eightY-fifth issue
May 14, 2025
Rilzabrutinib may be a new effective treatment option for patients with chronic spontaneous urticaria
JAMA Dermatology
JAMA Dermatology
We’re itching to find new treatments for chronic spontaneous urticaria!
Chronic spontaneous urticaria (CSU), characterized by spontaneous eruptions of hives and angioedema, is classically treated with second-generation antihistamines and omalizumab, an anti-IgE antibody. However, many patients experience refractory symptoms and inadequate response to treatment. Bruton tyrosine kinase (BTK), expressed in mast cells, B cells, basophils, and macrophages, plays a role in IgE- and IgG-mediated signaling, providing a potential therapeutic target for CSU treatment. A 52-week phase 2 randomized clinical trial evaluated the efficacy of rilzabrutinib, a BTK inhibitor, in patients with CSU whose symptoms were inadequately controlled by H1-antihistamines.
What did they find?
Chronic spontaneous urticaria (CSU), characterized by spontaneous eruptions of hives and angioedema, is classically treated with second-generation antihistamines and omalizumab, an anti-IgE antibody. However, many patients experience refractory symptoms and inadequate response to treatment. Bruton tyrosine kinase (BTK), expressed in mast cells, B cells, basophils, and macrophages, plays a role in IgE- and IgG-mediated signaling, providing a potential therapeutic target for CSU treatment. A 52-week phase 2 randomized clinical trial evaluated the efficacy of rilzabrutinib, a BTK inhibitor, in patients with CSU whose symptoms were inadequately controlled by H1-antihistamines.
What did they find?
- At 12 weeks, those on rilzabrutinib 1200 mg/day achieved improvements in itch and hives compared to placebo, as measured by the ISS7 (least squares [LS] mean difference = −3.44 [95% CI = −6.25 to −0.62]), UAS7 (LS mean difference = −6.75 [95% CI = −12.23 to −1.26]), and HSS7 (LS mean difference = −3.24 [95% CI = −6.08 to −0.39]).
- A rapid response to treatment was observed by week 4, with improvement in itch and hives, measured by UAS7 (LS mean difference = −6.60 [95% CI = −11.22 to −1.97]).
- At 12 weeks, biomarkers were reduced in patients receiving rilzabrutinib, including soluble Mas-related G protein–coupled receptor X2 (median difference = -22.8% [IQR =−57.7% to −6.4%]), IgG antithyroid peroxidase (median difference = -46.7% [IQR = −69.0% to −7.4%]), IgG anti-Fc-ε receptor 1 (median difference = -38.7% [IQR = −91.8% to 162.9%]), and interleukin-31 (median difference = -8.1% [IQR = −22.3% to 15.0%]).
- The most commonly reported adverse events were mild diarrhea and nausea.
Effect of finger socks on clinical cure in interdigital tinea pedis
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Got athlete’s foot? Try slapping on some gloves, but for your feet!
Tinea pedis, known as athlete’s foot, is a fungal dermatophyte infection predominantly affecting the interdigital spaces of the toes. Fungi tend to grow in moist, humid environments, and affected individuals often experience recurrences even after oral antifungal treatment. Finger socks, which separate the toes from one another, have been proposed as a potential curative therapeutic option for tinea pedis. In this non-blinded controlled study, patients were assigned to either wear finger socks in addition to receiving oral antifungal therapy or receive antifungal therapy alone for four weeks.
What did they find?
Main Takeaway: Wearing finger socks alongside oral antifungal therapy led to a significantly higher cure rate in patients with interdigital tinea pedis, suggesting this simple intervention may enhance treatment effectiveness and reduce recurrence.
Tinea pedis, known as athlete’s foot, is a fungal dermatophyte infection predominantly affecting the interdigital spaces of the toes. Fungi tend to grow in moist, humid environments, and affected individuals often experience recurrences even after oral antifungal treatment. Finger socks, which separate the toes from one another, have been proposed as a potential curative therapeutic option for tinea pedis. In this non-blinded controlled study, patients were assigned to either wear finger socks in addition to receiving oral antifungal therapy or receive antifungal therapy alone for four weeks.
What did they find?
- Of the 54 patients with confirmed interdigital tinea pedis on microscopy, 31 were assigned finger socks plus antifungal therapy, while 23 were assigned antifungal therapy alone.
- The most common organisms seen were Trichophyton rubrum and Candida parapsilosis.
- Complete cure rate was 74.2% in the finger socks group compared to 21.7% in the control group (P < 0.01).
Main Takeaway: Wearing finger socks alongside oral antifungal therapy led to a significantly higher cure rate in patients with interdigital tinea pedis, suggesting this simple intervention may enhance treatment effectiveness and reduce recurrence.
Can Demodex Mites be seen with UV-light aided dermoscopy?
Journal of Investigative Dermatology
Journal of Investigative Dermatology
Light up the Mites!
Demodex mite visualization plays an important role in diagnosing several skin conditions, including rosacea, perioral dermatitis, and pityriasis folliculorum. However, traditional identification using light microscopy can be technically challenging and time-consuming. This study explored the use of a dermatoscope combined with ultraviolet (UV) light at 365 nm as an alternative method to enhance visualization of Demodex mites.
Technique
A standardized skin biopsy containing scales, hair, and Demodex mites was examined under 365 nm UV light. This technique allowed for easier visualization of both Demodex folliculorum and Demodex brevis, as well as estimation of mite density.
Demodex mite visualization plays an important role in diagnosing several skin conditions, including rosacea, perioral dermatitis, and pityriasis folliculorum. However, traditional identification using light microscopy can be technically challenging and time-consuming. This study explored the use of a dermatoscope combined with ultraviolet (UV) light at 365 nm as an alternative method to enhance visualization of Demodex mites.
Technique
A standardized skin biopsy containing scales, hair, and Demodex mites was examined under 365 nm UV light. This technique allowed for easier visualization of both Demodex folliculorum and Demodex brevis, as well as estimation of mite density.
Fig 1. Demodex mites under dermoscopy UV light (356 nm) as indicated by the white arrows.
Main Takeaway: UV-enhanced dermoscopy at 365 nm may be a useful tool for improving Demodex detection and supporting the diagnosis of related skin disorders.
Main Takeaway: UV-enhanced dermoscopy at 365 nm may be a useful tool for improving Demodex detection and supporting the diagnosis of related skin disorders.
Skin of color patients with atopic dermatitis can report their experiences with xerosis and dyspigmentation with newly developed questionnaires
British Journal of Dermatology
British Journal of Dermatology
Spring is in the air, and so are new questionnaires for atopic dermatitis!
Atopic dermatitis (AD) is a chronic inflammatory disease that affects individuals of all skin tones, but disproportionately impacts those with skin of color (SOC). In patients with SOC, xerosis and dyspigmentation are common sequelae of AD, yet patient-reported outcome measures specific to these concerns have been lacking. To address this, researchers developed two questionnaires, X-AD, for xerosis, and D-AD, for dyspigmentation, incorporating expert input and assessing content validity through interviews with 15 patients with SOC.
What did they find?
Main Takeaway: The X-AD and D-AD questionnaires show promise as tools to capture patient-reported outcomes related to xerosis and dyspigmentation in patients with SOC who have AD, addressing a critical gap in individualized, skin tone-sensitive care.
Atopic dermatitis (AD) is a chronic inflammatory disease that affects individuals of all skin tones, but disproportionately impacts those with skin of color (SOC). In patients with SOC, xerosis and dyspigmentation are common sequelae of AD, yet patient-reported outcome measures specific to these concerns have been lacking. To address this, researchers developed two questionnaires, X-AD, for xerosis, and D-AD, for dyspigmentation, incorporating expert input and assessing content validity through interviews with 15 patients with SOC.
What did they find?
- All patients reported xerosis and associated itching, with universal agreement that xerosis was bothersome.
- 14 patients reported skin dyspigmentation, with 11 reporting hyperpigmentation and 8 hypopigmentation.
- All patients felt the questionnaire was relevant and comprehensive of their AD experience.
Main Takeaway: The X-AD and D-AD questionnaires show promise as tools to capture patient-reported outcomes related to xerosis and dyspigmentation in patients with SOC who have AD, addressing a critical gap in individualized, skin tone-sensitive care.
The impact of vitiligo is more than just skin deep!
Vitiligo is a chronic autoimmune condition characterized by the loss of melanocytes, resulting in well-demarcated, hypopigmented patches. It can significantly impact mental health and quality of life, especially in individuals with darker skin tones. More than half of vitiligo patients experience mental health comorbidities, particularly those with facial or hand involvement or greater body surface area affected. Despite this, the specific psychosocial burden in patients with skin of color (SOC) remains underexplored. To address this gap, the Global VALIANT survey analyzed responses from 3,541 vitiligo patients, comparing those with Fitzpatrick skin types IV–VI (darker skin) to types I–III (fairer skin).
What did they find?
Main Takeaway: This international survey highlights that vitiligo patients with skin of color experience significantly greater psychosocial burden and mental health impact. These findings underscore the urgent need for more inclusive, patient-centered care strategies that address the unique challenges faced by patients with SOC who have vitiligo.
Vitiligo is a chronic autoimmune condition characterized by the loss of melanocytes, resulting in well-demarcated, hypopigmented patches. It can significantly impact mental health and quality of life, especially in individuals with darker skin tones. More than half of vitiligo patients experience mental health comorbidities, particularly those with facial or hand involvement or greater body surface area affected. Despite this, the specific psychosocial burden in patients with skin of color (SOC) remains underexplored. To address this gap, the Global VALIANT survey analyzed responses from 3,541 vitiligo patients, comparing those with Fitzpatrick skin types IV–VI (darker skin) to types I–III (fairer skin).
What did they find?
- Patients with darker skin reported a higher median affected body surface area (6.6% vs 2.5%; P < 0.0001).
- Those with darker skin reported greater psychosocial burden, including higher Vitiligo Impact Patient scale scores (31.2 vs 24.5; P < 0.0001).
- Daily activities were more impacted in the darker skin group, including clothing choices (62.1% vs 50.5%) and beach/pool attendance (57.6% vs 46.6%).
- 51.8% of those with darker skin felt no one understood their condition (vs 42.9%), 48.7% felt less accepted (vs 37.3%), and 46.5% reported career impact (vs 38.7%).
- In those with darker skin, mental health conditions were more prevalent (73.4% vs 48.5%), and moderate-to-severe depression was more common (68.3% vs 45.8%; all P < 0.0001).
Main Takeaway: This international survey highlights that vitiligo patients with skin of color experience significantly greater psychosocial burden and mental health impact. These findings underscore the urgent need for more inclusive, patient-centered care strategies that address the unique challenges faced by patients with SOC who have vitiligo.
Is Macular Alopecia an under-recognized pattern of hair loss?
Pediatric Dermatology
Pediatric Dermatology
Spotting alopecia, right on target!
Alopecia areata (AA) is the most common form of non-scarring alopecia in children and presents in several known patterns: patchy, ophiasis, sisaipho, diffuse, and totalis. However, a distinct variant characterized by small, round macules less than 1 cm in diameter has not been formally described in current classifications. This retrospective single-center study describes and characterizes this underrecognized presentation, termed macular alopecia (MA), and identifies its unique demographic, clinical, and prognostic features.
What did they find?
Compared to typical patchy AA, macular alopecia was:
Alopecia areata (AA) is the most common form of non-scarring alopecia in children and presents in several known patterns: patchy, ophiasis, sisaipho, diffuse, and totalis. However, a distinct variant characterized by small, round macules less than 1 cm in diameter has not been formally described in current classifications. This retrospective single-center study describes and characterizes this underrecognized presentation, termed macular alopecia (MA), and identifies its unique demographic, clinical, and prognostic features.
What did they find?
Compared to typical patchy AA, macular alopecia was:
- More common in females (77%) and Hispanic/Latinx patients (62%) (P < 0.001)
- Diagnosed earlier (mean age 5.9 vs 8.7 years, P < 0.001)
- Characterized by smaller lesions (10.0 mm vs 30.0 mm, P < 0.001), often fewer in number (82% had ≤3 lesions, vs 55%, P < 0.001), and predominantly located on the parietal scalp (64% vs 45%, P < 0.001)
- More likely to resolve spontaneously (63% vs 20%, P < 0.001) and faster to recover (median 5.0 vs 8.0 months, P < 0.001)
- Less likely to recur (17% vs 37%, P < 0.001) and had longer time to recurrence (63.0 vs 17.0 months, P = 0.006)
Podcasts are a growing, accessible source of information on skin diseases for patients and healthcare providers. Dermatologists familiar with them can better guide patients to reliable content. This study analyzed the content and objectives of popular eczema and acne podcasts. In September 2023, the first three episodes of 25 English-language podcasts, identified from the top 50 search results for "acne" and "eczema" on major platforms, were reviewed for accuracy based on American Academy of Dermatology guidelines.
What did they find?
Main Takeaway: This study highlights the prevalence of misinformation about acne and eczema on popular podcasts, which may shape patient beliefs and treatment choices before clinical encounters. As a result, clinicians may need to spend more time addressing misconceptions and guiding patients toward evidence-based care and educational resources.
What did they find?
- All (100%) of the evaluated podcasts were intended to provide educational content to listeners.
- Most acne and eczema podcasts (84%) featured personal anecdotes, with many hosted by non-medical professionals such as patients, "health coaches," or organizations, while only a minority featured dermatologists.
- Misinformation was present in 56% of the podcasts, and 32% promoted advice contrary to dermatologic standards.
- Content in only 7 out of 25 total podcasts, all featuring dermatologists, aligned with AAD treatment guidelines.
Main Takeaway: This study highlights the prevalence of misinformation about acne and eczema on popular podcasts, which may shape patient beliefs and treatment choices before clinical encounters. As a result, clinicians may need to spend more time addressing misconceptions and guiding patients toward evidence-based care and educational resources.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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