ninetieth issue
JULY 23, 2025
Ixekizumab and malignant neoplasms: A pooled analysis of data from 25 randomized clinical trials
JAMA Dermatology
JAMA Dermatology
Disease remission without cancer acquisition — Ixekizumab is the right prescription!
Psoriasis (PsO), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) are chronic inflammatory diseases that may require lifelong biologic therapy. Given the immune system’s role in both inflammation and cancer surveillance, understanding the long-term malignancy risk of biologics, such as ixekizumab (IXE), is critical. This study pooled safety data from 25 randomized clinical trials to evaluate malignancy rates in over 9000 patients receiving IXE, with 22,000+ patient-years of IXE exposure.
What did they find?
Main Takeaway: This large pooled analysis supports the long-term safety of ixekizumab, with no evidence of excess malignancy risk compared to the general population.
Psoriasis (PsO), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) are chronic inflammatory diseases that may require lifelong biologic therapy. Given the immune system’s role in both inflammation and cancer surveillance, understanding the long-term malignancy risk of biologics, such as ixekizumab (IXE), is critical. This study pooled safety data from 25 randomized clinical trials to evaluate malignancy rates in over 9000 patients receiving IXE, with 22,000+ patient-years of IXE exposure.
What did they find?
- Malignant neoplasms (excluding NMSC) were uncommon, with incidence rates of 0.5 (PsO), 0.3 (PsA), and 0.4 (axSpA) per 100 patient-years.
- Standardized incidence ratios compared to the US population were <1 for PsO and PsA, and near 1 for axSpA, indicating no increased cancer risk.
- Rates remained low and stable over time, and malignancy-related deaths were rare.
Main Takeaway: This large pooled analysis supports the long-term safety of ixekizumab, with no evidence of excess malignancy risk compared to the general population.
Reported psychiatric adverse events among isotretinoin users: monitoring from a 20-year FDA adverse event reporting system
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Everything’s fine… except the undiagnosed mood swings, psychosis, and self-injury in patients taking isotretinoin
Since its FDA approval in 1982, isotretinoin has been a cornerstone treatment for severe acne and other dermatologic conditions. Despite its efficacy, concerns regarding the potential psychiatric side effects of the medication, including depression and suicide, have persisted. Notably, prior studies investigating the risk of psychiatric adverse events (AEs) while on isotretinoin have yielded mixed results. To address this gap, this study utilized data from the FDA Adverse Event Reporting System (FAERS) from 2004 to 2024 to identify and prioritize psychiatric AEs associated with isotretinoin use.
What did they find?
Main Takeaway: Psychiatric AEs linked to isotretinoin may include not only depression and suicidality but also mood changes, psychosis, and self-injury, often emerging early in treatment. Regular mental health monitoring, especially at the start of therapy, may help reduce risk.
Since its FDA approval in 1982, isotretinoin has been a cornerstone treatment for severe acne and other dermatologic conditions. Despite its efficacy, concerns regarding the potential psychiatric side effects of the medication, including depression and suicide, have persisted. Notably, prior studies investigating the risk of psychiatric adverse events (AEs) while on isotretinoin have yielded mixed results. To address this gap, this study utilized data from the FDA Adverse Event Reporting System (FAERS) from 2004 to 2024 to identify and prioritize psychiatric AEs associated with isotretinoin use.
What did they find?
- Of 46,442 adverse event reports involving isotretinoin users, 19,412 psychiatric AEs were reported by 12,312 patients.
- Among the patients reporting at least one psychiatric AE, depression (n=5846, 47.5%), suicidal ideation (n=2174, 17.7%), and anxiety (n=1843, 15.0%) were the most common.
- A total of 96 psychiatric AE signals showed a statistically significant association with isotretinoin use; using disproportionality analyses, 25 were prioritized as clinically important, including mood disturbance, self-injury, and psychosis.
- The median onset of moderate-priority AEs (i.e. those requiring intentional monitoring) was within the first 80 days (IQR: 31, 265).
Main Takeaway: Psychiatric AEs linked to isotretinoin may include not only depression and suicidality but also mood changes, psychosis, and self-injury, often emerging early in treatment. Regular mental health monitoring, especially at the start of therapy, may help reduce risk.
BRAF fusion and congenital melanocytic naevi: firm, itchy, and genetically distinct
British Journal of Dermatology
British Journal of Dermatology
BRAF is no laugh – don’t miss this firm and fibrotic fusion!
Giant congenital melanocytic naevi (CMN) are rare birthmarks that can be associated with increased melanoma risk and neurocutaneous melanosis. While most are due to NRAS mutations, a small subset are driven by BRAF fusion genes. In this multi-institutional case series, five patients with giant CMN and BRAF fusions were evaluated for clinical and histopathological features.
What did they find?
Main Takeaway: CMN with BRAF fusion genes exhibit distinctive clinical and histologic patterns, particularly firmness, itch, and fibrotic satellite lesions, that may guide diagnosis and open doors to targeted therapy like MEK inhibition.
Giant congenital melanocytic naevi (CMN) are rare birthmarks that can be associated with increased melanoma risk and neurocutaneous melanosis. While most are due to NRAS mutations, a small subset are driven by BRAF fusion genes. In this multi-institutional case series, five patients with giant CMN and BRAF fusions were evaluated for clinical and histopathological features.
What did they find?
- All 5 patients had CMN with BRAF fusion as the sole pathogenic driver.
- 4 patients had >1000 firm, pruritic, satellite naevi, a feature not previously emphasized in this genotype.
- Histology consistently showed marked desmoplastic stroma.
- 1 patient had neurocutaneous melanosis and responded to the MEK inhibitor trametinib with symptom improvement.
- Identified BRAF fusions included AKAP9, ATAD2, ST13, and TRIM4 fusion partners.
Main Takeaway: CMN with BRAF fusion genes exhibit distinctive clinical and histologic patterns, particularly firmness, itch, and fibrotic satellite lesions, that may guide diagnosis and open doors to targeted therapy like MEK inhibition.
Picket-ing up on the DIF pattern
Linear IgA bullous dermatosis (LABD) and dermatitis herpetiformis (DH) are autoimmune blistering skin disorders with overlapping histologic features. Characteristic direct immunofluorescence (DIF) findings, including linear IgA deposition along the basement membrane in LABD and granular IgA deposition in the papillary dermis in DH, aid in definitive diagnosis. However, additional DIF patterns may be helpful in ambiguous cases. In a retrospective study, researchers compared immunoglobulin positivity and DIF patterns in patients with LABD (n = 45) and DH (n = 48).
What did they find?
Main Takeaway: The “picket fence pattern” of IgA deposition on DIF is highly specific for DH and may help to differentiate DH from LABD in unclear cases.
Linear IgA bullous dermatosis (LABD) and dermatitis herpetiformis (DH) are autoimmune blistering skin disorders with overlapping histologic features. Characteristic direct immunofluorescence (DIF) findings, including linear IgA deposition along the basement membrane in LABD and granular IgA deposition in the papillary dermis in DH, aid in definitive diagnosis. However, additional DIF patterns may be helpful in ambiguous cases. In a retrospective study, researchers compared immunoglobulin positivity and DIF patterns in patients with LABD (n = 45) and DH (n = 48).
What did they find?
- Fibrillar IgA deposition in the papillary dermis, also referred to as the “picket fence pattern,” was present in 47.9% of DH cases and absent in all LABD cases (P < 0.001).
- The “picket fence pattern” demonstrated 100% specificity and 47.9% sensitivity for DH.
- IgG (20% vs 8.3%) and IgM (15.5% vs 12.5%) levels were higher in LABD compared to DH.
Main Takeaway: The “picket fence pattern” of IgA deposition on DIF is highly specific for DH and may help to differentiate DH from LABD in unclear cases.
Myth versus reality: A review of social media claims and scientific evidence for Arnica montana in postinjectable procedures
Dermatologic Surgery
Dermatologic Surgery
Social media says Arnica can vanish bruises faster than your paycheck. Let’s fact-check that.
Arnica montana is a perennial herb native to Europe and commonly used in homeopathic and herbal medicine for its purported anti-inflammatory and analgesic properties. It is widely promoted on social media platforms like TikTok and Reddit to reduce bruising and swelling after cosmetic injectable procedures. This review systematically analyzed claims from 48 TikTok videos and 305 Reddit posts and compared them against scientific literature, assessing clinical evidence on Arnica’s effectiveness.
What did they find?
Main Takeaway: Despite large social media endorsement, scientific evidence supporting Arnica montana’s efficacy for post-injection bruising and swelling remains weak and inconclusive, warranting cautious patient counseling.
Arnica montana is a perennial herb native to Europe and commonly used in homeopathic and herbal medicine for its purported anti-inflammatory and analgesic properties. It is widely promoted on social media platforms like TikTok and Reddit to reduce bruising and swelling after cosmetic injectable procedures. This review systematically analyzed claims from 48 TikTok videos and 305 Reddit posts and compared them against scientific literature, assessing clinical evidence on Arnica’s effectiveness.
What did they find?
- 91.7% of TikTok posts endorsed the use of Arnica montana, despite limited scientific support.
- 58% of Reddit discussions recommended Arnica supplementation, primarily in oral form, often without physician oversight or reliable evidence.
- Scientific literature revealed mixed and inconclusive findings, with only one clinical trial directly examining Arnica’s effect after injectable cosmetic procedures and showing no significant benefit.
- Systematic reviews reported a small, statistically insignificant effect size (g = 0.18, P = 0.059) for Arnica in reducing post-procedure bruising and swelling.
Main Takeaway: Despite large social media endorsement, scientific evidence supporting Arnica montana’s efficacy for post-injection bruising and swelling remains weak and inconclusive, warranting cautious patient counseling.
Efficacy and safety of a novel nutraceutical for mild-to-moderate acne
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
Oral nutraceuticals may bring your skin care routine to the next level
Topical treatments alone may be insufficient for adult women with mild-to-moderate acne. Current literature suggests that immunologic, inflammatory, and hormonal factors contribute to acne pathogenesis and may be addressed with targeted nutraceuticals, oral supplements derived from food sources or natural compounds with potential therapeutic benefits. This 12‑week, multicenter randomized controlled trial of 102 women assessed whether adding a multi-targeting oral nutraceutical containing botanicals, adaptogens, probiotics, postbiotics, and metabolic-hormonal modulators could improve outcomes when used alongside a standardized topical regimen.
What did they find?
Topical treatments alone may be insufficient for adult women with mild-to-moderate acne. Current literature suggests that immunologic, inflammatory, and hormonal factors contribute to acne pathogenesis and may be addressed with targeted nutraceuticals, oral supplements derived from food sources or natural compounds with potential therapeutic benefits. This 12‑week, multicenter randomized controlled trial of 102 women assessed whether adding a multi-targeting oral nutraceutical containing botanicals, adaptogens, probiotics, postbiotics, and metabolic-hormonal modulators could improve outcomes when used alongside a standardized topical regimen.
What did they find?
- Of the 92 women who completed the trial, 47 received the oral nutraceutical and 45 received placebo.
- At week 12, 44% of participants in the nutraceutical group achieved clear or almost clear skin on the Investigator Global Assessment (IGA), compared to 13% in the placebo group (P < 0.01).
- Mean IGA scores improved from approximately 2.2 to 1.47 in the treatment group (P = 0.02).
- Inflammatory lesion counts in the active group decreased by 56.2% from baseline (P < 0.01), although this was not statistically significant compared to placebo.
- Participants receiving the nutraceutical reported significant improvements in post-inflammatory erythema (P < 0.01), scarring (P < 0.05), skin smoothness and softness (P < 0.05), and overall skin appearance (P < 0.05).
- The nutraceutical was generally well tolerated, with only one case of moderate nausea leading to withdrawal and no serious adverse events.
When the erythema is subtle but the stats still hit
The Ichthyosis Scoring System is a validated tool used to assess erythema and scale severity in ichthyosis. However, it was primarily developed using lighter skin tones. This study evaluated its reliability in skin of color using professional photographs of Fitzpatrick IV–VI patients.
What did they find?
Main Takeaway: The Ichthyosis Scoring System performs reliably across different skin types and may support more inclusive trial enrollment and improve clinical care for patients with more pigmented skin.
The Ichthyosis Scoring System is a validated tool used to assess erythema and scale severity in ichthyosis. However, it was primarily developed using lighter skin tones. This study evaluated its reliability in skin of color using professional photographs of Fitzpatrick IV–VI patients.
What did they find?
- 14 dermatologists independently scored 94 images from the National Ichthyosis Registry.
- Scale scores in FST IV–VI had excellent interrater reliability (ICC 0.97-0.99).
- Erythema scores in FST IV–VI also showed strong reliability (ICC 0.90-0.94).
- There was no significant difference in average erythema (P = 0.32) or scale scores (P = 0.86) between groups.
Main Takeaway: The Ichthyosis Scoring System performs reliably across different skin types and may support more inclusive trial enrollment and improve clinical care for patients with more pigmented skin.
The role of access to care in the epidemiology of melanoma
Physician shortages and geographic maldistribution have been linked to delays in diagnosis and treatment. This study examined how dermatologist density influences the incidence and stage at diagnosis of malignant melanoma (MM) across U.S. counties. Researchers conducted a correlational analysis using data from the National Cancer Institute State Cancer Resource Database (2017–2021) and the Health Resources and Services Administration (2020).
What did they find?
What did they find?
- A weak positive correlation was observed between dermatologist prevalence and total MM incidence in non-Hispanic White populations (r = 0.1412, P < 0.001).
- A moderate positive correlation was found for non–late-stage MM (r = 0.2795, P < 0.001).
- A negative correlation was noted for late-stage MM, suggesting that higher dermatologist prevalence may reduce late-stage diagnoses (r = −0.1516, P < 0.001).
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.
Copyright © 2025 - All Rights Reserved.