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

{"title":"Predictors of clinical response to biologics in psoriasis: A systematic review and meta-analysis","authors":"Xuerui Mao,&nbsp;Shuo Meng,&nbsp;Panyu Wu,&nbsp;Lei Cao,&nbsp;Lei Wang","doi":"10.1111/jdv.70462","DOIUrl":"10.1111/jdv.70462","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Biologic therapies have revolutionized psoriasis management, yet inter-individual response varies significantly and reliable predictors of complete skin clearance remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to identify prognostic predictors of biologic efficacy in patients with psoriasis through a systematic review and meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched four databases (from their inception to January 28, 2026). Studies were screened and data extracted per predefined criteria; quality was assessed using the Newcastle-Ottawa Scale (NOS), and analyses were performed in Stata 15.0.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty studies (<i>n</i> = 13,902) were included. Negative predictors of clearance included older age (odds ratio [OR] 0.99, 95% CI 0.98–0.99, <i>p</i> &lt; 0.001), higher body mass index (OR 0.94, 95% CI 0.92–0.97, <i>p</i> &lt; 0.001), comorbidities (OR 0.75, 95% CI 0.63–0.9, <i>p</i> = 0.002), and involvement of special areas (OR 0.71, 95% CI 0.56–0.89, <i>p</i> = 0.003). Conversely, a positive family history (OR 1.42, 95% CI 1.18–1.71, <i>p</i> &lt; 0.001) emerged as a significant predictor associated with better outcomes. No significant associations were observed for other analysed variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older age, higher comorbidity burden, obesity, and special-site involvement are associated with poorer biologic response in psoriasis, whereas family history is associated with better outcomes. These readily available baseline factors facilitate phenotype-based risk stratification and may guide treatment selection in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 9","pages":"1469-1480"},"PeriodicalIF":9.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701794","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":"Practical recommendations for seborrheic dermatitis management: An expert consensus","authors":"L. Naldi,&nbsp;A. Kyrgidis,&nbsp;G. S. Tiplica,&nbsp;M. A. de Rie,&nbsp;D. Tatsis,&nbsp;P. Gisondi,&nbsp;D. Ioannides,&nbsp;O. Chosidow,&nbsp;M. Deleuran,&nbsp;the Delphi SD study experts","doi":"10.1111/jdv.70444","DOIUrl":"10.1111/jdv.70444","url":null,"abstract":"<p>To establish consensus-driven practical recommendations for the clinical management of Seborrheic Dermatitis (SD), covering both acute treatment and long-term maintenance strategies. We conducted a modified Delphi consensus involving 33 dermatology experts under the auspices of the EADV. The process utilized an efficient, two-round, blinded voting structure to iteratively refine an initial list of 84 evidence-based statements, facilitating a structured convergence of expert opinion. The iterative Delphi process proved effective in building consensus. After the second round of voting on a refined list of 68 statements, a final consensus was achieved for 44 statements, with near-consensus for another 6. This demonstrates the method's efficiency in harmonizing expert opinion on key clinical questions. This consensus delivers clear, clinically actionable recommendations for managing SD. The key clinical implications include prioritizing combined antifungal and anti-inflammatory strategies for both acute flares and long-term maintenance. Furthermore, the consensus provides a structured framework for therapeutic escalation to systemic agents in extensive or refractory cases, offering practical guidance where formal guidelines are lacking.</p>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 9","pages":"1460-1468"},"PeriodicalIF":9.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70444","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795385","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":"Living with lichen sclerosus: A narrative of transformation, advocacy and community building","authors":"Muriel Rouffaneau,&nbsp;Alessia Paganelli","doi":"10.1111/jdv.70499","DOIUrl":"10.1111/jdv.70499","url":null,"abstract":"&lt;p&gt;I was diagnosed with genital lichen sclerosus (LS) in the mid-1990s, not because of pain, itch or other obvious symptoms, but due to the observation of whitish patches during a routine gynaecological examination. At the time, awareness and structured care pathways for LS were extremely limited.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Initial recommendations—primarily topical corticosteroids—were applied without the supportive measures that are now considered essential, such as emollients, moisturizers and regenerative strategies.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The absence of symptoms reduced my perceived urgency to engage with treatment, inadvertently allowing the disease to progress. Over time, anatomical and structural changes became increasingly evident, gradually reshaping my everyday life. Daily activities as simple as dressing, sitting or travelling began to trigger anxiety about symptom worsening. However, the mental burden of constant vigilance was, in many ways, as impactful as physical changes. This ‘unknown’ is often what patients fear most: the idea that their body may change in ways that are difficult to predict, control or even explain. Even in phases where symptoms appear mild or clinically limited, the perceived threat of progression can generate disproportionate distress, underscoring the gap between clinical assessment and lived experience.&lt;/p&gt;&lt;p&gt;For years, LS rendered me ‘invisible’ to others and, in some way, to myself. The condition limited my understanding of what was happening to my body and created a disconnect between subjective sensations and objective changes. It was only through careful self-observation and photographic documentation that I could contextualize and track changes, anchoring abstract sensations to visual evidence. This process highlighted a key gap in care: without imagery or structured resources, many patients remain uncertain, disoriented and unsupported in managing their condition. In this sense, visual documentation became not only a personal coping strategy but also a bridge between patient experience and clinical evaluation, facilitating more meaningful dialogue with healthcare providers.&lt;/p&gt;&lt;p&gt;Another key dimension, often under-recognized, is the lack of societal understanding of LS. Even in 2026, patients widely perceive that the emotional and physical impact of the disease is underestimated by those around them. This includes not only broader society but also professional environments, family dynamics and intimate relationships. Communicating the complexity of LS is inherently challenging: it is a condition that is not immediately visible, difficult to describe and deeply personal. As a result, patients frequently experience a sense of isolation, compounded by the practical difficulties of managing symptoms in the present and the persistent fear of future progression. This invisibility contributes to a perceived lack of validation, which may further amplify psychological distress and hinder help-seeking behavio","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 9","pages":"1552-1553"},"PeriodicalIF":9.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70499","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849189","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":"Sex disparities in melanoma: Beyond stage at diagnosis","authors":"Eglė Janušonytė,&nbsp;Myrto Trakatelli","doi":"10.1111/jdv.70431","DOIUrl":"https://doi.org/10.1111/jdv.70431","url":null,"abstract":"&lt;p&gt;This exciting study by Lyngstrand et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; provides population-based evidence that men face a dual disadvantage in melanoma: more advanced disease at diagnosis and inferior stage-specific prognosis. In a cohort of nearly 30,500 Danish patients, men more often presented with thicker, ulcerated tumours and were more likely to have nodal involvement or distant metastases at diagnosis compared with women.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; To what extent are these disparities modifiable, and what should we do differently?&lt;/p&gt;&lt;p&gt;The instinctive answer would be that observed disparities in stage at diagnosis reflect differences in healthcare-seeking behaviour. Men consistently demonstrate lower rates of skin self-examination and delayed presentation with suspicious lesions.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Anatomical distribution could explain that as melanomas in men occur more frequently on the trunk, areas less accessible to self-detection compared to the lower extremity predominance seen in women.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;However, if late presentation were the sole explanation, stage-adjusted analyses would eliminate the sex disparity. They do not. In fact, the persistence of a 20–40% increased risk of recurrence and a 30–50% increased risk of melanoma-specific mortality in men, as demonstrated in this study, points towards biological differences in tumour behaviour or host response.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This aligns with European cohort data showing females retain a survival advantage even after adjusting for thickness, ulceration and anatomical site.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The uncomfortable truth is that even if men presented as early as women, they would still fare worse.&lt;/p&gt;&lt;p&gt;How do we explain this? Sex hormones may influence melanoma progression, and oestrogen receptor beta (ERβ) may have an anti-proliferative role, as ERβ expression decreases with increasing Breslow thickness and is associated with more invasive disease.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; However, the persistence of the female survival advantage when adjusted for proxy menopausal status (based on age at diagnosis) suggests that circulating oestrogen levels alone do not fully explain sex-specific outcomes.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Moreover, the immune response seems to differ by sex, with female antigen-presenting cells demonstrating greater efficiency and X chromosome-linked immune genes potentially contributing to the difference of outcomes.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;These findings carry practical implications and unmet needs for future investigations. Current AJCC staging and NCCN/ESMO guidelines do not incorporate sex into risk stratification. Whether surveillance protocols should incorporate sex-specific follow-up for men with localized disease merits a formal evaluation. From a research perspective, molecular characterization of tumours stratified by sex could show whether biological differences at the tumour level explain prognostic disparities, while tri","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 9","pages":"1445-1446"},"PeriodicalIF":9.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70431","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811135","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":"International consensus on dose reduction of biologics for patients with psoriasis: The DR. Delphi study","authors":"C. A. M. van Riel,&nbsp;W.-H. Boehncke,&nbsp;J. L. W. Lambert,&nbsp;P. I. Spuls,&nbsp;L. S. van der Schoot,&nbsp;I. van Ee,&nbsp;E. M. G. J. de Jong,&nbsp;J. M. P. A. van den Reek,&nbsp;the eDelphi consortium","doi":"10.1111/jdv.70447","DOIUrl":"10.1111/jdv.70447","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dose reduction (DR) of biologics for psoriasis is already applied in clinical practice but without clear guidelines, while dermatologists addressed the need for guidance. An international consensus may contribute to optimal implementation of biologic DR in clinical psoriasis practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This consensus study aims for international consensus on DR of biologics in adult patients with psoriasis among dermatologists worldwide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An international, modified eDelphi consensus study was performed among dermatologists worldwide. A total of 11 statements on biologic DR were generated by the international steering committee, based on a previous literature review. Invitations were distributed via international dermatological societies. Participants rated their level of agreement per statement on a 9-point Likert scale. A maximum of three consensus rounds and one (digital) consensus meeting were expected. Statements reached consensus if ≥70% agreed and &lt;15% disagreed; otherwise, statements were revised for a next consensus round.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 62 dermatologists from Europe, South America, Asia, North America, Africa and Australia completed the eDelphi. After one round, 9 out of 11 statements reached consensus. The remaining 2 statements were adapted and reached consensus in the second round. Participants agreed on criteria when to consider and initiate/(dis)continue DR and on a two-step DR algorithm for adalimumab, etanercept and ustekinumab. Participants agreed that this two-step DR strategy can also be considered for IL-17 and IL-23 inhibitors while awaiting more scientific evidence on DR of these newer biologics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Dermatologists worldwide reached consensus on when and how to initiate and (dis)continue DR of biologics, and on a two-step DR algorithm for adalimumab, etanercept and ustekinumab in adult patients with psoriasis. DR of IL-17 and IL-23 inhibitors was deemed feasible; however, underlying evidence is still limited. This first international consensus provides essential information for uptake and implementation of biologic DR for psoriasis on a global scale.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 9","pages":"1449-1459"},"PeriodicalIF":9.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70447","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795242","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":"Durability of response to icotrokinra for high-impact site psoriasis: 1-year ICONIC-TOTAL findings","authors":"Richard B. Warren,&nbsp;Melinda Gooderham,&nbsp;Edward Lain,&nbsp;Robert Bissonnette,&nbsp;Yu-Huei Huang,&nbsp;Julien Ringuet,&nbsp;Matthias Hoffmann,&nbsp;Andreas Pinter,&nbsp;Joseph F. Merola,&nbsp;Jessica H. Rubens,&nbsp;Dorothy Fan,&nbsp;Ming-Chun Hsu,&nbsp;Shu Li,&nbsp;Ya-Wen Yang,&nbsp;Cynthia M. C. DeKlotz,&nbsp;Eingun James Song","doi":"10.1111/jdv.70471","DOIUrl":"10.1111/jdv.70471","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>High-impact site plaque psoriasis is difficult to treat. Icotrokinra, an oral peptide with high specificity for the interleukin (IL)-23 receptor, demonstrated significantly higher rates of high-impact site psoriasis clearance, versus placebo, with no safety signals, through Week (W)16.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Report clinical response rates and safety through 1 year of icotrokinra treatment in participants with high-impact site plaque psoriasis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants (≥12 years of age; psoriasis body surface area ≥1%; Investigator's Global Assessment [IGA] ≥2) with at least moderate scalp, genital or hand/foot psoriasis were randomized (2:1) to once-daily icotrokinra 200 mg (<i>N</i> = 208) or placebo (<i>N</i> = 103), with placebo-to-icotrokinra transition at W16 (<i>N</i> = 92). Rates (using nonresponder imputation) of achieving clear/almost clear (0/1) or clear (0) overall skin (IGA), genital (static Physician's Global Assessment of genitalia [sPGA-G]), hand/foot (hf-PGA) psoriasis and absent/very mild (0/1) or absent (0) scalp psoriasis (scalp-specific-IGA [ss-IGA]), modified Nail Psoriasis Severity Index (mNAPSI) percent improvement and safety were assessed through W52.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-eight per cent (275/311) of participants completed treatment through W52. In icotrokinra-randomized participants, response rates increased through W24 and were durable through W52 for overall psoriasis clearance (IGA 0/1 range: 67%–70%) and across high-impact sites (ss-IGA 0/1: 72%–78%; sPGA-G 0/1: 85%–90%; hf-PGA 0/1: 54%–62%); responses were consistent among placebo-randomized participants after transitioning to icotrokinra. High proportions of icotrokinra-randomized participants achieved complete clearance during W24–52 (IGA 0: 44%–51%; ss-IGA 0: 57%–66%; sPGA-G 0: 73%–84%; hf-PGA 0: 44%–58%). Mean mNAPSI improvement increased from W16 (33%) to W52 (62%). Exposure-adjusted rates of participants with ≥1 adverse event (AE) or serious AE through W16 were similar between icotrokinra and placebo, with no increase in AE rates or occurrence of a safety signal through W52.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Icotrokinra demonstrated high and durable rates of psoriasis clearance across high-impact sites, with a favourable safety profile, through 1 year.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 9","pages":"1502-1514"},"PeriodicalIF":9.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70471","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148008556","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":"Purpuric targetoid eruption revealing disseminated mucormycosis","authors":"Francisco Mano,&nbsp;João Teixeira","doi":"10.1111/jdv.70349","DOIUrl":"10.1111/jdv.70349","url":null,"abstract":"<p>A 76-year-old man with newly diagnosed diffuse large B-cell lymphoma was admitted for chemotherapy with curative intent. During treatment he developed febrile neutropenia and a respiratory infection that rapidly progressed to septic shock. Dermatology was consulted for a 3-day purpuric eruption on the left hemithorax and flank, composed of well-demarcated annular targetoid plaques with central induration and purpuric rims (Figure 1a). In the setting of refractory sepsis despite broad-spectrum antimicrobials, the morphology suggested septic emboli or vasculotropic infection. Punch biopsies from the centre and rim were sent for histopathology, culture and molecular testing and escalation to liposomal amphotericin B was recommended. Histology revealed extensive occlusive angioinvasive fungal thrombi (Figure 1b); PCR identified Mucorales, establishing disseminated mucormycosis, likely from a pulmonary source. This case highlights how recognition of a purpuric targetoid eruption in an immunocompromised, critically ill patient can provide a crucial clue to life-threatening invasive fungal infection.</p><p>The authors have nothing to report.</p><p>None declared.</p><p>Not applicable.</p><p>The patient in this manuscript has given informed consent to the publication of his clinical images.</p>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 9","pages":"1550-1551"},"PeriodicalIF":9.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097689","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":"Managing the unmanageable? Practical guidance for lichen planopilaris","authors":"Cristian Papara,&nbsp;Petra Rózsa,&nbsp;Rolland Gyulai","doi":"10.1111/jdv.70541","DOIUrl":"10.1111/jdv.70541","url":null,"abstract":"&lt;p&gt;We read with great interest the position statement by Seyed Jafari et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; on the management of classic lichen planopilaris (LPP), published on behalf of the EADV Task Force on Hair Diseases. We commend the authors for developing the first European expert consensus on this challenging condition and recognize the comprehensive synthesis of evidence provided by a panel of internationally renowned specialists.&lt;/p&gt;&lt;p&gt;Therapeutically, the proposed stepwise approach closely reflects real-world practice (Figure 1). Potent topical corticosteroids and intra-lesional corticosteroids remain cornerstone therapies and are among the most frequently prescribed treatments, often combined with systemic agents in active disease.&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt; Hydroxychloroquine remains one of the most commonly prescribed systemic therapies, whereas retrospective studies suggest the best response rates with hydroxychloroquine, methotrexate and cyclosporine.&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt; Cyclosporine may induce more rapid remission, although often at the expense of higher rates of adverse effects and treatment discontinuation.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Importantly, these findings are derived from retrospective analyses rather than prospective comparative studies. Among emerging therapeutic approaches, Janus kinase (JAK) inhibitors currently represent one of the most promising developments.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The position statement stratifies patients into mild, moderate and severe disease categories recommending systemic therapy predominantly in moderate-to-severe disease. Although this construct is clinically intuitive, the statement does not provide explicit, reproducible criteria defining each category. In the absence of measurable thresholds, whether derived from the Lichen Planopilaris Activity Index, extent of scalp surface area affected, trichoscopic parameters, histopathological features, rate of progression or a combination of these parameters, this stratification may be interpreted variably across clinical settings, highlighting the need for further refinement and standardization in future studies.&lt;/p&gt;&lt;p&gt;Another aspect that may warrant further discussion is the rationale underlying the stepwise treatment approach endorsed by the position statement. Current understanding of LPP emphasizes that the disease leads to irreversible follicular damage and that timely recognition and intervention are critical to limiting progression and preserving remaining follicles. This concept suggests that the therapeutic window for meaningful follicular preservation may narrow as fibrosis advances. Yet the recommended algorithm reserves systemic therapy for patients with moderate-to-severe or progressive disease, which creates a logical contradiction. If LPP is indeed a trichologic emergency, as suggested in the literature, treatment decisions should depend primarily on active perifollicular inflammation, the process responsible for destruction ","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1288-1289"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70541","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633565","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 T-cell lymphomas and dupilumab for atopic dermatitis: A systematic review and expert consensus","authors":"Florent Amatore,&nbsp;Madeleine Neildez,&nbsp;Adèle de Masson,&nbsp;Maxime Battistella,&nbsp;Marie Tauber,&nbsp;Saskia Ingen-Housz-Oro,&nbsp;Catherine Droitcourt,&nbsp;Delphine Staumont-Sallé,&nbsp;Marie Beylot-Barry","doi":"10.1111/jdv.70407","DOIUrl":"10.1111/jdv.70407","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Dupilumab, a standard treatment for atopic dermatitis (AD), has been associated with cutaneous T-cell lymphomas (CTCL), particularly mycosis fungoides (MF) and Sézary syndrome (SS). Nevertheless, the available data remain heterogeneous.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To characterize the clinical features, timeline and outcomes of dupilumab-related CTCL emergence in order to develop consensus-based recommendations for dupilumab use in CTCL-related settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted involving 51 studies reporting cases of CTCL in patients treated with dupilumab, followed by a modified delphi process to generate expert consensus recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data were obtained from 547 patients (mean age: 58 years; SD: 11.5; range: 10–85). New or worsening skin lesions were reported after dupilumab initiation, occurring at a mean of 8.9 months (SD 5.1; range 0.5–27 months). These were diagnosed as MF in 72% of cases, SS in 11% and other CTCL subtypes in 19%, of which 53% were at an early stage (stage ≤IIA). Dupilumab was discontinued in 75% of cases, and 62% received CTCL-directed treatment. Clinical remission was achieved in 44 of the 63 patients with available follow-up. The expert panel reached broad consensus, agreeing that dupilumab may unmask or exacerbate pre-existing CTCL and should be avoided in cases of MF/SS and mogamulizumab-induced rashes. They emphasized the importance of diagnostic vigilance, providing recommendations for skin biopsy, histology and clonality testing before and during treatment, particularly for patients with AD onset after the age of 40 or with atypical features. Dupilumab should be discontinued once CTCL confirmed, and methotrexate or phototherapy considered as alternatives. Cyclosporine and JAK inhibitors are considered unsuitable, and switching to other Th2-targeting biologics is discouraged due to insufficient data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Dupilumab may unmask or exacerbate CTCL, particularly MF and SS. The consensus-based recommendations offer practical guidance for the safe management of patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1344-1358"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446672","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":"Dupilumab versus tralokinumab in atopic dermatitis: A propensity score adjusted comparison from BioDay","authors":"Lian F. van der Gang,&nbsp;Nicolaas P. A. Zuithoff,&nbsp;Inge M. Haeck,&nbsp;Veroniek E. M. Harbers,&nbsp;Simone Stadhouders-Keet,&nbsp;Klaziena Politiek,&nbsp;Albert J. Oosting,&nbsp;Anneke M. T. van Lynden-van Nes,&nbsp;Hoo-Yin Lam,&nbsp;Anne-Moon van Tuyll van Serooskerken,&nbsp;Shiarra M. Stewart,&nbsp;Antoni Gostynski,&nbsp;Annebeth Flinterman,&nbsp;Berit Velstra,&nbsp;Wouter R. H. Touwslager,&nbsp;Francine C. van Erp,&nbsp;Marie L. A. Schuttelaar,&nbsp;Marjolein S. de Bruin-Weller,&nbsp;Marlies de Graaf","doi":"10.1111/jdv.70442","DOIUrl":"10.1111/jdv.70442","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Dupilumab and tralokinumab for atopic dermatitis (AD) target the type 2 axis through different mechanisms of action, which may lead to variation in effectiveness and safety. Head-to-head trials, however, are lacking.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To compare the real-world effectiveness and safety of dupilumab and tralokinumab in AD.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This prospective cohort study enrolled biologic−/Janus kinase inhibitor-naïve AD patients (≥12 years) from the BioDay registry who initiated dupilumab or tralokinumab between November 2021 and September 2024. Visits were scheduled at baseline, 4 weeks and every 3 months up to 52 weeks. Effectiveness outcomes included Eczema Area and Severity Index (EASI), weekly mean pruritus Numeric Rating Scale (NRS), treat-to-target thresholds (EASI ≤ 7; NRS-pruritus ≤ 4, with patients discontinuing treatment considered non-responders) and drug survival. Adverse events (AEs) were assessed at each visit. Inverse probability of treatment weighting (IPTW) was used to balance treatment groups.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In total, 750 patients were included (643 dupilumab; 107 tralokinumab). After IPTW, baseline characteristics were well balanced. During follow-up, dupilumab patients had lower EASI scores than tralokinumab patients, although differences were not consistently statistically significant (&lt;i&gt;p&lt;/i&gt; = 0.10). NRS-pruritus scores were significantly lower with dupilumab at all visits (&lt;i&gt;p&lt;/i&gt; &lt; 0.0001), mean differences did not exceed the 2-point clinical relevance threshold. The probability of achieving EASI ≤ 7 and NRS-pruritus ≤ 4 was higher with dupilumab (both &lt;i&gt;p&lt;/i&gt; &lt; 0.0001), with risk differences of 34.7% and 40.2% at 52 weeks, respectively. After 52 weeks, dupilumab drug survival was 92.6% vs. 70.6% for tralokinumab. Ocular surface disease incidence was similar (HR 1.0, 95% CI 0.6–1.6, &lt;i&gt;p&lt;/i&gt; = 0.94) between treatments, leading to discontinuation of dupilumab in &lt;i&gt;n&lt;/i&gt; = 23 (3.4/100 PY) and tralokinumab in &lt;i&gt;n&lt;/i&gt; = 5 (5.4/100 PY).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In this real-world comparison, dupilumab provided superior effectiveness compared with tralokinumab. In responders continuing treatment, EASI and NRS-pruritus differences were small. More substantial differences were observed when treatment targets EASI ≤ 7 and NRS-pruritus ≤ 4, and discontinuation rates were ","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1359-1371"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70442","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680253","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}