JEADV clinical practice最新文献

{"title":"Considerations and Tips for Promoting Skin Barrier Maintenance and Quality of Life in Patients With Diabetes Mellitus: An Expert Consensus","authors":"Robert S. Kirsner,&nbsp;Anneke Andriessen,&nbsp;Brian Berman,&nbsp;Natasha Mesinkovska,&nbsp;Heather Woolery-Lloyd,&nbsp;Lawrence Schachner","doi":"10.1002/jvc2.70164","DOIUrl":"https://doi.org/10.1002/jvc2.70164","url":null,"abstract":"<p>Skin changes such as xerosis and pruritus are common complications among diabetes patients and may lead to serious adverse events such as diabetic foot syndrome and amputations. Evidence suggests that daily application of optimal skincare, including gentle cleansers and moisturizers, may help improve skin barrier function, preventing complications by providing early-stage treatment for patients with diabetes. Recognition, management and education on xerosis and pruritus in patients with diabetes are essential in maximizing the prevention of xerosis, supporting a healthy skin barrier and avoiding severe complications. The current practical guide for clinicians treating patients with diabetes may increase insights and awareness into diabetes-related xerosis and pruritus for educating patients and implementing effective skincare regimens.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"5 1","pages":"20-25"},"PeriodicalIF":0.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147565001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Based Quantification to Assess the Automatic Psoriasis Area and Severity Index","authors":"Taig Mac Carthy,&nbsp;Daniel Dagnino,&nbsp;Alfonso Medela,&nbsp;Gerardo Fernández,&nbsp;Andy Aguilar,&nbsp;Antonio Martorell,&nbsp;Pedro Gómez-Tejerina,&nbsp;Gastón Roustán-Gullón","doi":"10.1002/jvc2.70143","DOIUrl":"https://doi.org/10.1002/jvc2.70143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Psoriasis is a chronic inflammatory skin condition affecting millions globally, traditionally assessed via the Psoriasis Area and Severity Index (PASI). Despite its widespread use, PASI suffers from subjectivity, limited sensitivity for small lesions, and high interobserver variability. Recent advances in artificial intelligence offer a promising route to overcome these limitations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to develop and validate the Automatic Psoriasis Area and Severity Index (APASI), an AI-driven system for rapid, objective, and standardised assessment of psoriasis severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We compiled the Legit.Health-PsO-PASI dataset, consisting of 2857 images spanning various disease severities and annotated by three expert dermatologists. Two deep learning modules were developed: one for lesion segmentation and another for visual sign intensity classification (erythema, induration and desquamation). Multiple encoder architectures, including ResNet, SE_ResNeXt, Xception, Inceptionv4, EfficientNet, and SegFormer, were evaluated using a five-fold cross-validation approach. Performance metrics included accuracy, root mean square error, intersection over union, confusion matrices and Cohen's kappa for assessing interobserver variability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The best-performing model, MiT_b2, achieved human-comparable performance, with accuracies of 60.6% for erythema, 54.3% for induration, and 61.8% for desquamation. For lesion segmentation, the Xception model outperformed expert dermatologists, achieving an intersection over union of 0.752.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>APASI provides a robust AI-driven framework for psoriasis severity assessment, delivering rapid, objective, and precise evaluations. Its integration into clinical and research workflows could enhance disease monitoring, improve treatment assessment and reduce evaluation costs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"5 1","pages":"82-90"},"PeriodicalIF":0.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147564088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual Topical Therapy. The Future of Stretch Marks?","authors":"Vicente Manuel Cisneros Rosell,&nbsp;Ramon Grimalt","doi":"10.1002/jvc2.70234","DOIUrl":"https://doi.org/10.1002/jvc2.70234","url":null,"abstract":"<p>Striae distensae, or stretch marks, are linear scars that result from mechanical stretching of dermal tissue. They are most prevalent in women and in pregnancy, puberty, and obesity. The psychological and cosmetic symptoms may present a pathological synergy with the physical distress that stretch marks represent, especially if the patient is going through pregnancy or puberty. The progression occurs in two phases: striae rubrae and striae albae which can be identified by histopathological examination, characterized by reduced elasticity and structural integrity. Tretinoin has demonstrated significant improvement in striae rubrae. Clinical trials show patients treated with tretinoin experienced improvements in appearance, and a reduction in length and width of the marks. In addition to improving patient satisfaction, the combination with glycolic acid has demonstrated to increase the elastin content. Other treatments such as hyaluronic acid have shown improvement especially when combined with other ingredients such as <i>Centella asiatica</i>; the use of other creams has only shown to reduce the severe stretch marks to a moderate level, inconclusive or lack of evidence. Preventive and early treatment on stretch marks should be encouraged due to the psychological importance it has on patients. Topical therapies, particularly tretinoin with glycolic or hyaluronic acid offer promising results especially in striae rubrae. Given the multifactorial pathogenesis of stretch marks, a therapy with a combination of ingredients that address multiple aspects of skin remodeling (e.g., collagen production, elasticity, and inflammation) may yield better results. For the severity and symptoms of striae rubrae the most effective treatment is Tretinoin, while the combination with glycolic acid is recommended for striae albae to reduce width and improve clinical status. Preventive topical therapies should be considered for at-risk populations, for pregnant women tretinoin, pregnant women with previous stretch marks use trofolastin and for postpartum women <i>Centella asiatica</i> with hyaluronic acid.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"5 1","pages":"26-31"},"PeriodicalIF":0.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147567451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Methotrexate on Cardiovascular Outcomes in Psoriasis: A Systematic Review and Meta-Analysis","authors":"Tiago A. S. Costa,&nbsp;Sheila T. K. Medorima,&nbsp;Renata F. Magalhães","doi":"10.1002/jvc2.70081","DOIUrl":"https://doi.org/10.1002/jvc2.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Psoriasis is a chronic immune-mediated inflammatory disease with a global prevalence of 2%–3% and 1.3% in Brazil. It is associated with comorbidities such as obesity, hypertension, and diabetes, all of which contribute to increased cardiovascular risk due to systemic inflammation and endothelial dysfunction. Methotrexate (MTX), a commonly used treatment for psoriasis, may influence cardiovascular outcomes through its anti-inflammatory effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the impact of methotrexate on cardiovascular outcomes in patients with psoriasis, particularly its potential to reduce cardiovascular risk by controlling systemic inflammation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted according to PRISMA guidelines. Searches were performed in PubMed, Cochrane, Embase, and Web of Science databases. Eligible studies assessed the effects of methotrexate on cardiovascular outcomes in psoriasis patients. Case reports and narrative reviews were excluded. Study quality was assessed using the RoB-2 and GRADE tools. From 143 initially identified records, four studies met the inclusion criteria. Meta-analyses using fixed-effects and random-effects models were conducted to estimate pooled odds ratios (ORs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Under the fixed-effects model, methotrexate was associated with a significant reduction in cardiovascular risk (OR = 0.62; 95% CI: 0.57–0.68). However, due to high heterogeneity, the random-effects model yielded nonsignificant results (OR = 0.86; 95% CI: 0.54–1.35). The incidence of cardiovascular events was similar between the methotrexate (3.6%) and control (3.7%) groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Methotrexate shows promise in reducing cardiovascular risk in psoriasis patients, likely due to its anti-inflammatory properties. It appears to be a safer option compared to agents such as retinoids. Nonetheless, the high heterogeneity and methodological limitations of available studies hinder definitive conclusions. Further research should prioritize standardized outcome measures, comparisons with biologics, and individualized therapeutic approaches.</p>\u0000 \u0000 <p><b>PROSPERO Registration Number:</b> CRD42024575673.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"5 1","pages":"59-66"},"PeriodicalIF":0.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147570218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unravelling the Major Cardiovascular Risks of Systemic Psoriasis Medications: A Literature Systematic Review","authors":"Mai Thi Hoai Son,&nbsp;Yves Julien Mbama Biloa,&nbsp;Pauline Gouttefarde,&nbsp;Thomas Franck,&nbsp;Gilles Cizeron,&nbsp;Mathieu Oriol,&nbsp;François Maccari,&nbsp;Elisa Cinotti,&nbsp;Beatrice Trombert-Paviot,&nbsp;Bienvenu Bongue,&nbsp;Jean-Luc Perrot","doi":"10.1002/jvc2.70134","DOIUrl":"https://doi.org/10.1002/jvc2.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Psoriasis is a chronic inflammatory dermatological condition associated with an elevated risk of cardiovascular events (CVEs). Systemic therapies have transformed disease management, but their cardiovascular (CV) safety profiles remain incompletely understood and inconsistently reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To systematically evaluate and synthesize current evidence on the CV risks of systemic psoriasis treatments, with particular attention to treatment-specific effects, study design quality and consistency of CV outcome reporting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following PRISMA guidelines, we searched four major databases for studies published from January 2013 to August 2024. Eligible studies included randomized-controlled trials (RCTs), registry-based RCTs (rRCTs), cohort studies, pharmacovigilance analyses and systematic reviews/meta-analyses reporting CVEs in adults treated with systemic psoriasis therapies. We used Cochrane Risk of Bias Tools (ROB 2) and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-1) to assess the quality of included citations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 14,744 records, 195 studies involving 1,795,823 patients were included. Methotrexate (MTX) and tumour necrosis factor inhibitors (TNFi) consistently demonstrated CV protective effects, with reductions in myocardial infarction, stroke and CV mortality supported by high-quality evidence. Interleukin-17 (IL-17) inhibitors showed neutral to potentially beneficial CV profiles in both RCTs and observational studies. In contrast, cyclosporine, retinoids and fumaric acid esters were associated with elevated CV risks, particularly in retrospective cohorts. Evidence for IL-12/23 and IL-23 inhibitors was mixed—short-term trials indicated safety, but some real-world and pharmacovigilance data raised concerns. Sensitivity analyses confirmed that conclusions were robust when allocated to studies with a low risk of bias and prespecified CV endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CV safety varies substantially among systemic psoriasis therapies. MTX and TNFi agents appear most favourable for patients at elevated CV risk. IL-17 inhibitors may also be safe alternatives. Further long-term, high-quality studies are needed to clarify the safety of newer biologics and Janus kinase (JAK) inhibitors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"5 1","pages":"32-58"},"PeriodicalIF":0.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147563282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applicability of Novel Laser Scanning Microscopy Techniques in Demonstrating Characteristic Features of Porokeratosis: In Vivo and Ex Vivo Investigation","authors":"Rahime Inci,&nbsp;Noora Neittaanmäki,&nbsp;Jeemol James,&nbsp;Marica B. Ericson,&nbsp;Sirkku Peltonen,&nbsp;Despoina Kantere","doi":"10.1002/jvc2.70149","DOIUrl":"https://doi.org/10.1002/jvc2.70149","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Porokeratoses represent a group of keratinization disorders characterized histopathologically by the presence of a cornoid lamella. The recognition of porokeratosis as a genodermatosis, along with its association with increased risk of skin cancer, underscores the importance of accurate and timely diagnosis. Clinical diagnosis can be challenging, often requiring confirmatory skin biopsies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to compare traditional diagnostic methods including dermoscopy and conventional histopathology with advanced laser microscopy including reflectance confocal microscopy (RCM) and multiphoton microscopy (MPM) for diagnosing porokeratosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seven patients with various clinical types of porokeratosis, two patients with psoriasis vulgaris, and one patient with lichen planus underwent clinical evaluation, dermoscopic examination and in vivo imaging with RCM. Subsequently, punch biopsies were performed for routine histopathological examination and for ex vivo MPM analyses. Data obtained from RCM and MPM were compared with histopathological findings to assess the diagnostic value and accuracy of these advanced imaging modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The parakeratotic cornoid lamella, a hallmark histopathological feature of porokeratosis, was successfully identified in all examined subtypes of porokeratosis while lacking in control samples using both RCM and MPM. Notably, MPM based on imaging autofluorescence demonstrated a superior capability compared to RCM in visualizing individual parakeratotic cells, highlighting its enhanced potential for detailed morphological assessment in porokeratosis diagnostics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although novel laser microscopy techniques require investments in training, workflow adjustments and time to master, they demonstrate significant potential as noninvasive diagnostic tools for porokeratosis, potentially minimizing the need for invasive biopsy procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"5 1","pages":"91-100"},"PeriodicalIF":0.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147566177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Picks","authors":"","doi":"10.1002/jvc2.70269","DOIUrl":"https://doi.org/10.1002/jvc2.70269","url":null,"abstract":"<p>Psoriasis and dermatomyositis may appear together; on the other hand, cutaneous dermatomyositis can be challenging to diagnose, especially if presenting with psoriasiform clinical features. Gordon et al. review four patients with concomitant psoriasis and dermatomyositis at their institution (Figure 1) and 20 cases in the medical literature, for a total of 24 patients. The analysis of the series reveals a high rate of dermatomyositis being misdiagnosed with psoriasis, including true overlap versus psoriasiform-like rashes known to be associated with dermatomyositis. Concurrent disease should be more suspected in those with personal or family history of autoimmunity, when rashes of differing behaviour or morphology appear years apart, and when therapy for one condition might have induced the other. In the latter scenario, psoriasis may be triggered with oral corticosteroids for dermatomyositis, and conversely, treatment of psoriasis with biologics such as anti-TNF-alpha or anti-IL17 agents or phototherapy.</p><p>Psoriasis is known to be associated with an elevated risk of cardiovascular events; however, the role of systemic therapies for psoriasis in the development of such events is incompletely understood. Son et al. systematically review current evidence on the cardiovascular risks of systemic psoriasis treatments. From 14,744 records, 195 studies involving 1,795,823 patients were included (Figure 2). Methotrexate and tumour necrosis factor inhibitors consistently demonstrated cardiovascular protective effects, with reductions in myocardial infarction, stroke and cardiovascular mortality. Interleukin-17 inhibitors showed neutral to potentially beneficial cardiovascular profiles, whereas cyclosporine, retinoids and fumaric acid esters were associated with elevated cardiovascular risks. Evidence for IL-12/23 and IL-23 inhibitors was mixed. Long-term, high-quality studies are needed to clarify the safety of newer biologics and JAK inhibitors, particularly regarding cardiovascular events.</p><p>Chronic lower leg ulcers are common and affect the quality of life of patients, particularly in elderly populations. Van Zanten et al. retrospectively review the impact of punch grafting on pain in 74 patients with chronic lower leg ulcers treated at a single institution (Figures 3 and 4). Results reveal a significant decrease in pain and opioid use, with 30% of patients no longer requiring any analgesics. A minimally invasive procedure, such as punch grafting, is an effective intervention for chronic ulcer patients while promoting healing. Complications of punch grafting are minor, including small infections and donor-site issues.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"5 1","pages":"7-9"},"PeriodicalIF":0.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147564346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's New in JEADV – Editor-in-Chief 's Selection","authors":"Carle Paul","doi":"10.1002/jvc2.70281","DOIUrl":"https://doi.org/10.1002/jvc2.70281","url":null,"abstract":"&lt;p&gt;In an authoritative review, Gupta et al. summarise the evidence regarding the clinical and laboratory data on &lt;i&gt;Trichophyton indotineae&lt;/i&gt;, a new pathogen responsible for widespread, resistant cases of tinea corporis or tinea cruris [&lt;span&gt;1&lt;/span&gt;]. &lt;i&gt;T. indotineae&lt;/i&gt; belongs to the &lt;i&gt;Trichophyton mentagrophytes/Trichophyton interdigitale&lt;/i&gt; complex (TMTIC) and exhibits significant resistance to terbinafine, fluconazole and griseofulvin. Treatment requires a regimen developed by expert dermatologists including itraconazole, voriconazole or posaconazole (Figure 1). These results were confirmed by Kong et al. in a survey from the China Antifungal Resistance Dermatophytes Surveillance Network study [&lt;span&gt;2&lt;/span&gt;] (Figure 2). The authors analysed 230 TMTIC strains across nine Chinese hospitals. They observed a decreased susceptibility of TMTIC to azoles and the emergence of &lt;i&gt;T. indotinea&lt;/i&gt; as a cause of tinea corporis and tinea cruris in eastern China. Dermatologists should be aware of the decreased susceptibility to azoles of TMTIC and screen for &lt;i&gt;T. indotinea&lt;/i&gt; in patients returning from Asia and presenting with widespread tinea corporis/cruris [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Metabolic and cardiovascular comorbidities have been linked to late-onset psoriasis. Although this association has been confirmed by many epidemiological studies, there is limited information on how changing ‘unhealthy’ behaviour influences psoriasis outcome. In a large-scale database study on the UK Biobank, Zhou et al. identified lifestyle-related metabolites significantly associated with the development of late-onset psoriasis and linked to lipid and glucose metabolism pathways. Machine learning that incorporates clinical, genetic and metabolomic data could enhance psoriasis risk prediction and motivate patients to change their lifestyle behaviour [&lt;span&gt;4&lt;/span&gt;] (Figure 3). Similarly, smoking is a known risk factor for psoriasis. There is limited high-quality data on the effect of smoking cessation on psoriasis risk. In a nationwide study from Korea, Kim et al. showed that patients who stop smoking have a lower risk of developing psoriasis or palmar-plantar pustulosis [&lt;span&gt;5&lt;/span&gt;] (Figure 4). This risk reduction is attenuated in patients who have gained weight, which is a major concern for those trying to quit smoking. These data should encourage dermatologists to advise patients at risk of psoriasis to adopt a healthy lifestyle and quit smoking. However, patients need appropriate dietary support to avoid weight gain when quitting smoking.&lt;/p&gt;&lt;p&gt;The March issue of the JEADV, co-edited by Professor Jo Lambert and Professor Curdin Conrad, is dedicated to personalised medicine in dermatology. This special issue explores how advanced biological analyses, such as genetic studies, spatial transcriptomics and biomarker identification, help us to better understand skin diseases and pave the way for individually tailored treatments.&lt;/p&gt;&lt;p&gt;This concept of personalis","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"5 1","pages":"15-19"},"PeriodicalIF":0.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147564353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Analysis Into the Effect of Punch Grafts in Patients With Chronic Ulcers of the Lower Leg","authors":"M. van Zanten,&nbsp;J. E. Geskes,&nbsp;M. M. E. Thung,&nbsp;P. Velthuis,&nbsp;C. van Montfrans","doi":"10.1002/jvc2.70132","DOIUrl":"https://doi.org/10.1002/jvc2.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic lower leg ulcers affect approximately 2% of adults in Western countries and are associated with significant pain, impaired quality of life and substantial healthcare costs. Effective pain management, which often includes opioid analgesics, is critical but complicated by adverse outcomes, particularly in frail elderly populations. Punch grafting, a minimally invasive technique involving the transfer of small skin sections to the ulcer, is increasingly used to promote healing and pain relief.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To retrospectively evaluate the impact of punch grafting on pain scores and analgesic use in patients with chronic lower leg ulcers treated at Erasmus Medical Center, Rotterdam.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective recruitment between 2018 and 2023. Pain scores were assessed using the Numeric Rating Scale (NRS) at baseline and 6 weeks posttreatment, and analgesic use was documented. Ulcer reduction was visually assessed from clinical photographs, and healing rates were categorized. Statistical analyses included the Wilcoxon signed-rank and McNemar's tests for paired comparisons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median NRS pain score decreased significantly from 5.5 at baseline to 1.5 at 6 weeks (<i>p</i> &lt; 0.001). Opioid use declined from 52% at baseline to 33% posttreatment (<i>p</i> &lt; 0.001) and 30% of patients no longer required any analgesics. Complications were minor, primarily small infections and donor-site issues. Photographic assessment showed complete wound healing in 7% of patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings suggest minimal invasive punch grafting as an effective intervention for reducing pain and opioid dependency in chronic ulcer patients while promoting healing. Prospective studies and randomized controlled trials are needed to refine patient selection criteria and compare punch grafting with other interventions. Punch grafting holds promise as a valuable option in managing painful chronic ulcers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"5 1","pages":"75-81"},"PeriodicalIF":0.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147566537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence–Based Automated Scoring to Support Dermatology Consultations","authors":"Nicolas Kluger,&nbsp;Lidiya N. Todorova","doi":"10.1002/jvc2.70270","DOIUrl":"https://doi.org/10.1002/jvc2.70270","url":null,"abstract":"&lt;p&gt;Standardized scoring tools are crucial for assessing severity, following disease activity and evaluating treatment efficacy both in randomized controlled trials and in real life. The rapid development of efficient biotherapies in various chronic cutaneous conditions prompts dermatologists to know about and use those scores, sometimes on a daily basis: Psoriasis Area and Severity Index (PASI, psoriasis), EASI (atopic eczema), VASI (vitiligo), SALT (alopecia areata), CLASI (cutaneous lupus) and so forth. Scoring suffers from several limitations: challenges to learn complex scoring systems, subjectivity, limited sensitivity to smaller lesions and significant intra- and interrater variability may impact the outcome. Even though practice leads to mastery, their use can be time-consuming within the limited duration of a consultation, which is already demanding for patients with chronic inflammatory dermatoses due to history taking, clinical examination, assessment of quality-of-life impact through questionnaires and discussion of treatment strategies. Some tools are of course at the disposal of dermatologists such as hand-held calculator (Figure 1) or free online score calculator on the internet (Figure 2), however they barely save time much time nor solve the limitations stressed above.&lt;/p&gt;&lt;p&gt;In an article of this issue [&lt;span&gt;1&lt;/span&gt;], Taig MacCarthy et al. reported on the development and validation of APASI. This new AI-driven system automatically evaluates the severity of psoriasis using clinical images. Psoriasis severity is traditionally measured by the PASI, but PASI scoring suffers from subjectivity, limited sensitivity to smaller lesions and significant variability between clinicians. The authors assembled a large data set of clinical images annotated by dermatologists and trained deep learning models for two tasks: segmenting psoriatic lesions and classifying the intensity of key visual signs (erythema, induration, desquamation). They tested various neural network architectures and found one (MiT_b2) that achieved performance comparable to human experts for classifying visual signs, and another (Xception) that outperformed experts in lesion segmentation.&lt;/p&gt;&lt;p&gt;APASI can provide rapid, objective and standardized assessments of psoriasis severity. In addition, tools as APASI could also be valuable for potential integration in teledermatology, where only a correct image-taking would be necessary to do the evaluation, without the need for a real on-site specialist. APASI undeniably offers a considerable amount of benefits, but so far, it also lacks the accuracy of the human eye because of the 2D surface of the image it analyses. This represents the inability to evaluate as accurately as possible the induration and scaling of the lesions in comparison to an expert dermatologist. The data set used to train the AI must also include a comprehensive photography of all Fitzpatrick skin types; moreover, each data set of skin type should include a re","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"5 1","pages":"10-12"},"PeriodicalIF":0.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70270","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147564347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}