One Hundred and EIGHTH issue
april 15TH, 2026
Big itch energy, minimal GPA effect
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease characterized by pruritus, eczematous lesions, and a significant impact on quality of life across all ages. Although AD is associated with sleep disturbance, psychosocial stress, and various comorbidities, its effect on academic performance remains unclear, with prior studies showing conflicting results. This population-based cohort study from Denmark and England evaluated the association between AD and academic outcomes on standardized exams in 782,837 children, while accounting for disease phenotype and socioeconomic factors.
What did they find?
Main Takeaway: Atopic dermatitis does not appear to meaningfully impair academic performance, even in large, well-controlled cohorts. These findings are reassuring for patients, families, and clinicians, and suggest that future research should focus on quality of life and targeted support for children with active or more severe disease.
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease characterized by pruritus, eczematous lesions, and a significant impact on quality of life across all ages. Although AD is associated with sleep disturbance, psychosocial stress, and various comorbidities, its effect on academic performance remains unclear, with prior studies showing conflicting results. This population-based cohort study from Denmark and England evaluated the association between AD and academic outcomes on standardized exams in 782,837 children, while accounting for disease phenotype and socioeconomic factors.
What did they find?
- In the Denmark cohort, there was minimal difference in academic failure, with nonpassing rates of 12% in children with AD vs 11.2% in those without AD.
- Children with active AD in Denmark had slightly worse outcomes, with nonpassing rates of 13.7% vs 11.1% in those without AD.
- In the England cohort, outcomes were paradoxically better among students with AD, with nonpassing rates of 37.7% vs 47.4% in those without AD.
- Disease phenotype influenced performance, with moderate-declining AD (+12.75 points) and moderate-frequent AD (+11.58 points) associated with differences in exam scores (95% CI, 7.27-18.24; 95% CI, 5.32-17.38).
Main Takeaway: Atopic dermatitis does not appear to meaningfully impair academic performance, even in large, well-controlled cohorts. These findings are reassuring for patients, families, and clinicians, and suggest that future research should focus on quality of life and targeted support for children with active or more severe disease.
Tumor location… because melanoma needed another variable.
Primary tumor location (PTL) has shown inconsistent associations with survival in cutaneous malignant melanoma (CMM) and is not currently included in standard staging systems. In this large retrospective SEER study (2000-2021), investigators evaluated 162,871 patients to determine whether PTL independently predicts all-cause and melanoma-specific mortality after adjusting for key demographic, tumor, and treatment variables.
What did they find?
Main Takeaway: Primary tumor location is an independent predictor of melanoma outcomes. Head and neck melanomas are associated with worse survival, while extremity lesions are associated with improved outcomes compared to trunk. Incorporating PTL into risk stratification may improve prognostication and help guide surveillance and management decisions.
Primary tumor location (PTL) has shown inconsistent associations with survival in cutaneous malignant melanoma (CMM) and is not currently included in standard staging systems. In this large retrospective SEER study (2000-2021), investigators evaluated 162,871 patients to determine whether PTL independently predicts all-cause and melanoma-specific mortality after adjusting for key demographic, tumor, and treatment variables.
What did they find?
- Head and neck melanomas were associated with higher mortality compared to trunk (aHR 1.08 all-cause; 1.05 melanoma-specific).
- Upper and lower extremity melanomas were associated with lower mortality vs trunk (all-cause aHR 0.91 and 0.89; melanoma-specific aHR 0.79 and 0.96).
- Among 162,871 patients (median follow-up 6.3 years), 23.0% died, with melanoma accounting for 21.9% of deaths.
- Tumor thickness modified outcomes, with attenuation of the head and neck survival disadvantage in thicker tumors.
Main Takeaway: Primary tumor location is an independent predictor of melanoma outcomes. Head and neck melanomas are associated with worse survival, while extremity lesions are associated with improved outcomes compared to trunk. Incorporating PTL into risk stratification may improve prognostication and help guide surveillance and management decisions.
PCOS ≠ prescriptions come out skewed!
Polycystic ovary syndrome (PCOS) is a common endocrine disorder defined by hyperandrogenism and ovulatory dysfunction, affecting up to 15% of reproductive-aged women and often presenting with early cutaneous manifestations such as acne. Despite known racial and ethnic disparities in PCOS prevalence and acne treatment, data on acne management among adolescents with PCOS remain limited. This retrospective chart review evaluated treatment differences by race and ethnicity in high-risk populations, examining female patients <18 years old with PCOS and acne vulgaris at a single urban academic center (2012–2022) using ICD-confirmed diagnoses.
What did they find?
Main Takeaway: Significant racial and ethnic disparities in acne treatment persist among adolescents with PCOS. Hispanic patients were less likely to receive spironolactone, combined oral contraceptives, and isotretinoin, while Black patients were less likely to receive topical antibiotics, even after adjusting for severity and access factors. These findings suggest that system-, provider, and patient-level factors contribute to inequities and highlight the need for more equitable care during a critical period.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder defined by hyperandrogenism and ovulatory dysfunction, affecting up to 15% of reproductive-aged women and often presenting with early cutaneous manifestations such as acne. Despite known racial and ethnic disparities in PCOS prevalence and acne treatment, data on acne management among adolescents with PCOS remain limited. This retrospective chart review evaluated treatment differences by race and ethnicity in high-risk populations, examining female patients <18 years old with PCOS and acne vulgaris at a single urban academic center (2012–2022) using ICD-confirmed diagnoses.
What did they find?
- A total of 138 adolescents met inclusion criteria: White 35.5%, Hispanic 36.2%, Black 10.9%, Asian 8.0%, and other 9.4%.
- Acne severity did not differ by race or ethnicity (P = 0.49), but insurance type and interpreter use varied significantly (both P < 0.001); dermatology evaluation rates were similar (P = 0.7).
- Spironolactone (P = 0.019) and isotretinoin (P = 0.045) prescribing differed by race or ethnicity, with lower use among Hispanic patients and no isotretinoin use in Black patients.
- Severe acne predicted systemic therapy, including oral antibiotics (aOR 6.50), spironolactone (aOR 10.1), and COCs (aOR 10.1); private insurance was associated with higher use of spironolactone (P = 0.001) and oral antibiotics (P = 0.024).
- On multivariable analysis, Hispanic patients had lower odds of receiving spironolactone (aOR 0.22), COCs (aOR 0.16), and isotretinoin (aOR 0.08), while Black patients had lower odds of topical antibiotic use (aOR 0.10) compared to White patients.
Main Takeaway: Significant racial and ethnic disparities in acne treatment persist among adolescents with PCOS. Hispanic patients were less likely to receive spironolactone, combined oral contraceptives, and isotretinoin, while Black patients were less likely to receive topical antibiotics, even after adjusting for severity and access factors. These findings suggest that system-, provider, and patient-level factors contribute to inequities and highlight the need for more equitable care during a critical period.
Defective splicing couldn’t piece this together… but we did.
Xeroderma pigmentosum (XP) is a rare DNA repair disorder caused by defects in nucleotide excision repair (NER), leading to extreme UV sensitivity, early-onset skin cancers, and, in some cases, progressive neurologic decline. This study describes two patients with a milder XP-A phenotype associated with a homozygous XPA variant (c.389G>A). Although this appears to be a conservative missense mutation, clinical and cellular findings suggested it was not functionally benign. Further investigation identified aberrant mRNA splicing, rather than impaired protein function, as the primary driver of disease.
What did they find?
Main Takeaway: Not all missense mutations act at the protein level. In XP-A, a splice-altering variant can significantly reduce functional XPA expression while preserving protein integrity, resulting in residual DNA repair and a milder, delayed phenotype. These findings highlight the importance of mRNA splicing in disease expression and suggest potential therapeutic targets at the RNA level.
Xeroderma pigmentosum (XP) is a rare DNA repair disorder caused by defects in nucleotide excision repair (NER), leading to extreme UV sensitivity, early-onset skin cancers, and, in some cases, progressive neurologic decline. This study describes two patients with a milder XP-A phenotype associated with a homozygous XPA variant (c.389G>A). Although this appears to be a conservative missense mutation, clinical and cellular findings suggested it was not functionally benign. Further investigation identified aberrant mRNA splicing, rather than impaired protein function, as the primary driver of disease.
What did they find?
- Milder, delayed phenotype with cutaneous XP and late or absent neurologic involvement.
- Severe TC-NER defect, with markedly impaired transcription-coupled repair and no recovery of RNA synthesis after UV damage.
- Residual GG-NER activity, with reduced but detectable global repair consistent with a milder phenotype.
- Protein function preserved, as the XPA R130K variant was stable and functionally intact in repair assays.
- Splicing defect drives disease, with abnormal mRNA processing resulting in ~5% functional XPA protein.
Main Takeaway: Not all missense mutations act at the protein level. In XP-A, a splice-altering variant can significantly reduce functional XPA expression while preserving protein integrity, resulting in residual DNA repair and a milder, delayed phenotype. These findings highlight the importance of mRNA splicing in disease expression and suggest potential therapeutic targets at the RNA level.
No need to fret, retinoids applied topically may be safe during pregnancy!
Isotretinoin and topical retinoids are commonly used to treat acne. Teratogenicity is well-established for systemic, oral retinoid use, but it is less explored for topical application. This study determined the prevalence of topical retinoid use in Nordic women of reproductive age across an 18-year period and conducted a population-based cohort study to assess the risk of major congenital malformations.
What did they find?
Main Takeaway: Despite the prevalence of topical retinoid use tripling in Nordic women over the years, there has been no observed increased risk in major congenital malformations reinforcing the possible safety of topical retinoids during pregnancy.
Isotretinoin and topical retinoids are commonly used to treat acne. Teratogenicity is well-established for systemic, oral retinoid use, but it is less explored for topical application. This study determined the prevalence of topical retinoid use in Nordic women of reproductive age across an 18-year period and conducted a population-based cohort study to assess the risk of major congenital malformations.
What did they find?
- The prevalence of topical retinoid use increased from 8.7 per 1000 in 2006 to 28.5 per 1000 in 2024 representing a 3.3-fold increase.
- In infants exposed to topical retinoids within the first trimester, 3.3% had any major congenital malformations (71 of 2172):
- Compared to 3.0% among unexposed infants (aRR 1.1, 95% CI 0.87–1.38).
- Compared to 2.6% among infants exposed to azelaic acid or clindamycin (aRR 1.1, 95% CI 0.87–1.47).
- Compared to 3.0% among unexposed infants (aRR 1.1, 95% CI 0.87–1.38).
Main Takeaway: Despite the prevalence of topical retinoid use tripling in Nordic women over the years, there has been no observed increased risk in major congenital malformations reinforcing the possible safety of topical retinoids during pregnancy.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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