Ninety-seventh issue
OCTOBER 29, 2025
Hydrocolloid dressing vs petroleum ointment for scar appearance after dermatologic surgery: A randomized clinical trial
JAMA Dermatology
JAMA Dermatology
From slather to sticker: a new era in scar care!
Hydrocolloid dressings (HCDs) are occlusive, absorbent sheets that preserve a moist healing environment while remaining vapor-permeable. They are widely used for chronic wounds because they can accelerate epithelialization, support angiogenesis, and limit inflammation. Evidence in post-dermatologic excision care has been limited. This randomized clinical trial enrolled 146 patients after dermatologic surgery and compared HCDs with standard petroleum ointment for scar appearance, complications, and patient experience over 7, 30, and 90 days.
What did they find?
Hydrocolloid dressings (HCDs) are occlusive, absorbent sheets that preserve a moist healing environment while remaining vapor-permeable. They are widely used for chronic wounds because they can accelerate epithelialization, support angiogenesis, and limit inflammation. Evidence in post-dermatologic excision care has been limited. This randomized clinical trial enrolled 146 patients after dermatologic surgery and compared HCDs with standard petroleum ointment for scar appearance, complications, and patient experience over 7, 30, and 90 days.
What did they find?
- At 7 days, patients using HCDs rated scar appearance slightly higher than those using petroleum ointment (mean VAS 7.4 vs. 6.6; P = 0.02).
By 30 and 90 days, scar appearance ratings were statistically similar between groups (mean difference −0.08 and −0.09; P > 0.6). - Rates of complications were comparable, though minor bleeding and wound dehiscence were slightly higher in the hydrocolloid group (20.6% vs. 8.8% bleeding; 6.2% vs. 0% dehiscence).
- Patients found HCDs far more convenient and comfortable (86.9% vs. 46.8% “convenient”; 73.8% vs. 48.3% “comfortable”).
Disease severity assessment could be a new application of image-based artificial intelligence
British Journal of Dermatology
British Journal of Dermatology
AI in DSA is A-Okay!
Artificial intelligence (AI) is increasingly used for disease severity assessment (DSA) in atopic dermatitis (AD), psoriasis, and acne, but reported performance varies. This systematic review (45 studies) with meta-analysis (19 studies) evaluated image-based AI models for severity scoring across skin conditions.
What did they find?
Main Takeaway: Image-based AI shows high specificity and moderate to high sensitivity for DSA across conditions, performing best in AD. Higher-quality, standardized studies are needed to guide practical implementation in dermatology.
Artificial intelligence (AI) is increasingly used for disease severity assessment (DSA) in atopic dermatitis (AD), psoriasis, and acne, but reported performance varies. This systematic review (45 studies) with meta-analysis (19 studies) evaluated image-based AI models for severity scoring across skin conditions.
What did they find?
- Overall performance: Pooled sensitivity 80.5% (95% CI 76.2–84.2) and specificity 96.2% (95% CI 94.9–97.2).
- By condition: Sensitivity was highest in AD (P = 0.005), next in acne (P = 0.044), and lowest in psoriasis. Specificity was also highest in AD (P = 0.014).
- Scoring systems: Accuracy varied by metric and severity level. EASI showed higher accuracy than IGA (P < 0.001).
- Acne severity: Specificity was higher at the most severe grade (94.9%, 95% CI 91.5–97.0).
Main Takeaway: Image-based AI shows high specificity and moderate to high sensitivity for DSA across conditions, performing best in AD. Higher-quality, standardized studies are needed to guide practical implementation in dermatology.
Infantile hemangioma management in the beta-blocker era: A multicenter cohort study
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
You get timolol, you get propranolol… because watching and waiting is sooo 2003.
Infantile hemangiomas (IH) are the most common benign vascular tumors of infancy. Historically, many were observed for spontaneous involution. Since 2008, beta-blockers have transformed care. This retrospective cohort across three tertiary pediatric dermatology centers examined 1,701 IH patients from 2012 to 2016 to evaluate management patterns in the beta-blocker era.
What did they find?
Infantile hemangiomas (IH) are the most common benign vascular tumors of infancy. Historically, many were observed for spontaneous involution. Since 2008, beta-blockers have transformed care. This retrospective cohort across three tertiary pediatric dermatology centers examined 1,701 IH patients from 2012 to 2016 to evaluate management patterns in the beta-blocker era.
What did they find?
- Treatment rates nearly doubled: 68% received active treatment vs 38% in a comparable 2002 to 2003 cohort (P < 0.01).
- Primary indication: Risk of disfigurement drove most treatments (74%), followed by functional impairment (26.5%) and ulceration (17%).
- Therapy selection by risk: Systemic beta-blockers were used in higher-risk patients based on higher Hemangioma Severity Scores (median 11 vs 7 with topical therapy, P < 0.001) and AAP risk categories.
- Earlier treatment: Treated patients were younger at presentation (median 98 days vs 164 days observed, P < 0.0001).
- Most common agents: Topical timolol was used in 59.7%. Systemic beta-blockers such as propranolol, nadolol, or atenolol were used in 36.2%.
Genetics, stress, and scalp sensitivity predict premature hair graying in young women
Journal of Investigative Dermatology
Journal of Investigative Dermatology
Tracing silver strands back to their roots, the genetic ones.
Premature hair graying (PHG), defined as onset before age 30, can significantly affect self-esteem, yet the causes remain unclear in young women. This cross-sectional survey of 2,439 women under 30 in Shanghai examined lifestyle, genetic, and scalp factors linked to early graying.
What did they find?
Premature hair graying (PHG), defined as onset before age 30, can significantly affect self-esteem, yet the causes remain unclear in young women. This cross-sectional survey of 2,439 women under 30 in Shanghai examined lifestyle, genetic, and scalp factors linked to early graying.
What did they find?
- Prevalence: 36.7% reported PHG, higher than prior estimates in similar cohorts.
- Genetics: Family history strongly predicted PHG
- Paternal side OR 2.27
- Maternal side OR 2.11
- Both sides OR 2.74
- Scalp factors: Sensitive scalp associated with greater severity (OR 2.12); dandruff was more common in the PHG group.
- Hair loss disorders: Inversely associated with PHG severity (OR 0.66), possibly reflecting treatment effects.
- Lifestyle and stress: Higher income, smoking, alcohol cessation, and moderate to high stress were more frequent among women with PHG, consistent with oxidative stress pathways.
Hair’s to the future
Alopecia areata (AA) is an autoimmune hair loss disorder with substantial psychosocial impact in children. Systemic options for those younger than 12 are limited. This Phase 1, open-label pharmacokinetic study evaluated ritlecitinib (a JAK3/TEC inhibitor approved in adolescents and adults) to inform dosing and safety in children aged 6–12. Participants received 20 mg once daily for 7 days with plasma and urine sampling for exposure.
What did they find?
Alopecia areata (AA) is an autoimmune hair loss disorder with substantial psychosocial impact in children. Systemic options for those younger than 12 are limited. This Phase 1, open-label pharmacokinetic study evaluated ritlecitinib (a JAK3/TEC inhibitor approved in adolescents and adults) to inform dosing and safety in children aged 6–12. Participants received 20 mg once daily for 7 days with plasma and urine sampling for exposure.
What did they find?
- Participants: 15 enrolled, 93.3 percent completed treatment; 1 discontinuation due to mild urticaria.
- Pharmacokinetics: Median Tmax ≈ 0.5 h, mean t½ ≈ 1.19 h, geometric mean AUC₀–₂₄ = 437.5 ng·h/mL, Cmax = 208.7 ng/mL.
- Safety: 3 of 15 (20 percent) had mild to moderate AEs. No serious adverse events and no clinically significant laboratory or vital sign changes.
Rural skin-vestigations – shedding light on skin disease in rural South Africa
Skin diseases affect over 1.8 billion people worldwide and carry major physical, mental, and economic burdens. Data are especially sparse in low-income regions. This cross-sectional, community-based point prevalence study assessed skin disease prevalence in two rural villages in the Eastern Cape, South Africa, a region with high poverty and limited healthcare access.
What did they find?
Skin diseases affect over 1.8 billion people worldwide and carry major physical, mental, and economic burdens. Data are especially sparse in low-income regions. This cross-sectional, community-based point prevalence study assessed skin disease prevalence in two rural villages in the Eastern Cape, South Africa, a region with high poverty and limited healthcare access.
What did they find?
- Participants: 698 adults enrolled (56% female, mean age 37.4 years).
Socioeconomics: 75% of households earned < ZAR 3,000 per month (about $173 USD), with lower education, higher unemployment, and poorer water and sanitation access than the general population. - Prevalence: Point prevalence of any skin disease 62.9% (95% CI 59.3–66.5). 42.8% had one condition. 20.1% had two or more.
- Sex differences: Women 65.8% vs men 59.2%, and women had more comorbidities.
- Most common diagnoses: Acne 9.0%, xerosis 6.6%, tinea capitis 4.9%, melasma 4.3%, dermatosis papulosa nigra 3.9%.
- Age patterns: Younger participants were more affected by infectious conditions such as tinea, scabies, and acne. Older adults more often had dyspigmentation and alopecia. Xerosis was frequent across all ages.
Use of minimally invasive tunnel (MINT) procedure for treating hidradenitis suppurativa tunnels
Innovation/Scoop
Innovation/Scoop
Keeping HS in “MINT” Condition: New minimally invasive treatments
Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease characterized by painful nodules and tunnels in intertriginous sites. Biologics are standard therapy, yet persistent inflammation and microbial dysbiosis can blunt response, and tunnels signal more severe disease with frequent recurrence after deroofing or excision. The minimally invasive tunnel (MINT) procedure is a tissue-sparing, bedside approach designed to treat tunnels while also targeting the microbiota and inflammation.
MINT technique
Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease characterized by painful nodules and tunnels in intertriginous sites. Biologics are standard therapy, yet persistent inflammation and microbial dysbiosis can blunt response, and tunnels signal more severe disease with frequent recurrence after deroofing or excision. The minimally invasive tunnel (MINT) procedure is a tissue-sparing, bedside approach designed to treat tunnels while also targeting the microbiota and inflammation.
MINT technique
- Identify tunnels, infiltrate local anesthesia, make a 4 mm punch incision proximal to the tunnel.
- Probe the tract and instill an antimicrobial gel (benzalkonium chloride, polyethylene glycol, sodium citrate, citric acid) through a 16-gauge catheter attached to a 3 mL syringe.
- Patients continue daily antimicrobial gel and dressings until healed.
- Cohort: 15 adults at a single center, mostly Hurley stage 2 with mild to moderate HS-PGA scores.
- Tunnel resolution: 14 of 15 tunnels (93.3%) resolved within 4 weeks (mean 11.6 days) by ultrasound confirmation.
- Microbiome: Bacterial load decreased from 5.46 to 3.88 (P = 0.0337). Post-MINT composition resembled healthy axillary skin.
- Inflammation: TNF-α, IL-17, and IL-8 decreased, indicating downregulation of pathogen-induced cytokine signaling.
Hidradenitis suppurativa unroofing procedure costs in the context of medical inflation
Student Spotlight
Student Spotlight
Are costs for hidradenitis suppurativa unroofing procedures outpacing medical inflation?
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting ~1–2% of people in the United States and disproportionately impacting low-SES and disadvantaged populations. This retrospective claims analysis used 15 years of IBM MarketScan® Commercial Claims data to evaluate cost trends for HS unroofing procedures.
What did they find?
Main Takeaway: Unroofing costs for HS have risen substantially, and patient out-of-pocket spending increases alongside total costs. This likely worsens access disparities in already underserved populations and underscores the need for policy and reimbursement advocacy.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting ~1–2% of people in the United States and disproportionately impacting low-SES and disadvantaged populations. This retrospective claims analysis used 15 years of IBM MarketScan® Commercial Claims data to evaluate cost trends for HS unroofing procedures.
What did they find?
- 2005–2020 cost growth per claim: Inguinal +116%, perianal/umbilical +80.6%, axillary +56%.
- Positive correlation between patient out-of-pocket expenses and total cost per claim for CPT (Current Procedural Terminology) codes:
- CPT 55620 (vulva, perineum, introitus): r = 0.91 (95% CI 0.75–0.97)
- CPT 11462 (inguinal, simple or intermediate): r = 0.92 (95% CI 0.79–0.97)
- CPT 11450 (axillary, simple or intermediate): r = 0.89 (95% CI 0.70–0.96)
- Included CPT codes are not HS-specific and may capture procedures performed for other conditions.
Main Takeaway: Unroofing costs for HS have risen substantially, and patient out-of-pocket spending increases alongside total costs. This likely worsens access disparities in already underserved populations and underscores the need for policy and reimbursement advocacy.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.