Editor’s Picks July 2025

Carle Paul

Skin barrier homeostasis plays an important role in inflammatory skin diseases such as atopic dermatitis, psoriasis, Darier disease and rosacea.

In a comprehensive review, Dajnoki et al. analyse the topographic variations of the skin barrier: physical, chemical, immunological and microbiome (Figure 1). Regional differences in skin barrier components may play an important role in the pathogenesis of many inflammatory skin diseases and can also be the target of specific interventions. The authors conclude that location is key to understanding skin barrier function and pathology, as our skin is not uniform.

Dajnoki Z, Kapitány A, Eyerich K, et al. Topographical variations in the skin barrier and their role in disease pathogenesis. J Eur Acad Dermatol Venereol 2025; 39: 1228–1238. doi:10.1111/jdv.20463.

The mounting incidence of cutaneous melanoma in Europe poses a public health challenge. In this population study from Iceland, Thomas et al. show that the incidence of melanoma has risen from 1991 to 2006 both for in situ and invasive melanoma (Figure 2). Since 2007, invasive melanoma incidence has dramatically declined with melanoma-specific mortality falling since 2012, while in situ melanoma incidence has increased.

This suggests that sun protection campaigns, regulation of sunbeds and early detection of melanoma can change its detection and prognosis at the national level, hopefully stimulating discussion and courageous decision-making at the European level.

Matos TR, Walsh S, Stratigos AJ, et al. Regulating sunbed use: Skin cancer risks linked to tanning beds. J Eur Acad Dermatol Venereol 2025; 39: 1209–1211. doi:10.1111/jdv.20586

Thomas S, Hoyt D, Stoddard G, et al. Declining invasive and rising in situ melanoma incidence trends in Iceland: A nationwide cohort study. J Eur Acad Dermatol Venereol 2025; 39: 1278–1284. doi:10.1111/jdv.20386.

The appealing concept that earlier use of biological agents in psoriasis may improve disease control and its course needs to be formally tested.

In a carefully designed analysis of the Dermbio Danish registry, Thein et al. analysed the effect of the pre-biologic patient journey on biologic drug survival in nearly 2500 patients with psoriasis. They found that the number and duration of conventional treatments did not impact the first biologic drug survival and thus its efficacy, provided the patient's psoriasis was adequately controlled (Figure 3). A tailored patient-centric treatment approach is key.

Thein D, Nielsen ML, Maul JT, et al. Impact of the pre-biologic treatment journey on biologic drug survival in psoriasis: A nationwide cohort study. J Eur Acad Dermatol Venereol 2025; 39: 1315–1323. doi:10.1111/jdv.20259.

Penile leukokeratosis is a known precursor of epidermoid carcinoma in elderly patients with lichen sclerosus. Bennamou et al. describe benign leukokeratosis of the foreskin with occasional ulceration in 14 young men as a new clinical entity. Histological analysis revealed benign epidermal hyperplasia without HPV infection or lichen sclerosus. Masturbation or traumatism possibly contributed.

The authors propose a simple management algorithm: first-line treatment with topical steroids and subsequent biopsy only with persisting lesions after 3 months. Recognizing this entity will reduce the need for surgical intervention in young patients with benign reactional leukokeratosis of the penis (Figure 4).

Benammou S, Salle R, Cavelier-Balloy B, et al. Reactional genital leukokeratosis as a new clinico-histological variant of penile squamous hyperplasia in young men. J Eur Acad Dermatol Venereol 2025; 39: e610–e613. doi:10.1111/jdv.20613.