One Hundred and Eleventh issue
may 27th, 2026
Isotretinoin treatment in adolescence and adult height
JAMA Dermatology
JAMA Dermatology
Turns out the only thing isotretinoin might shrink is your acne…not your future!
Concerns have long existed that isotretinoin could impair skeletal growth by causing premature epiphyseal closure in teenagers. To investigate, Danish researchers conducted a nationwide cross-sectional study linking military conscription height records to prescription data for 379,196 adolescents and young adults examined between 2001 and 2015, comparing adult heights across isotretinoin users, tetracycline users, topical acne users, and a no-acne-treatment reference group.
What did they find?
Concerns have long existed that isotretinoin could impair skeletal growth by causing premature epiphyseal closure in teenagers. To investigate, Danish researchers conducted a nationwide cross-sectional study linking military conscription height records to prescription data for 379,196 adolescents and young adults examined between 2001 and 2015, comparing adult heights across isotretinoin users, tetracycline users, topical acne users, and a no-acne-treatment reference group.
What did they find?
- No clinically meaningful reduction in adult height was associated with isotretinoin use (+0.31 cm in men and +0.25 cm in women vs controls).
- Even at higher cumulative doses (median ~5,000 mg in men), there was no evidence of increasing height reduction.
- Even among boys starting isotretinoin before age 13, height differences (−1.70 cm) remained well below the predefined clinically important threshold of 5 cm.
- Prevalence of stunting was 1.51% in isotretinoin users vs. 2.14% in the no-acne group, suggesting no adverse skeletal impact.
Turns out good antibiotic stewardship doesn’t stop with nail surgery
Nail surgery is commonly performed for diagnostic and therapeutic purposes. In the absence of standardized guidelines, perioperative management varies between providers. This study used a modified Delphi process, with 10 dermatologists from 9 different countries, to create recommendations for perioperative nail surgery care.
What did they find?
Limitations: Panel was small (n=10) and limited to dermatologists, which may restrict generalizability. The >70% threshold is accepted but arbitrary.
Main Takeaway: This first international Delphi consensus on perioperative nail surgery management helps standardize management and maintain safety.
Nail surgery is commonly performed for diagnostic and therapeutic purposes. In the absence of standardized guidelines, perioperative management varies between providers. This study used a modified Delphi process, with 10 dermatologists from 9 different countries, to create recommendations for perioperative nail surgery care.
What did they find?
- Routine antibiotic prophylaxis is not recommended and should be reserved for bone exposure, active infection, reoperation after infection, and high-risk patients (immunosuppressed, peripheral vascular disease, etc).
- Distal digital block was preferred as first-line anesthesia, and recommended strategies were slow infiltration at 1mL/min, 30-gauge needles, distraction techniques, and topical anesthetics.
- Antithrombotic agents should be continued, especially in patients at increased risk.
- Smoking was identified as the most important modifiable risk factor for delayed wound healing.
Limitations: Panel was small (n=10) and limited to dermatologists, which may restrict generalizability. The >70% threshold is accepted but arbitrary.
Main Takeaway: This first international Delphi consensus on perioperative nail surgery management helps standardize management and maintain safety.
Single-cell transcriptomics unveils metabolic and cellular dysregulation in striae gravidarum
British Journal of Dermatology
British Journal of Dermatology
Stretch marks? More like fibroblast marks.
While striae gravidarum (SG) affects up to 90% of pregnant women, fibroblast heterogeneity and metabolic dysregulation involved in its pathogenesis are poorly understood. Specimens from human SG lesions and matched normal skin were subject to integrated single-cell RNA sequencing (scRNA-seq) and single-nucleus RNA sequencing (snRNA-seq) to elucidate mechanisms of fibroblast subclustering, intercellular communication, and metabolic reprogramming.
What did they find?
Main takeaway: SG is driven by ACSBG1-mediated fatty acid metabolic reprogramming and a fibroblast differentiation blockade, repositioning SG as a fibro-inflammatory disorder and identifying ACSBG1 as a novel therapeutic target.
While striae gravidarum (SG) affects up to 90% of pregnant women, fibroblast heterogeneity and metabolic dysregulation involved in its pathogenesis are poorly understood. Specimens from human SG lesions and matched normal skin were subject to integrated single-cell RNA sequencing (scRNA-seq) and single-nucleus RNA sequencing (snRNA-seq) to elucidate mechanisms of fibroblast subclustering, intercellular communication, and metabolic reprogramming.
What did they find?
- Fibroblast subclustering revealed distinct subpopulations in SG lesional skin, with upregulation of ACSBG1, a long-chain fatty acid activation gene. A higher omega-6/omega-3 ratio was associated with increased SG risk (IVW OR = 2.85, 95% CI = 1.02 - 7.96, p = 0.046). These findings implicate fatty acid metabolic reprogramming in SG pathogenesis.
- Differentiation blockade was identified in SG fibroblasts, implicating disrupted fibroblast maturation in ECM homeostasis failure.
- Altered intercellular signaling networks were identified in SG, including dysregulated fibroblast-keratinocyte and fibroblast-immune cell crosstalk, consistent with a fibro-inflammatory disease mechanism.
- Functional validation using triacsin C (a broad-spectrum acyl-CoA synthetase inhibitor) and ACSBG1 silencing attenuated pro-fibrotic fibroblast behavior and omega-6/omega-3 ratio, supporting fatty acid metabolism as a potential therapeutic target.
Main takeaway: SG is driven by ACSBG1-mediated fatty acid metabolic reprogramming and a fibroblast differentiation blockade, repositioning SG as a fibro-inflammatory disorder and identifying ACSBG1 as a novel therapeutic target.
Acute hemorrhagic edema of infancy: a safe diagnosis or a diagnostic challenge? A 15 year retrospective analysis
Pediatric Dermatology
Pediatric Dermatology
A tale of two vasculitides…
Acute hemorrhagic edema of infancy (AHEI) is considered a benign, self-limiting leukocytoclastic vasculitis diagnosed clinically in young children. However, because AHEI can closely resemble more serious conditions such as IgA vasculitis (IgAV), clinicians face challenges balancing reassurance with the risk of missing systemic disease. This retrospective Dutch cohort study reviewed 89 children initially diagnosed with AHEI from 2007 to 2024, analyzing demographic and clinical features associated with later diagnostic revision, particularly to IgAV.
What did they find?
Acute hemorrhagic edema of infancy (AHEI) is considered a benign, self-limiting leukocytoclastic vasculitis diagnosed clinically in young children. However, because AHEI can closely resemble more serious conditions such as IgA vasculitis (IgAV), clinicians face challenges balancing reassurance with the risk of missing systemic disease. This retrospective Dutch cohort study reviewed 89 children initially diagnosed with AHEI from 2007 to 2024, analyzing demographic and clinical features associated with later diagnostic revision, particularly to IgAV.
What did they find?
- Among 89 children initially diagnosed with AHEI, nearly all appeared clinically well and presented with a skin rash.
- 22.5% had their diagnosis revised, most commonly to IgAV (n = 9); despite the benign nature of AHEI, nearly half underwent laboratory testing, and 1 in 5 was hospitalized, reflecting clinician diagnostic uncertainty.
- Patients whose diagnoses were revised to IgAV were older (p < 0.001), more likely to have a painful rash (p = 0.044), more likely to have a non-blanchable rash (p < 0.001), and had a higher complication rate (p < 0.001); notably, hematuria on urinalysis was exclusive to the IgAV group.
- The strongest predictor of revision to IgAV was older age (OR = 1.10, 95% CI = 1.04–1.15); all children diagnosed with IgAV were older than 12 months.
Comprehensive genomic profiling of acral melanoma: Insights from the AACR project GENIE database
Dermpath
Dermpath
She’s not like the other melanomas; she’s an acral melanoma!
Acral melanoma (AM) is a rare subtype of cutaneous melanoma that arises on hairless skin and disproportionately affects individuals with darker skin tones. Prognosis and survival rates of AM are lower than non-AM melanoma, likely due to delayed diagnosis and greater tumor thickness at presentation. This multi-site genomic analysis utilized clinical and genomic data from the AACR Project GENIE database to identify recurrent somatic mutations in AM to better understand its prognosis and potential therapeutic targets.
What did they find?
Main Takeaway: Compared to UV-driven cutaneous melanoma, the mutation pattern of AM has less frequent BRAF mutations but more NRAS involvement, which suggests that there might be an alternative activation mechanism for the MAPK pathway in AM, a signaling pathway that modulates in cell proliferation, differentiation, and survival.
Acral melanoma (AM) is a rare subtype of cutaneous melanoma that arises on hairless skin and disproportionately affects individuals with darker skin tones. Prognosis and survival rates of AM are lower than non-AM melanoma, likely due to delayed diagnosis and greater tumor thickness at presentation. This multi-site genomic analysis utilized clinical and genomic data from the AACR Project GENIE database to identify recurrent somatic mutations in AM to better understand its prognosis and potential therapeutic targets.
What did they find?
- NRAS mutations were the most prevalent somatic mutations (identified in 21.2% of cases in the cohort), followed by BRAF (18.3%), KIT (9%), and TERT (6.1%) mutations.
- Loss of heterozygosity affecting tumor suppressor genes CDKN2A and CDKN2B was found in 24.2% and 21.% of tumor samples, while amplification events were observed for several oncogenes, including CCND1 (19.1%), CDK4 (19.9%), and TERT (19.9%).
- There were distinct mutational differences across sex and racial groups; notably, PIK32C2G (n = 10; p = 0.002), KRAS (n = 16, p = 0.003), and RAD52 (n = 6; p = 0.03) mutations were exclusively found in males, PIK3CD (n = 3), SDHAF (n = 2), and EWSR1 (n = 1) were exclusively found in black patients, and NAV3 and CASP8 mutations were exclusively found within Asian patients (n = 1; p < 0.001).
- RAF1 mutations (p = 0.003) and LRP1B mutations (p = 0.026) were associated with reduced survival, while NRAS mutations (p = 0.048) were associated with improved overall survival (p = 0.048).
Main Takeaway: Compared to UV-driven cutaneous melanoma, the mutation pattern of AM has less frequent BRAF mutations but more NRAS involvement, which suggests that there might be an alternative activation mechanism for the MAPK pathway in AM, a signaling pathway that modulates in cell proliferation, differentiation, and survival.
Utilization of Mohs micrographic surgery for keratinocyte carcinomas among Medicare beneficiaries
Derm Surg
Derm Surg
Got a mole on your head or neck? Moh problem!
Keratinocyte carcinomas, including basal cell carcinoma and cutaneous squamous cell carcinoma, are the most common skin cancers treated in dermatologic surgery. Mohs micrographic surgery (MMS) is commonly used for high-risk tumors because it removes cancer while preserving healthy tissue and has high cure rates; however, its use for benign adnexal tumors of the skin (BATS) has also increased. This study systematically reviewed the clinical presentation and outcomes of BATS treated with MMS and analyzed demographic and clinical factors associated with MMS utilization.
What did they find?
Keratinocyte carcinomas, including basal cell carcinoma and cutaneous squamous cell carcinoma, are the most common skin cancers treated in dermatologic surgery. Mohs micrographic surgery (MMS) is commonly used for high-risk tumors because it removes cancer while preserving healthy tissue and has high cure rates; however, its use for benign adnexal tumors of the skin (BATS) has also increased. This study systematically reviewed the clinical presentation and outcomes of BATS treated with MMS and analyzed demographic and clinical factors associated with MMS utilization.
What did they find?
- Mohs micrographic surgery utilization is varied significantly based on anatomic location, with head and neck tumors representing ~90.6% of BATS to undergo MMS compared with truncal/extremity lesions (p < 0.001).
- Patients with tumors considered high risk based on size, recurrence, or histologic characteristics were more likely to undergo MMS.
- Utilization patterns differed across limited demographic characteristics reported in the included case reports, with a predominance of female patients (63.5%). No formal statistical analysis of disparities by race, socioeconomic status, or geographic region was performed.
- MMS use continued to increase overall during the study period, reflecting expanding adoption of tissue-sparing surgical approaches in dermatologic oncology.
Maybe she’s born with it, maybe it’s vitamins.
Diffuse hair thinning poses a significant quality-of-life burden, mainly caused by telogen effluvium. A combination of millet extract, vitamin B5, L-cystine, and vitamin B7 in vitro has demonstrated increased keratinocyte proliferation and enhanced rate of anagen hair development, making it a promising therapeutic for individuals struggling with diffuse hair loss. An open-label, multicenter study was conducted in France and Poland to evaluate the impact of this supplement on hair loss and density in patients with mild seasonal (non-chronic) hair loss.
What did they find?
Main Takeaway: A combination of millet extract, vitamin B5, L-cystine, and vitamin B7 has been shown to increase hair density and decrease telogen phase hairs in a small cohort of patients, underscoring the need for larger randomized trials in this area.
Diffuse hair thinning poses a significant quality-of-life burden, mainly caused by telogen effluvium. A combination of millet extract, vitamin B5, L-cystine, and vitamin B7 in vitro has demonstrated increased keratinocyte proliferation and enhanced rate of anagen hair development, making it a promising therapeutic for individuals struggling with diffuse hair loss. An open-label, multicenter study was conducted in France and Poland to evaluate the impact of this supplement on hair loss and density in patients with mild seasonal (non-chronic) hair loss.
What did they find?
- Total increased hair density at week 8 (p = 0.005) and week 12 (p < 0.001)
- Significant increase in anagen phase hairs at weeks 4, 8, and 12 (3%, 4%, 5%, respectively, p < 0.001).
- Significant decrease in telogen phase hairs at weeks 4, 8, and 12 (18%, 22%, 27%, respectively, p < 0.001).
- Improvement in the anagen/telogen growth ratio at weeks 4, 8, and 12 (43%, 55%, 73%, respectively, p < 0.001).
Main Takeaway: A combination of millet extract, vitamin B5, L-cystine, and vitamin B7 has been shown to increase hair density and decrease telogen phase hairs in a small cohort of patients, underscoring the need for larger randomized trials in this area.
An investigator-developed regimen for treatment and prevention of post-inflammatory hyperpigmentation in skin of color
Skin of Color (JDD)
Skin of Color (JDD)
A chemical peel day keeps the PIH at bay
Post-inflammatory hyperpigmentation (PIH) is a common pigmentary concern that is especially common in skin of color. It may take months to years to fade, contributing to self-esteem concerns and reduced quality of life. This 12-week prospective study evaluated a hydroquinone-free regimen for PIH in 10 patients with skin of color (Fitzpatrick IV-VI) using pigment-balancing peels plus a daily at-home skincare routine.
What did they find?
Main Takeaway: A hydroquinone-free regimen combining chemical peels with daily pigment-targeting skincare improved PIH, quality of life, and patient satisfaction in this small skin of color cohort. Larger randomized studies are needed, but these findings support continued exploration of safe and tolerable treatment options for PIH in darker skin tones.
Post-inflammatory hyperpigmentation (PIH) is a common pigmentary concern that is especially common in skin of color. It may take months to years to fade, contributing to self-esteem concerns and reduced quality of life. This 12-week prospective study evaluated a hydroquinone-free regimen for PIH in 10 patients with skin of color (Fitzpatrick IV-VI) using pigment-balancing peels plus a daily at-home skincare routine.
What did they find?
- Facial appearance satisfaction improved from 41.8 at baseline to 79.2 at week 12, (p < .001).
- Mean dermatology life quality index decreased from 6.5 to 0.7, with 70% of participants reporting no quality-of-life impact by the final visit.
- Psychological function scores increased from 64.6 to 94.6, while social function scores increased from 66.3 to 77.9.
- Patients reported high improvement in PIH, overall facial appearance, skin feel, and satisfaction with the regimen.
Main Takeaway: A hydroquinone-free regimen combining chemical peels with daily pigment-targeting skincare improved PIH, quality of life, and patient satisfaction in this small skin of color cohort. Larger randomized studies are needed, but these findings support continued exploration of safe and tolerable treatment options for PIH in darker skin tones.
Safety and accessibility of commercially available color-matching products for adolescents with vitiligo in the U.S.
Vitiligo affects up to 2% of the population and can lead to diminished well-being, particularly in adolescence, a time of identity formation and heightened sensitivity to peer approval. While some adolescents with vitiligo choose to use commercially available color-matching (camouflage) products, there is limited guidance for clinicians regarding the safety, cost, and accessibility of these products. A systematic review was conducted of commercially available color-matching products for vitiligo in the United States, evaluating product cost, ingredient lists, shade inclusivity, application instructions, and safety considerations, with a focus on adolescent use.
What did they find?
Main Takeaway: Color-matching products in the United States, which are predominantly marketed to women, vary widely in cost and ingredient composition, and some contain ingredients flagged for potential safety concerns, including talc (possible asbestiform fiber contamination), certain color additives (risk of aniline and heavy metal contamination), and parabens (potential endocrine disruption).
Vitiligo affects up to 2% of the population and can lead to diminished well-being, particularly in adolescence, a time of identity formation and heightened sensitivity to peer approval. While some adolescents with vitiligo choose to use commercially available color-matching (camouflage) products, there is limited guidance for clinicians regarding the safety, cost, and accessibility of these products. A systematic review was conducted of commercially available color-matching products for vitiligo in the United States, evaluating product cost, ingredient lists, shade inclusivity, application instructions, and safety considerations, with a focus on adolescent use.
What did they find?
- Among 17 U.S.-available color-matching products for vitiligo, 13 offered multiple shades with a mean of 23 colors (range: 10–68), while 4 relied on repeated applications of dihydroxyacetone to achieve different tones; average cost was $39.70/oz ($1.34/mL), ranging from $6.50/oz to $107.13/oz –a 1,548% price difference between the least and most expensive products.
- Application instructions varied widely, with only 10 products providing demonstration videos and full ingredient lists available for just 10 products. Commonly flagged ingredients included talc, certain color additives with contamination risk, and parabens.
Main Takeaway: Color-matching products in the United States, which are predominantly marketed to women, vary widely in cost and ingredient composition, and some contain ingredients flagged for potential safety concerns, including talc (possible asbestiform fiber contamination), certain color additives (risk of aniline and heavy metal contamination), and parabens (potential endocrine disruption).
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.
Copyright © 2025 - All Rights Reserved.