A newsletter that delivers the latest in dermatology research directly to you.
One Hundred and Ninth issue
April 29TH, 2026
AI might tell you what it is… just not what to do about it.
Artificial intelligence (AI)-powered tools are increasingly being used by consumers to understand skin concerns, but their real-world impact on patient understanding and decision-making remains unclear. This randomized survey study evaluated whether an AI-powered dermatology application improves layperson ability to understand skin conditions and determine appropriate next steps compared to standard information-seeking methods.
What did they find?
Main Takeaway: AI tools may improve consumers’ ability to recognize and name skin conditions. Models trained on accurate dermatology information are better positioned to equip users to accurately understand skin conditions and make decisions about case escalation. This highlights gaps in currently available and widely used AI tools in supporting users to make informed decisions.
Artificial intelligence (AI)-powered tools are increasingly being used by consumers to understand skin concerns, but their real-world impact on patient understanding and decision-making remains unclear. This randomized survey study evaluated whether an AI-powered dermatology application improves layperson ability to understand skin conditions and determine appropriate next steps compared to standard information-seeking methods.
What did they find?
- Of 2345 participants evaluating dermatology cases, participants using standard AI (62.26%, 95% CI=60.75%-63.76%) and a dermatology AI application (61.76%, 95% CI=60.21%-63.28%) were more willing to name a condition compared to control (41.21%, 95% CI=39.66%-42.76%).
- There was greater diagnostic accuracy with the dermatology AI application (36.20%, 95% CI=34.70%-37.73%) and AI (22.79%, 95% CI=21.48%-24.09%), compared to control (7.86%, 95% CI=7.03%-8.71%), but remained modest overall.
- Only those using the dermatology AI application showed marginally improved accuracy in determining urgency of next steps (62.95%, 95% CI=61.42%-64.44%) compared to control (60.10%, 95% CI=58.55%-61.65%).
- AI users were slightly more likely to undercall severity (recommend less urgent care than a dermatologist).
Main Takeaway: AI tools may improve consumers’ ability to recognize and name skin conditions. Models trained on accurate dermatology information are better positioned to equip users to accurately understand skin conditions and make decisions about case escalation. This highlights gaps in currently available and widely used AI tools in supporting users to make informed decisions.
Rethinking routine labs in psoriasis care.
Biologic therapies are widely used in the treatment of psoriasis. Despite being generally well-tolerated and rarely requiring routine laboratory monitoring, baseline screening and ongoing laboratory testing are frequently performed in clinical practice. This systematic review was conducted to better define the value of routine laboratory testing for psoriasis patients being treated with biologics.
What did they find?
Main Takeaway: The majority of routine baseline and monitoring lab tests for patients receiving biologics for psoriasis provide minimal clinical benefit, if any, with excessive testing contributing to higher costs and unnecessary interventions. Targeted testing should be pursued when clinically implicated.
Biologic therapies are widely used in the treatment of psoriasis. Despite being generally well-tolerated and rarely requiring routine laboratory monitoring, baseline screening and ongoing laboratory testing are frequently performed in clinical practice. This systematic review was conducted to better define the value of routine laboratory testing for psoriasis patients being treated with biologics.
What did they find?
- Tuberculosis (TB) screening appears to provide meaningful benefit only in patients receiving TNF-α inhibitors, with the authors recommending both baseline and annual TB testing.
- In hepatitis B core antibody-positive patients, TNF-α inhibitors carried the highest risk of HBV reactivation. In this setting, monitoring HBV DNA and liver function tests may offer modest benefits.
- In patients taking IL-17 inhibitors, symptom-based monitoring is recommended for superficial mucocutaneous candidiasis, while routine inflammatory bowel disease screening in asymptomatic patients is not recommended.
- Baseline hepatitis C virus screening and reactivation monitoring are not recommended in asymptomatic patients. Evidence is insufficient to support HIV screening or CD4/viral load monitoring. Baseline CBC, CMP, and lipid screening is also not recommended.
Main Takeaway: The majority of routine baseline and monitoring lab tests for patients receiving biologics for psoriasis provide minimal clinical benefit, if any, with excessive testing contributing to higher costs and unnecessary interventions. Targeted testing should be pursued when clinically implicated.
Expanding clinical and genetic understanding of extensive dermal melanocytosis
British Journal of Dermatology
British Journal of Dermatology
Not all “blue spots” are created equal.
Extensive dermal melanocytosis (EDM) is a congenital pigmentary disorder characterized by large, persistent blue-gray macules that can mimic benign “blue spots” but carry potential systemic and oncologic implications. The genetic basis has remained poorly understood, with only GNAQ previously implicated. This study combined deep phenotyping with targeted sequencing in a pediatric cohort to better define the clinical and genetic landscape of EDM.
What did they find?
Main Takeaway: EDM is a genetically heterogeneous mosaic disorder with meaningful extracutaneous associations. Differentiating it from benign “blue spots” is critical, as patients may require ophthalmologic evaluation, consideration of neurologic workup, and long-term monitoring for melanoma risk.
Extensive dermal melanocytosis (EDM) is a congenital pigmentary disorder characterized by large, persistent blue-gray macules that can mimic benign “blue spots” but carry potential systemic and oncologic implications. The genetic basis has remained poorly understood, with only GNAQ previously implicated. This study combined deep phenotyping with targeted sequencing in a pediatric cohort to better define the clinical and genetic landscape of EDM.
What did they find?
- Among 47 patients, ophthalmologic involvement was present in ~40%.
- Two of five patients undergoing MRI showed ischemic infarcts, suggesting possible neurologic involvement.
- In addition to GNAQ, four new mosaic genetic causes were identified: HRAS, PIK3CA, ACTB, and GNA11.
- Mosaic variants were restricted to affected skin and not detected in blood.
- EDM was frequently multifocal (63%) and often misidentified as congenital melanocytic naevi.
Main Takeaway: EDM is a genetically heterogeneous mosaic disorder with meaningful extracutaneous associations. Differentiating it from benign “blue spots” is critical, as patients may require ophthalmologic evaluation, consideration of neurologic workup, and long-term monitoring for melanoma risk.
Do shave and punch biopsies provide comparable diagnostic accuracy in cutaneous T-Cell lymphoma?
Dermpath
Dermpath
Myth Busting Mycosis Fungoides
Diagnosing mycosis fungoides (MF), a form of cutaneous T-cell lymphoma, can be challenging and is often delayed. Although broad shave biopsies are thought to be superior to punch biopsies for diagnosis, the evidence is limited. This retrospective chart review evaluated 165 patients with patch or plaque-stage MF to compare the diagnostic accuracy of shave vs punch biopsies.
What did they find?
Main Takeaway: Both shave and punch biopsies can be effective in diagnosing MF, and shave biopsies did not demonstrate a diagnostic benefit over punch biopsies.
Diagnosing mycosis fungoides (MF), a form of cutaneous T-cell lymphoma, can be challenging and is often delayed. Although broad shave biopsies are thought to be superior to punch biopsies for diagnosis, the evidence is limited. This retrospective chart review evaluated 165 patients with patch or plaque-stage MF to compare the diagnostic accuracy of shave vs punch biopsies.
What did they find?
- 77.6% of patients had MF confirmed on the initial biopsy, while 22.4% required additional biopsies.
- Of the initial diagnostic biopsies, 71.5% were punch biopsies while 27.3% were shave biopsies. The remainder were excisional biopsies.
- There was no significant difference in diagnostic accuracy between shave and punch biopsies (p=1).
Main Takeaway: Both shave and punch biopsies can be effective in diagnosing MF, and shave biopsies did not demonstrate a diagnostic benefit over punch biopsies.
We numbed the skin but not the thoughts.
Mohs micrographic surgery’s (MMS) psychological impact is underrecognized. This systematic review and meta-analysis evaluated perioperative psychological distress and reviewed US MMS consent forms for inclusion of psychological risks.
What did they find?
Mohs micrographic surgery’s (MMS) psychological impact is underrecognized. This systematic review and meta-analysis evaluated perioperative psychological distress and reviewed US MMS consent forms for inclusion of psychological risks.
What did they find?
- Meta-analysis revealed a pooled psychological distress rating of 25.26 out of 100 (95% CI=10.44-61.11).
- Psychological symptoms were reported across all included studies.
- 0 of 20 reviewed consent forms included psychological risks, despite evidence of distress.
A randomized controlled triple-blinded clinical trial comparing AbobotulinumtoxinA to OnabotulinumtoxinA for glabellar lines
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
Choosing between workflow efficiency and patient comfort
Botulinum toxin type A injections are the gold standard treatment for dynamic glabellar lines, but most commercially available formulations require reconstitution prior to administration, introducing variability in dilution accuracy and preparation time. A ready-to-use liquid formulation of abobotulinumtoxinA has been developed, which may simplify workflow and reduce injector-dependent variability. This randomized, controlled, triple-blinded clinical trial compared ready-to-use abobotulinumtoxinA with reconstituted onabotulinumtoxinA for moderate-to-severe glabellar lines.
What did they find?
Main Takeaway: Ready-to-use abobotulinumtoxinA demonstrated similar efficacy, durability, and safety compared with onabotulinumtoxinA for treating moderate-to-severe glabellar lines, supporting its role as a clinically equivalent alternative formulation. However, increased injection-related discomfort and the absence of superior aesthetic outcomes suggest that adoption may depend more on workflow efficiency and injector preference than on measurable clinical advantage.
Botulinum toxin type A injections are the gold standard treatment for dynamic glabellar lines, but most commercially available formulations require reconstitution prior to administration, introducing variability in dilution accuracy and preparation time. A ready-to-use liquid formulation of abobotulinumtoxinA has been developed, which may simplify workflow and reduce injector-dependent variability. This randomized, controlled, triple-blinded clinical trial compared ready-to-use abobotulinumtoxinA with reconstituted onabotulinumtoxinA for moderate-to-severe glabellar lines.
What did they find?
- Both formulations produced comparable neuromuscular inhibition: Electromyographic activity of the procerus and corrugator supercilii muscles decreased significantly after treatment in both groups (p=0.001), with no differences between toxins (p>0.05).
- Wrinkle severity improved similarly across treatments: Significant reductions in glabellar line severity during contraction were observed through 4 months for both formulations, with no intergroup differences (p>0.05).
- Patient satisfaction improved in both groups: FACE-Q scores increased significantly after treatment with both toxins (p=0.001), although onabotulinumtoxinA showed higher satisfaction at 2-months (p=0.01).
- Injection discomfort differed between products: Ready-to-use abobotulinumtoxinA was associated with significantly higher pain scores during injection compared with onabotulinumtoxinA (p=0.01).
- Both treatments demonstrated favorable safety profiles: Only mild transient adverse events were reported, including localized itching, rash, and under-eye swelling, all resolving without intervention.
Main Takeaway: Ready-to-use abobotulinumtoxinA demonstrated similar efficacy, durability, and safety compared with onabotulinumtoxinA for treating moderate-to-severe glabellar lines, supporting its role as a clinically equivalent alternative formulation. However, increased injection-related discomfort and the absence of superior aesthetic outcomes suggest that adoption may depend more on workflow efficiency and injector preference than on measurable clinical advantage.
Care is available… just not easy to reach.
Access to pediatric dermatology care remains limited for many racially and ethnically minoritized families. This qualitative study used semi-structured interviews with parents of children receiving care at an academic children’s hospital to better understand the barriers and facilitators that shape access to dermatologic care.
What did they find?
Main Takeaway: Barriers to pediatric dermatology care go beyond access alone and include communication, trust, and system-level challenges. Improving navigation, culturally responsive care, and community awareness may help make dermatologic care more accessible.
Access to pediatric dermatology care remains limited for many racially and ethnically minoritized families. This qualitative study used semi-structured interviews with parents of children receiving care at an academic children’s hospital to better understand the barriers and facilitators that shape access to dermatologic care.
What did they find?
- Among 32 parents interviewed, most identified as American Indian or Alaska Native (37.5%), Black (34.4%), or Hispanic (43.8%).
- Parents described barriers including difficulty navigating the healthcare system, long wait times, distance from care, and uncertainty about insurance, with some families traveling over 11 hours to be seen.
- Skin conditions were often viewed as less urgent or more cosmetic, which delayed care until symptoms worsened.
- Poor clinician communication and language barriers made families feel unheard or dismissed, while interpreters, primary care referrals, and clear, respectful communication helped build trust and improve follow-through.
- Community factors also played a role, including limited awareness of dermatology, assumptions about high cost, and broader distrust of the healthcare system.
Main Takeaway: Barriers to pediatric dermatology care go beyond access alone and include communication, trust, and system-level challenges. Improving navigation, culturally responsive care, and community awareness may help make dermatologic care more accessible.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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