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

{"title":"Consensus recommendations for the diagnosis and management of delusional infestation: A Delphi study","authors":"Patrick M. H. J. Kemperman,&nbsp;Nienke C. C. Vulink,&nbsp;Floortje E. Feikema,&nbsp;Anthony Bewley,&nbsp;Peter Lepping,&nbsp;Maria-Angeliki Gkini,&nbsp;Rick Waalboer-Spuij,&nbsp;Menno A. de Rie","doi":"10.1111/jdv.70502","DOIUrl":"10.1111/jdv.70502","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Delusional infestation (DI) is a psychiatric disorder defined as a fixed false belief of being infested with animate or inanimate material in the absence of objective medical evidence. It presents frequently to dermatology and psychiatry and poses diagnostic and communication challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To develop a Delphi consensus on the definition, diagnostic work-up and management of DI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Under the auspices of the European Society for Dermatology and Psychiatry (ESDaP), a core expert group drafted 22 statements based on prior survey data and the literature. International experts in DI (dermatology, psychiatry, tropical medicine) participated in two anonymous e-Delphi rounds followed by a consensus meeting. Consensus was predefined as ≥ 75% agreement or disagreement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 47 invited experts, 37 completed round 1 and 34 round 2; 23 joined the final meeting. Consensus was reached for 20/22 statements. Agreements included: (i) defining DI as a psychiatric disorder with fixed beliefs of infestation; (ii) distinguishing primary versus secondary DI; (iii) acknowledging quality-of-life impairment; (iv) examining patient-provided material as useful diagnostically and for rapport; (v) considering blood tests, urine toxicology and selective neuroimaging when indicated; (vi) early and concurrent management of psychiatric and cutaneous aspects; (vii) antipsychotics as first-line treatment, with choice guided by evidence and patient factors; (viii) limited role for long-acting depot formulations and CBT; (ix) importance of dermatology–psychiatry collaboration; and (x) using adapted terminology with patients while ensuring informed consent for antipsychotic prescribing. Non-consensus items concerned explicitly naming the diagnosis to patients and routine use of standardized outcome scales.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This international Delphi consensus statement provides practical, expert-informed recommendations for the assessment and management of DI, and is intended to inform future research and formal guideline development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 10","pages":"1591-1599"},"PeriodicalIF":9.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148214139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Darier disease—A review highlighting new insights from the Darier Disease International Task Force","authors":"Sofia Labbouz,&nbsp;Alain Hovnanian,&nbsp;Grace Xiong,&nbsp;Dedee Frances Murrell,&nbsp;Simon M. Mueller,&nbsp;Khaled Ezzedine,&nbsp;Nessa Aghazadeh Mohandesi,&nbsp;Ahmed Salem Aldhaheri,&nbsp;Nissim Asayag,&nbsp;Eulalia Baselga,&nbsp;Chen Nadler,&nbsp;Keith Choate,&nbsp;Chia-Yu Chu,&nbsp;John Robert Edminister,&nbsp;Emmanuella Guenova,&nbsp;Melis Gönülal,&nbsp;Antoni Gostynski,&nbsp;Ankan Gupta,&nbsp;Lalit Kumar Gupta,&nbsp;Juliette Mazereeuw-Hautier,&nbsp;Wolfram Hoetzenecker,&nbsp;Peter Itin,&nbsp;Marek Jankowski,&nbsp;Akiharu Kubo,&nbsp;Haur Yueh Lee,&nbsp;Julia Scott Lehman,&nbsp;Anfisa Lepekhova,&nbsp;Márta Medvecz,&nbsp;Jemima E. Mellerio,&nbsp;Verena Moosbrugger-Martinz,&nbsp;Amy S. Paller,&nbsp;Dóra Plázár,&nbsp;Amadeu José Rodrigues Queiróz,&nbsp;Josep Riera-Monroig,&nbsp;Ralph Rosa,&nbsp;Matthias Schmuth,&nbsp;Maella Severino Freire,&nbsp;Itzhak Shabat,&nbsp;Jonathan Shapiro,&nbsp;Cory L. Simpson,&nbsp;Diego Soto-García,&nbsp;Alexander J. Stratigos,&nbsp;Gianluca Abel Tadini,&nbsp;Takuya Takeichi,&nbsp;Kaushal K. Verma,&nbsp;Jakob D. Wikström,&nbsp;Alexander Zink,&nbsp;Michael Ziv,&nbsp;Alexander Navarini,&nbsp;Roni Pircha Dodiuk-Gad","doi":"10.1111/jdv.70483","DOIUrl":"10.1111/jdv.70483","url":null,"abstract":"<p>Darier disease (DD) is a rare autosomal dominant genodermatosis. This comprehensive review, developed by the Darier Disease International Task Force (DDITF), consolidates current knowledge on the genetic basis, molecular pathophysiology, clinical presentation, diagnosis and management of DD, offering a global perspective that unites shared expertise. The disease arises from pathogenic variants in the <i>ATP2A2</i> gene, which encodes sarco/endoplasmic reticulum Ca²⁺-ATPase isoform 2 (SERCA2), leading to disrupted calcium homeostasis and impaired desmosomal integrity. Clinically, DD is classified based on lesion type (classic vs. non-classic) and is often accompanied by significant extracutaneous manifestations. Management remains challenging and requires a multifaceted approach, including topical therapies, systemic retinoids and lifestyle modifications. Emerging treatments that target the underlying molecular mechanisms offer promise for improved outcomes. This review aims to provide an updated reference and practical guidance for clinicians involved in the care and study of DD.</p>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 10","pages":"1626-1647"},"PeriodicalIF":9.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140620","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":"Large-scale meta-analysis of infection risk with JAK–STAT inhibitors in 29,000 patients","authors":"Máté Krebs,&nbsp;Lili Gulyás,&nbsp;Karen Krisztina Fazekas,&nbsp;Benedek Nagy,&nbsp;Mária Veronika Kolonics,&nbsp;Fanni Adél Meznerics,&nbsp;Norbert Kiss,&nbsp;András Bánvölgyi,&nbsp;Péter Hegyi,&nbsp;Péter Holló,&nbsp;Lajos Vince Kemény","doi":"10.1111/jdv.70508","DOIUrl":"10.1111/jdv.70508","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Janus kinase signal transducer and transcription activator (JAK–STAT) inhibitors have revolutionized the treatment of immune-mediated inflammatory diseases (IMIDs) of the skin, such as in atopic dermatitis, alopecia areata and vitiligo. Although several meta-analyses have confirmed their efficacy, concerns remain about the risk of infection, as the JAK–STAT pathway plays a key role in immune defence. Previous meta-analyses examined only selected, pre-specified infection categories and have not comprehensively evaluated all reported infection types or compared systemic and topical agents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that reported infection-related adverse events in patients treated with systemic or topical JAK–STAT inhibitors for IMIDs of the skin. The study followed the PRISMA 2020 and Cochrane guidelines (PROSPERO: CRD 42024615839). Overall risk ratios (RRs) with 95% confidence intervals (CI) were calculated using a random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-four RCTs were included, involving more than 29,000 patients. JAK–STAT inhibitors were associated with an increased risk of influenza (RR = 2.12, 95% CI 1.03–4.36), bronchitis (RR = 2.03, 95% CI 1.43–2.88) and herpes zoster (RR = 1.67, 95% CI 1.29–2.15) compared to a placebo. The risk was particularly elevated in patients with atopic dermatitis (influenza: 3.22, 95% CI 2.03–5.10, herpes zoster: RR = 2.00, 95% CI 1.34–2.99). No significant risks were identified for serious, fungal or opportunistic infections, and topical JAK–STAT inhibitors demonstrated a favourable safety profile comparable to vehicle controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This meta-analysis provides a comprehensive assessment of the risk of infection associated with JAK–STAT inhibitors in IMIDs of the skin. Although overall safety is acceptable, clinicians should be aware of the higher infection risk of influenza and herpes zoster and should consider vaccination and preventive strategies for high-risk patients with atopic dermatitis. The main limitation is that the included studies involved highly selected populations with few comorbidities and short follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 10","pages":"1662-1674"},"PeriodicalIF":9.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70508","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148039124","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":"Thirty-five years of JEADV: A conversation with past and present Editors-in-Chief","authors":"Johannes Ring,&nbsp;Carle Paul","doi":"10.1111/jdv.70681","DOIUrl":"https://doi.org/10.1111/jdv.70681","url":null,"abstract":"&lt;p&gt;&lt;/p&gt;&lt;p&gt;Johannes Ring&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;Carle Paul&lt;/p&gt;&lt;p&gt;JEADV marks its 35th anniversary at a time of rapid change in dermatology, venereology and scientific publishing. To reflect on the journal's past, present and future, Prof. Johannes Ring, former Editor-in-Chief and Prof. Carle Paul, current Editor-in-Chief, were invited to answer a shared set of questions.&lt;/p&gt;&lt;p&gt;In the following edited Q&amp;A, both editors discuss how JEADV has evolved, what they have learned from leading the journal, and how they see its role in the years ahead.&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;i&gt;Ring&lt;/i&gt;&lt;/b&gt;: As the official journal of the EADV, the journal already had a stable and growing readership with an increasing quality of articles. However, papers were printed strictly in order of acceptance, which made it difficult for the reader to get an overview. There was also a long delay, sometimes more than 1 year, between acceptance and print, and I inherited a backlog of several hundred manuscripts. In addition, the dark red cover appeared somewhat dull.&lt;/p&gt;&lt;p&gt;My aim was to make JEADV more attractive, but the first priority was to reduce the backlog by adding 5 to 10 manuscripts per issue. This was not ideal for the impact factor, which only increased slowly, but it eventually rose from 2.8 to 9.2!&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;i&gt;Paul&lt;/i&gt;&lt;/b&gt;: Thanks to the dedication and hard work of the previous Editors, the JEADV was already a respected, high-profile journal in dermatology and venereology when I succeeded Prof. Johannes Ring in October 2023. Our aim was to further increase physicians' knowledge, promote high-quality medical science and ultimately improve disease understanding and patient outcomes.&lt;/p&gt;&lt;p&gt;In collaboration with the Editorial office in Lugano and the Associate Editors, we developed a strategic plan to strengthen the Journal's profile, visibility and impact. It was built around three main initiatives:&lt;/p&gt;&lt;p&gt;First, we aimed to &lt;i&gt;enhance the quality, impact and readability of the JEADV, while maximizing the author experience&lt;/i&gt;. We sought to attract clinical guidelines, position papers, commissioned reviews and primary high-quality clinical trials through proactive engagement with researchers and medical societies. We also wanted to address the most important scientific, social and political challenges our specialty faces through editorials and mini-reviews. In parallel, we expanded the Journal's social media activity and increased the visibility of articles through commentaries, editorials, graphical abstracts, videos and PowerPoint presentations.&lt;/p&gt;&lt;p&gt;Second, we set out to &lt;i&gt;establish a large and robust network of JEADV editors, supported by a collaborative team spirit&lt;/i&gt;. A large team of 5 Associate Editors and 17 Section Editors now provides the broad scientific expertise required across the full range of our specialty. The Associate Editors have taken on an expanded role in the Journal's strategy, content development and the manuscript review process, mirroring the workflows of other high-pr","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 10","pages":"1571-1574"},"PeriodicalIF":9.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70681","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149028996","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":"Advances in the diagnosis and epidemiology of anti-p200 pemphigoid","authors":"Henry Tseng,&nbsp;Dédée F. Murrell","doi":"10.1111/jdv.70667","DOIUrl":"https://doi.org/10.1111/jdv.70667","url":null,"abstract":"&lt;p&gt;The diagnosis of anti-p200 pemphigoid remains difficult to secure within the spectrum of subepidermal autoimmune blistering diseases (AIBDs).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Its clinical phenotype frequently overlaps with bullous pemphigoid (BP) or epidermolysis bullosa acquisita (EBA); yet, definitive identification has long been hindered by the lack of highly sensitive, standardized serological diagnostic tools.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Historically, confirming the disease relied on western blotting to detect a 200-kDa band on human dermal extract.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; However, this method is fundamentally restricted by its reliance on denatured proteins, which systematically obscure conformational epitopes and yield low diagnostic sensitivity.&lt;/p&gt;&lt;p&gt;To address these diagnostic barriers, Jouen, Joly and colleagues in the French study group have provided a major breakthrough by evaluating a commercial cell-based immunoassay (CBIA) using the recombinant laminin β4 (LAMB4) subunit in a nationwide cohort.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In a group of 93 patients with exclusive dermal-floor binding on salt-split skin, the anti-LAMB4 CBIA demonstrated a diagnostic sensitivity of 91%.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; This performance significantly exceeded traditional dermal immunoblotting, which detected only 47% of cases (&lt;i&gt;p&lt;/i&gt; &lt; 0.0001) (Table 1). Applying these findings to national French registries for BP and pemphigus, the authors project an annual French incidence for anti-p200 pemphigoid ranging from 0.23 to 0.83 cases per million inhabitants.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; This demonstrates that anti-p200 pemphigoid is two to four times more common than EBA, proving that its historical scarcity was an artefact of insensitive laboratory assays rather than clinical reality.&lt;/p&gt;&lt;p&gt;Importantly, these epidemiological insights are mirrored by critical pathophysiological findings. While anti-laminin γ1 autoantibodies were long thought to be the primary target in this disease, they consistently failed to demonstrate pathogenic activity in functional models.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Conversely, recent functional assays demonstrate that anti-laminin β4 IgG actively drives subepidermal split formation. In human skin cryosection models, patient-derived anti-LAMB4 IgG recruits polymorphonuclear neutrophils and induces tissue damage through Fc gamma receptor-dependent leucocyte activation and reactive oxygen species release.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Furthermore, the histopathology of anti-p200 pemphigoid is characterized by a neutrophil-predominant or mixed infiltrate at the dermo–epidermal junction, contrasting with the classic eosinophil-rich infiltrate of BP.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Because these infiltrating neutrophils abundantly express C5a receptors (C5aR1 and C5aR2), the classical, alternative and terminal complement pathways represent compelling therapeutic angles. Recent in vitro data confirm that selective blockade of these complement pathways effective","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 10","pages":"1581-1582"},"PeriodicalIF":9.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70667","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029057","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":"Cutaneous lupus in Korea: Converging figures, remaining caveats","authors":"Charles Cassius","doi":"10.1111/jdv.70652","DOIUrl":"https://doi.org/10.1111/jdv.70652","url":null,"abstract":"&lt;p&gt;Epidemiology is the cartography of medicine. Refining the incidence of a disease, resolving it across subpopulations and tracking both its trajectory over time and its associations are the foundations on which clinical knowledge is built. It is what allows us to situate a disease within the wider pathological landscape. Beyond this static mapping, the periodic re-evaluation of a disease's epidemiology is what exposes its evolution, changes that can in turn be related to shifts in the exposome and the environment.&lt;/p&gt;&lt;p&gt;In this respect the nationwide study by Song et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; is a valuable contribution — and one that underscores how much the knowledge we can extract depends on rigorous disease coding, linked registries and the public-health infrastructure that sustains them. They investigate the nationwide incidence of CLE in Korea, its association with malignant skin lesions and the risk of progression to SLE, studying the Korean National Health Insurance Service–National Health Information Database between 2005 and 2020.&lt;/p&gt;&lt;p&gt;For the dermatologist managing cutaneous lupus erythematosus (CLE) without systemic involvement, a central concern is not to overlook progression to systemic lupus erythematosus (SLE), which mandates a different therapeutic strategy and closer surveillance.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Song et al. report a progression rate of 2.0% and a mean time to progression of 3.2 years – a rate at the lower end, and a latency at the upper end, of published estimates. We would suggest that part of this divergence may be methodological rather than purely populational. Because a prescription of oral hydroxychloroquine was accepted as one of the qualifying criteria for CLE ascertainment in patients without SLE, the cohort is, by construction, enriched in hydroxychloroquine-exposed individuals. Given accumulating evidence that early hydroxychloroquine may itself blunt the cutaneous-to-systemic transition,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; this selection feature could plausibly contribute to both the lower progression rate and the longer latency observed.&lt;/p&gt;&lt;p&gt;Song et al. examined the association between CLE and actinic keratosis (AK), non-melanoma skin cancer (NMSC) and melanoma over a median follow-up of 8.5 years (IQR 4.4–13.3). Beyond the excess of AK, the more striking signals are the adjusted hazard ratios for NMSC (aHR 3.54; 95% CI 2.80–4.47) and melanoma (2.32; 1.19–4.53). Reassuringly, the authors' own time-stratified analysis tempers these figures: the risk is heavily front-loaded – implausibly high within the first two years (aHR 13.48 and 8.68 for AK and NMSC) – and attenuates markedly thereafter. Tellingly, this temporal signature is not unique to the Korean data: in the Swedish registry&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; the NMSC hazard ratio fell from 6.9 (95% CI 2.1–22.0) in the first year to 2.4 (1.0–5.8) thereafter, and the overall NMSC hazard ratio (3.6) closely matched the adjusted Korean estimate (Figure 1). A latency ","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 10","pages":"1585-1586"},"PeriodicalIF":9.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70652","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029059","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":"Deep and disseminated dermatophytosis in immunocompromised populations—A systematic review","authors":"Aditya K. Gupta,&nbsp;Tong Wang,&nbsp; Susmita,&nbsp;Ditte Marie L. Saunte,&nbsp;Roderick Hay,&nbsp;Vincent Piguet","doi":"10.1111/jdv.70115","DOIUrl":"10.1111/jdv.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dermatophytes—a group of obligate keratinophilic fungi that infect the skin, hair and nails—represent the most common cause of fungal infections worldwide. In immunocompromised individuals, a growing body of literature has documented rare instances of dermatophyte infections of the dermis and subcutaneous tissue, which can lead to deep dermatophytosis with systemic dissemination and pseudomycetoma as secondary complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess patient characteristics, risk factors, diagnostic evidence and treatment options for deep dermatophytosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted in June 2025 to identify patients presenting with deep dermatophytosis of the glabrous skin; all cases were validated by confirmatory testing per histopathologic examination and fungal culture. Majocchi's granuloma diagnoses were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The search yielded 96 studies (1954–2025) documenting 134 patients. The number of reports has notably increased since the 21st century; however, diagnosis remains challenging due to possible dermatophyte adaptation in the dermal/subcutaneous environment. <i>Trichophyton rubrum</i> is the most frequently isolated pathogen. Acquired immunodeficiencies (e.g. renal transplant recipients) and primary immunodeficiencies (e.g. CARD9, STAT3 mutations) elevate the risk of deep dermatophytosis. Systemic dissemination, often accompanied by lymphadenopathy, was reported in 24 patients, with the most common being infection of the axillary and inguinal lymph nodes. Infections of the bones, lungs, and brain were also reported. Terbinafine (125–1000 mg/day) and itraconazole (100–400 mg/day), with adjunctive topical antifungals and surgical interventions, have been tried for deep dermatophytosis. The use of newer triazoles (voriconazole, posaconazole) should follow the principles of antifungal stewardship and therapeutic drug monitoring recommendations. Multidrug resistance is a potential concern in immunocompromised patients who will often require extended or lifelong treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Healthcare providers should be cognizant that dermatophytosis may become invasive and disseminated in immunocompromised populations. Testing and early treatment should not be overlooked in these patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 10","pages":"1648-1661"},"PeriodicalIF":9.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310684","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":"Personalized medicine for lentigo maligna: Beyond ‘one knife fits all’?","authors":"Annemiek Leeman,&nbsp;Tom Hillary","doi":"10.1111/jdv.70651","DOIUrl":"https://doi.org/10.1111/jdv.70651","url":null,"abstract":"&lt;p&gt;Lentigo maligna (LM) remains one of the most challenging forms of melanoma in situ encountered in daily dermatological practice. Predominantly affecting elderly patients on chronically sun-damaged skin of the head-and-neck, LM frequently extends beyond its clinically visible borders, making diagnosis, treatment planning and long-term surveillance difficult. Clinicians must continuously balance complete tumour clearance against preservation of function, cosmetic outcome, treatment burden and the patient's overall health status.&lt;/p&gt;&lt;p&gt;Forsea and colleagues present the first International Dermoscopy Society consensus recommendations dedicated exclusively to LM.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Bringing together an impressive multidisciplinary panel of international experts, they combine available evidence with structured expert consensus to provide practical recommendations for diagnosis, treatment and follow-up. In an area where randomized evidence remains scarce, this provides an important framework for clinical practice.&lt;/p&gt;&lt;p&gt;Perhaps the greatest strength of this document is not the recommendation of a particular treatment, but its explicit recognition that LM management should be individualized. Surgery appropriately remains the preferred treatment, while topical imiquimod, radiotherapy and, in selected patients, active surveillance are acknowledged as legitimate alternatives when surgery is either not feasible or not desirable. This represents an important evolution from a traditional ‘surgery-or-nothing’ paradigm towards genuine patient-centred care.&lt;/p&gt;&lt;p&gt;However, in daily practice, the greatest challenge in LM management starts before treatment decisions are made. The fundamental question is not only how to treat LM, but whether the lesion truly represents melanoma in situ alone or already harbours an invasive component. This diagnostic uncertainty drives virtually every subsequent therapeutic decision. Despite careful clinical examination, dermoscopy and targeted biopsies, lesion borders remain difficult to define, while occult invasion cannot always be excluded, even with reflectance confocal microscopy (RCM).&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The guideline appropriately highlights the value of RCM for diagnosis, biopsy guidance and preoperative margin assessment. Yet access to RCM remains limited to relatively few expert centres worldwide. For most dermatologists, optimal management will therefore continue to rely on careful clinicopathological correlation rather than advanced imaging alone.&lt;/p&gt;&lt;p&gt;This diagnostic uncertainty also influences one of the most important clinical dilemmas: proportionality of treatment. The consensus appropriately reviews the risk of progression from LM to invasive melanoma. LM usually follows an indolent course over decades, while melanoma-specific mortality remains remarkably low. For many elderly patients, competing comorbidities are far more likely to determine life expectancy than LM itself. Consequently, the objective","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 10","pages":"1577-1578"},"PeriodicalIF":9.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70651","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027748","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":"Darier disease international task force: From mechanistic insights to precision medicine","authors":"Florence Assan,&nbsp;Annabel Maruani","doi":"10.1111/jdv.70660","DOIUrl":"https://doi.org/10.1111/jdv.70660","url":null,"abstract":"&lt;p&gt;The manuscript by Labbouz et al.,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; on behalf of the Darier Disease International Task Force (DDITF), provides a timely and comprehensive synthesis of current knowledge on Darier disease (DD), highlighting both recent advances and the persistent challenges in its understanding and management. DD represents a unique model at the intersection of keratinocyte biology, immunology and genetics. Over the past decade, major advances in molecular and cellular biology have expanded our understanding of its pathogenesis. However, these scientific discoveries have not yet translated into evidence—ased therapeutic guidelines, underscoring the need for an updated and clinically relevant review. By integrating clinical, biological, pathological and genetic evidence of DD, the authors successfully bridge fundamental disease mechanisms with their clinical and therapeutic implications.&lt;/p&gt;&lt;p&gt;DD is an autosomal dominant disorder caused by pathogenic variants in &lt;i&gt;ATP2A2&lt;/i&gt;, most of which are missense mutations distributed throughout the gene, with limited genotype–phenotype correlation. These variants disrupt intracellular Ca&lt;sup&gt;2+&lt;/sup&gt; homeostasis, leading to defective epidermal differentiation and activation of the MAPK signalling pathway. Nevertheless, important mechanistic questions remain unresolved, particularly regarding the links between calcium dysregulation, the TH17-driven immune response and the dysbiosis observed in lesional skin.&lt;/p&gt;&lt;p&gt;A few major aspects of this review deserve particular attention. First, the authors propose reconsidering DD as a syndromic epidermal differentiation disorder (EDD), based on the growing recognition of its extracutaneous manifestations, including neuropsychiatric, ophthalmological, salivary gland (parotid) and cardiac involvement. This conceptual shift is important, as it redefines DD as a systemic disorder. Consequently, it supports the need for multidisciplinary care involving dermatologists, geneticists, ophthalmologists, psychiatrists, cardiologists and other specialists when appropriate. Second, the review highlights how recent advances in our understanding of DD pathogenesis are paving the way for novel therapeutic strategies, including drug repurposing and precision medicine approaches. Similar strategies have emerged in other rare diseases, such as superficial vascular malformations linked to post-zygotic variants, illustrating the broader potential of mechanism-based therapeutic development.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; &lt;i&gt;Drug repurposing is emerging as a promising paradigm for inherited skin disorders. Encouraging results have been reported in pachyonychia congenita, where the use of the EGFR inhibitor erlotinib was rationally developed from mechanistic insights&lt;/i&gt;,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; &lt;i&gt;as well as in Netherton syndrome and other congenital EDD&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; In DD, the activation of the IL-17/IL-23 pathway, together with encouraging clinical reports of biologi","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 10","pages":"1579-1580"},"PeriodicalIF":9.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70660","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029055","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":"The promise of oral IL-23 blockade: One-year control of high-impact site psoriasis","authors":"Fatma Jendoubi","doi":"10.1111/jdv.70593","DOIUrl":"https://doi.org/10.1111/jdv.70593","url":null,"abstract":"&lt;p&gt;Psoriasis affecting high-impact sites, including the scalp, genital area, palms and soles, represents a distinct therapeutic challenge. Although these localizations often involve a limited body surface area, their impact on health-related quality of life can be substantial. In addition, these areas are frequently difficult to treat.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Biologic therapies targeting cytokine pathways have transformed the management of moderate-to-severe psoriasis. In particular, IL-23 inhibitors have demonstrated high levels of efficacy and a favourable safety profile, including in difficult-to-treat areas. However, reluctance towards injectable therapies remains a reality in daily practice.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Icotrokinra, the first oral peptide targeting the IL-23 receptor, is approved for the treatment of moderate-to-severe plaque psoriasis in adults and adolescents eligible for systemic therapy or phototherapy. ICONIC-TOTAL is an ongoing phase 3, multicentre, randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of icotrokinra in adults and adolescents with at least moderate psoriasis affecting the scalp, genital or hand/foot regions and a body surface area involvement ≥1%.&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Journal of the European Academy of Dermatology and Venereology&lt;/i&gt;, Warren et al. report the 52-week results of the ICONIC-TOTAL study.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The main finding was the sustained efficacy of icotrokinra across all evaluated locations. Clinical responses continued to improve beyond Week 16 and were maintained through Week 52. At 1 year, clear or almost clear disease was achieved in 72% of patients with scalp psoriasis, 85% of those with genital psoriasis and 62% of those with hand/foot psoriasis. Improvements in itch, symptoms and quality of life were also maintained throughout follow-up.&lt;/p&gt;&lt;p&gt;These findings are clinically relevant, as the burden associated with psoriasis affecting high-impact sites is often related more to symptoms and functional impairment than to the extent of skin involvement. The results further support the role of the IL-23 pathway in psoriasis occurring in these locations and suggest that oral IL-23 receptor blockade may achieve levels of efficacy previously observed mainly with injectable biologics.&lt;/p&gt;&lt;p&gt;No new safety signals were identified during 1 year of treatment. Nevertheless, longer follow-up will be required to better define the long-term safety profile of this new therapeutic option.&lt;/p&gt;&lt;p&gt;Some limitations should be acknowledged. The placebo-controlled period was limited to 16 weeks, with all participants subsequently receiving active treatment. As a consequence, long-term efficacy and safety assessments remain descriptive. Another limitation is the absence of an active comparator. Therefore, it remains difficult to compare the efficacy observed with icotrokinra with that reported for other systemic treatments. Head-to-head studies ","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 9","pages":"1443-1444"},"PeriodicalIF":9.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811134","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}