One Hundred and thirteenth issue
June 24th, 2026
Clinicopathologic features and long-term outcomes of adult hypopigmented mycosis fungoides
JAMA Dermatology
JAMA Dermatology
When ‘it’s probably nothing’ lasts 27 months.
Hypopigmented mycosis fungoides (HMF) is a rare variant of cutaneous T-cell lymphoma that can mimic benign hypopigmented disorders such as vitiligo, often leading to delayed diagnosis. This multicenter retrospective cohort study evaluated 224 adults with biopsy-confirmed HMF from 6 US tertiary referral centers to characterize clinicopathologic features, treatment outcomes, and predictors of disease progression.
What did they find?
Hypopigmented mycosis fungoides (HMF) is a rare variant of cutaneous T-cell lymphoma that can mimic benign hypopigmented disorders such as vitiligo, often leading to delayed diagnosis. This multicenter retrospective cohort study evaluated 224 adults with biopsy-confirmed HMF from 6 US tertiary referral centers to characterize clinicopathologic features, treatment outcomes, and predictors of disease progression.
What did they find?
- The cohort was composed of 83% Black patients and 73% women, reflecting the higher prevalence of HMF in these populations. 98% of the cohort presented with early-stage disease.
- 77% achieved an overall response (26% complete response, 51% partial response), and 90% were managed with skin-directed therapy alone.
- Only 6% progressed to a higher stage, and just 2% progressed from early- to advanced-stage disease during follow-up.
- Peripheral blood TCR monoclonality may predict lower response rates but not worse prognosis.
Cutting the brakes affects more than just the tumor.
Immune checkpoint inhibitors (ICIs) are increasingly associated with autoimmune bullous diseases (AIBDs), but diagnostic delays and inconsistent management remain common. This clinical review synthesizes the pathogenesis, clinical presentation, diagnosis, and management of seven ICI-triggered immunobullous dermatoses.
What did they find?
Main Takeaway: As ICI use expands, dermatologists will increasingly encounter these immunobullous reactions. This review provides a practical framework for biopsy indications and prioritization of biologics over doxycycline.
Immune checkpoint inhibitors (ICIs) are increasingly associated with autoimmune bullous diseases (AIBDs), but diagnostic delays and inconsistent management remain common. This clinical review synthesizes the pathogenesis, clinical presentation, diagnosis, and management of seven ICI-triggered immunobullous dermatoses.
What did they find?
- Bullous pemphigoid (BP) is the most common ICI-associated AIBD (prevalence 1-5%), often preceded by a prolonged non-bullous phase of refractory pruritus mimicking eczema or urticaria, with mucosal involvement more frequent than idiopathic BP (10-30%).
- ELISA for BP180 can be negative or borderline early in ICI-BP, and direct immunofluorescence (DIF) may show weaker or focal staining. Biopsy of perilesional skin for DIF is recommended in any ICI-treated patient with unexplained refractory pruritus, even without classic blistering.
- Dupilumab is a favorable first-line steroid-sparing biologic (600 mg loading, then 300 mg q2 weeks) and is now included in National Comprehensive Cancer Network immune-related adverse event guidelines. Omalizumab and rituximab are alternatives for refractory disease. JAK/TYK2 inhibitors are not recommended due to potential impairment of antitumor immunity.
- Doxycycline may be associated with worse progression-free and overall survival in ICI-treated patients, supporting a biologic-first approach.
Main Takeaway: As ICI use expands, dermatologists will increasingly encounter these immunobullous reactions. This review provides a practical framework for biopsy indications and prioritization of biologics over doxycycline.
Microbiota-fibroblast crosstalk represents the missing link in skin barrier dysfunction and fibrosis
BJD
BJD
Fibroblasts have beef with your bacteria.
Skin fibroblasts have traditionally been viewed as passive structural cells that only produce extracellular matrix, but emerging evidence shows they actively sense microbial signals and help drive cutaneous inflammation. This review summarizes mechanistic literature on how microbial dysbiosis reprograms fibroblasts to contribute to barrier dysfunction, impaired wound healing, and fibrotic skin disease.
What did they find?
Main Takeaway: Fibroblasts act as central integrators of microbial signals, making the microbiota-fibroblast axis a promising shared target for treating barrier dysfunction and fibrosis across multiple skin diseases.
Skin fibroblasts have traditionally been viewed as passive structural cells that only produce extracellular matrix, but emerging evidence shows they actively sense microbial signals and help drive cutaneous inflammation. This review summarizes mechanistic literature on how microbial dysbiosis reprograms fibroblasts to contribute to barrier dysfunction, impaired wound healing, and fibrotic skin disease.
What did they find?
- In psoriasis, dysbiosis favoring Corynebacterium, Staphylococcus, and Streptococcus species pushes fibroblasts toward a pro-inflammatory phenotype that sustains the IL-23/IL-17 axis, while the protective commensal Cutibacterium declines with disease severity and correlates with antioxidant glutathione levels (r = 0.821, p < 0.001).
- In atopic dermatitis, Staphylococcus aureus activates fibroblasts via NOD2/TLR2 signaling to promote mast cell degranulation and dendritic cell recruitment, whereas the commensal Staphylococcus epidermidis secretes butyrate that activates a reparative ERK/FFAR2 pathway in fibroblasts.
- During wound healing, fibroblasts progress through four functional states, and this transition is shaped by microbial metabolites; beneficial species like Lactobacillus rhamnosus and Clostridium butyricum support regeneration, while pathogens such as Candida albicans and Enterobacter cloacae impair healing and promote keloid formation.
- In fibrotic diseases, including keloid, scleroderma, and graft-versus-host disease, specific microbial products show antifibrotic effects, including bacterial vesicles that reduce collagen I/III expression and gut species like Bacteroides ovatus and Blautia linked to lower fibrotic burden.
Main Takeaway: Fibroblasts act as central integrators of microbial signals, making the microbiota-fibroblast axis a promising shared target for treating barrier dysfunction and fibrosis across multiple skin diseases.
The pediatric AD treatment toolbox just got bigger!
Topical corticosteroids and calcineurin inhibitors are limited by safety concerns and variable efficacy in pediatric atopic dermatitis (AD), prompting interest in topical Janus kinase (JAK) inhibitors as nonsteroidal alternatives. This systematic review summarizes eight studies evaluating ruxolitinib cream or delgocitinib ointment for pediatric atopic dermatitis.
What did they find?
Topical corticosteroids and calcineurin inhibitors are limited by safety concerns and variable efficacy in pediatric atopic dermatitis (AD), prompting interest in topical Janus kinase (JAK) inhibitors as nonsteroidal alternatives. This systematic review summarizes eight studies evaluating ruxolitinib cream or delgocitinib ointment for pediatric atopic dermatitis.
What did they find?
- Ruxolitinib produced rapid responses in children aged 2-11 years, with 67.2% reaching EASI-75 (≥ 75% improvement from baseline in the Eczema Area and Severity Index) by Week 8. One trial in children with more extensive disease (>35% BSA) showed 84% of participants reaching EASI-75 by Week 8.
- Phase 2 data for delgocitinib showed mean reductions in modified EASI of -54.2% and -61.8% (with 0.25% and 0.5% ointment, respectively) versus -4.8% with control ointment at Week 4. Phase 3 data report sustained disease control through Week 52 in infants.
- Patient-reported quality of life improved significantly with ruxolitinib in adolescents aged 12-15 (children's dermatology quality of life index change -6.0 vs. -2.3 with control, p = 0.0012), though the 16- 17 age subgroup did not reach significance (dermatology quality of life index change -5.1 vs. -4.3, p = 0.06).
- Both agents were well-tolerated, with application-site reactions uncommon (ruxolitinib: 2.8% - 4.6%; delgocitinib: 0.7% - 4.3%), no treatment-related serious adverse events (AEs), and only four discontinuations due to AEs across all eight studies.
A battle between BCC’s mightiest heroes
Accurate classification of histopathologic basal cell carcinoma (BCC) subtypes is important for treatment selection. Dermoscopy and reflectance confocal microscopy (RCM) have both been described as effective methods to enhance the diagnostic accuracy of BCC; however, the literature on the predictability of BCC subtypes using these two methods remains limited. This retrospective study compared the diagnostic accuracy of predefined confocal criteria and dermoscopic criteria for predicting BCC histopathologic subtype.
What did they find?
Limitations: there was a small number of patients, particularly in aBCC, and the diagnostic results were limited to data from a single center, which may not generalize to all clinical situations.
Main Takeaway: BCC subtypes have distinct histological features that are well predicted by both RCM and dermoscopy. RCM is more accurate in predicting nBCC and aBCC, while dermoscopy is more accurate in predicting sBCC.
Accurate classification of histopathologic basal cell carcinoma (BCC) subtypes is important for treatment selection. Dermoscopy and reflectance confocal microscopy (RCM) have both been described as effective methods to enhance the diagnostic accuracy of BCC; however, the literature on the predictability of BCC subtypes using these two methods remains limited. This retrospective study compared the diagnostic accuracy of predefined confocal criteria and dermoscopic criteria for predicting BCC histopathologic subtype.
What did they find?
- The most frequent diagnostic features observed on confocal evaluation of superficial basal cell carcinoma (sBCC), nodular basal cell carcinoma (nBCC), and aggressive basal cell carcinoma (aBCC) were keratinocyte atypia (85.29%), peripheral palisading (74.55%), and small tumor islands (68.75%), respectively.
- On dermoscopy, the most frequent diagnostic features of sBCC, nBCC, and aBCC were shiny white–red structureless areas (85.71%) and arborizing vessels (90.32%, 80%), respectively.
- RCM is superior to dermoscopy for predicting the diagnosis of nBCC with a sensitivity of 91.7% and specificity of 80.7%, and aBCC with a sensitivity of 87.5% and specificity of 97.8%.
- Dermoscopy is superior to RCM for predicting the diagnosis of sBCC, with a sensitivity of 95.0% and specificity of 95.2%.
Limitations: there was a small number of patients, particularly in aBCC, and the diagnostic results were limited to data from a single center, which may not generalize to all clinical situations.
Main Takeaway: BCC subtypes have distinct histological features that are well predicted by both RCM and dermoscopy. RCM is more accurate in predicting nBCC and aBCC, while dermoscopy is more accurate in predicting sBCC.
Does prior treatment with facial injectables increase the risk of rhytidectomy complications?
Derm Surg
Derm Surg
Your filler era may not be your facelift villain origin story.
Since facial injectables have become increasingly common, many patients pursuing rhytidectomy (facelift surgery) are seen to have a history of fillers or biostimulatory injectables. There have been concerns raised that prior injectables may alter tissue planes or increase postoperative complications. To address these concerns, this retrospective chart review of patients undergoing deep plane rhytidectomy over 15 months compared complication rates between those with and without prior facial injectables.
What did they find?
Main Takeaway: A history of facial injectable treatments, including hyaluronic acid, calcium hydroxylapatite, and poly-L-lactic acid, does not appear to significantly increase the risk of complications after deep plane rhytidectomy.
Since facial injectables have become increasingly common, many patients pursuing rhytidectomy (facelift surgery) are seen to have a history of fillers or biostimulatory injectables. There have been concerns raised that prior injectables may alter tissue planes or increase postoperative complications. To address these concerns, this retrospective chart review of patients undergoing deep plane rhytidectomy over 15 months compared complication rates between those with and without prior facial injectables.
What did they find?
- 57% of patients undergoing deep plane rhytidectomy had received prior facial injectables before surgery.
- Overall, 25 patients (24%) experienced a postoperative complication following rhytidectomy.
- Complications occurred in 17 of 106 patients (16%) with prior injectables compared with 8 of 106 patients (8%) without prior injectables.
- Despite the numerically higher complication rate, there was no statistically significant difference between groups (p = 0.188), which suggests that prior injectable treatment did not significantly increase postoperative risk.
Main Takeaway: A history of facial injectable treatments, including hyaluronic acid, calcium hydroxylapatite, and poly-L-lactic acid, does not appear to significantly increase the risk of complications after deep plane rhytidectomy.
Recent advances and future directions in Bellafill as a regenerative biomaterial: biological mechanisms, clinical applications, and safety
JCD
JCD
Move over filler, we have *regenerative biomaterial scaffolds* now
Bellafill is a polymethylmethacrylate microsphere dermal filler in a bovine collagen carrier that works to both induce collagen production and act as a framework for fibroblasts and ECM remodeling. Current filler options are short-term solutions that do not allow for any endogenous regeneration, making the increased regenerative potential of Bellafill a promising new option. This narrative review describes the biological mechanisms, safety profile, and growing clinical applications of Bellafill.
What did they find?
Main Takeaway: Bellafill is a novel filler that increases endogenous collagen production and serves as a scaffold and has demonstrated efficacy in improving acne scars, wound healing, and is used as filler in the nasolabial folds and peri-orbital area.
Bellafill is a polymethylmethacrylate microsphere dermal filler in a bovine collagen carrier that works to both induce collagen production and act as a framework for fibroblasts and ECM remodeling. Current filler options are short-term solutions that do not allow for any endogenous regeneration, making the increased regenerative potential of Bellafill a promising new option. This narrative review describes the biological mechanisms, safety profile, and growing clinical applications of Bellafill.
What did they find?
- 2 studies found 64-64.4% improvement in atrophic acne scars with Bellafill compared to 32.6-33% in saline controls.
- Multiple case reports have used Bellafill in wound healing, with one achieving 96% reduction in a chronic, previously non-healing temporoparietal wound with no adverse events.
- Low immunogenicity with consistently low adverse event rate <1%.
Main Takeaway: Bellafill is a novel filler that increases endogenous collagen production and serves as a scaffold and has demonstrated efficacy in improving acne scars, wound healing, and is used as filler in the nasolabial folds and peri-orbital area.
Clinical characteristics and treatment patterns in patients with vitiligo
Skin of Color (JAMA Derm)
Skin of Color (JAMA Derm)
One disease. Endless treatment side quests.
Vitiligo is a chronic autoimmune disease that causes loss of skin pigmentation and can have a substantial psychosocial impact. While several treatments are used in clinical practice, less is known about how vitiligo is managed outside of clinical trials. This retrospective cohort study used linked claims and electronic health record data to examine the clinical characteristics and treatment patterns of 24,949 patients with vitiligo in the United States.
What did they find?
Main Takeaway: In this large real-world study, many patients with vitiligo did not receive treatment after diagnosis, while those who did often experienced short treatment durations and highly variable treatment pathways. These findings highlight ongoing challenges in the long-term management of vitiligo and the need for more consistent approaches to care.
Vitiligo is a chronic autoimmune disease that causes loss of skin pigmentation and can have a substantial psychosocial impact. While several treatments are used in clinical practice, less is known about how vitiligo is managed outside of clinical trials. This retrospective cohort study used linked claims and electronic health record data to examine the clinical characteristics and treatment patterns of 24,949 patients with vitiligo in the United States.
What did they find?
- Only 5.3% of patients had body surface area involvement documented at diagnosis, despite disease extent playing an important role in treatment decisions.
- Among patients with a documented location, the face was the most commonly affected site overall (32.9%), while patients with >10% BSA involvement more often had lesions on the arms (52.2%) and trunk (52.5%).
- Approximately 27% to 32% of patients did not receive treatment during follow-up, regardless of documented disease extent.
- Treatment patterns were highly variable, with 64% of treated patients advancing to a second treatment line, 43% to a third, and 20% reaching a fifth line of therapy. Median treatment duration ranged from just 1.8 to 4.1 months.
Main Takeaway: In this large real-world study, many patients with vitiligo did not receive treatment after diagnosis, while those who did often experienced short treatment durations and highly variable treatment pathways. These findings highlight ongoing challenges in the long-term management of vitiligo and the need for more consistent approaches to care.
Pediatric tinea capitis is a common fungal infection of the scalp primarily caused by Trichophyton and Microsporum species, and treatment failures may occur when the infecting organism is not identified. Understanding species-specific efficacy is important for clinical dermatologists because empiric therapy may lead to lower cure rates and contribute to emerging antifungal resistance. This narrative review evaluates the clinical use of griseofulvin, terbinafine, itraconazole, and fluconazole in children with tinea capitis, focusing on species-specific outcomes and dosing regimens.
What did they find?
What did they find?
- Griseofulvin remained highly effective for both Trichophyton and Microsporum infections when administered at the currently recommended dose of 20–25 mg/kg/day.
- Terbinafine demonstrated strong efficacy against Trichophyton species but performed substantially worse against Microsporum species.
- Itraconazole and fluconazole showed promising results as alternative therapies, particularly in situations where first-line agents were not suitable, though both require careful monitoring for potential hepatotoxicity.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.