Infants and young children with severe atopic dermatitis (AD) have a high burden of disease with a strong impact on quality of life. Here we assess long-term efficacy and safety of dupilumab in pediatric patients aged 6 months to 5 years with severe AD. This is a subgroup analysis of patients aged 6 months to 5 years enrolled in the ongoing LIBERTY AD PED open-label extension (OLE) study of dupilumab who had previously participated in the parent study LIBERTY AD PRESCHOOL part B and had severe AD (Investigator's Global Assessment [IGA] = 4) at parent study baseline. Patients received weight-tiered dupilumab every 4 weeks (200 mg for patients weighing 5 to < 15 kg; 300 mg for patients weighing 15 to < 30 kg). Key endpoints included the incidence and rate of treatment-emergent adverse events (TEAEs), the proportion of patients with a ≥ 75% improvement in Eczema Area and Severity Index (EASI-75) from parent study baseline, proportions of patients achieving IGA = 0/1 and IGA ≤ 2, and the proportion of patients with a ≥ 6-point improvement in Children's Dermatology Life Quality Index (CDLQI) for patients aged ≥ 4 years or Infants' Dermatitis Quality of Life (IDQoL) questionnaire for patients aged < 4 years. This analysis included 121 patients, of whom 50 completed the week 104 visit. TEAEs were reported in 88% of patients; most TEAEs were mild or moderate and not related to treatment. Common TEAEs included upper respiratory tract infection, nasopharyngitis, and cough. Conjunctivitis events were reported in 19% of patients and were mild or moderate, with a median duration of 8 days. No conjunctivitis event led to treatment discontinuation, and most events resolved during the study. One drug-related event (severe urticaria) led to treatment discontinuation, but it was not serious and resolved over time. Serious TEAEs were reported in 17 patients (14%), including one drug-related pinworm event. No serious TEAE led to treatment discontinuation. By week 4 of the OLE study, patients who had received placebo in the parent study exhibited efficacy improvements comparable to patients who had received dupilumab. By week 104, 96% of patients achieved EASI-75 from parent study baseline, 27% of patients achieved an IGA score of 0/1 (clear/almost clear skin), 92% of patients achieved IGA ≤ 2 (clear skin to mild AD), and the least squares mean percent change in EASI from parent study baseline was - 89%. Additionally, 89% (23/26) of patients achieved a ≥ 6-point (clinically meaningful) improvement in CDLQI, and 100% (3/3) of patients achieved a ≥ 6-point improvement in IDQoL. Long-term treatment with dupilumab for up to 2 years showed acceptable safety and sustained efficacy in signs, symptoms, and quality of life in patients aged 6 months to 5 years with severe AD, with a rapid improvement for patients who had received placebo in the parent study. Long-term safety in the OLE study was consistent with the short-term safety profile observed in the parent study, with no new safety signals detected. [Graphical abstract and plain language summary available] CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT02612454 and NCT03346434 (part B). Atopic dermatitis (AD) is one of the most common inflammatory diseases in children. Severe AD can have a strong negative impact on children’s well-being, with a high risk of long-term persistence. In a previous study, treatment with dupilumab for 16 weeks demonstrated significant health benefits in children aged 6 months to 5 years with severe AD. To analyze the effects of dupilumab treatment for a longer time, children who had participated in the 16-week study continued in the present study, in which they received 200/300 mg of dupilumab (depending on body weight) every 4 weeks for up to 2 years. During 2 years of treatment, 88% of patients reported health issues, mostly mild or moderate and not related to dupilumab. Only one patient interrupted treatment due to a health issue (intense skin rash) that was considered a side effect of dupilumab, but it was not considered serious and resolved over time. In another patient, one serious pinworm infection was also considered related to dupilumab, but it did not cause the patient to interrupt treatment. By the end of the 2 years, 27% of patients achieved clear or almost clear skin, 92% had clear skin to mild AD, and 96% achieved a 75% improvement in AD extent and severity. Most patients also reported improvements in quality of life. In summary, long-term treatment with dupilumab was beneficial for infants and young children with severe AD with a low risk of side effects, consistent with results observed in older children, adolescents, and adults.
Trichoscopy enhances diagnostic accuracy in primary cicatricial alopecias (PCA), yet comparative data on its application across diverse skin phototypes remain limited. The aim of this study was to characterize trichoscopic features across various forms of PCAs and compare findings between fair and dark phototypes. This is a descriptive, multicenter international study analyzing trichoscopic patterns in 1102 patients with PCAs across a range of ethnic backgrounds and skin phototypes. The absence of follicular openings was the most consistent trichoscopic finding across all phototypes. Notable variations in trichoscopic patterns were observed based on skin color. In both fair and dark phototypes, signs of clinical and trichoscopic activity were predominantly observed within the first five years of disease duration, when inflammation is typically more pronounced. Clinicians should be aware of trichoscopic variations both between and within the same PCA according to the phototype. Such awareness enhances the recognition and interpretation of trichoscopic features, particularly during the early and active stages of the disease, and helps guide the selection of optimal biopsy sites across PCA subtypes in both fair and dark skin. This approach can ultimately facilitate histopathological confirmation and support clinical decision-making.
Artificial intelligence (AI) is being increasingly used in dermatology education and research as digital health data expands and large language models (LLMs) advance. This scoping review synthesized current applications, benefits, and limitations of AI in these domains. The review followed PRISMA-ScR methodology, including 102 studies published between 2010 and 2025, with 28 studies examining educational applications and 74 examining research applications. Educational applications included the use of LLMs for examination preparation, question and case generation, and image-based learning through generative and adaptive imaging tools. Research applications included machine learning and natural language processing for large-scale data analysis, pharmacovigilance, social media and clinical text mining, predictive modeling, biomarker and gene-signature discovery, and the use of LLMs to support literature synthesis, manuscript writing, and research workflow tasks. Across education and research, key limitations related to accuracy, bias, transparency, and ethical governance. These issues highlight the need for ongoing human oversight, the use of dermatology-specific training datasets, and structured implementation frameworks. Despite these considerations, AI has substantial potential to enhance dermatology learning and improve dermatologic research efficiency. Future work should focus on evaluating real-world performance, model reliability, and the effectiveness of human-AI collaboration in dermatology practice and training.
Systemic lupus erythematosus (SLE) is a chronic, multi-organ autoimmune disease characterised by a highly heterogeneous presentation. Specific genetic variations predispose patients to the disease, and rare monogenic forms caused by single-gene variations have been identified in a small percentage of patients, often with early disease onset. In this study, we used exome sequencing in a large cohort of patient with juvenile-onset SLE to gain insight into the genetic basis of juvenile SLE (jSLE). Patients were selected if disease onset occurred before the age of 18. We performed exome sequencing on 263 individuals across 172 distinct families. The majority of cases were solo exomes (n = 118), while others included affected duos, trios, or multiplex families (n = 18 + 5 + 1), as well as classical trios with unaffected parents (n = 30). A molecular diagnosis consistent with the clinical presentation was established in 17 patients from unrelated families (10%). Among them, we identified pathogenic or likely pathogenic variants in genes previously associated with monogenic lupus, including a novel C1QA variant as well as other lupus-associated genes (COPA, ADAR, TLR7, IKZF3, RELA, PTPN11, SERPING1). Strikingly, exome sequencing also revealed variants in immunodeficiency-associated genes (IRAK4, USB1), autoinflammatory disorders (PSTPIP1) and unexpected candidates like ETV6, and MAN1B1 revealing previously unrecognised pathways in SLE development. Syndromic features and very early-onset (before the age of 5) were strongly associated with a higher diagnostic yield, reaching nearly 33% in these subgroups. This study expands our understanding of causes of lupus, highlighting its genetic heterogeneity. It also supports the systematic use of genetic testing in cases of juvenile lupus, especially those with very early onset or syndromic features, regardless of the clinical presentation. Given the range of unexpected molecular diagnoses identified in this study, pangenomic analysis such as exome or genome sequencing appears to be the most appropriate approach in these cases. This work was supported by: The Institut National de la Santé et de la Recherche Médicale (INSERM); Government grants managed by the Agence Nationale de la Recherche (ANR) as part of the "Investment for the Future" program: Institut Hospitalo-Universitaire Imagine (ANR-10-IAHU-01), Recherche Hospitalo-Universitaire (ANR-18-RHUS-0010); The Centre de Référence Déficits Immunitaires Héréditaires (CEREDIH); The Fondation pour la Recherche Médicale (FRM: EQU202103012670, FDM202006011291); French and European grants managed by the ANR: ANR-14-CE14-0026 (Lumugène), ANR-21-CE17-0064 (SOCSIMMUNITY); The National Reference Center for Rheumatic, Autoimmune and Systemic Diseases in Children (RAISE).
Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000-489 000), 144 000 deaths (131 000-162 000), and 11·7 million (10·7-13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5-36·1) globally, from 197 000 (173 000-218 000) in 1990, but increased in the WHO African region by 55·6% (25·5-92·4), from 31 500 (24 900-38 500) to 49 000 (42 600-58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5-26·5) in GBD 2017 to 10·5% (8·1-13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2-52·0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.
Postexposure prophylaxis with doxycycline (Doxy-PEP) significantly reduces incidence of certain bacterial STIs in men who have sex with men (MSM) and individuals with recurrent STIs. We assessed knowledge, attitudes, and clinical experience regarding Doxy-PEP of dermatologists specialized in STI prevention, diagnosis, and treatment in Italy. A cross-sectional survey was conducted in March 2025 using a questionnaire to investigate knowledge of Doxy-PEP prescribing protocols and patient eligibility, perceptions of its efficacy against several STIs, personal experience in Doxy-PEP prescription and drawbacks, opinions on its future use. Thirty-six dermatologists participated. All knew about Doxy-PEP. The population most frequently considered eligible for Doxy-PEP was represented by MSM (69.4%). Respondents would prescribe Doxy-PEP after recent exposure (<72 hours) to chlamydia (58.3%), syphilis (50.0%), gonorrhea (25.0%), or multiple partnership (55.6%). Chemsex was indicated as the main risky behavior worth prescribing Doxy-PEP (69.4%). Approximately half of the respondents considered Doxy-PEP effective against chlamydia (47.2%), whereas only 14.3% and 2.8% were convinced of its efficacy against syphilis and gonorrhea, respectively. Only 19.4% of the respondents had prescribed Doxy-PEP, with no adverse events reported. Doxy-PEP failure was observed by 36.1% of the dermatologists. The main concerns included Neisseria gonorrhoeae resistance (91.7%), methicillin-resistant Staphylococcus aureus (MRSA) selection (91.7%), and microbiota alterations (86.1%). A progressive increase in Doxy-PEP use is anticipated, driven by patient demand, community influences, and international guidelines. Dermatologists of Italian STI centers demonstrate appropriate awareness of Doxy-PEP but maintain cautious attitudes toward efficacy and show a substantial concern about antibiotic resistance.
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.
Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.
Hidradenitis suppurativa (HS) is a chronic inflammatory disease associated with substantial impairment in quality of life and psychological well-being. The impact of cumulative treatment exposure and its relationship with multidimensional disease burden in HS has not been sufficiently discussed. The aim of this study is to investigate the associations between cumulative treatment burden, quality of life impairment, psychological symptom burden, disease activity, and patient-perceived severity in patients with HS. This multicenter cross-sectional study included previously treated adult HS patients. Participants completed validated Turkish versions of the Dermatology Life Quality Index (DLQI), Symptom Checklist-90-Revised (SCL-90-R), and the Hidradenitis Suppurativa Self-Assessment Tool (HSSA). A Treatment Burden Index (TBI) was developed to quantify cumulative therapeutic exposure based on guideline-weighted treatment modalities. Ninety-three patients were included (mean age 34.5 ± 11.0 years; 57% male). Higher TBI was moderately correlated with greater QoL impairment (Spearman ρ = 0.401, p < 0.001) and flare frequency. TBI was weakly correlated with psychological symptom burden. DLQI scores were positively associated with flare frequency and SCL-90-R scores, whereas the SCL-90-R scores were not associated with flare frequency or patient-perceived disease severity. HS burden is multidimensional, with partially independent domains of disease activity, treatment burden, quality of life impairment, and psychological distress. Cumulative treatment exposure is closely linked to QoL impairment and disease activity but only weakly associated with psychological symptom burden. Identification of distinct burden phenotypes may facilitate more personalized and patient-centered management strategies in HS.
Atopic dermatitis (AD), is a chronic, relapsing inflammatory skin disorder that can pose a significant burden to patients and their caregivers and decrease their quality of life. Although substantial advances have been made in the safety and effectiveness of treatments for moderate to severe AD, opportunity for improvement remains. To better understand the patient journey and to consider the management of both current and emerging treatments, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in November 2025. This article provides a qualitative summary of the panel discussion. Key insights include that delayed diagnosis and limited access to dermatology specialists are top gaps in the provision of equitable care in moderate to severe AD and that despite treatment advances, more effective and affordable options are needed. Additionally, treatment adherence and positive outcomes in moderate to severe AD are multifactorial and may be affected by elements such as timely access, care coordination, disease severity and variability, and medication coverage and costs. Emerging agents show promise for a more durable response with less frequent dosing than current therapies, but payers are waiting for additional data to demonstrate long-term safety and efficacy and real-world outcomes. These findings can support informed clinical and coverage decisions, can offer practical actions for payers, and may inform future work.
In recent years, the introduction of interleukin (IL)-23 inhibitors has revolutionized psoriasis treatment, allowing the majority of patients to achieve a long-term, complete clinical control of the disease. Nevertheless, there are no real-world studies exploring the cost benefit ratio of these new drugs compared to the currently most prescribed therapies as adalimumab biosimilars. We performed a retrospective study to evaluate the clinical effectiveness, measured as Psoriasis Area and Severity Index (PASI)90-number needed to treat (NNT) and the cost-effectiveness of IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab) in patients with moderate to severe psoriasis as compared to adalimumab biosimilars (imraldi, hyrimoz, yuflima, and amgevita). Assessments were performed at Weeks 16 and 52. Our analysis included 616 patients with moderate to severe psoriasis who had been treated with adalimumab biosimilars or an anti-IL-23 inhibitor for at least 16 weeks. Overall, IL-23 inhibitors were shown to be more effective compared to adalimumab biosimilars, with significantly lower NNT. Risankizumab achieved the highest PASI90 response rates, whereas guselkumab had the most favorable incremental cost per PASI90 responder at Weeks 16 and 52. Our study highlights the substantial clinical benefit of IL-23 inhibitors over adalimumab biosimilars, with guselkumab as the more cost-effective option than the other IL-23 inhibitors for the real-world management of moderate-to-severe psoriasis.
This study aimed to investigate the value of non-invasive skin detection techniques for the therapeutic assessment of moderate-to-severe acne vulgaris. In this study, we collected patients with moderate-to-severe acne vulgaris who attended the Department of Dermatology at the First Affiliated Hospital of Guilin Medical University between October 2021 and December 2022, and analyzed their high-frequency ultrasound (HFUS) and color Doppler flow imaging (CDFI) characteristics at the Weekend 0 (T0), Weekend 4 (T1), and Weekend 12 (T2) of their treatment. A total of 30 patients with moderate-to-severe acne vulgaris [mean age 21.1 ± 3.4 years; 14 males (46.7%), 16 females (53.3%)] were enrolled. HFUS assessment revealed improvements (p < 0.05) in multiple parameters following treatment. Prior to treatment, there was perfect agreement (κ = 1.0) between the Pillsbury clinical grading and the SSSA ultrasound grading in all 30 patients (100%). Among the 30 patients who completed the 12-week follow-up, post-treatment ultrasound grading was higher than the clinical Pillsbury grading in 17 cases (56.7%). Agreement between the two grading methods post-treatment was poor (κ = 0.3, p = 0.645, 95% CI: -0.17, 0.77), though statistical significance was limited by sample size. HFUS effectively visualizes deep acne lesions (nodules/cysts). Although ultrasound grading demonstrates slower severity reduction than clinical assessment, it provides more objective severity evaluation. CDFI enhances hemodynamic analysis through real-time flow visualization. Combined HFUS/CDFI enables enhanced severity and prognostic assessment in moderate-to-severe acne vulgaris.
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Chronic cutaneous lupus erythematosus (CCLE) is the most common form of cutaneous lupus erythematosus, accounting for about 80% of cases. While patients with CCLE can develop systemic lupus erythematosus (SLE), the prevalence and risk factors of this association remain poorly studied, especially in North African populations. We conducted a bicentric study including all patients with histologically confirmed CCLE in two tertiary referral hospitals in Tunis between 2013 and 2023. SLE was classified using three criteria sets: ACR 1997, SLICC 2012, and ACR/EULAR 2019. Univariate and multivariate analyses were performed. Ninety-five patients with CCLE (median age 48 years, 75% female) were included. The prevalence of SLE varied significantly depending on the classification criteria used: 24% with ACR 1997, 32% with SLICC 2012, and 21% with ACR/EULAR 2019. Independent risk factors for SLE included arthralgias consistently across all classification criteria. Other risk factors for SLE differed among classification systems. For instance, asthenia and elevated ESR were independent risk factors under the ACR 1997 criteria, while female sex and extensive skin involvement were unique to the SLICC 2012 criteria. This study, the largest in North Africa aiming to identify the prevalence and risk factors of SLE among CCLE patients, showed significant variability depending on the used classification criteria. Arthralgias represented an independent risk factor for SLE in CCLE patients. The findings of this study were used to develop a diagnostic algorithm to assist clinicians.
Paradoxical psoriasis (PP) is a known adverse event of anti-tumor necrosis factor (anti-TNF) agents in hidradenitis suppurativa (HS), yet evidence regarding its management remains limited. The objective was to assess the effectiveness of interleukin-17 inhibitors (IL-17i) in treating anti-TNF-induced PP in patients with HS. This multicenter retrospective study included 40 adults with HS who developed PP during anti-TNF therapy and were subsequently treated with IL-17i. Outcomes for PP were measured using the Physician's Global Assessment (PGA); HS severity was evaluated using the International Hidradenitis Suppurativa Severity Score System (IHS4) and Hurley scores. Paired comparisons were performed using the Wilcoxon signed-rank or McNemar's test, as appropriate. Multivariate analysis was performed using LASSO-regularized logistic regression. Missing data were managed by multiple imputation. Of the patients, 27.5% achieved a clinically meaningful PP response, while 45% experienced worsening. Female sex, older age at HS onset, and prior exposure to secukinumab were associated with nonresponse. Conversely, HS severity improved significantly in 70% of patients (p < 0.001). IL-17i showed limited effectiveness for anti-TNF-induced PP in HS, though improvement in hidradenitis was observed.
Primary localized cutaneous amyloidosis (PLCA) is a chronic pruritic dermatological disorder characterized by amyloid deposits in the papillary dermis, significantly impairing patients' quality of life. Although the pathogenesis of PLCA is multifaceted, emerging evidence highlights the pivotal role of dysregulated cytokines, particularly the members of interleukin-6 (IL-6) cytokines family in PLCA. Oncostatin M (OSM) mediates keratinocyte proliferation through the STAT5-KLF7 axis upon OSMRβ engagement. Pathogenic variants in OSMR disrupt receptor dimerization, thereby suppressing signal transduction. These alterations together with cytokine dysregulation concomitantly elevate the expression of AHNAK and suppress that of Bcl-xL, which accelerate keratinocyte differentiation and apoptosis respectively, leading to the thickening of the stratum corneum and amyloid fibril deposition. Furthermore, dysregulated expression of chemokine monocyte chemoattractant protein-1 (MCP-1) by pathogenic variant in IL-31RA reduces monocyte-mediated clearance of amyloid fibrils, thereby promoting their pathological retention. The mechanisms of IL-31-mediated pruritus remain to be elucidated, given the conflicting observations that while some studies report wider cutaneous innervation in FPLCA patients, others demonstrate opposing results in general lichen amyloidosis patients. This review aims to synthesize recent advances in understanding PLCA pathogenesis with a focus on IL-31 and OSM cytokines network dysregulation especially driven by pathogenic variants, and provide critical insights for identifying therapeutic targets and put forward challenges in the future.
Teledermatology is increasingly used in European dermatology for triage, diagnosis, and workflow optimization, though artificial intelligence (AI) adoption remains limited. A survey of 252 dermatologists revealed variable usage, gaps in guidelines awareness, and concerns about security and technical issues. Strengthening infrastructure, regulation, and clinician engagement is key to its broader implementation.
Sentinel lymph node biopsy (SLNB) is one of the strongest prognostic indicators to date for cutaneous melanoma. However, its indication in elderly patients is controversial due to lower prognostic benefits, comorbidities, and surgical risks. The aim of this study was to develop and validate a predictive model specifically tailored to patients aged ≥ 75 years with cutaneous melanoma, and to compare its performance with the Melanoma Institute Australia (MIA) and Memorial Sloan Kettering Cancer Center (MSKCC) calculators. A multicenter, retrospective cohort study (SENTINOLD) including 795 patients aged ≥ 75 years was conducted across seven Spanish hospitals, representing one of the largest European datasets of elderly melanoma patients. A multivariable logistic regression model was developed using 12 clinicopathologic variables. Model performance was assessed by discrimination (AUC), calibration, and decision curve analysis (DCA), and compared with MIA and MSKCC calculators. Temporal validation was performed using a hold-out dataset representing the most recent diagnoses. The SENTINOLD nomogram demonstrated robust discrimination (AUC = 0.71), outperforming the MSKCC (0.66) and MIA (0.64) models (p < 0.05). Calibration and decision curve analysis confirmed greater clinical usefulness within the 5%-20% decision threshold range. Temporal validation showed stable performance (AUC = 0.68; Brier = 0.187). An interactive web-based calculator is freely available at https://sentinold.netlify.app, allowing clinicians to estimate the risk of SLN positivity using key tumor and patient characteristics. The SENTINOLD nomogram provides a reliable, user-friendly, and population-specific tool for individualized prediction of sentinel lymph node positivity in elderly melanoma patients. Its use may assist clinicians in guiding SLNB decision-making in this age group, although independent external validation and prospective evaluation of clinical impact are warranted. Older adults with melanoma often face difficult decisions about whether to undergo a sentinel lymph node biopsy, a procedure that helps determine whether the cancer has spread. In people over 75, this operation carries higher risks, and the benefit is sometimes uncertain. In this study, Spanish researchers analyzed data from nearly 800 elderly patients to develop a new predictive tool, SENTINOLD, that estimates the likelihood that the sentinel node is affected. The model performed better than two widely used international calculators (from Australia and the United States), showing greater accuracy and reliability over time. By providing a more precise, individualized risk estimate, SENTINOLD can help doctors and patients make better‐informed decisions, avoiding unnecessary surgery in low‐risk cases while ensuring that those who are likely to benefit receive the procedure safely.
The aim of the present study is to investigate the presence of various factors in individuals diagnosed with chronic venous disease (CVD), as compared to a control group. These factors include both those that have been empirically validated and those that remain unproven or have received less study. The second objective was to ascertain the factors influencing disease severity among patients with CVD. A questionnaire was employed to collect data on risk factors, anthropometrics, and medical history. The study involved 209 CVD patients and 194 controls. The Venous Clinical Severity Score and the Clinical, Etiologic, Anatomic and Pathophysiologic Classification were utilized to evaluate the severity of the disease. Regular exercise was more prevalent in the control group (p = 0.001), while prolonged sitting/standing (> 8 h) was more prevalent in the patient group (p < 0.001). Patients had higher levels of obesity and hypertension (p < 0.001). Female gender (p = 0.010) and family history of varicose veins (p = 0.002) contributed to mild venous disease. Prior deep vein thrombosis (p < 0.001), obesity (p = 0.031), extended sitting/standing (p = 0.035), inactivity (p = 0.001), and family history of varicose veins (p < 0.001) were associated with severe venous disease. Prior thrombosis was found to be associated with a more active utilization of compression therapy (p < 0.001). The findings emphasize that specific risk factors, including weight and physical inactivity, which are modifiable, correlate strongly with severe venous disease. Disease outcomes may improve through identification and modification of these factors.
Erythrodermic psoriasis (EP) is a rare but severe condition. Because of its low prevalence, there are no standardized treatment recommendations for EP. Specific EP guidelines are outdated, prioritizing conventional disease-modifying antirheumatic drugs (cDMARDs) and tumor necrosis factor-alpha (TNF-α) inhibitors. We conducted a multicenter retrospective chart analysis in five academic centers in Bavaria, Germany (Augsburg, Erlangen, LMU Munich, TU Munich, Regensburg). Patients diagnosed with EP between 2019 and 2024 who received systemic treatment were included in the study. A total of 29 patients were included. cDMARDs were initiated in 8 patients (27.6%). Biologics were used in 21 patients (72.4%). Psoriasis Area and Severity Index (PASI) decreased from 31.9 to 10.8 across all therapies (p < 0.001). PASI 75 was achieved with methotrexate (1), cyclosporine (1), fumarates (1), infliximab (1), ustekinumab (2), ixekizumab (1), secukinumab (2), risankizumab (4), and guselkumab (1). PASI 100 was achieved with infliximab (1), ustekinumab (1), and risankizumab (2). Adverse events occurred most frequently in the cDMARDs group. There is a wide variety of treatment approaches. Standardized guidelines are needed. Biologic therapies, especially interleukin (IL)17 and IL23-inhibitors, showed favorable outcomes in this cohort and warrant prospective evaluation. Erythrodermic psoriasis (EP) is a rare disease in which at least 75% of the body surface is affected by a chronic disease called psoriasis. Patients experience extensive redness, scaling, and general inflammation. EP may be accompanied by fever and a reduced general condition; therefore, it may become life‐threatening. Unlike psoriasis vulgaris (PsO), research into the pathophysiology of this disease and its treatment options is limited, and the existing guidelines for managing this severe condition are outdated. We therefore conducted a retrospective study in five centers in Bavaria, Germany, to collect and analyze data from patients with EP who were treated with systemic therapies commonly used in PsO. The study period was from 2019 to 2024. A total of 29 patients were included. They received 12 different systemic treatments. Therapy had to be discontinued in eight patients. Modern biologic agents showed marked clinical improvement in this cohort, whereas conventional treatments were also effective but more frequently associated with adverse events. These findings demonstrate the wide range of treatment approaches, even within a specific geographic location in Germany. Prospective studies and updated treatment guidelines are urgently needed.