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

{"title":"Editor’s Picks August 2026","authors":"","doi":"10.1111/jdv.70558","DOIUrl":"10.1111/jdv.70558","url":null,"abstract":"<p></p><p>Emek Kocatürk</p><p>Exosomes are tiny membrane-bound particles released by cells that act like ‘delivery packages’, carrying proteins, lipids, microRNAs and mRNAs to other cells. In their recent review, Moslehi et al. describe exosomes as promising tools because their cargo can reflect the condition of their parent cell and influence inflammation, immune signalling, pigmentation, wound repair, hair growth, angiogenesis and tumour behaviour (Figure 1).</p><p>The authors emphasize that exosomes are not yet established dermatologic therapies, and most evidence remains preclinical or from small early human studies. More rigorous human trials and quality-control standards are needed.</p><p>Moslehi D, Nahm WJ, Serwald G, et al. Exosomes in precision dermatology: from biomarkers to targeted therapeutics in personalized care. <i>J Eur Acad Dermatol Venereol</i> 2026; 40:1332–1343. doi:10.1111/jdv.70387.</p><p>In a large multicentre international study, Abdalla et al. evaluated the impact of chronic spontaneous urticaria (CSU) on the quality of life of patients' family members and caregivers (Figure 2). Poorly controlled CSU significantly worsened family quality of life. Higher disease activity and lower disease control were associated with many issues including greater emotional distress, physical burden and caregiving responsibilities. Older family members and closer family relationships may reduce the negative impact, whereas insufficient or complex treatment regimens may worsen family burden. Overall, CSU management should address not only patient symptom control, but also family support, education and psychosocial care.</p><p>Abdalla BMZ, Criado RFJ, Kulthanan K, et al. Family quality-of-life burden in chronic spontaneous urticaria: a multicentre study. <i>J Eur Acad Dermatol Venereol</i> 2026; 40:1406–1419. doi:10.1111/jdv.70290.</p><p>This systematic review and expert consensus examined reported cases of cutaneous T-cell lymphoma (CTCL) emerging or worsening during dupilumab treatment for presumed atopic dermatitis (AD), particularly mycosis fungoides (MF) and Sézary syndrome.</p><p>The authors emphasize that dupilumab may unmask pre-existing CTCL rather than directly cause it, although it may also worsen pre-existing CTCL. This is important because early MF can clinically resemble AD. In some cases, previous biopsies performed before dupilumab were later re-evaluated and retrospectively diagnosed as CTCL. Risk factors, biopsy recommendations (with histopathology and T-cell clonality testing) and treatment concerns – including alternatives – are also addressed (Figure 3).</p><p>Amatore F, Neildez M, de Masson A, et al. Cutaneous T-cell lymphomas and dupilumab for atopic dermatitis: a systematic review and expert consensus. <i>J Eur Acad Dermatol Venereol</i> 2026; 40:1344–1358. doi:10.1111/jdv.70407.</p><p>This multicentre real-world study from the EADV Task Force ‘Dermatology for Cancer Patients’ evaluated dermatologic adverse events ass","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1283-1285"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70558","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633570","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":"Addiction and chronic skin diseases: A Pan-European study on prevalence, associations and patient impact","authors":"Stefanie Ziehfreund, Magdalena Saak, Alisa Schaal, Roxana Mazilu, Emmanuel Mahé, Carla Hajj, Emma K. Johansson, Josefin Lysell, Gunnthorunn Sigurdardottir, Franz J. Legat, Catherina Koch, Astrid Schmieder, Caroline Glatzel, Brian Kirby, Emily Pender, Anna Zalewska-Janowska, Katarzyna Tomaszewska, Giulia Ciccarese, Pia Lauriola, Michael J. Boffa, Stephanie Farrugia, Anna Caroline Pilz, Franziska Schauer, Magdalena Trzeciak, Weronika Zysk, Krisztián Gáspár, Andrea Szegedi, Giovanni Damiani, Andrea Carugno, Ilona Hartmane, Ingmars Mikazans, Skaidra Valiukeviciene, Livija Petrokaite, Jacek C. Szepietowski, Beata Jastrząb, Petra Staubach, Suzana Ljubojević Hadžavdić, Daška Štulhofer Buzina, Christian Posch, Jakob Jochmann, Antonia Wiala, Ludwig Scheffenbichler, Emanuele Trovato, Laura Calabrese, Gyula Laszlo Fekete, Pavel Chernyshov, Lidiia Kolodzinska, Julia Welzel, Karisa Thölken, Julia-Tatjana Maul, Lara Valeska Maul, Damian Meyersburg, Stephanie Bowe, Cathal O. Connor, Razvigor Darlenski, Stephan Traidl, Christian Vestergaard, Elena Lucía Pinto-Pulido, Maria Polina Konstantinou, Eszter Szlávicz, Kristine Heidemeyer, Nikhil Yawalkar, Hanka Agnes Caroline Lantzsch, Aleksandra Soplinska, Anna-Theresa Seitz, Tiago Torres, Zenon Brzoza, Ana Sanader Vučemilović, Liana Manolache, Nina Magnolo, Emanuele Scala, Kilian Eyerich, Tilo Biedermann, Alexander Zink","doi":"10.1111/jdv.70245","DOIUrl":"10.1111/jdv.70245","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic skin diseases such as psoriasis (PSO), atopic dermatitis (AD) and hidradenitis suppurativa (HS) are frequently associated with psychological distress, potentially promoting maladaptive coping mechanisms including addictive behaviours. Despite evidence of higher addiction rates among dermatology patients, comprehensive multicenter data across Europe are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To estimate the prevalence and patterns of addictive behaviours among patients with chronic skin diseases in European tertiary dermatology centres and explore associated sociodemographic and clinical factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicentre cross-sectional study recruited adult patients with PSO, AD, HS, alopecia areata (AA), urticaria, or vitiligo from dermatology departments in 20 European countries. Participants completed a standardized questionnaire assessing sociodemographics, disease characteristics, and addictive behaviours (smoking, alcohol use, drug use, gambling, internet addiction, and eating disorders). Descriptive analyses and multivariate logistic regression were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 3585 participants (median age 43 years; 51.1% female), the prevalence of addictive behaviours was notable: smoking (25.7%), pathological gambling (4.5%), hazardous drinking (8.8%), alcohol dependence (2.5%), drug use disorders (5.3%), eating disorders (1.8%), and internet addiction (29.7%). Smoking was most common among PSO and HS patients (48.6%), and gambling among AA and vitiligo patients (8.2%). Significant associations included male sex, younger age, single status, higher Dermatology Life Quality Index (DLQI) scores, and regional variation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Addictive behaviours are prevalent in dermatology patients and are associated with both sociodemographic and disease-related factors. The DLQI was positively correlated with multiple addictions, suggesting that reduced quality of life may contribute to maladaptive coping. However, due to the absence of a control group, the tertiary care setting, limited center distribution, and unknown response rate, generalizability is restricted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Addiction screening and supportive mental health strategies sh","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1392-1405"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70245","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145759338","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":"Beyond the numbers: Understanding and acting on gender gaps in academic dermatology","authors":"Marie-Aleth Richard, Myrto Trakatelli","doi":"10.1111/jdv.70539","DOIUrl":"10.1111/jdv.70539","url":null,"abstract":"<p>Walter, Martin and Murrell<span><sup>1</sup></span> have examined gender representation across four roles at EADV Congresses held in 2015, 2019 and 2023. Their findings are clear: women, who make up 65% of EADV members, held fewer than 40% of plenary speaker, session speaker, session chair and abstract reviewer positions. Change over the study period was modest and, for most roles, not statistically significant. These results are worth examining carefully in order first to understand and interpret them correctly and then take effective and meaningful actions.</p><p>Congress programmes reflect the pool of senior academics that existed years earlier, when most of today's mid-career women were still in training. The proportion of women in senior dermatology positions has grown steadily, but less than their representation in the overall workforce. This is largely because women's career paths are more frequently interrupted—by maternity leave, family responsibilities or caregiving—than those of their male colleagues. These interruptions, followed by re-engagement and renewed productivity, slow progression to the seniority levels from which congress speakers are typically drawn. A gap observed today therefore partly reflects the career landscape of a decade ago, not necessarily the present one. The significant increase in female session chairs over the study period—from 33.7% in 2015 to 42.8% in 2023—suggests that, as the pipeline matures, other roles will follow.<span><sup>1</sup></span></p><p>As Walsh and Richard noted in this journal in 2024,<span><sup>2</sup></span> the gap between female membership and female representation in congress roles is driven, at least in part, by choices that women themselves make—including the choice to step back from certain professional commitments during periods of intensive family life. This choice is legitimate and should not be penalized. Academic structures have historically been designed around a career model that treats any interruption as a deficit. The solution is therefore not simply to impose numerical parity on congress programmes—it is to redesign the career structures within which academic reputations are built. In other words, what needs to change is not women's choices, but the academic systems that treat career interruptions as permanent setbacks rather than temporary pauses.</p><p>Research consistently shows that women in academic medicine are more likely than men to experience impostor syndrome—a persistent feeling of not being qualified enough, despite objective evidence to the contrary.<span><sup>3</sup></span> This affects whether women accept invitations to speak or chair sessions, submit abstracts or seek leadership roles. When a qualified woman declines a congress invitation, the reason is often not a lack of interest or ability, but a lack of confidence that appropriate mentorship and encouragement can address.</p><p>A recent paper<span><sup>4</sup></span> presented a current snapshot of d","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1300-1301"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70539","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633547","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":"Management of classic lichen planopilaris: The EADV task force on hair diseases position statement","authors":"Seyed Morteza Seyed Jafari,&nbsp;Michela Starace,&nbsp;Alexander Katoulis,&nbsp;Zoe Apalla,&nbsp;Leila Asfour,&nbsp;Stefania Barruscotti,&nbsp;Vasiliki Chasapi,&nbsp;Azael Freites-Martinez,&nbsp;Giuseppe Gallo,&nbsp;Dimitrios Ioannides,&nbsp;Awatef Kelati,&nbsp;Małgorzata Olszewska,&nbsp;Francesca Pampaloni,&nbsp;Bianca Maria Piraccini,&nbsp;Adriana Rakowska,&nbsp;Lidia Rudnicka,&nbsp;Andrea Sechi,&nbsp;Anita Takwale,&nbsp;Anastasia Therianou,&nbsp;Sergio Vañó-Galván,&nbsp;Dmitri Wall,&nbsp;Anna Waśkiel-Burnat,&nbsp;Matilde Iorizzo","doi":"10.1111/jdv.70379","DOIUrl":"10.1111/jdv.70379","url":null,"abstract":"<p>Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia primarily affecting the vertex or parietal scalp. This immune-mediated condition involves mainly CD8⁺ cytotoxic T cells targeting follicular antigens, causing inflammation and permanent damage to hair follicles. Early diagnosis and prompt intervention are then essential to minimize hair loss and prevent further disease progression. Managing LPP is challenging due to the absence of curative treatments and the unpredictable nature of the disease and treatment responses. This position statement summarizes the results of an extensive literature review analysed through the collective expertise of the European Academy of Dermatology and Venereology (EADV) Task Force on Hair Diseases. Treatment strategies for LPP encompass a range of topical, systemic, and interventional therapies. First-line treatments often include potent topical and intralesional steroids, which can be used alone or in combination with other therapies. For patients with moderate to severe disease, resistance to topical/intralesional steroids, or a progressive disease course, systemic therapy or a combination approach should be considered, tailored to disease activity, comorbidities, and patient preferences. While there is no known cure for LPP, randomized controlled trials are limited and no head-to-head treatment comparisons have been conducted to date, these recommendations should be personalized for each patient.</p>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1306-1317"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147477684","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":"Between awareness and impact: The role and limitations of art in the destigmatization of skin disease","authors":"Elfie Deprez,&nbsp;Jo Lambert","doi":"10.1111/jdv.70537","DOIUrl":"10.1111/jdv.70537","url":null,"abstract":"&lt;p&gt;The skin is the most visible part of the human body, making skin disease not only a medical condition but also a social and visual experience. Photography and exhibitions can therefore play an important role in reshaping how visible skin conditions are perceived. The ‘My Precious Skin’ exhibition discussed by Näslund-Koch et al. represents an example of how artistic representation may foster awareness and destigmatization.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;People with visible skin diseases frequently adopt concealment strategies, including covering clothing, cosmetic camouflage or avoidance of exposure to manage anticipated stigma.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; While such strategies may provide short-term protection, they can also reinforce societal norms that position visible skin disease as something that should remain hidden. Interestingly, participants in the exhibition reported being less likely to adapt their clothing to conceal their condition after involvement in the project. This may reflect a shift away from concealment-based coping and towards greater comfort with visibility. Beyond individual impact, reduced concealment may also have a broader social effect, as visible representation can help normalize skin diversity and challenge stigma for others with similar conditions. However, whether these behavioural changes are sustained or translated into everyday settings remains unclear and requires further evaluation.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;At the same time, important methodological questions remain. Although visitors may report improved self-image after exposure to photographs of visible skin disease, it is uncertain whether this translates into lasting increases in empathy towards people with skin diseases or reduced stigma in daily life, for example during ordinary social encounters. Future research should therefore focus on how destigmatization outcomes can be more robustly measured.&lt;/p&gt;&lt;p&gt;Questions also arise regarding external validity. Art exhibitions often attract relatively highly educated, culturally engaged and socio-economically advantaged audiences rather than a truly broad public. In this case, the visitor population may have consisted largely of collaborators, healthcare professionals, friends or family connected to the project itself, which restricts generalizability. In addition, limited demographic information about respondents makes it difficult to determine whether findings reflect diverse social or age groups. Selection bias may also exist among the photographed participants. Individuals willing to publicly display their skin condition may already feel more resilient or accepting of visibility, whereas those experiencing greater shame or avoidance may remain absent from such initiatives. As a result, exhibitions may unintentionally privilege more empowered narratives of living with skin disease.&lt;/p&gt;&lt;p&gt;The broader cultural context is also important. Historically, visual representations of skin have been shaped by aes","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1302-1303"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70537","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633517","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 lymphoma and dupilumab for atopic dermatitis: Practical guidance for a clinical conundrum","authors":"Anna De Benedetto,&nbsp;Kathleen A. Mannava","doi":"10.1111/jdv.70542","DOIUrl":"10.1111/jdv.70542","url":null,"abstract":"&lt;p&gt;The article presented by Amatore et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; addresses a timely and clinically important question regarding the reported association between cutaneous T-cell lymphomas (CTCL) and treatment with dupilumab in patients with atopic dermatitis (AD). The article provides a systematic review of the available peer-reviewed literature reporting cases of CTCL in dupilumab-treated AD patients, summarizing clinical and histologic features. The authors then present recommendations from a Delphi-based expert consensus to provide guidance in clinical practice.&lt;/p&gt;&lt;p&gt;The authors acknowledge that the quality of studies reviewed was variable (mostly moderate to poor), with most cases from retrospective cohort and pharmacovigilance studies (see table 1 in Amatore et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;). Many of the cases reviewed lacked critical clinical and demographic information. Moreover, as known pharmacovigilance and case reports are subject to reporting bias and do not capture the total number of treated individuals. Notably, no cases from randomized trials (RCTs) were included; a pooled safety analysis of dupilumab in AD reported only two CTCL cases: one in the placebo arm and one deemed unrelated to treatment.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Based on current evidence, many reported cases of CTCL during dupilumab treatment for AD might reflect unmasking of pre-existing disease, rather than de novo development of lymphoma. Of the CTCL patients included in this review, less than 10% (&lt;i&gt;n&lt;/i&gt; = 50) had skin biopsies performed prior to dupilumab exposure. Of the 33 biopsies that were re-evaluated, 5 were re-classified as suspicious for CTCL. This possibly underestimates the true incidence of unmasking, as biopsies of early-stage mycosis fungoides (MF) are frequently non-diagnostic. It is well established that clinical and histologic diagnosis of MF is often delayed and requires multiple biopsies over time.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Immunohistochemical stains and molecular studies for T-cell clonality are often unremarkable or misleading in biopsies of early (patch/plaque)-stage MF, as the majority of lymphocytes in these specimens are reactive, rather than neoplastic.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Development of CTCL has also been reported in psoriasis (Th1/Th17 skewed) during treatment with TNF-α inhibitors, IL-17 inhibitors or IL-12/-23 inhibitors (see ref. 139 in Amatore et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;). Suggesting that other pathways, beyond type 2 inflammation, may also be implicated in CTCL pathogenesis or unmasking in predisposed individuals. However, as noted in the manuscript (ref 144 in Amatore et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;), high hazard ratios for MF and Sezary syndrome were reported in a US population-based cohort of asthma patients (without skin rash) treated with dupilumab, thus suggesting a pathway independent of pre-existing skin disease, but no clear mechanism has been investigated/uncovered.&lt;/p&gt;&lt;p&gt;To add complexity, reports h","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1290-1291"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70542","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633542","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":"Diagnosing skin conditions in patients with skin of colour: Is colour the only challenge?","authors":"Emanuele Scala,&nbsp;Maria Angeliki Gkini","doi":"10.1111/jdv.70465","DOIUrl":"10.1111/jdv.70465","url":null,"abstract":"&lt;p&gt;Inflammatory skin diseases can manifest differently across diverse skin types. Clinical images and data representing individuals with skin colour (SoC) remain limited, reflecting their underrepresentation in medical education and dermatological research.&lt;/p&gt;&lt;p&gt;In this issue of JEADV, Shencoru et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; surveyed 132 medical students using images of common dermatoses across different skin types. Diagnostic accuracy was lower in SoC, particularly for urticaria and seborrheic dermatitis (SD), raising important questions about whether SoC constitutes a diagnostic challenge and how dermatology training should balance core principles—such as morphology, distribution and pattern—with variations in clinical presentation across skin tones. Students were more accurate in lighter skin, suggesting that reduced visibility of erythema in SoC may hinder recognition. While erythema is more apparent in lighter skin, urticarial lesions in SoC may appear skin-coloured, darker or greyish-purple. Nevertheless, the defining feature is the presence of wheals, which should be recognized regardless of skin tone.&lt;/p&gt;&lt;p&gt;SD typically presents with erythema and scale; however, in darker skin, it may also appear as hypopigmented patches with subtle erythema. Arcuate or petaloid lesions along the hairline (‘petaloid seborrheic dermatitis’) may occur, often with minimal scaling. Other inflammatory skin conditions, such as atopic dermatitis, may present as follicular eczema or with post-inflammatory dyspigmentation in individuals with SoC. Familiarity with these variable presentations is essential for accurate diagnosis.&lt;/p&gt;&lt;p&gt;Emerging artificial intelligence (AI) technologies may support dermatology education, but important limitations remain. Recently, Joerg et al.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; evaluated four leading text-to-image generators and found poor clinical accuracy alongside limited representation of diverse skin tones, reflecting biases in training data. The study also highlighted the limitations of relying solely on the Fitzpatrick skin phototype scale and emphasized the need for more representative datasets. Alternative classification systems, including the Monk Skin Tone Scale, the Individual Typology Angle (ITA) and the Eumelanin Human Skin Colour Scale, have been proposed to better capture skin tone variation.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;To improve clinical care, dermatology training must be more inclusive, combining greater exposure to SoC with a structured emphasis on lesion morphology, distribution and pattern recognition. International initiatives, including those from the International Psoriasis Council (IPC) and the International League of Dermatologic Societies (ILDS), have developed image galleries and atlases reflecting diverse populations. Additional resources, such as the JAAD SoC Image Atlas and recent textbooks—including Taylor &amp; Kelly's Dermatology for Skin of Color (2026) and Taylor &amp; Elbuluk's Atlas and Synopsis for ","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1304-1305"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70465","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633554","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":"When hair dig into the brain, JAKi, may help!","authors":"Michela Starace,&nbsp;Bertrand Richert","doi":"10.1111/jdv.70536","DOIUrl":"10.1111/jdv.70536","url":null,"abstract":"&lt;p&gt;Alopecia areata (AA) is not only a disease of the hair follicle. The real burden of AA also includes impaired self-image, social limitation and psychological distress. The association between AA, anxiety and depression has been consistently reported, with meta-analytic evidence showing higher odds of both anxiety and depression in patients with AA compared with controls.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In this context, the study by Ho et al. is particularly relevant, as it moves the focus from hair regrowth alone to the possible impact of effective systemic treatment on mental health.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Ho et al. used the TriNetX international healthcare database to investigate whether Janus kinase inhibitors (JAKi) were associated with a reduced incidence of major depressive disorder (MDD) in patients with AA. After propensity score matching, 1838 patients treated with JAKi were compared with 1838 patients not receiving JAKi. JAKi treatment was associated with a significantly lower risk of MDD, with an aHR of 0.42 (&lt;i&gt;p&lt;/i&gt; = 0.009), and with fewer new antidepressant prescriptions, with an aHR of 0.46 (&lt;i&gt;p&lt;/i&gt; &lt; 0.001).&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; These results were consistent across different follow-up periods and suggest that JAKi may have benefits extending beyond visible hair regrowth.&lt;/p&gt;&lt;p&gt;This finding is clinically important because the relationship between AA and depression is complex: AA increased the risk of subsequent MDD, while MDD also increased the risk of subsequent AA, supporting a bidirectional association.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; More recently, a Mendelian randomization study suggested that genetic liability to AA may increase the risk of MDD and anxiety, although the effect on MDD was modest and requires cautious interpretation.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; These data support the idea that depression in AA should not be considered only as an emotional consequence of hair loss, but possibly as part of a broader skin–brain inflammatory interaction.&lt;/p&gt;&lt;p&gt;Several mechanisms may explain the results of Ho et al. First, effective hair regrowth may improve self-esteem, social confidence and quality of life. Second, JAKi act on pathways that are central to AA pathogenesis, including interferon-γ and cytokines such as IL-2, IL-7 and IL-15, which signal through the JAK/STAT pathway.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; It is therefore plausible that JAK inhibition may reduce inflammatory signals relevant not only in the hair follicles but also, indirectly or directly, in psychological distress. However, this remains a hypothesis and has not yet been demonstrated.&lt;/p&gt;&lt;p&gt;The main strength of the study is its large real-world cohort and the careful matching of many potential confounders. However, several limitations must be considered. The retrospective design prevents causal conclusions. The TriNetX does not include standardized measures of AA severity, such as the Severity of Alopecia Tool score, and this is a major limitation because disease ","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1296-1297"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70536","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633568","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":"Reassessing the OX40/OX40L axis in atopic dermatitis after the termination of Rocatinlimab's clinical development program","authors":"Thomas Bieber","doi":"10.1111/jdv.70460","DOIUrl":"10.1111/jdv.70460","url":null,"abstract":"&lt;p&gt;&lt;/p&gt;&lt;p&gt;Thomas Bieber&lt;/p&gt;&lt;p&gt;The therapeutic landscape of atopic dermatitis (AD) has undergone a profound transformation over the past decade, driven by advances in immunology and the successful introduction of targeted biologics. Among the most promising investigational pathways is the OX40/OX40L axis, with two late-stage candidates (rocatinlimab and amlitelimab) positioned as potential next-generation systemic therapies. The review article in this issue&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; provides a comprehensive overview of their mechanisms as well as some clinical data. Since the acceptance of this review, the situation has significantly changed with the recent news of the termination of all rocatinlimab clinical trials following emerging safety signals.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; This represents an inflection point for OX40-directed therapies requiring a broader contextualization of this pathway and its future role in AD management.&lt;/p&gt;&lt;p&gt;Rocatinlimab, an anti-OX40 monoclonal antibody, had advanced into an extensive Phase 3 program, including the ROCKET-IGNITE and ROCKET HORIZON trials. Early data suggested meaningful improvements in skin inflammation and pruritus, consistent with the central role of OX40 in T-cell activation and memory formation. A Lancet commentary&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; underscored the mechanistic rationale for targeting this pathway in AD, highlighting its involvement beyond classical Th2-driven inflammation. However, very recently, the clinical development program (CDP) was halted after a planned safety review not only identified some safety signals of concern such as frequent chills, gastro-intestinal ulcerations but also confirmed suspected cases of Kaposi's sarcoma, raising concerns about impaired immune surveillance under OX40 blockade. The decision to discontinue all trials—despite previously encouraging efficacy—illustrates the vulnerability of late-stage immunomodulatory programs when unexpected safety signals emerge that requested several thousands of individuals exposed to a given drug. This event challenges assumptions about the therapeutic window of OX40 inhibition and forces a reassessment of how deeply T-cell co-stimulation can be modulated in a chronic inflammatory disease without compromising host defence.&lt;/p&gt;&lt;p&gt;What are the implications for the Amlitelimab program as well as for the more than 15 other CDPs of new drugs targeting the OX40 pathway either as a monotherapy or as part of a bispecific strategy? Amlitelimab, an anti-OX40L monoclonal antibody, remains in late-stage development. Recent Phase 3 data from the SHORE and COAST programs demonstrated significant improvements in clinical endpoints, with early onset of action and progressive benefit over time.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; These results support the therapeutic potential of OX40L blockade, although some analyses have noted that efficacy may be less robust than established agents such as dupilumab at the usual reference time point of Week 16. The mechani","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1286-1287"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70460","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633527","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":"Exosomes in precision dermatology: From biomarkers to targeted therapeutics in personalized care","authors":"Dorsa Moslehi,&nbsp;William J. Nahm,&nbsp;Gerry Serwald,&nbsp;Zahna Bigham,&nbsp;Vinod E. Nambudiri","doi":"10.1111/jdv.70387","DOIUrl":"10.1111/jdv.70387","url":null,"abstract":"<p>Exosomes, nanoscale extracellular vesicles released by nearly all cell types, have attracted substantial interest as potential diagnostic and therapeutic tools in dermatology due to their ability to selectively transport proteins, nucleic acids and lipids between cells. Experimental studies have demonstrated exosome involvement in immune signalling, inflammation, pigmentation, wound repair, hair biology and tumour behaviour, supporting their broad but still largely experimental relevance across dermatologic disease processes. However, despite rapid scientific progress, clinical translation remains at an early stage. Most evidence supporting dermatologic applications is derived from in vitro or animal studies, and few well-designed, adequately powered human trials exist. As of September 2025, only a small number of exosome-based clinical studies in dermatology have been completed, and no exosome therapeutic has received FDA approval. Major challenges—including the lack of standardized isolation and manufacturing methods, batch-to-batch variability, limited mechanistic understanding, inconsistent regulatory frameworks and unresolved safety considerations—continue to impede clinical adoption. Current clinical trials, although promising, are heterogeneous and often underpowered, with insufficient long-term safety and efficacy data to support routine use. Collectively, exosomes represent a compelling but still developmental platform for precision dermatology. Their successful integration into clinical practice will require rigorous mechanistic studies, harmonized quality control standards and large, high-quality randomized controlled trials to confirm therapeutic benefit, ensure safety and enable regulatory approval.</p>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"40 8","pages":"1332-1343"},"PeriodicalIF":9.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147346151","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}