A newsletter that delivers the latest in dermatology research directly to you.
One Hundred and third issue
February 4th, 2026
Acne on T: Timing, Trajectory, and Treatment
Acne is a common concern among transgender and gender-diverse patients, particularly after starting gender-affirming hormone therapy (GAHT). Prior studies, mostly single-center, suggested acne is frequent in transmasculine individuals on testosterone, but large multicenter data with matched cisgender comparison groups have been limited. Less has been known about acne patterns in transfeminine individuals after estradiol. This retrospective matched-cohort study used the STRONG cohort across 4 Kaiser Permanente regions to compare incident and moderate-to-severe acne in transmasculine and transfeminine individuals (including a GAHT-initiation subcohort) versus matched cisgender men and women over up to 5 years of follow-up.
What did they find?
Main Takeaway: This multicenter cohort shows that acne is a predictable and clinically important outcome of GAHT, especially for transmasculine individuals starting testosterone, where risk peaks in the first year and remains elevated over time. Clinicians should proactively counsel, monitor, and treat acne per guidelines, and continue screening in transfeminine individuals after estradiol initiation.
Acne is a common concern among transgender and gender-diverse patients, particularly after starting gender-affirming hormone therapy (GAHT). Prior studies, mostly single-center, suggested acne is frequent in transmasculine individuals on testosterone, but large multicenter data with matched cisgender comparison groups have been limited. Less has been known about acne patterns in transfeminine individuals after estradiol. This retrospective matched-cohort study used the STRONG cohort across 4 Kaiser Permanente regions to compare incident and moderate-to-severe acne in transmasculine and transfeminine individuals (including a GAHT-initiation subcohort) versus matched cisgender men and women over up to 5 years of follow-up.
What did they find?
- Transmasculine individuals had the highest acne burden: 15.8% developed acne within 5 years, compared with 3.8% of cisgender men and 10.5% of cisgender women.
- After testosterone initiation, acne risk was highest in year 1 (HR ~8.5 vs cis men; HR 2.6 vs cis women) and stayed elevated beyond 1 year.
- Moderate-to-severe acne occurred in 5.9% of transmasculine individuals at 5 years, rising to 7.6% after testosterone initiation.
- Transfeminine individuals had a 6.0% 5-year acne incidence, higher than cisgender men (2.9%) but lower than cisgender women (8.4%), including after estradiol initiation.
- Dermatology visits and use of systemic therapy (including isotretinoin) were more common among transgender individuals after acne diagnosis.
Main Takeaway: This multicenter cohort shows that acne is a predictable and clinically important outcome of GAHT, especially for transmasculine individuals starting testosterone, where risk peaks in the first year and remains elevated over time. Clinicians should proactively counsel, monitor, and treat acne per guidelines, and continue screening in transfeminine individuals after estradiol initiation.
Not all biologics are created equal.
Biologics and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) have transformed care outcomes for both psoriasis (PsO) and psoriatic arthritis (PsA), but their immunosuppressive effects raise concerns about viral reactivation. Hepatitis B and C viruses are common comorbid infections in PsO, and their reactivation has been associated with the use of TNF-α inhibitors (TNFi) and IL-12/23 inhibitors (IL-12/23i). Still, comparative long-term safety data across newer biologic classes, including IL-17 and IL-23 inhibitors, have been limited. In this 15-year, multicenter cohort study in Taiwan, investigators examined patients with PsO and PsA who received biologics or tsDMARDs and had available hepatitis B and C serology, comparing risks of hepatitis B and C reactivation across different drug classes.
What did they find?
Main Takeaway: Psoriasis therapies differ substantially in their risk of hepatitis B and C reactivation. IL-23i may be the most preferred option for patients with viral hepatitis or reactivation risk factors.
Biologics and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) have transformed care outcomes for both psoriasis (PsO) and psoriatic arthritis (PsA), but their immunosuppressive effects raise concerns about viral reactivation. Hepatitis B and C viruses are common comorbid infections in PsO, and their reactivation has been associated with the use of TNF-α inhibitors (TNFi) and IL-12/23 inhibitors (IL-12/23i). Still, comparative long-term safety data across newer biologic classes, including IL-17 and IL-23 inhibitors, have been limited. In this 15-year, multicenter cohort study in Taiwan, investigators examined patients with PsO and PsA who received biologics or tsDMARDs and had available hepatitis B and C serology, comparing risks of hepatitis B and C reactivation across different drug classes.
What did they find?
- Among 1,525 treatment episodes (1343 hepatitis B virus (HBV); 182 hepatitis C virus (HCV)), HBV and HCV reactivation occurred in 10.6% and 9.9% of episodes, respectively.
- TNFi carried the highest risk of both HBV and HCV reactivation, followed by IL-12/23i and IL-17i, with IL-23i showing the lowest risk.
- HBV reactivation incidence rates ranged from 95.3/1000 person-years with TNFi to 31.1/1000 person-years with IL-23i.
- TNFi carried the shortest time to HBV reactivation, followed by IL-12/23i and IL-17i, with IL-23i showing the longest latency.
- Key risk factors for HBV reactivation included HBV surface antigen-positivity, HBV e-antigen-positivity, higher baseline viral load, concomitant immunosuppressant use, and lack of antiviral prophylaxis.
Main Takeaway: Psoriasis therapies differ substantially in their risk of hepatitis B and C reactivation. IL-23i may be the most preferred option for patients with viral hepatitis or reactivation risk factors.
Real-world evidence on palmoplantar pustulosis: Patient characteristics, diagnostic challenges, and predictive factors for treatment survival
BJD
BJD
Palmoplantar pustulosis (PPP)? More like Persistent Problematic Pustulosis!
Palmoplantar pustulosis (PPP) is a chronic, painful inflammatory disorder marked by recurrent sterile pustules, erythema, and scaling on the palms and soles, often with fissuring and functional impairment. Despite this clinical burden, PPP remains difficult to diagnose and lacks widely approved, disease-specific treatments. In this retrospective registry study, investigators examined real-world patient characteristics, diagnostic challenges, and treatment survival in PPP to better understand care patterns and outcomes.
What did they find?
Main Takeaway: Palmoplantar pustulosis is frequently diagnosed late and treated inconsistently. Clinicians should consider PPP early in patients with chronic, treatment-resistant palmoplantar pustular disease. Biologic therapies, particularly IL-12/23 inhibitors, demonstrated better treatment persistence compared with phototherapy and conventional systemic agents. Given the higher likelihood of treatment discontinuation, patients with comorbidities may benefit from closer follow-up and proactive reassessment of treatment.
Palmoplantar pustulosis (PPP) is a chronic, painful inflammatory disorder marked by recurrent sterile pustules, erythema, and scaling on the palms and soles, often with fissuring and functional impairment. Despite this clinical burden, PPP remains difficult to diagnose and lacks widely approved, disease-specific treatments. In this retrospective registry study, investigators examined real-world patient characteristics, diagnostic challenges, and treatment survival in PPP to better understand care patterns and outcomes.
What did they find?
- More than half of patients experienced diagnostic delays of multiple years, often due to initial misdiagnosis of eczema.
- PPP was frequently associated with multiple comorbidities, including psoriatic arthritis and plaque psoriasis.
- The IL-12-23p40 inhibitor, ustekinumab, showed the best long-term treatment survival.
- Shorter disease duration and concomitant plaque psoriasis were associated with higher rates of treatment discontinuation.
- Treatment persistence varied widely, highlighting the lack of standardized, effective long-term therapies for PPP.
Main Takeaway: Palmoplantar pustulosis is frequently diagnosed late and treated inconsistently. Clinicians should consider PPP early in patients with chronic, treatment-resistant palmoplantar pustular disease. Biologic therapies, particularly IL-12/23 inhibitors, demonstrated better treatment persistence compared with phototherapy and conventional systemic agents. Given the higher likelihood of treatment discontinuation, patients with comorbidities may benefit from closer follow-up and proactive reassessment of treatment.
MSA: Maybe Some Association
Dermatomyositis (DM) is an autoimmune condition with variable clinical and histopathologic features. Myositis-specific antibodies (MSAs) are associated with distinct disease subtypes; however, the relationship between autoantibody profiles and histopathologic findings remains unclear. In this retrospective study, researchers reviewed 47 biopsies from 30 patients with DM to evaluate associations between histopathologic patterns and MSAs.
What did they find?
Main Takeaway: Overall, the differences in skin biopsy findings across DM antibody profiles are limited. However, isolated perivascular inflammation in NXP-2-positive patients and the absence of dermal mucin in TIF-1y-positive patients may aid diagnosis in atypical cases.
Dermatomyositis (DM) is an autoimmune condition with variable clinical and histopathologic features. Myositis-specific antibodies (MSAs) are associated with distinct disease subtypes; however, the relationship between autoantibody profiles and histopathologic findings remains unclear. In this retrospective study, researchers reviewed 47 biopsies from 30 patients with DM to evaluate associations between histopathologic patterns and MSAs.
What did they find?
- 27 patients (90%) were positive for at least one MSA, with NXP-2 being the most common and SAE-1/2 the least.
- The most frequent features were vacuolar interface dermatitis (70.4%), dermal mucin (71.1%), and mild superficial perivascular inflammation (81.5%).
- NXP-2 positivity was significantly associated with isolated perivascular inflammation without interface change (P<0.01), but no overall association between MSAs and the inflammatory patterns was observed (P=0.1428).
- Dermal mucin was associated with MSAs overall (P=0.028), and TIF-1y positive biopsies were significantly less likely to show dermal mucin compared to all other MSAs (33.3% vs 81.8%, P<0.01).
Main Takeaway: Overall, the differences in skin biopsy findings across DM antibody profiles are limited. However, isolated perivascular inflammation in NXP-2-positive patients and the absence of dermal mucin in TIF-1y-positive patients may aid diagnosis in atypical cases.
Cut once, measure twice.
Penile squamous cell carcinoma (SCC) is rare, and organ-sparing surgery (OSS) is commonly favored to preserve quality of life, though its oncologic adequacy is debated. Using the National Cancer Database (2004–2019), this retrospective cohort study analyzed 11,055 adults with excised penile SCC to compare positive surgical margin rates and survival across surgical approaches.
What did they find?
Penile squamous cell carcinoma (SCC) is rare, and organ-sparing surgery (OSS) is commonly favored to preserve quality of life, though its oncologic adequacy is debated. Using the National Cancer Database (2004–2019), this retrospective cohort study analyzed 11,055 adults with excised penile SCC to compare positive surgical margin rates and survival across surgical approaches.
What did they find?
- Positive margins were significantly higher with organ-sparing surgery (18.8%) vs partial penectomy (9.7%) (OR 2.31, P < 0.001).
- Advanced tumors were associated with markedly increased margin positivity (pT3 OR 2.12; pT4 OR 6.20, both P < 0.001).
- Positive margins independently predicted worse survival, with a 50% increased hazard of death (HR 1.53, P < 0.01).
Targeting melasma: Innovations in pigment deposition and photoaging in cosmetic dermatology
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
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.
Unveiling artificial intelligence's diagnostic power and challenges in dermatology for skin of color
SOC
SOC
Trying its best …. but wasn't trained for this
Artificial intelligence (AI) has gained traction in dermatology, particularly for lesion recognition and skin cancer detection. However, concerns remain about whether these tools perform equitably across diverse skin tones. This review examined recent literature to assess how AI diagnostic models perform in skin of color and to identify emerging strategies aimed at reducing performance disparities.
What did they find?
Artificial intelligence (AI) has gained traction in dermatology, particularly for lesion recognition and skin cancer detection. However, concerns remain about whether these tools perform equitably across diverse skin tones. This review examined recent literature to assess how AI diagnostic models perform in skin of color and to identify emerging strategies aimed at reducing performance disparities.
What did they find?
- Across multiple studies, AI models showed reduced diagnostic performance in darker skin tones (Fitzpatrick V-VI), with lower sensitivity, specificity, and overall accuracy compared with lighter skin tones.
- Performance gaps were largely attributed to training datasets dominated by lighter-skinned images, which limited generalizability.
- Two studies demonstrated that synthetic image augmentation (image‑to‑image translation that darkens lighter-skinned images while preserving lesion features) improved model performance on darker skin tones.
- Use of a diverse dermatology image dataset during training was associated with improved accuracy for darker skin types.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.