OBJECTIVE: Basal cell carcinoma (BCC) is characterized by slow growth and a low malignant potential. Recently, active surveillance (AS) has gained attention as an alternative management option for BCC patients. This stud...OBJECTIVE: Basal cell carcinoma (BCC) is characterized by slow growth and a low malignant potential. Recently, active surveillance (AS) has gained attention as an alternative management option for BCC patients. This study aimed to explore the experiences of patients and their proxies with AS. METHODS: An interview study was conducted involving 15 patients who previously chose AS for one or more BCC and 12 accompanying proxies. Patients from two hospitals (Radboud University Medical Center, Nijmegen, the Netherlands, and University Hospital Ghent, Belgium) were included. RESULTS: Five themes emerged: reasons for choosing AS, experiences during AS, reasons for continuation or discontinuation, needs and barriers, and proxies' experiences. Overall, the experience with AS was positive, with minimal impact on daily life. Negative experiences included the follow-up burden and BCC symptoms. Patient's needs included clear communication about the nature of BCC and proactive discussion of AS by the healthcare provider. Impact on the proxies was limited, but they played a valuable supportive role in decision-making and follow-up. CONCLUSIONS: The experiences of patients and proxies indicate that AS is a valuable option for BCC, particularly for older patients and/or patients experiencing cumulative treatment burden. The need for dermatologists to proactively discuss AS was highlighted.
BACKGROUND: Acne vulgaris (AV) is an inflammatory disorder of the pilosebaceous unit commonly managed with systemic antibiotics. Since antibiotics are known triggers of severe cutaneous adverse drug reaction (SCARs), pat...BACKGROUND: Acne vulgaris (AV) is an inflammatory disorder of the pilosebaceous unit commonly managed with systemic antibiotics. Since antibiotics are known triggers of severe cutaneous adverse drug reaction (SCARs), patients with AV receiving prolonged antibiotics are at potential risk. This study aims to describe reported cases of SCARs occurring among AV patients treated with systemic antibiotics. METHODS: A literature search was conducted in November 2025 using PubMed, Web of Science, ClinicalKey, Ovid and Cochrane library. Eligible studies included reports of AV patients who developed SCARs in association with systemic antibiotic treatment. RESULTS: Twenty-eight articles (27 reports, 1 case series) were identified, encompassing a total of 31 patients with SCARs. Tetracycline class was the most frequently implicated antibiotic, with a mean latency period of approximately 4 weeks. Drug reaction with eosinophilia and systemic symptoms (DRESS) was reported in 24 cases, Stevens-Johnson syndrome (SJS) in 5 cases and acute generalized exanthematous pustulosis (AGEP) in 2 cases. Three patients died, and five developed long-term complications. CONCLUSION: Although rare, SCARs may occur in AV patients receiving systemic antibiotics. Clinicians should maintain a high index of suspicion during therapy, ensure regular follow-up, and counsel patients on early recognition of skin reactions to mitigate potential risks.
OBJECTIVES: To evaluate the efficacy of intralesional human papillomavirus (HPV) vaccination in the management of cutaneous warts. METHODS: A comprehensive search of PubMed, MEDLINE, Embase, Scopus, and ClinicalTrials.go...OBJECTIVES: To evaluate the efficacy of intralesional human papillomavirus (HPV) vaccination in the management of cutaneous warts. METHODS: A comprehensive search of PubMed, MEDLINE, Embase, Scopus, and ClinicalTrials.gov was conducted in accordance with a registered PROSPERO protocol (CRD420251170324). Chronic or persistent warts were defined as lesions lasting more than six months or showing inadequate response to conventional therapies. The primary outcome was complete wart clearance, and pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: Six studies were included. Intralesional HPV vaccination was associated with a significantly higher rate of complete clearance compared with intralesional normal saline (RR 18.54; 95% CI 6.59-52.18). Subgroup analyses demonstrated comparable efficacy between bivalent and quadrivalent vaccines. Reported adverse events were mild and localized. CONCLUSION: Intralesional HPV vaccination demonstrated significant therapeutic efficacy in the treatment of cutaneous warts and represents a promising immunotherapeutic option for patients with persistent or treatment-refractory disease.
BACKGROUND: The efficacy of interleukin-17 inhibitors may be impacted by baseline psoriasis features. OBJECTIVE: This analysis aimed to explore the efficacy of vunakizumab in patients with moderate-to-severe plaque psor...BACKGROUND: The efficacy of interleukin-17 inhibitors may be impacted by baseline psoriasis features. OBJECTIVE: This analysis aimed to explore the efficacy of vunakizumab in patients with moderate-to-severe plaque psoriasis stratified by diverse disease features. METHODS: This post hoc analysis used data from a phase III trial (NCT04839016); 690 patients with moderate-to-severe plaque psoriasis receiving vunakizumab ( = 461) or placebo ( = 229) were included. RESULTS: The proportions of patients achieving Psoriasis Area and Severity Index (PASI) 75, PASI 90, PASI 100, and static physician's global assessment (sPGA) 0/1 responses at week (W)12 were significantly higher in the vunakizumab group than in the placebo group, regardless of the duration of psoriasis, PASI score, body surface area (BSA) involvement, and sPGA score. Similarly, at W4 and W8, treatment response rates were higher in the vunakizumab group than in the placebo group, regardless of the above-mentioned features. The same trend was also found at W24. However, treatment responses at W52 were almost not different between patients continuously receiving vunakizumab and those switching from placebo to vunakizumab, regardless of disease duration and disease severity. CONCLUSION: Vunakizumab shows satisfactory efficacy in patients with moderate-to-severe plaque psoriasis, regardless of psoriasis duration and severity.
OBJECTIVES: Abrocitinib is approved for moderate-to-severe atopic dermatitis (AD); however, real-world data evaluating its efficacy in AD control using multidimensional-treatment-targets like optimal-disease-control (ODC...OBJECTIVES: Abrocitinib is approved for moderate-to-severe atopic dermatitis (AD); however, real-world data evaluating its efficacy in AD control using multidimensional-treatment-targets like optimal-disease-control (ODC) and moderate-disease-control (MDC) remain limited. This study aimed to assess the proportion of patients with moderate-to-severe AD achieving ODC and MDC during abrocitinib-treatment and to explore associated factors. MATERIALS AND METHODS: Retrospective multicentric study including patients with moderate-to-severe AD receiving abrocitinib across five hospitals. Disease severity was assessed using clinician-reported-outcomes (EASI, SCORAD, IGA, BSA) and patient-reported-outcomes (peak-pruritus and sleep-disturbance NRS) at baseline and follow-ups. ODC and MDC were defined according to consensus-based criteria, integrating clinician- and patient-reported outcomes. RESULTS: Fifty-four patients were included (35.1 years; 68.5% men; baseline EASI 25.7 and peak-pruritus NRS 7.5). At final visit (variable follow-up across patients; mean 20.9 weeks), EASI and peak-pruritus NRS decreased to 8.7 and 3.3, respectively. ODC was achieved by 43.8% of patients and MDC by 59.4%. ODC was associated with lower baseline BSA and SCORAD, lower prevalence of allergic conjunctivitis, fewer prior systemic treatments, and less frequent facial involvement. CONCLUSIONS: In real-world practice, a substantial proportion of patients treated with abrocitinib achieved ODC and MDC. Lower baseline severity and fewer prior systemic therapies were associated with ODC.
OBJECTIVE: To evaluate the concordance between artificial intelligence (AI)-recommended and dermatologist-selected treatments in real-world psoriasis care. METHODS: Eighty-two patients with psoriasis were included in thi...OBJECTIVE: To evaluate the concordance between artificial intelligence (AI)-recommended and dermatologist-selected treatments in real-world psoriasis care. METHODS: Eighty-two patients with psoriasis were included in this study. An AI model (ChatGPT) was provided along with treatment guidelines and clinical trial data to generate treatment recommendations. The concordance was assessed for systemic therapy indications ( = 73) and drug selection ( = 58). Clinical outcomes were evaluated using Psoriasis Area and Severity Index (PASI) 75 and 90 responses. RESULTS: Among 43 patients treated with biologics or deucravacitinib, the PASI 75 and 90 response rates at week 48 exceeded 90% and 80%, respectively. Concordance for systemic therapy indication was 79.5% (95% CI, 68.7-87.6%) overall and 89.4% (95% CI, 76.9-96.5%) among patients with PASI ≥5. For drug selection, concordance was 46.6% (95% CI, 33.7-59.8%) within the top three and 62.1% (95% CI, 48.5-74.5%) within the top five recommendations. Binary κ values were 0.41 and 0.58, and weighted κ values were 0.52 and 0.68 for the top three and top five recommendations, respectively, indicating moderate-to-good agreement. CONCLUSION: AI showed moderate-to-good concordance in determining systemic therapy indications and drug selection. These findings highlight the potential of AI in supporting treatment decisions for psoriasis.
OBJECTIVE: To compare efficacy, recovery, pigmentary safety, and patient-reported outcomes of radiofrequency microneedling (RFMN) and fractional carbon dioxide laser (FCO) for facial atrophic acne scars. METHODS: In this...OBJECTIVE: To compare efficacy, recovery, pigmentary safety, and patient-reported outcomes of radiofrequency microneedling (RFMN) and fractional carbon dioxide laser (FCO) for facial atrophic acne scars. METHODS: In this prospective, randomized, split-face, evaluator-blinded exploratory trial, 33 patients were enrolled, and 30 completed the study. Each facial side was assigned to RFMN or FCO. Three treatment sessions were performed at 8-week intervals. The primary endpoint was the change in Echelle d'Evaluation Clinique des Cicatrices d'Acné (ECCA) score. Secondary outcomes included physician-rated improvement, satisfaction, Dermatology Life Quality Index, pain, recovery-related outcomes, and adverse events. RESULTS: Both modalities significantly improved acne scars over time. Mean ECCA scores decreased from 54.73 to 30.53 with RFMN and from 53.67 to 31.03 with FCO, without a significant between-treatment difference. Physician-rated improvement was comparable. RFMN showed higher efficacy satisfaction after the first session and higher safety satisfaction at all follow-up assessments. RFMN was associated with shorter erythema, pain, swelling, and scab-detachment durations and fewer post-inflammatory hyperpigmentation events. CONCLUSIONS: Both treatments improved facial atrophic acne scars in this exploratory split-face sample. RFMN offered faster recovery, fewer pigmentary events, and higher safety satisfaction.
Blauvelt A, Draelos ZD, Gold LS
… +17 more, Alonso-Llamazares J, Bhatia N, DuBois J, Forman SB, Gooderham M, Green L, Guenthner ST, Hebert AA, Lain E, Moore AY, Papp KA, Zirwas M, Kato S, Snyder S, Krupa D, Burnett P, Berk DR
Simpson E, Eichenfield LF, Papp KA
… +16 more, Forman SB, Hebert AA, Gonzalez ME, Gooderham MJ, Hong HC, Prajapati VH, Guttman-Yassky E, Silverberg JI, Seal MS, Krupa D, Almaraz E, Hanna D, Burnett P, Snyder S, Higham RC, Berk DR
BACKGROUND: Melasma shows clinical heterogeneity, but the role of vascular components in treatment resistance remains unclear. METHODS: This retrospective cohort study included 75 melasma patients stratified by severity...BACKGROUND: Melasma shows clinical heterogeneity, but the role of vascular components in treatment resistance remains unclear. METHODS: This retrospective cohort study included 75 melasma patients stratified by severity (mild/moderate/severe, = 25 each) and classified into pure pigmentary (M-type, = 42) and mixed pigmentary-vascular (M + V-type, = 33). All received low-fluence Q-switched 1064 nm laser plus oral tranexamic acid. Primary outcome was modified Melasma Area and Severity Index (mMASI) reduction. Multiple regression and interactionanalyses were performed. RESULTS: M-type showed significantly higher mMASI reduction than M + V-type ( < 0.001). Treatment resistance rate was markedly higher in M + V-type ( < 0.001). M + V-type, diseaseduration ≥5 years, and severe disease were independent negative predictors. A significantclinical type × severity interaction was detected ( = 0.018), with the M + V effect most pronounced in severe patients. CONCLUSION: Mixed pigmentary-vascular type is independently associated with poor response, aggravated by severe disease. For severe M + V-type, adjunctive anti-vascular or anti-inflammatory strategies may be warranted.
BACKGROUND: Photodynamic therapy (PDT) is an effective treatment for port-wine stains (PWS). However, the relationship between the diameter of malformed capillaries and the efficacy of PDT in PWS has been rarely studied....BACKGROUND: Photodynamic therapy (PDT) is an effective treatment for port-wine stains (PWS). However, the relationship between the diameter of malformed capillaries and the efficacy of PDT in PWS has been rarely studied. OBJECTIVE: This study aimed to investigate the relationship between the diameter of malformed capillaries and the efficacy of PDT in PWS. METHODS: Dermoscopy and capillaroscopy images were obtained before the first treatment to assess the capillary patterns and diameters of malformation capillaries in PWS, respectively. VISIA images were captured before treatment and two months after the second PDT session to evaluate treatment efficacy. RESULTS: Forty-seven patients were included in this study. Univariate analysis indicated that lesion location, prior treatment history, and capillary pattern influenced the outcomes of facial PWS after two PDT sessions. However, no significant differences were observed among patients with varying capillary diameters. Logistic regression analysis confirmed that capillary pattern and lesion location were significant factors affecting the efficacy of PDT, whereas capillary diameter was not. CONCLUSION: In this study, no significant correlation was observed between the responses of facial PWS to PDT and the varying vascular diameters. However, a significant correlation was observed between PDT efficacy and the capillary pattern or lesion location.
OBJECTIVES: Structured benefit-risk assessments evaluate multiple patient-relevant endpoints simultaneously, weighing therapeutic benefits against risks, enabling healthcare professionals and patients to select the most...OBJECTIVES: Structured benefit-risk assessments evaluate multiple patient-relevant endpoints simultaneously, weighing therapeutic benefits against risks, enabling healthcare professionals and patients to select the most suitable treatment. Such assessments evaluating therapeutic options for atopic dermatitis (AD) have not yet been published. We performed a structured benefit-risk assessment based on multicriteria decision analysis, using data from the 24-week Heads Up trial comparing dupilumab versus upadacitinib in adults with moderate-to-severe AD. METHODS: A benefit-risk score (0-100) measured overall performance of both treatments as the weighted sum of values of outcomes selected from an independent patient preference study identified during a literature search. RESULTS: Using efficacy and safety data up to week 24, the benefit-risk score for dupilumab was 66, compared with 61 for upadacitinib. A sensitivity analysis varying the total weight assigned to benefits showed that the overall benefit-risk score of dupilumab was consistently higher than that of upadacitinib. Another sensitivity analysis, using week 16 data, showed that dupilumab and upadacitinib had the same overall benefit-risk score of 65. CONCLUSIONS: This benefit-risk assessment using 24-week Heads Up trial data considered all key benefits and risks and demonstrated a higher benefit-risk score for dupilumab than upadacitinib.
AIM OF THE REVIEW: Psoriasis is increasingly recognized as a systemic inflammatory disease frequently associated with a cluster of cardiometabolic comorbidities, including obesity, type 2 diabetes, and cardiovascular dis...AIM OF THE REVIEW: Psoriasis is increasingly recognized as a systemic inflammatory disease frequently associated with a cluster of cardiometabolic comorbidities, including obesity, type 2 diabetes, and cardiovascular disease. Central to this association is the interleukin-17 (IL-17) signaling axis, a key driver of both cutaneous inflammation and systemic metabolic dysfunction. MATERIALS AND METHODS: This review examines the complex immunometabolic interactions mediated by IL-17 and synergistic cytokines such as TNF‑α, IL‑6, IL‑1β, IL‑23, and adipokines, which contribute to endothelial dysfunction, insulin resistance, and adipose-tissue inflammation. RESULTS: Beyond its established role in psoriasis pathogenesis, the IL-17 pathway is implicated in the 'psoriatic march,' linking chronic skin inflammation to accelerated atherosclerosis. The advent of IL-17 inhibitors has transformed the management of moderate-to-severe psoriasis, achieving unprecedented skin clearance (PASI 90/100). Emerging evidence suggests that these agents may also exert potential beneficial effects on selected inflammatory and cardiometabolic markers. However, their direct impact on metabolic parameters remains under investigation. CONCLUSION: Understanding these shared molecular pathways is essential for adopting a holistic therapeutic approach that addresses both cutaneous disease and the systemic burden of psoriatic patients.
OBJECTIVES: Atopic dermatitis is a chronic inflammatory skin disorder characterized by epidermal barrier dysfunction, microbial dysbiosis, and dysregulated immune signaling. colonization is associated with disease sever...OBJECTIVES: Atopic dermatitis is a chronic inflammatory skin disorder characterized by epidermal barrier dysfunction, microbial dysbiosis, and dysregulated immune signaling. colonization is associated with disease severity and contributes to inflammatory amplification, with IL-36 serving as a marker of epithelial stress. Polyhexanide is a cationic polymer delivered in topical formulations. GX03 is a novel extended-release topical formulation designed to provide sustained delivery of liquid polyhexanide at the skin surface. This study evaluated whether GX03 reduces disease severity in a murine model of -induced cutaneous inflammation characterized by IL-36 expression. METHODS: Skin inflammation was induced using a standardized exposure protocol, with confirmation of IL-36 protein expression. Animals were treated topically with GX03 or left untreated. Disease severity was assessed with blinded investigator global assessment scoring using the validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD). RESULTS: Epicutaneous exposure produced reproducible inflammatory disease with consistent IL-36 expression. Treatment with GX03 resulted in a significant reduction in disease severity, with mean global assessment scores decreasing from 3.00 in untreated controls to 1.44 in treated animals (52% reduction; = 0.0003). CONCLUSIONS: These findings suggest that extended-release topical polyhexanide (GX03) reduces disease severity in a murine dermatitis model characterized by IL-36 expression.
INTRODUCTION: Psoriasis is a chronic immune-mediated inflammatory dermatosis associated with systemic comorbidities, including metabolic disorders, atherosclerosis, and increased cardiovascular mortality. OBJECTIVES: To...INTRODUCTION: Psoriasis is a chronic immune-mediated inflammatory dermatosis associated with systemic comorbidities, including metabolic disorders, atherosclerosis, and increased cardiovascular mortality. OBJECTIVES: To evaluate the impact of methotrexate (MTX) on clinical manifestations of psoriasis, lipid profile, endothelial function, nitric oxide bioavailability, and pro-inflammatory biomarkers. METHODS: This prospective, open-label pilot study assessed patients before and after 12 weeks of MTX therapy (15 mg/week). Endothelial function was evaluated by flow-mediated dilation (FMD1 and FMD2). Nitric oxide bioavailability was estimated by nitrate and nitrite (NOx) levels. Pro-inflammatory biomarkers analyzed included gasdermin D (GSDMD), interleukin-1β (IL-1β), NLRP3 inflammasome, LOX-1 receptor, and VCAM-1. Clinical outcomes (PASI, BSA, DLQI) and laboratory parameters were also assessed. RESULTS: Among 242 screened patients, 29 completed the study. After 12 weeks, significant clinical improvement was observed (PASI, BSA, DLQI; < 0.001), along with reductions in LDL, total cholesterol, and non-HDL cholesterol ( ≤ 0.024). No significant changes were found in endothelial function, NOx levels, or inflammatory biomarkers. CONCLUSION: MTX improved psoriasis severity and lipid profile without affecting endothelial function or inflammatory biomarkers. It appears cardiovascularly safe in patients without baseline endothelial dysfunction, though longer studies are needed.
INTRODUCTION: Infantile hemangiomas are common and can be treated with propranolol. Cardiovascular side effects are a potential risk of propranolol treatment. We assessed real-world propranolol side effects to help guide...INTRODUCTION: Infantile hemangiomas are common and can be treated with propranolol. Cardiovascular side effects are a potential risk of propranolol treatment. We assessed real-world propranolol side effects to help guide safe use of propranolol for infantile hemangiomas. MATERIALS AND METHODS: This is a descriptive cross-sectional study using retrospectively collected data from patients' electronic medical records from 2015 to 2023, with a sample of 64 patients. Patients diagnosed with infantile hemangiomas, who received oral propranolol, were included in the study. Data regarding the clinical features of the hemangiomas, oral propranolol dosing regimen, treatment response, adverse effects, and rebound hemangioma rate was collected. RESULTS: Seventy percent of the hemangiomas were less than 10 cm in size. Adverse effects were uncommon. The most common adverse effects were hyperkalemia, hypotension, and nightmares, which accounted for 23%, 9%, and 9% of patients, respectively. After treatment, 81% of the hemangiomas completely resolved, 8% demonstrated partial improvement, and 8% exhibited no improvement. The rate of rebound hemangiomas was 3%. CONCLUSION: The majority of patients with infantile hemangioma can be safely managed with oral propranolol in an outpatient setting.
PURPOSE: Achieving sustained on- and off-treatment disease control is an important therapeutic goal in atopic dermatitis (AD). This study evaluated achievement of off-treatment disease control in patients randomized to p...PURPOSE: Achieving sustained on- and off-treatment disease control is an important therapeutic goal in atopic dermatitis (AD). This study evaluated achievement of off-treatment disease control in patients randomized to placebo following 12 weeks of abrocitinib 200 mg. MATERIALS AND METHODS: In the phase 3 JADE REGIMEN study, patients with moderate-to-severe AD who achieved Investigator's Global Assessment (IGA) of 0/1 (with ≥2 grades of improvement) and ≥75% improvement in Eczema Area and Severity Index (EASI) after 12 weeks of abrocitinib 200 mg were randomized (1:1:1) to placebo, abrocitinib 100 mg, or abrocitinib 200 mg for 40 weeks. This post-hoc analysis evaluated patients by flare status (protocol flare definition: ≥50% loss of initial EASI post-randomization response and IGA score ≥2). EASI, IGA, Peak Pruritus Numerical Rating Scale (PP-NRS), and Dermatology Life Quality Index (DLQI) were evaluated. RESULTS: There were no off-treatment flares in 21.3% of patients in the placebo arm. The no-flare group had EASI, IGA, PP-NRS, and DLQI mean scores indicating clear/mild AD at week 52 (2.9, 1.0, 2.6, and 3.5, respectively). CONCLUSIONS: After 12 weeks of abrocitinib 200 mg, some patients achieved 40 weeks of sustained off-treatment disease control, with assessments demonstrating clear/mild AD, suggesting attainment of disease remission. TRIAL REGISTRATION: NCT03627767.