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

{"title":"Editor's Picks September 2025","authors":"","doi":"10.1111/jdv.20860","DOIUrl":"https://doi.org/10.1111/jdv.20860","url":null,"abstract":"<p></p><p>Carle Paul</p><p>Atopic dermatitis (AD) is one of the most common skin diseases. Wollenberg et al. summarize updated living AD guidelines (with participation from clinicians and patient representatives), now encompassing a large armamentarium of injectable/oral agents for patients with moderate to severe disease. Topical therapy with corticosteroids or topical calcineurin inhibitors remain the standard of care for mild to moderate disease, while biologic agents and oral JAK inhibitors show long-term efficacy with moderate to severe AD. The stepped-care plan for children with AD delineates a new life-changing path that will ensure long-term control of AD (see Figure 1).</p><p>Wollenberg A, Kinberger M, Arents B, et al. European Guideline (EuroGuiDerm) on atopic eczema: Living update. <i>J Eur Acad Dermatol Venereol</i> 2025; <b>39</b>: 1537–1566. https://doi.org/10.1111/jdv.20639.</p><p>Alternatives to topical corticosteroids are needed in patients with moderate to severe chronic hand eczema. Delgocitinib is a topical JAK inhibitor approved for the treatment of moderate to severe hand eczema. In this open-label phase I pharmacokinetic trial, Thaçi et al. showed that systemic exposure to topical delgocitinib after twice daily application to the hands was minimal, with a relative bioavailability versus oral dosing of <1%, indicating the absence of a systemic immunosuppressive effect (see Figure 2). It is unknown if application on larger surfaces (including areas with thin skin and higher absorption) can cause significant systemic exposure.</p><p>Thaçi D, Gooderham M, Lovato P, et al. Systemic exposure and bioavailability of delgocitinib cream in adults with moderate to severe Chronic Hand Eczema. <i>J Eur Acad Dermatol Venereol</i> 2025; <b>39</b>: 1612–1621. https://doi.org/10.1111/jdv.20777.</p><p>In most healthcare systems, patients with skin diseases are usually seen first by a general practitioner (GP) and referred to a dermatologist only when needed. In this study from Finland, Lovén et al. evaluated the cost-effectiveness of integrating dermatologists into primary care with direct examination of patients with skin diseases by a dermatologist, without a prior GP appointment. While this strategy increased the likelihood of detecting skin cancers and appropriately diagnosing skin diseases, dramatically reducing healthcare costs, it should be balanced with its feasibility and the likely high number of dermatologists required (see Figure 3).</p><p>Lovén M, Huilaja L, Paananen M, et al. The integration of dermatology experts into primary care to assess and treat patients with skin lesions is cost-effective: A quasi-experimental study. <i>J Eur Acad Dermatol Venereol</i> 2025; <b>39</b>: 1666–1674. https://doi.org/10.1111/jdv.20451.</p><p>The risk of developing psoriasis is a combination of genetic and environmental factors (including increased body mass index and exposure to tobacco and alcohol). In this large and well-conducted popula","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 9","pages":"1521-1522"},"PeriodicalIF":8.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144894430","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":"Bridging the gap: Assessing safety beyond clinical trials in psoriasis","authors":"Luigi Naldi, Simone Cazzaniga","doi":"10.1111/jdv.20831","DOIUrl":"https://doi.org/10.1111/jdv.20831","url":null,"abstract":"<p>There is a lack of symmetry between the assessment of efficacy and safety for a given intervention. While efficacy is usually demonstrated through randomized clinical trials (RCTs), questions about safety often remain unresolved. There are multiple reasons for this, the most obvious of which are statistical and related to the artificial conditions of RCTs. The typical sample size in an RCT rarely exceeds a few thousand carefully selected participants, who are evaluated over a relatively short period of time. This is generally sufficient to document common short-term outcomes—such as improvement of a chronic condition or resolution of an acute one in a simplified patient population, especially when compared against placebo—but inadequate for assessing rare or long-latency adverse events (AEs). These AEs, by necessity, can only be reliably evaluated once the drug has entered the market, in the so-called post-marketing phase.</p><p>Disease-specific clinical registries offer a valuable means of assessing medical interventions in this post-marketing context.<span><sup>1</sup></span> They enable evaluation of efficacy and safety in a broader, less selected patient population and in a real-world setting (‘real-world’ being an often-abused term, sometimes used to simply describe what was once considered a ‘case series’). Several variables, summarized in Table 1, can affect drug assessment in such real-world contexts and should be considered in study design. We are indebted to psoriasis registries such as the BadBIR registry in the United Kingdom,<span><sup>2</sup></span> the Italian registry Psocare<span><sup>3</sup></span> and the Spanish registry BioBadaderm<span><sup>4</sup></span> for improving our understanding of the factors influencing clinical response and its maintenance over time—and ultimately for enhancing psoriasis management.</p><p>In this issue of the Journal, data from the BioBadaderm study are presented, specifically focusing on safety assessments of targeted biologic and some non-biologic therapies in psoriasis.<span><sup>5</sup></span> Various lessons can be learned from the study.</p><p><i>First</i>, a distinction should be made between AEs and adverse reactions (ARs)—a difference that is not merely semantic. AEs were considered in the BioBadaderm registry. According to the <i>Medical Dictionary for Regulatory Activities</i> (MedDRA), an AE is ‘any unfavorable and unintended event temporally associated with the use of a medical treatment or procedure, regardless of whether it is considered related to the treatment’, whereas an AR implies the establishment of a causal relationship. Clinical judgement about the relevance and aetiologic role of a given drug is missing. The analysis of AEs can raise signals, but it does not establish causality.</p><p><i>Second</i>, the limitations of conventional RCTs in assessing safety cannot be overcome by meta-analyses, even those employing a network meta-analysis design. As highlighted by the auth","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 9","pages":"1533-1534"},"PeriodicalIF":8.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20831","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144894148","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":"Marcus Maurer: A legacy of innovation, collaboration and mentorship in urticaria research","authors":"Özge Sevil Karstarli Bakay, Emek Kocatürk","doi":"10.1111/jdv.20830","DOIUrl":"https://doi.org/10.1111/jdv.20830","url":null,"abstract":"<p>One year has passed since Professor Marcus Maurer set out to hike Monte Giove on July 31, 2024, unaware that this journey would mark the end of a life dedicated to advancing our understanding of dermatoallergology, particularly mast cell-mediated diseases. His tragic passing remains profoundly saddening, and he is deeply missed, yet his pioneering research and invaluable contributions continue to shape and inspire the field, guiding clinicians and researchers in their efforts to improve patient care and scientific knowledge.</p><p>Marcus Maurer was a revolutionary physician and scientist whose relentless pursuit of the question, “Why do we have mast cells?”—the focus of his habilitation—defined his lifelong dedication to uncovering their role in health and disease. Naturally, his clinical focus centered on mast cell-mediated conditions such as urticaria, angioedema, mastocytosis and pruritus; however, urticaria stands out as the area where his impact was truly transformative.</p><p>In addition to being a good clinician, Marcus Maurer has attempted to address all aspects of urticaria, including its pathogenesis, public health implications, healthcare costs, diagnostic challenges and treatment strategies.<span><sup>1-10</sup></span> Furthermore, prioritizing the understanding and facilitation of patients' journeys was central to his approach, significantly impacting both his clinical practice and publications.<span><sup>4</sup></span> Maurer's multifaceted perspective has empowered numerous scientists and physicians—dermatologists, immunologists, allergists, as well as basic and translational scientists worldwide—to identify key research questions in urticaria and foster meaningful collaboration in this important area of investigation.</p><p>Professor Maurer has made efforts as a leader or part of many organizations that provided an environment for scientific partnership, collaboration and joint data production. He has actively promoted collaboration with his European colleagues in his role as head of the Urticaria Network e.V. (UNEV), active roles in EADV Urticaria and Angioedema Taskforce, The European Network for IgE-Mediated Autoimmunity and Autoallergy (ENIGMA) initiative,<span><sup>2</sup></span> the EU COST program Mast Cells and Basophils and the UCARE and ACARE programmes—a GA<sup>2</sup>LEN initiative; centers of reference and excellence in the field of urticaria and angioedema-.<span><sup>6, 7</sup></span> Under Maurer's leadership, these programmes have established a global network, bringing physicians and scientists together to collaborate and advance knowledge in urticaria and angioedema. Through this spirit of collaboration, numerous high-impact projects have emerged, addressing unmet needs in urticaria and leading to influential publications that continue to shape the field<span><sup>8</sup></span> and have facilitated the development and continual updating of guidelines for diagnosing and treating urticaria.<span><sup>7</sup></s","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 9","pages":"1523-1526"},"PeriodicalIF":8.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20830","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144894426","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":"Pinpointing when and how of teledermatology","authors":"Paola Pasquali, Lara Ferrándiz","doi":"10.1111/jdv.70001","DOIUrl":"10.1111/jdv.70001","url":null,"abstract":"<p>We read with considerable interest the research conducted by Reinders et al.<span><sup>1</sup></span> This study aimed to address the underutilization of teledermatology in Germany for managing psoriasis, a chronic condition that requires ongoing follow-up care. The relevance of this work is highlighted by the necessity for continuous patient monitoring, the occurrence of acute flares that require prompt—though not necessarily urgent—specialist intervention and the longstanding relationships typically established between patients and their treating physicians. These factors are especially significant in a context where waiting times are increasingly extended. Regrettably, this issue is relevant to many countries, where a lack of specialists significantly limits access to standard care, making the implementation of teledermatology more of a necessity than an option.</p><p>We fully agree with the authors on the importance of aligning digital health services with the needs explicitly expressed by patients themselves. It emphasizes the importance of understanding the specific requirements associated with each medical condition and the individual needs of patients. In fact—and although it may appear contradictory to some critics—telemedicine is a tool that serves the individualization of medical care. It makes it possible to offer the type and intensity of care that each patient needs, at the right time and in the most convenient setting, which in many cases may be the patient's own home. However, it is important to recognize that acquiring telemedicine technology alone does not guarantee its successful implementation. Telemedicine is a transversal innovation that has repercussions on multiple dimensions of the healthcare organization: from the structure of agendas, allocation of human resources, training, clinical protocols, and face-to-face access circuits, as well as interoperability with other information systems (diagnostic imaging, prescription and dispensing of drugs, etc.). Therefore, the integration of teledermatology into services and consultations, particularly within specialized units such as a psoriasis clinic, necessitates a thorough redesign of both functional and structural aspects to effectively address patient needs. Most of the current perceptions of teledermatology among patients—clearly highlighted in this study—are largely attributable to the technology adoption process that occurred without the corresponding redesign of dermatology services and units implementing it.</p><p>In addition, the study indicates a low perceived privacy risk among patients, which could reassure authorities considering regulations that balance privacy with accessibility. Efforts might be better directed toward ensuring reimbursement for teledermatology services, aligning them with traditional face-to-face consultations.</p><p>Regarding technology acceptance and competency, factors such as age and gender play a significant role. Specifically, the findi","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 10","pages":"1709-1710"},"PeriodicalIF":8.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839909","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":"Correction to ‘Retrospective evaluation of a TEN/SJS series managed with a new treatment protocol’","authors":"","doi":"10.1111/jdv.20892","DOIUrl":"10.1111/jdv.20892","url":null,"abstract":"<p>Steinhoff M, Buddenkotte J, Al-Shafi W, Al-Marri H, Emam F, Iqneibi M, Harris TRE, Thomas SH, Asad SM, Al-Maslamani H, Joy FE, Therachiyil L, Jochebeth A, Leo R, Younis SM, Abu Raddad LJ, Dargham SR, Al-Khawaga S. Retrospective evaluation of a TEN/SJS series managed with a new treatment protocol. <i>J Eur Acad Dermatol Venereol</i>. 2025;39:e42–5.</p><p>In the ‘Funding Information’ section, the text ‘Supported by MRC Fund #MRC-01-21-763, Hamad Medical Corporation, Qatar (to M.S., J.B. and S.A.K.)’ was incorrect. This should have read ‘Supported by MRC Fund #MRC-01-21-736, Hamad Medical Corporation, Qatar (to M.S., J.B. and S.A.K.)’.</p><p>In addition, in the ‘Ethical Approval’ section, an incorrect approval number #MRC-01-21-763 was reported. The correct ethical approval number is #MRC-01-21-736.</p><p>We apologize for this error.</p>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 10","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20892","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755577","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":"Enhancing tolerability in photodynamic therapy for actinic keratosis without compromising efficacy","authors":"Hans Christian Wulf,&nbsp;Stine Regin Wiegell","doi":"10.1111/jdv.20791","DOIUrl":"https://doi.org/10.1111/jdv.20791","url":null,"abstract":"&lt;p&gt;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).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The trial included 56 patients who received 5-aminolevulinic acid (ALA) PDT in four symmetrical areas of the face and scalp.&lt;/p&gt;&lt;p&gt;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&lt;sup&gt;2&lt;/sup&gt;, 62 mW/cm&lt;sup&gt;2&lt;/sup&gt;). 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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;Previous studies have demonstrated that the standard red-light dose of 37 J/cm&lt;sup&gt;2&lt;/sup&gt; may exceed what is necessary for activation of the accumulated PpIX.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; More than 85% of available PpIX is activated after just 18 J/cm&lt;sup&gt;2&lt;/sup&gt;, suggesting that the remaining 19 J/cm&lt;sup&gt;2&lt;/sup&gt; may offer little additional benefit.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;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.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; 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.&lt;/p&gt;&lt;p&gt;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,&nbsp;Antonella Tosti","doi":"10.1111/jdv.20787","DOIUrl":"https://doi.org/10.1111/jdv.20787","url":null,"abstract":"&lt;p&gt;The recent study published in this journal, ‘Management of folliculitis decalvans: The EADV task force on hair diseases position statement’&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; provides practical guidance for diagnosing and managing folliculitis decalvans (FD).&lt;/p&gt;&lt;p&gt;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.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Therefore, accurate diagnosis and management are crucial to control scalp inflammation, prevent irreversible scarring and avoid systemic complications due to persistent inflammation.&lt;/p&gt;&lt;p&gt;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, &lt;i&gt;Staphylococcus aureus&lt;/i&gt; levels differ between these patterns: higher than 20% in FD, but lower in FDLPPPS.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Hair experts from this task force emphasize the importance of trichoscopy for diagnosis, assessing disease activity and selecting optimal biopsy sites.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;Oral antibiotics are recommended for their activity against &lt;i&gt;S. aureus&lt;/i&gt;, 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.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; 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":"Clinical clusters in hidradenitis suppurativa: Interesting observations but incomplete answers","authors":"Charles Cassius,&nbsp;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>¹</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>²</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>³</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>⁴</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":"Does AI need anything more than a single image to diagnose melanoma?","authors":"Aimilios Lallas,&nbsp;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>¹</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>²</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>³</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>⁴</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":"Editor’s Picks August 2025","authors":"","doi":"10.1111/jdv.20790","DOIUrl":"https://doi.org/10.1111/jdv.20790","url":null,"abstract":"&lt;p&gt;&lt;/p&gt;&lt;p&gt;Rolland Gyulai&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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. &lt;i&gt;J Eur Acad Dermatol Venereol&lt;/i&gt; 2025; &lt;b&gt;39&lt;/b&gt;: 1449–1459. doi:10.1111/jdv.20452.&lt;/p&gt;&lt;p&gt;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).&lt;/p&gt;&lt;p&gt;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. &lt;i&gt;J Eur Acad Dermatol Venereol&lt;/i&gt; 2025; &lt;b&gt;39&lt;/b&gt;: 1442–1448. doi:10.1111/jdv.20350.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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. &lt;i&gt;J Eur Acad Dermatol Venereol&lt;/i&gt; 2025; &lt;b&gt;39&lt;/b&gt;: 1489–1499. doi:10.1111/jdv.20479.&lt;/p&gt;&lt;p&gt;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}