Editor’s Picks August 2025

Abstract

Rolland Gyulai

Actinic keratoses (AK) are icebergs of skin photodamage—visible lesions among UV-induced mutations—and treatment is vital to prevent squamous cell carcinoma. Although photodynamic therapy (PDT) is a widely used treatment for AKs and its efficacy has been demonstrated, no objective data on long-term efficacy are available.

Here, Reinhold et al. demonstrate in a randomized, placebo-controlled trial that 12 months after one to two treatments with field ALA-PDT, almost 60% of patients remain symptom-free in the treated area (Figure 1). In addition, ALA-PDT treatment showed clear improvement in skin cosmetic parameters.

Reinhold U, Philipp-Dormston WG, Dirschka T, et al. Long-term follow-up of a randomized, double-blind, phase III, multi-centre study to evaluate the safety and efficacy of field-directed photodynamic therapy (PDT) of mild to moderate actinic keratosis using BF-200 ALA versus placebo and the BF-RhodoLED® lamp. J Eur Acad Dermatol Venereol 2025; 39: 1449–1459. doi:10.1111/jdv.20452.

Mycosis fungoides (MF), the most common form of cutaneous T-cell lymphoma (CTLC), although usually indolent, is challenging to treat. Nikolaou and colleagues use real-world data analysis to demonstrate that methotrexate (MTX) is an important part of the CTLC treatment armamentarium. Over half of MTX-treated patients responded to treatment, and almost 30% showed complete response. This is the first large-scale trial with a significant number of patients to demonstrate efficacy of MTX specifically in erythrodermic MF (ORR in erythrodermic vs. tumour stage MF: 61.1% vs. 44.8% and progression-free survival: 46.0 vs. 5.7 months, respectively; Figure 2).

Nikolaou V, Panou E, Tsimpidakis A, et al. Effectiveness and safety of methotrexate in the treatment of mycosis fungoides: Real-world data from a multicentre study. J Eur Acad Dermatol Venereol 2025; 39: 1442–1448. doi:10.1111/jdv.20350.

AI can outperform dermatoscopic experts in detecting melanoma, as previously confirmed by Kurtansky and colleagues. However, clinicians usually consider other metadata, for example, the presence of a lesion that differs from other moles as an important diagnostic marker (‘ugly duckling sign’, Figure 3) yet its value in human or AI diagnosis is unknown.

The authors found that including seven additional mole images from the same patient did not significantly affect diagnostic accuracy by either a human or AI. It is unclear whether this was due to the relatively few images or if this is a general phenomenon.

Kurtansky NR, Primiero CA, Betz-Stablein B, et al. Effect of patient-contextual skin images in human- and artificial intelligence-based diagnosis of melanoma: Results from the 2020 SIIM-ISIC melanoma classification challenge. J Eur Acad Dermatol Venereol 2025; 39: 1489–1499. doi:10.1111/jdv.20479.

Passera and colleagues grouped patients with hidradenitis suppurativa (HS) according to disease characteristics using an unbiased automated methodology based on AI. By analysing baseline data from over 1000 patients, the authors identified three subgroups (Figure 4): mainly females with less severe disease (Cluster 1); patients from Asia-Pacific, Middle Eastern and African regions with moderate disease (Cluster 2); and patients with severe symptoms and a history of prior biologic treatment and surgical management (Cluster 3). Expectedly, compared to the other groups, Cluster 3 required a higher dosing frequency of secukinumab to ensure adequate treatment efficacy.

Passera A, Muscianisi E, Demanse D, et al. New insights on hidradenitis suppurativa phenotypes and treatment response: An exploratory automated analysis of the SUNSHINE and SUNRISE trials. J Eur Acad Dermatol Venereol 2025; 39: 1410–1420. doi:10.1111/jdv.20234