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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.
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.
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.
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.
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Keratinocyte carcinoma (KC) is the most common cancer in the US, resulting in considerable clinical and economic burdens. Nicotinamide has been shown to reduce new KCs among high-risk patients. Despite growing clinical interest, the cost-effectiveness of nicotinamide for KC prevention has not been examined. To evaluate the cost-effectiveness of oral nicotinamide for KC prevention. This economic evaluation with a 1-year horizon included data from individuals within the Veterans Health Administration (VHA). Individuals with and without nicotinamide exposure for 30 or more days were included. Data were analyzed from September to October 2025. Oral nicotinamide use compared to no nicotinamide use. The primary outcome was the annual number of KC events prevented, translated into quality-adjusted life-years (QALYs) gained. Costs included annual nicotinamide expenses and weighted average treatment costs per KC episode. Incremental cost-effectiveness ratios were calculated as the differential cost divided by the differential QALYs gained, supplemented by probabilistic and 1-way sensitivity analyses, non-VHA cost assumptions, and symptom-related quality-of-life modeling. Among the 33 822 individuals included in the analysis and contributing 78 726 person-years of follow-up, the unexposed cohort had a mean (SD) age of 76.9 (8.7) years, compared with 77.2 (8.9) years in the exposed cohort, and 98.0% were male in both exposure groups. KC incidence was 0.204 per person-year in those exposed to nicotinamide and 0.255 in those who were not exposed, reflecting an absolute risk reduction of 0.051 and 624 annually prevented KCs among 12 287 users. Total nicotinamide cost was $161 451, with $526 032 in treatment cost savings, resulting in a net savings of $364 581. Assuming a 0.01-QALY decrement per KC, nicotinamide use yielded 6.24 QALYs gained per year across the cohort and a differential cost of -$58 426 per QALY gained. At the cohort level, this represented a 19.9% reduction in yearly KC treatment costs. Probabilistic, 1-way, and non-VHA cost analyses resulted in median (IQR; range) and scenario differential costs of -$57 700 (-$79 851 to -$38 836; -$116 853 to -$16 326) and $14 407 per QALY gained, respectively. Prevention of 624 KCs among those exposed to nicotinamide in the cohort preserved more than 8 Skindex-16 symptom points per KC in veterans and civilians. In this economic evaluation, oral nicotinamide was a cost-effective and patient-centric preventive approach for KC, particularly in individuals with KC history at high risk of multiple primary KC.
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.
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.
This case series study evaluates the effectiveness and safety of stapokibart in treating patients with refractory palmoplantar pustulosis.
The prevalence of germline pathogenic variants in familial melanoma genes has primarily been studied in individuals with a personal or family history of cancer, an approach that may introduce ascertainment bias. To estimate the prevalence of pathogenic variants in clinically actionable familial melanoma genes and their associated cancer risks. This was a genome-first analysis of 2 population-scale genomically ascertained cohorts of individuals registered in the UK Biobank (UKBB) and the US Geisinger MyCode (GMC) databases, each linked with institutional (GMC) or national (UKBB) cancer registry data from 1970 through 2024. Data analyses were conducted from January 2025 through January 2026. Germline pathogenic variant status in familial melanoma genes. Prevalence of pathogenic variants in 8 major familial melanoma genes: ACD, BAP1, CDKN2A, CDK4, MITF E318K, POT1, TERF2IP, and TERT promoter; and associated cancer risks among individuals in the UK and US who had been genomically ascertained. Cancer odds ratios and time to cancer analyses were adjusted for sex, birth year, body mass index, and smoking status. The analysis included a total of 696 665 individuals who were genomically ascertained, 227 286 (mean [SD] age, 57.7 [19.6] years) from GMC and 469 379 (mean [SD] age, 70.0 [8.0] years) from UKBB. The cohorts were predominantly female (GMC, 60.6%; UKBB, 54.2%), and of European genetic ancestry (GMC, 93.6%; UKBB, 94.2%). The combined prevalence of the pathogenic variants across all genes evaluated-ACD, BAP1, CDKN2A, CDK4, MITF E318K, POT1, TERF2IP, and TERT promoter-ranged from 0.5% (GMC) to 0.9% (UKBB) in both cohorts. Among individuals with multiple cutaneous melanomas or a first cutaneous melanoma diagnosed before age 40 years, pathogenic variant prevalence exceeded the 2.5% threshold commonly used to recommend germline testing for high- and moderate-penetrance cancer susceptibility genes. Case-control analyses replicated established associations for CDKN2A (brain, cutaneous melanoma, head and neck, pancreas), MITF E318K (cutaneous melanoma, kidney), and POT1 (cutaneous melanoma, hematologic, thyroid). Additional associations, either novel or inconsistently reported, were observed for BAP1 (prostate), CDKN2A (biliary tract, breast, nonmelanoma skin, small intestine), MITF E318K (cervix, nasal cavity and middle ear, nonmelanoma skin), and POT1 (myeloma). In both cohorts, individuals with CDKN2A PVs or MITF E318K developed cutaneous melanoma at younger ages than did noncarriers, although age-of-onset patterns for internal cancers were less consistent. In this cohort study, the prevalence of pathogenic variants in familial melanoma genes and their associated cancer risks were estimated, findings that may inform and revise germline testing recommendations and cancer risk counseling. These data also suggest that the spectrum of cancer risk for several genes may be broader than previously recognized.
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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 Viewpoint discusses concerns with the current grading of cutaneous toxic effects in Common Terminology Criteria for Adverse Events (CTCAE) version 6.0 and proposes an updated framework.
This cohort study examines skin and intestinal disease presentations and emerging treatment options for cutaneous Crohn disease.
The incidence of cutaneous squamous cell carcinoma of the head and neck (cSCCHN) has increased, including among those with high-risk disease. Delays to access and initiation of care are associated with disease progression and worse outcomes. Capecitabine has previously been shown to be effective antitumor activity with low toxic effects. To evaluate the efficacy and tolerability of neoadjuvant capecitabine (NC) in advanced cSCCHN by evaluating the clinical and pathologic stage migration. This prospective case series was conducted from January 2024 to September 2025 at 2 academic centers in Montreal, Canada, and included consecutive patients with advanced cSCCHN who were awaiting surgery. The data were analyzed in November 2025. Two cycles of NC (1000 mg, twice daily, on days 1-14, followed by a 1-week rest period) were administered according to the Capecitabine Prior to Tumor Resection in ENT Oncology (CAPTURE) protocol, with surgical resection performed within 1 to 2 weeks after treatment completion. Clinical tumor response and clinical to pathologic stage migration, defined as the comparison of initial clinical stage with the postsurgical pathologic stage. The mean (SD) age of the cohort of 15 patients was 77 (8.1) years; 6 patients (40%) were female, and 9 patients (60%) were male. Clinical tumor regression was observed in 10 of 15 patients (67%). Among those who underwent resection, 5 (42%) achieved a complete pathologic response. Two patients avoided surgery due to complete treatment response and opted to receive radiotherapy. Nonresponse occurred for 5 patients, including 1 patient who experienced progression to metastatic disease. No grade 3 or higher capecitabine-related toxic effects were reported. This case series found that NC demonstrated significant tumor regression and pathologic response without severe treatment-related toxic effects. NC may be an effective treatment option for providing disease control and tumor downstaging in patients with advanced cSCCHN.
This case report describes a young man who presented with a long history of progressive right hemifacial deformity and a streak of scarring alopecia from eyebrow to scalp.