Symptomatic dermographism (SD), the most common chronic inducible urticaria subtype, manifests as strip-shaped, pruritic wheals after skin friction. Conclusive data on its associated factors are limited, and direct comparisons between individuals with and without SD remain scarce. We aimed to identify factors associated with SD internationally. The PREVALENCE-D (Prevalence Estimation of Dermographism) study was an international cross-sectional survey conducted from 2021 to 2024 across 19 countries. An expert-designed questionnaire diagnosed SD and assessed potential associated factors. SD participants were defined as those who self-reported chronic recurrent urticarial dermographism with itch. Factors associated with SD were identified by comparing participants with and without SD. Of 68,513 participants, 3101 had SD (female 73.3%). Their mean age was 40.2 ± 16.2 years. Key factors associated with SD included atopic dermatitis (adjusted odds ratio [aOR] 4.20, 95% confidence interval [CI] 3.62‒4.88) and allergic rhinitis (aOR 2.11, 95% CI 1.88‒2.37). Participants with at least one atopic condition (allergic rhinitis, atopic dermatitis, or asthma) were significantly more likely to have SD (aOR 2.70, 95% CI 2.47‒2.95). Those with all three atopic conditions had a further increased likelihood of SD (aOR 7.75, 95% CI 5.31‒11.29). Other associations included working and older age groups, female sex, dyslipidemia, and thyroid disease. Atopic dermatitis and allergic rhinitis emerged as the strongest correlates of SD, especially those with all three atopic conditions. Thus, allergic comorbidities should be assessed in SD patients. Further research is needed to clarify the pathophysiological relationship between these conditions and SD. [Graphical abstract available online].

The incidence of cutaneous squamous cell carcinoma (CSCC) is on the rise. While the majority of cases are curable with surgery alone, the burden of high-risk tumors that require additional therapies is increasing. While systemic therapy has long been used to treat locally advanced and metastatic CSCC, immunotherapy is a more recent advancement, and use of neoadjuvant and adjuvant systemic therapy in the perioperative setting is an area of ongoing study. While chemotherapy, epidermal growth factor inhibitors, and chemoradiation have all been studied in the perioperative setting, the response is highly variable, and side effects are common. Immunotherapy, in particular programmed cell death protein/ligand-1 inhibitors, have revolutionized treatment of advanced CSCC. Cemiplimab and pembrolizumab have been studied for neoadjuvant and adjuvant use, and atezolizumab for neoadjuvant use. Cemiplimab has shown the most promise, with a 64-75% major or complete pathologic response rate in the neoadjuvant setting, and significantly improved recurrence, metastasis, and disease-free survival rates over placebo in the adjuvant setting. While neoadjuvant and adjuvant immunotherapy has evolved as a promising treatment option for high-risk CSCC, several questions remain unanswered and are subject to ongoing research. This includes investigating optimal treatment regimens, duration, and timing; developing methods to better predict and identify responders; establishing long-term outcomes and safety data; and carrying out further studies in special populations such as organ transplant recipients.

As women of childbearing potential constitute a considerable portion of the total psoriasis population, dermatologists must consider both the clinical and psychosocial implications of psoriasis when treating these patients. This review summarizes key clinical considerations when treating women of childbearing potential with psoriasis, regarding family planning, pregnancy, and the postpartum period, aiming to assist in identifying common concerns within this population. Many women report initiating the discussion on family planning but having limited access to information. Concerns about the impact of psoriasis and its treatment on fertility, pregnancy, and lactation are common, and lack of adequate information can lead to irrevocable decisions. Despite conflicting results, current evidence suggests a potential negative correlation between moderate-to-severe psoriasis and fertility. Studies on adverse maternal and neonatal events associated with psoriasis show inconsistent outcomes and should be communicated with caution. With the increase in available treatment options during pregnancy and lactation, particularly in cases of severe psoriasis, personalized treatment plans are becoming more achievable, allowing dermatologists to better address the needs of their patients. The majority of patients can be treated during pregnancy with topical treatments or ultraviolet-B irradiation. While the general recommendation is to stop systemic treatment before conception, decisions should be made on an individualized basis. If treatment cannot be discontinued, tumor necrosis factor-α inhibitors and cyclosporine can be used. It is essential to inform parents of the additional risks associated with live or live-attenuated vaccines in cases where the mother has received systemic treatment during pregnancy and to delay vaccinations accordingly.

Management of hidradenitis suppurativa (HS) can be challenging and often requires a multimodal approach with use of on- and off-label medications. There has been a rapid expansion of available HS treatments in the years since the 2019 North American HS (NAHS) clinical management guidelines. Herein we present an up-to-date practical management algorithm based on the diagnosis and management strategies set forth by the 2019 NAHS guidelines using newly available literature. Evaluation and diagnosis of HS disease involves assessment of severity, extent of disease, and impact on patient quality of life. Initial diagnosis of HS should be shortly followed by comorbidity screening. The multimodal approach to HS treatment typically involves use of treatment stacking of topical therapies, systemic and topical antibiotics, retinoids, hormonal and metabolic therapies, biologics and small molecule inhibitors, systemic immunosuppressants, surgical treatment, pain management, lifestyle modifications, adjunctive treatment, wound care, and flare therapy. Thus, the proposed algorithm aims to guide clinicians in their implementation of treatment stacking in HS.

Tapinarof cream 1% is an aryl hydrocarbon receptor agonist approved by the US Food and Drug Administration to treat atopic dermatitis (AD) in patients down to age 2 years. The aim of this study was to evaluate the safety and pharmacokinetics of tapinarof cream 1% once daily (QD) in adolescents and children with extensive AD under maximal usage conditions. Patients with a validated Investigator Global Assessment scale for Atopic Dermatitis™ (vIGA-AD™) score ≥3 and body surface area (BSA) involvement ≥25% (ages 12-17 years) or ≥35% (ages 2-11 years) were enrolled into three age cohorts (2-6, 7-11, and 12-17 years) and received tapinarof cream 1% QD for 4 weeks. Overall, 36 patients (12 per cohort) were enrolled; mean BSA affected was 42.8% (range 26.0-90.0) and mean Eczema Area and Severity Index (EASI) score was 23.8. At baseline, 28 patients (77.8%) had a vIGA-AD™ score of 3 (moderate). No-to-minimal tapinarof systemic exposure was observed (25% of post-treatment plasma samples were below the quantifiable limit of a highly sensitive assay [<50pg/mL]). Mean maximum plasma concentration (Cmax) was 2.44ng/mL, and median time to Cmax was 2.9h. Eight patients (22.2%) reported treatment-emergent adverse events (TEAEs), which were mild or moderate; only one patient discontinued due to two unrelated TEAEs. One case of mild folliculitis and no contact dermatitis occurred. Tapinarof was well tolerated, including on sensitive skin and extensor/flexural surfaces. Tapinarof cream exhibits highly favorable safety and pharmacokinetics in adolescents and children down to age 2 years with extensive AD. ClinicalTrials.gov: NCT05186805.

Ruxolitinib cream has demonstrated anti-inflammatory and antipruritic activity and was well tolerated in a phase 3 study in patients aged 2-11 years with mildtomoderate atopic dermatitis (AD). This study examined the safety, tolerability, pharmacokinetics, efficacy, and quality of life (QoL) with ruxolitinib cream under maximum-use conditions and with longer-term use. Eligible patients were aged 2-11 years with moderate to severe AD [Investigator's Global Assessment (IGA) score 3-4], and ≥ 35% affected body surface area (BSA). Patients applied 1.5% ruxolitinib cream twice daily to all baseline-identified lesions during the 4-week maximum-use period, then to active lesions only up to week 52 (patients with ≤ 20% affected BSA from week 8). Safety was assessed by frequency and severity of adverse events. Pharmacokinetic parameters were assessed as secondary endpoints, and efficacy and QoL were exploratory endpoints. Overall, 29 patients (median age 5years) were enrolled. Treatment-emergent adverse events were reported in 9/29patients (31.0%); there were no adverse events of special interest (i.e., no serious infections, malignancies, major adverse cardiovascular events, or thromboses) during the study period. Mean steady-state plasma concentration during the maximum-use period was below the known half-maximal inhibitory concentration of Janus kinase-mediated myelosuppression in adults. Reductions in affected BSA and IGA observed at week 4 were sustained with as-needed use through 52weeks. Improvements in patient-reported outcomes and QoL measures were consistent with efficacy results. These results support the safety of ruxolitinib cream in children (2-11years) with AD, including those with extensive disease, and are consistent with previous efficacy findings. NCT05034822, first registered 30 August 2021.

BackgroundData are lacking to guide diagnosis and treatment in patients with skin of color and atopic dermatitis (AD), a population traditionally underrepresented in clinical trials. ObjectiveThe aim of this study was to evaluate the efficacy and safety of lebrikizumab in adults and adolescents with skin of color and moderate-to-severe AD.MethodsIn the open-label ADmirable trial, 90 adults and adolescents with moderate-to-severe AD, Fitzpatrick skin phototype IV–VI, and self-reported race other than White received lebrikizumab 250 mg subcutaneously every 2 weeks (Q2W), following a 500-mg loading dose at baseline and Week 2, for 16 weeks. From Week 16 to Week 24, responders, defined as patients with at least 75% improvement in Eczema Area and Severity Index (EASI 75) and/or Investigator’s Global Assessment (IGA) score of 0/1 with at least a 2-point improvement from baseline, received lebrikizumab every 4 weeks (Q4W); inadequate responders continued lebrikizumab Q2W. The primary endpoint was the percentage of patients achieving EASI 75 at Week 16. Secondary and exploratory efficacy endpoints and safety were assessed throughout. Data were analyzed as observed and using imputation, with Q2W and Q4W populations pooled for Weeks 16–24.ResultsMean age at baseline was 40.7 years; 43.3% were female; and 43.3%, 24.4%, and 32.2% had Fitzpatrick skin phototypes IV, V, and VI, respectively. Baseline mean EASI and Pruritus Numeric Rating Scale (NRS) scores were 26.4 and 7.0, respectively; 68.9% of patients had moderate disease (IGA = 3). At Week 16 (number of patients with non-missing values [Nx] = 78), EASI 75, EASI 90 (≥ 90% improvement from baseline in EASI), and IGA 0/1 (IGA response of clear or almost clear) were achieved by 69.2%, 44.9%, and 44.9% of patients, respectively; for Pruritus NRS (Nx = 62), 58.1% of patients reported ≥ 4-point improvement. At Week 24 (Nx = 74) (pooled treatment arms), EASI 75, EASI 90, and IGA 0/1 were achieved by 78.4%, 47.3%, and 54.1% of patients, respectively. EASI 75 was achieved by 62.9%, 88.2%, and 95.5% of patients with Fitzpatrick skin phototype IV (Nx = 35), V (Nx = 17), and VI (Nx = 22), respectively, at Week 24. Most patients (64.4%) with baseline PDCA-Derm™-assessed hyperpigmented areas showed reduced hyperpigmentation at Week 24. Most treatment-emergent adverse events were mild or moderate in severity; none were serious or led to discontinuation. One case of conjunctivitis was reported.ConclusionIn this first lebrikizumab study in patients with skin of color (Fitzpatrick skin phototype IV, V, and VI) and moderate-to-severe AD, lebrikizumab improved signs and symptoms of AD and confirmed its favorable safety profile.Trial RegistrationClinicalTrials.gov Identifier: NCT05372419 (registered May 5, 2022).Supplementary InformationThe online version contains supplementary material available at 10.1007/s40257-025-00970-8.

Hidradenitis suppurativa is a chronic inflammatory condition characterized by recurrent abscesses, nodules, tunnels, and scarring. Fluctuations in disease activity are common during pregnancy, and more than half of women with hidradenitis suppurativa report experiencing post-partum flares. Both treatment efficacy and safety of the woman and fetus or infant must be considered when developing a treatment plan for pregnant and lactating women with hidradenitis suppurativa. Although certain commonly used hidradenitis suppurativa medications, such as tetracyclines and spironolactone, are contraindicated during pregnancy, there are still various medical therapies, including topicals, systemic antibiotics, metabolic modulators, and biologics, as well as procedural therapies that may be utilized during pregnancy. This paper aims to provide an updated evidence-based review of the management of hidradenitis suppurativa in pregnancy with an emphasis on safety data.