One Hundred and tenth issue
may 13th, 2026
Pediatric skin disease frequencies and dermatology use by race and ethnicity in US children’s hospitals
JAMA Dermatology
JAMA Dermatology
Derm referrals really said: correlation ≠ consultation
As pediatric dermatology has grown, increasing attention has been placed on racial and ethnic disparities in pediatric skin disease burden and access to specialty dermatologic care. Prior studies suggest Black children may experience higher rates of certain dermatologic diseases and lower access to dermatology care, highlighting the need to better understand these disparities within pediatric health systems. This multicenter cross-sectional study evaluated racial and ethnic differences in pediatric skin disease frequency and dermatology utilization across 8 US children’s hospitals participating in the PEDSnet database.
What did they find?
Main Takeaway: This study demonstrates racial and ethnic disparities in pediatric dermatology care within large US children’s hospitals. Black children had disproportionately high burdens of AD, acne, and HS, yet consistently lower access to dermatology specialists, raising concern for systemic inequities in referral pathways, disease recognition, and access to care.
As pediatric dermatology has grown, increasing attention has been placed on racial and ethnic disparities in pediatric skin disease burden and access to specialty dermatologic care. Prior studies suggest Black children may experience higher rates of certain dermatologic diseases and lower access to dermatology care, highlighting the need to better understand these disparities within pediatric health systems. This multicenter cross-sectional study evaluated racial and ethnic differences in pediatric skin disease frequency and dermatology utilization across 8 US children’s hospitals participating in the PEDSnet database.
What did they find?
- There were 10 469 (95% CI, 10 414-10 524) cases of AD per 100 000 Black children in comparison to 3099 (95% CI, 3083-3114) per 100 000 White children.
- Black children had the lowest dermatology utilization despite higher disease burden, including AD (19.1% vs 35.0%), acne (28.2% vs 45.6%), and HS (39.4% vs 55.4%).
- Infantile hemangioma was less common in Black children (290 per 100,000) than in White children (764 per 100,000).
- Psoriasis prevalence was highest in American Indian/Alaska Native children (166 per 100,000) and lowest in Black children (100 per 100,000).
- Hispanic children had higher dermatology utilization than non-Hispanic children across all conditions.
Main Takeaway: This study demonstrates racial and ethnic disparities in pediatric dermatology care within large US children’s hospitals. Black children had disproportionately high burdens of AD, acne, and HS, yet consistently lower access to dermatology specialists, raising concern for systemic inequities in referral pathways, disease recognition, and access to care.
Surgery isn’t the only answer anymore. Topicals to the rescue!
Bowen’s disease (BD), or cutaneous squamous cell carcinoma in situ, is commonly treated with surgical excision (SE), though non-invasive options such as topical 5-fluorouracil (5FU) and methylaminolevulinate photodynamic therapy (MAL-PDT) offer potential cosmetic and practical advantages. In this multicenter randomized controlled trial, investigators evaluated the long-term efficacy of SE, 5FU, and MAL-PDT in 250 patients with BD followed for 3–5 years after treatment.
What did they find?
Main Takeaway: Long-term recurrence risk after treatment of Bowen’s disease appears to be low, particularly after surgical excision and the use of 5FU. While surgery remains the most effective treatment, topical 5FU demonstrated durable long-term clearance, supporting its role as a practical first-line non-invasive alternative for appropriately selected patients.
Bowen’s disease (BD), or cutaneous squamous cell carcinoma in situ, is commonly treated with surgical excision (SE), though non-invasive options such as topical 5-fluorouracil (5FU) and methylaminolevulinate photodynamic therapy (MAL-PDT) offer potential cosmetic and practical advantages. In this multicenter randomized controlled trial, investigators evaluated the long-term efficacy of SE, 5FU, and MAL-PDT in 250 patients with BD followed for 3–5 years after treatment.
What did they find?
- The 4-year probability of tumor-free survival was highest with surgical excision (97.5%) compared with 5FU (86.2%) and MAL-PDT (82.7%).
- Only 1 additional recurrence occurred during long-term follow-up, developing 5 years after MAL-PDT.
- No patient developed invasive cutaneous squamous cell carcinoma within the treated area during follow-up.
- 5FU remained non-inferior to surgical excision, while the non-inferiority of MAL-PDT could not be established.
Main Takeaway: Long-term recurrence risk after treatment of Bowen’s disease appears to be low, particularly after surgical excision and the use of 5FU. While surgery remains the most effective treatment, topical 5FU demonstrated durable long-term clearance, supporting its role as a practical first-line non-invasive alternative for appropriately selected patients.
Thin melanoma prognosis may be better predicted by tumor features other than by Breslow thickness alone
British Journal of Dermatology
British Journal of Dermatology
And the plot thickens for prognostic factors of thin melanomas!
Thin melanomas, defined as melanomas with Breslow thickness ≤1 mm, are often considered highly curable via surgical excision, but they still account for a meaningful proportion of melanoma deaths. Prognostication in thin melanoma remains challenging, as traditional histopathologic factors do not always accurately predict recurrence or survival outcomes. This retrospective cohort study evaluated 802 patients with stage IA or IB thin melanoma diagnosed from 2000 to 2015 to identify clinicopathologic features associated with recurrence, melanoma-specific survival, and overall survival.
What did they find?
Main takeaway: In thin melanomas, prognosis may depend more on features such as mitotic rate, tumor-infiltrating lymphocytes, and absence of radial growth phase than on Breslow thickness alone, helping identify patients who may need closer surveillance.
Thin melanomas, defined as melanomas with Breslow thickness ≤1 mm, are often considered highly curable via surgical excision, but they still account for a meaningful proportion of melanoma deaths. Prognostication in thin melanoma remains challenging, as traditional histopathologic factors do not always accurately predict recurrence or survival outcomes. This retrospective cohort study evaluated 802 patients with stage IA or IB thin melanoma diagnosed from 2000 to 2015 to identify clinicopathologic features associated with recurrence, melanoma-specific survival, and overall survival.
What did they find?
- 71 patients experienced recurrence, representing a recurrence rate of 8.9%.
- Higher mitotic rate was associated with increased recurrence risk (OR = 1.28, 95% CI = 1.08–1.52; p = 0.004).
- Presence of tumor-infiltrating lymphocytes was associated with recurrence (OR = 3.26, 95% CI = 1.15–9.21; p = 0.03).
- Absence of radial growth phase was strongly associated with recurrence (OR = 7.52, 95% CI = 1.37–41.19; p = 0.02) and worse 5-year overall survival (HR = 1882.2, 95% CI = 7.56–468,427.60; p = 0.007).
Main takeaway: In thin melanomas, prognosis may depend more on features such as mitotic rate, tumor-infiltrating lymphocytes, and absence of radial growth phase than on Breslow thickness alone, helping identify patients who may need closer surveillance.
JAK1 and done? Not quite… but topical Jak inhibitors may be onto something.
Frontal fibrosing alopecia (FFA) is a scarring alopecia driven by inflammation and fibrosis around the hair follicle, often leading to irreversible hair loss if left untreated. Current treatment options are limited, with no FDA-approved therapies, and inconsistent responses to commonly used systemic or topical agents. Because FFA lesions show strong T helper 1 (Th1)/IFN-γ signaling and activation of the JAK/STAT pathway, this randomized controlled trial evaluated whether topical delgocitinib cream, a pan-JAK inhibitor, could improve the molecular and clinical features of FFA.
What did they find?
Frontal fibrosing alopecia (FFA) is a scarring alopecia driven by inflammation and fibrosis around the hair follicle, often leading to irreversible hair loss if left untreated. Current treatment options are limited, with no FDA-approved therapies, and inconsistent responses to commonly used systemic or topical agents. Because FFA lesions show strong T helper 1 (Th1)/IFN-γ signaling and activation of the JAK/STAT pathway, this randomized controlled trial evaluated whether topical delgocitinib cream, a pan-JAK inhibitor, could improve the molecular and clinical features of FFA.
What did they find?
- Delgocitinib significantly reduced Th1-associated biomarkers, including CXCL9, CXCL10, and IFN-γ.
- Delgocitinib-treated lesions improved 4% toward a nonlesional molecular profile, while vehicle-treated lesions worsened by 33%.
- Treatment with Delgocitinib led to greater reductions in FFASS (Frontal Fibrosing Alopecia Severity Score) at 12 weeks compared with vehicle.
- Hair density, follicular units, and hair shaft thickness improved with delgocitinib, while vehicle-treated patients generally worsened or remained stable.
- No serious adverse events or application-site reactions occurred
Hair today, gone viral tomorrow.
Alopecia, or hair loss, is a common dermatologic condition in children and young adults that can significantly impact quality of life, self-esteem, and mental health. With the rise of social media, many young patients are increasingly exposed to hair loss-related content and direct-to-consumer (DTC) treatments online, often promoted by social media influencers rather than medical professionals. This cross-sectional survey study evaluated how pediatric and young adult patients with physician-diagnosed alopecia engage with social media content, perceive its credibility, and use DTC hair loss products, with a goal to better understand how online platforms influence treatment behaviors and health perceptions in this population.
What did they find?
Alopecia, or hair loss, is a common dermatologic condition in children and young adults that can significantly impact quality of life, self-esteem, and mental health. With the rise of social media, many young patients are increasingly exposed to hair loss-related content and direct-to-consumer (DTC) treatments online, often promoted by social media influencers rather than medical professionals. This cross-sectional survey study evaluated how pediatric and young adult patients with physician-diagnosed alopecia engage with social media content, perceive its credibility, and use DTC hair loss products, with a goal to better understand how online platforms influence treatment behaviors and health perceptions in this population.
What did they find?
- 86% of pediatric and young adult patients with alopecia reported being at least somewhat worried about their hair loss.
- 65% of respondents reported social media use, which increased with age (90% ≥18 years, 72% ages 12–17 years, 34% <12 years; p < 0.001), with TikTok, Instagram, and YouTube as the most common sources of content.
- 59% encountered hair loss content, many were uncertain of creator qualifications, and nearly 25% rarely or never questioned the accuracy of the information presented.
- 28% tried treatments seen online, associated with low satisfaction, side effects, and variable out-of-pocket costs ranging from $0 to >$500.
- 60% had tried at least one DTC treatment, though perceived effectiveness was inconsistent.
(CO2 Laser) Grinding away the pain of ingrown toenails
Ingrown toenails can be significant sources of pain for patients with treatments ranging from splints to surgery with goals of treatment to decompress the lateral nail fold without damaging surrounding tissue. Splinting may take many months for patients to experience relief, and surgery can have significant downtime from daily activities and cosmetic outcomes that are not as desirable. CO2 lasers have been reported to be used to ablate periungual tissue; however, this study of 23 patients reports CO2 laser grinding of grooves along the dorsal plate to decrease pressure on the nail fold while avoiding damage to surrounding tissue.
What did they find?
Limitation: The study was a small, single-arm study with short-term followup. The use of concurrent urea cream does not enable the ability to decipher the impact of CO2 laser grinding alone.
Main Takeaway: CO2 laser grinding combined with low-concentration urea cream can be a beneficial option for patients suffering from ingrown toenails without the need for surgery or long-term splinting
Ingrown toenails can be significant sources of pain for patients with treatments ranging from splints to surgery with goals of treatment to decompress the lateral nail fold without damaging surrounding tissue. Splinting may take many months for patients to experience relief, and surgery can have significant downtime from daily activities and cosmetic outcomes that are not as desirable. CO2 lasers have been reported to be used to ablate periungual tissue; however, this study of 23 patients reports CO2 laser grinding of grooves along the dorsal plate to decrease pressure on the nail fold while avoiding damage to surrounding tissue.
What did they find?
- 2mm wide grooves were created on half the nail bed depth using the CO2 ultrapulse mode at 10,600-nm avoiding periungual contact.
- All patients resumed normal activity immediately following the procedure with 60% of patients reporting only mild discomfort during the surgery and 40% having no pain.
- Following procedure patients used 10% urea cream for 8 weeks to affected area.
- At 8 weeks post procedure median erythema significantly decreased from 1 to 0 on a 3 point scale and mean pain decreased by 3 points.
Limitation: The study was a small, single-arm study with short-term followup. The use of concurrent urea cream does not enable the ability to decipher the impact of CO2 laser grinding alone.
Main Takeaway: CO2 laser grinding combined with low-concentration urea cream can be a beneficial option for patients suffering from ingrown toenails without the need for surgery or long-term splinting
The Mu-RPA suitcase laboratory is the ~ultimate carry-on~ for rapid Buruli ulcer diagnosis
Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a necrotizing skin disease that predominantly affects children in Africa and can lead to severe tissue destruction, disability, and amputation. Although PCR targeting the IS2404 sequence is the diagnostic gold standard, access to molecular testing is limited in endemic regions. To address this gap, researchers developed the rapid M. ulcerans recombinase polymerase amplification (Mu-RPA) assay, an isothermal molecular test that detects M. ulcerans DNA within 15 minutes, which was integrated into a portable suitcase laboratory for point-of-care diagnosis. This study evaluated the feasibility and diagnostic performance of the Mu-RPA assay compared to standard PCR testing across three BU clinics in Ghana.
What did they find?
Main Takeaway: The Mu-RPA suitcase laboratory is a feasible and effective field-based tool for rapid diagnosis of Buruli ulcers, offering faster turnaround times, lower cost, and strong diagnostic performance compared with conventional PCR in resource-limited settings.
Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a necrotizing skin disease that predominantly affects children in Africa and can lead to severe tissue destruction, disability, and amputation. Although PCR targeting the IS2404 sequence is the diagnostic gold standard, access to molecular testing is limited in endemic regions. To address this gap, researchers developed the rapid M. ulcerans recombinase polymerase amplification (Mu-RPA) assay, an isothermal molecular test that detects M. ulcerans DNA within 15 minutes, which was integrated into a portable suitcase laboratory for point-of-care diagnosis. This study evaluated the feasibility and diagnostic performance of the Mu-RPA assay compared to standard PCR testing across three BU clinics in Ghana.
What did they find?
- Most suspected BU cases occurred in females (61.6%), with ulcers being the most common lesion type (60.3%).
- Nearly half of the lesions were early stage/category I (49.3%), while 50.6% were category II or III.
- The Mu-RPA suitcase laboratory reduced diagnostic turnaround time to ~45 minutes compared to at least 2 days for standard PCR testing
- Of 73 suspected BU cases, 39 were PCR-confirmed, and the Mu-RPA assay achieved 82% sensitivity and 100% specificity.
- Agreement between the Mu-RPA assay and PCR was high overall (90%; κ = 0.81), with the strongest concordance seen in swab samples (96%; κ = 0.91).
Main Takeaway: The Mu-RPA suitcase laboratory is a feasible and effective field-based tool for rapid diagnosis of Buruli ulcers, offering faster turnaround times, lower cost, and strong diagnostic performance compared with conventional PCR in resource-limited settings.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.