Ninety-Fourth issue
September 17, 2025
When you’ve got psoriasis clearance and cardiovascular reassurance.
Patients with psoriasis and related conditions have increased cardiometabolic risk. Because blocking the Th17/IL-17 pathway may influence plaque stability and trigger early major adverse cardiovascular events (MACEs), this national French case-time-control study examined whether starting IL-17(R)A inhibitors increases short-term MACE risk.
What did they find?
Patients with psoriasis and related conditions have increased cardiometabolic risk. Because blocking the Th17/IL-17 pathway may influence plaque stability and trigger early major adverse cardiovascular events (MACEs), this national French case-time-control study examined whether starting IL-17(R)A inhibitors increases short-term MACE risk.
What did they find?
- Among 34,241 individuals starting secukinumab, ixekizumab, or brodalumab, initiation was not significantly associated with MACEs: OR 1.25 (95% CI 0.75–2.08).
- TNF-α inhibitor initiation was likewise not associated: OR 0.90 (95% CI 0.65–1.24).
- When adjusted and directly compared with TNF-α inhibitors, IL-17(R)A inhibitors again showed no significant association: OR 1.40 (95% CI 0.77–2.54).
- Results were consistent across cardiovascular-risk strata.
Sensitivity analyses confirmed the findings: broader MACE definition (OR 0.97, 95% CI 0.60–1.59) and shortened risk period to 3 months (OR 1.36, 95% CI 0.60–3.10) did not alter results.
Efficacy, safety, and recurrence in seborrheic dermatitis: A dose-dependent analysis of oral isotretinoin
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Maximizing results, minimizing recurrence!
Seborrheic dermatitis (SD) is a chronic, relapsing skin condition where standard topical therapies often provide only transient relief and fail to offer long-term control in moderate-to-severe cases. Because of its sebo-suppressive and anti-inflammatory effects, low-dose oral isotretinoin has been investigated as a potential systemic treatment. This retrospective cohort study evaluated SD severity, recurrence, and patient satisfaction at two isotretinoin doses.
What did they find?
Seborrheic dermatitis (SD) is a chronic, relapsing skin condition where standard topical therapies often provide only transient relief and fail to offer long-term control in moderate-to-severe cases. Because of its sebo-suppressive and anti-inflammatory effects, low-dose oral isotretinoin has been investigated as a potential systemic treatment. This retrospective cohort study evaluated SD severity, recurrence, and patient satisfaction at two isotretinoin doses.
What did they find?
- 234 patients with SD were included: 126 received 10 mg daily and 108 received 20 mg daily.
- At 12 months, patients taking 20 mg achieved better disease control with significantly lower SDASI (median 3.0 vs. 7.5, P<0.001) and DLQI (median 2.0 vs. 5.0, P<0.001).
Recurrence-free probability was higher in the 20 mg group: 83.3% vs. 42.1% at 1 month, 60.2% vs. 22.2% at 3 months, and 36.1% vs. 14.3% at 12 months (P<0.001). - Multivariate regression confirmed 20 mg isotretinoin as protective against recurrence (OR 0.131, 95% CI 0.037–0.459, P=0.002).
- Patient satisfaction was higher with 20 mg at both 6 months (4.1 vs. 3.1, P<0.001) and 12 months (4.5 vs. 2.9, P<0.001).
- Adverse events were mild, with dose-related differences: more frequent dry lips (85.7%) and dry skin (75.4%) in the 10 mg group, and more frequent muscle-joint pain (40.7%) and epistaxis (40.7%) in the 20 mg group.
Breaking resistance: Intermittent chemotherapy re-sensitizes melanoma to immunotherapy
British Journal of Dermatology
British Journal of Dermatology
Turning resistance into response!
Patients with metastatic BRAF wild-type melanoma who show primary resistance to immune checkpoint inhibitors (ICIs) face a poor prognosis and limited treatment options. The PROMIT phase II multicenter trial tested whether two cycles of dacarbazine (DTIC) could “reset” the tumor microenvironment, enabling patients to respond to the same ICI regimen that previously failed.
What did they find?
Patients with metastatic BRAF wild-type melanoma who show primary resistance to immune checkpoint inhibitors (ICIs) face a poor prognosis and limited treatment options. The PROMIT phase II multicenter trial tested whether two cycles of dacarbazine (DTIC) could “reset” the tumor microenvironment, enabling patients to respond to the same ICI regimen that previously failed.
What did they find?
- 38 evaluable patients with primary ICI resistance were re-treated after DTIC.
- 18.4% achieved partial responses, and the disease control rate was 36.8%.
- Median overall survival was 16.2 months.
- Grade ≥3 adverse events occurred in 10.4% of patients, indicating a manageable safety profile.
- Quality of life showed modest declines in physical and role functioning, while global health and symptom scores remained stable.
Mites oh my!
Discoid lupus erythematosus (DLE) is a common subtype of chronic cutaneous lupus that most often affects the face, scalp, and neck. Demodex brevis are mites that reside in hair follicles and sebaceous glands. Recent evidence suggests a potential link between Demodex infestation and DLE pathogenesis. This retrospective study compared clinical and histologic parameters based on the presence or absence of Demodex infestation in 85 DLE patients.
What did they find?
Main Takeaway: Demodex infestation was more common in DLE patients with facial involvement, but showed no significant correlation with demographic or histopathologic parameters.
Discoid lupus erythematosus (DLE) is a common subtype of chronic cutaneous lupus that most often affects the face, scalp, and neck. Demodex brevis are mites that reside in hair follicles and sebaceous glands. Recent evidence suggests a potential link between Demodex infestation and DLE pathogenesis. This retrospective study compared clinical and histologic parameters based on the presence or absence of Demodex infestation in 85 DLE patients.
What did they find?
- DLE localization was most common on the face (51 patients, 60%), followed by the scalp (30 patients, 35.3%), and rarely the trunk or forearm (4 patients, 2.4% each).
- Demodex positivity was observed in 31 patients (36.5%), while 54 patients (63.5%) were Demodex negative.
- Demodex infestation was more common in facial lesions than scalp lesions (P=0.006, 47.1% vs. 16.7%).
- There were no significant associations between Demodex positivity and age, sex, or histopathologic features.
Main Takeaway: Demodex infestation was more common in DLE patients with facial involvement, but showed no significant correlation with demographic or histopathologic parameters.
Rethinking and restaging – how immunosuppression worsens progression
Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, and while usually curable, it can be deadly in high-risk cases. This prospective single-center study (2014–2021) assessed 1,400 invasive cSCC cases treated with Mohs micrographic surgery to determine whether immunosuppression independently predicts poor outcomes compared with traditional high-risk tumor features.
What did they find?
Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, and while usually curable, it can be deadly in high-risk cases. This prospective single-center study (2014–2021) assessed 1,400 invasive cSCC cases treated with Mohs micrographic surgery to determine whether immunosuppression independently predicts poor outcomes compared with traditional high-risk tumor features.
What did they find?
- 16.8% (n=156) of cSCC patients were immunosuppressed, and these patients had a significantly higher risk of poor outcomes (P<0.0001) compared to immunocompetent patients.
- Immunosuppression had an adjusted odds ratio (AOR) of 3.44 for predicting poor outcomes (P=0.011), outperforming size ≥2 cm (AOR 2.45; P=0.021), perineural invasion (AOR 2.81; P=0.54), and deep invasion (AOR 6.2; P=0.073).
- Immunosuppressed patients were more likely to present with advanced Brigham and Women’s Hospital T2b/T3 tumors (P<0.0001), which accounted for 73% of all poor outcomes.
- Immunosuppressed status was a stronger predictor of poor outcomes than size, PNI, or depth of invasion.
Axillary hyperpigmentation treatment: A systemic review of the literature
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
Targeting underarm pigmentation just got an evidence-based upgrade
Axillary hyperpigmentation (AH) is a common aesthetic and psychosocial concern, particularly in women with skin of color. No standardized treatment exists. This systematic review synthesized evidence from 10 studies evaluating topical therapies, light/laser modalities, and comparative approaches for AH to clarify efficacy and safety.
What did they find?
Axillary hyperpigmentation (AH) is a common aesthetic and psychosocial concern, particularly in women with skin of color. No standardized treatment exists. This systematic review synthesized evidence from 10 studies evaluating topical therapies, light/laser modalities, and comparative approaches for AH to clarify efficacy and safety.
What did they find?
- Ten studies were included: 6 topical, 3 light/laser, and 1 comparative; most participants were Fitzpatrick III–V.
- Desonide 0.05% and niacinamide 4% both outperformed placebo, with desonide showing the strongest depigmenting effect (P=0.002).
Cyperus rotundus oil (CREO) matched hydroquinone (HQ) in pigment reduction but caused no erythema or itching (vs 82%/48% with HQ). - Q-switched Nd:YAG and IPL significantly improved pigmentation, with IPL offering similar results but less pain.
IPL outperformed AHA in whitening (70% vs 35%) and smoothness (45% vs 5%) with fewer adverse effects.
When apremilast shows up and suddenly clobetasol isn’t looking so essential
There are currently no FDA-approved treatments for central centrifugal cicatricial alopecia (CCCA), a scarring alopecia that disproportionately affects Black women. Apremilast, an oral PDE-4 inhibitor, has shown promise in other inflammatory skin conditions. This open-label pilot study evaluated its use over 24 weeks in women with mild to moderate vertex-predominant CCCA.
What did they find?
Main Takeaway: Apremilast showed moderate clinical benefit in women with CCCA, particularly improving itch and perceived hair loss. While not a cure, it provides early evidence for a much-needed treatment option in scarring alopecia.
There are currently no FDA-approved treatments for central centrifugal cicatricial alopecia (CCCA), a scarring alopecia that disproportionately affects Black women. Apremilast, an oral PDE-4 inhibitor, has shown promise in other inflammatory skin conditions. This open-label pilot study evaluated its use over 24 weeks in women with mild to moderate vertex-predominant CCCA.
What did they find?
- 20 women of African ancestry were enrolled; 15 completed the full 24 weeks.
- Apremilast 30 mg twice daily led to a +0.24 improvement in physician global scores (P=0.04).
- Patients reported a +1.31 improvement in global assessment (P=0.01).
- Pruritus scores decreased by –2.31 on the numeric rating scale (P=0.00).
- Visual analog scores for hair loss improved by +1.85 (P=0.05).
Main Takeaway: Apremilast showed moderate clinical benefit in women with CCCA, particularly improving itch and perceived hair loss. While not a cure, it provides early evidence for a much-needed treatment option in scarring alopecia.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.
Copyright © 2025 - All Rights Reserved.