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Understanding which children present with skin disease and reach specialty care is essential for characterizing patterns of disease frequency and care use. To describe the frequencies of common pediatric skin diseases and patterns of dermatology use, stratified by race and ethnicity, across 8 US children's hospitals participating in the PEDSnet system. This was a multicenter cross-sectional study of 8 US children's hospitals in PEDSnet from January 2009 to July 2022. Data were analyzed from January 3 to March 26, 2024. The study cohort included children with 1 or more dermatology clinic visit or 2 or more non-dermatology clinic visits coded for atopic dermatitis (AD), acne, infantile hemangioma, psoriasis, or hidradenitis suppurativa (HS). Disease frequency per 100 000 children and proportion of children using dermatology care for each condition, stratified by race and ethnicity. Of 536 776 patients, the mean (SD) age was 6.4 (6.3) years, 51.5% were female, and 0.2% were American Indian or Alaska Native, 6.4% Asian, 27.9% Black, 14.1% Hispanic, 0.3% Native Hawaiian or Other Pacific Islander, 8.4% non-Hispanic, 44.3% White, 4.3% multiple races, 5.5% unknown ethnicity, and 16.6% unknown race. Case counts were 377 970 for AD, 139 632 for acne, 54 305 for infantile hemangioma, 11 339 for psoriasis, and 5722 for HS. Electronic health record-derived frequencies varied across race and ethnicity groups. There were 10 469 (95% CI, 10 414-10 524) cases of AD per 100 000 Black children compared with 3099 (95% CI, 3083-3114) per 100 000 White children. There were 290 (95% CI, 280-300) cases of infantile hemangioma per 100 000 Black children compared with 764 (95% CI, 756-772) per 100 000 White children. Black children had a low proportion of dermatology use across all 5 conditions, yet high frequencies of AD, acne, and HS. In this study, across all studied conditions, Black children had a low proportion of dermatology use at participating PEDSnet US children's hospitals, despite having high frequencies of AD, acne, and HS. Further research is required to determine whether these patterns represent appropriate specialty care use or reflect gaps in care.
Cardiovascular disease (CVD) is the leading cause of mortality in patients with psoriasis, yet structured CVD prevention is not routinely embedded in dermatology care. To evaluate the effectiveness of a text-messaging intervention in improving patient activation and cardiovascular risk factors among patients with psoriasis. This single-center, parallel-group randomized clinical trial took place at a tertiary hospital dermatology clinic in Australia from February 2024 to February 2025. Adults with dermatologist-confirmed psoriasis were randomized 1:1 during outpatient dermatology visits between April and July 2024. Data were analyzed from February to April 2025. A 6-month text-messaging intervention (Tobacco, Exercise, and Diet Messages for Psoriasis [TEXTME PSO]), comprising 4 text messages per week, compared with standard care. The primary outcome was score on the 13-item Patient Activation Measure. Secondary outcomes included Mediterranean Diet Score, physical activity, cardiometabolic measures, psoriasis-CVD knowledge, medication adherence, Psoriasis Area and Severity Index, Dermatology Life Quality Index, and user feedback. Analysis of covariance was used to adjust for baseline values under an intention-to-treat framework with multiple imputation. Among 111 participants (mean [SD] age, 51.8 [13.2] years; 71 [65.1%] male), the intervention showed a statistically significant improved patient activation at 6 months compared with usual care (adjusted mean difference, 10.8 points; 95% CI, 7.0-14.6 points; P < .001). Statistically significant improvements were also observed in Mediterranean diet adherence (adjusted mean difference, 1.7; 95% CI, 1.0-2.4; P < .001), medication adherence (adjusted mean difference, 1.6; 95% CI, 0.8-2.5; P < .001), and psoriasis-CVD knowledge (adjusted mean difference, 6.6; 95% CI, 4.7-8.4; P < .001). Minutes per week of physical activity increased (adjusted mean difference, 127.9; 95% CI, 21.9-234.0; P = .02), and body mass index, calculated as weight in kilograms divided by height in meters squared, decreased (adjusted mean difference, -1.0; 95% CI, -1.4 to -0.7; P < .001). No statistically significant between-group differences were observed for lipid parameters, hemoglobin A1c, smoking behavior, dermatology-specific quality of life, or psoriasis severity. In this randomized clinical trial, a text-messaging intervention improved patient activation and cardiovascular risk behaviors in adults with psoriasis. While biomarker changes were modest or not statistically significant, findings support digital tools as an adjunct to cardiovascular risk in dermatology care. ANZCTR Identifier: ACTRN12624000498594.
Necrobiosis lipoidica (NL) is a rare, chronic granulomatous skin disease for which no US Food and Drug Administration (FDA)-approved treatments exist. PCS499, an oral deuterated pentoxifylline analog, may offer therapeutic benefit. To evaluate the safety and exploratory efficacy of PCS499 in adults with biopsy-confirmed NL. A phase 2, open-label nonrandomized clinical trial (from January 2019-February 2020) with a 6-month treatment period with an optional 6-month extension was conducted at the University of Pennsylvania and University of Pittsburgh dermatology research centers. Adults aged 18 to 80 years with biopsy-confirmed NL were eligible. Inclusion required a reference lesion of 10 cm2 or larger and Investigator Global Assessment (IGA) of NL activity score of 2 or greater (scale 0-5). Key exclusions were recent corticosteroid, immunosuppressant, biologic, phototherapy, or pentoxifylline-class use; significant comorbidities; and pregnancy or lactation. Data were analyzed in May 2025. PCS499, 900 mg, orally twice daily for 6 months, with optional 6-month extension. Safety was assessed through adverse event (AE) monitoring, laboratory testing, and electrocardiograms. Exploratory efficacy end points included changes from baseline in IGA, Physician Global Assessments and Patient Global Assessments (PGA, PtGA), NL Color and Ulcer Scale (NLCUS), Dermatology Life Quality Index (DLQI), and Skindex-29 scores. Twelve participants were enrolled (median [range] age, 41 [19-66] years; all female individuals; 10 [83%] with diabetes; mean [SD] disease duration, 12.7 [9.3] years), and 10 completed treatment. The most common AE was mild gastrointestinal symptoms (33%). No serious AEs or clinically significant laboratory abnormalities occurred. Participants with ulcerated NL (n = 2 [17%]) achieved complete ulcer closure by day 85 and day 351 without recurrence. Six participants (50%) achieved clear or almost clear IGA status (median [range] time, 111 [54-166] days). Significant improvements were observed in IGA activity (median [IQR] change, -1.5 [-2.0 to 0.0]; P = .03), PGA (median [IQR] change, -1.3 [-2.8 to -0.9]; P = .04), NLCUS inflammation/color (median [IQR] change, -1.0 [-1.8 to 0.0]; P = .02), and induration (median [IQR] change, -1.0 [-2.0 to 0.0]; P = .04), and Skindex-29 function scores (median [IQR] change, -14.6 [-27.1 to 3.1]; P = .05). This nonrandomized clinical trial found that PCS499 was safe and well tolerated, with evidence of clinical and quality-of-life improvement, particularly in ulcerated NL; however, larger trials are warranted. ClinicalTrials.gov Identifier: NCT03698864.
Psoriasis is a chronic, immune-mediated inflammatory skin disease that significantly impacts patients quality of life and is frequently associated with obesity. This comorbidity may influence disease progression and treatment outcomes. Risankizumab, an interleukin-23 (IL-23) inhibitor, has demonstrated high efficacy in treating moderate to severe plaque psoriasis. However, its performance in obese patients remains unclear due to conflicting data. This scoping review aims to evaluate the impact of obesity, specifically BMI ≥ 30 kg/m², on the efficacy and safety of risankizumab in adults with moderate to severe plaque psoriasis. A comprehensive literature search was carried out in databases including PubMed, Scopus, JAMA, Elsevier, and Wiley, between December 2024 and February 2025. The selection included studies from 2020 to 2025, focusing on Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) outcomes in psoriatic patients receiving risankizumab, with or without obesity. 24 articles were included and analyzed by study design, patient characteristics, treatment response, and BMI influence. Risankizumab consistently demonstrated strong efficacy and safety in reducing PASI scores and improving DLQI across all BMI categories. While most studies reported no significant difference in response due to BMI, some suggested enhanced early responses in non-obese patients. Continuous treatment showed long-term benefits regardless of BMI, with 90% or greater improvement in the PASI (PASI90) and complete clearance (PASI100) maintained up to five years. Risankizumab is a highly effective and safe biologic therapy for moderate to severe psoriasis, even in patients across all BMI. Although some variations in response exist, the overall evidence supports its use across diverse patient profiles. Weight management should still be considered a complementary strategy in psoriasis care.
Vitiligo is a chronic autoimmune disease characterized by loss of pigment in the skin, hair, or both, which can impact quality of life. To describe the demographic and clinical characteristics of patients with vitiligo and to characterize vitiligo treatment patterns, by vitiligo extent and age. This retrospective cohort study analyzed deidentified data from the linked Komodo Healthcare Map and OMNY Health Foundation databases. The linked databases capture health care and pharmacy claims and electronic health record data for patients with vitiligo receiving care in US dermatology practices and across all other settings. The index date was the date of first observed diagnosis of vitiligo during the index identification period (January 1, 2018, to August 31, 2023), allowing for 3 months or more of follow-up. Eligible patients were those with diagnosed vitiligo and 365 days or more of continuous health care plan enrollment (or eligibility proxy for patients with open claims) before index date. Patients missing age data or without any follow-up were excluded. Patients were stratified into cohorts by age and vitiligo percentage of body surface area (BSA) involvement (≤10%, >10%, and no BSA assessment) at index. The data analysis was conducted between April 2024 and August 2024. Baseline demographics, baseline clinical characteristics, and vitiligo treatment patterns following index date were described. Of the 24 949 included patients, 1329 (5.3%) had a BSA assessment at index (963 had ≤10% BSA involvement; 366 had >10%). Most patients (n = 21 996 [88.2%]) were 18 years and older and female (n = 14 057 [56.3%]). The face was the most frequently affected area at index, impacting 5482 of 16 674 patients (32.9%) with reported location of vitiligo. Across BSA groups, 27% (6308 of 23 620 without BSA assessment) to 32% (310 of 963 with ≤10% BSA involvement) of patients did not receive treatment for vitiligo during follow-up. The most common treatments following index were topical and oral corticosteroids and topical calcineurin inhibitors/phosphodiesterase-4 inhibitors, with no substantial differences across BSA groups during follow-up. Topical treatments were prescribed more frequently to children and adolescents vs adults, while systemic treatments were prescribed more to adults. High variability across treatment sequences was observed. Median therapy duration ranged from 1.8 (95% CI, 1.6-2.1) months to 4.1 (95% CI, 3.7-4.4) months, for first and second lines of treatment depending on treatment type. This cohort study reported treatment patterns in patients with vitiligo. A high proportion of patients with vitiligo did not receive treatment during follow-up, and therapy duration was relatively short.
Periodic comprehensive skin examinations of asymptomatic individuals are widely accepted by dermatologists and the public, resulting in deployment of skin cancer (SC) surveillance practices that may include patients at low risk for SC. To define the demographics, SC risk factors, and near-term outcomes of asymptomatic individuals seeking comprehensive skin examinations. This cross-sectional study is a secondary analysis of data collected through a routine, previsit survey completed by patients who visited the Emory Healthcare Dermatology Clinic between March 2021 and October 2022. This study involved new patients who had no specific skin complaints and requested a general skin examination because they had general concerns about SC. Data were analyzed between from July to December 2025. The main objective was to identify patients at higher risk for SC development by evaluating characteristics including demographics and SC risk factors including skin phototype, eye and hair color, and family and personal history of SC. The number needed to examine to diagnose 1 SC was calculated for the entire cohort and for subgroups. A total of 1074 new patients who noted no skin complaints but sought examinations for concerns about SC were identified (mean [SD] age, 50.3 [15.9] years; 643 [59.9%] female). Of these patients, 186 reported a personal history of SC, with the percentage reporting a history of SC increasing with age. Among those reporting SC history, 184 (99.5%) had skin phototypes I through III. Overall, 131 patients (12.2%) underwent 146 skin biopsies, and 38 SCs were diagnosed. Three patients younger than 50 years were diagnosed with SC, and 37 of 38 SCs were diagnosed in patients with skin types I through III. The number needed to be examined to diagnose 1 SC was 181 in patients 50 years or younger and 7 in patients 70 years or older. The number needed to examine for patients with and without a history of SC was 12 and 52, respectively. This study found that populations of new patients without specific skin complaints seeking care for SC surveillance may contain substantial percentages of people at low risk for diagnosis of SC. Implementation of simple triage criteria for asymptomatic patients seeking SC surveillance based on age, skin phototype, and SC history could select for patients at substantially higher risk for SC diagnosis.
This case report describes an immunocompetent man in his 50s presenting with a 6-month history of facial ulcers caused by cutaneous emergomycosis.
This cohort study examines the association of a change in International Hidradenitis Suppurativa Severity Score System score with intravenously and subcutaneously administered golimumab in patients with moderate to severe hidradenitis suppurativa.
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Overweight and obesity affect 60% to 78% of patients with psoriasis, affecting disease severity, treatment response, and clinical outcomes. However, no large, randomized, active-controlled clinical trial has evaluated a treatment strategy that addresses both diseases simultaneously. To evaluate the efficacy and safety of ixekizumab with or without tirzepatide in participants with psoriasis and overweight or obesity. This phase 3b, randomized, open-label, 52-week clinical trial was conducted at 72 sites in the US in adults with moderate to severe plaque psoriasis who have overweight with 1 or more weight-related comorbidities or obesity. The trial started on September 30, 2024, and completed the week 36 primary end point on January 8, 2026. Data were analyzed from January to February 2026. Participants were randomized (1:1) to ixekizumab plus tirzepatide or ixekizumab as adjunct to diet and exercise in both treatment arms. At week 36, the primary end point was simultaneous achievement of Psoriasis Activity and Severity Index (PASI) 100 and 10% or greater weight reduction. Key secondary end points were PASI 100 and simultaneous PASI 75 and 5% or greater weight reduction, as well as 10% or greater weight reduction. Among the 274 randomized participants (mean [SD] age, 45.6 [12.7] years; 123 [44.9%] women and 151 [55.1%] men; mean [SD] screening body mass index [calculated as weight in kilograms divided by height in meters squared], 39.2 [9.1]; mean [SD] duration of psoriasis, 14.6 [13.0] years; mean [SD] PASI, 19.7 [8.1]), 231 (84.3%) completed the treatment through week 36. Overall, 27.1% of participants simultaneously achieved PASI 100 and a 10% or greater weight reduction with ixekizumab plus tirzepatide vs 5.8% with ixekizumab (risk difference [RD], 21.2%; 95% CI, 12.8%-29.7%; P < .001). Also, 40.6% vs 29.0% of participants achieved PASI 100 (RD, 11.6%; 95% CI, 0.3%-22.9%; P = .04), 79.9% vs 17.9% simultaneously achieved PASI 75 and a 5% or greater weight reduction (RD, 62.0%; 95% CI, 51.7%-72.2%; P < .001), and 69.2% vs 9.1% achieved a 10% or greater weight reduction (RD, 60.0%; 95% CI, 50.4%-69.7%; P < .001), respectively. Adverse events were generally consistent with established drug safety profiles, the most common being gastrointestinal tract events and injection site reactions. Gastrointestinal tract events occurred more frequently with ixekizumab plus tirzepatide vs ixekizumab. The trial results suggest that concomitant ixekizumab and tirzepatide produced clinically meaningful, statistically significant improvements in skin clearance and reductions in weight in participants with moderate to severe psoriasis, with no new safety concerns, while providing additional cardiometabolic benefits and a potential to elevate care. ClinicalTrials.gov Identifier: NCT06588283.
Currently, there are no standardized outcome domains or measures in clinical trials for facial aging. Heterogeneity in outcome domains and measurement instruments across clinical trials creates difficulty in directly comparing interventions, determining superior therapies, and developing high-quality meta-analyses. To develop a core outcome set (COS) of essential domains to be reported in clinical trials evaluating the efficacy of interventions for facial aging. PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, and CINAHL were searched from September 2005 to September 2015. An updated search of the same databases was performed from September 2015 to February 2026. Studies were included if (1) they were randomized clinical trial or controlled clinical trial in design, (2) they assessed the efficacy or safety of an intervention for facial aging, (3) they were published in English, and (4) they involved human participants. Complementary sources, including patient interviews, were used to capture further relevant outcomes. Two rounds of Delphi surveys, followed by consensus meetings, were used to identify outcome domains considered most important by both patient and physician stakeholders. The final COS consists of 6 outcome domains: (1) overall convenience of treatment; (2) time to return to normal work and social activity; (3) overall assessment of focused area of treatment (at the point in time when treatment is expected to provide peak benefit); (4) duration of treatment effect; (5) severity of persistent local or systemic adverse events, including pigmentary change, skin texture change, delayed healing, scarring, and serious adverse events; and (6) patient satisfaction with treatment. The 6 outcome domains identified through a Delphi consensus are recommended for reporting in future facial aging trials to ensure that outcomes that matter most to patients and clinicians are measured and that results are comparable across interventions.
An adolescent boy presented with more than 10-year history of skin discoloration and difficulty protruding the tongue. Clinical examination revealed waxy, glistening nodules with a pale, firm, cobblestone-like appearance along the lateral borders and ventral surface of the tongue. What is your diagnosis?
Isotretinoin is an effective treatment for moderate to severe acne, but concerns exist that exposure during adolescence could impair linear growth. To examine whether isotretinoin use in adolescence is associated with reduced adult height. This nationwide population-based cross-sectional study analyzed individuals eligible for military conscription in Denmark between January 1, 2001, and December 31, 2015, including all men and women volunteers. Conscription records were linked via unique personal identifiers to prospectively collected data from nationwide Danish registries. Individuals without a recorded height or with implausible height values were excluded. Data were analyzed from April 2025 to January 2026. Prior use of isotretinoin, oral tetracycline-class antibiotics, or topical acne therapies, ascertained from linked prescription records before outcome assessment. Individuals without prescribed acne treatment or hospital-diagnosed acne served as the reference group. Adult height measured at conscription. Linear regression models adjusted for birth cohort and educational level were used to estimate mean differences in height. The predefined minimal clinically important difference was 5 cm or greater. Analyses were stratified by age at isotretinoin initiation and cumulative dose before conscription. Stunting was examined as a secondary outcome. The study included 379 196 individuals, of whom 368 338 were men (16 739 [4.5%] isotretinoin users) and 10 858 were women (278 [2.6%] isotretinoin users). Median age at conscription was 19.0 years (IQR, 18.7-20.0 years) among men and 19.2 years (IQR, 18.7-20.5 years) among women. The mean (SD) height at age 19 years was 180.4 (6.7) cm in men and 168.3 cm (5.9) in women. There was little variation in adult height across exposures. Compared with the reference group, in the isotretinoin group, the adjusted mean difference in height was 0.31 cm (95% CI, 0.20-0.41 cm) among men and 0.25 cm (95% CI, -0.47 to 0.96 cm) among women; both estimates were below the predefined minimal clinically important difference. Findings were consistent across analyses stratified by age at initiation, cumulative dose, and when using stunting as the outcome. In this nationwide cross-sectional study, isotretinoin for acne was not associated with reduced adult height. These findings may inform evidence-based decision-making when considering isotretinoin treatment during adolescence.
Silk sericin, a hydrophilic protein extracted from Bombyx mori cocoons, has emerged as a promising biomaterial for wound healing applications due to its bioactivity and cost-effective production. In this study, isolated sericin was characterized by Fourier transform infrared (FTIR) spectroscopy and mass spectrometry, confirming high purity with minimal fibroin contamination. Endotoxin contamination was excluded by LAL gel clot assay (<0.03 EU/ml). In vitro studies using human keratinocytes (HaCaT) and rat fibroblasts demonstrated that sericin at 600 μg/ml significantly enhanced cell viability (30% increase, p < 0.01) and accelerated in vitro wound healing (p < 0.001). Real-time PCR and Western blot analyses revealed modulation of cytokeratins 16 and 17 (KRT16/17) and up-regulation of junctional adhesion molecule A (JAM-A), suggesting enhanced epithelial activation and cell-cell adhesion. This response coincided with increased NF-κB and IL-17 expression. In fibroblasts, sericin significantly increased the expression of matrix metalloproteinase-9 (MMP9) and vascular endothelial growth factor (VEGF) (p < 0.01), suggesting pro-remodeling and pro-angiogenic potential. In HaCaT cells, sericin induced a transient increase in IL-1β (p < 0.01) followed by a reduction in tumor necrosis factor α (TNF-α) (p < 0.05) and an increase in IL-10 at 48 h. In THP-1-derived macrophages, sericin reduced IL-1β and TNF-α (p < 0.001), increased IL-10 (p < 0.05), and shifted polarization toward the M2 phenotype, as indicated by upregulation of CD163 and downregulation of CD86 (p < 0.001). Sericin showed no antibacterial activity against Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus. Its accessibility, cytocompatibility, and ability to modulate epithelial activation, matrix-remodeling responses, and inflammation position sericin as a promising candidate for advanced wound care strategies.
A 62-year-old Vietnamese man with a history of hepatitis B presented with a chronic, generalized pruritic rash that involved the back, trunk, and upper and lower extremities. What is your diagnosis?
This cross-sectional study uses the Global Burden of Disease database to summarize epidemiology, subgroup patterns, and projections for malignant melanoma, cutaneous squamous cell carcinoma, and basal cell carcinoma.
This case report describes a previously healthy man in his 40s who presented with a 2-day history of asymptomatic rash, prior to which he experienced fever.
This cohort study examines the type 1 and type 2 reactions associated with the monthly regimen of rifampin, moxifloxacin, and minocycline among patients with leprosy.
In Germany, a population-based skin cancer screening (SCS) program was implemented in 2008. The benefit of the intervention is unclear. To determine whether the German SCS program was associated with reduced melanoma mortality. This population-based, ecological comparative effectiveness study compared trends in melanoma mortality from 2009 to 2022 in Germany with those in neighboring countries without population-based SCS using data on melanoma mortality from the official cause-of-death statistics. The total populations of 15 federal states of Germany and 9 neighboring countries were examined. The German federal state of Schleswig-Holstein was excluded from the analysis due to a potential lasting effect of a preceding pilot project, conducted in 2003 and 2004. Data were analyzed from November 7, 2025, to February 11, 2026. The German SCS program entitles men and women aged 35 years and older to a visual skin examination every 2 years, regardless of their individual skin cancer risk. The 2-year participation rate was estimated at approximately 32%. Pooled estimates of annual percentage changes (APCs) in age-standardized melanoma mortality rates in German and non-German control regions were calculated using a random-effects model. Data include a mean of 79.1 million inhabitants in Germany and 164.8 million inhabitants in 9 neighboring countries. Between 2009 and 2022, age-standardized melanoma mortality rates decreased in each included region. In Germany, APCs ranged from -3.8% (95% CI, -5.5% to -2.2%) to -0.1% (95% CI, -1.7% to 1.5%). In the control regions, mortality rates decreased between -3.8% (95% CI, -4.9% to -2.7%) and -1.0% (95% CI, -1.9% to -0.2%) per year. Pooled APC estimates are -1.8% (95% CI, -2.3% to -1.4%) for Germany and -2.2% (95% CI, -2.8% to -1.6%) for the non-German control regions; the difference was not statistically significant (P = .42). The findings of this ecological study are in line with previous studies that failed to show a melanoma mortality benefit associated with the German SCS program. To enable a well-founded decision on the future of the program, the causes of its poor performance should be investigated.