Editor's Picks March 2025

Reflectance confocal microscopy is a skin imaging technique that improves the detection of subclinical malignant pigmentary lesions. In a prospective study, Elshot et al. show the clinical utility of handheld reflectance confocal microscopy (HHRCM) to precisely define surgical margins for lentigo maligna prior to surgical intervention (Figure 1). Lesion mapping is relatively rapid, improving the ability of surgery to achieve complete removal of the tumour. Using HHRCM is associated with dramatically reduced recurrence. This study shows the high utility of skin imaging techniques when mastered by expert centres resulting in improved patient outcomes.

Elshot YS, Lasso Peña DJP, Zupan-Kajcovski B, et al. Successful implementation of handheld reflectance confocal microscopy as the standard of care in the (surgical) management of lentigo maligna (melanoma). J Eur Acad Dermatol Venereol 2025; 39:604–611. doi:10.1111/jdv.20210

According to psychologist Martin Seligman, happiness has three major dimensions: pleasantness, engagement and connection. In a large European study, Ziehfreund et al. evaluated happiness and quality of life in 1039 patients with psoriasis or atopic dermatitis. The authors show the negative effect of inflammatory skin diseases on happiness and the positive effect of systemic treatment.

They also identify significant differences between European countries, with Italian and Austrian patients exhibiting the highest level of happiness. These data highlight that skin diseases can hinder the quest for happiness, but dermatological care has a positive impact (Figure 2).

Ziehfreund S, Wecker H, Mittag S, et al. Happiness across the borders-A cross-sectional study among patients with psoriasis and atopic dermatitis in Europe. J Eur Acad Dermatol Venereol 2025; 39:529–542. doi:10.1111/jdv.20288

A major component of the psychological burden of skin diseases is stigmatization. People with visible skin diseases suffer from frequent microaggressions that have a detrimental effect on self-confidence and well-being.

In a systematic review, Stuhlmann et al. aimed to identify mechanisms and parameters that contribute to self-stigmatization in patients with inflammatory skin diseases (Figure 3). They identified social stigma, lack of acceptance and lack of social support as main predictors of self-stigma. Interventions to promote acceptance, social support and information dissemination about skin diseases should help patients to better cope with the psychological burden of skin diseases.

Stuhlmann CFZ, Traxler J, Paucke V, da Silva Burger N, Sommer R. Predictors and mechanisms of self-stigma in five chronic skin diseases: A systematic review. J Eur Acad Dermatol Venereol 2025; 39:622–630. doi:10.1111/jdv.20314

Global warming and wasted natural resources are current major challenges. I am always impressed by the long queues of colleagues waiting for samples from cosmeceutical companies at medical congresses.

Salimi et al. evaluated the impact of sample distribution at the EADV 2023 congress. They found that a zealous delegate could obtain 9.67 kg of samples from 15 booths totalling 149 products (a carbon footprint of approximately 100 kg CO₂-equivalent), highlighting the enormous potential negative impact of such practices (Figure 4).

Banning samples from dermatology conferences would be a courageous albeit healthy measure to promote sustainability of future dermatology conferences.

Salimi M, Tso S. Reflection on the environmental sustainability of cosmeceutical samples received by delegates at the EADV Congress 2023. J Eur Acad Dermatol Venereol 2025; 39:e232–e233. doi:10.1111/jdv.20205