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Rapid Pain and Skin Improvement of Chronic Hand Eczema with Delgocitinib Cream
Chronic hand eczema (CHE) is a common inflammatory dermatosis affecting up to 10% of the general population and is associated with pain, impaired hand function, and reduced quality of life. Despite its prevalence and morbidity, effective and well-tolerated treatment options remain limited. Delgocitinib 2% cream, a recently FDA-approved topical nonsteroidal pan–Janus kinase (JAK) inhibitor, has demonstrated efficacy across multiple CHE subtypes in clinical trials. We report a case of rapid and complete symptomatic remission in a patient with CHE presenting with fingertip fissures, edema, erythema, moderate pain (5/10), and mild pruritus (1/10) following initiation of delgocitinib monotherapy. Marked clinical improvement with complete resolution of both pain and itch was observed within four days of treatment initiation, with continued cutaneous healing and sustained symptom control thereafter. This case highlights the potential of topical pan-JAK inhibition to rapidly improve both objective disease features and patient-reported outcomes, particularly pain and pruritus, which substantially contribute to CHE-related quality-of-life impairment.
Copyright (c) 2026 Dr. Faraz Yousefian, Jaclyn Murphy, Christopher G. Bunick, M.D., Ph.D., Naiem T. Issa, M.D., Ph.D http://creativecommons.org/licenses/by/4.0
Sun Protection Awareness Through Reading in Kids (SPARK): A Pilot Study in Pediatric Dermatology Clinic
This pilot study aimed to create and evaluate a scientifically accurate children’s book about sun protection and assess its impact on caregiver knowledge and satisfaction. Twenty caregivers completed pre- and post-intervention surveys, revealing significant improvement in sun safety knowledge (p=0.0312) and identifying common barriers such as “My child doesn’t like wearing sunscreen” and “Staying in the shade is hard.” Caregivers unanimously agreed that the book effectively delivered relevant safety information to children and offered valuable insights for fostering sun protective behaviors. These findings suggest the utility of educational children’s literature as a promising tool for improving sun safety practices and identifying caregiver barriers.
Copyright (c) 2025 Grace Rabinowitz, BA, Braxton R. Schuldt, BA, Raphaella Lambert, BA, Hannah Verma, BA, Nicholas Gulati, MD, PhD, Nanette Silverberg, MD, Justine Fenner, MD http://creativecommons.org/licenses/by/4.0
Neuromodulators for Facial Aesthetics: Mechanistic Postulates and Clinical Implications
Background Neuromodulators, primarily botulinum toxin type A (BoNT-A), are a widely used nonsurgical intervention for facial aesthetics. Their applications have expanded from the upper face to the midface, lower face, and neck, driven by advances in anatomical understanding, injection techniques, and patient-tailored approaches. The growing number of available BoNT-A formulations and advanced injection techniques necessitates a detailed understanding to optimize outcomes and minimize complications. Methods A targeted PubMed search was conducted using a combination of the following keywords: ‘botulinum toxin’ and ‘neuromodulators.’ Articles were screened for relevance. Additional articles were included through citation tracking and authors’ clinical expertise. Results Although all BoNT-A products share a common mechanism of action, variability in molecular potency, receptor interactions, patient factors, and injection technique contribute to heterogeneous clinical outcomes. This review synthesizes current mechanistic, biochemical, and clinical evidence to propose a series of postulates that explain how toxin–receptor binding, synaptic vesicle protein 2 (SV2) receptor availability, light chain activity, and toxin distribution collectively determine clinical effect. Recent innovations include formation of hybrid toxins, the use of neuromodulators for facial lifting and shaping, microdroplet (microbotox) techniques for skin quality improvement, and ultrasound-guided injections for anatomical precision. Conclusions Neuromodulators are central to modern facial aesthetics, with expanding formulations and innovations. We propose a series of postulates that may assist clinicians in optimizing toxin selection, injection strategy, and patient outcomes while minimizing adverse effects.
Copyright (c) 2026 Aysham Chaudry, DO, Wilhelmina Lam, DO, Alexandra DeVries, BS, Alec Lawson, BA, Mark S. Nestor, MD, PhD http://creativecommons.org/licenses/by/4.0
Interleukin-17 A/F Inhibitor vs Interleukin-17 Receptor Blocker: The Tale of the Sponge and the Plug
Introduction Brodalumab (BRO) and bimekizumab (BIM) are treatments for moderate-to-severe psoriasis with distinct mechanisms of action. BRO, an interleukin (IL)-17 receptor A antagonist, selectively binds and inhibits receptor interactions with cytokine IL-17 isoforms A, C, E, and F. BIM, an IL-17A and -17F antagonist, selectively binds circulating IL-17A/F to inhibit IL-17 receptor complex interaction. Thus, BRO acts as a plug, binding to the receptor, whereas BIM acts as a sponge, attaching to circulating cytokines. As there are no head-to-head trials, we present clinical profile comparisons to assist clinicians in understanding key differences between BRO and BIM. Methods Data were extracted from clinical , network meta-analyses (NMAs) of clinical trials, prescribing information, and real-world studies. Precedence was given to studies providing comparisons between BRO and BIM. Results A retrospective study reported nonsignificant differences at week 36 between BRO and BIM, respectively, in 90% improvement from baseline in psoriasis area and severity index (PASI 90; 76% vs 83%) and PASI 100 (67% vs 74%). Likewise, an NMA reported similar efficacy vs placebo in PASI 90 risk ratios (RRs) at week 28 (BRO, 13.98; BIM, 14.76). However, 2 NMAs reported superior PASI 90 for BIM vs BRO. Regarding onset of action, a retrospective study reported that BRO vs BIM had significantly lower PASI 100 (P<0.05), but not PASI 90 rates (P≥0.05), at week 4. Additionally, an NMA reported similar average times to achieve PASI 90 for BRO and BIM (46.7 vs 41.5 days). Phase 3 trial post hoc analyses reported higher PASI 100 rates with BIM in patients with prior biologic exposure (BIM, 72% [week 156]; BRO, 50%-55% [week 120]). Specialized psoriasis treatment comparisons were limited by inconsistent endpoints. Still, for nail psoriasis, an NMA reported higher probability of achieving complete resolution at weeks 24-28 with BRO (37%) vs BIM (30%). For safety results, a retrospective study of BRO vs BIM reported fewer eczematous reactions (0 vs 2) and candidiasis cases (1 vs 4). Candidiasis rates were lower for BRO vs BIM in pharmacovigilance reports (<1% vs 9%) and prescribing information (<1% vs 10% [mostly oral candidiasis]), and an NMA reported lower infection RR with BRO (1.15) vs BIM (1.36). BRO inhibits more IL-17 cytokines than BIM (A/C/E/F vs A/F, respectively). BRO (210 mg) is given as subcutaneous injection (SC) at weeks 0, 1, and 2, with maintenance dosing every 2 weeks. BIM (320 mg) is given SC at weeks 0, 4, 8, 12, and 16, with maintenance every 8 weeks and considerations for every 4 weeks in patients weighing ≥120 kg. Conclusions Studies demonstrate comparable efficacy and onset of action between BRO and BIM, with some favoring BIM. Increased rates of eczematous eruptions and fungal infections are associated with BIM. Balanced decision-making that considers efficacy and adverse events is warranted when choosing between BRO and BIM.
Poster Presentations from WC26 Miami and Real World Dermatology for Residents Conference®: Psoriasis
Copyright (c) 2026 Joshua Zeichner, Leon Kircik, Edward (Ted) Lain, April Armstrong , Brad Glick, John Koo, Naiem Issa, Mark Lebwohl http://creativecommons.org/licenses/by/4.0
Pilot Evaluation of the Efficacy and Safety of Xtressé™ Gummy-Based Nutraceutical Supplement in Women with Hair Loss
Background: Hair loss in women is a prevalent condition with significant psychosocial impact, yet therapeutic options remain limited. Nutraceutical supplements are widely used as adjunctive therapy; however, few formulations—particularly gummy-based delivery formats designed to improve adherence—have been evaluated using objective imaging endpoints. Methods: This prospective, single-center, single-arm pilot study evaluated the safety and efficacy of Xtressé™, a dermatologist-developed gummy nutraceutical, in 24 women with self-perceived hair thinning. Participants consumed two gummies daily for four months. Seventeen participants (11 non-scarring alopecia, 6 scarring alopecia) completed the study. Primary outcomes included change in hair density by Canfield HairMetrix® phototrichogram analysis and change in global alopecia severity by SOCAi Vision™. Results: Among participants with non-scarring alopecia, 81.8% met responder criteria by Canfield HairMetrix® phototrichogram analysis, with mean increases in total hair density (+7.35%, 11.4 hairs/cm²) and terminal hair density (+6.81%, 10.2 hairs/cm²); 63.6% also demonstrated improvement in global scalp coverage by SOCAi Vision™. Among participants with scarring alopecia, localized phototrichogram parameters within scarred regions of interest declined (16.7% responder rate by Canfield), consistent with irreversible follicular loss, whereas global imaging detected improvement in surrounding non-scarred scalp in 66.7% by SOCAi Vision™. Mean relative improvement in global coverage exceeded 20% among SOCAi responders in both subgroups. No adverse events were reported. Conclusion: Xtressé™ was safe, well tolerated, and associated with measurable improvements in hair parameters among women with non-scarring alopecia. These findings support the potential role of multi-ingredient nutraceutical therapy as adjunctive treatment for hair loss. Larger, controlled trials are warranted.
Copyright (c) 2026 Spencer Hawkins, Chesahna Kindred, Michelle Peters, Adam Leavitt, Matt Leavitt http://creativecommons.org/licenses/by/4.0
Patient Characteristics and Treatment Approaches in Delusional Infestation Across Two Medical Centers: A Retrospective Study
Background: Delusional Infestation (DI) is a psychiatric disorder marked by persistent, false belief of infestation despite medical evidence to the contrary. Large-scale research on DI is limited, with only one population-based study to date. DI remains poorly understood and difficult to manage. Methods: We conducted a multicenter retrospective chart review of adult outpatients seen in tertiary dermatology clinics at the University of Michigan and University of California, San Francisco between January 2021 and May 2024. Patients were identified using relevant ICD codes, and eligibility was confirmed by manual review for DSM-5 criteria for DI. Key clinical and demographic data were extracted, and relevant risk was calculated using national prevalence data from NAMI and SAMHSA. Results: We identified 155 patients with DI; most were female (79%), non-Hispanic (94%), and white (73%). Mean age of onset was 54 years, with a three-year diagnostic delay. Delusions commonly involved parasites (25%) or bugs/insects (27%). Diagnostic evaluations included skin biopsy (34%) and skin scrapings (15%), with significant variation between centers. Substance use and psychiatric comorbidities were prevalent, with elevated relative risks compared to population data. Treatments most often involved antiparasitic agents, pimozide, or second-generation antipsychotics; pimozide was associated with the highest rate of improvement Conclusions: DI primarily affects middle-aged female and is marked by delayed diagnosis, frequent substance use, and psychiatric comorbidities. Despite varied diagnostic approaches, treatment outcomes remain poor. Multidisciplinary care and standardized protocols are needed to improve management and outcomes.
Copyright (c) 2026 Megan Hauptman, Amélie Spangenberg, Joanna Rew, Liam A Matthews, Andrea Leung, Allison Kranyak, Radhika Gupta, Miranda Chen, Alina Feng, Parsa Mokhtar, Hayden Schandua, John Koo, Wilson Liao, Mio Nakamura http://creativecommons.org/licenses/by/4.0
Energy-Based Non-Light Devices for Dermatological Conditions: Current Indications and New Innovations
Background Non–light-based energy devices are increasingly used in dermatology as minimally invasive treatments that employ thermal, mechanical, and electromagnetic energy for medical and aesthetic indications. This review summarizes current evidence and emerging innovations in this rapidly evolving field. Methods A targeted PubMed search was performed using the keywords radiofrequency, microwave, ultrasound, energy-based devices, and dermatology. English-language articles were included, supplemented by citation tracking and authors’ clinical expertise. Results Radiofrequency (RF) devices demonstrate efficacy for skin laxity, rhytides, acne, acne scarring, vascular lesions, hyperhidrosis, and select cutaneous neoplasms through thermally induced dermal remodeling. Fractional RF microneedling is particularly effective in darker skin phototypes with low risk of postinflammatory hyperpigmentation. High-frequency RF ablation provides precise, low-pain treatment of benign cutaneous lesions. Ultrasound therapies, including high-intensity focused ultrasound, are effective for skin tightening, body contouring, cellulite, inflammatory dermatoses, and selected keratinocyte carcinomas. Cryolipolysis achieves significant localized fat reduction with evidence of dermal remodeling. Microwave therapy is effective for actinic keratoses, viral warts, axillary hyperhidrosis, and osmidrosis. Cold atmospheric plasma shows promise for infectious, inflammatory, and neoplastic skin conditions. Conclusion Non–light-based energy devices offer versatile, safe treatment options across dermatology with minimal downtime and applicability to all skin phototypes. Ongoing advances emphasize precision delivery, combination therapies, and personalized treatment strategies.
Copyright (c) 2026 Alec Lawson, BA, Alexandra DeVries, BS, Wilhelmina Lam, DO, Aysham Chaudry, DO, Mark S. Nestor, MD, PhD http://creativecommons.org/licenses/by/4.0
Unique Presentation of a Large Mastocytoma in an Adult
SKINmages: Clinical Images in Dermatology
Copyright (c) 2026 Donald J. Peretti, Diana C. Norton, Christina A. Kavran, Brett M. Condon http://creativecommons.org/licenses/by/4.0
When to Reapply Moisturizers: Evidence-Based Intervals from a 24-Hour Hydration Study
Abstract Introduction: Hydration is essential for healthy skin, and humectants like glycerin, hyaluronic acid, and urea are often included in topical moisturizers to attract and lock in water within the stratum corneum. However, the duration of hydration provided by these ingredients is not well established, making the frequency of reapplication largely anecdotal. This study assessed the hydration effects and duration of four topical humectant formulations over 24 hours using Tissue Dielectric Constant (TDC) measurements of skin water content. Methods: Thirty participants were applied randomly assigned formulations—Ceramide and Hyaluronic Moisturizing Cream (CHMC), Glycerin and Petrolatum Moisturizing Cream (GPMC), Urea and Shea Butter Repair Cream (USRC), and Multi-Hyaluronic Acid and Botanical Serum (MHBS)—to forearm sites, with TDC values recorded at baseline, 1 hour, 4 hours, and 24 hours. Generalized estimating equations (GEE) modeled epidermal hydration trends, and intersection analyses identified when hydration was no longer greater than untreated skin. Results: In the 24-hour GEE model, only MHBS showed a statistically significant increase in epidermal hydration compared to the control. At the same time, CHMC, GPMC, and USRC did not differ significantly over the entire 24-hour period. Intersection analysis found that hydration above baseline was temporary, lasting approximately 3–4 hours for CHMC, GPMC, and USRC, and nearly 5 hours for MHBS. Conclusion: These results provide evidence-based guidelines for moisturizer reapplication, suggesting that humectant-based products should be reapplied every 3–5 hours to maintain epidermal hydration.
Copyright (c) 2026 Kawaiola Cael Aoki, Emily Deehan, Marissa Ruppe, Gregory Bartos, Harvey Mayrovitz http://creativecommons.org/licenses/by/4.0
Baricitinib Induced Hypoglycemic Seizures in a Patient with Hair Loss and Type I Diabetes Mellitus: A Case Report
Alopecia Areata (AA) is an autoimmune-mediated form of non-scarring hair loss. Novel treatment involves Janus Kinase (JAK) inhibitors that aim to stop the progression of AA and restore hair growth. Baricitinib is a selective JAK1/JAK2 inhibitor that has shown efficacy in the treatment of AA. Overall safety of baricitinib is favorable, however, we present a patient who experienced recurrent hypoglycemic seizures. A 60-year-old female presents with a long-standing history of hair loss and type 1 diabetes mellitus. She was started on baricitinib 4mg daily and quickly observed hair regrowth and reduced shedding. However, the patient also experienced four hypoglycemic seizures in the first 30 days. Blood glucose measurements were performed following each seizure, with values ranging from 25-38mg/dL. At her initial follow-up, the patient did not want to discontinue medication due to her hair improvement and therefore the baricitinib dose was reduced to 2mg daily. The patient subsequently denied additional seizures and glucose readings below 40mg/dL. Although hypoglycemia is not a reported FDA side effect of baricitinib, there are few reports of JAK inhibitors causing this outcome in at risk patients. Hypoglycemia as an adverse event may be explained by the role of JAK-STAT pathways in β-cell destruction. With the increasing use of JAK inhibitors in dermatology, close glucose monitoring and increased patient education is advisable until the potential for hypoglycemia as an adverse effect is further understood.
Copyright (c) 2026 Cathleen V. D'Angelo, Megan Jones-Sheets http://creativecommons.org/licenses/by/4.0
Unanticipated Skin Discovery at the Lateral Thigh
Copyright (c) 2026 Yaniel Ramirez Sanchez, Prince Adotama http://creativecommons.org/licenses/by/4.0
Effectiveness and Safety of Montelukast as an Adjuvant Therapy to Isotretinoin Treatment of Acne Vulgaris: A Randomized Controlled Trial
Introduction Isotretinoin effectively targets all acne-related pathological mechanisms but is associated with various side effects. On the other hand, montelukast serves as an antagonist to LB4, which is an important mediator in acne pathogenesis. Objectives This study aimed to compare the efficacy of montelukast as an adjuvant treatment to isotretinoin versus isotretinoin alone for moderate acne vulgaris and to evaluate treatment tolerability by monitoring side effects. Materials and Methods A randomized comparative prospective trial included 40 patients from the Dermatology and Venereology Hospital at Damascus University. They were assigned into two groups: group A received montelukast (10mg/day) with isotretinoin (20 mg/day for 10 days, followed by 0.6 mg/kg/day for three months), while group B received isotretinoin alone (20 mg/day for 10 days, followed by 0.6 mg/kg/day for three months). Follow-ups occurred on the 40th day and then monthly, assessing GAGS, comedones, inflammatory lesions, total lesions, and side effects at each visit. Additionally, patient satisfaction was assessed during the final visit. Results Adding montelukast to isotretinoin significantly reduced GAGS, comedones, inflammatory lesions, and total lesions, with statistically significant differences between the beginning and end of treatment. By evaluating patients at the end of treatment period, there were significant statistical differences between the two treatment groups regarding GAGS, inflammatory lesions, total lesions, and patient satisfaction, with more side effects reported in the isotretinoin group. Conclusion Montelukast combined with isotretinoin is an effective treatment for moderate acne vulgaris, outperforming isotretinoin alone with fewer side effects.
Copyright (c) 2026 Rima Alhalabi, Ahmad Alhalabi, Dima Alhalabi, Manal Mouhamad http://creativecommons.org/licenses/by/4.0
Varicella-Zoster Virus Reactivation Masquerading as Granuloma Faciale
Background Varicella-zoster virus (VZV) typically presents as a dermatomal eruption of vesicles following a prodrome of burning pain. Atypical presentations may complicate diagnosis, especially when histopathologic features mimic inflammatory dermatoses. Case Presentation A 38-year-old man presented with a one-week history of an erythematous, edematous plaque over the left glabella and periorbital region, associated with headache. Initial evaluation favored preseptal cellulitis, and imaging showed soft tissue thickening. Despite broad-spectrum antibiotics, the rash persisted. Skin biopsy revealed a dense perivascular and periadnexal lymphohistiocytic infiltrate with plasma cells and rare eosinophils, favoring granuloma faciale. Despite biopsy findings, empiric antiviral therapy was initiated given clinical suspicion for herpes zoster. VZV PCR ultimately returned positive. The patient completed a course of oral valacyclovir with resolution of symptoms. Discussion This case illustrates an unusual presentation of VZV, histologically mimicking granuloma faciale without classic viral cytopathic changes. While granulomatous reactions are more often associated with chronic postherpetic changes, concurrent granulomatous inflammation during acute VZV reactivation is rare. Early consideration of VZV in atypical facial eruptions and the use of molecular testing are crucial to avoid diagnostic delays. Conclusion Clinicians should maintain a high index of suspicion for VZV in atypical facial rashes, even when initial clinical and histopathologic findings suggest alternative diagnoses. Early PCR testing can facilitate prompt treatment and improve outcomes.
Copyright (c) 2026 Jake Nusynowitz, Nicholas Gessner, Nicole Edmonds, Ruth Foreman, John Trinidad http://creativecommons.org/licenses/by/4.0
Sunscreens: Limitations of Past and Current UVA Protection Metrics in an Era of Rising UVA-Driven Skin Cancers
Purpose Current literature indicates a significantly rising incidence of UVA-associated skin cancers, including squamous cell carcinoma (SCC) and malignant melanoma (MM), relative to UVB-associated basal cell carcinoma (BCC) and a shift in the SCC to BCC ratio, challenging the long-held view that BCC predominates. This review examines the extent to which ultraviolet (UV) protection metrics in the United States might have contributed to this ongoing change. Methods A PubMed search was conducted using the terms “UV protection metrics”, “UVA”, and “UVB”. Results were screened for relevance and articles written in only English. Additional articles were included via citation tracking. The authors' expert clinical opinions were also included. Results and Discussion Recent epidemiological data demonstrate a substantial increase in SCC incidence relative to BCC, particularly among older individuals and in regions with high cumulative UV exposure. In the U.S., the BCC to SCC incidence ratio (including subtypes) has shifted from approximately 4:1 in 1992 to nearly 1:1 in 2012 and further to 1:3 by 2024, with SCC subtypes now representing a growing proportion of nonmelanoma skin cancer (NMSC) cases. Similarly, the incidence of melanoma continues to steadily rise. Sunscreen remains a primary method of UV protection, with early formulations targeting UVB radiation before the role of UVA in carcinogenesis was recognized. The sun protection factor (SPF), adopted by the U.S. Food and Drug Administration (FDA) in the 1980s, labels sunscreens by quantifying protection against UV-induced erythema and is calculated as the ratio of the minimal erythema dose (MED) in protected skin to that in unprotected skin. Because erythemogenic effects are primarily mediated by UVB, SPF largely reflects UVB protection and remains the primary measure of sunscreen efficacy despite advances in broad-spectrum, UVA-filtering formulations. Because UVA radiation lacks a clear, easily observable endpoint comparable to UVB-induced sunburn (erythema), a standardized metric for quantifying UVA protection has not been established in the U.S. Instead, UVA damage accumulates subtly, a concept referred to as “the silent UVA,” making sunscreen UVA protection difficult to quantify. While advancements have been made in providing UVA protection through development of broad-spectrum labeling standards by the U.S. FDA, multiple studies have demonstrated suboptimal UVA coverage with modern sunscreens. A study conducted in 2021 evaluating the performance of 32 U.S. commercially available broad-spectrum sunscreens, six showed failure to meet the critical wavelength of ≥ 370 nm needed for broad-spectrum labeling, and approximately 40% of sunscreen products tested had suboptimal UVA protection. Conclusion The primary reliance on UVB-derived SPF to quantify UV protection, combined with the lack of a comparable UVA metric, has likely contributed to the rising incidence of UVA-driven cancers and underscores the need for improved UVA-specific metrics and continued research.
Non-Melanoma Skin Cancers and Benign Cutaneous Tumors
Copyright (c) 2026 Alexandra DeVries, BS, Alec Lawson, BA, Aysham Chaudry, DO, Wilhelmina Lam, DO, Mark S. Nestor, MD, PhD http://creativecommons.org/licenses/by/4.0
Early and Sustained Effects of Clindamycin Phosphate 1.2%/Adapalene 0.15%/Benzoyl Peroxide 3.1% Gel
Introduction The combination of a topical antibiotic, retinoid, and benzoyl peroxide (BPO) is one of the most effective therapies for acne and has demonstrated greater efficacy versus monotherapy or dyads. However, it is unknown if triple-combinations impart rapid efficacy along with minimal tolerability issues, which may improve patient adherence. The only triple-combination acne topical, clindamycin phosphate 1.2%/adapalene 0.15%/BPO 3.1% (CAB) gel, has demonstrated efficacy and favorable tolerability in clinical trials. This pooled analysis assessed efficacy and safety of CAB versus vehicle following 4 and 12 weeks of treatment. Methods Pooled data from 4 double-blind, 12-week trials (phase 2, NCT03170388 and NCT04892706; phase 3, NCT04214639 and NCT04214652) of participants aged ≥9 years (≥12 years in NCT04892706) with moderate to severe acne were used to assess change from baseline in inflammatory/noninflammatory lesions and treatment success (percentage of participants achieving ≥2-grade reduction from baseline in Evaluator’s Global Severity Score and a score of 0 or 1 [clear/almost clear]). Treatment-emergent adverse events (TEAEs) and cutaneous safety/tolerability were also evaluated. Results Analyses were performed on data from 1115 participants randomized to CAB or vehicle (n=618 and n=497, respectively). At week 4, inflammatory lesions were reduced by >50% with CAB, with continued reductions of >75% at week 12, significantly greater than with vehicle (week 4, 53.8% vs 39.6%, respectively; week 12, 76.9% vs 52.9%; P<0.001 both). Similar trends were observed for noninflammatory lesions (P<0.001 both). Treatment success was achieved by 51.0% of CAB-treated participants vs 18.3% with vehicle (P<0.001) at week 12, with significant differences observed at week 4 (10.7% vs 4.2%; P<0.001). Application-site pain was the only treatment-related TEAE in ≥5% of CAB-treated participants. By week 4, transient increases in mean safety/tolerability scores for scaling, erythema, itching, stinging, and burning with CAB generally resolved to at/near baseline levels. Conclusions In this pooled analysis, treatment with fixed-dose CAB led to rapid clinical improvements as early as week 4 with favorable tolerability. Though long-term topical acne treatment may be needed to achieve clear skin, the fast-acting efficacy of the only approved triple-combination product for acne—coupled with its once-daily dosing and tolerability—may improve patient satisfaction and treatment adherence.
Copyright (c) 2026 Leon H. Kircik, Edward (Ted) Lain, Hilary Baldwin, Linda Stein Gold, Joshua A. Zeichner, Karol Wroblewski, Michael Gold, Valerie D. Callender, Zoe D. Draelos, Julie C. Harper http://creativecommons.org/licenses/by/4.0
Curcumin (Curcuma longa): Applications in Clinical, Regenerative and Aesthetic Dermatology
Background Curcumin (CUR), the principal polyphenol in Curcuma longa, has gained increasing interest in dermatology because of its antioxidant, anti-inflammatory, antimicrobial, photoprotective, and regenerative properties. Despite versatile biological activity, its clinical use has been limited by poor bioavailability and significant product variability across formulations. Methods A targeted PubMed search was conducted using a combination of the following keywords: ‘curcumin,’ ‘turmeric,’ and ‘dermatology.’ Only articles in English and relevant to this review were included. Additional articles were included through citation tracking and authors’ clinical expertise. Results The search yielded 375 results, and 94 articles and two webpages were included based on inclusion and exclusion criteria. Discussion CUR modulates multiple intracellular pathways resulting in reduced pro-inflammatory cytokine expression, improved oxidative balance, and enhanced tissue repair. Despite an extremely favorable safety profile, CUR’s clinical use remains limited by poor bioavailability; however, newer formulations, including FDA-recognized medical foods, have substantially improved absorption and product consistency. Clinically, CUR has shown immunomodulatory and anti-inflammatory effects applicable to cutaneous conditions including psoriasis, atopic dermatitis, and photodamage, and has exhibited antimicrobial activity in acne. Aesthetically, CUR reduces melanogenesis and provides firming effects by limiting oxidative stress and matrix metalloproteinase activity. Regeneratively, it modulates key longevity-associated pathways involved in cellular senescence, wound healing and anti-aging. Conclusion CUR represents a safe and multifaceted agent with clinical, aesthetic, and regenerative dermatologic benefits. Prescriptive “medical foods” may be an answer to the clinical and aesthetic limitations of the use of CUR by increasing bioavailability and reducing variability, though more robust clinical trials are needed to define optimal dosing and long-term efficacy.
Copyright (c) 2026 Alexandra DeVries, BS, Wilhelmina Lam, DO, Alec Lawson, BA, Aysham Chaudry, DO, Mark S. Nestor, MD, PhD http://creativecommons.org/licenses/by/4.0
Novel Cosmeceutical to Improve Skin Quality, Reduce Photodamage and Decrease Actinic Keratoses: In Vitro, in Vivo, and Clinical Case Series Analysis
Actinic keratoses (AKs) are visible markers of chronic ultraviolet (UV) induced photodamage and accelerated cutaneous aging, with an estimated annual progression risk of 0.025-16% to invasive squamous cell carcinoma. AKs may extend into deeper epidermal layers and remain clinically unapparent, contributing to recurrence and incomplete clearance. Two-thirds of cutaneous malignancies are thought to arise from pre-existing AKs, underscoring the importance of early, field directed intervention. While standard treatments such as cryotherapy and 5-fluorouracil are effective, they are limited by side effects, adherence challenges, and recurrence. Preventive strategies that enhance cellular repair, reverse photodamage, and support long-term field control are therefore increasingly sought. In this study, we evaluated an adaptogenic, multi-active topical cosmeceutical incorporating Genoplex Microdelivery Activator (GMA) technology, containing niacinamide, bakuchiol, green tea and coffee extract, hydroxytyrosol, oleuropein, and ceramides. In vitro assays assessed effects on UV induced oxidative stress, inflammatory cytokines, extracellular matrix integrity, hypoxia-related signaling, and cellular senescence. In vivo antioxidant capacity was evaluated using PAOT analysis. A cohort of thirteen patients with recurrent facial AKs applied the formulation twice daily for ≥12 weeks, either as monotherapy or with adjunctive topical 1% simvastatin. Outcomes were assessed using the Actinic Keratosis Area and Severity Index (AKASI) and evaluation of standardized high-resolution photography. A separate real-world longitudinal analysis evaluated AK burden across consecutive visits in 48 patients from an independent dermatology clinic. Multicentre questionnaire data were analyzed to characterize patient-reported tolerability, satisfaction, and perceived effectiveness. The formulation demonstrated activity across biological pathways implicated in cutaneous aging and carcinogenesis. In vivo PAOT analysis showed up to a 95.5% reduction in reactive oxygen species. In vitro testing demonstrated attenuation of UV-induced inflammatory cytokines, restoration of extracellular matrix and hypoxia-related markers, and reduced expression of senescence-associated signals. Clinically, all patients in the prospective cohort improved, with a mean AKASI reduction of 2.10 (p<0.0001), visible improvement in surrounding photodamaged skin, and no treatment-related adverse events; four patients achieved near-complete lesion clearance, with the largest improvements observed in those receiving treatment containing adjunctive simvastatin. AK counts also demonstrated consistent reductions across consecutive visits, supporting durable benefit. Multicentre questionnaire data showed patients reports of 87% global satisfaction, 83% perceived effectiveness, and 96% with little to no side effects. This adaptogenic cosmeceutical targets key biological drivers of aging skin, including oxidative stress, chronic inflammation, extracellular matrix degradation, and cellular senescence. The reductions in AK burden, combined with visible improvement in surrounding photodamaged tissue, support this cosmeceutical as a promising adjunct for aesthetic and anti-aging practice Its favorable clinical, real-world, and patient-reported outcomes support its role as a field-directed, prevention-focused adjunct in aesthetic and anti-aging dermatology.
Copyright (c) 2026 Kashika Sareen, Yufei Chen, Anna Matveev, Marc Jeschke, Jason Zhao, Wei Jing Loo, Tiffany Parsons, Rahul Shukla, Brandon Howell, Abdalaziz Alukhaizeem, Rade Sajic, Dusan Sajic http://creativecommons.org/licenses/by/4.0
The Value of the 31-GEP for Rural Areas and Health Resource Allocation
Copyright (c) 2026 Shannon Trotter, Michelle Daffer, Haowei Han, Aysham Chaudry, Alexandra DeVires, Wilhelmina Lam, Alec Lawson, Brooke Bartley, Lauren DeBusk http://creativecommons.org/licenses/by/4.0
Psoriasis Retreatment Efficacy: Is Immunogenicity A Threat?
Introduction Although biologic therapy has revolutionized psoriasis treatment by enabling potential disease remission, there is a risk of immunogenicity and antidrug antibody (ADA) formation, especially with intermittent therapy. Although clinically unproven, formation of ADAs, specifically neutralizing antibodies (NAbs), may reduce treatment efficacy. Here, we summarize and compare ADA and Nab incidences, as well as retreatment efficacy, of plaque psoriasis−indicated monoclonal antibodies (mAbs). Methods Evaluated compounds included anti–tumor necrosis factor α (anti-TNFα; infliximab, adalimumab, certolizumab pegol), anti–interleukin-12/-23 (anti–IL-12/-23; ustekinumab), anti–IL-23 (guselkumab, tildrakizumab, risankizumab), and anti–IL-17 (secukinumab, ixekizumab, brodalumab, bimekizumab) mAbs. Prescribing information and published literature were leveraged for ADA/NAb incidence and retreatment data, respectively. ADA incidences represent the percentage of patients with ADAs among all patients who received each mAb. NAb incidences represent the percentage of patients with NAbs among all patients who were positive for ADAs. These incidences are reported for the population of interest (ie, those treated for plaque psoriasis) except for secukinumab and ustekinumab, for which ADA/NAb rates are reported for several indications, including plaque psoriasis. Results Fully human antibodies (adalimumab, ustekinumab, guselkumab, secukinumab, brodalumab) had lower ADA incidences (range, <1%-12%) than humanized (tildrakizumab, risankizumab, ixekizumab, bimekizumab), humanized Fab' fragment (certolizumab pegol), or chimeric (infliximab) antibodies (range, 6%-51%). The anti-TNFα mAb infliximab had the highest ADA incidence (20%-51%) across all target classes. Although the anti–IL-17 class (range, <1%-45%) had fairly similar ADA incidences to anti–IL-12/-23 and anti–IL-23 classes (range, 6%-24%), the anti–IL-17 class had lower NAb incidences (ranges, 0%-16% vs 6%-57%, respectively). The lowest incidences of ADAs and NAbs were observed for secukinumab, brodalumab, and guselkumab (ADAs: range, <1%-9%; NAbs: range, 0%-8%). Therapies with low ADA/NAb rates tended to exhibit high levels of retreatment efficacy: among patients re-randomized to treatment after experiencing relapse during treatment withdrawal, ≥85% of patients receiving brodalumab (ADAs, 3%; NAbs, 0%) achieved ≥90% improvement from baseline in psoriasis area and severity index (PASI 90) after 8 weeks of retreatment, whereas only 31% of patients receiving tildrakizumab (ADAs, 6%; NAbs, 40%) achieved PASI 90 after ≤36 weeks of retreatment. Conclusions Of mAbs assessed, anti–IL-17 and anti–IL-23 classes (secukinumab, brodalumab, guselkumab) had the lowest ADA and NAb incidences. Only brodalumab had no NAbs detected. Although direct comparisons between biologics cannot be made due to differences in ADA assays and clinical trial designs, there is a trend of improved efficacy upon retreatment among mAbs with low ADA and NAb incidences.
Copyright (c) 2026 Mark G. Lebwohl, Andrew F. Alexis, Brad Glick, Adelaide A. Hebert, Naiem T. Issa, Leon H. Kircik, James G. Krueger http://creativecommons.org/licenses/by/4.0
Resolution of Hidradenitis Suppurativa-Associated Peripheral Ulcerative Keratitis with High-Dose, High-Frequency Infliximab
Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory skin disease characterized by painful nodules, abscesses, and tunnels in intertriginous areas. HS is rarely associated with inflammatory eye disease that can progress to corneal thinning and ulceration. Here, we describe a case of HS-associated peripheral ulcerative keratitis (PUK) treated with infliximab, an intravenous tumor necrosis factor (TNF)-alpha inhibitor, resulting in resolution. Our case demonstrates that high-dose, high-frequency infliximab may have therapeutic potential for severe inflammatory eye disease associated with HS.
tumor necrosis factor (TNF)-alpha inhibitors
Copyright (c) 2026 Jon Suzich, Nidhi Kuchimanchi, Tara L. McGehee, R. Hal Flowers, Abby Wills http://creativecommons.org/licenses/by/4.0
Time-to-Efficacy Outcomes by Observed Abrocitinib Dosing Patterns Among Patients With Moderate-to-Severe Atopic Dermatitis: A Post Hoc Analysis of JADE REAL
Introduction Abrocitinib, an oral JAK1-selective inhibitor, is approved for the treatment of moderate-to-severe atopic dermatitis (AD) in patients aged ≥12 years. JADE REAL (NCT04564755), an open-label, expanded-access-protocol study, provided abrocitinib to patients with inadequate response to approved AD therapies. Patients received 100 or 200 mg daily at investigator discretion, with dose adjustments allowed to simulate real world clinical practice. Patients could up-titrate from 100 mg to 200 mg if clinical response was inadequate after ≥4 weeks of treatment and they did not experience dose-limiting adverse events. Conversely, patients could down-titrate at investigator discretion for safety reasons, or if the investigator considered that disease maintenance could occur at a lower dose. This analysis evaluated time-to-efficacy outcomes overall and by flexible dosing strategy. Methods Time to achieve Eczema Area and Severity Index (EASI)-75, EASI-90, EASI-100, and EASI-90 + Peak Pruritus-Numerical Rating Scale (PP-NRS) 0/1 was analyzed overall, and by abrocitinib dosing: 100 mg consistent dose (initiated 100 mg without dose escalation), 200 mg consistent dose (initiated 200 mg and continued the high dose), dose escalation (initiated 100 mg and increased dose, with ≥1 dose change), and dose reduction (initiated 200 mg and reduced dose, with ≥1 dose change), up to Week 72 of abrocitinib treatment. Patients were censored if they did not achieve response by the end of follow-up in the study. Results Analyses included 77, 117, 42, and 73 patients in the 100 mg consistent dose, 200 mg consistent dose, dose escalation, and dose reduction groups, respectively. Median time to achieve EASI-75 response was 85, 43, 85, and 30 days for 100 mg consistent dose, 200 mg consistent dose, dose escalation, and dose reduction groups, respectively. Median time to EASI-90 response was 169, 169, 254, and 84 days; to EASI-100, 327, not evaluable (NE), 427 and 182 days; and to EASI-90 + PP-NRS 0/1, 253, 684, NE and 167 days in the 100 mg consistent dose, 200 mg consistent dose, dose escalation, and dose reduction groups, respectively. Conclusions Patients across all dosing groups demonstrated achievement of all efficacy endpoints over time. Patients with clinical response to abrocitinib 200 mg may switch to the lowest effective dose, while continuous 200 mg dosing may also be an option based on provider decision and patients’ clinical needs. Patients with lower response to 100 mg may benefit from up-dosing to 200 mg, and patients who respond well to the 100 mg dose may continue on the lowest effective dose. Among patients with moderate-to-severe AD receiving abrocitinib in JADE REAL, flexible dosing enabled individualized management of moderate-to-severe AD. Funding This study was funded by Pfizer.
Copyright (c) 2026 Melinda J. Gooderham, Raj Chovatiya, Stephan Weidinger, Zhao Zuotao, Yukari Okubo, Irina Lazariciu, Herwig Koppensteiner, Carmen Tsang, Simon Chen http://creativecommons.org/licenses/by/4.0
Bimekizumab Durability of High-Level Clinical and Quality of Life Responses in Early Responders with Moderate to Severe Plaque Psoriasis: 4-Year Results from Four Phase 3 Trials
Introduction Bimekizumab (BKZ) has demonstrated rapid, sustained efficacy in moderate to severe plaque psoriasis, with many patients achieving skin responses at Week (Wk)4, after one dose.1 While early clinical response is important to patients, as demonstrated using a cross-sectional survey by Gorelick et al., disease chronicity makes long-term durability crucial for both patients and clinicians.2,3 Here, we examine the maintenance of clinical and quality of life (QoL) outcomes over 4 years (yrs) in patients achieving early skin responses with BKZ. Procedure/study Data were pooled from the 52/56-wk phase 3 trials BE VIVID/BE SURE/BE READY and their 144-wk open-label extension (OLE), BE BRIGHT.1,4–7 Patients received BKZ 320mg every 4 wks (Q4W) to Wk16, then BKZ Q4W or Q8W into the OLE (BKZ Total). All received BKZ Q8W from OLE Wk100/104 or next scheduled visit. A subgroup received BKZ Q4W to Wk16 then Q8W thereafter (BKZ Q4W/Q8W; approved dosing regimen for most patients with psoriasis).8 Maintenance of ≥75/≥90/100% improvement in Psoriasis Area and Severity Index (PASI 75/90/100) and Dermatology Life Quality Index (DLQI) 0/1 was assessed through Wk196/200 (Yr4) in Wk4 PASI 75/90 responders. Patients discontinuing treatment due to lack of efficacy/treatment-related adverse events were considered non-responders at subsequent timepoints; multiple imputation was used for all other missing data. Results Overall, 771 patients received BKZ continuously and entered the OLE (BKZ Total); 592 (76.8%)/331 (42.9%) were Wk4 PASI 75/90 responders (BKZ Q4W/Q8W [N=197]: 158 [80.2%]/79 [40.1%]). Baseline characteristics were similar between Wk4 PASI 75/90 responders and the overall population. In the BKZ Total group, 95.3% of Wk4 PASI 75 responders maintained PASI 75 to Yr4. In BKZ Total Wk4 PASI 75 responders, PASI 90/PASI 100/DLQI 0/1 responses increased from Wk4 (55.9%/20.8%/41.3%) to Wk16 (95.2%/71.3%/73.6%) and were maintained to Yr4 (87.6%/67.5%/78.6%). Among BKZ Total Wk4 PASI 90 responders, 95.6%/89.2% maintained PASI 75/90 responses to Yr4. In Wk4 PASI 90 responders, PASI 100/DLQI 0/1 responses increased from Wk4 (37.2%/49.7%) to Wk16 (79.7%/79.4%) and were maintained to Yr4 (73.2%/80.7%). Responses were similar in the BKZ Q4W/Q8W subgroup. Conclusion Patients with early skin improvement after 4 wks of bimekizumab maintained or improved high skin and QoL responses through 4 yrs, providing insight for clinicians and patients that bimekizumab may provide both rapid and durable psoriasis disease control.
Copyright (c) 2026 Naiem T. Issa, Anna Campanati, André VE. Carvalho, Eingun J. Song, Alexander Zink, Leonor Avó, Sarah Kavanagh, Nicolas Hurni, Vimal H. Prajapati http://creativecommons.org/licenses/by/4.0
Toxic Shock Syndrome After Fractionated Ablative CO2 Laser
Patient History: A 62-year-old female with history of hyperlipidemia, alcohol use disorder and transient ischemic attack presented to the emergency department with disorientation and a diffuse exanthematous eruption. Five days prior, she underwent a cosmetic CO2 fractionated laser procedure at a medical spa by a non-board-certified physician. Two days post-treatment she developed fever, headache, nausea, vomiting, visual changes and profuse watery diarrhea. Her condition worsened, marked by persistent fever and continuous diarrhea. She was brought to the ED five days post-procedure after developing a rash and altered mental status. Vitals revealed tachycardia, hypotension, with subsequent vitals showing tachycardia and fever. Physical examination displayed a well-demarcated, mask-like honey-colored crusted facial rash with notable sparing around the eyes and lips, with a diffuse morbilliform rash and pronounced intertriginous erythema. Ultimately, she developed chronic petaloid facial scarring, decompensated mixed septic-cardiogenic shock and retinal injury before recovering from targeted antibiosis. Biopsies & Laboratory data: Heavy growth methicillin-sensitive staph aureus on bacterial culture. Herpes Simplex and Zoster PCR negative. Severe thrombocytopenia. No histologic analysis was required for diagnosis. Diagnosis: Staphylococcal toxic shock syndrome Treatment: ICU resuscitation. Clindamycin, cefazolin, mupirocin, and prophylactic acyclovir in addition to cephalexin at discharge. Discussion: This case highlights the severe complications that can arise post-cosmetic laser treatments, emphasizing the importance of a thorough patient history, post-operative care and communication, and proper training of personnel performing laser procedures.
Copyright (c) 2026 Penny Smith, Dr. Elisha Myers, Hannah Gandy, Dr. Alan Snyder, Dr. Tammam Alanazi, Dr. Laura Winterfield http://creativecommons.org/licenses/by/4.0
Same-Day Biopsy During Mohs Surgery for Non-Melanoma Skin Cancer: An Exploratory Analysis
Background Non-melanoma skin cancer (NMSC) affects over 3 million Americans annually, and the traditional two-visit pathway can result in substantial delays between diagnostic biopsy and definitive treatment. During Mohs surgery visits, clinicians may identify other clinically suspicious lesions separate from the tumor already scheduled for treatment, creating an opportunity for same-day biopsy rather than delayed evaluation. Although delays may not affect mortality, prior studies suggest that longer intervals to Mohs surgery may be associated with larger defects at the time of excision and, for higher-grade squamous cell carcinoma (SCC), tumor growth or progression. Objective To characterize the diagnostic yield and clinical features of other clinically suspicious lesions identified during same-day Mohs surgery visits and to assess the feasibility of same-day biopsy as an opportunistic workflow in NMSC care. Methods A retrospective analysis was performed of NMSC patients who underwent same-day biopsy and subsequent Mohs surgery at a single academic medical center Mohs unit (January 2022 to June 2023). Descriptive statistics were conducted to characterize demographics, diagnoses, and treatment decisions for the biopsied lesions. Results A total of 140 lesions were biopsied in 116 patients. Of these lesions, 101 (72.1%) were NMSC, including 65/140 (46.4%) pathology-confirmed basal cell carcinomas (BCC) and 36/140 (25.7%) SCC. Of the 36 SCCs, 20 (55%) were located in medium-risk, 10 (29%) in high-risk, and 6 (16%) in low-risk anatomic areas per Mohs appropriate use criteria (AUC). All 101 lesions diagnosed as NMSC were excised on the same day as biopsy. Conclusions Additional lesions identified during scheduled Mohs visits were frequently malignant. Same-day biopsy enabled immediate confirmation and definitive treatment for all NMSC lesions in this cohort, supporting the feasibility of integrating same-day biopsy into the Mohs workflow. Same-day biopsy may facilitate more efficient care pathways and reduce missed or delayed NMSC diagnoses; however, longitudinal outcomes require further investigation.
Copyright (c) 2026 Sabine Obagi, Aleksi J Hendricks MD, Jason DuPont MD http://creativecommons.org/licenses/by/4.0
A Case of Erdheim-Chester Disease in a Patient with Langerhans Cell Histiocytosis
Erdheim-Chester Disease (ECD) is a rare non-Langerhans cell histiocytosis with widely variable presentations. Cutaneous findings typically consist of yellow-brown papules and plaques on the eyelids, neck, axillae, trunk, and/or groin. ECD can be diagnosed along with or subsequently to Langerhans Cell Histiocytosis (LCH), constituting a mixed histiocytosis phenotype. In this Brief Article, we present the case of a patient with LCH who developed new lesions on the scalp and axillae consistent with ECD. We emphasize the consideration of co-occurring ECD or other mixed phenotypes in patients diagnosed LCH who develop new cutaneous findings.
Copyright (c) 2026 Nidhi Kuchimanchi, Margaret A. Kreher, Emily M. Gardner , R. Hal Flowers http://creativecommons.org/licenses/by/4.0
Prevalence of Self-Reported Physician Diagnosis of Chronic Hand Eczema in Adults: A Cross-Sectional Study of More Than 10,000 Participants in the General Population – Results From the CHECK Study in the United States
Copyright (c) 2026 Raj Chovatiya, Sanjeev Balu, Aseel Bin Sawad, Eydna Didriksen Apol, Shannon Schneider, Douglas Maslin, Lysel Brignoli, Perrine Le Calvé, Eric Simpson http://creativecommons.org/licenses/by/4.0
Clinical Associations of Itch in Hidradenitis Suppurativa: A Retrospective Cohort Study
Itch in hidradenitis suppurativa (HS) is a symptom that has commonly been overlooked in the literature, and emerging evidence suggests that it imposes a significant burden on patients’ quality of life (QoL). A retrospective cohort study was conducted of 164 patients seen at a single-center HS specialty clinic and found that nearly two-thirds of patients reported experiencing HS-related itch. Furthermore, higher numerical rating scale (NRS) itch scores were associated with increased pain, drainage, greater disease severity, and worse QoL. Current research on itch in HS has demonstrated that itch can impact sleep and overall life quality, and some patients report experiencing itch as a prodromal symptom for HS flares. Itch is a symptom experienced by many patients living with HS. Evaluating for HS-related pruritus and implementing management strategies to alleviate itch may help improve QoL.
Copyright (c) 2026 Claire S. Chung, BS, Kenan Kherallah, BS, Chelsea Moon, BS, Raveena Ghanshani, MS, Vivian Y. Shi, MD, Jennifer L. Hsiao, MD, Katrina H. Lee, MD http://creativecommons.org/licenses/by/4.0
Severe Psoriasis Leading to Scarring Alopecia of the Scalp Responding to Biologic Therapy
Scalp psoriasis affects the majority of patients with psoriasis and can cause disproportionate pruritus, pain, and psychosocial burden. While most cases respond to topical therapies and/or systemic agents, progression to scarring alopecia is rare and remains poorly described, with limited guidance on optimal management. We report a 36-year-old woman with psoriasis and psoriatic arthritis who developed severe, recalcitrant scalp psoriasis with progressive hair loss despite sequential systemic therapies over four years, in addition to adjunctive scalp-directed treatments. After a two-year lapse in care during which she was off all therapies, she re-presented with psoriasis involving thick vertex scalp plaques with micaceous scale and patches of complete alopecia with scarring. Bimekizumab 320 mg every 4 weeks was initiated, followed by development of a generalized pruritic eruption consistent with bimekizumab-associated eczema that was managed with adjunct dupilumab. Over the following months, scalp erythema and scaling progressively improved and hair density increased, permitting transition to maintenance dosing every 8 weeks, when disease recurred and again improved after escalation back to every-4-week dosing. To our knowledge, this is the first report of psoriatic scarring alopecia improving with bimekizumab, suggesting that dual IL-17A/IL-17F blockade may be beneficial in this rare, refractory phenotype and warrants further study.
Copyright (c) 2026 Hayden YK Fung, Kateryna Karpoff, Mark Lebwohl http://creativecommons.org/licenses/by/4.0
Evaluating the Impact of the Dermatology Medical Literacy Program on Undergraduate Trainee Outcomes
Introduction: Dermatology is a complex specialty, and early education and exposure can meaningfully contribute to generating interest and enhancing long-term involvement in the specialty. The Dermatology Medical Literacy Advocacy (DMLA) program at Texas Tech University Health Sciences Center was designed to broaden the undergraduate students' base of knowledge, skills, and exposure to health disparities of dermatology. Methods: The program included sixteen bi-weekly 2-hour lectures, participatory workshops, and exposure to the community. The quality of the program was assessed by the prospective study through the use of pre- and post-surveys. Results: Results indicated substantial improvements in students' knowledge of dermatology, recognition of health disparities, and ease with dermatologic competencies. Ease with community outreach also improved slightly, yet not to the point of a statistically significant factor. Conclusions: The DMLA program successfully improved prime areas of dermatology education. Future iterations will address additional community involvement via direct activity, the area where most deficit occurred.
Copyright (c) 2026 Rebecca Joseph, BS, Alexander D. Smith, B.S, Hannah Chaudhury, B.S, Gaurav Agrawal, B.A, Milcah Poothakary, BA, Michelle B. Tarbox, MD http://creativecommons.org/licenses/by/4.0
Cold Agglutinin Disease with Livedo Reticularis: A Case Report
We report a case of livedo reticularis as a presenting sign of Evans syndrome in a 72-year-old male with a history of myelofibrosis status post matched unrelated donor stem cell transplant. The patient was previously diagnosed with cold agglutinin disease (CAD), an autoimmune hemolytic anemia characterized by hemolysis triggered by cold temperatures. He developed a violaceous, net-like, non-blanching rash consistent with livedo reticularis, which improved with warmth and worsened with cold exposure. Laboratory findings confirmed hemolysis and thrombocytopenia, supporting a diagnosis of Evans syndrome, defined by concurrent autoimmune hemolytic anemia and immune thrombocytopenia (ITP). The patient was treated with sutimlimab, a C1s complement inhibitor, followed by rituximab, resulting in resolution of the cutaneous findings. This case highlights the importance of recognizing livedo reticularis as a possible manifestation of systemic autoimmune processes such as CAD and Evans syndrome and underscores the value of targeting the underlying pathology to achieve dermatologic resolution.
Copyright (c) 2026 Margaret Mercante, Dr. Shira Lanyi, Dr. R. Hal Flowers http://creativecommons.org/licenses/by/4.0