Acta Dermato-Venereologica is a well-established Open Access journal in the field of Dermatology and Venereology. With more than 100 years of experience and an impressive Impact Factor it is a trusted source for both readers and authors.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work. Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
Higher Doses of Oral Propranolol for Resistant Infantile Haemangio­mas
Propranolol at 3 mg/kg/day is considered the gold standard for treating infantile haemangiomas. Nevertheless, the management of propranolol-resistant infantile haemangiomas (PRIH) remains challenging. This national multicentre retrospective observational study includes all PRIHs who received propranolol > 3 mg/kg/day. The study aims to investigate the pattern of PRIHs, assess the effects and tolerance of a higher dose, and identify predictive factors for response to this increased dosage. Fifteen PRIHs were included (prevalence 0.45%), mainly females, and most presented with a large lesion. Three distinct patterns of PRIH were identified: facial segmental lesions (47%), facial localized lesions with a subcutaneous component (40%), and body-localized mixed and ulcerated lesions (13%). Six PRIH (40%) responded to the higher dose (from 3.75 to 4 mg/kg/day). Three predictive factors were significantly associated with a good response: IGIc-IH1 at the end of 3 mg/kg/day regimen (OR = 22.9, 95% CI [1.2–1844.1]), a duration of 3.5 months or more at 3 mg/kg/day (OR = 17.5, 95% CI [1.22–250.37]), and 7 months or more at > 3 mg/kg/day (OR = 17.5, 95% CI [1.22–250.37]). Tolerance was generally good, although one patient experienced severe hypotension during dose escalation. Propranolol doses higher than 3 mg/kg/day may therefore be considered a potential treatment option for PRIHs.
Copyright (c) 2026 Isabelle Dreyfus, Charlène Dénos, Olivia Boccara, Sébastien Barbarot, Véronique Gagey-Caron, Annabel Maruani, Juliette Miquel, Catherine Droitcourt, Michèle Bigorre, Ludovic Martin, Christine Leauté-Labrèze, Juliette Mazereeuw-Hautier https://creativecommons.org/licenses/by-nc/4.0
Assessing Targeted Proteomics in Inflammatory Skin Diseases with the Tape-stripping Method
This cross-sectional study aimed to determine the detectability of a panel of 92 inflammatory biomarkers in tape strips from the skin of patients with inflammatory skin diseases, and whether this depended on the number of tape strips taken. Furthermore, the biomarker levels in the patients were compared with those in healthy controls. Eight consecutive uniform tape strips (each 3.8 cm²) were obtained from 2 adjacent skin sites from 8 atopic dermatitis, contact dermatitis, and psoriasis patients, respectively, and 5 controls. Three separate analyses were carried out using the Olink® Target Inflammation panel: (i) all 8 tape strips (1–8) from 1 skin site and from the other skin site, (ii) the first 4 tape strips (1–4), and (iii) the next 4 tape strips (5–8). Biomarkers were above the detection limit for 65.7% of atopic dermatitis, 70.2% of psoriasis, and 45.1% of contact dermatitis samples. There were no significant differences in biomarker levels between the use of 4 or 8 tape strips, or between the first and last 4 tape strips. In general, atopic dermatitis and psoriasis patients were distinguishable from controls, whereas contact dermatitis patients were not. Based on the overall data quality, analysing protein signatures in tape strips with the targeted inflammatory panel is feasible.
Copyright (c) 2026 Anna Schultz Vinge, Sule Altintas, Niels Ødum, Jeanne Duus Johansen, Marianne Bengtson Løvendorf, Lone Skov https://creativecommons.org/licenses/by-nc/4.0
Autologous Patch Healing vs Secondary Intent Healing after Mohs Micrographic Surgery: A Randomized Controlled Trial
Secondary intent healing is a viable option for wound closure after facial tumour removal by Mohs micrographic surgery. Secondary intent healing involves prolonged healing time and carries risk of infection and complications related to scarring. Healing with an autologous patch made from the patient’s own blood may be beneficial. This study on 22 patients evaluates the effect of applying an autologous patch to the wound after Mohs micrographic surgery. A randomized controlled assessor-blinded trial was carried out. Patients had Mohs micrographic surgery on day 0 and clinical evaluation on day 12, day 19, and after 6 months. Transepidermal water loss was measured on day 12 and day 19. Reflectance confocal microscopy was applied exploratively. At 6 months’ follow-up the Patient and Observer Scar Assessment Scale was evaluated. Primary outcome was fully epithelialized wounds on day 19 and secondary outcome was 50% epithelialized wounds on day 12. One wound from each group was fully epithelialized and wound area reduction was higher in the patch group although not significant. Transepidermal water loss decreased to a larger extent, indicating that the patch creates a moist environment. Wound healing with an autologous patch is equivalent to secondary intent healing but may prompt benefits in certain wound healing factors. Patch healing appears safe with high patient satisfaction.
Copyright (c) 2026 Marie K. Hjorth, Ewa A. Burian, Tonny Karlsmark, Mette Mogensen, Martin Glud, Anna Ahm Harager, Anthony Rossi, Katrine E. Karmisholt https://creativecommons.org/licenses/by-nc/4.0
Increases in One-year Mortality Risk Among Chronic Skin Ulcer Patients During the Period 1980–2020
Chronic ulcer patients often suffer from multiple comorbidities and may even face increased risk of death. This study investigated short-term mortality of 5,230 ulcer patients treated in tertiary healthcare between 1980 and 2020, and their 15,594 matched references. Hazard risks (HR) for mortality were compared between patients with venous, arterial, mixed, vasculitic, and pyoderma gangrenosum ulcers (PG) and between 4 x 10-year study periods. One-year mortality risk was increased among all ulcer patients over the whole study period (HR 3.8), and it was highest among patients with vasculitic (HR 8.5), arterial (HR 7.0), and PG (HR 6.6) ulcers. During the 4 study decades the mortality HR of all ulcer patients increased from 2.3 to 4.9. However, among patients with vasculitic and PG ulcers, mortality risk decreased between the last decades observed. Among causes of death, highest 1-year HR for mortality from underlying causes of death was diabetes (HR 31.6), and of selected immediate causes of death, mortality from sepsis was notably increased (HR 22.1). In conclusion, patients with chronic ulcers were at almost fourfold increased risk of 1-year mortality and the risk increased over time. The study stresses the need for a multidisciplinary approach and effective treatment of underlying conditions.
Copyright (c) 2026 Jenni E. Salenius, Teea T. Salmi, Minna Suntila, Heini Huhtala, Teija Kimpimäki https://creativecommons.org/licenses/by/4.0
The Validity and Reliability of Patient-provided Photographs for Diagnosing and Assessing the Severity of Hand Eczema
Hand eczema (HE) is a common skin disease, diagnosed through clinical evaluation. However, the increasing need to deliver healthcare remotely, along with the demand for valid and reliable evaluations of HE in research, prompts exploration of the potential benefits of remote assessment. This study assessed the criterion validity and inter- and intra-rater reliability of patient-provided photographs to diagnose and assess the severity of HE. The presence and severity of HE were assessed by 1 of the 2 clinical raters. Following instructions, patients took 4 photographs of their hands. All photographs were assessed twice by the clinical raters and 2 additional raters. In total, 98 patients were included. The sensitivity, specificity, positive and negative predictive value were respectively 85.1%, 79.2%, 92.6%, and 63.3%. Kappa values of 0.35 and 0.66 were found for inter- and intra-rater reliability. The intraclass correlation coefficients based on the Hand Eczema Severity Index (HECSI) were > 0.90. Kappa values for the criterion validity and inter- and intra-rater reliability using the photographic guide were respectively 0.71, 0.58–0.77, and 0.77. The findings indicate that patient-provided photographs are valid and reliable for remote assessment of HE and could be of benefit in healthcare and research by reducing in-person visits and enabling continuous monitoring.
Copyright (c) 2026 Marjolein J. Brands, Elke Weisshaar, Klaziena Politiek, Manon M. Sloot, Ute Bültmann, Laura Loman, Marie L.A. Schuttelaar https://creativecommons.org/licenses/by-nc/4.0
The Role of the Cysteamine Dioxygenase (ADO) Gene in Atopic Dermatitis
Atopic dermatitis is a chronic inflammatory skin disorder influenced by genetic and environmental factors. A chromosome conformation capture study identified the cysteamine dioxygenase (ADO) gene as being associated with atopic dermatitis in differentiating keratinocytes. We aimed to evaluate the causal and pathophysiological roles of ADO in atopic dermatitis. This study utilized transcriptomic data and immunostaining techniques to analyse ADO expression. Human keratinocyte cell line (HaCat), and zebrafish models were employed to explore the functional role of ADO. RNA sequencing and immunostainings indicated higher ADO expression in lesional skin than in non-lesional skin in atopic dermatitis patients. Moreover, atopic dermatitis patients carrying the risk allele (C) exhibited increased levels of ADO in lesional skin. In vivo, zebrafish embryos with dysregulated ADO expression displayed impaired epidermal morphogenesis, particularly in their tails, along with increased neutrophil infiltration, indicating an inflammatory response. In vitro, alterations in ADO expression in HaCaT cells led to expression changes of proinflammatory cytokines and skin barrier markers. Further, both upregulation and downregulation of ADO were associated with enhanced reactive oxygen species production. These findings suggest that the ADO gene plays a critical role in maintaining skin homeostasis, and its dysregulation contributes to inflammation and compromised skin barrier function in the pathogenesis of atopic dermatitis.
Copyright (c) 2026 Sailan Wang, Raquel Vaz, Josefin Lysell, Jesper Eisfeldt, Pelin Sahlén, Samina Asad, Carl-Fredrik Wahlgren, Magnus Nordenskjöld, Maria Bradley, Isabel Tapia-Paez https://creativecommons.org/licenses/by/4.0
How Adequately is the Severity of Atopic Dermatitis Assessed by Resident Physicians Training in Dermatology? Evaluation of the Intrarater and Interrater Reliability of Clinical Scoring Systems (EASI, oSCORAD, IGA, TIS Score, SASSAD)
Various scoring systems for atopic dermatitis assess different aspects of the disease, but the supporting data on their validation and reliability are often limited. To ensure accurate interpretations, it is essential to conduct thorough reliability and agreement testing. This study aimed to evaluate the reliability and reproducibility of 5 atopic dermatitis assessment tools – Eczema Area and Severity Index (EASI), objective Scoring Atopic Dermatitis Index (oSCORAD), validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD), Three Item Severity (TIS) score, and Six-Area, Six-Sign Atopic Dermatitis (SASSAD) severity score – among trained dermatology residents. Thirteen patients were assessed twice by 11 raters using each scoring system. Intrarater and interrater reliability were evaluated. EASI demonstrated the highest interrater reliability (ICC = 0.768 and 0.796); SASSAD and oSCORAD followed closely (ICC = 0.741 and 0.772; ICC = 0.723 and 0.709, respectively). The TIS (ICC=0.553 and 0.584) and IGA (Kendall’s W=0.273 and 0.315) exhibited the lowest reliability. Given the generally higher reliability in this study compared with previous research, implementing standardized training on atopic dermatitis scoring systems early in the education of resident physicians may improve the reliability of these tools, equipping future dermatologists to perform effectively in clinical trials and drug programmes.
Copyright (c) 2026 Katarzyna Waligóra-Dziwak, Katarzyna B. Kubiak, Aleksandra Dańczak-Pazdrowska, Dorota Jenerowicz https://creativecommons.org/licenses/by-nc/4.0
Impact of Teledermoscopy on Melanoma Diagnosis and Triage Efficiency in Northern Sweden
The increasing incidence of cutaneous melanomas requires safe, efficient diagnostic methods to improve patient outcomes while optimizing healthcare resource utilization. Teledermoscopy was incorporated into clinical practice in 2014 in northern Sweden to improve diagnostic accuracy of cutaneous lesions and increase access to specialist dermatology care. This study aimed to evaluate whether teledermoscopy has led to earlier and more efficient diagnostics of cutaneous melanomas. Data on all excised pigmented cutaneous lesions from County Council of Västerbotten analysed at the Department of Clinical Pathology from 2010 to 2019 were collected. Before the introduction of teledermoscopy, the mean Breslow thickness was significantly higher (1.44 mm vs 1.08 mm, p=0.008), the proportion of Breslow ≤ 0.8 mm significantly lower (51.4% vs 70.6%, p< 0.001), and the mean Number Needed to Excise (23.32 vs 9.01, p< 0.001) significantly higher before the introduction of teledermoscopy. This indicates that teledermoscopy contributes to earlier and more efficient melanoma diagnosis.
Copyright (c) 2026 Antonia Lindfors, Virginia Zazo, Daniel Nosek, Per Hallberg, Zinaida Bucharbajeva, Nina Lycksell, Nirina Andersson https://creativecommons.org/licenses/by/4.0
Poor Outcome of Metastatic Cutaneous Squamous Cell Carcinoma: A Swedish Retrospective Study
The incidence of cutaneous squamous cell carcinoma is increasing rapidly, and 1.5–5% of cases develop metastatic disease, which is associated with a markedly worse prognosis. This study aimed to describe the characteristics of the primary tumour, the patients, and the metastases, as well as treatment and outcomes in patients with metastatic cutaneous squamous cell carcinoma. A total of 137 patients with a diagnosis of metastatic cutaneous squamous cell carcinoma within the Stockholm region during 2012–2020 were identified and included. Median age was 81; 79% were male; 70% had a WHO performance status of 0–1. 50% of the primary tumours were classified as high-risk tumours according to the Brigham and Women’s Hospital system. The median time between diagnosis of the primary tumour and the diagnosis of regional metastases was 7 months and 90% of the metastases were diagnosed within 2 years. Most patients were treated with a combination of surgery and radiotherapy. Overall survival at 2 years was 56%. This study shows that metastatic cutaneous squamous cell carcinoma occurs in elderly but otherwise generally healthy patients, that primary tumours with a high risk of causing metastases seem hard to identify, and that metastases occur within 2 years after primary tumour diagnosis. The patient group overall has a high mortality rate, particularly among those who do not undergo surgery.
Copyright (c) 2026 Charlotta L. Palmqvist, Mathias von Beckerath https://creativecommons.org/licenses/by/4.0
Atopic Dermatitis in Denmark: Regional Variation
Using national registers, this study investigates regional variations in the number of individuals with and treatment of atopic dermatitis (AD) in Denmark. AD, a prevalent chronic skin disorder, affects up to 20% of children and 3% of adults globally; yet its epidemiology in Denmark remains unclear. A recent study indicated a lifetime prevalence of 21% among school-aged children in Odense, a medium-sized city in Denmark, highlighting the long-lasting nature of the condition. With advancements in machine learning, researchers can now identify AD cases in both adults and children through healthcare utilization data. While Denmark’s single-payer system aims to provide equitable access to healthcare, factors such as decentralized administration and patient choice can lead to regional variations in the treatment setup. The study spans from 1995 to 2020, revealing an overall identification of 537,001 individuals with AD. Results demonstrate consistent regional variations, with the Central Denmark Region exhibiting the highest recorded rates over 11 out of 14 years. There are also notable differences in advanced treatment rates and hospital consultations among regions. Thus, regional variation was observed, and to reduce unwarranted regional variation it is important to minimize diagnostic uncertainty and provide
Copyright (c) 2026 Kristina Ibler, Ann Hærskjold, Jens Olsen, Lotte Themstrup, Maiken Dalager, Lone Skov, Charlotte G. Mørtz, Emilie Balk-Møller, Christian Vestergaard https://creativecommons.org/licenses/by-nc/4.0
COVID-19 Infection vs Vaccination and the Risk of New-onset Psoriasis
Emerging evidence has suggested a link between new-onset psoriasis and both COVID-19 infection and vaccination, though findings have been limited by small case numbers and lack of adequate control groups. This retrospective cohort study used electronic health records from the US Collaborative Network of TriNetX from January 2020 to January 2025 to compare the risk of developing new-onset psoriasis in individuals with confirmed COVID-19 infection and no vaccination history vs those vaccinated without prior infection. Propensity score matching was applied to balance demographics, comorbidities, and psoriasis risk factors. The primary outcome was a new diagnosis of psoriasis (ICD10-CM: L40.0–5) within 3 months following infection or vaccination. Subgroup analyses assessed the specific codes L40.0-5 separately. Kaplan–Meier survival analysis and Cox proportional hazards models were used to compare outcomes. Patients with COVID-19 infection had a significantly higher risk of developing psoriasis compared with vaccinated individuals (HR 1.30; 95% CI, 1.14–1.49; p < 0.001). Increased risks were also observed for psoriatic arthritis and pustulosis palmaris et plantaris. These findings suggest a potential triggering role of infection in psoriasis pathogenesis and support the safety profile of vaccination. Further studies are needed to confirm causality and guide clinical decision-making.
Copyright (c) 2026 Sophie L. Preuß, Henning Olbrich, Katja Bieber, Artem Vorobyev, Eva Lotta Moderegger, Khalaf Kridin, Henner Zirpel, Diamant Thaçi, Evelyn Gaffal, Ralf J. Ludwig, Philip Curman https://creativecommons.org/licenses/by/4.0
Serum Brain-derived Neurotrophic Factor, Stress Levels, and Quality of Life Among Leprosy Patients: A Cross-sectional Study
This study aimed to evaluate serum brain-derived neurotrophic factor levels, stress, and quality of life in leprosy patients, and to explore their interrelations. A cross-sectional study was conducted from September 2024 to May 2025 at 3 hospitals in Medan, Indonesia, involving 45 leprosy patients aged ≥ 18 years who met inclusion criteria. Serum brain-derived neurotrophic factor levels were measured using ELISA, stress was assessed using the Perceived Stress Scale-10, and quality of life was evaluated through the WHOQOL-BREF questionnaire. Descriptive statistics, Shapiro–Wilk normality test, and Spearman’s rank correlation were used for analysis. The mean serum brain-derived neurotrophic factor level was 7.38±3.37 ng/mL. Patients with multibacillary leprosy without reaction had higher brain-derived neurotrophic factor levels than those with type 1 or type 2 reactions. Stress levels were mild in 42.22% and severe in 28.89% of patients. Quality of life scores varied widely. A strong negative correlation was found between brain-derived neurotrophic factor and stress (r=–0.953, p< 0.0001), and a strong positive correlation between brain-derived neurotrophic factor and quality of life (r=0.962, p< 0.0001). These findings suggest that serum brain-derived neurotrophic factor levels are associated with psychological well-being in leprosy patients and may serve as a potential biomarker for mental health monitoring in this population.
Copyright (c) 2026 Nahrisyah, Ramona Dumasari Lubis, Riana Miranda Sinaga https://creativecommons.org/licenses/by-nc/4.0
Incidence and Mortality of Mycosis Fungoides and Sezary Syndrome: A Nationwide Registry Study in Finland
This study investigated the incidence, mortality, and causes of death in Finnish patients with mycosis fungoides (MF) or Sezary syndrome (SS). The study population consisted of 450 patients with MF and 23 with SS and their 1:1 matched controls. Data were collected from nationwide Finnish healthcare registries. The average incidence of MF was 0.38 and of SS 0.02 per 100,000 persons in 2007–2019 and was highest among older adults. Patients with SS had a low 5-year overall survival of 33.5% vs 64.5% in their controls (p = 0.0046), whereas 62.3% of patients with MF were alive 10 years after diagnosis vs 71.4% of their controls (p = 0.0011). SS diagnosis (hazard ratio [HR] 11.85 [5.08, 27.65]; p < 0.001) and higher age (HR 1.07 [1.01, 1.12]; p = 0.01) were risk factors of poorer disease-specific survival. Moreover, patients with MF had a 2.38-fold [1.07, 5.27] risk of thyroid diseases (p = 0.033) and over 1.5-fold [1.17, 2.07] risk of cardiovascular diseases (p = 0.002) compared with controls. In conclusion, in the Finnish population, patients with MF or SS had a higher incidence and mortality and more late comorbidities than controls. More awareness, earlier diagnostic tools, and more effective treat-ment for MF/SS are needed.
Copyright (c) 2026 Anu Partanen, Marjaana Häyrinen, Milla E.L. Kuusisto, Anna Anttalainen, Liisa Ukkola-Vuoti, Iiro Toppila, Hanne Kuitunen, Tatu Miettinen, Aino Rönkä, Outi Kuittinen https://creativecommons.org/licenses/by-nc/4.0
Increased Mortality in Patients with Bullous Pemphigoid: A Nationwide Population-based Cohort Study of 5,738 Patients in Sweden
Bullous pemphigoid (BP) is the most common autoimmune blistering disease and has been linked to increased mortality, although previous studies have generally relied on small populations and no data have been available specifically for the Swedish population. This study aimed to evaluate the 1- and 10-year mortality rates and all-cause mortality in Swedish patients with BP compared with the general population. Using the National Patient Register, we conducted a retrospective cohort study and identified all BP cases in Sweden from 1 January 2005, to 31 December 2016. Age, sex, and county of residence matched controls without BP were drawn from the general population, and mortality data were obtained from the Swedish Cause of Death Register. In total, 5,738 patients with BP and 17,167 controls were included. BP patients had a significantly higher all-cause mortality (HR 2.15, 95% CI 2.06–2.24) than controls, with 1- and 10-year mortality rates of 21.2% and 80.2%, respectively. Cardiovascular diseases accounted for the largest proportion of deaths (25.3%). Notably, improved survival was observed among BP patients treated with methotrexate (MTX), prednisolone, and potent topical corticosteroids (HR 0.76, 95% CI 0.69–0.83). To our knowledge, this is the first nationwide Swedish study on BP mortality and one of the largest to date, confirming a significantly increased mortality risk in BP patients, particularly due to cardiovascular causes, while also suggesting that combined MTX, prednisolone, and potent topical steroid treatment may improve survival outcomes.
Copyright (c) 2026 Zeyad Albadri, Henrike Häbel, Kristofer Thorslund, Carina Grönhagen, Oliver Seifert https://creativecommons.org/licenses/by/4.0
Patient Reported Outcomes in Multidisciplinary Care for High-risk Head and Neck Cutaneous Squamous Cell Carcinoma
Multidisciplinary care pathways may improve quality of care, yet little is known about patients’ perspectives regarding multidisciplinary treatment for high-risk head and neck cutaneous squamous cell carcinoma. This study examined health-related quality of life, decisional conflict, and satisfaction with care in 78 high-risk head and neck cutaneous squamous cell carcinoma patients undergoing multidisciplinary care. Pre-treatment, patients completed a baseline questionnaire, the EuroQoL-5D-5L, and the Decisional Conflict Scale. One month post-treatment, they completed the EuroQoL-5D-5L, Basal and Squamous Cell Carcinoma Quality of Life, and EORTC IN-PATSAT32 satisfaction questionnaires. Mean generic health-related quality of life scores were 0.76 pre-treatment and 0.81 post-treatment (p = 0.077), with minimal impact on disease-specific health-related quality of life (mean Basal and Squamous Cell Carcinoma Quality of Life scores ranging from 0.46 to 1.05). However, 73.7% of patients expressed worries about prognosis, and 12% of patients reported concerns regarding diagnosis and treatment substantially affecting health-related quality of life. The mean Decisional Conflict Scale total score was 26.61, with 19.2% of patients exceeding the clinically relevant threshold of 37.5, indicating decision delay or uncertainty regarding implementation. Approximately one-third of patients reported a need for better decision-making support. Overall, patients reported high satisfaction with care. In conclusion, while multidisciplinary care had minimal impact on health-related quality of life and resulted in high patient satisfaction, one-third of patients required more comprehensive information and value clarification.
Copyright (c) 2026 Emmy C. Cruts, Myrthe M.G. Moermans, Patty J. Nelemans, Lieke C.J. van Delft, Eric A. Dik, Satish F.K. Lubeek, Nicole W.J. Kelleners-Smeets, Klara Mosterd https://creativecommons.org/licenses/by-nc/4.0
Prevalence of Steatotic Liver Disease with Fibrosis and Diagnostic Screening Tools in Patients with Psoriasis
The prevalence of steatotic liver disease (SLD) with fibrosis in patients with psoriasis is unknown and no consensus on screening exists. Therefore, patients from The Copenhagen Translational Skin Immunology Biobank and Research Programme (BIOSKIN) were examined. SLD was defined as controlled attenuation parameter (CAP) > 250 dB/m and fibrosis as median liver stiffness measurement (LSM) ≥ 8 kPa using transient elastography. Biomarkers included fibrosis-4 index (FIB-4), N-terminal propeptide of collagen (type III), and enhanced liver fibrosis (ELF) test. A total of 403 patients (median age 51 years, 54% men, median BMI 27), 80% with moderate-to-severe psoriasis were enrolled. Based on the transient elastography, 40% of the patients had steatosis (mean CAP 245, ± 55 dB/m) and 5% had fibrosis (median LSM 4.8 kPa, IQR 3.8–5.8). According to self-reported alcohol consumption, all patients with steatosis except for 2 were categorized as having metabolic dysfunction-associated steatotic liver disease (MASLD). With transient elastography as the reference, FIB-4 and ELF had better diagnostic accuracy than PIIINP with Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.92 (95% confidence interval 0.87–0.97) for FIB-4, 0.90 (0.83–0.97) for ELF test, and 0.77 (0.66–0.87) for PIIINP.
Copyright (c) 2026 Charlotte Näslund-Koch, Marianne B. Løvendorf , Helene M. Martin, Mila B. Johansen, Morten B. Trelle, Claus Zachariae , Lise L. Gluud, Lone Skov https://creativecommons.org/licenses/by/4.0
Epidemiology and Comorbidity of Vitiligo in Germany: A Claims Data Analysis
Vitiligo is a chronic skin disease resulting in destruction of melanocytes and loss of pigmentation. Little is known about epidemiology and comorbidity in Germany. This retrospective cohort analysis used nationwide statutory health insurance data (2016 to 2020). Disease rates were calculated using varying case definitions. Comorbidity was assessed against 3 control groups: persons without vitiligo, with atopic dermatitis, and with psoriasis (1:3 propensity score matching). In 2020, 4,631 persons were diagnosed with vitiligo in DAK-Gesundheit (DAK-G, mean age 56.93 years, ~148,437) and 5,820 persons in the German Analysis Database for Evaluation and Health Services Research (~144,855). Prevalence ranged from 0.12% (confidence interval [CI] 0.12–0.12) to 0.20% (CI 0.19–0.20), and incidence from 0.04% (CI 0.03–0.04) to 0.06% (CI 0.06–0.06). Rates increased with age. Women (mean age 58.60 years) were more frequently affected. Vitiligo was associated with alopecia areata (relative risk 7.14, CI 4.63–11.00) and systemic sclerosis (relative risk 3.20, CI 1.58–6.47). Several mental illnesses (depression: relative risk = 1.23, CI 1.15–1.32, anxiety: relative risk = 1.32, CI 1.19–1.47), were linked to skin diseases like vitiligo, atopic dermatitis, or psoriasis. Vitiligo affects a notable proportion of the population, with detected comorbidities supporting prior findings. To ensure reliable results, claims data should be validated through primary data linkage or sensitivity testing.
Copyright (c) 2026 Theresa Klinger, Matthias Augustin, Susanne Baumeister, Jennifer Riedel, Claudia Grellmann, Anja Kamps, Markus Böhm, Kristina Hagenström https://creativecommons.org/licenses/by/4.0
Real-world Evidence of Self-reported Treatments, Signs, and Symptom Burden in Chronic Hand Eczema: Findings from the Multinational CHECK Study
Chronic hand eczema is a multifactorial disease that can impact quality of life considerably. This observational questionnaire study aimed to investigate real-world treatments and patients’ experiences of disease burden across the broad severity spectrum represent-ed by the general chronic hand eczema population. The study included 1,948 individuals from 6 countries (mean age 43.2 years; 64.5% females) with self-reported physician-diagnosed chronic hand eczema. Ongoing treatment was reported in 68.6%, which included systemics or phototherapy (with or without topicals; 10.7%), topical corticosteroids (with or without additional topicals; 36.0%) and other topical treatments (no topical corticosteroids; 21.8%). At survey time, 43.0% were in flare state. About half, 51.1%, reported moderate to severe disease signs (past week). Treatment with topical corticosteroids was suboptimal in 9.7% of those with moderate to severe disease. Experience of symptoms was common, particularly itch. Symptom burden differed significantly between groups with different treatments and severity levels; it was highest among those reporting systemics/phototherapy and those for whom topical corticosteroids were suboptimal. The results indicate that, despite a high treatment rate, chronic hand eczema is associated with a considerable disease burden that varies significantly across the severity spectrum. A particularly high burden in treatment stages beyond topical corticosteroids indicates a need for more effective management of symptoms.
Copyright (c) 2026 Sonja Molin, Maria Concetta Fargnoli, Marie Noelle Crepy, Ana Maria Giménez-Arnau, Lysel Brignoli, Perrine Le Calvé, Michal Krupka, Jenny M. Norlin, Christian Apfelbacher, Anthony Bewley https://creativecommons.org/licenses/by-nc/4.0
Risk Factors for Melanoma Survival: DGCR8 as a Predictive Factor for Mortality in Young Patients
MicroRNA-processing enzymes – Dicer and DGCR8 – have been found to be dysregulated in melanoma. This study investigated whether these microRNA-processing enzymes could be used as risk factors for mortality. A retrospective cohort including medical history and samples of 74 patients was reviewed. Clinical and pathological variables were compared with mortality. Percentage of immunoreactive tumour cells (%IRC) for each enzyme was evaluated using immunohistochemistry. A dichotomous breakdown of DGCR8 and Dicer expression (negative or positive test) was performed using a cut-off of 80% IRC. The 5-year survival rate of stage 0–I–II was 89.5% and stage III–IV was 18.5%. In the bivariate analysis, variables associated with lower survival were: aged over 42 years, histologic subtypes, Breslow thickness ≥ 0.8mm, ulceration, vascular invasion, metastatic melanoma, positive sentinel node, more than 1 positive node, LDH > 200 IU/L, distant metastasis, and stage III–IV. In the multivariate Cox model, the analysis for stage III–IV showed a significantly lower survival curve in patients with a positive DGCR8 test and aged ≤ 42 years (p = 0.0152, Wald test). The Cox proportional hazards model showed that a positive DGCR8 test was a predictive factor for mortality in patients aged ≤ 42 years (HR = 14.3, 95%CI 1.5–140, p = 0.024). This study highlights a potential biomarker for melanoma survival and its utility in stratifying high-risk patients.
Copyright (c) 2026 Fabiola Schafer, Enrique Bellolio, Tatiana Sepúlveda, Mirta Espinoza, Juan-Jose Orellana, Miguel Angel Villaseca, Rodrigo Miranda https://creativecommons.org/licenses/by-nc/4.0
Cutaneous Lymphoma Associated with JAK Inhibitors: A Pharmacovigilance Analysis of the FAERS Database and Literature Review
The increasing use of JAK inhibitors in clinical practice is raising concerns regarding the potential risk of cutaneous lymphoma. This study aimed to conduct a comprehensive search for cases of cutaneous lymphoma associated with JAK inhibitors in the Food and Drug Administration’s Adverse Event Reporting System. The clinical characteristics of cases from January 2004 to September 2023 were retrieved from the FAERS database. Disproportionality and Bayesian analyses were performed to detect signals for cutaneous lymphoma associated with JAK inhibitors. In total, 24 cases of cutaneous lymphoma were identified associated with JAK inhibitors, including tofacitinib, ruxolitinib, baricitinib, upadacitinib, and abrocitinib. The majority of patients (64%) were aged 60 or older, with no significant difference in incidence between genders. The average onset time was 8.64 months. One patient with ruxolitinib experienced a fatal outcome, and 1 patient with tofacitinib had a life-threatening event. Cutaneous lymphoma associated with baricitinib has the highest reporting odds ratio (23.91, 95% confidence interval 10.71–53.4), proportional reporting ratio (23.88, χ2 = 103.67), information component (4.57, IC025 = 2.05), and empirical Bayes geometric mean (23.73, EBGM05 = 12.12). The occurrence of cutaneous lymphoma associated with JAK inhibitors highlights the importance of pharmacovigilance studies to deepen our understanding of both the medications and associated conditions.
Copyright (c) 2026 Lu Lu, Jindi Feng, Huimin He, Yubin Peng, Shiyu Zhang, Lu Yang, Yuehua Liu, Tao Wang https://creativecommons.org/licenses/by-nc/4.0
Clinical and Pathological Characteristics of Skin Cancer Patients at Southern Medical University, Guangzhou, China
The incidence of skin cancer is increasing in China, yet large-scale clinical and pathological data from China remain scarce. A retrospective analysis was conducted of 648 histopathologically confirmed skin cancer cases diagnosed at the Dermatology Hospital, Southern Medical University from January 2020 to July 2023. Patient demographics, tumour distribution, histological subtypes, and treatment approaches were evaluated. Squamous cell carcinoma (31.9%) and basal cell carcinoma (31.2%) were the most prevalent, followed by cutaneous lymphomas (13.9%), dendritic cell and histiocytic neoplasms (13.3%), and melanoma (9.7%). Over half of the patients (53.5%) were aged ≥ 60 years. basal cell carcinoma and squamous cell carcinoma primarily involved the head and neck, while acral sites were dominant in melanoma (79.4%). Most cases of both basal cell carcinoma and squamous cell carcinoma were managed surgically, with surgical treatment performed in 95.5% of basal cell carcinomas and 94.2% of squamous cell carcinomas. Skin cancers in China predominantly affect older adults and commonly involve sun-exposed areas. Basal cell carcinoma is typically managed surgically due to its low-risk nature, while squamous cell carcinoma demonstrates clinical heterogeneity, warranting varied treatment strategies. The higher proportion of cutaneous lymphomas among younger patients highlights the need for age-specific diagnostic and therapeutic considerations.
Copyright (c) 2026 Siqi Li, Jingwen Zou, Rongyi Chen, Lian Zhang https://creativecommons.org/licenses/by-nc/4.0
Predicting Melanoma Impact on the Swedish Healthcare System from the Adult Population Using Machine Learning on Registry Data
Melanoma incidence has increased in Western countries over the past 50 years, leading to significant healthcare costs. In Sweden, comprehensive healthcare registries enable large-scale prediction studies using machine learning. Several machine learning models were evaluated to predict melanoma diagnoses using Swedish registry data, assessing the added value of diagnostic and medication data beyond demographics. The study included all adults in Sweden with continuous residency for 9.5 years (n = 6,036,186). The outcome was a melanoma diagnosis, including melanoma in situ, recorded within 5 years after the index date (31 December 2014). Predictors included age, sex, income, education, marital status, region of birth, diagnoses, and dispensed drugs. Models tested were logistic regression, gradient boosting, random forests, and a neural network. A total of 38,582 individuals (0.64%) developed melanoma. The gradient boosting model using all predictors performed best, with an area under the receiving operating characteristics curve (AUC) of 0.735 (95% confidence interval [CI], 0.725–0.746). When diagnosis and medication data were excluded, AUC dropped to 0.681 (95% CI: 0.670–0.691). The findings highlight that including healthcare codes improves predictive performance, and demonstrate the utility of Swedish registries for computational phenotyping. This approach may support early detection of melanoma and targeted follow-up.
Copyright (c) 2026 Martin Gillstedt, Lena Stempfle, John Paoli, Fredrik D. Johansson, Sam Polesie https://creativecommons.org/licenses/by/4.0
Economic Burden of Generalized Pustular Psoriasis: A Population-based Register Study in Finland
Generalized pustular psoriasis is an inflammatory disease characterized by potentially life-threatening flares. This study assessed the economic burden of generalized pustular psoriasis in Finland by comparing healthcare resource utilization and both direct and indirect costs to population-based and psoriasis vulgaris control groups and between generalized pustular psoriasis patients with and without flares. Patients with ≥ 2 generalized pustular psoriasis diagnoses (ICD-10: L40.1) at a dermatology clinic in secondary healthcare and matched controls were identified during 1996–2019 from national registers. Direct costs were based on primary and secondary healthcare resource utilization and medications, and indirect costs on productivity loss due to sick leaves, disability pensions, and rehabilitation periods. All-cause annual direct costs were 3-fold higher in generalized pustular psoriasis (mean: €10,323) compared with population-based (€3,345; p < 0.001), and psoriasis vulgaris controls (€3,569; p < 0.001). Having flares was associated with 2.7-fold higher direct costs compared with no flares (cost ratio 2.7; 95% CI, 2.1–3.5; p < 0.001), driven by higher hospitalization rates of patients with flares. Flares were also associated with 2.5-fold higher indirect costs (cost ratio 2.5; 95% CI, 1.6–4.0; p < 0.001) compared with no flares. This first comprehensive economic evaluation of generalized pustular psoriasis highlights the substantial economic impact, in particular in patients with flares, and emphasizes costs due to work disability.
Copyright (c) 2026 Xavier Teitsma, Laura Huilaja, Mirkka Koivusalo, Juha Mehtälä, Aino Vesikansa, Bregt Kappelhoff, Maria Grönman, Jarmo Kaukua, Pauliina Nuutinen, Rafael Pasternack https://creativecommons.org/licenses/by-nc/4.0
Molecular Classification in a Cohort of Occupational Dermatological Patients: Diagnostic Results and Course of Ability to Work and Sick Leave Over Two Years
Hand eczema is the most common occupational skin disease (OSD), often leading to sick leave or job termination. Standard diagnostic procedures are often ambiguous. Molecular classification has been described to improve differentiation between eczema and psoriasis, which is the most common differential diagnosis. Since 2020, a cohort of 287 patients with suspected, occupational hand and/or foot dermatoses (eczema or psoriasis) has been established in Germany. The current analysis focuses on descriptive results on the days of absence from work, occupational retention and legal recognition of OSD after 24 months. A total of 38.9% of the patients did not receive a distinct clinical diagnosis, while molecular diagnostics provided results in 93.1% of these cases. Sick leave days significantly decreased over 2 years (p<0.005) from a mean of 28.7 to 8.2 days. Legal recognition of OSD tripled from 10.1% to 30.2%. Job terminations due to skin diseases reached 27.1%, primarily from job changes or unemployment. Molecular diagnostics enhance diagnostic precision and may support improved prevention and disease management, reducing sick leave. The findings underscore the individual severity and social impact of skin diseases like eczema and psoriasis in high-risk employments.
Copyright (c) 2026 https://creativecommons.org/licenses/by-nc/4.0
Successful Treatment of Refractory Hailey-Hailey Disease with Narrow-Band Ultraviolet B Light: A Case Series
To evaluate the efficacy and safety of narrow-band ultraviolet B (NB-UVB) in treating refractory Hailey-Hailey Disease (HHD), four HHD patients (36–68 years old, disease duration 5–20 years) were included. NB-UVB was administered twice weekly, with initial doses 0.300–0.500 J/cm2; and 0.050 J/cm2; increments per session, and some patients received concurrent topical medications; follow-up lasted 1.5–3 months, with outcomes assessed via lesion body surface area (BSA) and Visual Analog Scale scores (disease severity, Refractory Visual Analog Scale, pruritus). Onset time was 0.25–4 months: 2 patients achieved complete lesion clearance, the other 2 had 60% and 87.5% BSA reduction, and the longest remission was 18 months; only 1 patient reported moderate irradiation-site pain, with no severe adverse events. NB-UVB shows satisfactory efficacy and good safety in refractory HHD and may serve as a viable treatment option.
Perioperative Pembrolizumab in Locally Advanced Melanoma: A Real-world Single-centre Retrospective Study
Perioperative immune-checkpoint inhibition (ICI) using pembrolizumab (3 doses of pembrolizumab 200 mg every 3 weeks before surgery and 15 doses afterwards) in advanced resectable melanoma has shown substantial pathological response rates and improved event-free survival (EFS) compared to postoperative (adjuvant) ICI. Real-world evidence on efficacy and safety of perioperative ICI in melanoma remains limited. In this retrospective single-centre study, 20 patients with resectable stage IIIB&#x2013;IV melanoma were treated with perioperative pembrolizumab. Radiological and pathological responses, early survival outcomes and treatment-related adverse events were analysed at a median follow-up of 13.9 months. Eighteen patients (18/20) underwent surgery. A pathological complete response was observed in 44% (8/18), while 56% (10/18) showed a pathological non-response. No patient (0/18) had a pathological partial response. One-year EFS was 66.5% (95% confidence interval (CI) 47.3–93.3), 1-year relapse-free survival 77.6% (95% CI 57.9–100) and 1-year overall survival 89.2% (95% CI 76.0–100, identical with 1-year melanoma-specific survival). Immune-related adverse events occurred in 50% of the patients (≥grade 3 in 15%). Our study confirms the feasibility of perioperative pembrolizumab in a real-world setting and shows promising efficacy and tolerability in melanoma. Pathological response may guide surgical and adjuvant strategies.
Knowledge Gaps on Skin Cancer and Sun Protection in Organ Transplant Recipients Under Long-term Immunosuppression
Organ transplant recipients (OTRs) face an elevated risk of skin cancer due to ultraviolet radiation (UVR) exposure and the need for chronic immunosuppression. Patient education is essential for early skin cancer detection and prevention. This cross-sectional study evaluated knowledge and attitudes regarding sun protection and skin cancer among 177 OTRs during their routine check-up at a specialized dermatologic outpatient clinic in a German University Hospital, using the validated Skin Cancer and Sun Knowledge (SCSK) scale. Demographic, clinical and transplant-related variables were analysed to identify factors associated with specific knowledge gaps. The mean SCSK score was 16.59 (standard deviation, SD±3.96). While most patients understood basic sun protection, key deficits were noted in their understanding of tanning risks, the meaning of sun protection factor (SPF) and symptoms of skin cancer. Heart transplant recipients (p=0.002) and those with immunosuppression >3 years (p=0.028) had significantly lower scores indicating inferior knowledge. Male sex and age <40 and >60 years were also associated with lower knowledge levels. Self-reported “well-informed” patients scored significantly higher (p=0.003). Despite specialized routine dermatologic care, knowledge gaps persist in high-risk subgroups of OTRs, highlighting the need for targeted, longitudinal education strategies in interdisciplinary transplant aftercare.
The Economic Burden of Alopecia Areata: Evidence from a Survey in Norway and Sweden
While international studies have assessed the economic burden of alopecia areata (AA), its societal costs have not been quantified in a Nordic context. We conducted a cross-sectional survey among adults with self-reported AA in Norway and Sweden, recruited via a patient organization and social media. A total of 329 respondents (263 from Norway, 66 from Sweden) provided information on demographics, disease characteristics, healthcare utilization, out-of-pocket expenses, productivity losses and treatment satisfaction. Costs were estimated from a societal perspective, combining direct medical, direct non-medical and indirect costs from reduced productivity. The annual mean total cost of AA was €7,677 in Norway and €12,582 in Sweden, with indirect costs (61–64% of the total) as the largest component, primarily driven by presenteeism and long-term sick leave. A notable finding is the significant out-of-pocket costs. In Norway, individuals paid about 65% of direct costs themselves, in Sweden about 50%. Dissatisfaction with treatment and healthcare support was widespread. Only a minority received systemic therapies, and treatment frequency with Janus kinase inhibitors was low, likely due to lack of reimbursement. AA imposes a considerable societal and individual economic burden in Norway and Sweden, underscoring the need for better therapies, healthcare support and policy recognition of its impact.
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
Body Modifications in Patients with Chronic Dermatoses: Associations with Body Dysmorphic Disorder and Illness Acceptance
Body modifications such as tattoos and piercings are increasingly popular, yet their psychological implications in dermatology patients remain understudied. This study examined the prevalence of body modifications, their association with body dysmorphic disorder (BDD) symptom tendencies and their relationship with illness acceptance. A cross-sectional survey was conducted among 333 consecutive dermatology outpatients in Wrocław, Poland. Participants provided demographic data, chronic skin disease status and information on tattoos and piercings. BDD symptoms were assessed with the Appearance Anxiety Inventory (AAI; score≥20 indicating high BDD risk), while the Acceptance of Illness Scale (AIS) measured psychological adaptation. Statistical analyses included t-tests, χ2 tests, ANOVA and Spearman’s correlation. Overall, 29.4% of participants reported body modifications – 20.7% tattoos and 15.9%piercings. BDD symptom tendencies were present in 15.9% of patients but were significantly more frequent among those with tattoos (26.1%) and piercings (34%). Individuals with body modifications were younger and more often female. AIS and AAI scores showed a significant negative correlation, suggesting that lower illness acceptance was linked to higher BDD symptomatology. Body modifications among dermatology patients are associated with increased risk of screening positive for BDD tendencies and reduced acceptance of illness. These findings emphasize the need for psychological screening in dermatological practice and training dermatologists to recognize and address underlying mental health concerns.
Catastrophizing in Chronic Itch: Associations with Demographic, Clinical and Psychological Factors
Catastrophizing, defined as an overly negative evaluation of one’s situation, is associated with worse disease outcomes in patients with chronic pain but remains unexplored in pruritus medicine. In this cross-sectional study, we included patients with chronic prurigo (CPG, n=50), chronic pruritus on nonlesional skin (CPNL, n=50) and chronic spontaneous urticaria (CSU, n=50) to investigate catastrophizing and determine possible associations with demographic and clinical factors. Patients completed validated questionnaires assessing catastrophizing (Itch-Cognition-Questionnaire), itch intensity, disease control, quality of life, anxiety, depression, stress and attention to itch. We recorded median [interquartile range] catastrophizing scores of 19.0 [11.0; 29.0] for CPG, 17.0 [11.8; 24.3] for CPNL and 10.0 [5.0; 18.3] for CSU patients. Catastrophizing correlated positively with itch intensity (r=0.382–0.678, p<0.001–0.006), quality of life impairment (r=0.554–0.716, p<0.001) and vigilance and awareness to itch (r=0.407–0.591, p<0.001–0.003) across patient groups. Linear regression analysis revealed a lower likelihood of catastrophizing in CSU patients (CSU: β=−5.905, p<0.001; CPG: reference), a positive association of catastrophizing with average itch intensity (β=1.119, p=0.008) and attention to itch (β=0.150, p<0.001), and a negative association with age (β=−0.095, p=0.004) and short disease duration (β=−5.797, p=0.049). Catastrophizing represents a pivotal cognitive process, which is associated with worse clinical outcomes in chronic itch patients.
Can Foot Dermatophyte Infections Signal Future Diabetes Risk? Findings from a Register-based Study
Dermatophyte infections are common in general practice and occur more often in individuals with type 2 diabetes (T2D), but whether they signal undiagnosed T2D remains unclear. We conducted a register-based cohort study including positive PCR tests for dermatophyte infection from the feet or nails, matched 1:3 to individuals from the same geographic area in Denmark. Those with known diabetes, type 1 diabetes or aged under 20 were excluded. Incidence rates (IRs) and incidence rate ratios (IRRs) for new-onset T2D were estimated using Poisson regression. The final cohort comprised 78,140 individuals, with a median age of 51 years, and 60.8% were male. The IR for T2D was 9.23 per 100 person-years in the exposed group and 9.00 in the unexposed group, with an adjusted IRR of 1.00 (0.91–1.11, p=0.94), indicating no significant association. In a sensitivity analysis excluding unexposed individuals with prior topical antifungal treatment, the IRR increased to 1.15 (1.08–1.23, p=0.001). While the primary analysis showed no significant association, the sensitivity analysis suggested a modest increased risk when exposure misclassification was reduced, supporting dermatophyte infection as a possible early signal of undiagnosed T2D in selected populations.
Copyright (c) 2026 Anne Sofie Frølunde, Jan Brink Valentin, Lise Kristensen, Pernille Kræmer Schachsen, Janus Laust Thomsen, Christian Vestergaard https://creativecommons.org/licenses/by-/4.0
Cutaneous Leishmaniasis in Patients under Biologic Therapies: A Spanish CLINI-AEDV Multicentre Study
Anti-TNFα agents have been associated with the reactivation of granulomatous infections, including leishmaniasis. Cases of atypical or recurrent cutaneous (CL) or mucocutaneous leishmaniasis (MCL) have been reported in patients on biologics. We conducted a retrospective analysis of a multicenter database to describe the clinical characteristics and management of CL and MCL in patients receiving biological therapy in an endemic area. Clinical features, diagnostics, therapies, and outcomes were analyzed. Seventy-one patients were included (63 CL and 8 MCL). The most common underlying condition was inflammatory bowel disease (33.8%). Lesions were multifocal in 40% and larger than 1 cm in 94.4%. Treatment failures were more frequent in MCL (50%) than CL (8.1%). Biologic therapy was discontinued in 53.5%, leading to worsening of the underlying disease in 44.7%. No significant difference in cure rates was observed between patients who continued vs. discontinued biologics (p=0.868). These findings highlight the clinical burden of CL and MCL in patients undergoing anti-TNFα therapy and suggest that discontinuation of biologic therapy did not significantly impact cure rates, emphasizing the need for standardized strategies balancing infection control and underlying inflammatory disease management.
Quality of Life and Economic Burden in Swedish Adults with Atopic Dermatitis: A Cross-sectional Survey of Patientreported Outcomes
Atopic dermatitis (AD) is a chronic skin disease associated with impaired quality of life. Evidence from Sweden on out-of-pocket expenses and productivity losses remains limited. This study assessed the burden of AD among adults in relation to health-related quality of life (HRQoL), work productivity, activity impairment, willingness to pay for symptom relief, economic outcomes, considering comorbid asthma, allergies, depression and anxiety. A cross-sectional survey was conducted between 2024 and 2025 among 220 members of the Swedish Asthma and Allergy Patient Association. Validated instruments included the Dermatology Life Quality Index (DLQI), EuroQol five-dimensions, five-levels instrument (EQ-5D-5L), Patient Benefit Index, and Work Productivity and Activity Impairment questionnaire. Descriptive and regression analyses were performed. Respondents (89.8% female; mean age 43 years) reported moderate HRQoL impairment (mean DLQI 10.1). DLQI and EQ-5D-5L were worse among those with allergic or non-atopic comorbidities but did not differ by asthma status. Mean annual out-of-pocket costs and productivity losses were €900 (95% CI: 401.1–1,758.4) and €1,972 (95% CI: 1,198.7–2,828.0), respectively. Itch intensity and activity impairment were associated with lower HRQoL and higher costs. AD is related to worsened work and activity functioning and high economic burden, suggesting the need for improved support and management strategies for affected adults.
Efficacy and Safety of Abrocitinib for Moderate-to-severe Atopic Dermatitis in Adults: A 52-week Real-world Multicentre StudyIL-AD (Italian Landscape Atopic Dermatitis)
Abrocitinib, an oral selective Janus kinase 1 inhibitor, is approved for the treatment of moderate-tosevere atopic dermatitis (AD) in adults, but realworld evidence remains limited. We retrospectively collected data from 187 adult patients (mean age:37.9 years; 60.4% male), with AD and up to oneyear exposure to abrocitinib either 100 or 200 mg, between 2023 and 2025 across 22 Italian dermatology centres. Nearly half of patients were bio-experienced and 80 % had difficult-to-treat areas. Beginning at week 8, with either 100 (59%) or 200 mg, 52 % achieved Investigator Global Assessment 0/1, significantly increasing to 88 % at week 52. Similarly, Eczema Area and Severity Index (EASI) and itch had significantly higher 1-year response: increasing from 27.8% and 34.7%, respectively, at week 8, 79.6 % achieved EASI-90 and 73.5% reached Peak Pruritus-Numerical Rating Scale 0/1. Minimal disease activity, a stringent composite endpoint, was met by 18 % at week 8 and by 66 % at week 52. Safety was good, with mild adverse events mostly including abdominal pain, upper respiratory infections and headache. The 100 mg dose had a significantly better safety profile, with efficacy similar to 200 mg. These data confirm the efficacy and safety of abrocitinib, with early, progressive clinical benefits sustained through 1 year.
Efficacy and Safety of Xeligekimab Compared to Other IL-17A Inhibitors for Chinese Patients with Moderate-to-severe Plaque Psoriasis: A Matching-adjusted Indirect Comparisons
Direct comparative evidence between IL-17A inhibitors for plaque psoriasis in Chinese populations remains limited. This study evaluated the comparative effectiveness of Xeligekimab vs Secukinumab and Ixekizumab through matchingadjusted indirect comparisons (MAICs). Individual patient data from the Xeligekimab trial (N=281) were weighted to match baseline characteristics from Chinese trials of Secukinumab (N=221) and Ixekizumab (N=176/92). Matching variables were determined following NICE and EUnetHTA MAIC guidelines, incorporating prognostic factors identified through multivariate regression. Primary endpoints included PASI 75/90/100 achievement at weeks 12, 52 and 60. At week 12, Secukinumab showed numerically higher PASI 75 (97.7% vs 93.0%, p=0.052) without statistical significance, while other endpoints were comparable (all p>0.05). At week 52, Xeligekimab showed significantly higher PASI 100 achievement (57.8% vs 42.1%, p=0.005) and DLQI 0/1 (68.8% vs 47.5%, p<0.001) vs Secukinumab. At week 60, Xeligekimab maintained significantly higher PASI 75 vs Ixekizumab (92.6% vs 76.1%, p<0.001) with lower infection rates during induction period (7.9% vs 34.7%, p<0.001) and maintenance period (22.4% vs 56.5%, p<0.001). This MAIC provides hypothesis-enerating evidence that Xeligekimab may offer advantages in specific long-term efficacy endpoints and safety outcomes, requiring confirmation in direct randomized controlled trials.
Sex Differences in Loss in Life Expectancy in Primary Cutaneous Melanoma, a Swedish Cohort Study
Sex differences in cutaneous melanoma (CM) survival are pronounced. It is unclear how these differences impact the loss in life expectancy (LLE). A population-based cohort from the Swedish Melanoma registry was used to analyze sex differences in life expectancy (LE) and LLE following a CM diagnosis. The cohort included 12 ,893 men and 12 ,572 women aged 40 years or above diagnosed with a first invasive CM in Sweden between 2000 and 2014. The average remaining LE at CM diagnosis was 15.45 years (95% CI 15.21, 15.7) for men and 20.14 years (95% CI 19.89, 20.43) for women, and the LLE was 2.95 years (95% CI 2.70, 3.19) and 2.4 years (95% CI 2.11, 2.67), respectively. If men had the same relative survival as women, the average LE for men would instead be 17.33 years (95% CI 17.03, 17.65) and the LLE 1.07 years (95% CI 1.07, 1.38). Men lose more years due to CM than women. Baseline age, stage or location are not sufficient to explain the sex differences.
Copyright (c) 2026 Anna Oksanen, Elisavet Syriopoulou, Kari Nielsen, Hanna Eriksson, Therese Andersson https://creativecommons.org/licenses/by/4.0
An Exploratory Study to Identify Factors Associated with Recurrence of Generalized Pustular Psoriasis Flares in Adult Patients in Japan
Generalized pustular psoriasis (GPP) is a rare, systemic inflammatory disease characterized by a heterogeneous and often unpredictable clinical course involving chronic symptoms and recurrent flares. Due to the rarity of GPP, our understanding of factors associated with flare recurrence remains unclear. Using an existing data set of adult patients with GPP in Japan, we performed univariate and multivariate analyses to investigate potential factors related to GPP flare recurrence, including patient demographics, treatment and severity of baseline flare. In total, 150 patients with a baseline flare were included in this analysis; 27.3% (n=41) experienced flare recurrence during the follow-up period (mean duration: 4.16 years). For the overall population, 56.0% of patients were male (n=84), the mean age at baseline was 55.5 years, and the mean body mass index was 24.3 kg/m2. Based on the Cox proportional hazards model, comorbid diabetes mellitus, a fever of ≥38.5°C at baseline flare, experience of flare(s) prior to baseline and certain respiratory infections were associated with a higher risk of flare recurrence, similar to previously published findings. These results could help identify patients at risk of GPP flares; however, clinically applicable prediction of GPP flares requires further research in a wider population.
Noninvasive Skin Surface Sampling Identifies Elevated IL-1β and IL-6 in Paediatric Atopic Dermatitis Patients
Despite extensive research, the molecular signature in atopic dermatitis (AD) remains underexplored. While previous studies have explored the expressions of pro-inflammatory markers in AD skin using biopsies and tape-stripping techniques, non-invasive sampling from the skin surface in pediatric<span id="cc2bf70c-07e9-481f-9a2b-b2478a86aa28" class="ins cts-1 jrnlLQCRefAlter" title="Inserted by Shanthipriya (COPYEDITOR) - 20/03/2026, 09:06 am" data-cid="1773977763720" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="8f640a4f-d3d4-478b-8c61-a6d8616ef6c3" data-time="1773977762863" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">paediatric AD patients has not been examined. This study aimed to identify and compare cytokine expression on the skin surface of children with AD and healthy controls. We enrolled 50 children, 40 with mild -to -moderate AD and 10 without AD as controls. Samples were collected using sticky bandages soaked in sterile phosphate-buffered saline, and concentrations of 15 cytokines were measured by a multiplex immunoassay. The effect of various factors on cytokine expression was assessed by redundancy analysis (RDA), while significance among groups was identified by factorial ANOVA. We found higher levels of IL-1β in non-lesional areas of AD patients compared to healthy subjects and increased expression of IL-1β and IL-6 in lesional areas compared to non-lesional skin. Factors such as skin folds and sex were found to affect cytokine secretion. This study demonstrates the feasibility of non-invasive cytokine sampling from the skin surface in pediatric<span id="823e74fb-66f2-43a4-a426-c4dab4a21e65" class="ins cts-1 jrnlLQCRefAlter" title="Inserted by Shanthipriya (COPYEDITOR) - 20/03/2026, 09:06 am" data-cid="1773977765410" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="4e79bd19-5d9f-49ca-a5a4-ae3cdbf17f87" data-time="1773977765208" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">paediatric AD patients. It underscores its potential for identifying additional biomarkers, complementing research on deeper skin layers.
Quality of Life in a Swedish Cohort of Patients with Mycosis Fungoides
Mycosis fungoides (MF) is a disease that evolves slowly over years with few options for curative treatment. Improving health-related quality of life (HRQoL) is therefore an important treatment goal. This study aims to contribute to a better understanding of HRQoL, using a dermatology-adapted HRQoL questionnaire, Dermatology Life Quality Index (DLQI), in patients with MF. Baseline data from a cohort study (BIO-MUSE) of patients with MF wasere used to investigate which aspect of DLQI is the most affected and how DLQI relates to different clinical and physiological parameters. Data from a period of 12 months were used to study how DLQI changes over time. The symptom domain, for example itching, was the aspect of the DLQI that had the greatest impact on HRQoL. Thymus and activation-regulated chemokine (TARC)/ chemokine (C-C) ligand 17 (CCL17) were analysed in blood and were shown to have a positive correlation with DLQI (r=0.482, <span id="e5fb7f2c-deba-4afc-8371-a9bf0c9f8475" class="jrnlPatterns" title="changed from 'P' to 'p'" data-cid="e5fb7f2c-deba-4afc-8371-a9bf0c9f8475" data-track-detail="" data-tag-desc="VAR,OPR,VAL,OPRS,VALS,UNT" data-tag-type="VAR" data-offset="937" data-match="P=0.043" data-replace="P" data-pattern="$1" data-tag-index="1_2" data-function="lowercase,addItalics" data-track-change="P" data-time="" data-username="" data-userid="">p=0.043). It was further shown that increased itching at baseline was a strong predictor of a worse DLQI score in the domain of symptoms (r=0.677, <span id="ae9f2d3c-e2d2-44b7-a976-e2e34ae41952" class="jrnlPatterns" title="changed from 'P' to 'p'" data-cid="ae9f2d3c-e2d2-44b7-a976-e2e34ae41952" data-track-detail="" data-tag-desc="VAR,OPR,VAL,OPRS,VALS,UNT" data-tag-type="VAR" data-offset="1085" data-match="P= 0.002" data-replace="P" data-pattern="$1" data-tag-index="1_4" data-function="lowercase,addItalics" data-track-change="P" data-time="" data-username="" data-userid="">p=0.002). Future research in a larger cohort is needed to investigate the effect of itch in HRQoLhealth-related quality of life in patients with MF.
Sun Protection Behaviours and Photosensitivity in Japanese Children: Toyama Adjunct Study of Japan Environment and Children’s Study (JECS)
Children have up to three3 times the annual sun exposure of adults. This cross-sectional study evaluated sun protection behavior<span id="80cb02c1-43df-4bff-8122-220a9e763511" class="ins cts-1 jrnlLQCRefAlter" title="Inserted by Shanthipriya (COPYEDITOR) - 15/04/2026, 05:47 am" data-cid="1776212273360" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="b08ea139-6e11-4d9a-9056-e0126aa7080f" data-time="1776212273184" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">behaviour, related factors<span id="ceb2da18-37e2-463d-acb5-58282e09f0ea" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 15/04/2026, 05:47 am" data-cid="1776212276890" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="f67e7d61-58e2-4cc3-acde-062449b641ca" data-time="1776212276450" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">, and the incidence of photosensitivity in Japanese children. A self-administered questionnaire administered to mothers of second2nd-grade children as part of the Toyama Adjunct Study of the Japan Environment and Children’s Study was used and analyzed<span id="a6b0e621-68c5-40fc-a9b4-360acea16b86" class="ins cts-1 jrnlLQCRefAlter" title="Inserted by Shanthipriya (COPYEDITOR) - 15/04/2026, 05:48 am" data-cid="1776212281136" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="1344fac3-6df2-4ffe-a3a0-a53629f3bd91" data-time="1776212281072" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">analysed (n=1,691). The results showed that 67.5 % of children always or sometimes used sunscreen when going out for a long time, while 73.2 % used at least one method of sun protection when swimming in an outdoor pool. Behaviors<span id="02351ec2-668d-4b90-8865-93de1094aa0f" class="ins cts-1 jrnlLQCRefAlter" title="Inserted by Shanthipriya (COPYEDITOR) - 15/04/2026, 05:48 am" data-cid="1776212285294" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="eeb8616c-b2c5-4846-837d-7e588ff69bdb" data-time="1776212284652" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">Behaviours related to sun exposure were related to the sex of the child, Fitzpatrick skin phototype, skin symptoms after sun exposure, annual household income, father’s highest educational level<span id="c01e36e3-b5a3-4aec-93dd-3c981bf95482" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 15/04/2026, 05:48 am" data-cid="1776212288324" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="31765b6b-2fe1-4932-877e-cd4683283b05" data-time="1776212287667" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">, and maternal age. The incidence of photosensitivity disorders was 0.5 %. Diagnoses included polymorphous light eruptions in 4 (50%) and solar urticaria in 2 (25%). However, 5.9 % of children had skin symptoms after sun exposure<span id="ea56113d-21ca-47aa-bd87-ef0cae4f96bb" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 15/04/2026, 05:48 am" data-cid="1776212290420" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="7b36780a-3ab6-47a9-956f-9e8b2ffad5db" data-time="1776212290214" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">, but were undiagnosed. In general, photosensitivity is rarely encountered in pediatric<span id="84e01250-2181-4135-8b27-b78c8c4d9daa" class="ins cts-1 jrnlLQCRefAlter" title="Inserted by Shanthipriya (COPYEDITOR) - 15/04/2026, 05:48 am" data-cid="1776212293720" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="5ac8e012-0cfe-49ed-96b9-eb848e7d9ec0" data-time="1776212292863" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">paediatric patients; in this study, we determined its prevalence in children in Japan. Six factors appeared to be relevant to behaviors<span id="2ab5cabf-d67f-48af-840e-4214fad3edaa" class="ins cts-1 jrnlLQCRefAlter" title="Inserted by Shanthipriya (COPYEDITOR) - 15/04/2026, 05:48 am" data-cid="1776212295933" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="9a9b468f-83ec-4940-9471-dd7d55ef01c3" data-time="1776212295470" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">behaviours related to sun exposure. Further investigation is required to confirm these findings.
Comparison of the Burden of Acne Vulgaris in China vs Globally: Insights from the Global Burden of Disease Study (2021) and Projections to 2050
Acne vulgaris (AV) poses a significant health challenge in China, adversely affecting patients’ quality of life and mental health. Updated evidence on acne burden in China integrating temporal trends, China–global comparisons, change-point patterns<span id="60a56497-1982-43ff-be3a-0ddc2e0387b3" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 15/04/2026, 06:44 am" data-cid="1776215663456" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="c1907cb1-8f41-4124-81e2-b791ed20106e" data-time="1776215663232" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">, and future projections remains limited. This study aimed to provide an updated assessment of AVacne vulgaris burden in China, including temporal trends and future projections, and to clarify its public health implications. Using data from the 2021 Global Burden of Disease (GBD) study, estimated annual percentage changes (EAPCs) for AVacne vulgaris were calculated for China and globally, while change-point patterns were assessed using joinpoint regression. An age–period–cohort (APC) analysis was subsequently performed, followed by Bayesian age-period-cohort (BAPC) projection of China’s AVacne vulgaris burden to 2050. From 1990 to 2021, the prevalence, incidence<span id="b9353eac-6e0c-4d91-8be7-149694c3415b" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 15/04/2026, 06:44 am" data-cid="1776215666134" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="79cc03b1-77ea-4ec5-bac8-0cd5df0a1788" data-time="1776215665569" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">, and disability-adjusted life years (DALYs) associated with AVacne vulgaris in China exhibited sustained increases, outpacing global rates. APCAge–period–cohort analysis revealed a peak incidence at ages 10–14 years. Overall, the main burden was concentrated in adolescence. BAPCBayesian age-period-cohort projections indicated that China’s AVacne vulgaris burden will continue to rise from 2022 to <span id="8115f40f-651c-4f67-831f-1452395b7192" class="jrnlPatterns" title="changed '2050' to '2050,'" data-cid="8115f40f-651c-4f67-831f-1452395b7192" data-track-detail="" data-tag-desc="VAL,RNGS,RNGC,RNGE,UNT" data-tag-type="THSE" data-offset="1224" data-match="2022 to 2050" data-replace="2050," data-pattern="default" data-tag-index="1_5" data-track-change="2050" data-time="" data-username="" data-userid="">2050,, with a disproportionately greater impact on females. These findings support prioritising evidence-based prevention, early recognition<span id="89cc0361-79eb-4d1f-a0f2-4f1132f11229" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 15/04/2026, 06:44 am" data-cid="1776215668752" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="64fe3da6-143d-440d-b06a-458fbfabb061" data-time="1776215667879" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">, and management strategies for adolescents and for females in China.
Cross-sectional Study of Dermatitis Herpetiformis with Focus on Neurological Comorbidities
Dermatitis herpetiformis (DH) is a chronic autoimmune blistering skin disease strongly associated with <span id="16dea301-cfcb-4269-8b29-5891ff482f9a" class="ins cts-1 jrnlLQCRefAlter" title="Inserted by Shanthipriya (COPYEDITOR) - 02/04/2026, 06:54 am" data-cid="1775093058398" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-rid="ae76e08a-83d4-4c5b-b9e1-247a9d7085fc" data-time="1775093058204" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb" data-track-detail="">coeliac disease. This cross-sectional study investigated the clinical, serological<span id="8e9fd771-7912-4360-9d73-78b27843e198" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 02/04/2026, 06:54 am" data-cid="1775093064816" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-rid="35041cbf-6d66-48e1-a9d1-c61b65ab2508" data-time="1775093063915" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb" data-track-detail="">, and neurological characteristics of 114 DH patients (70 males, 44 females; mean age: 50.2 years; 13 newly, 101 previously diagnosed) at Semmelweis University, Budapest, between 2020 and 2023. Diagnosis was confirmed by direct immunofluorescence microscopy. Serum autoantibodies against transglutaminase 2 (TG2), 3 (TG3)<span id="b2ffaa05-703c-4a6f-b122-3c92221f52cc" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 02/04/2026, 06:54 am" data-cid="1775093067644" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-rid="4970f510-906c-442c-b95d-d36c261cbfe3" data-time="1775093067326" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb" data-track-detail="">, and 6 (TG6) were quantified using immunoassays. While at the time of evaluation, 65.8% of patients adhered to a strict gluten-free diet (GFD), 34.2% followed an incomplete or no GFD. Autoantibodies against TG2 and TG3 were each detected in 24.6% of patients, while TG6 autoantibodies<span id="3ef671a7-194f-4589-aa38-a25c05e7d9c3" class="ins cts-1 jrnlLQCRefAlter" title="Inserted by Shanthipriya (COPYEDITOR) - 02/04/2026, 06:54 am" data-cid="1775093073328" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-rid="41f1c1dc-2ca5-4b0d-8b01-6b009d886ead" data-time="1775093073166" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb" data-track-detail=""> were detected in 53.5%. Neurological comorbidities were reported in 43.9%, with headache and radiculopathy being the most prevalent. Hashimoto’s thyroiditis was present in 19.3%, and <span id="c77883f2-6a12-4246-ac10-296ce508bc82" class="ins cts-1 jrnlLQCRefAlter" title="Inserted by Shanthipriya (COPYEDITOR) - 02/04/2026, 06:54 am" data-cid="1775093076858" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-rid="b33e38f5-eda5-4678-b891-6029ad6f70d3" data-time="1775093076432" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb" data-track-detail="">anaemia in 32.5% of patients. These findings, derived from a globally relevant patient cohort, underscore the systemic nature of DH and its strong association with transglutaminase autoimmunity, neurological and autoimmune comorbidities, emphasizing the need for early diagnosis, strict adherence to a GFD<span id="45b81705-bd1c-4f68-90fc-a2f4eb9423b1" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 02/04/2026, 06:55 am" data-cid="1775093107816" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-rid="f6c14b7e-369a-4354-8d87-6570ed65a9b0" data-time="1775093107411" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb" data-track-detail="">, and a multidisciplinary approach to optimize patient outcomes.
Real-world Efficacy and Safety of Stapokibart in Children and Adolescents with Moderate-to-severe Atopic Dermatitis: A Retrospective Study
Paediatric real-world evidence for stapokibart in moderate-to-severe atopic dermatitis (AD) is scarce. We retrospectively analysed 55 patients aged 6–17 years treated at a single centre for 16 weeks using weight-tiered dosing (<30 kg: 600 mg loading, then 300 mg every 4 weeks; ≥30 kg: 600 mg loading, then 300 mg every 2 weeks). Eczema Area and Severity Index (EASI), Scoring Atopic Dermatitis (SCORAD), body surface area (BSA), Investigator’s Global Assessment (IGA), Children’s Dermatology Life Quality Index (CDLQI) and Pruritus Numerical Rating Scale (P-NRS) were assessed at baseline and weeks 4, 8, 12 and 16. At week 16, median EASI fell from 10.0 to 1.95 and SCORAD from 46.2 to 13.3; P-NRS from 8.0 to 1.0 and CDLQI from 14.0 to 4.0. Week 16 response rates were 92.7% (EASI-50), 70.9% (EASI-75), 38.2% (EASI-90), 52.7% (IGA 0/1) and 67.3% (P-NRS≤2). Mild adverse events occurred in 9.1%. Stapokibart was associated with rapid improvements in disease severity, itch and quality of life and was well tolerated in routine paediatric care.
The Effects of Sun Exposure and Pigmentation Phenotype on Prognosis in Metastatic Melanoma
Ultraviolet radiation exposure and a fair pigmentation phenotype are well-established risk factors for primary cutaneous melanoma. However, the prognostic relevance of these risk factors is largely unexplored in metastatic disease. The aim of this study was to examine whether phenotypic characteristics and sun exposure patterns affect the prognosis of metastatic melanoma with immunotherapy available. In this retrospective study, 210 patients with stage IV melanoma were included. All patients were asked to answer a standardized questionnaire regarding risk factors for melanoma, including items on sun exposure habits and self-assessment of phenotypic features. Survival analyses were performed with overall survival as the endpoint. Patients who reported >5 severe sunburns during childhood had a significantly decreased risk of death compared to patients with 0–1 sunburn (HR 0.46, CI 0.25–0.85, p=0.013). A fair or intermediate pigmentation phenotype was associated with a decreased risk of death compared to a dark phenotype after adjustment for distant metastasis category (HR 0.57, CI 0.34–0.93, p=0.026). This study indicates that the number of severe sunburns during childhood is associated with a more favourable prognosis in metastatic melanoma. However, due to the limited size of the study population, further research is required to confirm these results.
Perceived Stress, Illness and Stigma in Patients with Alopecia Areata
Alopecia areata is a nonscarring autoimmune hair loss disorder. Little is known about patients’ perceptions of their condition. This French cross-sectional online study primarily aimed to assess patients’ perception of stress as a causal factor, with secondary objectives examining illness perception and stigma. Adults aged ≥18 years with a confirmed alopecia areata diagnosis were included. The primary outcome was patients” attribution of stress as a cause of alopecia areata, while secondary outcomes included IPQ-R and PUSHD scores. Among 96 participants, there was a strong female predominance (15.6 : 1) and a high proportion of alopecia totalis (65%). Stress was identified as a cause by 52 patients (54%), and this belief was shared by their dermatologist in 18 cases (35%). Patients reported significant emotional consequences, major life impact and a chronic course. Those attributing alopecia areata to stress showed higher perceived personal control (15.3±4.9 vs. 12.7±4.3; p=0.006). The mean PUSHD score was 18. Poorer perceived consequences and stronger emotional representations correlated with greater stigma (ρ=0.56; ρ=0.59; p<0.05), while lower disease understanding correlated with higher stigma (ρ=−0.34; p<0.05). Integrating educational programmes into routine care may enhance patients with alopecia areata understanding and coping.
Comprehensive Transcriptomic Profiling of Nonatopic Prurigo Nodularis in Korean Patients Reveals Il-22–driven Epidermal Stress and Neuro-immuno-fibrotic Remodelling
Prurigo nodularis (PN) is a chronic pruritic dermatosis with incompletely defined pathogenesis, and molecular data from East Asian populations are limited. We characterized the transcriptomic signatures of non-atopic PN in Korean patients to identify pathways linked to chronic itch and lesion persistence. RNA sequencing was performed on lesional and non-lesional skin from 17 PN patients and normal skin from 11 controls, followed by differential expression, functional enrichment<span id="9f9215fe-25f8-4b22-845a-5016afd55da6" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 19/03/2026, 07:00 am" data-cid="1773883810608" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="d7a9aa80-4b7e-4893-84eb-6be6d29ffd2e" data-time="1773883810308" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">, and correlation analyses. Lesional PN skin showed distinct transcriptional signatures with upregulation of Th22/IL-22–related genes and IL-22–inducible epidermal stress markers (S100A7/A8/A9, SERPINB4, HRNR), along with keratinization genes (KRT6C, KRT16, KRT17). Itch severity correlated strongly (Spearman’s ρ␣' to '>'" data-cid="8ea22449-7657-49ef-ad1e-43be5b7d521c" data-track-detail="" data-tag-desc="VAR,OPR,VAL,OPRS,VALS,UNT" data-tag-type="OPR" data-offset="802" data-match="ρ &gt; 0.7" data-replace=">" data-pattern=">" data-tag-index="2_1" data-track-change=" &gt; " data-time="" data-username="" data-userid="">>0.7) with IL-22–inducible stress genes, IL4R, profibrotic mediators (WNT5A), JAK–STAT regulators (JAK3, SOCS1/3), neuromodulatory/epidermal–neural genes (TRPV3), and senescence markers (CDKN1A, CXCL8, PLAUR). Non-lesional skin showed intermediate expression patterns, consistent with subclinical inflammation. Despite the modest sample size and single-ethnicity design, these findings indicate that non-atopic PN in Korean patients is characterized by IL-22–driven epidermal stress, fibroblast remodelling, neuroimmune signalling, and senescence programs<span id="8d0872ba-4f61-4f56-b8fa-0d32e6a979a9" class="ins cts-1 jrnlLQCRefAlter" title="Inserted by Shanthipriya (COPYEDITOR) - 19/03/2026, 07:00 am" data-cid="1773883844302" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="46684788-a8ee-4868-ac2e-ae895c642af2" data-time="1773883843655" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">programmes, highlighting therapeutic targets including IL-31RA, IL-4Rα/JAK1, antifibrotic and senescence-directed pathways.
Absolute Eczema Area and Severity Index Responses with Lebrikizumab in Patients with Moderate-to-severe Atopic Dermatitis: A Secondary Analysis of Two Phase 3 Trials
The ADvocate trials (NCT04146363, NCT04178967) investigated adults/adolescents with moderate-to-severe atopic dermatitis (AD) receiving lebrikizumab (LEB) monotherapy, using percent improvement in the Eczema Area and Severity Index (EASI). In clinical trials, percent EASI improvement is used to compare study arms and measure treatment effect size/impact. In clinical practice, however, absolute EASI scores are used (especially in Europe), as they measure an individual’s disease state regardless of baseline severity. This post-hoc analysis assessed absolute EASI response – EASI≤7, ≤5, ≤3, and ≤1 – from the ADvocate trials to understand LEB efficacy in adults/adolescents with moderate-to-severe AD. Week-16 data from patients receiving LEB 250 mg Q2W (n=564) were compared with placebo (n=287). Across baseline moderate/severe/very severe EASI and baseline Investigator’s Global Assessment (IGA) 3/4, significantly higher percentages of patients receiving LEB than those receiving placebo achieved each absolute EASI response. Week--16 LEB EASI 75 responders (n=284) and per-protocol LEB non-responders (n=215) were assessed through week 52. Absolute EASI scores were generally low and stable among responders and reduced among non-responders. Overall, LEB was associated with high rates of durable absolute EASI response, even in cases of high baseline severity or suboptimal week-16 outcomes. Results reflect clinically meaningful improvements that could help guide clinical practice.
European Expert Consensus on Essential Variables for Teledermatological Assessment of Skin Tumours
Teledermatology is increasingly used for the assessment of suspicious skin tumours, yet referral content remains poorly standardized. To develop a European expert consensus on the essential clinical and visual variables required for teledermatological assessment of primary skin tumours. A 3-round modified Delphi study was conducted among experienced dermatologists. In round 1, participants proposed essential variables. In round 2, variables were rated for essentiality, clinical relevance and feasibility. In round 3, binary voting was used to define final consensus. Consensus was predefined as ≥67% agreement. Interquatile ranges were calculated to assess response stability. A total of 47 variables were proposed in round 1. Following quantitative scoring, 34 variables progressed to round 3. Twelve variables met the predefined consensus threshold, primarily related to image quality and lesion characteristics. Sensitivity analyses using geographic subgroups and higher consensus thresholds demonstrated that image-quality variables were the most robust. This European expert consensus defines a focused and clinically practical core dataset for teledermatological assessment of skin tumours. These variables may support standardization of referrals and facilitate future validation and AI-assisted workflows.
Efficacy and Safety of Dupilumab in Immune Checkpoint Inhibitor Induced Bullous Pemphigoid: A Spanish Multicentric Case Series
Immune checkpoint inhibitors (ICIs) have signifi-cantly improved oncologiconcological outcomes. However, ICIs can elicit immune-mediated adverse effects that may require treatment discontinuation and potentially affect cancer prognosis. Bullous pemphigoid (BP) can be induced by ICIs in up to 1 % of treated patients. Conventional treatments for BP (topical and systemic glucocorticoids as well as other classical immunosuppressants) associate substantial toxicities and may impair antitumour responses. Dupilumab, a monoclonal antibody that blocks IL-4/IL-13 signalling, represents a promising alternative, offering effective disease control with an improved safety profile. In this study, we assessed the efficacy and safety of dupilumab for the treatment of ICI-induced BP (ICI-BP) in a real-world multicentre case series of 19 patients, an underreported clinical setting. The median time to ICI-BP development from ICI initiation was 390 days (IQR 295). Overall, 18 patients (94.74%) achieved a clinical response, of whom 16 (84.21%) attained complete remission. Disease stabilization was observed in one1 patient. Among 17 patients receiving systemic corticosteroids prior to dupilumab, 14 (82.35%) discontinued them afterwards. Additionally, 11 patients (61.11 %; n=18) were able to continue or reintroduce ICI after dupilumab initiation. Dupilumab was well tolerated, with 18 patients (94.74%) experiencing no significant adverse events and only one case of suspected psoriasiform toxicity.
From Onset to Outcome: A Long-term Retrospective, Single centre Study of Guttate Psoriasis from Israel
Guttate psoriasis is often precipitated by strepto-coccal infections and is generally regarded as a mild subtype of psoriasis; however, its potential associations with systemic comorbidities are insufficiently explored. In this study, we aimed to evaluate the association of guttate psoriasis with systemic comorbidities such as metabolic syndrome and psoriatic arthritis and identify factors affecting recurrence. In this retrospective single-centercentre study, we reviewed the data of patients with the first eruption of guttate psoriasis between 1998 and 2020 and at least 4 years of follow-up data. Demographic information and medical data (type of treatment, psoriasis flare-ups, remission of disease, and development of metabolic syndrome and/or psoriatic arthritis) were retrieved. Of 395 patients included (mean follow up, 83±34.7 months), 34.9 % experienced at least one recurrence, 14.68 % had multiple recurrences, 5.6 % developed psoriatic arthritis, and 8.6 % had metabolic syndrome. Male sex, topical treatment and residual disease were significant risk factors for recurrence. Psoriatic arthritis was strongly associated with multiple recurrences, while a possible association with metabolic syndrome was observed, highlighting the importance of careful long-term monitoring in this population.
Comparative Efficacy of JAK Inhibitors in Acute vs Nonacute Alopecia Areata: A Retrospective Cohort Study
Despite advancements in systemic treatments, the efficacy of Janus kinase (JAK) inhibitors in acute versus non-acute alopecia areata (AA) remains poorly defined, necessitating comparative studies to optimize therapeutic strategies. This retrospective, single-centercentre cohort study included 158 AAalopecia areata patients treated with JAKJanus kinase inhibitors (tofacitinib or ritlecitinib) between 2021 and 2025, aimed at evaluating clinical outcomes and identifying predictors of super-responder (SR) status. Patients were stratified into acute (n=41) and non-acute (n=117) groups based on disease duration and treatment history, with efficacy assessed using the Severity of Alopecia Tool (SALT) through week 24. Our findings demonstrate that patients with acute AAalopecia areata achieved significantly superior outcomes, with 65 % reaching SALT100 by week 24 compared to 39.5 % in the non-acute group (p=0.041). Binary logistic regression analysis further identified tofacitinib treatment (OR=2.883, p=0.009) and mild-to-moderate baseline severity (OR=2.802, p=0.015) as significant predictors of SRsuper-responder status, while acute AAalopecia areata status showed borderline predictive value (OR=2.418, p=0.098). Although limited by its single-centercentre design and sample size, this study underscores that early intervention with JAKJanus kinase inhibitors in acute AAalopecia areata leads to enhanced hair regrowth, emphasizing the critical importance of timely clinical management.
A Real-world Meta-analysis Study of Disease Severity in European Patients Who Received Baricitinib for Atopic Dermatitis: Data from BioDay, SCRATCH and TREATgermany
Clinical trials have demonstrated the effectiveness of baricitinib, an oral selective Janus kinase 1/2 inhibitor, for patients with moderate-severe atopic dermatitis, but data from real-world practice are limited. This non-interventional cohort study evaluated clinician- and patient-reported disease severity over 16 weeks using 3 national atopic dermatitis registries: BioDay (Netherlands), SCRATCH (Denmark) and TREATgermany (Germany). Absolute scores for Eczema Area and Severity Index (EASI) and itch Numerical Rating Scale (Itch-NRS) were assessed at baseline and follow-up (Week 13/16) for each registry and for the overall pooled cohort. Descriptive analyses, generalized linear mixed modelling and meta-analysis approaches were applied to complete-case and multiply-imputed datasets. In total, 264 patients (89 BioDay, 117 SCRATCH, 58 TREATgermany) were included. Results showed improvements in EASI, with 58%, 68% and 62% achieving EASI≤7 at Week 13/16 in BioDay, SCRATCH and TREATgermany, respectively. In the pooled cohort, the proportion was 62% (95% CI: 50–73%). The pooled mean EASI change was -7.8 [14.4,–1.1]. Effectiveness was generally observed in both biologic-naïve and -experienced patients. Notable heterogeneity was observed, particularly for Itch-NRS, with the proportion achieving NRS≤4 ranging from 20% (BioDay) to 71% (TREATgermany). These real-world findings support the effectiveness of baricitinib while also highlighting variability in patient outcomes.
Hidradenitis Suppurativa Changes Major Life Decisions of Affected Patients: A Cross-sectional Study
Hidradenitis suppurativa (HS) is a chronic inflammatory disease associated with substantial physical and psychosocial burden. Its long-term impact on major life-changing decisions (MLCD) remains poorly investigated. This cross-sectional study included 123 adult HS patients assessed using the validated Major Life-Changing Decision Profile (MLCDP). Disease severity was evaluated with Hurley staging and IHS4. Quality of life (DLQI, HiSQOL), disease acceptance (AIS)<span id="8c80a92c-c67e-4bcc-be41-d10c4a7e2d47" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 19/05/2026, 09:01 pm" data-cid="1779204665200" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-rid="73474d83-1e1b-472f-8e47-968cfeac424d" data-time="1779204664603" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb" data-track-detail="">, and psychiatric symptoms (PHQ-9, GAD-7) were also assessed. Overall, 87.887.8% of patients reported at least one affected MLCD, with a mean of 6.2±65.2 decisions per patient. The mean MLCDP total score was 20.1±1720.91 points<span id="d71096c3-3333-4d24-a5b0-818abaf21b17" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 19/05/2026, 09:01 pm" data-cid="1779204669602" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-rid="78cb1f0d-6c99-4902-a424-2768de90a275" data-time="1779204669305" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb" data-track-detail="">, without sex differences. The most frequently affected areas concerned lifestyle habits, physical activity<span id="9367348d-92af-44bf-ba79-0f7ed060ec1b" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 19/05/2026, 09:00 pm" data-cid="1779204651138" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-rid="a4ff6567-ada9-4e4d-b9d8-57ec35d8a78b" data-time="1779204650573" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb" data-track-detail="">, and intimate relationships. Patients with Hurley stage III demonstrated significantly higher MLCDP scores compared with stages I and II. MLCDP correlated with IHS4 (r=r0.218), pain intensity (r=r0.256), DLQI (r=r0.401), HiSQOL (r=r0.507), PHQ-9 (r=r0.354)<span id="8e32092a-7edc-4c6a-8692-f70bb15730b3" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 19/05/2026, 09:01 pm" data-cid="1779204674196" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-rid="acef62df-3a58-4574-b9fe-d50a6c96b896" data-time="1779204673601" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb" data-track-detail="">, and GAD-7 (r=r0.315) (all <span id="f2ca851a-fcb6-40d6-8aa4-78e90cc65beb" class="jrnlPatterns" title="changed from 'p' to 'p'" data-cid="f2ca851a-fcb6-40d6-8aa4-78e90cc65beb" data-track-detail="" data-tag-desc="VAR,OPR,VAL,OPRS,VALS,UNT" data-tag-type="VAR" data-offset="1089" data-match="p &lt; 0.05" data-replace="p" data-pattern="$1" data-tag-index="1_9" data-function="lowercase,addItalics" data-track-change="p" data-time="" data-username="" data-userid="">p<span id="068aa01a-1ad9-48b9-8312-848f3213c491" class="jrnlPatterns" title="changed '␣<␣' to '<'" data-cid="068aa01a-1ad9-48b9-8312-848f3213c491" data-track-detail="" data-tag-desc="VAR,OPR,VAL,OPRS,VALS,UNT" data-tag-type="OPR" data-offset="1090" data-match="p &lt; 0.05" data-replace="<" data-pattern="<" data-tag-index="1_9" data-track-change=" &lt; " data-time="" data-username="" data-userid=""><<span id="6550af2a-8e7d-48ed-bf4d-2147edff9fe9" class="jrnlPatterns" title="changed from '0.05' to 'p'" data-cid="6550af2a-8e7d-48ed-bf4d-2147edff9fe9" data-track-detail="" data-tag-desc="VAR,OPR,VAL,OPRS,VALS,UNT" data-tag-type="VAR" data-offset="1089" data-match="p &lt; 0.05" data-replace="p" data-pattern="$1" data-tag-index="1_9" data-function="lowercase,addItalics" data-track-change="0.05" data-time="" data-username="" data-userid="">p0.05). A strong inverse correlation was observed with illness acceptance (r = −0.584, <span id="19a79ec4-67d3-4e2d-8d7f-cf2d4dcfaeb3" class="jrnlPatterns" title="changed from 'p' to 'p'" data-cid="19a79ec4-67d3-4e2d-8d7f-cf2d4dcfaeb3" data-track-detail="" data-tag-desc="VAR,OPR,VAL,OPRS,VALS,UNT" data-tag-type="VAR" data-offset="1181" data-match="p &lt; 0.001" data-replace="p" data-pattern="$1" data-tag-index="1_10" data-function="lowercase,addItalics" data-track-change="p" data-time="" data-username="" data-userid="">p<span id="e2be494e-9383-4832-9f2c-d218410a875e" class="jrnlPatterns" title="changed '␣<␣' to '<'" data-cid="e2be494e-9383-4832-9f2c-d218410a875e" data-track-detail="" data-tag-desc="VAR,OPR,VAL,OPRS,VALS,UNT" data-tag-type="OPR" data-offset="1182" data-match="p &lt; 0.001" data-replace="<" data-pattern="<" data-tag-index="1_10" data-track-change=" &lt; " data-time="" data-username="" data-userid=""><<span id="5ba9024c-0006-4834-af30-13d0604a2982" class="jrnlPatterns" title="changed from '0.001' to 'p'" data-cid="5ba9024c-0006-4834-af30-13d0604a2982" data-track-detail="" data-tag-desc="VAR,OPR,VAL,OPRS,VALS,UNT" data-tag-type="VAR" data-offset="1181" data-match="p &lt; 0.001" data-replace="p" data-pattern="$1" data-tag-index="1_10" data-function="lowercase,addItalics" data-track-change="0.001" data-time="" data-username="" data-userid="">p0.001). HS substantially influences key life decisions, particularly in patients with advanced disease and reduced psychological adaptation.
Psoriasis Triggers and Disease Activity: Analysis of Survey Data from the PSODEEP1 Study
Numerous patients with psoriasis will associate disease triggers to changes in disease activity over time. Modern treatments induce remission, but relapse is common if the treatment is stopped. Exploring patients’ first-hand experiences is a key starting point to identify triggers that may influence disease relapse. A cross-sectional digital questionnaire was distributed to 2716 individuals with psoriasis in Chile, Denmark, Sweden<span id="14c814ea-d697-494a-95c7-fc01eea4badc" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 16/04/2026, 06:30 am" data-cid="1776301259506" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="a272b602-c369-4787-bfae-242e23801d58" data-time="1776301258758" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">, and the Netherlands. 71% of participants reported psoriatic disease triggers. Triggers were classified into 24 subgroups dominated by stress (55.3%), infections (17.7%) and alcohol (10.8%). The majority (65%) of the participants experienced seasonal variation in disease activity, and approximately half reported fluctuating disease activity with periods of flare-ups. The self-reported trigger prevalence varied by gender, disease manifestation (skin psoriasis and/or psoriatic arthritis), and country of residence. The female participants more often reported stress and infections as triggers. Alcohol consumption is more often reported as a trigger in males. Chileans more often reported stress and less frequently reported infections as triggers. Insights into patient-reported disease variations and triggers can be used to aid patient-physician conversations and patient phenotyping during routine clinical practice. Trigger assessment and management could potentially contribute to patient counselling and motivate lifestyle changes.
Relationship between Dermatology Life Quality Index Scores and EQ-5D-5L Utility Values in Adults with Atopic Dermatitis: Development of a Swedish Mapping Model
Atopic dermatitis (AD) is associated with impaired health-related quality of life (HRQoL), especially in moderate-to-severe disease. The Dermatology Life Quality Index (DLQI) is the most widely used dermatology-specific measure, whereas the EuroQol Five-Dimension, Five-Level questionnaire (EQ-5D-5L), a generic preference-based instrument, assesses health status across diseases. This study examined the relationship between DLQI and EQ-5D-5L in Swedish adults with ADatopic dermatitis and developed a mapping model to estimate EQ-5D-5L utilities from DLQI scores. In this cross-sectional study, 112 Swedish adults with self-reported physician-diagnosed ADatopic dermatitis, recruited through the Swedish Asthma and Allergy Patient Association, completed both questionnaires. DLQI scores correlated strongly and negatively with EQ-5D-5L index values (r=−-0.64, p<0.001). Each 5-point increase in DLQI corresponded on average to a 0.07 decrease in EQ-5D-5L utility. A fractional logit regression model including covariates age, sex, and disease severity, showed good calibration and explained 27 % of the variance in EQ-5D-5L values. These findings demonstrate that DLQI scores meaningfully reflect generic HRQoL among adults with ADatopic dermatitis and can be used to estimate EQ-5D-5L utilities when preference-based data are unavailable. The results enhance understanding of how DLQI relaterelates to overall health status and support the application of DLQI-derived utilities in cost-effectiveness analyses and health technology assessments.
Cell-free DNA Levels in Cellulitis: A Cross-sectional Prospective Study
Cellulitis is a prevalent inflammatory dermatosis caused by bacterial infection that lacks a definitive quantitative biomarker for assessing disease activity and monitoring therapeutic response, leading to diagnostic ambiguity and management challenges. Cell-free DNA (cfDNA), consisting of short nucleic acid fragments released into circulation from necrotic and apoptotic cells, represents a potential objective measure of systemic inflammation. We hypothesized that cfDNA levels would be elevated in patients with cellulitis and correlate with established inflammatory parameters and clinical outcomes. We conducted a cross-sectional prospective study of 36 patients with confirmed cellulitis and 30 healthy controls. Plasma cfDNA levels were quantified at baseline (admission), 72 hours after antibiotic initiation, at discharge<span id="103f0d4c-5a0b-41cf-b3cb-313b7ea2a9c9" class="del cts-1 jrnlLQCRefAlter" title="Deleted by Shanthipriya (COPYEDITOR) - 22/05/2026, 06:48 pm" data-cid="1779455900150" data-stage="Copyediting" data-user-email="shanthiselvamfreelance@gmail.com" data-track-detail="" data-rid="b7863a66-6275-48f3-9f68-1dd25df0c6a0" data-time="1779455899578" data-username="Shanthipriya (COPYEDITOR)" data-userid="copyeditor 9046d08f-68e3-454b-a4ee-853e0b2e95eb">, and at 3-week follow-up. We assessed correlations between cfDNA and traditional inflammatory markers, including C-reactive protein (CRP) and white blood cell (WBC) counts, as well as patient-reported pain scores. Patients with cellulitis exhibited significantly elevated plasma cfDNA levels at admission compared with healthy controls. Following antibiotic therapy, cfDNA levels declined rapidly and were positively correlated with reductions in WBCwhite blood cell/neutrophil counts. Higher cfDNA levels were also associated with increased subjective pain scores. These findings suggest that cfDNA may serve as a promising biomarker for the diagnosis of cellulitis and for objectively monitoring treatment efficacy, with potential utility as an objective proxy for pain severity.
Long-term Recurrence after Curettage ± Electrodesiccation for Basal Cell Carcinoma: A Nationwide Cohort Study of 47,358 Tumours from Dermatology Practices
The incidence of basal cell carcinoma is increasing globally, with Denmark showing a 220% rise between 2013 and 2021, underscoring the need to optimize treatment strategies. Curettage with or without electrodesiccation (C±E) is commonly used, yet updated tumour-specific recurrence data are limited. Using the Danish Skin Cancer Registry, we assessed long-term recurrence after C±E for 47,358 basal cell carcinomas treated in office-based dermatological practices between 2013 and 2022. Follow-up began one year after treatment, and recurrence was evaluated using Kaplan–Meier analysis and Cox regression to estimate cumulative recurrence rates and hazard ratios (HR) by tumour characteristics. The 5-year recurrence rate was 9.9% (95% CI 9.4–10.3), increasing to 13.3% (12.6–14.1) at 8 years. Head and neck tumours had the highest recurrence (25.1% at 8 years; HR 2.25, 2.00–2.53), as did tumours >10 mm (16.7% at 8 years; HR 1.80, 1.62–1.99), while superficial basal cell carcinomas had the lowest recurrence (8.4% at 8 years; HR 0.46, 0.38–0.56). Incomplete follow-up may have introduced bias in recurrence estimates. This nationwide study, the largest to date with up to 8 years of follow-up, shows that C±E remains a viable treatment, but careful tumour selection is essential to optimize long-term outcomes.
Joint Relationship of Cardiovascular-kidney-metabolic Syndrome and Psoriasis with All-cause and Cause-specific Mortality in Adults: A Population-based Analysis
Psoriasis has been associated with cardiovascular risk, but the combined association of psoriasis and cardiovascular-kidney-metabolic (CKM) syndrome with mortality remains unclear. This study examined the individual and joint associations of CKM syndrome and self-reported psoriasis with allcause and cardio-cerebrovascular disease (CCD) mortality among 9,598 U.S. adults aged ≥20 years from NHANES 2003–2006 and 2009–2014. CKM syndrome stages were defined according to the 2023 American Heart Association framework, and psoriasis was assessed by self-reported physician diagnosis. Mortality was ascertained through linkage to the National Death Index through 2019. During a median follow-up of 9.3 years, 860 deaths occurred. Advanced CKM syndrome was associated with higher all-cause mortality (HR=3.67; 95% CI: 3.00–4.50) and CCD mortality (HR=8.16; 95% CI: 5.42–12.28). Psoriasis was also associated with higher all-cause mortality (HR=2.06; 95% CI: 1.47–2.90) and CCD mortality (HR=2.69; 95% CI: 1.42–5.08). Participants with both advanced CKM syndrome and psoriasis had the highest observed risks of all-cause mortality (HR=7.09; 95% CI: 4.93–10.19) and CCD mortality (HR=16.47; 95% CI: 7.26–37.33). Formal interaction testing did not show significant multi-plicative interaction for all-cause mortality (p for interaction=0.16) or CCD mortality (p for interaction=0.80). These findings suggest that coexisting advanced CKM syndrome and psoriasis may identify adults with particularly elevated mortality risk.
Efficacy and Safety of Nemolizumab at Week 48: Results from the Maintenance Phase of Two Global Phase 3 Pivotal Studies (ARCADIA 1&2) in Patients with Moderate-to-Severe Atopic Dermatitis
Nemolizumab with background topical therapy (corticosteroids±calcineurin inhibitors) significantly improved skin lesions, itch and sleep in two global phase 3 trials (ARCADIA 1&2) in adolescents and adults with moderate-to-severe atopic dermatitis through week (W)16. Efficacy and safety of nemolizumab, combined with background topical therapy, were evaluated for an additional 32 weeks (W16–W48) with a focus on maintained skin responses in clinical responders (patients achieving Investigator’s Global Assessment [IGA] score of 0/1 [clear/almost clear] or ≥75% improvement in Eczema Area and Severity Index [EASI-75] at W16). At W16, clinical responders (N=507) to nemolizumab every 4 weeks (Q4W) were rerandomized (1 : 1 : 1) to receive nemolizumab 30 mg-Q4W/-Q8W/placebo (nemolizumab-withdrawal) subcutaneously with background topical therapy. At W48, 61.5% (strata-adjusted difference versus nemolizumab-withdrawal group [Δ], 11.8% [95% CI 1.3–22.3]) and 76.3% (Δ, 12.4% [95% CI 2.7– 22.0]) of patients in nemolizumab-Q4W; 60.4% (Δ, 10.7% [95% CI 0.3–21.0]) and 75.7% (Δ, 11.8% [95% CI 2.1–21.5]) in nemolizumab-Q8W; and 49.7% and 63.9% in nemolizumab-withdrawal group maintained response rate for IGA success and EASI-75, respectively. The percentage of patients who experienced ≥1 adverse events were similar across the groups (range: 53.5%–58.3%). Up to W48, skin responses were maintained without notable differences in the safety profile of both nemolizumab dosing regimens.
Association of Skin Dryness and Disease-related Parameters with Mechanical Alloknesis in Atopic Dermatitis: A Crosssectional and Prospective Cohort Study
Mechanical alloknesis (MA), namely itch hypersensitivity evoked by normally innocuous mechanical stimuli, may exacerbate the itch–scratch cycle in atopic dermatitis (AD). Although various molecular and neural pathways have been identified in animal models, the clinical mechanisms underlying MAmechanical alloknesis remain unclear, particularly in relation to disease severity and biomarkers. We hypothesized that AD atopic dermatitis severity-related parameters are associated with MAmechanical alloknesis. To investigate this, we performed a cross-sectional study comparing healthy controls and ADatopic dermatitis patients, and a prospective cohort study evaluating ADatopic dermatitis patients receiving dupilumab. In the cross-sectional study, MAmechanical alloknesis scores were significantly higher in lesional than in non-lesional or healthy skin. Skin dryness parameters (transepidermal water loss and stratum corneum hydration) showed no significant correlation with MAmechanical alloknesis. Among serum biomarkers, only thymus and activation-regulated chemokine (TARC) levels showed a moderate positive correlation with MAmechanical alloknesis but not with spontaneous itch. In the prospective study, dupilumab significantly reduced eosinophil counts, IgE, TARC, spontaneous itch, and MAmechanical alloknesis scores, although TARC remained correlated with MAmechanical alloknesis after treatment. These findings suggest that TARC may be involved in the induction of MAmechanical alloknesis and represent a potential biomarker or therapeutic target for MAmechanical alloknesis in ADatopic dermatitis.
Patient Perspectives, Unmet Needs and Dilemmas in Reproductive Decision-making for Genodermatoses: A Qualitative Interview Study
Impact on quality of life due to inherited skin diseases (also known as genodermatoses) may lead to reproductive dilemmas for affected couples or individuals considering parenthood. Currently, little is known about reproductive decision-making (RDM) for those affected by or at-risk of genodermatoses. Couples/individuals’ perspectives with genodermatoses were qualitatively explored by focusing on (i) the impact of these diseases on the desire to have children, (ii) the knowledge of different reproductive options and personal considerations and, (iii) experiences with reproductive counselling. Semi-structured interviews were conducted with participants aged ≥16 years, diagnosed with a genodermatosis, and an active, (un)fulfilled or future desire to have children and analysed using a reflexive thematic content approach. Thirty participants were interviewed until saturation. Two main themes and 9 subthemes were identified. Participants preferred wanting to avoid passing on their genodermatosis to offspring, thereby complicating RDM. This preference was influenced by negative experiences with the disease, resulting in fear and uncertainty about severe manifestations in offspring. Positives and shortcomings in clinical practice were expressed, particularly the lack of reproductive counselling as a standard part of care. This study highlights the substantial impact of genodermatoses in RDM and the importance of routine reproductive counselling for those affected by or at-risk of genodermatoses.
Clinical and Pathological Predictors of Unfavourable Outcomes in Thin and In Situ Melanomas: A Retrospective Cohort Study from Taiwan
Thin melanoma, defined as tumour thickness ≤1.0 mm, and melanoma in situ are increasingly diagnosed. However, acral-predominant Asian populations appear to experience higher rates of adverse outcomes than Western cohorts. This study aimed to identify prognostic factors among Taiwanese patients with early-stage melanoma. We reviewed 178 melanoma in situ/thin melanoma cases diagnosed from 1995 to 2025 at a tertiary centre and analysed overall survival, melanoma specific survival, recurrence-free survival, and distant metastasis-free survival using Cox and Fine–Gray competing-risk models. During a mean follow-up of 81 months, adverse events were not uncommon, including recurrence (8.8%), distant metastasis (4.7%) and melanoma-specific mortality (5.1%). Age was the most consistent predictor across endpoints in both Cox and competing-risk analyses. A Breslow thickness ≥0.8 mm independently increased the risk of melanoma-specific mortality, whereas ulceration and mitotic activity were not significant predictors. In conclusion, melanoma in situ and thin melanoma in this acral-predominant Asian cohort are not uniformly low risk. Older patients or those with tumours approaching or exceeding 0.8 mm in thickness warrant closer, risk-adapted surveillance.
The Diagnostic Accuracy of Ex Vivo Confocal Laser Scanning Microscopy for Basal Cell Carcinoma: A Systematic Review and Meta-analysis
This systematic review and meta-analysis evaluated available data on the diagnostic accuracy of ex vivo confocal laser scanning microscopy (EVCM) for the diagnosis of basal cell carcinoma (BCC) in tissue specimens and for margin assessment in micrographic surgery, using conventional histopathological analysis as reference standard. MEDLINE and Embase were systematically searched in November 2024 in accordance with PRISMA guidelines to identify diagnostic accuracy studies evaluating EVCM for BCC. Pooled sensitivity and specificity were estimated using bivariate random effects models. Sixteen studies comprising 1,387 specimens were included. The pooled mean EVCM acquisition time was 7.0 min (95% confidence interval [CI]: 5.3–9.4). For BCC diagnosis in tissue specimens, pooled sensitivity was 91.4% (95% CI: 85.9–94.9) and pooled specificity was 91.1% (95% CI: 79.2–94.5). Regarding margin assessment, pooled sensitivity and specificity were 79.5% (95% CI: 65.0–89.0) and 92.2% (95% CI: 85.5–95.9). In conclusion, EVCM shows high sensitivity and specificity for BCC diagnosis in tissue specimens and may selectively replace conventional histology when rapid diagnosis is desired. For margin assessment, EVCM has high specificity but moderate sensitivity. Therefore, conventional histology should still be considered as a subsequent step, particularly after the final excision stage of stepwise micrographic surgery.
Organ Involvement and Treatment Response across Cutaneous Sarcoidosis Subtypes
Cutaneous sarcoidosis presents with diverse morphologies, yet comparative data on systemic involvement, disease course and treatment response across subtypes remain limited. We conducted a 2-centre cross-sectional study including patients with histologically confirmed sarcoidosis identified through ICD codes, stratified into patients with and without cutaneous involvement and further by cutaneous subtype. Demographics, extracutaneous organ involvement, treatment response, clinical course and the organ leading to initial diagnosis were analysed. Among 125 patients (median age 53 years; 57% female), 99 had cutaneous sarcoidosis and 26 had no skin involvement. All major subtypes of cutaneous sarcoidosis were represented: plaque (39), papular (19), scar (15), subcutaneous (13) and lupus pernio (4); erythema nodosum (9) represented acute disease. Papular sarcoidosis (19) showed the mildest systemic involvement. Lymph nodes (64%) and lungs (48%) were most frequently affected with subtype specific variation. Skin lesions led to diagnosis in 78% of cases. Remission with topical therapy was rare (11%), whereas systemic glucocorticoids (21%) and other immunosuppressants (37%) showed higher response rates; sirolimus (11%), hydroxychloroquine (10%) and TNF inhibitors (8%) were most effective. Relapse occurred in 40% and 46% required long-term systemic therapy. Cutaneous sarcoidosis subtypes differ markedly in systemic involvement, treatment response and disease course, supporting biological heterogeneity and the need for individualized management.
“Drug Reaction with Eosinophilia and Systemic Symptoms” (DRESS): Long-term Outcomes Based on Severity – A Cohort Study
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug-induced reaction characterized by exanthema, eosinophilia and organ involvement. Patients reported sequelae comprising skin or organ alterations and autoimmune diseases. We investigated long-term complications of patients included in the German Registry of severe skin reactions between 2003 and 2023 with a definite or probable diagnosis of DRESS using a follow-up questionnaire. Cases were classified by severity (mild, moderate-to-severe) employing 2 scores (drug-induced liver injury [DILI] and acute kidney injury [AKI]). In total, 36/61 questionnaires (59%) were analysed revealing an equal distribution: 18 mild and 18 moderate-to-severe cases. All patients experienced long-term complications. Skin disorders occurred in 81%, mucosal problems in 31% and hair/nail complications in 43%. Severity groups were equally affected, whereas laboratory abnormalities appeared more often in moderate-to-severe cases. Haematological abnormalities were most frequently observed (94%), followed by elevated liver enzymes (88%) and impaired renal function parameters (31%). Alterations of HbA1c occurred in 16% and abnormal thyroid function in 19%, including 2 cases of Graves’ disease. Intolerance reactions to other medication were observed in 27% of cases, explaining fear of further medication (51%) and resulting avoidance behaviour (49%).
Dermatologists’ Attitudes toward Ultrasound-guided One-step Excision for Cutaneous Melanoma: A Survey of Clinical Practice and Perceived Barriers
Wide local excision of primary cutaneous melanoma is usually performed in 2 stages: diagnostic excision followed by definitive surgery with margins based on histopathological Breslow thickness. High-frequency ultrasound may enable reasonably accurate preoperative thickness estimation and may allow a single-stage approach. However, its adoption in routine practice remains limited. This study evaluated dermatologists’ acceptance of ultrasound-guided 1-step melanoma surgery and explored barriers to its implementation. An electronic survey including 9 clinical vignettes with dermoscopy images and preoperative ultrasound measurements was sent to dermatologists in the Loire Valley, France. Participants selected preferred management strategies, rated ultrasound utility and patient preference on Likert scales, and provided open-ended responses about perceived obstacles. Fifty-three dermatologists completed the questionnaire (57% response rate). One-step surgery was selected in 28% of scenarios, in creasing to 47% when diagnosis was confirmed by biopsy and decreasing to 24.5% without histopathological confirmation (p<0.0001). Most respondents acknowledged ultrasound’s usefulness for thickness estimation (median Likert score 3 [IQR 3–4]) and believed patients would prefer a single procedure (median 4 [IQR 3–5]). Major barriers included limited access to high-resolution ultrasound (n=18), concerns regarding overtreatment (n=14) and medico-legal risk in the absence of histopathological confirmation (n=9). Dermatologists remain cautious about 1-step melanoma surgery, primarily due to diagnostic uncertainty and resource limitations.
Neisseria gonorrhoeae in Six University Hospital STI Clinics in Sweden – Distribution, Antimicrobial Resistance and Treatment
Gonorrhoea is a sexually transmitted infection caused by Neisseria gonorrhoeae with an increasing incidence and a widespread antimicrobial resistance. The aim was to investigate the case burden, distribution of infection site, management and antibiotic resistance in N. gonorrhoeae cases in 6 university hospitals in Sweden. Diagnosis of N. gonorrhoeae was made by nucleic acid amplification tests (NAAT). Included were 1,060 cases with 27.3% women, 72.4% men and 4 transgender persons, constituting around one third of all 3,356 N. gonorrhoeae cases in Sweden 2022. The NAAT test for N. gonorrhoeae from urine was positive in 51.7% (428/828), 40.4% (428/1,060) among the total included population, from vagina/cervix in 87.9% (246/280), 23.2% (246/1,060) in the total population and from rectum in 66.1% (353/534), 33.3% (353/1,060) among all included cases, with 78.9% (277/351) positive rectal samples in men and 21.1% (74/351) in women (p<0.001), the majority being among men having sex with men (76.5%). Antimicrobial resistance was most common against ciprofloxacin, seen in 43.7% (463/1,060) and second most common against azithromycin, in 9.4% (150/1,060). The study elucidates the complexity of handling gonococcal infections regarding relevant test methods, infections in several locations and the problem with antibiotic resistance.
Reported Penicillin Allergy Affects the Length of Hospital Stay in Patients with Erysipelas
Patients with a reported penicillin allergy are often treated with less effective antibiotics. This study examined the impact of anamnestic penicillin allergy on the length of hospital stay in patients with erysipelas, a condition for which penicillin is considered the first-line therapy and addresses the question: Does anamnestic penicillin allergy directly affect the length of hospital stay in patients with erysipelas? This retrospective analysis included patients who were admitted to the University Medical Center Regensburg for the treatment of erysipelas. The data analysed were sex, age at diagnosis, body temperature at admission, C-reactive protein, leucocyte count, procalcitonin, length of hospital stay, Charlson Comorbidity Index and antibiotic therapy. Patients were divided into 2 groups: with and without the label anamnestic penicillin allergy. Multiple regression analysis showed that patients with anamnestic penicillin allergy stayed 1.83 days longer in hospital than patients without anamnestic penicillin allergy (mean length of stay 12.17±7.01 days for patients with anamnestic penicillin allergy compared to 10.34±4.80 days for patients without anamnestic penicillin allergy, as determined by a t-test p=0.046). According to our data, anamnestic penicillin allergy is associated with prolonged hospital stay. Therefore, delabelling of penicillin allergy should be widely implemented.
Psychological Resilience and Quality of Life in Mycosis Fungoides Patients: A BIO-MUSE Study
Cutaneous T-cell lymphoma is a chronic disease with a highly heterogeneous and unpre-dictable clinical course, and the impact on psychological resilience is still unknown. The primary aim was to investigate psychological resilience in cutaneous T-cell lymphoma patients over time and to relate it to dermatology-related quality of life (QoL) metrics. Psychological investigations were evaluated in 45 patients with mycosis fungoides included in the BIO-MUSE study. Psychological resilience was assessed using the Connor–Davidson Resilience Scale (CD-RISC), and dermatology-associated QoL was assessed with the Dermatology Life Quality Index (DLQI) and numeric rating scales for itch and sleep disorders. The resilience of the mycosis fungoides patients was further compared to a Swedish general population cohort comprising more than 2,500 individuals. This study demonstrates that mycosis fungoides patients in the BIO-MUSE cohort, where 39 of 45 cases had early-stage disease, exhibit a high and stable resilience over 1 year of the disease. The CD-RISC score is higher than in a Swedish general population cohort and in a subgroup of that cohort with psoriasis or eczema. Furthermore, the DLQI was consistently low, indicating a higher QoL in the BIO-MUSE cohort than in published data for similar patient populations.
A Cross-sectional Study on Quality of Life in EB: Validation of the Italian QOLEB and Assessment in Italian Patients
Inherited epidermolysis bullosa comprises a heterogeneous group of skin fragility diseases, presenting with a range of manifestations and complications that profoundly affect quality of life (QoL). A disease-specific instrument, Quality of Life in EB (QOLEB), has been developed to assess the impact of epidermolysis bullosa signs and symptoms on QoL. The aim of this cross sectional study, conducted as part of a European project – BUR-EB, was to test the psychometric properties of the Italian version of the QOLEB and to assess QoL in Italian epidermolysis bullosa patients. Demographic, clinical, and QOLEB data of 56 Italian patients aged ≥11 years participating in the BUR-EB online survey were analysed. Principal component analysis showed excellent internal consistency of Italian QOLEB, and high convergent validity with the generic questionnaire EQ-5D. About 40% of patients reported severe to very severe disease burden, and a strong correlation was observed between disease severity and QOLEB scores. Independent variables associated with worse QoL were pain, chronic wounds, wheelchair use and patient organization membership. Our study confirms the good psychometric properties of the Italian QOLEB. In addition to depicting the major impact of epidermolysis bullosa on QoL, it identifies pain, chronic wounds and functional disability as major targets for therapeutic interventions.
Validation and Responsiveness of the Rosacea Area and Severity Index in a Chinese Cohort: A Comparative Study with the Investigator’s Global Assessment
The Rosacea Area and Severity Index (RASI) is a recently developed tool for assessing rosacea severity, but its validation has so far been limited, requiring further independent evaluation. This study aimed to comprehensively assess the reliability, validity and responsiveness of the RASI in a Chinese cohort. Six trained observers independently evaluated standardized photographs of 230 Chinese patients with rosacea using both the RASI and the Investigator’s Global Assessment (IGA). Round 1 assessment was used to determine interobserver reliability and convergent validity, while a subgroup of 60 patients was reassessed to evaluate intraobserver reliability and responsiveness (Round 2). In this subgroup, baseline and 1-month follow-up photographs were rescored after 3 months by the same observers. Results showed moderateto-strong correlations between RASI and IGA at baseline, supporting validity. Interobserver reliability was high for both RASI and IGA overall scores, with intraclass correlation coefficients of 0.923 and 0.935. Intraobserver reliability showed no significant deviation (p>0.05). For responsiveness, RASI demonstrated a higher standardized response mean than IGA (0.43 vs 0.37) with a similar effect size. Additionally, RASI detected statistically significant changes (p<0.001) in patients classified as “stable” by IGA. Overall, RASI showed robust reliability, validity and superior responsiveness
Distinctive Reactivity to the C-terminal Epitope of BP180 Characterizes Immune Checkpoint Inhibitor–associated Bullous Pemphigoid, and an ELISA Based on the BP180 Ectodomain Enables Prompt Diagnosis in a Subset of Patients
Growing evidence has linked bullous pemphigoid (BP) to immune checkpoint inhibitor (ICI) therapy in cancer treatment. However, the immunological features of ICI-associated BP (ICI-BP) are not yet fully elucidated. In order to characterize the humoral response in ICI BP patients and investigate whether their epitope profile differs from idiopathic BP (IBP), 53 ICI-BP patients were enrolled, immunologically characterized and compared with 59 IBP patients. ICI-BP had a distinctive IgG humoral profile, with reduced reactivity toward BP230 and recognition of multiple BP180 epitopes beyond the immunodominant extracellular noncollagenous 16A domain (NC16A). Specifically, reactivity to BP180 ectodomain was present in 94% of ICI-BP and 78% of IBP (p=0.044). Moreover, BP180 C-terminal epitope was more frequently targeted in ICI-BP than IBP (72% vs 41%, p=0.002). Notably, the combined use of an in-house BP180 ectodomain ELISA and the commercial BP180 test increased diagnostic sensitivity from 83% to 100%. Enhanced IgG reactivity toward nonimmunodominant epitopes, and especially C-terminal epitope recognition, characterize the humoral immune response in ICI-BP. Our data suggest that combining NC16A and fulllength BP180 ectodomain ELISAs may help reduce diagnostic delay in ICI-BP patients, in whom a timely diagnosis is crucial to appropriately manage the disease and ultimately avoid discontinuation of cancer therapy.
Treatment Response to JAK Inhibitors in Long-standing Alopecia Areata (≥8 Years): A Real-world Observational Study
Long-standing alopecia areata is a therapeutically challenging subgroup lacking robust evidence regarding Janus kinase (JAK) inhibitors. This retrospective, single-centre study evaluated the efficacy and safety of baricitinib, tofacitinib or ritlecitinib in patients with current alopecia areata episodes lasting ≥8 years, treated between February 2021 and December 2025. Among 41 screened patients, 31 met the inclusion criteria (mean age 24.6±10.1 years; mean episode duration 12.7±4.6 years). The mean baseline SALT score was 62.8±30.2, with 64.5% of patients presenting a baseline SALT score ≥50. At week 24 (n=29), 27.6% and 24.1% of patients achieved absolute SALT scores ≤20 and ≤10, respectively. Relative improvements (SALT30, SALT50 and SALT80) were observed in 48.3%, 31.0% and 24.1% of patients. Treatment discontinuation occurred in 58.1% (18/31) of patients, primarily driven by a lack of efficacy (66.7% of these discontinuations). The most frequent adverse events were folliculitis (22.6%) and acne (12.9%). While the overall therapeutic response to JAK inhibitors remains limited in long-standing alopecia areata, a subset achieves clinically meaningful hair regrowth, supporting their use as a viable treatment option.
Standardizing Prurigo Control Assessment Globally: Linguistic Validation and Cross-cultural Adaptation of Prurigo Control Test in 18 Languages
Chronic prurigo (CPG), including prurigo nodularis (PN), is a neuroimmune-inflammatory skin condition characterized by persistent itching and fibrotic lesions. PN commonly affects older adults (>55 years) and imposes substantial disease burden, necessitating effective disease control. Prurigo Control Test (PCT) is the first validated, patient reported, disease control assessment test for PN/ CPG. To ensure broad accessibility and utility, cultural and linguistic adaptation of PCT is essential. We present the first comprehensive translation initiative of PCT into 18 widely spoken languages, beyond its original German and English versions: Arabic/Chinese (Simplified)/ Chinese (Traditional)/Czech/Danish/Dutch/Finnish/ French/Hebrew/Icelandic/Italian/Japanese/Korean/ Norwegian/Portuguese/Spanish/Swedish/Turkish. We followed best translation practices recommen ded by ISPOR, EMA and FDA ‒ conceptual analysis, forward/backward translation, author review, cognitive interviews, proofreading and finalization. The availability of PCT in multiple languages facilitates its global applicability and empowers physicians/caregivers/patients to assess the PN/CPG control using PCT in their preferred language, thereby enhancing implementation of this test across diverse clinical and cultural settings. The goal of translating this academically developed test while ensuring broader demographic representation (ages 18–80, diverse educational and occupational backgrounds) is to facilitate meaningful conversations between physicians and patients and optimize treatment decisions while transcending language barriers. To our knowledge, PCT is the first disease control assessment test specifically designed for PN/CPG to undergo such extensive linguistic adap-tation, contributing to the advancement of global dermatological assessment.
Dupilumab in Difficult-to-treat Chronic Spontaneous Urticaria: A Real-world Multicentre Cohort Study
Chronic spontaneous urticaria (CSU) remains difficult to manage in patients refractory to antihistamines and omalizumab. Although dupilumab has recently been approved and incorporated into international guidelines, real-world evidence remains limited, particularly in treatment-refractory populations. We conducted a multicentre ambispective cohort study across 16 Spanish hospitals including adults with CSU, with or without concomitant chronic inducible urticaria, treated with dupilumab and followed for ≥4 weeks. The primary outcome was well-controlled disease within 24 weeks (Urticaria Control Test ≥12 and Urticaria Activity Score over 7 days≤6). Fiftyone patients were included; 92.0% had previously received omalizumab. At week 24, 69.7% (23/33) achieved well-controlled disease and 39.4% (13/33) complete control. Among patients with available week-52 data, 90.5% (19/21) and 61.9% (13/21), respectively, achieved these outcomes. Concomitant therapy use declined from 94.1% at baseline to 55.6% at week 52. Among omalizumab-experienced patients evaluable at week 24, dupilumab response was lower in prior nonresponders than in those with at least partial response to omalizumab (40% vs 85%, p=0.011). Atopic comorbidities were associated with greater UAS7 reduction (p=0.018). Dupilumab was well tolerated, with mostly mild adverse events. In routine clinical practice, dupilumab provides effective disease control in patients with difficult-totreat CSU, including most omalizumab-experienced individuals.
Psychiatric Risk in Chronic Spontaneous Urticaria: A Retrospective Cohort Study
Chronic spontaneous urticaria (CSU) has been associated with psychiatric comorbidity, but previous studies have often been limited by cross-sectional designs, reverse causation and surveillance bias. We conducted a retrospective matched cohort study using the TriNetX US Collaborative Network to evaluate the risk of incident psychiatric disorders after CSU diagnosis. Adults with newly diagnosed CSU and no prior psychiatric diagnosis were propensity score matched 1 : 1 to non-CSU controls. Outcomes were depression, reaction to severe stress and adjustment disorders, schizophrenia and suicidal ideation or suicide attempts during 3 years of follow-up. After matching, 98,785 individuals were included in each group. CSU was associated with a modestly increased risk of reaction to severe stress and adjustment disorders (hazard ratio 1.15, 95% confidence interval 1.09–1.22), consistent across sensitivity analyses. No consistent increased risk was observed for depression, schizophrenia or suicide-related outcomes. A complementary asso ciation analysis including patients with pre-existing psychiatric disease reproduced previously reported associations with depression and stress-related disorders. These findings suggest that CSU is not broadly associated with incident psychiatric disease but is linked to a small, reproducible increase in stress-related psychiatric morbidity.
Recurrence of Basal Cell Carcinoma across Different Treatment Modalities: A Nationwide Study with 8 Years of Follow-up and Modelled Prediction
Despite the rising incidence of basal cell carcinoma (BCC), few studies have compared treatment outcomes or predicted recurrences using nationwide real-world datasets. Hence, the objective was to investigate and compare recurrence rates of nodular BCC (nBCC) and superficial BCC (sBCC) following treatment with standard excision (SE), curettage, cryotherapy, photodynamic therapy and imiquimod. Additionally, we identified predictors of BCC 2 year recurrence using machine-learning. The study examined BCCs treated in state-funded, office-based dermatology practices registered in the Danish Skin Cancer Registry from 2014 to 2024. A total of 131,119 tumours were included, comprising 100,221 nBCCs and 30,898 sBCCs. For nBCC, the lowest rate of recurrence was observed for SE, with an 8-year cumulative recurrence rate (CRR) of 16.5% (95% confidence interval: 14.4–19.0%) and hazard ratio of 0.80 (0.76–0.84) compared with curettage. For sBCC, both SE and curettage had similarly low 8 year CRRs of 16.3% (12.7–20.8%) and 16.3% (15.2 17.5%), respectively, with no significant difference in hazard. The machine-learning model identified key predictors of BCC recurrence, including facial location, larger tumour size, having a high number of hospital-registered diagnoses and short distance to dermatological clinics. These findings highlight the impact of treatment selection and patient-specific factors in guiding dermatologists towards optimal BCC management.
Resource Use and Cost Comparison of Mohs Micrographic Surgery vs Traditional Surgery for High-risk Facial Basal Cell Carcinoma
High-risk facial basal cell carcinomas are preferably treated with Mohs micrographic surgery, but despite its documented benefits, it remains underused in Sweden. The aim of this study was to evaluate healthcare resource utilization and direct costs for patients with high-risk facial basal cell carcinomas treated with Mohs micrographic surgery compared with traditional surgical excision. In this retrospective registry study, all patients undergoing Mohs micrographic surgery or surgical excision at Sahlgrenska University Hospital between 2020 and 2024 were included, supplemented by regional healthcare data from the Vega registry, to assess long-term healthcare use up to 10 years after primary treatment. Mohs micrographic surgery was associated with higher initial costs than surgical excision but a slower accumulation of costs over time. Patients initially treated with surgical excision who later required Mohs micrographic surgery incurred the highest total costs, often after multiple prior procedures. These findings indicate that although Mohs micrographic surgery is costlier initially, early access prevents the substantial downstream costs associated with treatment failure. Primary Mohs micrographic surgery is a cost-efficient strategy for high-risk facial basal cell carcinomas and should be used more frequently in order to enable better utilization of resources and improved outcomes for the patient.
Chronic Pruritus in Predialysis Chronic Kidney Disease: Prevalence, Phenotype and Temporal Patterns in a Prospective Cohort
CKD-associated pruritus (CKD-aP) is a burden some symptom with incompletely understood pathophysiology and limited predialysis data. In this prospective observational study, 95 adult nondialysis CKD patients (stages G1–G5) were followed for up to 36 months (232 observations), 86 patients were analysed after exclusion of chronic dermatological conditions. Chronic pruritus (≥6 weeks) was assessed using a numerical rating scale (NRS) and anatomical mapping. Chronic pruritus occurred in 26 of 86 patients (30.2%), with numerically higher prevalence in advanced CKD (G3b-5 : 32.8% vs G1-3a: 22.7%), whereas intensity was numerically higher in early CKD (median 8 vs 5). The back, legs and head/ face were most frequently affected, consistent with the bilateral, nondermatomal pattern described in dialysis populations. Among patients with repeated assessments, 19.0% showed an episodic trajectory and 7.6% had persistent pruritus. Multivariable logistic regression and generalized estimating equations (GEE) were used to identify independent predictors of chronic pruritus. No laboratory parameter, including PTH, was independently associated with pruritus. Dyslipidaemia was the only clinical characteristic significantly associated with pruritus status (69.2% vs 43.3%, p=0.035). Given the modest sample size, smaller effect estimates may have been missed. CKD-aP affects approximately 1 in 3 predialysis patients, follows an episodic course, and is not explained by any single biochemical marker, supporting multifactorial pathophysiology.
Psychological Distress, Symptom Burden and Quality of Life in Patients with Mycosis Fungoides and Sézary Syndrome
Mycosis fungoides (MF) and Sézary syndrome (SS) are rare cutaneous lymphomas with limited data on psychological burden. This observational, cross sectional questionnaire study assessed symptom burden, psychological distress and quality of life (QoL) in patients with MF and SS in Western Sweden and compared outcomes with psoriasis. Sixty patients were included, 80% with early-stage disease. Most reported minimal depression, anxiety and QoL impairment. Moderate-to-severe depression occurred in 36% of advanced disease cases and 16% of early disease cases and moderate-to-severe QoL impairment in 33% and 17%, respectively. Pruritus correlated strongly with impaired QoL (ρ=0.67, p<0.001). Fatigue correlated with depression (Montgomery–Åsberg Depression Rating Scale Self-report (MADRS-S): ρ=0.60, Hospital Anxiety and Depression Scale-Depression subscale: ρ=0.63), anxiety (ρ=0.49) and QoL impairment (ρ=0.53), all p<0.001. Compared with psoriasis, patients reported lower pain and QoL impairment. Overall, psychological burden was limited but increased with advanced disease and fatigue severity.
Copyright (c) 2026 Rudy Bittar, Karolina Wojewoda, Martin Gillstedt, Catharina Lewerin, Mikael Alsterholm, Amra Osmancevic https://creativecommons.org/licenses/by/4.0
Persistent SARS-CoV-2 Spike Protein in Vasculitic Skin Lesions after Infection or mRNA Vaccination: A Retrospective Case control Immunofluorescence Study
Vasculitic skin lesions have been reported in association with both SARS-CoV-2 infection and vaccination. Whether viral proteins persist in lesional vessels beyond the acute phase remains unclear. The aim of this study was to investigate the presence of SARS-CoV-2 spike protein in persistent or delayed-onset cutaneous vasculitis temporally associated with COVID-19 infection or vaccination. This retrospective case–control study includes 9 patients with persistent or delayed-onset vasculitic skin lesions following COVID-19 infection (n=4) or mRNA vaccination (n=5). Skin biopsies were analysed using immunofluorescence for SARS-CoV-2 spike protein. Prepandemic leukocytoclastic vasculitis (n=3) and healthy postinfection/postvaccination skin (n=3) served as controls. Spike protein was detected in vascular endothelial cells of all 9 patients with COVID-19- or vaccine-associated vasculitis. Staining was absent in all prepandemic vasculitis and healthy control samples. Histopathology showed typical features of leukocytoclastic vasculitis without evidence of viral cytopathic changes. We found that SARS-CoV-2 spike protein can persist in endothelial cells of vasculitic skin lesions weeks to months after COVID-19 infection or mRNA vaccination. These findings suggest that retained viral proteins may contribute to prolonged or delayed-onset vasculitic skin manifestations. Further studies are needed to clarify the mechanisms underlying spike persistence and its clinical significance.
Clinical Characterization and Outcomes of Dupilumab for Pemphigoid Gestationis: A Case Series of Five Patients and Literature Review
Treatment of pemphigoid gestationis (PG) mainly consists of systemic and potent topical corticosteroids. This retrospective case series describes patients with severe PG treated with dupilumab, including serological follow-up, and reviews all published cases. PG was confirmed by direct immunofluorescence (linear C3 and/or IgG deposition along the basement membrane zone) and serology (IgG epidermal staining on salt-split skin or anti-BP180 NC16A IgG ELISA). Pruritus, quality of life and anti-BP180 NC16A IgG and anti-BP180 NC16A IgE were monitored longitudinally. In 5 pregnant women, dupilumab was initiated with a 600 mg loading dose followed by 300 mg biweekly. Baseline pruritus was severe (NRS 8–10), with high DLQI scores (18–30). Blistering ceased within 1 week in 2 patients and within 4 weeks in 1. Two patients required weekly dosing for disease control. Systemic corticosteroids were discontinued in 3 patients and tapered to ≤10 mg/day in 2 before delivery. In one case, anti-BP180 IgG paralleled clinical improvement. Anti-BP180 IgE remained negative. All patients delivered healthy infants. In 10 reported cases, pruritus improved rapidly and systemic corticosteroids were tapered. These findings suggest dupilumab may be a promising corticosteroid-sparing option for PG, with rapid clinical response and a favourable safety profile, despite off-label use in pregnancy.
Systemic Inflammatory Indexes as Easy-to-Use Markers for Monitoring Psoriasis and Hidradenitis Suppurativa
Copyright (c) 2026 Eugenia Veronica Di Brizzi, Dario Buononato, Alfonso Luca Falco, Elisabetta Fulgione, Stefano Caccavale, Giuseppe Argenziano, Anna Balato https://creativecommons.org/licenses/by-nc/4.0
Chronic Prurigo: Current Knowledge, Treatment Strategies, Future Perspectives, and Unmet Needs
Copyright (c) 2026 Ignasi Figueras, Esther Serra-Baldrich, Sonja Ständer https://creativecommons.org/licenses/by-nc/4.0
High-frequency Ultrasound Reveals Epidermal-dermal Structural Alterations in an Experimental Model of Epidermolysis Bullosa
Copyright (c) 2026 Karl Wallblom, Artur Schmidtchen, Manoj Puthia https://creativecommons.org/licenses/by/4.0
Novel TP63 Mutation (c.1768C>T, p.Pro590Ser) Expands the Phenotypic Spectrum of TP63-related Disorders: Severe Palmoplantar Hyperkeratosis, Ectodermal Dysplasia, and Cutaneous Squamous Cell Carcinoma
Copyright (c) 2026 Xiukuan Xu, Zhimiao Lin, Yayan Lin, Hong Kang, Cuirong Xiao https://creativecommons.org/licenses/by-nc/4.0
X-linked Recessive Ectodysplasin A Mutations Induced Hypohidrotic Ectodermal Dysplasia and Severe Atopic Dermatitis Successfully Treated with Dupilumab
Primary Cutaneous Adult T-cell Leukaemia/Lymphoma Presenting as Generalized Purpura
Non-invasive Analysis of Skin in Recessive Dystrophic Epidermolysis Bullosa Using High-Frequency Ultrasound: A First Case Report
Comfort-based Pain Management for Intralesional Treatment of Pediatric Post-otoplasty Keloids
Subcutaneous Panniculitis-like T-cell Lymphoma with Secondary Haemophagocytic Lymphohistiocytosis Arising at Widespread Tattoo Sites: A Case Report
A Case of Systemic Sarcoidosis Revealed by Tattoo Associated Granuloma and Uveitis
Dermoscopic Findings of a Rare Variant of Elastolytic Giant Cell Granuloma: Papular Form
A Novel Presentation of Mycobacterium haemophilum Cutaneous Infection: A Diagnostic Challenge
Diagnostic Challenges of Neurosyphilis: A Case of Lues Maligna with Neuropsychiatric Symptoms
Patients with Positive Blood Cultures in Cellulitis: A Large Single-centre Study
Case Report Concerning a Varicella Zoster Virus Infection in a Six-year-old Child Receiving Dupilumab for Atopic Dermatitis
Vedolizumab-induced Bullous Pemphigoid: A Case Report with Serological Evidence and Mechanistic Insights
Is Staphylococcus epidermidis Involved in the Etiopathogenesis of Pitted Keratolysis?
A Rare Case of Leprosy in Sweden Mimicking Drug Eruption
Ultrasound-detected Hypervascular Proliferating Trichilemmal Tumour
“Election Nail” – A Nail Providing Electoral Integrity Mechanism
The Use of Artificial Intelligence in Dermatology Systematic Reviews: A Comparative Analysis of Elicit Against Human Reviewers
Successful Treatment of Pityriasis Rubra Pilaris with Upadacitinib: Report of Two Cases
Verruciform Xanthoma of the Prepuce Causing Secondary Phimosis and Urinary Dysfunction
A Case of Transient Nodules with Venous Calcification during Acute Exacerbation of Chronic Kidney Disease
Concurrent Drug-induced Rowell Syndrome and Acute Generalized Exanthematous Pustulosis
Atypical Prurigo Pigmentosa Following Ketogenic Diet: Successful Treatment with Doxycycline and Tofacitinib
Successful Treatment of Crohn Disease and Concomitant Alopecia Totalis with Upadacitinib: Case Report and Systematic Review of the Literature
Infantile Haemangiomas with Minimal or Arrested Growth
Impact of Large Language Model–assisted Differential Diagnosis on Clinical Decision-making in Dermatology: A Feasibility Study Using ChatGPT-5
Successful Treatment of Cutaneous Manifestations of Blau Syndrome with UVA-1 Phototherapy in a Paediatric Patient
Corticosteroid-resistant Terbinafine-induced Acute Generalized Exanthematous Pustulosis: Therapeutic Challenges and Clinical Infection Overlap
A Rare Soft Tissue Presentation of Mixed Histiocytosis with Multiple Disseminated Subcutaneous Masses
Verrucous Venous Malformation Presenting on the Face: A Case Series of Two Patients
A Case of Nonpedal Subcorneal Haematoma Mimicking Melanoma
Magnified Dermoscopy Allows Better Differentiation between Dermal Nevi and Basal Cell Carcinoma
The Candle Spot: An Unreported Sign of SULT2B1-nEDD
Chronic Pain and Pain Tolerance in Psoriasis: A Cross-sectional Study of Three Population-based Cohorts in the Netherlands and Norway
Prior Specific Biologic Use as a Potential Risk Factor for Administration-related Reactions to Ixekizumab after Excipient Modification: A Single-centre Retrospective Study
Bullous Pemphigoid Following IgG/IgA Pemphigus: Possible Involvement of SGLT2 and DPP-4 Inhibitors
Primary Cutaneous Nocardiosis after Dermal Filler Injection: A Case Report and Review of Cosmetic-procedure-associated Nocardiosis
High Self-compassion Despite Elevated Stress and Reduced Quality of Life in Women with Lipoedema
Detection of Circulating Tumour DNA in Plasma during the Treatment of In-transit Melanoma Metastases with Topical Imiquimod
Real-world Clinical Efficacy and Patient-reported Treatment Satisfaction of Nemolizumab Treatment in Prurigo Nodularis
Mycosis Fungoides with Concurrent Squamous Cell Carcinoma in a Young Patient: A Rare Case
Application of IL-17A Inhibitors in Psoriasis Complicated by Multiple Infections – Successful Treatment and Insights from a Case of Psoriasis with HIV and Neurosyphilis
Actinic Folliculitis (Formerly Acne Aestivalis and Mallora Acne): A Report of 18 Patients and Review of the Literature
Effectiveness of Baricitinib in Treating Atopic Dermatitis in Difficult-to-treat Areas: A Retrospective Real-world Study
Fungal Skin Infections in Cutaneous T-cell Lymphoma Patients under Mogamulizumab Treatment
National Learning Objectives in Dermatology and Venereology for the New Swedish Medical Programme
Effective medical education relies on clearly defined learning objectives that foster deep and meaningful learning. This article presents a consensus-driven proposal for national learning objectives in dermatology and venereology within Sweden’s new medical programme qualifying for licensure. The primary aim is to harmonize educational standards across all medical faculties and to establish a common understanding of the expected level of knowledge and competence at the point of medical licensure. Using a structured approach, existing curricula were analysed and categorized according to a modified version of Bloom’s taxonomy. The initial list of objectives and core conditions was then expanded through input from invited educators at all participating medical faculties as well as practising GPs. One designated assessor from each institution independently reviewed the expanded material to determine the expected knowledge level for each condition and to assess whether any items fell outside the intended scope. This process resulted in the identification of 36 learning objectives, along with a list of 124 core diagnoses and/or medications. The learning objectives encompass knowledge, practical skills, and professional attitudes in the management of dermatological and sexually transmitted diseases. The next step is to implement them with the aim of evaluating their impact on dermatology and venereology education. In this future work, student involvement should be prioritized to ensure a learner-centred approach throughout the process.
Copyright (c) 2026 Sam Polesie, John Paoli, Kari Nielsen, Andreas Sonesson, Alexander Shayesteh, Anna Josefson, Charlotta Enerbäck, Emma K. Johansson, Torborg Hoppe https://creativecommons.org/licenses/by/4.0
Health-related Quality of Life Measurements in Patients with Actinic Keratosis: A Systematic Review
Actinic keratosis is a common, chronic, and potentially pre-cancerous skin disease that can negatively impact patients’ health-related quality of life. This systematic review aimed to identify and describe the questionnaires used to assess health-related quality of life in patients with actinic keratosis and summarize reported impacts. Four databases (EMBASE, PsycINFO, PubMed, and Cochrane Library) were searched up to February 2025. Two reviewers independently screened articles, and risk of bias was assessed using tools appropriate to study design. Of 639 records, 37 studies including 9,326 patients met inclusion criteria. Most studies were interventional (59%) and of moderate to high quality (64%). Health-related quality of life was assessed using 3 disease-specific, 3 dermatology-specific, and 2 generic questionnaires. The most frequently used instruments were the Actinic Keratosis Quality of Life (n = 13) and the Dermatology Life Quality Index (n = 16). All questionnaires detected health-related quality of life impairment, especially during treatment. Actinic Keratosis Quality of Life identified patient subgroups with greater health-related quality of life reduction, including females, younger individuals, patients with comorbidities, and those with a history of skin cancer. All health-related quality of life questionnaires captured impairment in patients with actinic keratosis. The Actinic Keratosis Quality of Life and Dermatology Life Quality Index questionnaires were widely used. Actinic Keratosis Quality of Life identified subpopulations with health-related quality of life impairment. Among studies reporting mean health-related quality of life scores, the Dermatology Life Quality Index ranged from 1.55 to 24 and the Actinic Keratosis Quality of Life from 4.22 to 17, reflecting very broad variability and underlying differences in actinic keratosis severity across study populations.
Copyright (c) 2026 Zohra F. Ahmadzay, Mattias A.S. Henning, Gregor B.E. Jemec, Gabrielle R. Vinding https://creativecommons.org/licenses/by/4.0
Effects of Psychological Interventions on Itch, Scratching, and Excoriations: A Systematic Review and Meta-analysis
Psychological interventions reduce itch in patients with skin diseases. However, previous systematic reviews and meta-analyses did not include patients with non-skin-related chronic itch and did not consider excoriations as outcome. This study therefore summarized randomized controlled trials investigating effects of psychological interventions on itch, scratching, and excoriations in patients with chronic itch due to all causes. A systematic literature search was conducted. A random effects model was used to aggregate between-group effect sizes. It was found that 17 of the 20 trials included patients with atopic dermatitis. Small to large post-treatment and follow-up effects were observed on self-rated itch intensity (post-treatment: k = 12, g = –0.37 [–0.60; –0.15]; follow-up: k = 6; g = –0.59 [–0.97; –0.21]), externally rated excoriations (post-treatment: k = 6, g = –0.29 [–0.49; –0.09]; follow-up: k = 6; g = –0.34 [–0.53; –0.15]), and self-rated scratching intensity (post-treatment: k = 2, g = –0.99 [–1.35; –0.63]; follow-up: k = 2; g = –0.85 [–1.22; –0.48]). Small post-treatment effects were observed on self-rated itch frequency (k = 3, g = –0.22 [–0.40; –0.04]). Thus, psychological interventions show promise in reducing not only itch and scratching, but also excoriations, with effects lasting up to 1 year.
Copyright (c) 2026 Christina Schut, Johanna Munz, Frederic Maas genannt Bermpohl, Antoinette I.M. van Laarhoven, Jennifer Schmidt, Andrea W.M. Evers, Jörg Kupfer https://creativecommons.org/licenses/by-nc/4.0
Exploring the Impact of Fatigue and Sleep Disturbance in Hidradenitis Suppurativa: Perspectives from Patients and Healthcare Professionals
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects physical, social and emotional aspects of life for people living with HS (plwHS). Although many plwHS consider pain the most bothersome symptom, fatigue and sleep disturbance are underexplored in research and rarely discussed in clinical practice. This article shares perspectives from plwHS and people working with patients, including healthcare professionals (HCPs), from Europe and North America, on the impact of HS-related fatigue and sleep disturbance on quality of life (QoL). Fatigue was described as a debilitating symptom affecting QoL, with HCPs often noting that plwHS were unaware of the full impact of fatigue until treatment improved their HS symptoms. Sleep disturbance was mainly attributed to HS-related pain, pruritus and lesion drainage, with sleep deficits accumulating over time. The strain of HS impacted personal relationships, with plwHS expressing less interest in social interactions or intimate relationships, leading to feelings of guilt, failure, isolation and reduced self-esteem. Fatigue and sleep disturbance also affected work productivity, and consequently, career progression and financial stability. Recognizing the multifaceted HS symptoms, providing reasonable adjustments in the workplace, encouraging open dialogue with HCPs and measuring fatigue with a validated instrument could help improve QoL of plwHS.
Pregnancy in Women with Atopic Dermatitis: A Systematic Review of Concerns and Challenges
Atopic dermatitis (AD) has negative individual and societal implications. However, the potential impact of ADatopic dermatitis on reproduction has only been sporadically investigated. We aimed to provide an overview of pregnancy in ADatopic dermatitis, with a specific focus on concerns, challenges, the number of children, and adverse pregnancy and birth outcomes. A systematic literature search was performed using EMBASE and PubMed up until 19th January 2026 for original articles in relation to reproduction in female ADatopic dermatitis. Twenty-four highly heterogeneous studies were included. Concerns about ADatopic dermatitis in relation to pregnancy and family planning were reported in >50% of the patients in three3 out of four4 studies. Conflicting results were seen regarding fertility and disease severity during pregnancy. Pregnancy rates were similar or increased based on two2 studies. Eleven studies addressed adverse pregnancy and birth outcomes, of which five5 studies unanimously reported a protective or indifferent effect of ADatopic dermatitis on pre-term birth, gestational diabetes and stillbirth. Outcomes such as gestational hypertension, preeclampsia and miscarriage showed divergent results. Overall, ADatopic dermatitis causes considerable worries in relation to family planning. However, this review implies, that pregnancy rates as well as complications in pregnancy and during childbirth in women with ADatopic dermatitis overall are consistent with women without ADatopic dermatitis.
Atopic Dermatitis Across the Lifespan: Understanding, Measuring and Minimizing Cumulative Life Course Impairment
Atopic dermatitis (AD) presents a multidimensional burden, often beginning in infancy and accumulating over time. Beyond itch and pain, AD is associated with significant losses of health-related quality of life resulting from sleep disturbance, stigmatization, other atopic diseases and nonatopic comorbidities, among others. These associated conditions affect patients' physical and mental health, development, social interaction and productivity, resulting in what has been termed cumulative life course impairment (CLCI). To alter the trajectory of AD and improve patient outcomes, it is important to identify people at risk of CLCI, measure it in clinical practice and intervene with appropriate treatment. Although a digital, structured questionnaire for adults exists, a separate instrument to assess CLCI in children and adolescents would benefit our understanding of these issues in a patient population in need. This paper discusses the need for such a questionnaire, with the goal of increasing awareness of the lifelong impact of AD among healthcare professionals, caregivers and patients, potentially improving shared decision-making and facilitating conversations about treatment.
Recurrent Cutaneous Eosinophilic Vasculitis: A Systematic Review of Clinicopathologic Features and Treatment Outcomes
Recurrent cutaneous eosinophilic vasculitis is a rare, predominantly cutaneous vasculitis described mainly in isolated reports. We aimed to systematically synthesize published evidence on its clinico-pathological features, treatment and outcomes. We reviewed case reports and case series of recurrent cutaneous eosinophilic vasculitis and related entities identified in PubMed, Scopus and reference lists (last searched 16 February 2026), using structured report and case-level extraction, duplicate handling, Joanna Briggs Institute critical appraisal and descriptive synthesis. Twenty reports comprising 24 unique cases were included. Most patients presented with relapsing pruritic purpura of the lower extremities. Peripheral eosinophilia was frequent, antineutrophil cytoplasmic antibodies were negative in all reported cases and histopathology consistently showed eosinophil-rich vasculitis, usually with fibrinoid and/or necrotizing change. Systemic corticosteroids often induced improvement, but relapse during tapering or after withdrawal was common. The evidence was limited by small, heterogeneous reports and incomplete follow-up. Overall, the findings support a recognizable cutaneous-predominant, relapse-prone pattern, highlight the importance of assessing extracutaneous involvement in differential diagnosis and support provisional refinement of the previously proposed diagnostic framework.
Aspects of Adverse Effects of Cosmetic Products: An Invited Narrative Review
The use of cosmetic products is ubiquitous around the world. This article reviews the medical literature documenting adverse effects associated with cosmetic product use. An extensive, nonexhaustive literature search was conducted using the PubMed database. Studies reporting adverse effects from cosmetic products were included, encompassing case reports, case series, clinical trials and epidemiological studies. Contact dermatitis is the most common adverse effect associated with cosmetic use, affecting approximately 1–5% of the general population. Additional effects, including respiratory sensitization, photosensitization, workplace exposures and issues specific to pregnancy/lactation, are discussed. The clinical significance of these effects remains poorly understood, particularly regarding long-term exposure and cumulative health impacts. Cosmetic usage can result in a spectrum of adverse effects that represent significant clinical and public health concerns.
A Systematic Literature Review on Methotrexate Hepatotoxicity in Psoriasis Management: Preconceived Notion or Real Threat?
Methotrexate (MTX) is a widely used, cost-effective systemic treatment for moderate-to-severe psoriasis, but concerns about hepatotoxicity often limit its long-term use. Hepatic adverse effects range from transient enzyme elevations to fibrosis and cirrhosis. Despite established guidelines, monitoring practices remain inconsistent, and the mechanisms underlying MTX-induced hepatotoxicity in psoriasis patients are not fully elucidated. This systematic literature review evaluates the association between MTX and hepatotoxicity, identifies key risk factors, assesses monitoring strategies and addresses misconceptions about its hepatic safety. A comprehensive search of MEDLINE/PubMed, EMBASE, Cochrane Library and grey literature (2003–2024) included English and French studies on human subjects, encompassing guidelines, reviews and observational/interventional studies. MTX-related hepatotoxicity is multifactorial, with risk factors including obesity, diabetes, hyperlipidaemia, excessive alcohol consumption and pre-existing liver disease. Psoriasis itself may also contribute to liver dysfunction. There is no consensus on optimal monitoring frequency for liver function tests or the role of noninvasive tools like transient elastography. While folic acid supplementation may mitigate risk, dosing remains inconsistent.Though MTX carries a potential hepatotoxic risk, this is patient-specific rather than inherent to the drug. Standardized monitoring protocols and risk stratification are essential to optimize safety, prevent unnecessary treatment discontinuation and improve long-term psoriasis management.
The Role of RCM and LC-OCT in Genodermatoses Associated with Skin Cancer: A Narrative Review
Patients with genodermatoses, such as nevoid basal cell carcinoma syndrome, recessive dystrophic epidermolysis bullosa, familial atypical multiple mole and melanoma syndrome, xeroderma pigmentosum and ichthyosis with confetti, face a high risk of skin malignancies. While dermoscopy significantly improves diagnostic accuracy compared to clinical examination, its specificity remains limited when evaluating ambiguous lesions in these complex patients. This narrative review examines the role of reflectance confocal microscopy and line-field confocal optical coherence tomography in high-risk populations. By enabling the in vivo visualization of histologic-like features at cellular resolution, these noninvasive imaging technologies overcome the limitations of dermoscopy. The analysis of illustrative cases demonstrates that integrating these tools enhances both sensitivity and specificity, allowing for a precise differentiation between true malignancies and benign mimics. While reflectance confocal microscopy remains the standard for melanocytic criteria, line-field confocal optical coherence tomography complements it by overcoming depth limitations. Consequently, the use of combined noninvasive imaging supports a more conservative management strategy, potentially reducing the number of unnecessary excisions while ensuring the timely detection of skin cancer in patients with rare genetic syndromes.
Summer Thigh Eruption: An Unusual Case of Localized Dermatitis: A Quiz
Desmoplastic Melanocytic Naevus in a Paediatric Patient: Dermoscopical and Histopathological Findings of a Rare Entity: An Overlooked Diagnosis or a Misnomer?
Unilateral Blaschkolinear Agminated Pigmented Lesion in an 11-year-old Girl: A Quiz
An Elderly Man with Fever and a Pustular Eruption: A Quiz
A Wagyu Beef-like Appearance of Hyperpigmentation: A Quiz
Multiple Oral White Papules in a 3-year-old Girl: A Quiz
Nasal Plaque with Central Eschar in an Infant: A Quiz
Purplish-brown Patches and Ecchymoses on the Dorsal Hands: A Quiz
Red-yellow Papules and Nodules All over the Body: A Quiz
Innumerable Yellow Papules Predominantly Involving the Forehead: A Quiz
Swelling of the Left Upper Limb with Red Papules, Necrosis and Crusting: A Quiz
Polymorphic Skin Rash and Fatigue in a Patient with Diabetes Mellitus: A Quiz
Painful Destructive Plaques of the Face and Scalp: A Quiz
Two Painful Occipital Nodules in a Child Returning from South America: A Quiz
Widespread Erythematous Vesiculobullea: A Quiz
A Congenital Subcutaneous Tumour of the Scalp in a Child: A Quiz
An 8-year-old Girl with Multiple Whitish Dots on the Hair Shaft: A Quiz
A Facial Lesion with Cord-like Induration and Ring-like Appearance on MRI: A Quiz
Erythematous Nodules and Plaques on the Neck: A Quiz
Serum IL-13 and IL-31 Levels are not Attenuated upon Dupilumab Treatment: Lessons from a Prospective Cohort
Patient-reported Itch Outcome Measures for Chronic Pruritus in Dystrophic Epidermolysis Bullosa: Exploratory Analysis of a Phase 2 Randomized Controlled Trial
Low Subcutaneous Adipose Tissue is Associated with Poor Prognosis for Aged Patients with Cutaneous Angiosarcoma: A Retrospective Cohort Study
Clinically Meaningful Improvement in Atopic Dermatitis According to Treatment Type in a Real-World Cohort
Line-field Confocal Optical Coherence Tomography Detects Subclinical Disease Activity in Atopic Dermatitis during Treatment with Pimecrolimus: An Intrapatient, Controlled Study
Solitary Oral Progression in a Well-controlled Sézary Syndrome
Acral Intravascular Papillary Endothelial Hyperplasia Mimicking Melanoma on Dermoscopy
A Small Series of Large Congenital Nevi: Clinical and Dermoscopic Follow-up
Body Image Satisfaction among Patients with Female Acne
Severe Ulceronecrotic Evolution during Mogamulizumab Treatment in a Patient with Primary Cutaneous Peripheral T-cell Lymphoma
The Seasonal Trend of Brittle Nails: A Google Trends Analysis of English-speaking Countries
Reconsidering Efficacy and Safety: A Critical Appraisal of Repurposing Anti-inflammatory Targeted Drugs in Darier disease
A Little Finger with Long-standing Blue Discolouration and Nail Dystrophy
Cutis Marmorata Telangiectatica Congenita: An Atypical Clinical Presentation of Vascular Anomalies
Glucagon-Like Peptide-1 Receptor Agonists as a Potential Mitochondrial Modulation Therapy for Hidradenitis Suppurativa
Reported Pregnancy Outcomes after Biologic Therapy Exposure in Hidradenitis Suppurativa: A Systematic Review of Published Cases
Real-world Outcomes of Adalimumab in Hidradenitis Suppurativa: A 10-year Retrospective Longitudinal Study
Evaluation of Clinicians’ Knowledge of Terbinafine-resistant Extensive Dermatophytosis in France
A Postzygotic TRPM4 Variant in a Patient with Inflammatory Linear Verrucous Epidermal Nevus
Erratum: Inhibitory Effect of 505 nm Green Light Emitting Diode on Melanin Synthesis in Cellular Experiments and a Human Intervention Study
Commentary on "Prevalence of Central Sensitization in Notalgia Paresthetica Patients and Its Association with Vertebral Degeneration: A Cross-sectional Study"
Commentary on: "The Effects of Sun Exposure and Pigmentation Phenotype on Prognosis in Metastatic Melanoma"
Corrigendum: Does Teledermatology Enable Earlier Diagnosis of Cutaneous Squamous Cell Carcinoma Than Face-to-face Consultation?
Corrigendum to https://doi.org/10.2340/actadv.v105.44362