A newsletter that delivers the latest in dermatology research directly to you.
One Hundred and seventeenth issue
August 19th, 2026
Living HS-free is becoming millionaire behavior.
Biologics have transformed moderate-to-severe hidradenitis suppurativa (HS) care, but their high and variable prices complicate treatment-access decisions. This economic evaluation combined efficacy data from 6 phase 3 trials of adalimumab, secukinumab, and bimekizumab with January 2026 drug prices from the US, Canada, France, Germany, and Australia, comparing cost with adjusted HiSCR-50 and HiSCR-75 response rates.
What did they find?
Main Takeaway: Weekly adalimumab offered the most favorable balance between drug cost and clinical response across the health systems studied. This finding reflects economic efficiency and may change as prices, biosimilar availability, and treatment options evolve.
Biologics have transformed moderate-to-severe hidradenitis suppurativa (HS) care, but their high and variable prices complicate treatment-access decisions. This economic evaluation combined efficacy data from 6 phase 3 trials of adalimumab, secukinumab, and bimekizumab with January 2026 drug prices from the US, Canada, France, Germany, and Australia, comparing cost with adjusted HiSCR-50 and HiSCR-75 response rates.
What did they find?
- Adalimumab 40 mg weekly consistently remained on the efficiency frontier for both HiSCR-50 and HiSCR-75 across all 5 countries.
- Under US wholesale acquisition costs (WAC), secukinumab 300 mg every 4 weeks also appeared on the frontier.
- Non-US prices were often <20% of US WAC (adalimumab in Australia was just 6.3% of US WAC).
- On the US WAC frontier, adalimumab cost $76,814/year more than secukinumab but delivered a 15% higher HiSCR-50 rate.
Main Takeaway: Weekly adalimumab offered the most favorable balance between drug cost and clinical response across the health systems studied. This finding reflects economic efficiency and may change as prices, biosimilar availability, and treatment options evolve.
Topical versus systemic corticosteroids for drug reaction with eosinophilia and systemic symptoms syndrome: Real-world outcomes from a multicenter retrospective cohort
JAAD
JAAD
Either way, there’s a good chance you’ll need both.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous drug reaction, and systemic corticosteroids have long been the default treatment despite limited comparative data. This multicenter retrospective cohort of adults hospitalized with DRESS at two tertiary centers (2012-2021) compared outcomes between patients started on topical corticosteroids alone versus systemic corticosteroids.
What did they find?
Main Takeaway: Topical corticosteroids appear to be a reasonable initial approach for select hospitalized DRESS patients, given no statistical difference in mortality and discharge outcomes compared to systemic therapy, though close monitoring is warranted given nearly half of topical patients required escalation.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous drug reaction, and systemic corticosteroids have long been the default treatment despite limited comparative data. This multicenter retrospective cohort of adults hospitalized with DRESS at two tertiary centers (2012-2021) compared outcomes between patients started on topical corticosteroids alone versus systemic corticosteroids.
What did they find?
- Of 359 patients, 124 (35%) were started on topical corticosteroids alone, and 235 (65%) received systemic corticosteroids; 45% of the topical group later escalated to systemic therapy, with a median time to escalation of 2 days.
- 30-day mortality was similar between groups (weighted incidence rate=2.0 vs 2.9 per 1000 person-days, topical vs systemic), with an overlap-weighted hazard ratio (OWHR) of 1.56 (95% CI=0.19-12.68) for systemic versus topical therapy.
- Discharge rates were also comparable between groups (weighted incidence rate=76.2 vs 92.8 per 1000 person-days; OWHR=1.22, 95% CI=0.87-1.71).
- A sensitivity analysis anchored at the time of systemic initiation showed consistent results (OWHR=1.23, 95% CI=0.11-13.87 for mortality; OWHR=1.34, 95% CI=0.91-1.99 for discharge), and antibiotics were the leading suspected culprit drug class in both groups (53% topical, 56% systemic).
Main Takeaway: Topical corticosteroids appear to be a reasonable initial approach for select hospitalized DRESS patients, given no statistical difference in mortality and discharge outcomes compared to systemic therapy, though close monitoring is warranted given nearly half of topical patients required escalation.
Willingness to pay among individuals from the Dutch general population for artificial intelligence based apps for skin cancer detection: a survey-based mixed-methods study
BJD
BJD
AI healthcare could no longer be “on-the-house”.
AI-based mobile health apps for skin cancer detection are increasingly available to the public, but how much people are actually willing to pay for them, and why, has not been well studied. This survey-based study asked nearly 2,000 participants to report their willingness to pay (WTP) for three scenarios: AI alone, AI plus a teledermatologist, and an in-person dermatologist visit.
What did they find?
Main Takeaway: People consistently value a dermatologist's involvement over AI alone, and low willingness to pay may reflect various beliefs such as a distrust in AI or that skin cancer screening tools should be free.
AI-based mobile health apps for skin cancer detection are increasingly available to the public, but how much people are actually willing to pay for them, and why, has not been well studied. This survey-based study asked nearly 2,000 participants to report their willingness to pay (WTP) for three scenarios: AI alone, AI plus a teledermatologist, and an in-person dermatologist visit.
What did they find?
- Participants were willing to pay significantly more for AI combined with a teledermatologist than for AI alone (median €20 vs €5, p < 0.001), but both fell short of what they would pay for a physical dermatologist visit (median €50, p < 0.001).
- Older age was the only factor consistently linked to higher WTP across all three scenarios.
- Qualitative analysis revealed that similar WTP could stem from very different reasoning, as some participants reported low WTP due to distrust in AI, while others reported low WTP because they believed such tools should be free and accessible to everyone.
- Nearly 70% of participants wanted an AI-based app to be covered under mandatory basic health insurance rather than paid for out of pocket.
Main Takeaway: People consistently value a dermatologist's involvement over AI alone, and low willingness to pay may reflect various beliefs such as a distrust in AI or that skin cancer screening tools should be free.
The Three Musketeers of infantile AD.
Mother-to-infant bonding disorder (MIBD), a condition where a parent feels a lack of emotional connection toward their child, is linked to maternal depression, anxiety, and child abuse; however, the role of child-related risk factors like infantile atopic dermatitis (AD) remains poorly understood. This cross-sectional study used data from 4236 postpartum women in the Japan COVID-19 and Society Internet Survey (JACSIS) and estimated relative risks (RRs) of MIBD associated with maternally reported AD (R-AD) and physician-diagnosed AD (D-AD).
What did they find?
Main Takeaway: Infantile AD is associated with a higher risk of MIBD, particularly driving anger or rejection feelings, rather than lack of affection. Mothers of infants with AD may benefit from targeted support involving coordinated dermatology, pediatrics, obstetrics, and psychiatry.
Mother-to-infant bonding disorder (MIBD), a condition where a parent feels a lack of emotional connection toward their child, is linked to maternal depression, anxiety, and child abuse; however, the role of child-related risk factors like infantile atopic dermatitis (AD) remains poorly understood. This cross-sectional study used data from 4236 postpartum women in the Japan COVID-19 and Society Internet Survey (JACSIS) and estimated relative risks (RRs) of MIBD associated with maternally reported AD (R-AD) and physician-diagnosed AD (D-AD).
What did they find?
- MIBD was present in 24.2% of participants (n = 1024), and infantile AD was significantly associated with higher MIBD risk, regardless of whether it was maternally reported (RR = 1.22, 95% CI = 1.07 - 1.40) or physician-diagnosed (RR = 1.41, 95% CI = 1.18 - 1.69).
- AD was significantly associated with the Anger and Rejection MIBD subscale for both R-AD (RR = 1.29, 95% CI = 1.15 - 1.44) and D-AD (RR = 1.36, 95% CI = 1.17 - 1.59).
- In contrast, AD was not significantly associated with the Lack of Affection subscale for either R-AD (RR = 1.08, 95% CI = 0.93 - 1.25) or D-AD (RR = 1.09, 95% CI = 0.87 - 1.36).
- A history of maternal depression before childbirth was also strongly associated with MIBD (RR = 1.36, 95% CI = 1.15 - 1.61).
Main Takeaway: Infantile AD is associated with a higher risk of MIBD, particularly driving anger or rejection feelings, rather than lack of affection. Mothers of infants with AD may benefit from targeted support involving coordinated dermatology, pediatrics, obstetrics, and psychiatry.
Dermatologists hate to see an IDH mutation coming.
Isocitrate dehydrogenase 1 and 2 (IDH1, IDH2) encode metabolic enzymes that, when mutated, produce the oncometabolite D-2-hydroxyglutarate, which drives aberrant DNA methylation, epigenetic dysregulation, and altered cellular metabolism. Although IDH mutations are well described in many malignancies, they remain poorly characterized in melanoma. In this retrospective series, 9 cases of sequenced melanomas harboring IDH1 mutations were reviewed and reported on their clinicopathologic and molecular characteristics.
What did they find?
Takeaway: IDH1-mutated melanomas present with advanced disease and high-risk clinicopathologic features associated with adverse prognosis, including nodular growth pattern, increased Breslow thickness, and limited immune infiltration.
Isocitrate dehydrogenase 1 and 2 (IDH1, IDH2) encode metabolic enzymes that, when mutated, produce the oncometabolite D-2-hydroxyglutarate, which drives aberrant DNA methylation, epigenetic dysregulation, and altered cellular metabolism. Although IDH mutations are well described in many malignancies, they remain poorly characterized in melanoma. In this retrospective series, 9 cases of sequenced melanomas harboring IDH1 mutations were reviewed and reported on their clinicopathologic and molecular characteristics.
What did they find?
- Histologically, 8/9 cases were classified as nodular melanomas and exhibited epithelioid morphology and increased mitotic activity, indicating adverse clinical behavior.
- Median Breslow thickness ranged from 1.45 to 15 mm, with a median thickness of 2.87 mm; all tumors had a Clark level of III or higher, suggesting that the tumors presented at a relatively advanced pathological stage.
- PD-L1 expression was found in 3 tumors and occurred in the context of scarce or absent tumor-infiltrating lymphocytes.
- Immunohistochemically, all 9 tumors were positive for Melan-A and S100 expression with variable HMB-45 expression; a partial loss of p16 (20-50%) was observed in most cases, with two cases showing complete loss.
- Most cases showed co-occurring mutations including BRAF, NRAS, KRAS, CTNNB1, and MAP2K1, with non-V600E BRAF variants being the most prevalent.
Takeaway: IDH1-mutated melanomas present with advanced disease and high-risk clinicopathologic features associated with adverse prognosis, including nodular growth pattern, increased Breslow thickness, and limited immune infiltration.
The safety of perioperative liposomal bupivacaine injections in dermatologic surgery patients
Derm Surg
Derm Surg
The surgery ended. The bupivacaine did not.
Liposomal bupivacaine (LB) provides prolonged local anesthetic activity and has been increasingly used for postoperative analgesia, but there is limited evidence specifically evaluating its safety in dermatologic surgery. This retrospective chart review characterized LB use and identified adverse events, particularly local anesthetic systemic toxicity (LAST), in adults who received perioperative LB at the surgical site or surrounding skin.
What did they find?
Main Takeaway: Liposomal bupivacaine appears to be a well-tolerated option for postoperative analgesia in dermatologic surgery, including larger excisions and Mohs micrographic surgery.
Liposomal bupivacaine (LB) provides prolonged local anesthetic activity and has been increasingly used for postoperative analgesia, but there is limited evidence specifically evaluating its safety in dermatologic surgery. This retrospective chart review characterized LB use and identified adverse events, particularly local anesthetic systemic toxicity (LAST), in adults who received perioperative LB at the surgical site or surrounding skin.
What did they find?
- LB was most commonly used for excisional surgery (88 cases, 62.9%) and Mohs micrographic surgery (49 cases, 35%).
- The most frequent underlying diagnoses were hidradenitis suppurativa (77 cases, 55%) and cutaneous neoplasms (56 cases, 40%).
- The median LB dose was 20 mL (range 1.5–20 mL), and 134 of 136 administrations (98.5%) had no reported adverse events.
- Only 2 patients (1.5%) reported nausea on postoperative day 1, both while taking opioids. No cases of LAST were observed.
Main Takeaway: Liposomal bupivacaine appears to be a well-tolerated option for postoperative analgesia in dermatologic surgery, including larger excisions and Mohs micrographic surgery.
Current scar treatments, meet your new bestie: trichloroacetic acid
Trichloroacetic acid (TCA) is a chemical agent that can be used as a chemical peel or injection that increases collagen production and dermal thickening. It has been increasingly explored in the treatment of atrophic acne scars (typically caused by defects in collagen synthesis); however, no standard protocol or regimen has been developed. This scoping review followed JBI and PRISMA-ScR guidelines and analyzed 34 articles to explore TCA dosing, method of administration, outcomes, and safety profile.
What did they find?
Main Takeaway: TCA is a safe, affordable therapy that can be used as monotherapy via the CROSS technique or in combination with other current atrophic scar treatment options to improve dermal remodeling and acne scar appearance.
Trichloroacetic acid (TCA) is a chemical agent that can be used as a chemical peel or injection that increases collagen production and dermal thickening. It has been increasingly explored in the treatment of atrophic acne scars (typically caused by defects in collagen synthesis); however, no standard protocol or regimen has been developed. This scoping review followed JBI and PRISMA-ScR guidelines and analyzed 34 articles to explore TCA dosing, method of administration, outcomes, and safety profile.
What did they find?
- 14 studies (41.2%) used TCA as a chemical peel, ranging from superficial to deep for improving texture, superficial irregularities and shallow scars, and hyperpigmentation.
- 20 studies (58.8%) evaluated the CROSS technique: applying a high concentration of TCA (50-100%) into individual icepick or boxcar scars, which allowed for dermal remodeling at a more affordable price point compared to laser therapy.
- Addition of TCA to microneedling, other chemical agents, or energy devices demonstrated reduction in scar depth, improved texture, and homogeneous improvement.
- Transient post-inflammatory hyperpigmentation was the most common SE; others included erythema, local edema, and a burning sensation.
Main Takeaway: TCA is a safe, affordable therapy that can be used as monotherapy via the CROSS technique or in combination with other current atrophic scar treatment options to improve dermal remodeling and acne scar appearance.
Kinda feels NOT chic to be young and lose hair to chemo
Chemotherapy-induced alopecia is common during breast cancer treatment and can affect self-image, identity, and social well-being. This pilot study used the validated 35-item Hair QoL Measure to examine the impact of chemotherapy-related hair loss in 24 women with breast cancer from racial and ethnic minority groups, in a predominantly Black cohort.
What did they find?
Main Takeaway: In this predominantly Black breast cancer cohort, younger age was associated with a greater quality-of-life burden from chemotherapy-induced alopecia.
Chemotherapy-induced alopecia is common during breast cancer treatment and can affect self-image, identity, and social well-being. This pilot study used the validated 35-item Hair QoL Measure to examine the impact of chemotherapy-related hair loss in 24 women with breast cancer from racial and ethnic minority groups, in a predominantly Black cohort.
What did they find?
- Age was associated with 10 of the 35 Hair QoL items, making it the demographic factor most strongly associated with chemotherapy-induced alopecia-related quality-of-life burden.
- Younger patients were more likely to report feeling different from others (p = .0003), a negative impact on self-image (p = .013), and feeling that their facial features had changed (p = .03).
- Younger age was also associated with greater worry that hair loss would signal cancer to others (p = .0003), more difficulty coping with strangers’ reactions (P = .003), and difficulty maintaining their usual appearance (p = .013).
- Younger patients reported a greater impact on work (p = .016) and were less likely to report eyebrow or eyelash regrowth (p = .021).
- With increasing age, patients were more likely to report feeling like the same person inside (p = .014) and feeling good about their appearance despite hair loss (P = .004).
Main Takeaway: In this predominantly Black breast cancer cohort, younger age was associated with a greater quality-of-life burden from chemotherapy-induced alopecia.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.