A newsletter that delivers the latest in dermatology research directly to you.
One Hundred and Fifteenth issue
JULY 22ND, 2026
TB is ready when you, and your immune system, aren’t!
Systemic therapies are essential for inflammatory skin disease, but TB risk estimates and screening recommendations remain inconsistent, particularly across newer biologic classes and geographic settings. This systematic review and meta-analysis included 31 studies and 15,005 patients, evaluating active TB and latent tuberculosis infection (LTBI) conversion by treatment class and regional TB burden.
What did they find?
Main Takeaway: TB monitoring should be risk-stratified by treatment mechanism and regional epidemiology rather than applied uniformly. Conventional immunosuppressants and TNF inhibitors warrant the greatest caution, especially in high-TB-burden settings.
Systemic therapies are essential for inflammatory skin disease, but TB risk estimates and screening recommendations remain inconsistent, particularly across newer biologic classes and geographic settings. This systematic review and meta-analysis included 31 studies and 15,005 patients, evaluating active TB and latent tuberculosis infection (LTBI) conversion by treatment class and regional TB burden.
What did they find?
- LTBI conversion occurred in 4.3% overall and 4.0% among biologic-treated patients.
- Among biologics, LTBI conversion was highest with TNF inhibitors (4.9%), followed by IL-17 inhibitors (2.2%) and ustekinumab (1.8%).
- Active TB incidence was 1.0% overall, 0.6% with biologics, and 5.9% with conventional immunosuppressants.
- With TNF inhibitors, active TB incidence was higher in high-burden regions (1.6%) than in low-burden regions (0.8%).
Main Takeaway: TB monitoring should be risk-stratified by treatment mechanism and regional epidemiology rather than applied uniformly. Conventional immunosuppressants and TNF inhibitors warrant the greatest caution, especially in high-TB-burden settings.
Assessing skin cancer risk in systemic sclerosis patients with organ transplantation: a cohort study
JAAD
JAAD
When the cure for one problem becomes the risk factor for another.
Systemic sclerosis (SSc) is associated with an increased cancer risk, but the contribution of organ transplantation to skin cancer in this population has not been characterized. This cohort study from Mass General Brigham queried registry data from 1979–2024, comparing 48 SSc patients with kidney, lung, or bone marrow transplantation to 45 age-, sex-, and race-matched SSc controls without transplantation.
What did they find?
Systemic sclerosis (SSc) is associated with an increased cancer risk, but the contribution of organ transplantation to skin cancer in this population has not been characterized. This cohort study from Mass General Brigham queried registry data from 1979–2024, comparing 48 SSc patients with kidney, lung, or bone marrow transplantation to 45 age-, sex-, and race-matched SSc controls without transplantation.
What did they find?
- SSc patients with transplantation had a significantly increased risk of skin cancer compared to those without (RR = 5.31, p = 0.0047), specifically keratinocyte carcinoma (RR = 4.69, p = 0.0097).
- When examining only skin cancers that developed after transplantation, the risk remained elevated (RR = 3.75, p = 0.0306), with squamous cell carcinoma (SCC) driving the association (RR = 4.69, p = 0.0384).
- Female SSc transplant patients had a significantly increased risk of skin cancer (RR = 3.67, p = 0.0298) and keratinocyte carcinoma (RR = 3.33, p = 0.0468) compared to female SSc controls, while males did not show a statistically significant difference.
- Skin cancer patients who received a transplant had a higher average number of skin cancers (2.24 vs. 1.0) compared to those without transplantation.
Needles are so last biologic.
Icotrokinra is a new pill that targets a specific part of the immune system (IL-23) involved in psoriasis, offering an alternative to injectable biologic drugs for moderate-to-severe plaque psoriasis. This study reports one-year results from two large trials that compared icotrokinra to a placebo and to another oral psoriasis drug (deucravacitinib), then switched those groups onto icotrokinra partway through.
What did they find?
Icotrokinra is a new pill that targets a specific part of the immune system (IL-23) involved in psoriasis, offering an alternative to injectable biologic drugs for moderate-to-severe plaque psoriasis. This study reports one-year results from two large trials that compared icotrokinra to a placebo and to another oral psoriasis drug (deucravacitinib), then switched those groups onto icotrokinra partway through.
What did they find?
- By one year, 69%-75% of patients taking icotrokinra had skin that was clear or almost clear, which was sustained from the 6-month mark onward.
- About half of patients (48%-56%) had completely clear skin by one year.
- Patients who started on placebo or deucravacitinib and were later switched to icotrokinra reached similar clearance rates (73%-78%) by one year.
- Patients reported major relief in itching (73%-75% saw a big improvement) and quality of life (64%-70% said psoriasis no longer affected their daily life) by one year.
Can systemic treatment for childhood psoriasis be stopped in cases of remission? Data from ACMe cohort
Peds Derm
Peds Derm
Sometimes, no follow-up is the best follow-up.
In children with moderate-to-severe psoriasis, systemic treatments (acitretin, methotrexate, cyclosporine) are often required. However, whether they can be safely stopped once remission is achieved is unclear. This retrospective, multicenter, international study (the ACMe cohort) analyzed 433 children who discontinued first-line systemic therapy, comparing those who stopped due to remission versus other reasons, and tracked relapse over 6 months.
What did they find?
Main Takeaway: In children with moderate-to-severe psoriasis achieving remission on conventional systemic therapy, treatment discontinuation can be feasible and has a low risk of early relapse. However, larger prospective studies with longer follow-up are needed to identify who can safely stop systemic treatment long-term.
In children with moderate-to-severe psoriasis, systemic treatments (acitretin, methotrexate, cyclosporine) are often required. However, whether they can be safely stopped once remission is achieved is unclear. This retrospective, multicenter, international study (the ACMe cohort) analyzed 433 children who discontinued first-line systemic therapy, comparing those who stopped due to remission versus other reasons, and tracked relapse over 6 months.
What did they find?
- Only 79 of 433 patients (18.2%) discontinued treatment specifically because they achieved remission. The remaining 354 (81.8%) stopped for other reasons, most commonly inefficacy (33.6%), loss of effectiveness (30.5%), adverse events (17.8%), and loss to follow-up (10.4%).
- Patients who stopped due to remission were younger (9.0 ± 3.5 vs. 10.5 ± 4.1 years, p < 0.001) and had lower baseline disease severity (PGA: 3.0 ± 0.7 vs. 3.3 ± 0.8, p = 0.02; PASI: 9.3 ± 4.8 vs. 11.1 ± 6.8, p = 0.04) compared to those stopping for other reasons.
- Among those who stopped for remission, 88.6% (70/79) remained off systemic treatment for at least 6 months. This is a significantly higher rate than the 28.8% who stayed off therapy after stopping for other reasons (p < 0.001).
- None of the demographic, disease-related, or treatment-related factors examined were associated with which patients sustained remission.
Main Takeaway: In children with moderate-to-severe psoriasis achieving remission on conventional systemic therapy, treatment discontinuation can be feasible and has a low risk of early relapse. However, larger prospective studies with longer follow-up are needed to identify who can safely stop systemic treatment long-term.
When in doubt, look for PRAME!
Atypical fibroxanthoma (AFX) is a rare cutaneous tumor typically seen in elderly individuals, characterized by rapidly growing nodules on sun-exposed areas. Although its clinical course is benign, its diagnosis is complicated by morphologic and immunophenotypic overlap with more aggressive malignancies. Preferentially Expressed Antigen in Melanoma (PRAME) has shown promise in distinguishing melanocytic tumors, but its expression in AFX and other nonmelanocytic neoplasms remains unclear. This retrospective study of 15 cases assessed the diagnostic utility of PRAME expression in differentiating AFX from its histologic mimics.
What did they find?
Main takeaway: Atypical fibroxanthoma can be differentiated from malignant melanoma by block-type CD10 positivity and lack of PRAME expression, and from squamous cell carcinoma, leiomyosarcoma, and angiosarcoma using P40, desmin, and ERG, respectively.
Atypical fibroxanthoma (AFX) is a rare cutaneous tumor typically seen in elderly individuals, characterized by rapidly growing nodules on sun-exposed areas. Although its clinical course is benign, its diagnosis is complicated by morphologic and immunophenotypic overlap with more aggressive malignancies. Preferentially Expressed Antigen in Melanoma (PRAME) has shown promise in distinguishing melanocytic tumors, but its expression in AFX and other nonmelanocytic neoplasms remains unclear. This retrospective study of 15 cases assessed the diagnostic utility of PRAME expression in differentiating AFX from its histologic mimics.
What did they find?
- CD10 is consistently positive in AFX and is considered a key diagnostic marker; occasional weak staining for melanocytic markers HMB-45 and S100 was observed, but all cases were negative for PRAME.
- All cases of AFX demonstrated solar elastosis and were confined to the dermis; ulceration was present in 60% cases (n=9), and erythrocyte pools and brown pigment accumulation were observed in 13.3% cases (n=2). Necrosis, lymphovascular invasion, and perineural invasion were not detected in any cases.
- The most common misdiagnosis is squamous cell carcinoma, and testing for epithelial marker P40 in conjunction with histopathologic assessment can differentiate the two.
- AFX can be differentiated from leiomyosarcoma by negative smooth muscle marker desmin expression, and from angiosarcoma by negative vascular marker ERG.
Main takeaway: Atypical fibroxanthoma can be differentiated from malignant melanoma by block-type CD10 positivity and lack of PRAME expression, and from squamous cell carcinoma, leiomyosarcoma, and angiosarcoma using P40, desmin, and ERG, respectively.
Reducing waste in dermatologic surgery: An evidence-based review of sustainability strategies
Derm Surg
Derm Surg
That's some Casa Amor decision-making!
Healthcare generates a substantial amount of medical waste, and dermatologic surgery contributes significantly because of its high procedural volume within the field. However, evidence-based recommendations for reducing waste in dermatologic surgery have been limited. Therefore, this study completed a PubMed literature review to evaluate waste reduction methods using the Oxford Centre for Evidence-Based Medicine and GRADE criteria.
What did they find?
Main Takeaway: Dermatologic surgeons can meaningfully reduce environmental waste without compromising patient outcomes by adopting evidence-supported changes throughout the patient’s surgical journey.
Healthcare generates a substantial amount of medical waste, and dermatologic surgery contributes significantly because of its high procedural volume within the field. However, evidence-based recommendations for reducing waste in dermatologic surgery have been limited. Therefore, this study completed a PubMed literature review to evaluate waste reduction methods using the Oxford Centre for Evidence-Based Medicine and GRADE criteria.
What did they find?
- Using nonsterile gloves for many cutaneous surgical procedures did not increase surgical site infections compared with sterile gloves, while reducing cost and medical waste.
- Reusable surgical gowns, drapes, and metal instruments can safely replace many disposable items, substantially decreasing operating room waste without compromising sterility.
- Absorbable sutures can eliminate the need for a follow-up suture removal visit, which would reduce patient travel and clinic resource use.
Main Takeaway: Dermatologic surgeons can meaningfully reduce environmental waste without compromising patient outcomes by adopting evidence-supported changes throughout the patient’s surgical journey.
Hyperpigmentation in darker skin tones has finally met a worthy opponent.
Melasma is a complex pigmentation disorder stemming from the interaction between UV radiation and photoaging, hormones, chronic inflammation, and increased vascularization. It mainly affects women and individuals with darker skin tones (Fitzpatrick III-VI), with a profound impact on self-esteem and quality of life. This retrospective chart review seeks to explore the use of Fractional Q-Switch Ruby Laser (QSRL) therapy in Asian patients with Fitzpatrick skin types III-IV, which had previously been limited by the risk of post-laser hyperpigmentation.
What did they find?
Main Takeaway: Low-dose QSRL is a safe tool to decrease melasma pigmentation without the risk of post-inflammatory hyperpigmentation in Asian patients with Fitzpatrick skin types III-IV.
Melasma is a complex pigmentation disorder stemming from the interaction between UV radiation and photoaging, hormones, chronic inflammation, and increased vascularization. It mainly affects women and individuals with darker skin tones (Fitzpatrick III-VI), with a profound impact on self-esteem and quality of life. This retrospective chart review seeks to explore the use of Fractional Q-Switch Ruby Laser (QSRL) therapy in Asian patients with Fitzpatrick skin types III-IV, which had previously been limited by the risk of post-laser hyperpigmentation.
What did they find?
- Significant reduction in Type V pigmentation (darkest pigmentation) from 8.31% to 5.18% after 5 sessions (p < 0.05).
- Increased predominance of Type III and IV pigmentation (lighter pigmentation) from 91.8% to 94.9% (p < 0.05).
- No adverse events, rebound pigmentation, post-inflammatory hyper or hypopigmentation, or expansion at 6-month follow-up.
Main Takeaway: Low-dose QSRL is a safe tool to decrease melasma pigmentation without the risk of post-inflammatory hyperpigmentation in Asian patients with Fitzpatrick skin types III-IV.
AI had the whole color palette and still played favorites.
Multimodal large language models are increasingly being used to generate dermatologic images, but their outputs may reflect gaps in the data used to train them. This is especially concerning for autoimmune and immune-mediated skin diseases, many of which disproportionately affect patients with skin of color. In this study, researchers evaluated four image-generating models across 11 conditions to see how often they produced light, medium, and dark skin tones.
What did they find?
Main Takeaway: Across several autoimmune and immune-mediated skin diseases, AI image generators consistently favored lighter skin tones. These findings raise concerns about using generated images in dermatology education and clinical support without more representative training data and clinician review.
Multimodal large language models are increasingly being used to generate dermatologic images, but their outputs may reflect gaps in the data used to train them. This is especially concerning for autoimmune and immune-mediated skin diseases, many of which disproportionately affect patients with skin of color. In this study, researchers evaluated four image-generating models across 11 conditions to see how often they produced light, medium, and dark skin tones.
What did they find?
- Of 144 generated images, 70% showed light skin, compared with 19% medium skin and 11% dark skin.
- Light skin appeared significantly more often than either medium or dark skin, while the difference between medium and dark skin representation was not statistically significant.
- The pattern was consistent across all 11 diseases, with no significant difference in skin tone distribution by diagnosis (p = .94).
- Skin tone representation varied across the four models (p = 0.001). Adobe Firefly produced the highest proportion of dark-skin images at 25%, compared with 11% overall.
- Image realism did not differ by skin tone (p = 0.63).
Main Takeaway: Across several autoimmune and immune-mediated skin diseases, AI image generators consistently favored lighter skin tones. These findings raise concerns about using generated images in dermatology education and clinical support without more representative training data and clinician review.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.