A newsletter that delivers the latest in dermatology research directly to you.
Ninety-NINTH issue
November 26th, 2025
When scalp turns to systemic; how seborrheic keratosis reveals a broader barrier burden.
Seborrheic dermatitis (SD) causes scaly, flaky, and itchy patches that usually present on areas of the skin with many oil glands, such as the scalp and face. In addition to these symptoms, SD is associated with skin barrier dysfunction. Epithelial barrier disruption has been implicated in many epithelial barrier diseases (EBDs) involving the respiratory, gastrointestinal, and ocular systems. This retrospective cohort study of 20,274,189 patients explored the association between SD and EBDs.
What did they find?
Seborrheic dermatitis (SD) causes scaly, flaky, and itchy patches that usually present on areas of the skin with many oil glands, such as the scalp and face. In addition to these symptoms, SD is associated with skin barrier dysfunction. Epithelial barrier disruption has been implicated in many epithelial barrier diseases (EBDs) involving the respiratory, gastrointestinal, and ocular systems. This retrospective cohort study of 20,274,189 patients explored the association between SD and EBDs.
What did they find?
- Dermatologic conditions associated with SD: atopic dermatitis (OR 3.21), alopecia areata (OR 4.02), contact dermatitis (OR 2.25), psoriasis (OR 3.26), rosacea (OR 4.52), hidradenitis suppurativa (OR 1.63), chronic urticaria (OR 1.35), pemphigus vulgaris (OR 1.48), bullous pemphigoid (OR 1.60).
- EBDs associated with SD: rhinosinusitis (OR 1.24), celiac disease (OR 1.36), irritable bowel syndrome (IBS) (OR 1.32), ocular allergy (OR 1.39).
- Not associated with SD: chronic obstructive pulmonary disease (COPD) (OR 0.72) and pulmonary hypertension (OR 0.70).
RDEB has got to be kidney-ing me!
Recessive dystrophic epidermolysis bullosa (RDEB) is a rare collagen-deficiency genodermatosis causing severe blistering, scarring, and secondary infections. Renal involvement is not well defined beyond small case series. This longitudinal prospective study evaluated 120 patients with RDEB for kidney disease and its relationship to disease severity and survival.
What did they find?
Main Takeaway: Kidney disease is associated with higher disease severity and worse prognosis in RDEB. Routine surveillance for renal involvement and prompt nephrology co-management are recommended.
Recessive dystrophic epidermolysis bullosa (RDEB) is a rare collagen-deficiency genodermatosis causing severe blistering, scarring, and secondary infections. Renal involvement is not well defined beyond small case series. This longitudinal prospective study evaluated 120 patients with RDEB for kidney disease and its relationship to disease severity and survival.
What did they find?
- Prevalence of renal disease: 12.5% (15 of 120) had glomerular disease; 17.5% (21 of 120) had a tubulointerstitial presentation.
- Association with severity: Kidney disease correlated with greater RDEB severity (P = 0.002).
- Prognosis: Presence of kidney disease was linked to reduced overall survival (P = 0.0003).
Main Takeaway: Kidney disease is associated with higher disease severity and worse prognosis in RDEB. Routine surveillance for renal involvement and prompt nephrology co-management are recommended.
Prognostic impact of satelliteosis and in-transit metastases in cutaneous squamous cell carcinoma
JAAD
JAAD
Unmasking a rare threat in cutaneous SCC.
Cutaneous squamous cell carcinoma (cSCC) can rarely present with satellitosis or in-transit metastases (S-ITM), defined as tumor deposits between the primary site and draining lymph nodes. Although uncommon, S-ITM may indicate a high-risk course. This international retrospective cohort analyzed 8,901 cSCC patients across 12 institutions (1998-2023) to identify risk factors for S-ITM and its impact on outcomes.
What did they find?
Main Takeaway: S-ITM in cSCC is uncommon but a powerful, independent predictor of recurrence, metastasis, and disease-specific death. Findings support upstaging in future systems, early referral, close surveillance, and consideration of adjuvant therapy trials.
Cutaneous squamous cell carcinoma (cSCC) can rarely present with satellitosis or in-transit metastases (S-ITM), defined as tumor deposits between the primary site and draining lymph nodes. Although uncommon, S-ITM may indicate a high-risk course. This international retrospective cohort analyzed 8,901 cSCC patients across 12 institutions (1998-2023) to identify risk factors for S-ITM and its impact on outcomes.
What did they find?
- Rarity but high risk: 77 of 8,901 patients developed S-ITM (0.87%), and their outcomes were substantially worse.
- Risk factors for S-ITM: Older age (OR 1.03 per year), immunosuppression (OR 4.31), BWH T3 tumors (OR 30.27), and lymphovascular invasion (OR 4.57) (all P < 0.01).
- Adverse outcomes with S-ITM: Higher risks of local recurrence (subhazard ratio 2.40; P < 0.001), nodal spread (1.89; P = 0.04), distant spread (4.41; P = 0.01), and disease-specific death (4.48; P < 0.001).
- Five-year disease-specific death: 69% with S-ITM vs 18% in matched controls.
Main Takeaway: S-ITM in cSCC is uncommon but a powerful, independent predictor of recurrence, metastasis, and disease-specific death. Findings support upstaging in future systems, early referral, close surveillance, and consideration of adjuvant therapy trials.
Jak1 and done: Abrocitinib alone can clear GA
Granuloma annulare (GA) is a chronic inflammatory condition with no FDA-approved therapies and often years of refractory disease. Prior work suggests GA is driven by IFN-γ and other Jak1-dependent cytokines. This proof-of-concept trial tested whether selective Jak1 inhibition with abrocitinib could improve generalized GA over 6 months.
What did they find?
Granuloma annulare (GA) is a chronic inflammatory condition with no FDA-approved therapies and often years of refractory disease. Prior work suggests GA is driven by IFN-γ and other Jak1-dependent cytokines. This proof-of-concept trial tested whether selective Jak1 inhibition with abrocitinib could improve generalized GA over 6 months.
What did they find?
- All adherent participants improved: Of 10 enrolled, 6 tolerated abrocitinib 200 mg once daily and all 6 showed marked clinical responses.
- Disease burden fell sharply:
- BSA: 9.6% → 2.2% (P = 0.0005)
- GASMI: 32.7 → 7.0 (P = 0.0022)
- BSA: 9.6% → 2.2% (P = 0.0005)
- IGA normalized: All adherent participants reached IGA 0–1 (clear or almost clear) by 6 months.
- Quality of life improved: Skindex-16 scores decreased 56.3 → 3.14 (P < 0.0001).
Histology aligned with response: Post-treatment biopsies showed reduced inflammation and reversal of extracellular matrix changes. - Mechanism supported: Jak1-specific inhibition produced molecular effects similar to tofacitinib (Jak1/3>2), suggesting Jak1 blockade alone is sufficient.
Early MRI as a reliable seizure-screening tool in infants with upper-facial capillary malformations
Peds Derm
Peds Derm
See-zure the moment!
Upper facial capillary malformation (CM) can raise concern for Sturge-Weber syndrome (SWS), classically defined by CM, glaucoma, and seizures. While infants with suspected SWS need close monitoring, the role of screening MRI in asymptomatic infants is debated. Some recommend delaying MRI until 1-2 years because of possible false negatives before age 1, whereas others favor early MRI for parental reassurance and potential presymptomatic intervention. This retrospective study from the Boston Children’s Hospital Sturge-Weber Clinic (2012-2022) evaluated how well early, noncontrast 3T MRI predicts later seizures in 33 infants with forehead or temple CM and no prior seizures.
What did they find?
Main Takeaway: Early, high-quality noncontrast 3T MRI before age 1 shows excellent ability to potentially rule out future seizure development in infants with upper facial capillary malformations.
Upper facial capillary malformation (CM) can raise concern for Sturge-Weber syndrome (SWS), classically defined by CM, glaucoma, and seizures. While infants with suspected SWS need close monitoring, the role of screening MRI in asymptomatic infants is debated. Some recommend delaying MRI until 1-2 years because of possible false negatives before age 1, whereas others favor early MRI for parental reassurance and potential presymptomatic intervention. This retrospective study from the Boston Children’s Hospital Sturge-Weber Clinic (2012-2022) evaluated how well early, noncontrast 3T MRI predicts later seizures in 33 infants with forehead or temple CM and no prior seizures.
What did they find?
- 70% (14/20) of infants with abnormal early MRI later developed seizures, indicating a strong association between early MRI findings and seizure risk.
- 0% (0/11) of infants with a normal early MRI who later had repeat MRI developed seizures, suggesting excellent negative predictive value.
- 27% (3/11) of initially normal early MRIs showed new SWS-related abnormalities on repeat imaging, yet none of these infants developed seizures, reinforcing early MRI’s value for seizure prediction.
Main Takeaway: Early, high-quality noncontrast 3T MRI before age 1 shows excellent ability to potentially rule out future seizure development in infants with upper facial capillary malformations.
Publishing in dermatology isn’t a level playing field, some authors are ~stuck in the margins~
Low- and middle-income countries (LMICs) carry the highest burden of dermatologic disease, yet research funding historically skews toward high-income country priorities. When LMIC-affiliated authors publish in high-impact journals, they are often placed in less visible authorship positions. This bibliometric analysis evaluated LMIC authorship trends in six high-impact dermatology journals and assessed the scope of dermatology content in local and regional LMIC journals; areas with limited prior study.
What did they find?
Main Takeaway: LMIC authors are underrepresented in high-impact dermatology journals, with fewer lead and senior authorship roles. Increasing equitable representation would strengthen LMIC research capacity and broaden global coverage of region-relevant dermatologic topics.
Low- and middle-income countries (LMICs) carry the highest burden of dermatologic disease, yet research funding historically skews toward high-income country priorities. When LMIC-affiliated authors publish in high-impact journals, they are often placed in less visible authorship positions. This bibliometric analysis evaluated LMIC authorship trends in six high-impact dermatology journals and assessed the scope of dermatology content in local and regional LMIC journals; areas with limited prior study.
What did they find?
- Underrepresentation in high-impact journals: Only 12.2% (2,381/19,502) of full-text publications included LMIC-affiliated authors.
- Authorship position disparities: Low and lower-middle–income–affiliated authors were significantly less likely to be first or senior authors than those from high- and upper-middle–income countries (P < 0.001).
- Concentration of output: China, India, and Brazil accounted for most LMIC-affiliated publications.
- Robust local scholarship: In the WHO Global Index Medicus, there were 10,143 dermatology-related publications in LMIC-based journals over the same period, indicating vibrant research activity despite limited visibility on global platforms.
Main Takeaway: LMIC authors are underrepresented in high-impact dermatology journals, with fewer lead and senior authorship roles. Increasing equitable representation would strengthen LMIC research capacity and broaden global coverage of region-relevant dermatologic topics.
Utilizing punch excision for treatment of keloids with three distinct techniques
Innovations in Dermatology
Innovations in Dermatology
Keep the keloids away with a punch 3 ways
Keloids are benign fibroproliferative scars that extend beyond the original wound and often cause pain, pruritus, and psychosocial burden. Recurrence is common after monotherapies such as excision or steroids alone, which is why multimodal approaches are preferred. Punch excision has emerged as a quick, office-based, and tissue-sparing technique that cores the fibrotic nidus while allowing immediate intralesional corticosteroid delivery to suppress postoperative fibroblast activity. This systematic review examined the efficacy and safety of punch excision for keloid management across small clinical series.
What did they find?
Keloids are benign fibroproliferative scars that extend beyond the original wound and often cause pain, pruritus, and psychosocial burden. Recurrence is common after monotherapies such as excision or steroids alone, which is why multimodal approaches are preferred. Punch excision has emerged as a quick, office-based, and tissue-sparing technique that cores the fibrotic nidus while allowing immediate intralesional corticosteroid delivery to suppress postoperative fibroblast activity. This systematic review examined the efficacy and safety of punch excision for keloid management across small clinical series.
What did they find?
- 7 studies, 248 patients; all used punch excision plus intralesional corticosteroid across three technique variants.
- Drill technique (3 studies): VSS ↓ ~57%; in 2 studies POSAS ↓ ~61%; recurrence ~22% where reported.
- Side insertion (1 study): VSS ↓ ~83%; recurrence ~12.5%.
- Core excision (2 studies): 100% reached Physician’s Global Assessment = 1 and 95% had >50% size reduction; recurrence ~5%.
Figure 1: Schematic of 3 different punch excision techniques. A: Drill Technique, B: Side Insertion Technique, C: Core excision Technique
Main Takeaway: Punch excision with intralesional steroid appears effective and practical with low to modest recurrence, and core excision may offer the most favorable results. Higher quality comparative studies are needed to guide technique selection.
Main Takeaway: Punch excision with intralesional steroid appears effective and practical with low to modest recurrence, and core excision may offer the most favorable results. Higher quality comparative studies are needed to guide technique selection.
Can a probiotic-derived molecule from bacillus subtilis halt autoimmunity in vitiligo?
Student Spotlight
Student Spotlight
Vitiligo is an autoimmune disorder in which cytotoxic T cells destroy melanocytes, leading to depigmentation. Standard treatments (corticosteroids, phototherapy) are not universally effective and can have side effects. Emerging evidence links microbial imbalance to vitiligo pathogenesis. In this 18-week experiment, vitiligo-prone h3TA2 mice received weekly intraperitoneal Bacillus subtilis–derived exopolysaccharide (EPS) or control PBS to assess depigmentation and immune shifts in skin and spleen.
What did they find?
Main Takeaway: Bacillus subtilis–derived EPS mitigated T-cell–mediated depigmentation and induced a tolerogenic immune profile in a vitiligo mouse model, suggesting a potential microbiome-based adjunct or preventive strategy for vitiligo.
What did they find?
- Depigmentation reduced: EPS lowered dorsal depigmentation by 68% (P = 0.015) and ventral by 53% (P = 0.018) vs controls.
- Skin T-cell profile improved: CD8+ T cells ↓ 64% and regulatory T cells ↑ 70% (P < 0.006).
- Tolerogenic shift: EPS promoted a Th2 cytokine bias, doubled splenic M2 macrophages (P < 0.005), and increased IDO expression.
- Reduced autoimmune activation: Splenocytes from EPS-treated mice produced ~3× less IFN-γ after tyrosinase stimulation (P = 0.047).
Main Takeaway: Bacillus subtilis–derived EPS mitigated T-cell–mediated depigmentation and induced a tolerogenic immune profile in a vitiligo mouse model, suggesting a potential microbiome-based adjunct or preventive strategy for vitiligo.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.