Ninety-Second issue
August 20, 2025
Risk of new-onset and recurrent depression and anxiety among patients with hidradenitis suppurativa
JAMA Dermatology
JAMA Dermatology
Treatment or not, HS still messes with your thoughts.
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition associated with painful nodules, scarring, and significant psychosocial burden. While previous research has shown that patients with HS are at higher risk for depression and anxiety, it’s been unclear whether that risk is influenced by disease severity. This population-based study from Denmark evaluated over 10,000 patients with HS to determine the risk of new-onset and recurrent psychiatric conditions, and whether that risk varied based on treatment type or surgical burden.
What did they find?
Main Takeaway: Patients with HS are at an elevated risk for developing depression and anxiety, regardless of treatment intensity or surgical history. The mental health burden appears to be independent of disease severity. These findings support the importance of psychiatric screening and mental health support for all patients with HS.
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition associated with painful nodules, scarring, and significant psychosocial burden. While previous research has shown that patients with HS are at higher risk for depression and anxiety, it’s been unclear whether that risk is influenced by disease severity. This population-based study from Denmark evaluated over 10,000 patients with HS to determine the risk of new-onset and recurrent psychiatric conditions, and whether that risk varied based on treatment type or surgical burden.
What did they find?
- Compared to matched controls, patients with HS had a 69% higher risk of new-onset depression (HR 1.69) and 48% higher risk of new-onset anxiety (HR 1.48).
- This elevated risk for anxiety and depression persisted regardless of treatment type: topical treatment only (HR 1.62), systemic nonbiologic treatment (HR 1.61), biologic therapy (HR 1.38), no treatment (HR 1.36).
- Risk remained elevated across levels of HS-related surgical procedures.
- There was no increased risk of recurrent depression or anxiety among patients with prior diagnoses.
Main Takeaway: Patients with HS are at an elevated risk for developing depression and anxiety, regardless of treatment intensity or surgical history. The mental health burden appears to be independent of disease severity. These findings support the importance of psychiatric screening and mental health support for all patients with HS.
Abrocitinib versus dupilumab: Impact on skin barrier function and proteomics in atopic dermatitis
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
When symptom relief meets molecular repair.
Atopic dermatitis’s (AD) pathogenesis involves epidermal barrier impairment and dysregulated type 2 immune response. Management requires restoring both skin barrier integrity and immune balance, as achieved by dupilumab, an IL-4/13 receptor inhibitor, and Janus kinase (JAK)-1 inhibitors. JAK1 inhibitors act faster than dupilumab, but their effects on barrier repair remain unclear. To compare these therapies, 33 patients with moderate-to-severe AD were randomized to dupilumab (n=16) or abrocitinib (n=17), with outcomes in clinical response, barrier function, and proteomics assessed against healthy controls (n=17).
What did they find?
Main Takeaway: In moderate-to-severe AD, both dupilumab and abrocitinib improved disease severity, but abrocitinib provided greater skin barrier restoration and broader proteomic normalization toward healthy skin. These findings suggest JAK1 inhibition may offer distinct advantages for barrier repair alongside symptom control in AD.
Atopic dermatitis’s (AD) pathogenesis involves epidermal barrier impairment and dysregulated type 2 immune response. Management requires restoring both skin barrier integrity and immune balance, as achieved by dupilumab, an IL-4/13 receptor inhibitor, and Janus kinase (JAK)-1 inhibitors. JAK1 inhibitors act faster than dupilumab, but their effects on barrier repair remain unclear. To compare these therapies, 33 patients with moderate-to-severe AD were randomized to dupilumab (n=16) or abrocitinib (n=17), with outcomes in clinical response, barrier function, and proteomics assessed against healthy controls (n=17).
What did they find?
- Both dupilumab and abrocitinib significantly reduced Eczema Area and Severity Index (EASI) scores by week 4.
- Pruritus improved in both groups; however, abrocitinib yielded lower Peak Pruritus Numerical Rating Scale (PP-NRS) scores at week 12 (abrocitinib: 1.0 [95% CI, 1.0–3.0] vs. dupilumab: 4.5 [95% CI, 1.0–5.0], P = 0.0317).
- By week 4, AD lesional transepidermal water loss (TEWL) decreased in both groups, though abrocitinib achieved a larger reduction (-19.5 [95% CI, -25.6 to -13.5] vs. -10.4 [95% CI, -17.4 to -3.4], P=0.0438).
- After 12 weeks, only abrocitinib moved lesional and nonlesional proteomes toward healthy skin by restoring key barrier proteins (FLG2, loricrin) and reducing markers of barrier dysfunction and inflammation (KRT16, IL-18).
Main Takeaway: In moderate-to-severe AD, both dupilumab and abrocitinib improved disease severity, but abrocitinib provided greater skin barrier restoration and broader proteomic normalization toward healthy skin. These findings suggest JAK1 inhibition may offer distinct advantages for barrier repair alongside symptom control in AD.
Harmonizing measurement of eczema control: Mapping scores between the atopic dermatitis control tool and the recap of atopic dermatitis instrument
British Journal of Dermatology
British Journal of Dermatology
When control scores don’t match, it’s time to bridge the gap.
Long-term disease control is a key outcome in atopic dermatitis research and clinical care, yet it is measured using different instruments across studies. The Harmonizing Outcome Measures for Eczema (HOME) initiative recommends two validated tools to assess long-term eczema control: 1) the Atopic Dermatitis Control Tool (ADCT) and 2) the Recap of Atopic Eczema (RECAP). While both measure the same concept, there was previously no way to directly compare scores between them. In this single-center study, 50 adults with atopic dermatitis completed both instruments, along with other core outcome measures, to develop equations that allow score conversion.
What did they find?
Main Takeaway: A simple, accurate method now exists to translate scores between ADCT and RECAP, supporting consistent measurement in research and clinical practice, and strengthening the HOME core outcome set.
Long-term disease control is a key outcome in atopic dermatitis research and clinical care, yet it is measured using different instruments across studies. The Harmonizing Outcome Measures for Eczema (HOME) initiative recommends two validated tools to assess long-term eczema control: 1) the Atopic Dermatitis Control Tool (ADCT) and 2) the Recap of Atopic Eczema (RECAP). While both measure the same concept, there was previously no way to directly compare scores between them. In this single-center study, 50 adults with atopic dermatitis completed both instruments, along with other core outcome measures, to develop equations that allow score conversion.
What did they find?
- ADCT and RECAP scores were highly correlated (r = 0.970).
- Four mapping models were tested; the simple linear regression without intercept provided the best balance of accuracy (R² = 0.971) and interpretability.
- Conversion formulas were created:
- ADCT = 0.8127 × RECAP
- RECAP = 1.1947 × ADCT
- These equations enable standardized comparisons across studies using different tools.
Main Takeaway: A simple, accurate method now exists to translate scores between ADCT and RECAP, supporting consistent measurement in research and clinical practice, and strengthening the HOME core outcome set.
PDCs, easy as (CD)123
Plasmacytoid dendritic cells (PDCs) play a role in cutaneous lupus erythematosus (CLE) by producing large amounts of type I interferon, a key inflammatory cytokine in disease pathogenesis. PDC markers such as CD123 and MXA help to differentiate CLE from histopathologic mimics; however, differences in their expression between CLE subtypes has not been well described. In a retrospective study, researchers compared expression patterns of PDC markers in discoid lupus erythematosus (DLE; n=72) and acute cutaneous lupus erythematosus (ACLE; n=41). Histopathologic findings were correlated with clinical disease activity scores.
What did they find?
Main Takeaway: The number, location, and clustering of PDCs on histopathology differs between DLE and ACLE.
Plasmacytoid dendritic cells (PDCs) play a role in cutaneous lupus erythematosus (CLE) by producing large amounts of type I interferon, a key inflammatory cytokine in disease pathogenesis. PDC markers such as CD123 and MXA help to differentiate CLE from histopathologic mimics; however, differences in their expression between CLE subtypes has not been well described. In a retrospective study, researchers compared expression patterns of PDC markers in discoid lupus erythematosus (DLE; n=72) and acute cutaneous lupus erythematosus (ACLE; n=41). Histopathologic findings were correlated with clinical disease activity scores.
What did they find?
- There was a higher mean percentage of CD123+ and cells with strong and diffuse MXA positivity in DLE compared to ACLE.
- Absence of PDC clusters was observed more frequently in ACLE (P=0.01, 73.2% vs. 44.4%), whereas small clusters of PDCs were seen more frequently in DLE (P=0.01, 33.3% vs. 17.1%).
- CD123+ cells at the dermoepidermal junction were more common in DLE than in ACLE (P=0.051, 61.1% vs 41.5%).
- There were no significant correlations between PDC marker expression and clinical disease activity scores.
Main Takeaway: The number, location, and clustering of PDCs on histopathology differs between DLE and ACLE.
A comparative clinical and trichoscopic study between fractional radiofrequency microneedling versus intralesional steroids in treatment of alopecia areata
Dermatologic Surgery
Dermatologic Surgery
Fuller strands with fewer steroids – FRFM makes follicles flourish!
Alopecia areata (AA) is a non-scarring autoimmune hair loss condition often treated with intralesional steroids (ILS). This randomized controlled study compared fractional radiofrequency microneedling (FRFM) with ILS to assess efficacy using clinical grading and trichoscopy. The study enrolled 24 patients with multifocal patchy AA and outcomes included trichoscopic scaled scores (dystrophic & terminal hairs), physician global assessment (PGA) score, and global patient’s satisfaction score with prespecified success criteria.
What did they find?
Main Takeaway: FRFM achieved hair regrowth comparable to ILS with fewer adverse effects positioning FRFM as a viable, steroid-sparing option for patchy AA.
Alopecia areata (AA) is a non-scarring autoimmune hair loss condition often treated with intralesional steroids (ILS). This randomized controlled study compared fractional radiofrequency microneedling (FRFM) with ILS to assess efficacy using clinical grading and trichoscopy. The study enrolled 24 patients with multifocal patchy AA and outcomes included trichoscopic scaled scores (dystrophic & terminal hairs), physician global assessment (PGA) score, and global patient’s satisfaction score with prespecified success criteria.
What did they find?
- FRFM showed clinically robust regrowth by improving dystrophic hair score from 1.13 to 0.17 and terminal hair score from 0.54 to 3.17 (both P < 0.001).
- ILS had similar gains, with improvement of dystrophic hair score from 1.04 to 0.17 and terminal from 0.58 to 3.17 (both P < 0.001).
- Between-group differences were not significant at endpoint (terminal hair P = 1.000; dystrophic P = 0.736).
- Treatment success in 21/24 patches (87.5%) for both FRFM and ILS (P = 1.0); both outperformed control patches (PGA, P = 0.003 and P < 0.001 vs control).
- FRM had milder adverse events (transient pain/folliculitis) versus ILCS (atrophy, dyspigmentation, scarring, injection pain).
Main Takeaway: FRFM achieved hair regrowth comparable to ILS with fewer adverse effects positioning FRFM as a viable, steroid-sparing option for patchy AA.
Effects of a ceramide-containing glycinate-based cleanser on the condition of oily skin and skin post-IPL treatments
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
Sometimes, the right cleanser can do more than clean, it can actively repair.
While ceramide-rich moisturizers are well-studied, no prior research has focused on stand-alone ceramide-based cleansers, particularly for oily skin or skin recovering from intense pulsed light (IPL) treatment. This study evaluated whether a glycinate-based cleanser with three essential ceramides (EOP, NP, AP) used twice daily for 28 days could improve skin barrier function, sebum control, and redness reduction in women with oily skin (n=22), defined as mean forehead sebum > 100 µg/cm², or women who underwent their first facial IPL treatment (n=22).
What did they find?
While ceramide-rich moisturizers are well-studied, no prior research has focused on stand-alone ceramide-based cleansers, particularly for oily skin or skin recovering from intense pulsed light (IPL) treatment. This study evaluated whether a glycinate-based cleanser with three essential ceramides (EOP, NP, AP) used twice daily for 28 days could improve skin barrier function, sebum control, and redness reduction in women with oily skin (n=22), defined as mean forehead sebum > 100 µg/cm², or women who underwent their first facial IPL treatment (n=22).
What did they find?
- In women with oily skin, hydration improved by 47.37% at day 28 (P<0.05), transepidermal water loss (TEWL) decreased by 13.42% at day 28 (P<0.05), pore count decreased by 6.92% at day 28 (P<0.05), and sebum decreased by 98.01% immediately post-wash and sustained a decrease of 79.18% at day 28 (P<0.05).
- In women post-IPL treatment, redness decreased by 14.62% at day 28 vs immediate post-IPL (P<0.05), and there were significant reductions in self reported symptoms, such as itching, tightness, burning, and tingling, at all timepoints (P<0.001 for most comparisons).
- The glycinate-based cleanser was well-tolerated, with no adverse events reported.
When the melanoma’s real, but the system keeps calling it a bruise.
Acral lentiginous melanoma (ALM) often affects sites not routinely examined, like the palms, soles, and nail beds. It disproportionately affects patients with skin of color, particularly Black individuals. This study examined whether survival disparities in ALM persist even after adjusting for stage at diagnosis amongst nearly 5,000 patients from the National Cancer Database (2004–2019).
What did they find?
Acral lentiginous melanoma (ALM) often affects sites not routinely examined, like the palms, soles, and nail beds. It disproportionately affects patients with skin of color, particularly Black individuals. This study examined whether survival disparities in ALM persist even after adjusting for stage at diagnosis amongst nearly 5,000 patients from the National Cancer Database (2004–2019).
What did they find?
- Adjusted odds of death were 26% higher in Black patients compared to non‑Hispanic White patients, even when matched by stage and clinical factors (adjusted OR 1.26; 95% CI 1.10–1.45).
- Five‑year survival was 66.2% in Black patients versus 74.5% in White patients.
- Median tumor depth at diagnosis was similar between groups, suggesting outcomes are not driven by Breslow thickness.
- Survival disparities persisted within the same stage, pointing to factors beyond delayed detection.
DERMLITE Dermoscopy QUESTION OF THE WEEK
Melanoma in situ (MIS) represents the earliest form of melanoma, where malignant melanocytes are confined to the epidermis. Timely surgical treatment is critical to prevent progression to invasive melanoma, which carries a significantly worse prognosis. This retrospective cohort study investigates whether racial and ethnic disparities exist in the timely surgical management of MIS, an area of growing concern for dermatologists striving for equitable care.
What did they find?
Main Takeaway: Despite continuous insurance coverage, racial and ethnic minority patients were less likely to receive timely surgical treatment for MIS. These findings highlight the need for improved care navigation and equity-focused interventions in dermatologic oncology.
What did they find?
- Black patients had a significantly lower treatment rate (42.9%) compared to White patients (74.3%) within 3 months of diagnosis (OR 0.26, P<0.007).
- Hispanic/Latino patients also had lower treatment rates (44.1%) than non-Hispanic/Latino patients (67.4%) (OR 0.38, P=0.02).
Main Takeaway: Despite continuous insurance coverage, racial and ethnic minority patients were less likely to receive timely surgical treatment for MIS. These findings highlight the need for improved care navigation and equity-focused interventions in dermatologic oncology.
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Copyright © 2025 - All Rights Reserved.
Copyright © 2025 - All Rights Reserved.