The British journal of dermatology最新文献

{"title":"Gaps in Current Chronic Spontaneous Urticaria (CSU) Management.","authors":"Angèle Soria","doi":"10.1093/bjd/ljag389","DOIUrl":"https://doi.org/10.1093/bjd/ljag389","url":null,"abstract":"<p><p>Despite advances in therapy, chronic spontaneous urticaria (CSU) remains a challenging disease with a significant impact. Although antihistamines, anti-IgE therapy and immunosuppressants form the basis of treatment, there are still substantial gaps in diagnosis, endotyping, prediction of therapeutic response and implementation of international guidelines. Newly licensed CSU therapeutic agents, such as Bruton tyrosine kinase (BTK) inhibitors and anti-interleukin-4 receptor alpha (anti-IL4Rα) agents, offer hope to patients who do not respond to treatment. However, we currently lack validated biomarkers of disease-specific features to determine which patient should receive which therapy, and the optimal positioning of these agents within the treatment sequence remains undefined. This narrative review examines the ongoing challenges in CSU management and proposes a more integrated, personalised and patient-centred approach.</p>","PeriodicalId":520789,"journal":{"name":"The British journal of dermatology","volume":" ","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Biologic Therapy on Depression and Anxiety Symptoms in Patients With Moderate-to-Severe Plaque Psoriasis: A Systematic Review and Network Meta-Analysis.","authors":"Jiapeng Tang, Yuting Wen, Kebin Chen, Mengting Sun, Manjun Luo, Menglu Shen, Yiqing Li, Chunyu Wang, Yi Xiao, Xiang Chen, Minxue Shen","doi":"10.1093/bjd/ljag435","DOIUrl":"https://doi.org/10.1093/bjd/ljag435","url":null,"abstract":"<p><strong>Background: </strong>Various biologics are already widely used to treat patients with moderate-to-severe psoriasis, but there is currently a lack of comparative data on their effectiveness in improving symptoms of anxiety and depression.</p><p><strong>Objective: </strong>To evaluate and compare the effects of biologic therapies on depression and anxiety symptoms in patients with psoriasis using a systematic review and network meta-analysis.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials from inception to January 28, 2026. Randomized controlled trials and prospective comparative cohort studies in adults with moderate-to-severe psoriasis were included. Frequentist random-effects NMA was conducted at mechanism and drug levels, with network incoherence, sensitivity analyses, risk of bias, and certainty of evidence assessed. Skin-response associations and clinically interpretable psychological outcomes were additionally summarized.</p><p><strong>Results: </strong>Eight studies involving 4,319 patients were included. At the mechanism level, all biologic classes significantly improved depression and anxiety symptoms versus placebo. For depression, IL-12/23 inhibitors had the largest estimate [standardized mean difference (SMD) = 0.677, 95% confidence interval (CI): 0.473, 0.881]; for anxiety, IL-23 (SMD=0.457, 95%CI: 0.304, 0.610) and IL-12/23 (SMD=0.457, 95%CI: 0.335, 0.579) inhibitors had similar estimates. At the drug level, several agents showed benefit, but rankings were uncertain because networks were sparse and certainty ranged from high to low. Within-study and exploratory comparison-level analyses indicated that psychological improvement generally accompanied skin improvement, yet the two were not strictly proportional.</p><p><strong>Conclusion: </strong>Biologic therapy was associated with short-term improvement in depressive and anxiety symptoms in moderate-to-severe psoriasis, supporting mental health as a relevant component of overall treatment benefit. Psychological improvement generally accompanied skin response, while comparative differences across mechanisms and individual agents require confirmation in larger and longer randomized studies.</p>","PeriodicalId":520789,"journal":{"name":"The British journal of dermatology","volume":" ","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the Sustained Response to Systemic Treatment for Atopic Dermatitis in Patients Who Achieved Disease Remission: A Systematic Review and Network Meta-Analysis Comparing Withdrawal, Dose Reduction and Dosing Interval Extension Versus Continuation Therapy.","authors":"Juliana Nakano, Letícia Fernandes Barroso, Kleyton de Carvalho Mesquita, Ciro Martins Gomes, Jonathan I Silverberg","doi":"10.1093/bjd/ljag436","DOIUrl":"https://doi.org/10.1093/bjd/ljag436","url":null,"abstract":"<p><strong>Background: </strong>Recent therapeutic advances transformed the management of atopic dermatitis (AD). Medication withdrawal, dose reduction and dosing interval extension are sometimes necessary when managing AD.</p><p><strong>Objectives: </strong>This review aims to compare the effectiveness of withdrawal, dose reduction and dosing interval extension with that of continuation of systemic therapy in sustaining remission among patients with AD.</p><p><strong>Methods: </strong>A comprehensive search was conducted using the PubMed, Embase, Web of Science, and Scopus databases. Study selection was performed independently by two reviewers, and discrepancies were resolved by a third reviewer. The risk of bias was evaluated using the Cochrane risk of bias tool for randomized trials (RoB-2) and the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. The certainty of the evidence was determined in accordance with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The primary outcome was defined as sustained clinical improvement, measured by a 75% reduction in the Eczema Area and Severity Index (EASI), which was assessed 16 to 52 weeks after treatment withdrawal, dose reduction or dosing interval extension. Risk ratios (RRs) were compared using a network meta-analysis (NMA).</p><p><strong>Results: </strong>After the initial search yielded 21,169 references, 89 reports representing 55 studies were included. Raw data analysis indicated that most active treatments showed comparable RRs for EASI75 maintenance, whereas the discontinuation of oral therapies led to early relapses in AD activity. On the basis of 9 studies encompassing 26 pairwise comparisons and 2,585 observations across 13 regimens, our NMA revealed that lebrikizumab withdrawal and dosing interval extension conferred a lower risk of EASI75 response loss than withdrawal, dose reduction, or dosing interval extension with other active therapies did. A subgroup analysis also revealed that the maintenance of EASI75 responses after placebo withdrawal or dosing interval extension was greatest for induction dosing with lebrikizumab.</p><p><strong>Conclusions: </strong>While the withdrawal of systemic therapy is recommended in certain circumstances, such as during vaccination and pregnancy, the evidence reveals an early risk of relapse following the withdrawal of oral treatments. In contrast, biologic therapies resulted in sustained remission rates, even after prolonged withdrawal or dosing interval extension periods.</p>","PeriodicalId":520789,"journal":{"name":"The British journal of dermatology","volume":" ","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A UV-Free Strategy for Vitamin D Synthesis in Skin: Concept Verification and a Randomised Double-Blind Placebo-Controlled Clinical Trial of a Cholecalciferol Phosphate Patch (TransVitD).","authors":"Makiko Kawashita, Chui Hua Lim, Thomas Hibbard, Paolo Andriollo, Yanxiang Li, Karl P Lawrence, Ellen John, Paul R Royall, Qing Guo, Didar Tasdemir, Oscar Ayrton, Edmund Fitzgerald O'Connor, Faiza Benaouda, Shazia Bashir, Agostino Cilibrizzi, Peter Luebcke, Antony R Young, Abdel Douiri, Ryan O'Shaughnessy, Guy Carpenter, Mohamed Alhnan, Stuart A Jones","doi":"10.1093/bjd/ljag421","DOIUrl":"https://doi.org/10.1093/bjd/ljag421","url":null,"abstract":"<p><strong>Design: </strong>Laboratory and animal work was followed by a dose-finding study and a randomised, placebo-controlled, double-blind clinical trial (allocation 1:1:1:1).</p><p><strong>Setting: </strong>A single-centre study conducted in London, UK, with dosing over winter months.</p><p><strong>Participants: </strong>108 healthy volunteers between 18 and 65 years of age with suspected low vitamin D levels.</p><p><strong>Intervention: </strong>Cholecalciferol phosphate patch.</p><p><strong>Main outcome measures: </strong>Safety: blood calcium levels. Efficacy: Percentage change in the concentration of serum 25(OH)D3 compared to baseline.</p><p><strong>Results: </strong>In animals and ex vivo human skin, cholecalciferol phosphate penetrates the tissue and converts to cholecalciferol (vitamin D3). Biological responses mimic ultraviolet radiation (UVR) skin exposure, upregulating the vitamin D-binding protein (VDBP) in rodents and improving systemic vitamin D status without associated skin inflammation or DNA damage. In Part 1 of the clinical study, lasting 4 weeks, 16 participants were enrolled in two dose-escalating cohorts (total doses of 5 mg and 31 mg). Across both cohorts, two participants reported local skin irritation, but serum calcium and 25(OH)D3 did not change. A total of 92 participants were randomised in Part 2, lasting eight weeks; 30 were allocated to active arm A and 29 to placebo, and both arms continued to 8 weeks, whilst two arms, active B and active C, were stopped after 4 weeks. Seventy-three participants completed their final study visit and 19 discontinued. Comparing active arm A (total dose = 140 mg) with placebo, the per-protocol percentage change from baseline in 25(OH) D3 was +19.9 percentage points (95% CI -1.3 to +41.0; p = 0.065). In the modified intention-to-treat population (n = 54), the baseline adjusted difference in serum 25(OH)D3 at 8 weeks was +0.52 ng/mL (95% CI -2.18 to +3.22; p = 0.71). Adverse skin irritation events were reported by 42.9% of active and 42.3% of placebo participants (p = 1.00).</p><p><strong>Conclusion: </strong>A cholecalciferol phosphate patch generated vitamin D in the skin in animals without UV exposure. In humans, the patch was safe but did not improve vitamin D status; the benefit was not greater than approximately 3 ng/mL (300-500 IU/day of oral cholecalciferol).</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT06098846.</p>","PeriodicalId":520789,"journal":{"name":"The British journal of dermatology","volume":" ","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"K17 hi Hair Follicle Cells Orchestrate Psoriatic Inflammation Through S100A1-Dependent Signaling.","authors":"Xin Tang, Pei Qiao, Wanting Liu, Yang Yang, Yunfeng Gu, Xiaojuan Mao, Huiyi Quan, Yixin Luo, Ke Xue, Yanyang Guo, Johann E Gudjonsson, Zhiguo Li, Gang Wang, Shuai Shao","doi":"10.1093/bjd/ljag431","DOIUrl":"https://doi.org/10.1093/bjd/ljag431","url":null,"abstract":"<p><strong>Background: </strong>Psoriasis is a chronic inflammatory skin disease with frequent and refractory scalp involvement, but the mechanisms underlying regional susceptibility remain unclear.</p><p><strong>Objectives: </strong>To define the role of hair follicle cell (HFC) subsets in psoriatic inflammation and uncover their pathogenic mechanisms.</p><p><strong>Methods: </strong>We integrated bulk, single-cell and spatial transcriptomic data from healthy and psoriatic human skin across multiple anatomical sites. HFC subsets and regulatory programmes were profiled through single-cell analyses, and key molecular interactions and functional effects were validated by computational modeling, in vitro assays, and in vivo mouse models.</p><p><strong>Results: </strong>Five HFC subsets were identified, including K15hi hair follicle stem cells, K17hi, SPINK5hi, K23hi, and MT2Ahi HFCs. Among them, K17hi HFCs were markedly expanded in perilesional and lesional psoriatic skin and were preferentially distributed along a psoriasis-associated pseudotime trajectory enriched for pro-inflammatory programmes. Healthy scalp skin showed increased HFC abundance and preferential enrichment of K17hi HFCs compared with other anatomical sites, which was further enhanced in scalp psoriasis. S100A1, the top differentially expressed gene in K17hi HFCs, was regulated by TCF12 and mediated annexin A2 (ANXA2)-dependent CD4+ T cell activation and tissue-resident memory features. K17 perturbation further supported the upstream regulation of the TCF12-S100A1 axis, whereas ANXA2 blockade attenuated S100A1-induced T-cell responses. Topical S100a1 knockdown alleviated imiquimod (IMQ)-induced psoriasiform inflammation in vivo.</p><p><strong>Conclusion: </strong>K17 hi HFCs form a region-enriched pro-inflammatory niche that contributes to psoriasis through the TCF12-S100A1-ANXA2 follicular-immune axis. Targeting this axis may provide a potential therapeutic strategy for difficult-to-treat psoriasis.</p>","PeriodicalId":520789,"journal":{"name":"The British journal of dermatology","volume":" ","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Goals of melanoma surveillance: focusing on outcomes that matter most.","authors":"Katy J L Bell, Adewole S Adamson, Lisa Parker, Alexander C J van Akkooi, David Elder, Raymond L Barnhill, Elspeth Davies, Blake O'Brien, Brooke Nickel","doi":"10.1093/bjd/ljag430","DOIUrl":"https://doi.org/10.1093/bjd/ljag430","url":null,"abstract":"","PeriodicalId":520789,"journal":{"name":"The British journal of dermatology","volume":" ","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MetaboHealth and Metabolic vulnerability index, genetic susceptibility, and the risk of psoriatic disease.","authors":"Xinyi Shao, Zhaofu Tan, Tingqiao Chen, Jiaxing Ke, Jinghe Li, Genlong Bai, Jin Chen, Jingbo Zhang","doi":"10.1093/bjd/ljag433","DOIUrl":"https://doi.org/10.1093/bjd/ljag433","url":null,"abstract":"","PeriodicalId":520789,"journal":{"name":"The British journal of dermatology","volume":" ","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection risk in psoriasis: not all biologics are the same.","authors":"Raquel Rivera-Diaz, María Pérez-Jacoiste Asín","doi":"10.1093/bjd/ljag434","DOIUrl":"https://doi.org/10.1093/bjd/ljag434","url":null,"abstract":"","PeriodicalId":520789,"journal":{"name":"The British journal of dermatology","volume":" ","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Validation of the Cutaneous Lupus Erythematosus Quality of Life Index.","authors":"Vraj K Shah, Elena Wei, Stephen Neely, Motolani E Ogunsanya, Victoria P Werth, Benjamin F Chong","doi":"10.1093/bjd/ljag432","DOIUrl":"https://doi.org/10.1093/bjd/ljag432","url":null,"abstract":"","PeriodicalId":520789,"journal":{"name":"The British journal of dermatology","volume":" ","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-risk lesion, increased-risk patient: separating lesion prognosis from future melanoma risk.","authors":"Pablo Balado-Simó, Sebastian Podlipnik","doi":"10.1093/bjd/ljag427","DOIUrl":"https://doi.org/10.1093/bjd/ljag427","url":null,"abstract":"","PeriodicalId":520789,"journal":{"name":"The British journal of dermatology","volume":" ","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}