One Hundred and seventh issue
april 1st, 2026
Safety and efficacy of ICP-332 for moderate to severe atopic dermatitis a phase 2 randomized clinical trial
JAMA Dermatology
JAMA Dermatology
TYK2 selectivity: Focused treatment, fewer trade-offs
While oral JAK inhibitors have transformed the treatment of moderate to severe atopic dermatitis (AD), they carry class-wide black box warnings for serious infections, malignancy, and cardiovascular events. ICP-332 is a more selective oral TYK2 inhibitor that targets inflammatory cytokine pathways relevant to AD while largely sparing other JAK-mediated signaling. In this double-blind, placebo-controlled phase 2 trial, 75 adults with moderate-to-severe AD were randomized to receive ICP-332 80 mg, 120 mg, or placebo once daily for 4 weeks across 19 centers in China.
What did they find?
Main Takeaway: ICP-332 demonstrated rapid, meaningful efficacy and a differentiated safety profile compared to existing oral JAK inhibitors, supporting advancement to phase 3 trials. Longer studies in more diverse populations will be needed to confirm its benefit-risk profile.
While oral JAK inhibitors have transformed the treatment of moderate to severe atopic dermatitis (AD), they carry class-wide black box warnings for serious infections, malignancy, and cardiovascular events. ICP-332 is a more selective oral TYK2 inhibitor that targets inflammatory cytokine pathways relevant to AD while largely sparing other JAK-mediated signaling. In this double-blind, placebo-controlled phase 2 trial, 75 adults with moderate-to-severe AD were randomized to receive ICP-332 80 mg, 120 mg, or placebo once daily for 4 weeks across 19 centers in China.
What did they find?
- Both ICP-332 doses produced large EASI reductions at week 4 (-78% at 80 mg and -73% at 120 mg) versus placebo (-17%; both P < 0.001).
- EASI-75 was achieved by 64% of patients in both active arms versus 8% on placebo, and pruritus improved as early as day 2.
- No serious adverse events or deaths occurred; the most common treatment-emergent adverse event was decreased blood fibrinogen, whose clinical significance remains unclear.
- Adverse events typically associated with JAK inhibitors, including herpes zoster, acne, and elevated creatine phosphokinase, were notably absent.
Main Takeaway: ICP-332 demonstrated rapid, meaningful efficacy and a differentiated safety profile compared to existing oral JAK inhibitors, supporting advancement to phase 3 trials. Longer studies in more diverse populations will be needed to confirm its benefit-risk profile.
Insurance coverage isn’t just policy…it’s prognosis.
Merkel cell carcinoma (MCC) is an uncommon, but aggressive, cutaneous malignancy in which timely diagnosis and treatment are critical determinants of survival. Disparities in access to care, including lack of insurance, have been associated with delayed MCC diagnosis. The passage of the Affordable Care Act in 2010 aimed to expand Medicaid to improve healthcare access for low-income populations. While Medicaid expansion (ME) under the ACA has been shown to improve oncologic diagnoses and outcomes, its impact on MCC specifically remains poorly defined. In this study, authors analyzed the National Cancer Database to assess the impact of ME on overall survival among patients with surgically-resected MCC.
What did they find?
Main Takeaway: Medicaid expansion is associated with improved survival in resected MCC, likely by facilitating earlier, more consistent access to care.
Merkel cell carcinoma (MCC) is an uncommon, but aggressive, cutaneous malignancy in which timely diagnosis and treatment are critical determinants of survival. Disparities in access to care, including lack of insurance, have been associated with delayed MCC diagnosis. The passage of the Affordable Care Act in 2010 aimed to expand Medicaid to improve healthcare access for low-income populations. While Medicaid expansion (ME) under the ACA has been shown to improve oncologic diagnoses and outcomes, its impact on MCC specifically remains poorly defined. In this study, authors analyzed the National Cancer Database to assess the impact of ME on overall survival among patients with surgically-resected MCC.
What did they find?
- Among 14,802 patients, 60.9% lived in states with ME. These patients presented with more adverse MCC tumor features, including larger tumors (42.7% vs 38.4%, P=0.003), nodal disease (29.3% vs 27.4%, P=0.018), and lymphovascular invasion (37.8% vs 33.6%, P<0.001).
- Despite this, patients in ME states had higher survival rates than those in non-ME states for both stage I-II (5-year overall survival (OS): 61.4% vs 58.3%; median OS: 92.1 vs. 83.7 months, P=0.022) and stage III disease (46.9% vs 44.4%; 53.3 vs. 44.1 months, P=0.044).
- After implementation of ME in 2014, stage I-II MCC survival improved across all states, regardless of their ME status (5-year OS: 61.2% vs 57.8%; median OS: 91.5 vs. 84.2 months, P=0.002).
- Residence in a ME state (HR 0.92, P=0.02) and diagnosis during the era after ME (HR 0.87, P<0.001) were predictors of improved OS.
Main Takeaway: Medicaid expansion is associated with improved survival in resected MCC, likely by facilitating earlier, more consistent access to care.
Defining the undefined: Bringing structure to a controversial diagnosis.
Topical steroid withdrawal (TSW), or “red skin syndrome,” is a poorly defined condition that can mimic severe atopic dermatitis and steroid rebound. Despite growing recognition, the absence of diagnostic criteria has limited clinical identification and research. In this study, investigators used a 3-round Delphi process to establish consensus-based diagnostic features for the erythemato-oedematous subtype, informed by literature and patient-reported symptoms.
What did they find?
Main Takeaway: TSW remains a diagnosis of exclusion, but this Delphi consensus provides a structured framework to help differentiate it from atopic dermatitis and steroid rebound. Recognizing key features, especially burning pain, steroid nonresponse, and atypical distribution, may improve diagnostic clarity and support future development of validated criteria and treatment strategies.
Topical steroid withdrawal (TSW), or “red skin syndrome,” is a poorly defined condition that can mimic severe atopic dermatitis and steroid rebound. Despite growing recognition, the absence of diagnostic criteria has limited clinical identification and research. In this study, investigators used a 3-round Delphi process to establish consensus-based diagnostic features for the erythemato-oedematous subtype, informed by literature and patient-reported symptoms.
What did they find?
- A total of 18 key diagnostic features were identified across history, morphology, and symptoms.
- History of escalating topical steroid use (increasing potency/frequency) was a central diagnostic clue.
- Rash morphology and distribution differed from the primary condition, often spreading beyond treated areas.
- Severe burning pain and neuropathic symptoms (hyperesthesia) were distinguishing features vs eczema.
- TSW symptoms persisted for months to years and often failed to improve with reintroduction of steroids.
Main Takeaway: TSW remains a diagnosis of exclusion, but this Delphi consensus provides a structured framework to help differentiate it from atopic dermatitis and steroid rebound. Recognizing key features, especially burning pain, steroid nonresponse, and atypical distribution, may improve diagnostic clarity and support future development of validated criteria and treatment strategies.
Sneaky secondary syphilis
Secondary syphilis (SS) is often referred to as the “great imitator” due to its variable clinical and histopathologic presentations. Histopathology can be particularly useful when clinical or serologic findings are atypical or inconclusive. This systematic review and meta-analysis evaluated 8 studies (n=384 patients, 460 lesions) to identify the most consistent histologic features of SS to improve diagnostic accuracy.
What did they find?
Main Takeaway: Endothelial swelling and plasma cell-rich infiltrates were the most commonly observed histopathologic features in secondary syphilis and may support the diagnosis when clinical or serologic findings are unclear.
Secondary syphilis (SS) is often referred to as the “great imitator” due to its variable clinical and histopathologic presentations. Histopathology can be particularly useful when clinical or serologic findings are atypical or inconclusive. This systematic review and meta-analysis evaluated 8 studies (n=384 patients, 460 lesions) to identify the most consistent histologic features of SS to improve diagnostic accuracy.
What did they find?
- Endothelial swelling was the most commonly reported histologic feature, identified in five studies with a prevalence of 85% (95% CI 0.75-0.96).
- Six studies reported moderate-to-dense plasma cell infiltration, with a prevalence of 83% (95% CI 0.74-0.92).
- Acanthosis was noted in six studies, with a prevalence of 66% (95% CI 0.47-0.86%).
- Perivascular inflammatory infiltrate was observed in five studies, with a prevalence of 64% (95% CI 0.37-0.90).
Main Takeaway: Endothelial swelling and plasma cell-rich infiltrates were the most commonly observed histopathologic features in secondary syphilis and may support the diagnosis when clinical or serologic findings are unclear.
When your skin prefers a little buzz over a painful poke.
Procedural pain in dermatology is common and can deter patients from care. Vibration-assisted anesthesia (VKA), based on gate control theory, offers a noninvasive alternative. This prospective, split-lesion, intrapatient study (n = 629) compared pain scores with vs without a wearable VKA device during dermatologic procedures.
What did they find?
Main Takeaway: Vibration-assisted anesthesia provides clinically meaningful, noninvasive pain reduction with high patient satisfaction and no safety concerns, making it a promising adjunct to traditional anesthesia in dermatology.
Procedural pain in dermatology is common and can deter patients from care. Vibration-assisted anesthesia (VKA), based on gate control theory, offers a noninvasive alternative. This prospective, split-lesion, intrapatient study (n = 629) compared pain scores with vs without a wearable VKA device during dermatologic procedures.
What did they find?
- Significant pain reduction: VAS 6.46 → 3.94 and NRS 6.49 → 3.91 (P < 0.001; Cohen d > 1.0).
- Mean reduction ~2.5 points with ~75% achieving ≥ 2-point improvement.
- Clinical success at 81.5% and patient preference at 94.6% support real-world adoption.
- Pain shifted from “stabbing/burning” → “dull/prickling”, with no adverse events.
Main Takeaway: Vibration-assisted anesthesia provides clinically meaningful, noninvasive pain reduction with high patient satisfaction and no safety concerns, making it a promising adjunct to traditional anesthesia in dermatology.
Relative efficacy of immunomodulatory monotherapies for psoriasis of the scalp
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
When you want fast results but also long-term disease control
Scalp psoriasis affects up to 80% of patients with plaque psoriasis and is associated with a substantial psychosocial burden due to its visibility, pruritus, and treatment resistance stemming from the hair-bearing anatomy. While multiple biologic and small-molecule immunomodulators are now available, their comparative effectiveness for scalp-specific disease remains unclear. This network meta-analysis evaluated randomized trials published since 2015 to compare 22 immunomodulatory monotherapies across standardized scalp psoriasis endpoints, including the Psoriasis Scalp Severity Index (PSSI-90, PSSI-100) and the scalp-specific Physician Global Assessment (Sc-PGA 0/1), at multiple treatment time points.
What did they find?
Scalp psoriasis affects up to 80% of patients with plaque psoriasis and is associated with a substantial psychosocial burden due to its visibility, pruritus, and treatment resistance stemming from the hair-bearing anatomy. While multiple biologic and small-molecule immunomodulators are now available, their comparative effectiveness for scalp-specific disease remains unclear. This network meta-analysis evaluated randomized trials published since 2015 to compare 22 immunomodulatory monotherapies across standardized scalp psoriasis endpoints, including the Psoriasis Scalp Severity Index (PSSI-90, PSSI-100) and the scalp-specific Physician Global Assessment (Sc-PGA 0/1), at multiple treatment time points.
What did they find?
- IL-17 inhibitors demonstrated the strongest short-term efficacy: Ixekizumab 80 mg every 2 weeks ranked highest in achieving PSSI-100 at 12 weeks, outperforming lower doses and placebo.
- Bimekizumab performed best at 16 weeks: Bimekizumab 320 mg every 4 weeks ranked highest for achieving Sc-PGA 0/1 at 16 weeks and outperformed deucravacitinib, apremilast, and adalimumab.
- Secukinumab led early response outcomes: At 8 weeks, secukinumab 300 mg achieved the highest rates of scalp clearance and significantly exceeded apremilast.
- IL-23 inhibitors showed strong comparative performance overall: Guselkumab and tildrakizumab showed high efficacy and may provide durable long-term benefit despite a slower onset than IL-17 inhibitors.
- Small-molecule therapies showed modest improvements: Apremilast, deucravacitinib, and topical roflumilast foam improved scalp psoriasis but consistently ranked below biologic therapies across most endpoints.
When the basics aren’t basic
Atopic dermatitis affects up to 20% of children and 10% of adults in Africa, and daily emollient use remains the cornerstone of management. This cross-sectional survey of dermatologists across 16 African countries assessed the availability and affordability of these products in routine clinical practice.
What did they find?
Atopic dermatitis affects up to 20% of children and 10% of adults in Africa, and daily emollient use remains the cornerstone of management. This cross-sectional survey of dermatologists across 16 African countries assessed the availability and affordability of these products in routine clinical practice.
What did they find?
- Traditional emollients such as coconut oil and shea butter were widely available across most settings, though quality and formulation were often inconsistent.
- Most prescribed emollients were imported products, and cost was a major barrier, with a 100 mL tub of petroleum jelly accounting for up to 13.7% of monthly income in countries like Mauritania and 12.8% in Nigeria.
- In several settings, the cost of recommended treatments exceeded 100% of the monthly minimum wage.
- Access to dermatologic care was also limited, with dermatologist density ranging from 1 per 100,000 to 1 per 2 million people, and many steroid-sparing and systemic therapies costing up to or more than a monthly income.
DERMLITE Dermoscopy QUESTION OF THE WEEK
ContactInterested in joining the team or advertising with us?
Do you have questions or feedback? Contact us below! |
PODCAST & RESEARCH |
Content of sk(in depth) is for medical education purposes only.
Copyright © 2025 - All Rights Reserved.
Copyright © 2025 - All Rights Reserved.