One Hundred and Sixteenth issue
August 5th, 2026
In this week’s issue:
- Nearly a third of US adults, especially younger women and heavy drinkers, intentionally tan outdoors.
- Fish oil supplementation with low-dose isotretinoin for acne
- Most modern psoriasis biologics carry about the same serious infection risk, but risankizumab came out ahead of the pack.
- Skin microbiomes are altered in patients with HIV and idiopathic CD4 lymphopenia.
- Incidence rates of scabies, pruritus, and bacterial skin diseases have increased among neonates in low-income countries between 1990 and 2023.
- A randomized clinical trial showed that text groups focused on lifestyle improvement from dermatologists improved patient activation, diet, exercise, and BMI in patients with psoriasis.
- A Jaungo-inspired herbal complex reduced macrophage inflammatory signaling and preserved keratinocyte barrier-gene expression in a preclinical model relevant to psoriasis.
- Climate-driven floods are causing a plethora of complex skin infections, making early dermatologic intervention in disaster medicine more critical than ever.
Sun-seeking persists in the era of skin cancer prevention.
Indoor tanning prevalence has been characterized through national surveillance efforts, whereas comparable data on intentional outdoor tanning remain limited. This cross-sectional study used data from the 2024 National Health Interview Survey (N = 31,615 US adults) to estimate the prevalence of intentional outdoor tanning, identify associated demographic and behavioral factors, and characterize its relationship with sunburn.
What did they find?
Main Takeaway: More than a third of US women and a quarter of US men intentionally tan outdoors, with prevalence concentrated among younger, non-Hispanic White, physically active adults who report heavy or binge drinking.
Indoor tanning prevalence has been characterized through national surveillance efforts, whereas comparable data on intentional outdoor tanning remain limited. This cross-sectional study used data from the 2024 National Health Interview Survey (N = 31,615 US adults) to estimate the prevalence of intentional outdoor tanning, identify associated demographic and behavioral factors, and characterize its relationship with sunburn.
What did they find?
- Unadjusted prevalence of intentional outdoor tanning was 30.2% overall, including 35.6% among women (95% CI = 34.6 - 36.7) and 26.6% among men (95% CI = 25.6 - 27.7).
- Among women, adjusted prevalence was highest in those aged 18-29 (48.1%), non-Hispanic White women (41.3%), non-sun-sensitive women (38.3%), women meeting both aerobic and strength guidelines (39.5%), and heavy/binge drinkers (47.2%), all p < 0.001.
- Among men, the same general pattern held (highest in ages 18-29, non-Hispanic White, physically active, heavy/binge drinkers), with sun-sensitive men (rather than non-sun-sensitive) showing higher prevalence, and married/partnered men showing a modest association (25.8%, p = 0.04).
- Sunburn prevalence was nearly double among intentional tanners versus non-tanners (49.9% vs 28.3%, p < 0.001) across every demographic subgroup examined.
Main Takeaway: More than a third of US women and a quarter of US men intentionally tan outdoors, with prevalence concentrated among younger, non-Hispanic White, physically active adults who report heavy or binge drinking.
The superhero crossover we didn't expect.
Fish oil has been proposed as a way to reduce isotretinoin-associated mucocutaneous dryness and hypertriglyceridemia, but its impact on acne treatment efficacy has remained unclear. In this randomized, double-masked, non-inferiority trial, investigators evaluated whether adding 1 g/day fish oil to low-dose isotretinoin (10 mg/day) maintained efficacy while improving tolerability in 80 adults with moderate-to-severe acne treated for 3 months.
What did they find?
Fish oil has been proposed as a way to reduce isotretinoin-associated mucocutaneous dryness and hypertriglyceridemia, but its impact on acne treatment efficacy has remained unclear. In this randomized, double-masked, non-inferiority trial, investigators evaluated whether adding 1 g/day fish oil to low-dose isotretinoin (10 mg/day) maintained efficacy while improving tolerability in 80 adults with moderate-to-severe acne treated for 3 months.
What did they find?
- Fish oil plus low-dose isotretinoin was noninferior to isotretinoin alone, with a between-group difference in total acne count reduction of -6.0 lesions (95% CI = -16.5 to 4.5).
- Treatment success was similar between groups, with Investigator's Global Assessment success achieved in 62.5% of the fish oil group versus 60.0% of placebo (p = 0.818).
- Fish oil better preserved skin hydration (corneometer difference = 11.10, 95% CI = 3.55-18.65) and reduced triglyceride increases (difference = -10.9 mg/dL, 95% CI = -18.3 to -3.4).
- No serious adverse events occurred, and mucocutaneous side effects were generally mild in both groups.
Sure your psoriasis is gone, but at what cost?
Therapeutics for psoriasis primarily target the immune system, increasing infection risk among patients. While the infection risks associated with older drugs have been thoroughly described, the infection risk profile of newer IL-17 and IL-23 inhibitors requires additional characterization. This analysis of the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) database characterized the infection risk associated with systemic treatments for psoriasis.
What did they find?
Main Takeaway: Serious infection risk is largely comparable across systemic psoriasis medications, with the exception of risankizumab demonstrating lower risk than brodalumab, etanercept, and standard non-biologic therapies, representing valuable insights for therapeutic selection among patients at risk for serious infection.
Therapeutics for psoriasis primarily target the immune system, increasing infection risk among patients. While the infection risks associated with older drugs have been thoroughly described, the infection risk profile of newer IL-17 and IL-23 inhibitors requires additional characterization. This analysis of the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) database characterized the infection risk associated with systemic treatments for psoriasis.
What did they find?
- The incidence rate of first serious infections was 27.67 per 1000 person-years (95% CI = 26.72 - 28.65) across all treatments. The incidence rate was elevated in patients who had already had a prior infection: 78.70 per 1000 person-years (95% CI = 75.17 - 82.36).
- Respiratory tract infections were the most common serious infection (26.1%), followed by urinary tract (10.5%) and gastrointestinal (10.5%) infections. Infection-related deaths were rare (1.81 per 1000 person-years, 95% CI = 1.57 - 2.07).
- While risk profiles were largely consistent across medications (acitretin, cyclosporine, methotrexate, ustekinumab, apremilast, TNF-α inhibitors, IL-17 inhibitors, and IL-23 inhibitors), risankizumab demonstrated a lower serious infection risk compared to brodalumab (HR = 0.74, 95% CI = 0.55 - 0.99), etanercept (HR = 0.75, 95% CI = 0.60 - 0.94), and standard treatments (acitretin, cyclosporine, and methotrexate) (HR = 0.80, 95% CI = 0.65 - 0.98).
Main Takeaway: Serious infection risk is largely comparable across systemic psoriasis medications, with the exception of risankizumab demonstrating lower risk than brodalumab, etanercept, and standard non-biologic therapies, representing valuable insights for therapeutic selection among patients at risk for serious infection.
CD4 T-cells are protecting your skin microbiome one HPV strain at a time!
Human immunodeficiency virus (HIV) and idiopathic CD4 lymphopenia (ICL) both cause decreased CD4 T-cell counts, increasing the risk of opportunistic infections. The skin microbiome, which provides a first-line defense against pathogens, is profoundly altered in patients with immunodeficient conditions, yet remains underexplored in these two patient populations. The researchers performed shotgun metagenomic sequencing, metagenome assembly, and read-based taxonomic mapping to identify the multi-kingdom taxonomic diversity of skin microbiomes in patients with ICL and patients living with HIV (PLWH) compared to healthy controls.
What did they find?
Main Takeaway: CD4 T-cell deficiency, whether from HIV or idiopathic CD4 lymphopenia, disrupts the skin microbiome by increasing pathogenic viruses (especially high-risk HPV), fungi, and Staphylococcus while depleting Cutibacterium, but antiretroviral therapy can help restore this balance over time for HIV patients.
Human immunodeficiency virus (HIV) and idiopathic CD4 lymphopenia (ICL) both cause decreased CD4 T-cell counts, increasing the risk of opportunistic infections. The skin microbiome, which provides a first-line defense against pathogens, is profoundly altered in patients with immunodeficient conditions, yet remains underexplored in these two patient populations. The researchers performed shotgun metagenomic sequencing, metagenome assembly, and read-based taxonomic mapping to identify the multi-kingdom taxonomic diversity of skin microbiomes in patients with ICL and patients living with HIV (PLWH) compared to healthy controls.
What did they find?
- Both ICL and antiretroviral therapy-naive PLWH cohorts showed significantly greater inter-individual variation in skin microbiome composition compared to healthy controls (median Bray-Curtis dissimilarity 0.59 and 0.58 vs. 0.36, both p < 0.0001) and markedly higher viral relative abundances (median 8.5% and 1.2% vs. 0.01% in healthy controls), driven largely by HPV predominance, including high-oncogenic-risk alpha-HPV types like HPV16 and HPV31.
- ART-naïve PLWH demonstrated higher fungal relative abundances than ICL and HC (median = 9.2%, 2.1%, and 3.6%, respectively), including the dermatophyte Trichophyton rubrum that was detected on the feet of two PLWH patients and is rarely detected in healthy individuals.
- Cutaneous bacterial communities revealed that, compared to healthy controls, both patient groups showed significantly reduced Cutibacterium (notably in ICL,p = .0003) and significantly increased Staphylococcus, largely coagulase-negative species (p < .0001 in ICL, p = .0014 in PLWH), while Corynebacterium was significantly elevated in ICL patients relative to both PLWH (p = .0087) and healthy controls (p = .028).
- Following antiretroviral therapy initiation, PLWH's skin microbiomes progressively became more cohesive and shifted toward the healthy-control profile, with Staphylococcus abundance and pathogenic fungi (T. rubrum) declining over time, and while high-oncogenic-risk alpha-HPVs detected pre-ART remained detectable at 2 months on ART, they were mostly cleared by 14 months.
Main Takeaway: CD4 T-cell deficiency, whether from HIV or idiopathic CD4 lymphopenia, disrupts the skin microbiome by increasing pathogenic viruses (especially high-risk HPV), fungi, and Staphylococcus while depleting Cutibacterium, but antiretroviral therapy can help restore this balance over time for HIV patients.
Out with the fungal, in with…everything else?
Neonates are highly vulnerable to skin and subcutaneous diseases, which are particularly concerning in low-income settings where living conditions exacerbate disease morbidity and mortality. Targeted interventions are needed in the management of neonatal skin disorders, yet understanding of disease burden remains limited. This study utilized data from the Global Burden of Disease 2023 study to calculate incidence rates of neonatal skin and subcutaneous diseases between 1990 and 2023, characterize inequalities between nations, and project incidence trends to 2035.
What did they find?
Main takeaway: In low-income settings, neonatal skin diseases continue to pose a significant challenge and persistent disease burden. Longitudinal analyses predict increases in disease burden, which may inform targeted public health initiatives.
Neonates are highly vulnerable to skin and subcutaneous diseases, which are particularly concerning in low-income settings where living conditions exacerbate disease morbidity and mortality. Targeted interventions are needed in the management of neonatal skin disorders, yet understanding of disease burden remains limited. This study utilized data from the Global Burden of Disease 2023 study to calculate incidence rates of neonatal skin and subcutaneous diseases between 1990 and 2023, characterize inequalities between nations, and project incidence trends to 2035.
What did they find?
- Overall, the incidence rate of neonatal skin and subcutaneous diseases decreased between 1990 and 2023 [estimated annual percentage change (EAPC) = −0.07, 95% CI = −0.09 - −0.05], and females continued to have a higher incidence rate of these disorders (70,031.97 per 100,000) as compared to males (64,946.63 per 100,000).
- While the incidence of fungal diseases has declined (EAPC = −0.50, 95% CI = −0.58 - −0.42), incidence rates have increased for scabies (EAPC = 0.45, 95% CI = 0.39 - 0.51), pruritus (EAPC = 0.31, 95% CI = 0.28 - 0.35), other skin and subcutaneous diseases (EAPC = 0.29, 95% CI = 0.26 - 0.31), and bacterial skin diseases (EAPC = 0.06, 95% CI = 0.04 - 0.09).
- Socio-demographic index (SDI) showed an inverse correlation with disease incidence rates.
- Projections to 2035 suggest that the overall disease incident count will increase, and incidence rates will continue to follow observed sex- and disease- specific trends.
Main takeaway: In low-income settings, neonatal skin diseases continue to pose a significant challenge and persistent disease burden. Longitudinal analyses predict increases in disease burden, which may inform targeted public health initiatives.
Psoriasis care is going beyond the clinic and into the group chat.
Patients with psoriasis have increased cardiovascular (CV) risk, yet structured CV prevention is not routinely incorporated into dermatology care. This single-center randomized clinical trial enrolled 111 adults with psoriasis and compared usual care with a 6-month text-messaging intervention delivering 4 lifestyle-focused messages per week targeting tobacco use, exercise, and diet.
What did they find?
Limitations: This was a single-center trial with only 111 participants and a 6-month follow-up, so the intervention's ability to produce sustained behavioral change or meaningful reductions in actual cardiovascular events remains unknown.
Main Takeaway: A simple, scalable text-messaging intervention delivered through dermatology care improved patient activation, cardiovascular knowledge, diet, medication adherence, physical activity, and BMI in patients with psoriasis.
Patients with psoriasis have increased cardiovascular (CV) risk, yet structured CV prevention is not routinely incorporated into dermatology care. This single-center randomized clinical trial enrolled 111 adults with psoriasis and compared usual care with a 6-month text-messaging intervention delivering 4 lifestyle-focused messages per week targeting tobacco use, exercise, and diet.
What did they find?
- The text-messaging group had significantly greater patient activation at 6 months compared with usual care (adjusted mean difference = 10.8 points, 95% CI = 7.0 - 14.6, p < 0.001).
- Participants receiving text messages demonstrated improved Mediterranean diet adherence (adjusted mean difference = 1.7, 95% CI = 1.0 - 2.4, p < 0.001) and medication adherence (adjusted mean difference = 1.6, 95% CI = 0.8 - 2.5, p < 0.001).
- Psoriasis-CV disease knowledge increased substantially in the intervention group (adjusted mean difference = 6.6, 95% CI = 4.7 - 8.4, p < 0.001), while physical activity increased by approximately 128 minutes/week (adjusted mean difference = 127.9 minutes/week, 95% CI = 21.9 - 234.0, p = 0.02).
BMI decreased modestly in the intervention group (adjusted mean difference = −1.0, 95% CI = −1.4 to −0.7, p < 0.001), but there were no significant differences in lipid levels, HbA1c, smoking behavior, dermatology-specific quality of life, or psoriasis severity.
Limitations: This was a single-center trial with only 111 participants and a 6-month follow-up, so the intervention's ability to produce sustained behavioral change or meaningful reductions in actual cardiovascular events remains unknown.
Main Takeaway: A simple, scalable text-messaging intervention delivered through dermatology care improved patient activation, cardiovascular knowledge, diet, medication adherence, physical activity, and BMI in patients with psoriasis.
Jaungo-based herbal complex regulates psoriasis-related macrophage-keratinocyte inflammatory axis
Integrative Dermatology
Integrative Dermatology
Three medicinal plants, one traditional ointment, and a very inflamed set of macrophages.
The pathogenesis of psoriasis involves inflammatory cytokine production and barrier dysfunction, driven by dysfunctional macrophage-keratinocyte communication. This in vitro study evaluated a Jaungo-based herbal complex (JBHC) formulated from 70% ethanol extracts of Lithospermum erythrorhizon, Angelica gigas, and Astragalus membranaceus in a 4.5:4.5:1 ratio. Researchers integrated public transcriptomic data from psoriatic lesions with experiments in lipopolysaccharide-stimulated RAW264.7 macrophages and keratinocytes to test whether JBHC could interrupt macrophage-driven inflammatory signaling and preserve barrier-related gene expression.
What did they find?
Limitations: The experimental inflammatory stimulus was LPS in murine macrophages rather than a psoriasis-specific immune model.
Main Takeaway: A modified Jaungo-inspired herbal complex suppressed macrophage inflammatory signaling while preserving barrier-related genes in keratinocytes under inflammatory stress, suggesting potential for further investigations of utility in inflammatory skin diseases.
The pathogenesis of psoriasis involves inflammatory cytokine production and barrier dysfunction, driven by dysfunctional macrophage-keratinocyte communication. This in vitro study evaluated a Jaungo-based herbal complex (JBHC) formulated from 70% ethanol extracts of Lithospermum erythrorhizon, Angelica gigas, and Astragalus membranaceus in a 4.5:4.5:1 ratio. Researchers integrated public transcriptomic data from psoriatic lesions with experiments in lipopolysaccharide-stimulated RAW264.7 macrophages and keratinocytes to test whether JBHC could interrupt macrophage-driven inflammatory signaling and preserve barrier-related gene expression.
What did they find?
- In LPS-stimulated RAW264.7 macrophages, JBHC reduced NOS2 and PTGS2 mRNA, iNOS and COX-2 protein expression, and nitric oxide production. It also attenuated STAT1 and STAT3 phosphorylation without significantly inhibiting NF-κB/IκBα signaling (p < 0.05).
- JBHC reduced several macrophage-derived inflammatory mediators, including IL-1α, IL-1β, and IL-6. Cytokine-array findings also indicated reduced IL-1ra, IL-27, CCL5, and CXCL10 after treatment.
- Conditioned medium from LPS-stimulated macrophages suppressed FLG and LOR expression in keratinocytes, whereas conditioned medium from JBHC-treated macrophages significantly attenuated this suppression (p < 0.05).
Limitations: The experimental inflammatory stimulus was LPS in murine macrophages rather than a psoriasis-specific immune model.
Main Takeaway: A modified Jaungo-inspired herbal complex suppressed macrophage inflammatory signaling while preserving barrier-related genes in keratinocytes under inflammatory stress, suggesting potential for further investigations of utility in inflammatory skin diseases.
It turns out floodwater isn't just bad for your basement; it’s also terrible for your barrier.
Human-induced climate change has made floods one of the most widespread and ecologically disruptive natural disasters worldwide. Historically, dermatologic conditions have been major drivers of post-disaster morbidity, and they also serve as early signs of epidemiological strain on the healthcare system, signaling the compromise of local sanitation infrastructure before disease outbreaks start. This systematic review synthesizes data from 12 epidemiological studies, spanning over 71 million patient encounters worldwide, to understand the dermatologic consequences of flooding and improve post-disaster interventions.
What did they find?
Human-induced climate change has made floods one of the most widespread and ecologically disruptive natural disasters worldwide. Historically, dermatologic conditions have been major drivers of post-disaster morbidity, and they also serve as early signs of epidemiological strain on the healthcare system, signaling the compromise of local sanitation infrastructure before disease outbreaks start. This systematic review synthesizes data from 12 epidemiological studies, spanning over 71 million patient encounters worldwide, to understand the dermatologic consequences of flooding and improve post-disaster interventions.
What did they find?
- Data suggest that there is no significant increase in S. aureus infections after floods, but rather an increase in zoonotic pathogens (Leptospira sp. and Aeromonas sp.) that target mucous membranes instead.
- Environmental change delays outbreaks of vector-borne skin diseases, so dermatological monitoring should stay alert for unusual arthropod-borne lesions for 4-8 weeks after a disaster.
- Shelter overcrowding facilitates a progression of communicable disease outbreaks, predominantly ectoparasitic infestations (scabies, lice) and pyoderma, which disproportionately affects socially vulnerable groups.
- Floods trigger acute flares of atopic dermatitis and asthma due to high humidity, wind-driven aeroallergen resuspension of fungal spores, and indoor mold growth, specifically with elevated physiological stress for pediatric populations with immature skin barriers.
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Copyright © 2025 - All Rights Reserved.