distinguish MF/SS from MF/SS with large cell transformation and to differentiate untransformed MF from SS.
Can nanofat transform postburn scars?
Journal of Dermatologic Surgery
Journal of Dermatologic Surgery
Turning scars into stars with a little help from nanofat magic!
Postburn scars can cause aesthetic concerns, functional limitations, and psychological distress. This study explored autologous nanofat injections, rich in adipose-derived stem cells (ADSCs), for scar improvement. Thirty patients with postburn scars underwent liposuction, with harvested fat processed into nanofat and injected into scars. Outcomes were assessed using the Vancouver Scar Scale (VSS) and Antera 3D imaging after 4 months of treatment.
What did they find?
Main Takeaway: Autologous nanofat injections are a potential safe and effective method for enhancing the appearance and functionality of postburn scars, with significant improvements in scar pliability, pigmentation, and vascularity.
Postburn scars can cause aesthetic concerns, functional limitations, and psychological distress. This study explored autologous nanofat injections, rich in adipose-derived stem cells (ADSCs), for scar improvement. Thirty patients with postburn scars underwent liposuction, with harvested fat processed into nanofat and injected into scars. Outcomes were assessed using the Vancouver Scar Scale (VSS) and Antera 3D imaging after 4 months of treatment.
What did they find?
- VSS scores significantly improved, with average scores decreasing from 9.4 to 6.1.
- Scars <2 mm increased from 3.3% to 43.3%, while scars >5 mm decreased from 46.7% to 10%.
- Normal pigmentation increased from 13.3% to 50%, and normal vascularity rose from 3.3% to 33.3%.
- In terms of patient satisfaction, 86.6% reported moderate to excellent improvement.
Main Takeaway: Autologous nanofat injections are a potential safe and effective method for enhancing the appearance and functionality of postburn scars, with significant improvements in scar pliability, pigmentation, and vascularity.
Male hair thinning improves with nutraceutical supplement
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
Thinning Hair? Time to Botani-cure it!
Hair thinning is a common concern for many men, often influenced by hormones, stress, and metabolism. This 6-month double-blind, placebo-controlled study investigates the effects of a nutraceutical supplement on hair growth and quality. 85 participants were randomly assigned to either the hair nutraceutical or placebo group, taking four daily capsules. Assessments at baseline, Day 90, and Day 180, included physical exams, questionnaires, hair pull tests, and photos. Results were rated on a 7-point scale based on improvement from baseline.
What did they find?
Main Takeaway: Nutraceutical supplements significantly enhance hair growth and quality without affecting sexual function.
Hair thinning is a common concern for many men, often influenced by hormones, stress, and metabolism. This 6-month double-blind, placebo-controlled study investigates the effects of a nutraceutical supplement on hair growth and quality. 85 participants were randomly assigned to either the hair nutraceutical or placebo group, taking four daily capsules. Assessments at baseline, Day 90, and Day 180, included physical exams, questionnaires, hair pull tests, and photos. Results were rated on a 7-point scale based on improvement from baseline.
What did they find?
- Statistically significant improvement in hair growth ratings was observed in the nutraceutical group compared to placebo at Day 180 (P<0.01).
- At Day 90, 57% of subjects in the nutraceutical group reported improvement, which increased to 79% by Day 180 (P < 0.05).
- In the questionnaires, the nutraceutical group reported significantly better results than the placebo group when asked, "How effective do you think the treatment has been in slowing down your hair loss?" with 85% of the nutraceutical group reporting effectiveness vs. 55% in the placebo group (P < 0.05).
- There were no significant changes in sexual dysfunction in either group throughout the study.
Main Takeaway: Nutraceutical supplements significantly enhance hair growth and quality without affecting sexual function.
When you realize Fitzpatrick was made for sunburn risk and not skin tone …
For decades, dermatology has used the Fitzpatrick Skin Type (FST) scale, which was originally developed to assess sun sensitivity rather than to accurately classify skin tones. This study highlights the need for a more precise and inclusive approach.
What did they find?
For decades, dermatology has used the Fitzpatrick Skin Type (FST) scale, which was originally developed to assess sun sensitivity rather than to accurately classify skin tones. This study highlights the need for a more precise and inclusive approach.
What did they find?
- The Fitzpatrick scale, though not designed for skin tone classification, is still widely used.
- Many studies rely on race and ethnicity as shortcuts for skin type, leading to inconsistencies.
- New classification methods exist but lack validation and standardization.
- An improved system should account for both skin color and biological responses to improve accuracy.
Figure 1. Micronodular type basal cell carcinoma under polarized light (A) and UVFD (B) with black arrows denoting MAY globules and red arrows indicating MAY globules not seen under polarized light.
DERMLITE Dermoscopy QUESTION OF THE WEEK
Darier and Hailey-Hailey diseases are rare genodermatoses that cause painful blisters, plaques, and fissures on erythematous skin. With no treatment reliably inducing remission, patients often rely on symptom management. Dermatologists have explored various approaches, including photodynamic therapy (PDT). This systematic review evaluated PDT’s effectiveness, analyzing 12 studies that reported its use in treating Darier or Hailey-Hailey disease.
Key Findings:
-Darier Disease: 9/12 patients achieved sustained partial or full remission, lasting from three months to three years.
- Hailey-Hailey Disease: 26/28 patients showed significant clinical improvement, with complete or partial regression of lesions.
- A total of 40 cases were reported across both diseases, with 35 experiencing partial or complete responses lasting for several months or years.
Main Takeaway: While PDT shows promising results, further investigation is needed to address concerns about cost, tolerability, and efficacy in patients with skin of color before it can be considered a primary treatment. Given these preliminary findings, PDT warrants continued clinical exploration as a treatment option for both Hailey-Hailey and Darier diseases.
Key Findings:
-Darier Disease: 9/12 patients achieved sustained partial or full remission, lasting from three months to three years.
- Hailey-Hailey Disease: 26/28 patients showed significant clinical improvement, with complete or partial regression of lesions.
- A total of 40 cases were reported across both diseases, with 35 experiencing partial or complete responses lasting for several months or years.
Main Takeaway: While PDT shows promising results, further investigation is needed to address concerns about cost, tolerability, and efficacy in patients with skin of color before it can be considered a primary treatment. Given these preliminary findings, PDT warrants continued clinical exploration as a treatment option for both Hailey-Hailey and Darier diseases.