Ninety-First issue
August 6, 2025
This dynamic drug duo is giving CTCL a rash decision; it’s time to cut it out!
Cutaneous T-cell lymphoma (CTCL) is a rare and often aggressive cancer that primarily affects the skin, presenting with patches, plaques, or tumors, and may progress to advanced, multi-system disease. Relapsed or refractory advanced-stage CTCL carries a poor prognosis as treatments are limited. Researchers investigated the efficacy of a dual oral regimen of linperlisib, a next-generation phosphoinositide 3-kinase (PI3K) inhibitor, and chidamide, a histone deacetylase (HDAC), in patients with advanced CTCL.
What did they find?
Main Takeaway: The combination of linperlisib and chidamide demonstrated promising efficacy and a favorable safety profile, suggesting a potential new oral treatment option for patients with relapsed or refractory CTCL.
Cutaneous T-cell lymphoma (CTCL) is a rare and often aggressive cancer that primarily affects the skin, presenting with patches, plaques, or tumors, and may progress to advanced, multi-system disease. Relapsed or refractory advanced-stage CTCL carries a poor prognosis as treatments are limited. Researchers investigated the efficacy of a dual oral regimen of linperlisib, a next-generation phosphoinositide 3-kinase (PI3K) inhibitor, and chidamide, a histone deacetylase (HDAC), in patients with advanced CTCL.
What did they find?
- Among the 22 patients treated with combination therapy and evaluated for efficacy, the overall response rate (ORR) was 59.1% (13 of 22). Disease control rate (DCR) was 86.4% (19 of 22).
- Adverse events (AEs) occurred in five patients (22.7%) and were reported as mild to moderate (grade 3 out of 5).
- While not statistically significant due to small sample size, better responses appeared more common in patients with earlier-stage disease or the mycosis fungoides (MF) subtype.
Main Takeaway: The combination of linperlisib and chidamide demonstrated promising efficacy and a favorable safety profile, suggesting a potential new oral treatment option for patients with relapsed or refractory CTCL.
Outcomes of early hydroxychloroquine use in cutaneous lupus: preventing progression to systemic disease
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
CLE doesn’t have to mean SLE.
Cutaneous lupus erythematosus (CLE) carries a significant risk of progression to systemic lupus erythematosus (SLE); however, no established preventive strategies currently exist. In this long-term cohort study, researchers followed 286 patients with isolated CLE, comparing those treated with early hydroxychloroquine (HCQ) (n = 186) to those treated with topicals alone (n = 100). Progression to SLE was assessed using the 2019 EULAR/ACR classification criteria over an average follow-up of seven years.
What did they find?
Main Takeaway: Early use of hydroxychloroquine in CLE may significantly reduce both the risk and severity of progression to systemic lupus, supporting its use even in ANA-negative or mildly affected patients.
Cutaneous lupus erythematosus (CLE) carries a significant risk of progression to systemic lupus erythematosus (SLE); however, no established preventive strategies currently exist. In this long-term cohort study, researchers followed 286 patients with isolated CLE, comparing those treated with early hydroxychloroquine (HCQ) (n = 186) to those treated with topicals alone (n = 100). Progression to SLE was assessed using the 2019 EULAR/ACR classification criteria over an average follow-up of seven years.
What did they find?
- There was reduced progression to SLE, with only 4.8% of HCQ-treated patients (9 of 186) progressing to SLE, compared to 27% in the topical-only group (27 of 100) (P < 0.001).
- Severe SLE developed in 2.2% of HCQ patients vs. 12% in the topical group (P = 0.001), with fewer cases of nephritis, neuropsychiatric involvement, and severe flares.
- Among patients with baseline arthralgia, 2.8% in the HCQ group developed lupus arthritis (1 of 36) vs. 25.7% in the topical group (9 of 35) (P = 0.006).
- HCQ patients had less autoantibody seroconversion, including Anti-dsDNA (0% to 1.7% vs. 0% to 7%) and Anti-Smith (0% to 0% vs. 0% to 4%) (P values all < 0.05).
Main Takeaway: Early use of hydroxychloroquine in CLE may significantly reduce both the risk and severity of progression to systemic lupus, supporting its use even in ANA-negative or mildly affected patients.
Patients with hidradenitis suppurativa have a higher risk of developing psychiatric disease
British Journal of Dermatology
British Journal of Dermatology
Do flares cause despair?
Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful abscesses and draining tunnels, typically in intertriginous areas. While psychiatric comorbidity has been reported in HS, this systematic review and meta-analysis sought to quantify the specific prevalence of various psychiatric disorders in this population.
What did they find?
Main Takeaway: Patients with hidradenitis suppurativa have significantly elevated risks for a wide range of psychiatric disorders, underscoring the importance of integrated mental health support in HS care.
Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful abscesses and draining tunnels, typically in intertriginous areas. While psychiatric comorbidity has been reported in HS, this systematic review and meta-analysis sought to quantify the specific prevalence of various psychiatric disorders in this population.
What did they find?
- 83 studies were included in the review, with 78 studies included in the meta-analysis.
- The pooled prevalence of overall psychiatric disease in patients with HS was 24.5% (95% CI: 15.1–37.3), compared to 9.5% (95% CI: 6.5–13.6) in the general population.
- Patients with HS had significantly higher odds of:
- Bipolar disorder: OR 3.68 (95% CI: 1.11–12.20, P = 0.03)
- Substance use disorder: OR 3.58 (95% CI: 2.01–6.37, P < 0.001)
- Depression: OR 2.06 (95% CI: 1.75–2.41, P < 0.001)
- Schizophrenia: OR 2.00 (95% CI: 1.21–3.30, P = 0.007)
- Anxiety: OR 1.91 (95% CI: 1.64–2.22, P < 0.001)
- Alcohol abuse: OR 1.88 (95% CI: 0.98–3.58, P = 0.06)
- Suicide: OR 1.56 (95% CI: 1.14–2.14, P = 0.005)
- Bipolar disorder: OR 3.68 (95% CI: 1.11–12.20, P = 0.03)
Main Takeaway: Patients with hidradenitis suppurativa have significantly elevated risks for a wide range of psychiatric disorders, underscoring the importance of integrated mental health support in HS care.
Eczema’s got feelings too: Common stressors worsen childhood atopic dermatitis
Atopic dermatitis (AD) is one of the most burdensome chronic conditions in children, but predicting disease activity remains challenging. This population-based cohort study followed nearly 14,000 UK children from infancy to age 8.5, linking repeated measures of AD severity with caregiver-reported stressful life events (SLEs) to assess how early-life stress impacts disease activity.
What did they find?
Main Takeaway: Even everyday childhood events, if perceived as upsetting, can meaningfully worsen AD. These findings highlight the importance of anticipatory guidance and proactive treatment planning around life transitions in pediatric eczema care.
Atopic dermatitis (AD) is one of the most burdensome chronic conditions in children, but predicting disease activity remains challenging. This population-based cohort study followed nearly 14,000 UK children from infancy to age 8.5, linking repeated measures of AD severity with caregiver-reported stressful life events (SLEs) to assess how early-life stress impacts disease activity.
What did they find?
- Each SD increase in perceived stress linked to higher odds of active AD (OR 1.04). Odds were higher for moderate-to-severe AD (OR 1.13).
- Cumulative stress exposure across childhood carried stronger AD risk (OR 1.11).
- Unexpectedly, common events (e.g. new school, new sibling, pet death) were more strongly associated with AD activity than severe adverse events like abuse or parental separation (OR for cumulative common SLEs = 1.11; OR for cumulative severe adverse events = 1.05).
Main Takeaway: Even everyday childhood events, if perceived as upsetting, can meaningfully worsen AD. These findings highlight the importance of anticipatory guidance and proactive treatment planning around life transitions in pediatric eczema care.
Is dupilumab treatment for atopic dermatitis associated with a decreased risk of otitis media and related surgical procedures?
Pediatric Dermatology
Pediatric Dermatology
Dupilumab: Clearing skin and cleaning ears!
Atopic dermatitis (AD) and otitis media (OM) frequently co-occur in pediatric patients, likely due to shared mechanisms of type 2 inflammation. This retrospective cohort study used population-level data from the large-scale TriNetX research network to compare the risk of developing nonsuppurative (noninfectious) and suppurative (infectious) OM, as well as the need for OM-related surgical procedures, in patients with AD treated with dupilumab versus pimecrolimus. By analyzing real-world outcomes, the study aimed to clarify dupilumab’s impact on OM-related morbidity.
What did they find?
Atopic dermatitis (AD) and otitis media (OM) frequently co-occur in pediatric patients, likely due to shared mechanisms of type 2 inflammation. This retrospective cohort study used population-level data from the large-scale TriNetX research network to compare the risk of developing nonsuppurative (noninfectious) and suppurative (infectious) OM, as well as the need for OM-related surgical procedures, in patients with AD treated with dupilumab versus pimecrolimus. By analyzing real-world outcomes, the study aimed to clarify dupilumab’s impact on OM-related morbidity.
What did they find?
- Dupilumab was associated with a significantly reduced overall risk of otitis media in patients with atopic dermatitis (HR: 0.60; 95% CI: 0.54–0.67).
- This included both nonsuppurative (HR: 0.60; 95% CI: 0.52–0.70) and suppurative forms (HR: 0.61; 95% CI: 0.55–0.69).
- Dupliumab also lowered the likelihood of needing OM-related surgical procedures, such as ear tube placement (HR: 0.73; 95% CI: 0.58–0.90).
What can Ethiopia's approach to establishing dermatology residencies teach us about strengthening specialist care in other low- and middle-income countries?
Global Dermatology
Global Dermatology
A deep dive ~under the skin~ of Ethiopia’s dermatology residencies
Health professional education is a cornerstone of health equity, particularly in low- and middle-income countries where health systems often face severe workforce and resource constraints. While undergraduate medical education has expanded in many African nations, including Ethiopia, postgraduate training in dermatology remains limited despite the high burden of skin disease in the region. This mixed-methods study evaluated the development, outcomes, and ongoing challenges of establishing dermatology residency programs in Ethiopia through qualitative interviews and quantitative analysis of workforce output.
What did they find?
Health professional education is a cornerstone of health equity, particularly in low- and middle-income countries where health systems often face severe workforce and resource constraints. While undergraduate medical education has expanded in many African nations, including Ethiopia, postgraduate training in dermatology remains limited despite the high burden of skin disease in the region. This mixed-methods study evaluated the development, outcomes, and ongoing challenges of establishing dermatology residency programs in Ethiopia through qualitative interviews and quantitative analysis of workforce output.
What did they find?
- Ethiopia’s first dermatology residency program launched in 2006 with six residents and one local dermatologist, supported by international faculty.
- From 2008 to 2023, 194 dermatologists were trained across five institutions, with annual graduation numbers increasing six-fold, from 6 to 31 per year.
- Despite efforts to promote rural practice, 60% of graduates remain in urban centers.
- A survey of 112 dermatologists (representing 55% of the country’s dermatologists, via the Ethiopian Dermatovenerology Society) found:
- 50% practiced in the capital, Addis Ababa
- 45.5% were affiliated with academic institutions
- 29% were based in regional hospitals
- 25.5% worked in private practice
- Only 8 graduates had pursued dermatology subspecialty training.
Ultraviolet dermoscopy was just the beginning… now there’s sub-ultraviolet reflectance dermoscopy
Distinguishing between benign and malignant melanocytic lesions can be difficult, even with the aid of dermoscopy. Sub-ultraviolet reflectance dermoscopy (sUVRD), which emits light in the visible violet to blue spectrum, has been proposed as a tool to assess melanocyte depth, potentially helping differentiate malignant from benign lesions. This study used a digital camera–integrated dermatoscope equipped with 405 nm sub-UV capabilities to image melanocytic lesions.
What did they find?
Distinguishing between benign and malignant melanocytic lesions can be difficult, even with the aid of dermoscopy. Sub-ultraviolet reflectance dermoscopy (sUVRD), which emits light in the visible violet to blue spectrum, has been proposed as a tool to assess melanocyte depth, potentially helping differentiate malignant from benign lesions. This study used a digital camera–integrated dermatoscope equipped with 405 nm sub-UV capabilities to image melanocytic lesions.
What did they find?
- A blue-grey structureless macule containing hair follicles was evaluated using both conventional dermoscopy and sUVRD.
- While the lesion was clearly visible on conventional dermoscopy, it was not visible using sUVRD, suggesting the melanocytes were located deeper than 300 μm.
- Biopsy confirmed the diagnosis of a blue nevus.
- These findings suggest that sUVRD has a depth of penetration between 200–300 μm.
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Figure 1: Blue nevus visualized with normal dermoscopy (left) and with sUVRD (right).
Main Takeaway: Sub-ultraviolet reflectance dermoscopy (sUVRD) may serve as a complementary tool to conventional dermoscopy by helping assess the depth of pigmented lesions
Main Takeaway: Sub-ultraviolet reflectance dermoscopy (sUVRD) may serve as a complementary tool to conventional dermoscopy by helping assess the depth of pigmented lesions
The presence of numerous nevi is a well-established risk factor for melanoma, making accurate and consistent nevus counts critical for both research and clinical decision-making. Although an international protocol exists, developed by the International Agency for Research on Cancer (IARC), nevus counting and reporting remain inconsistent. This systematic review evaluated nevus counting studies to assess variation in methodology, adherence to the IARC protocol, and study reproducibility.
What did they find?
Main Takeaway: Future nevus research requires standardized methodologies and consistent adherence to established protocols to improve the reliability of melanoma risk prediction models and the clinical utility of nevus counts.
What did they find?
- Eight studies met inclusion criteria; none adhered fully to the IARC protocol.
- Nevus counting methods varied: three studies used predefined counting criteria, while five included observer training.
- Most studies lacked adequate procedural reporting, limiting reproducibility and comparison.
Main Takeaway: Future nevus research requires standardized methodologies and consistent adherence to established protocols to improve the reliability of melanoma risk prediction models and the clinical utility of nevus counts.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.
Copyright © 2025 - All Rights Reserved.