eightY-Seventh issue
June 11, 2025
Methotrexate really thought she methotrexATE
Adalimumab, a widely used anti-TNF-α monoclonal antibody biologic for treating psoriasis, has a favorable cost-effectiveness profile, but demonstrates lower effectiveness compared to other biologics. This target trial emulation cohort study evaluated whether concomitant methotrexate improves the effectiveness of adalimumab for treating plaque psoriasis. A total of 231 patients received adalimumab plus weekly methotrexate, while 1,553 received adalimumab alone.
What did they find?
Limitations: Due to a high number of treatment deviations and missing outcome data, the study results had uncertainty in measuring the treatment effect, both for PASI scores and pharmacokinetic outcomes.
Main Takeaway: The addition of methotrexate to adalimumab did not improve clinical effectiveness for plaque psoriasis, despite reduced antidrug antibody formation.
Adalimumab, a widely used anti-TNF-α monoclonal antibody biologic for treating psoriasis, has a favorable cost-effectiveness profile, but demonstrates lower effectiveness compared to other biologics. This target trial emulation cohort study evaluated whether concomitant methotrexate improves the effectiveness of adalimumab for treating plaque psoriasis. A total of 231 patients received adalimumab plus weekly methotrexate, while 1,553 received adalimumab alone.
What did they find?
- At 1 year, drug survival was 79.1% (95% CI, 71.8%–87.2%) in the intervention arm and 78.1% (95% CI, 76.1%–80.2%) in the comparator arm, with no evidence of a difference between groups (1.0%; 95% CI, −7.0% to 8.9%).
- At 3 years, Psoriasis Area and Severity Index (PASI75) rates were 37.2% (95% CI, 16.8%–57.6%) in the intervention arm and 32.4% (95% CI, 28.0%–36.8%) in the comparator, showing no evidence of a difference between groups (4.9%; 95% CI, −16.1% to 25.7%).
- There was no observed difference between cohorts for serious adverse events or adalimumab concentrations.
- Patients in the intervention arm had significantly lower antidrug antibody levels, with a risk difference of −123.7 AU/mL (95% CI, −200.5 to −46.9).
Limitations: Due to a high number of treatment deviations and missing outcome data, the study results had uncertainty in measuring the treatment effect, both for PASI scores and pharmacokinetic outcomes.
Main Takeaway: The addition of methotrexate to adalimumab did not improve clinical effectiveness for plaque psoriasis, despite reduced antidrug antibody formation.
Incidence and timing of recurrent non-melanotic skin cancers
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
One and done? Not so fast.
Skin cancer is the most common malignancy in the United States, yet national cancer registries often exclude nonmelanoma skin cancers (NMSCs) or only record the first occurrence, leaving subsequent tumors untracked. This underreporting limits true understanding of skin cancer multiplicity, a clinically important issue tied to increased morbidity, risk of internal malignancy, and potential for metastasis. To address this gap, the authors conducted a large, multi-cohort study using data from over 5.5 million patients across five U.S. healthcare systems to quantify how often and soon patients develop multiple skin cancers and to identify patterns that could inform surveillance strategies and improve resource allocation.
What did they find?
Skin cancer is the most common malignancy in the United States, yet national cancer registries often exclude nonmelanoma skin cancers (NMSCs) or only record the first occurrence, leaving subsequent tumors untracked. This underreporting limits true understanding of skin cancer multiplicity, a clinically important issue tied to increased morbidity, risk of internal malignancy, and potential for metastasis. To address this gap, the authors conducted a large, multi-cohort study using data from over 5.5 million patients across five U.S. healthcare systems to quantify how often and soon patients develop multiple skin cancers and to identify patterns that could inform surveillance strategies and improve resource allocation.
What did they find?
- 43% of patients developed more than one skin cancer.
- A distinct high-risk subset, 3% of patients, developed 10 or more skin cancers, accounting for 22% of all treated skin cancers.
- The median time to a second skin cancer was less than one year in nearly all age groups, with 71% of second tumors occurring within 2 years of the first.
- Among patients recurrence-free at 2 years, ~25% developed another within 5 years.
- Those with high tumor counts had persistently elevated skin cancer rates over two decades, suggesting long-term elevated risk.
- These high-risk patients had a younger average age at first cancer (68.0 vs. 70.6 years, P < 0.01).
Is bullying common in children with congenital ichthyosis?
Pediatric Dermatology
Pediatric Dermatology
More Than Skin Deep: The Hidden Scars of Children with Ichthyosis
Bullying is a significant public health concern, especially for children with visible chronic conditions. Congenital ichthyosis are rare genetic skin disorders characterized by extensive scaling and inflammation, making affected children vulnerable to stigma and bullying. While families often raise bullying as a concern, it remains under-examined in both clinical and research settings. This cross-sectional study used validated survey tools to assess the prevalence and impact of bullying on children with ichthyosis and their caregivers.
What did they find?
Bullying is a significant public health concern, especially for children with visible chronic conditions. Congenital ichthyosis are rare genetic skin disorders characterized by extensive scaling and inflammation, making affected children vulnerable to stigma and bullying. While families often raise bullying as a concern, it remains under-examined in both clinical and research settings. This cross-sectional study used validated survey tools to assess the prevalence and impact of bullying on children with ichthyosis and their caregivers.
What did they find?
- 33% of children reported moderate bullying exposure, significantly higher than national estimates for the general population (P < 0.05).
- Child-reported bullying strongly correlated with poor peer relationships (r = –0.63, adjusted P < 0.001) and moderate-to-severe stigma (r = 0.53, adjusted P < 0.001).
- Caregiver depression and anxiety scores moderately correlated with their perception of the child’s bullying (r = 0.46 and 0.52, adjusted P < 0.05).
- Poor family quality of life (FDLQI) correlated with caregiver anxiety (r = 0.59, adjusted P < 0.001) and poor child mobility, peer relationships, and depression (adjusted P < 0.05).
Patients with hidradenitis suppurativa have an increased incidence of noninfectious uveitis (NIU)
British Journal of Dermatology
British Journal of Dermatology
We didn’t see this one coming! Noninfectious uveitis incidence is double in hidradenitis supprativa patients!?
Hidradenitis suppurativa (HS) is a chronic, inflammatory disease characterized by painful abscesses and sinus tract formation, commonly within intertriginous areas. Noninfectious uveitis (NIU) is inflammation of intraocular structures such as the iris, ciliary body, and choroid, which can lead to vision loss. There is limited information on the incidence of NIU in HS patients. Researchers conducted a retrospective cohort study using an electronic health records database to compare 21,386 HS patients with 1,278,632 controls.
What did they find?
Hidradenitis suppurativa (HS) is a chronic, inflammatory disease characterized by painful abscesses and sinus tract formation, commonly within intertriginous areas. Noninfectious uveitis (NIU) is inflammation of intraocular structures such as the iris, ciliary body, and choroid, which can lead to vision loss. There is limited information on the incidence of NIU in HS patients. Researchers conducted a retrospective cohort study using an electronic health records database to compare 21,386 HS patients with 1,278,632 controls.
What did they find?
- HS incidence of NIU was 11.3 per 10,000 person-years (95% CI, 8.9–14.2).
- Control incidence of NIU was 5.5 per 10,000 person-years (95% CI, 5.3–5.7).
- Hazard ratio (HR) comparing HS vs. control was 2.06 (95% CI, 1.64–2.60) in unadjusted analysis.
- HR comparing HS vs. control was 1.81 (95% CI, 1.43–2.30) when adjusting for demographics and 1.37 (95% CI, 1.07–1.75) when additionally adjusting for comorbidities.
Looking for a needle in a haystack? Not to worry, mesh has your back!
Foreign body removal from soft tissue remains a challenging aspect of dermatologic and surgical care, particularly when the object is metallic and superficially embedded. Standard imaging methods have limitations: MRI is contraindicated for ferromagnetic materials, CT can visualize internal structures but lacks accuracy for superficial localization, and ultrasound may be unavailable or insufficient for detecting small metallic fragments. To address this gap, the authors tested a simple, low-cost technique to improve localization and guide removal of superficial foreign bodies using a 10 mm metal wire mesh marker with CT imaging.
What did they find?
Foreign body removal from soft tissue remains a challenging aspect of dermatologic and surgical care, particularly when the object is metallic and superficially embedded. Standard imaging methods have limitations: MRI is contraindicated for ferromagnetic materials, CT can visualize internal structures but lacks accuracy for superficial localization, and ultrasound may be unavailable or insufficient for detecting small metallic fragments. To address this gap, the authors tested a simple, low-cost technique to improve localization and guide removal of superficial foreign bodies using a 10 mm metal wire mesh marker with CT imaging.
What did they find?
- In a case involving a retained metallic needle in the scapular soft tissue, the mesh was placed over the skin before CT imaging.
- The mesh provided a visible surface reference on the scan, allowing for accurate localization of the needle’s position and depth.
- This enabled precise surface marking and a targeted incision, leading to successful foreign body removal.
Fig 1. Metal Wire Mesh placed on the surface of patients scapula
Fig 2. Computed tomography reconstruction of foreign body with metal wire mesh to allow visualization
Main Takeaway: Utilizing a 10 mm wire mesh marker with computed tomography offers a low-cost, effective method for localizing and extracting superficial foreign bodies within soft tissue. This approach enables visualization of both the position and depth of metallic objects and is especially useful when ultrasound is unavailable or unable to detect the foreign body.
Main Takeaway: Utilizing a 10 mm wire mesh marker with computed tomography offers a low-cost, effective method for localizing and extracting superficial foreign bodies within soft tissue. This approach enables visualization of both the position and depth of metallic objects and is especially useful when ultrasound is unavailable or unable to detect the foreign body.
GLP-1 agonists and CCCA: Could metabolic health influence hair regrowth?
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
We can’t “noma-lize” overlooking neglected tropical diseases like noma
Noma is a neglected tropical disease that primarily affects malnourished children in impoverished regions, particularly in sub-Saharan Africa. Characterized by rapidly progressive gangrene of the mouth and face, noma has a >90% mortality rate if untreated. The WHO classifies noma into five stages, with stages 1–3 (active noma) progressing over 1–2 weeks. While most cases occur in children aged 2–6, adult cases have been reported, especially in northern Nigeria. This retrospective study analyzed 1,383 patients treated in northern Nigeria from 1999 to 2024 to better characterize the disease’s incidence and clinical presentation.
What did they find?
Main Takeaway: This study identified a high overall incidence of noma in northern Nigeria (87.8 cases per 100,000), with significant regional and age-related disparities, particularly affecting children under 5 years old. These findings highlight the urgent need for early detection, targeted community education, and improved access to healthcare services to prevent progression from the early, active stages of noma to its later, disfiguring and irreversible stages.
Noma is a neglected tropical disease that primarily affects malnourished children in impoverished regions, particularly in sub-Saharan Africa. Characterized by rapidly progressive gangrene of the mouth and face, noma has a >90% mortality rate if untreated. The WHO classifies noma into five stages, with stages 1–3 (active noma) progressing over 1–2 weeks. While most cases occur in children aged 2–6, adult cases have been reported, especially in northern Nigeria. This retrospective study analyzed 1,383 patients treated in northern Nigeria from 1999 to 2024 to better characterize the disease’s incidence and clinical presentation.
What did they find?
- Among the 1,383 patients reviewed, 44.1% were under 5 years old, and 54.2% were male.
- Over half (51.3%) of patients were from Sokoto state, which has the highest poverty rate in Nigeria.
- Active noma (stages 1–3) was more common than arrested noma (stages 4–5), accounting for 67.3% of cases.
- Among active noma patients, 56.2% were under age 5.
- Adults were significantly more likely to present with arrested noma (P < 0.001).
- The right cheek was the most commonly affected site (55.5%), followed by the left cheek (49.4%).
- Children under 5 were more likely to have nose and lip involvement (P < 0.001–0.012).
- The estimated 26-year incidence of noma in northern Nigeria was 87.8 cases per 100,000, with a significantly higher rate in children under 5 (297.9/100,000).
Main Takeaway: This study identified a high overall incidence of noma in northern Nigeria (87.8 cases per 100,000), with significant regional and age-related disparities, particularly affecting children under 5 years old. These findings highlight the urgent need for early detection, targeted community education, and improved access to healthcare services to prevent progression from the early, active stages of noma to its later, disfiguring and irreversible stages.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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