Ninety-third issue
september 3, 2025
Biopharmaceutical switching in psoriasis treatment: A systematic review and meta-analysis
JAMA Dermatology
JAMA Dermatology
Biologic switch, better itch fix.
Psoriasis (PSO) is a chronic, inflammatory skin condition characterized by sharply demarcated erythematous plaques, seen most often on the scalp, elbows, and knees. For many patients, disease burden extends beyond what can be managed with topical agents, necessitating oral or injectable biologic therapy. This systematic review and meta-analysis included 24 randomized clinical trials (RCTs) of adult plaque psoriasis patients involving crossover or switching of biologic agents.
What did they find?
Main Takeaway: Interclass biologic switching provided faster short-term improvements and more stable long-term control in plaque psoriasis, suggesting clinicians may consider switching to optimize efficacy, manage costs, and limit adverse effects.
Psoriasis (PSO) is a chronic, inflammatory skin condition characterized by sharply demarcated erythematous plaques, seen most often on the scalp, elbows, and knees. For many patients, disease burden extends beyond what can be managed with topical agents, necessitating oral or injectable biologic therapy. This systematic review and meta-analysis included 24 randomized clinical trials (RCTs) of adult plaque psoriasis patients involving crossover or switching of biologic agents.
What did they find?
- Switching from anti-TNFɑ or anti-IL-12/23 to anti-IL-17 or anti-IL-23 led to marked improvements in skin clearance, both quickly and long-term (PASI 90: OR 6.53 at week 4; OR 28.61 long-term; PASI 100: OR 3.97 short-term; OR 18.76 long-term).
- Safety outcomes were comparable between switching and continuing the same therapy, with no significant overall difference in adverse events (OR 1.63; 95% CI, 0.72–3.69).
- Slightly higher infection and nasopharyngitis rates occurred when switching specifically from anti-TNFɑ to newer classes (0.62%, 0.54%, 0.49%).
Main Takeaway: Interclass biologic switching provided faster short-term improvements and more stable long-term control in plaque psoriasis, suggesting clinicians may consider switching to optimize efficacy, manage costs, and limit adverse effects.
Biologic-specific skin cancer risk in inflammatory disease: Findings from a 1.8 million-patient cohort
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Not all biologics are sensational, which ones can take the heat?
Patients with inflammatory diseases like psoriasis, rheumatoid arthritis (RA), and inflammatory bowel disease (IBD) are at increased baseline risk for skin cancer due to chronic immune activity, independent of treatment. This retrospective cohort study examined 1.8 million patients in the TriNetX network (2004–2024) to compare rates of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma between those receiving biologic therapy and those who did not. Propensity score matching accounted for demographics, prior therapies, and disease-specific factors.
What did they find?
Main Takeaway: Skin cancer risk in inflammatory disease differs by biologic class. TNF inhibitors raise NMSC risk, while IL and JAK inhibitors show no increase and may be protective in select subgroups. These findings highlight the value of tailoring biologic choice for patients at high risk of skin cancer.
Patients with inflammatory diseases like psoriasis, rheumatoid arthritis (RA), and inflammatory bowel disease (IBD) are at increased baseline risk for skin cancer due to chronic immune activity, independent of treatment. This retrospective cohort study examined 1.8 million patients in the TriNetX network (2004–2024) to compare rates of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma between those receiving biologic therapy and those who did not. Propensity score matching accounted for demographics, prior therapies, and disease-specific factors.
What did they find?
- Biologic use modestly increased non-melanoma skin cancer (NMSC): BCC risk rose by 0.23% and SCC by 0.10% vs. controls (P < 0.0001 for both).
- Melanoma risk was not significantly higher (P = 0.0621).
- TNF inhibitors conferred the greatest risk: BCC up 0.32% (P < 0.0001) and SCC up 0.09% (P = 0.0042).
- IL-17, IL-23, and JAK inhibitors were not linked to increased risk and were even associated with reduced BCC incidence in RA (−0.23%, P < 0.0001) and IBD (−0.15%, P = 0.0035).
Main Takeaway: Skin cancer risk in inflammatory disease differs by biologic class. TNF inhibitors raise NMSC risk, while IL and JAK inhibitors show no increase and may be protective in select subgroups. These findings highlight the value of tailoring biologic choice for patients at high risk of skin cancer.
High sensitivity and specificity seen with dermoscopy-guided high-frequency ultrasound for detection of basal cell carcinoma lateral margins
British Journal of Dermatology
British Journal of Dermatology
Handy-dandy new tool to detect BCCs.
Mohs micrographic surgery remains the gold standard for basal cell carcinoma (BCC) in certain anatomical locations, but access can be limited. Dermoscopy-guided high-frequency ultrasound (DG-HFUS) combines dermoscopic and ultrasound imaging and may assist in surgical planning. This single-center prospective study evaluated the accuracy of DG-HFUS for mapping BCC lateral margins.
What did they find?
Main Takeaway: DG-HFUS offers high diagnostic accuracy for detecting BCC within 2 mm of surgical margins, supporting its role as a valuable tool in preoperative planning when Mohs surgery is limited or unavailable.
Mohs micrographic surgery remains the gold standard for basal cell carcinoma (BCC) in certain anatomical locations, but access can be limited. Dermoscopy-guided high-frequency ultrasound (DG-HFUS) combines dermoscopic and ultrasound imaging and may assist in surgical planning. This single-center prospective study evaluated the accuracy of DG-HFUS for mapping BCC lateral margins.
What did they find?
- 61 margins from 20 BCCs across 18 patients were analyzed.
- DG-HFUS demonstrated high efficacy in detecting BCCs at lateral margins within 2 mm:
- 94.4% sensitivity (95% confidence interval (CI) 72.7–99.9).
- 93% specificity (95% CI 80.9–98.5).
- Positive predictive value of 85% (95% CI 65.4–94.4).
- Negative predictive value of 97.6% (95% CI 85.6–99.6).
- Overall diagnostic accuracy of 93.4% (95% CI 84.1–98.2).
Main Takeaway: DG-HFUS offers high diagnostic accuracy for detecting BCC within 2 mm of surgical margins, supporting its role as a valuable tool in preoperative planning when Mohs surgery is limited or unavailable.
Bullous Pemphigoid Blisters Get a Bacterial Boost
Bullous pemphigoid (BP), the most common autoimmune blistering disorder of the elderly, results from loss of adhesion at the dermal-epidermal junction via BP180 cleavage. While aging increases baseline BP180 cleavage, the contribution of cutaneous microbes has been less clear. This study investigated whether Staphylococcus aureus strains from BP skin alter keratinocyte protease activity and generate distinct BP180 cleavage patterns.
What did they find?
Main Takeaway: S. aureus can amplify BP180 cleavage by stimulating keratinocyte protease activity and proinflammatory signaling, positioning the skin microbiome as an active driver of BP pathogenesis in aged skin. Targeting S. aureus colonization or virulence factors may represent a novel therapeutic strategy for BP.
Bullous pemphigoid (BP), the most common autoimmune blistering disorder of the elderly, results from loss of adhesion at the dermal-epidermal junction via BP180 cleavage. While aging increases baseline BP180 cleavage, the contribution of cutaneous microbes has been less clear. This study investigated whether Staphylococcus aureus strains from BP skin alter keratinocyte protease activity and generate distinct BP180 cleavage patterns.
What did they find?
- Aging keratinocytes showed higher cleaved/full-length BP180 ratios, suggesting increased antigen availability with age.
- S. aureus strains from BP patients induced unique BP180 cleavage products beyond baseline cleavage.
- These effects were linked to keratinocyte protease activation rather than direct bacterial proteases.
- S. aureus supernatants upregulated MMP9 and, when combined with type 2 cytokines (IL-4/IL-13), further enhanced protease activity and IL-33 expression, fueling type 2 inflammation.
- USA200 and USA300 lineages, commonly isolated from BP skin, were particularly potent in driving these effects.
Main Takeaway: S. aureus can amplify BP180 cleavage by stimulating keratinocyte protease activity and proinflammatory signaling, positioning the skin microbiome as an active driver of BP pathogenesis in aged skin. Targeting S. aureus colonization or virulence factors may represent a novel therapeutic strategy for BP.
Streamlined work-up and management of pediatric staphylococcal scalded skin syndrome
Pediatric Dermatology
Pediatric Dermatology
Turn down the heat on SSSS!
Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated desquamating skin disease caused by Staphylococcus aureus. It remains difficult to diagnose and manage in pediatric patients, particularly outside the neonatal period where presentation can be more variable. Despite its clinical importance, no prior systematic review has synthesized evidence on ancillary testing, antibiotic choice, fluid management, and skin care in this population. This systematic review of 48 studies aimed to address these gaps.
What did they find?
Main Takeaway: Evidence supports conservative management of pediatric SSSS with beta-lactam antibiotics, fluids, and emollients, while avoiding unnecessary laboratory testing and clindamycin use.
Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated desquamating skin disease caused by Staphylococcus aureus. It remains difficult to diagnose and manage in pediatric patients, particularly outside the neonatal period where presentation can be more variable. Despite its clinical importance, no prior systematic review has synthesized evidence on ancillary testing, antibiotic choice, fluid management, and skin care in this population. This systematic review of 48 studies aimed to address these gaps.
What did they find?
- Laboratory tests (CBC, chemistry panels, inflammatory markers) were non-specific and did not improve diagnostic accuracy (P > 0.05).
- Aerobic cultures from infection foci had high yield (>70%), while blood cultures were rarely positive (<5%, P < 0.01).
- Clindamycin provided no clinical benefit compared with other regimens (treatment failure rates similar, P = 0.78), supporting beta-lactams as preferred first-line therapy.
- Supportive care with IV fluids (when oral intake was inadequate) and bland emollients consistently improved comfort and recovery (symptom resolution in 7–10 days, P < 0.05).
Main Takeaway: Evidence supports conservative management of pediatric SSSS with beta-lactam antibiotics, fluids, and emollients, while avoiding unnecessary laboratory testing and clindamycin use.
Climate change can leave our skin feeling ~under the weather~
The skin functions as the body’s primary barrier against environmental insults, but climate change has introduced new stressors that threaten skin health. Chronic exposure to fine particles, UV radiation, and volatile compounds has been linked to aging, inflammation, and epigenetic changes, with ozone depletion and rising global temperatures amplifying these effects. This review of 132 studies synthesized current evidence on mechanisms of pollution-induced skin damage, protective strategies, and research priorities.
What did they find?
The skin functions as the body’s primary barrier against environmental insults, but climate change has introduced new stressors that threaten skin health. Chronic exposure to fine particles, UV radiation, and volatile compounds has been linked to aging, inflammation, and epigenetic changes, with ozone depletion and rising global temperatures amplifying these effects. This review of 132 studies synthesized current evidence on mechanisms of pollution-induced skin damage, protective strategies, and research priorities.
What did they find?
- Fine particulate matter (<2.5 μm) penetrates skin, driving oxidative stress, collagen breakdown, inflammation, and premature aging.
- Pollution alters gene expression via DNA methylation, histone acetylation, and microRNA dysregulation, accelerating aging and barrier dysfunction.
- Particulate matter and heavy metals disrupt the skin microbiome, promoting proinflammatory strains and increasing risk of acne, eczema, and rosacea.
- Endocrine-disrupting chemicals (e.g., phthalates, BPA) interfere with hormonal pathways, worsening acne, melasma, and seborrheic dermatitis.
- Climate change factors such as higher temperatures, increased UV, and greater humidity, further worsen inflammatory skin disease, infections, and aging.
Utilizing plicature and forced approximation for second intention healing in functional nail surgery
Innovations
Innovations
Nailed it! Skip the graft to heal it fast!
Surgical defects after functional nail surgery (FNS) for malignant nail tumors are often repaired with full-thickness skin grafting (FTSG), but this can result in delayed healing, need for a donor site, and postinflammatory hyperpigmentation. Second-intention healing (SIH) avoids grafting and yields better aesthetics, but longer re-epithelialization limits its use. Plicature and forced approximation (PFA) is a stitching technique that inverts and partially approximates wound borders, accelerating granulation and re-epithelialization. This prospective study evaluated outcomes of PFA following FNS, with ≥6 months of follow-up.
What did they find?
Surgical defects after functional nail surgery (FNS) for malignant nail tumors are often repaired with full-thickness skin grafting (FTSG), but this can result in delayed healing, need for a donor site, and postinflammatory hyperpigmentation. Second-intention healing (SIH) avoids grafting and yields better aesthetics, but longer re-epithelialization limits its use. Plicature and forced approximation (PFA) is a stitching technique that inverts and partially approximates wound borders, accelerating granulation and re-epithelialization. This prospective study evaluated outcomes of PFA following FNS, with ≥6 months of follow-up.
What did they find?
- 11 patients underwent FNS (10 with in situ melanoma, 1 with SCC).
- PFA technique: wound borders inverted with stitches; dressings changed at 72 hours, stitches removed at 2 weeks.
- Pain scores steadily declined: 5.0 at 7 days, 2.18 at 14 days, 0.54 at 30 days.
- Mean defect area: 6.84 ± 2.41 cm².
- Mean time to complete re-epithelialization (TCRep): 51 ± 12.87 days.
- Prior reports without PFA: TCRep 66.7–77 days, showing faster healing with PFA.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2025 - All Rights Reserved.
Copyright © 2025 - All Rights Reserved.