Journal of the European Academy of Dermatology and Venereology最新文献

{"title":"Enhancing tolerability in photodynamic therapy for actinic keratosis without compromising efficacy","authors":"Hans Christian Wulf, Stine Regin Wiegell","doi":"10.1111/jdv.20791","DOIUrl":"https://doi.org/10.1111/jdv.20791","url":null,"abstract":"<p>The study by Tanew et al. presents a well-designed investigation into the efficacy of different illumination protocols in photodynamic therapy (PDT) for actinic keratosis (AK).<span><sup>1</sup></span> The trial included 56 patients who received 5-aminolevulinic acid (ALA) PDT in four symmetrical areas of the face and scalp.</p><p>The primary aim was to assess whether reducing the light dose and/or fluence would affect the efficacy of PDT. No difference was found in treatment efficacy, including recurrence rates and the development of new AKs, when the total light dose and fluence rate were halved compared to the standard protocol (red light: 37 J/cm<sup>2</sup>, 62 mW/cm<sup>2</sup>). Importantly, lowering the fluence rate (light intensity) resulted in significantly less pain during illumination. In contrast, reducing the total light dose alone did not affect pain perception. Additionally, peak phototoxicity, measured 2 days after PDT, did not vary significantly between protocols.</p><p>These findings are highly relevant for improving PDT tolerability without compromising therapeutic outcomes. PDT is an effective treatment of AK and field cancerization. During standard red-light PDT, ALA or methyl aminolevulinate is applied to the affected skin and incubated under a light occlusive dressing for 3 h, leading to the accumulation of the photosensitizer protoporphyrin IX (PpIX) in keratinocytes. Activation of PpIX by red-light results in the formation of reactive oxygen species which cause targeted cellular destruction via apoptosis and necrosis.</p><p>Previous studies have demonstrated that the standard red-light dose of 37 J/cm<sup>2</sup> may exceed what is necessary for activation of the accumulated PpIX.<span><sup>2</sup></span> More than 85% of available PpIX is activated after just 18 J/cm<sup>2</sup>, suggesting that the remaining 19 J/cm<sup>2</sup> may offer little additional benefit.<span><sup>2</sup></span> These results explain why lowering the light dose to half of the standard dose does not affect efficacy in the study by Tannew et al.<span><sup>1</sup></span></p><p>Pain during standard red-light PDT remains one of the most significant drawbacks of the treatment and can lead to interruption or even early termination of the illumination.<span><sup>3</sup></span> The mechanism underlying PDT-induced pain is closely tied to the synthesis and localization of PpIX. During the 3 h incubation with ALA/MAL, PpIX is synthesized in mitochondria and accumulates in the keratinocytes. As intracellular concentrations rise, excess PpIX is excreted into the extracellular space, where it can incorporate into free nerve endings located in the epidermis.<span><sup>3</sup></span> Therefore, during illumination, PpIX is not only activated in keratinocytes but also in nerve endings, resulting in the intense burning or stinging pain commonly reported during illumination.</p><p>Lowering the light intensity (fluence rate) during illumination has been shown","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 8","pages":"1376-1377"},"PeriodicalIF":8.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20791","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Activity-based therapeutic algorithm for folliculitis decalvans: A practical tool for effective management","authors":"Anna Bolzon, Antonella Tosti","doi":"10.1111/jdv.20787","DOIUrl":"https://doi.org/10.1111/jdv.20787","url":null,"abstract":"<p>The recent study published in this journal, ‘Management of folliculitis decalvans: The EADV task force on hair diseases position statement’<span><sup>1</sup></span> provides practical guidance for diagnosing and managing folliculitis decalvans (FD).</p><p>FD is the most common form of primary neutrophilic scarring alopecia typically affecting the scalp (most often the vertex), but also other hair-bearing areas (beard, neck, axillae and pubic region). It has a chronic-relapsing course and is associated with increased cardiovascular risk.<span><sup>2</sup></span> Therefore, accurate diagnosis and management are crucial to control scalp inflammation, prevent irreversible scarring and avoid systemic complications due to persistent inflammation.</p><p>Clinical diagnosis of FD is usually straightforward, but overlaps with lichen planopilaris (LPP) are not uncommon, both clinically and pathologically. This has been recently described as FD-LPP phenotypic spectrum (FDLPPPS), considered a progression from acute neutrophilic to chronic lympho-plasmocytic inflammation. Interestingly, <i>Staphylococcus aureus</i> levels differ between these patterns: higher than 20% in FD, but lower in FDLPPPS.<span><sup>3</sup></span></p><p>Hair experts from this task force emphasize the importance of trichoscopy for diagnosis, assessing disease activity and selecting optimal biopsy sites.</p><p>By integrating a comprehensive literature review with expert insights, this study introduces a therapeutic algorithm that significantly advances therapeutic decision-making. The algorithm is tailored to disease activity, assessed using the Investigator's Global Assessment score of FD activity (FD-IGA) and the Trichoscopy Activity Scale for FD. These scoring systems, respectively, evaluate clinical and trichoscopic features of peri- and interfollicular erythema, follicular pustules and crusts, among others.</p><p>This comprehensive approach is useful for dermatologists managing a disease where clinical trials and head-to-head studies comparing treatments are lacking, with all medications being off-label.</p><p>The therapeutic strategy divides management into two phases: the acute inflammatory phase, marked by pustules and exudative crusts, and the mild inflammatory phase, which may follow the treatment of the previous active phase or present mildly from the onset. Anti-inflammatory therapy in the acute phase includes oral antibiotics, alone or combined with oral corticosteroids for highly active disease.</p><p>Oral antibiotics are recommended for their activity against <i>S. aureus</i>, a key contributor to FD pathogenesis and for their immune modulating and anti-inflammatory functions. Tetracyclines administered for 3 months, or a 10-day combination therapy of clindamycin and rifampicin, are commonly prescribed. However, while the latter is believed to reduce relapse rates, recent studies and our experience do not confirm this.<span><sup>4</sup></span> Moreover, we believe that a","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 8","pages":"1368-1369"},"PeriodicalIF":8.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20787","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does AI need anything more than a single image to diagnose melanoma?","authors":"Aimilios Lallas, John Paoli","doi":"10.1111/jdv.20793","DOIUrl":"https://doi.org/10.1111/jdv.20793","url":null,"abstract":"<p>Recent research consistently demonstrates the high accuracy of artificial intelligence (ΑΙ)-driven image analysis in diagnosing melanoma. The key benchmark for comparison has usually been the performance of human readers, who were outperformed by AI even in the initial experimental studies.<span><sup>1</sup></span></p><p>A significant drawback of these studies is their failure to replicate the clinical setting, due to the omission of parameters that are highly relevant in real-world scenarios.<span><sup>2</sup></span> Most studies used single clinical or dermoscopic images of lesions both for training algorithms and for evaluating the performance of algorithms and human raters. While this approach seems logical for an AI algorithm, it contrasts sharply with the practice of clinicians. Clinicians do not evaluate single images but examine unique individuals, considering a multitude of factors that contribute to a comprehensive evaluation. The clinical assessment encompasses factors such as phenotype, phototype, pigmentary trait, total lesion count, detailed analysis of lesion types and their distinct features and texture and review of their evolution history. The failure of previous studies to include these important parameters was one of the main limitations to the applicability of their findings in clinical practice.</p><p>The study by Kurtansky et al. represents one of the first efforts to integrate contextual information into the training and evaluation of AI algorithms for melanoma diagnosis.<span><sup>3</sup></span> It reports on the outcomes of the 2020 SIIM-ISIC Melanoma Classification Challenge, which saw participation from 3308 teams across 97 countries, submitting a total of 101,845 entries to the AI competition. Most importantly, this was the first initiative to employ a data set of patient-contextual lesion images to evaluate the influence of intrapatient lesion patterns on classifying melanoma. In the reader study, each index image was first assessed alone and then alongside seven additional dermoscopic images of nevi from the same patient.</p><p>The study reports two main findings. First, the top performing AI algorithm for melanoma diagnosis achieved an area under the receiver operating curve of 0.95. This result is consistent with trends of steadily improving algorithm performance in recent years, driven by the availability of larger training sets and ongoing advancements in deep learning techniques.</p><p>Second, the study found that including patient-contextual lesion images had no significant effect on the diagnostic accuracy, neither for the algorithms nor for the human readers. This result is somewhat unexpected and challenges the assumption that intra-patient lesion comparisons enhance diagnostic performance. Prior evidence suggests that melanoma detection can be enhanced by contextual information, as demonstrated by the comparative approach, an intrapatient assessment strategy.<span><sup>4</sup></span> Moreover, it is imp","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 8","pages":"1378-1379"},"PeriodicalIF":8.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20793","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical clusters in hidradenitis suppurativa: Interesting observations but incomplete answers","authors":"Charles Cassius, Bénédicte Oules","doi":"10.1111/jdv.20788","DOIUrl":"https://doi.org/10.1111/jdv.20788","url":null,"abstract":"<p>Among the numerous challenges faced by clinicians managing hidradenitis suppurativa (HS), two stand out: the marked clinical heterogeneity of the disease and the relatively low response rates to existing treatments. In their recent publication, Passera et al.<span><sup>1</sup></span> attempt to address both issues by leveraging data from SUNSHINE and SUNRISE—the two pivotal Phase III trials that led to the approval of secukinumab for moderate-to-severe HS.<span><sup>2</sup></span></p><p>First, the classification of HS into clinically meaningful phenotypes has been the subject of more than 15 attempts over the past decade. The work by Canoui-Poitrine et al.<span><sup>3</sup></span> was among the first to propose a tripartite division based on clinical features. However, no consensus has yet emerged: inter-rater reliability remains modest, proposed phenotypes often overlap, and their clinical relevance continues to be debated.<span><sup>4</sup></span></p><p>Second, therapeutic response in HS remains disappointingly low compared with other chronic inflammatory dermatoses. This observation still persists despite extensive translational and clinical research efforts, including the development of biologics specifically targeting key cytokine pathways.</p><p>The authors applied unsupervised clustering to a large cohort of 1084 patients enrolled in the SUNSHINE and SUNRISE trials, using baseline clinical characteristics to stratify the population. This approach led to the identification of three distinct subgroups. Cluster 1 includes 54% of the patients, primarily obese women with moderate disease severity. Cluster 2 comprises 18% of the patients, characterized mainly by less obese, non-smoking, non-white men with earlier disease onset. Cluster 3 accounts for 28% of the patients and is associated with more severe and extensive disease, with a balanced gender distribution. These subgroups likely reflect real-world diversity and underscore the complexity of HS beyond conventional Hurley staging.</p><p>The authors conclude that secukinumab demonstrated efficacy versus placebo in the three clusters. However, a closer inspection of the primary endpoint—HiSCR50 at Week 16—reveals a lower response in Cluster 3 (37.5% and 34.7%) compared with Cluster 1 (50.3% and 48.9%). In addition, a higher proportion of lost-to-follow-up patients and persistently flat response curves in the group of patients treated by placebo for the first 16 weeks within Cluster 3 raise concerns about more refractory disease, as might be expected.</p><p>While the clustering approach is methodologically sound and clinically intuitive, the study also highlights key limitations in the current understanding of HS. Notably, the analysis does not incorporate any biological markers or molecular signatures—elements that would be essential to define mechanistic endotypes and eventually support precision medicine. Furthermore, the identified clinical clusters do not predict treatment response, lim","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 8","pages":"1370-1371"},"PeriodicalIF":8.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20788","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor’s Picks August 2025","authors":"","doi":"10.1111/jdv.20790","DOIUrl":"https://doi.org/10.1111/jdv.20790","url":null,"abstract":"<p></p><p>Rolland Gyulai</p><p>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.</p><p>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.</p><p>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. <i>J Eur Acad Dermatol Venereol</i> 2025; <b>39</b>: 1449–1459. doi:10.1111/jdv.20452.</p><p>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).</p><p>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. <i>J Eur Acad Dermatol Venereol</i> 2025; <b>39</b>: 1442–1448. doi:10.1111/jdv.20350.</p><p>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.</p><p>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.</p><p>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. <i>J Eur Acad Dermatol Venereol</i> 2025; <b>39</b>: 1489–1499. doi:10.1111/jdv.20479.</p><p>Passera and colleagues grouped patients with hidradenitis suppura","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 8","pages":"1363-1365"},"PeriodicalIF":8.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20790","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presence of draining tunnels denotes a distinct hidradenitis suppurativa phenotype","authors":"Thrasyvoulos Tzellos, Christos C. Zouboulis","doi":"10.1111/jdv.20792","DOIUrl":"https://doi.org/10.1111/jdv.20792","url":null,"abstract":"<p>The cross-sectional survey with retrospective data collection by Ingram et al. published in this issue targets the characterization of the clinical profile of patients with moderate-to-severe hidradenitis suppurativa (HS) with and without draining tunnels.<span><sup>1</sup></span> It came to the expected result that patients with draining tunnels had more inflammatory nodules, abscesses and scarring. Furthermore, the presence of draining tunnels was associated with significantly more inflammation/redness, drainage from lesions, pain on sitting, low mood/depression, sleep disturbance and fatigue. Physicians agreed that patients with draining tunnels experienced a negative impact of disease on their daily life, mental health, and sexual function compared to those without.</p><p>This evidence further enhances the notion that the presence of draining tunnels denotes a distinct HS phenotype with more severe disease, which depicts disease progression and exhibits a poorer response to many current HS treatments. Dermal tunnels are structures unique to HS and are associated with a more severe disease, cause significant pain and morbidity via chronic, malodorous discharge and have a detrimental impact on quality of life.<span><sup>2</sup></span> It has been suggested that the presence of tunnels is associated with a more aggressive course of Hurley stage 3 disease.<span><sup>2</sup></span></p><p>Furthermore, individual patient data analysis from the PIONEERs phase 3 adalimumab trials employing time-to-event analyses was performed to estimate time to achieve HiSCR and time to loss of HiSCR, whereas the presence of dermal tunnels significantly negatively influenced the odds of achieving HiSCR and the time to achieve HiSCR with adalimumab.<span><sup>3</sup></span> It was proven that integrating draining tunnel status [using the International Hidradenitis Severity Score System (IHS4)] reduced placebo response rates in both PIONEER studies regardless of if a binary or continuous variable was used. Effective treatments against draining tunnels are still an unmet need in the HS treatment.</p><p>HS samples with tunnels have a distinct molecular profile compared to HS samples without tunnels.<span><sup>2</sup></span> HS tunnels were at least in part dependent on IL-17 signalling. It is suggested that the response of the subcutaneous nodules to TNFα blockade and not the tunnels suggests that the cellular migration to and across tunnel epithelium is more dependent on IL-17 signalling rather than TNF-α signalling. Taken together, these data demonstrate a novel avenue for the development of therapeutics for this devastating disease and treatment with the newly developed and approved drugs bimekizumab and secukinumab, which target different subunits of IL-17 and seem promising in decreasing dermal tunnel drainage and in the resolution of sinus tracts.</p><p>All this evidence clearly suggests that the presence of draining tunnels should be considered a potential mark","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 8","pages":"1372-1373"},"PeriodicalIF":8.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20792","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methotrexate in mycosis fungoides revisited","authors":"Reinhard Dummer, Ariane Suter","doi":"10.1111/jdv.20789","DOIUrl":"https://doi.org/10.1111/jdv.20789","url":null,"abstract":"<p>Primary cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of non-Hodgkin lymphomas characterized by the accumulation of skin-homing lymphocytes, leading to macular or, in later stages, nodular skin lesions. Mycosis fungoides (MF) is the most common entity among CTCL. Diagnosis is based on clinical features and is supported by histological and molecular biological findings.<span><sup>1</sup></span> The treatment of MF, apart from allogenic stem cell transplantation, is palliative; therefore, maintaining quality of life is the primary focus. Topical therapies are the most frequently used first-line treatments, including corticosteroids, chlormethine or UV radiation (nbUVB or PUVA).<span><sup>1, 2</sup></span> If these measures are insufficient, immunomodulatory medications are often introduced combination with UV therapy. Candidate medications are methotrexate (MTX), Interferon alpha (IFN-<i>α</i>) and bexarotene.<span><sup>2</sup></span> Each of them can be combined well with UV treatment. Unfortunately, access to INF-<i>α</i> and bexarotene is currently limited due to logistical and financial reasons. Therefore, MTX often is the only immunomodulatory medication readily available.</p><p>For oncologic indications, MTX is typically administered at high doses and functions as an anti-folate antimetabolite. In contrast, low-dose MTX is well established in the treatment of various inflammatory conditions, including psoriasis and rheumatoid arthritis.<span><sup>2</sup></span> Under these circumstances, the mechanism of action might differ: MTX activates the enzyme AICAR, which inhibits AMP deaminase, leading to an accumulation of adenosine.<span><sup>3</sup></span> The resulting adenosine accumulation in lymphocytes results in reduced proliferation and activity of T cells. In CTCL, MTX is administered at low doses, probably due to its direct impact on T-cell proliferation. There are only a few reports on the current tolerability and efficacy of this medication in this context.<span><sup>2</sup></span></p><p>Nikolaou et al. report a retrospective multicentral series of 211 MF patients in Greece. MTX was administered either as monotherapy (112 patients) or combination therapy with various other treatments including phototherapy (<i>n</i> = 31), INF-<i>α</i> (<i>n</i> = 29; 25 received INF-<i>α</i> 2b,4 received pegylated interferon) and retinoids (<i>n</i> = 12; bexarotene and/or acitretin). MTX was given once weekly with a median oral dose of 15 mg/week, reflecting a low-dose approach.<span><sup>4</sup></span> Unfortunately the patient population is very heterogenous: 124 patients had late-stage disease (IIB-IVB). Moreover, there was no information provided on CD30 expression level within the cohort. First line treatment in patients with early staged MF showed a progression free survival (PFS) of more than a year<span><sup>4</sup></span> which is notably longer than what has been reported in prospective trials such as ALCANZA.</p><p>In this ","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 8","pages":"1374-1375"},"PeriodicalIF":8.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20789","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SmartProg-MEL-integrating dermatopathology and explainable artificial intelligence (AI) to improve prognostic accuracy and risk stratification in cutaneous melanoma","authors":"Franco Rongioletti, Stefania Guida","doi":"10.1111/jdv.20776","DOIUrl":"https://doi.org/10.1111/jdv.20776","url":null,"abstract":"<p>In the era of precision oncology, artificial intelligence (AI) is increasingly recognized for its potential to transform histopathological workflows and prognostic stratification. The study by Bossard et al.<span><sup>1</sup></span> introduces <i>SmartProg-MEL</i>, a deep learning–based model developed to predict 5-year overall survival (OS) in patients with primary cutaneous melanoma (stages I–III), using only routine haematoxylin–eosin (HE) or HE-saffron–stained whole slide images (WSIs). By offering an explainable, image-based prognostic tool, SmartProg-MEL aims to complement or surpass traditional clinicopathological risk assessments.</p><p>A major strength of this study lies in its robust validation across multiple independent cohorts. The model was trained on a discovery dataset of 342 patients (IHP-MEL-1) and externally validated on two independent sets: IHP-MEL-2 (<i>n</i> = 161) and TCGA (<i>n</i> = 63). It consistently achieved concordance indices of 0.72, 0.71 and 0.69, respectively, with sensitivity ranging from 71% to 100%. These metrics outperform earlier AI prognostic tools,<span><sup>2-4</sup></span> which were often limited by small datasets and lack of external validation. Notably, SmartProg-MEL maintained high performance across varying staining protocols and scanner types, supported by robust stain normalization and augmentation techniques—critical for clinical translation.</p><p>Clinically, the model's utility is underscored by its ability to refine prognostic classification beyond the current AJCC TNM staging system.<span><sup>5</sup></span> For instance, it identified high-risk patients within stage I melanomas—traditionally considered low risk—and reclassified a significant portion of stage IIB/IIC cases as low risk. Such refined stratification could support tailored decisions around surveillance intensity and adjuvant immunotherapy, potentially sparing low-risk individuals from overtreatment while ensuring timely intervention for those at greater risk.</p><p>Equally notable is the emphasis on interpretability. Using attention-based heatmaps and UMAP-based feature clustering, the model highlights morphologic correlates of risk. Features such as nuclear pleomorphism, cellular atypia, architectural disorganization and peritumoral immune infiltrates align with established histopathological prognostic factors. This transparency enhances clinician trust and positions SmartProg-MEL not merely as a ‘black box’ tool, but as an interpretable digital biomarker.</p><p>However, several limitations warrant discussion. The retrospective design introduces inherent selection biases, and treatment-related variables during follow-up were not incorporated into the survival models. This is particularly relevant given the growing impact of systemic therapies on melanoma outcomes. Furthermore, although SmartProg-MEL performed well across cohorts, a slight dip in performance in the TCGA set may reflect technical and biological heterogeneity. ","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 8","pages":"1380-1381"},"PeriodicalIF":8.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20776","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to make dermatology conferences more sustainable?","authors":"Branka Marinovic","doi":"10.1111/jdv.20755","DOIUrl":"https://doi.org/10.1111/jdv.20755","url":null,"abstract":"<p>I read with great interest the Letter to the editor, submitted to the JEADV by Lim and co-authors, titled Exploring the Environmental Sustainability of Dermatology Conferences.<span><sup>1</sup></span> They compared findings from exhibitions at two congresses of the European Academy of Dermatology and Venereology (EADV) and one Annual Scientific Meeting of the British Association of Dermatology (BAD). The authors assessed various aspects of samples collected and estimated the average carbon footprint associated with those samples, but they also gave some ideas about how we could collectively make improvements.</p><p>In recent years, sustainability has emerged as an important topic within the EADV, especially under the presidency of the immediate past president, Professor Martin Roecken. However, initiatives focused on sustainability at EADV Congresses began at an operational level prior to this period with the discontinuation of congress bag production and the shift to digital programme books, adjustments that elicited mixed responses from attendees. As stated in the Letter by Lim et al., the EADV Congress in Amsterdam offered reusable cups, made food donations and promoted public transport, as well as the use of bicycles. Furthermore, the formation of the EADV Climate Working Group 2 years ago has been instrumental in helping to address environmental concerns. The main goal is to promote awareness about the problem, highlight the effect of climate change on dermatological disease and show how dermatologists can help.</p><p>From the COVID-19 pandemic, we learned valuable lessons, notably the potential for conducting numerous activities online. In-person meetings remain essential for exchanging knowledge, experiences and ideas, as well as being part of human nature to meet and interact with colleagues. This necessity underscores the imperative to enhance the sustainability of conferences, which have a significant carbon footprint. Such events are usually attended by many attendees who often travel long distances by air, but also stay in hotels, generating substantial waste through single-use plastics, printed materials and food services.</p><p>Big dermatological societies, including EADV, are working on how to adopt sustainable practices further. Some strategies include the possibility of a hybrid meeting (if we do not think about the footprint produced by IT), choosing venues that prioritize sustainability, providing local sources of food and the provision of reusable water bottles. Some other options are to discuss sustainability with exhibitors to further align the exhibition with sustainability objectives. Lim et al. stated that an improvement is already visible, but there is still more intensive work to be done on the topic. Sustainability should not be perceived as a constraint but rather as an opportunity for innovation. Just as dermatology continuously adapts to emerging technologies and skincare research, it can also pioneer environmen","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 7","pages":"1222-1223"},"PeriodicalIF":8.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20755","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deucravacitinib: Long-term safety and efficacy reaffirm its place in the psoriasis treatment landscape","authors":"Ion Birkenmaier, Sezgi Sarikaya Solak, Julia-Tatjana Maul","doi":"10.1111/jdv.20751","DOIUrl":"https://doi.org/10.1111/jdv.20751","url":null,"abstract":"<p>Deucravacitinib is an oral, highly selective TYK2 inhibitor approved for the treatment of moderate to severe plaque psoriasis.<span><sup>1, 2</sup></span> A key aspect that differentiates this allosteric inhibitor from other oral immunomodulators is its selective binding to the regulatory domain of TYK2, avoiding inhibition of JAK1, JAK2 and JAK3. This selectivity enables targeted modulation of IL-12, IL-23 and type I interferon pathways, resulting in a distinct and potentially more favorable safety profile.<span><sup>1, 2</sup></span></p><p>Armstrong et al.<span><sup>1</sup></span> present 4-year results from the POETYK PSO-1, PSO-2 and their long-term extension trials, offering key insights into the durability of deucravacitinib's efficacy and safety. Given the chronic, immune-mediated nature of psoriasis, such findings are particularly relevant as they highlight the need for durable systemic treatment options.</p><p>The data are encouraging<span><sup>1</sup></span> – patients treated continuously with deucravacitinib maintained stable PASI 75 (72.0% at year one vs. 71.7% at year four) and PASI 90 response rates (45.6% at year one vs. 47.5% at year four) over 4 years. Nearly half of patients achieved DLQI 0/1, indicating minimal or no impact on their quality of life. Importantly, the safety outcomes remained stable throughout the 4393 patient-years of exposure, with low and consistent rates of serious infections, malignancies, major cardiovascular events and venous thromboembolism. Notably, no new safety concerns emerged and discontinuations due to adverse events decreased over time.</p><p>Certain limitations, however, must be considered. As an open-label extension, the study inherently includes a responder bias, as participants who did not benefit or tolerate treatment in the initial phase likely discontinued. Moreover, the apremilast arm was discontinued after year 1, preventing direct long-term comparisons of efficacy and safety against other therapies, including newer biologics and oral agents.</p><p>Despite these limitations, Armstrong et al. provide robust evidence supporting deucravacitinib's role as a reliable long-term oral therapy for moderate to severe psoriasis. Importantly, in contrast to other JAK inhibitors, deucravacitinib has not been subject to a black box warning by the FDA. This is significant, particularly considering FDA concerns surrounding cardiovascular and malignancy risks with JAK1/2/3 inhibitors. The presented 4-year data thereby further reinforce the benefits of TYK2 selectivity.</p><p>The February 2025 update of the EuroGuiDerm guideline nevertheless recommends monitoring full blood count, liver enzymes, creatine phosphokinase and lipid profile where clinically indicated, every 3–6 months during treatment and advises treatment interruption if myopathy or liver injury is suspected.<span><sup>3</sup></span> Reassuringly, the 4-year data did not show clinically meaningful changes from baseline in terms of laborator","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 7","pages":"1220-1221"},"PeriodicalIF":8.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20751","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}