Pub Date : 2026-01-14DOI: 10.1001/jamadermatol.2025.5496
Ivo Abraham, Adewole S Adamson, Kanade Shinkai
{"title":"Biologics Prescribing in Dermatology by Advanced Practice Clinicians-Trends in the Practice of Advanced Practice Clinicians in Dermatology.","authors":"Ivo Abraham, Adewole S Adamson, Kanade Shinkai","doi":"10.1001/jamadermatol.2025.5496","DOIUrl":"https://doi.org/10.1001/jamadermatol.2025.5496","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1001/jamadermatol.2025.5414
Xingyuan Jiang, Mark Y Jeng, Zhou Yang, Nelson Ugwu, Yuan Cheng, Caroline Echeandia-Francis, Ryland D Mortlock, Mitra V Mani, Natasha Rekhtman, Anna J Podolanczuk, Elizabeth Fiorino, Andrew Plodkowski, Ramrada Lekwuttikarn, Joyce Teng, Michael F Walsh, Helena A Yu, Zhimiao Lin, Keith A Choate
Importance: Acanthosis nigricans (AN) is commonly associated with impaired glucose tolerance, but early, severe presentation in individuals with normoglycemia may identify individuals at risk for systemic disease. While gain of function epidermal growth factor receptor (EGFR) pathogenic variants are associated with pulmonary cancers, their role in syndromic skin disease has not been clearly defined. This study identified activating EGFR variants that were associated with a syndrome characterized by generalized acquired keratoderma accentuated at flexural sites, woolly hair, palmoplantar keratoderma, and pulmonary disease with lung nodules, and the results suggest EGFR inhibitor therapeutic efficacy.
Objectives: To determine the genetic basis of early-onset, syndromic AN and assess response to pathogenesis-directed therapy.
Design, setting, and participants: Patients included 2 individuals with normoglycemia with early-onset periorificial hyperpigmentation and flexural skin thickening that subsequently generalized and 1 individual with an original diagnosis of widespread epidermal nevus. Participants underwent whole-exome sequencing and studies of affected skin and keratinocytes.
Main outcomes and measures: EGFR variant identification and assessment of pathway activation in lesional skin and keratinocytes, pulmonary function testing, lung imaging, and clinical response to EGFR inhibition.
Results: All 3 participants (aged 8, 18, and 17 years; 2 male individuals and 1 female individual) had an EGFR L858R variant, which arose as either de novo in generalized cases or a somatic variant in mosaic disease. Lesional skin and cultured keratinocytes demonstrated increased EGFR pathway activity, which was suppressed by pharmacologic inhibition in vitro. Systemic treatment with EGFR inhibitors was associated with skin disease regression, improvement in pulmonary disease, and resolution or reduction of the number of pulmonary nodules.
Conclusions and relevance: The findings of this case series study define a syndromic disorder with increased risk of pulmonary disease and lung nodules in patients with acquired, generalized AN that is associated with activating EGFR variants. Pulmonary nodules are precursor lesions for lung cancer, and treatment with EGFR inhibitions is associated with near-complete resolution of skin and pulmonary disease. Early recognition of syndromic EGFR AN will permit identification of individuals at risk for systemic disease who are candidates for EGFR-targeted therapy.
{"title":"De Novo Germline L858R EGFR Variants and Generalized Acanthosis Nigricans.","authors":"Xingyuan Jiang, Mark Y Jeng, Zhou Yang, Nelson Ugwu, Yuan Cheng, Caroline Echeandia-Francis, Ryland D Mortlock, Mitra V Mani, Natasha Rekhtman, Anna J Podolanczuk, Elizabeth Fiorino, Andrew Plodkowski, Ramrada Lekwuttikarn, Joyce Teng, Michael F Walsh, Helena A Yu, Zhimiao Lin, Keith A Choate","doi":"10.1001/jamadermatol.2025.5414","DOIUrl":"10.1001/jamadermatol.2025.5414","url":null,"abstract":"<p><strong>Importance: </strong>Acanthosis nigricans (AN) is commonly associated with impaired glucose tolerance, but early, severe presentation in individuals with normoglycemia may identify individuals at risk for systemic disease. While gain of function epidermal growth factor receptor (EGFR) pathogenic variants are associated with pulmonary cancers, their role in syndromic skin disease has not been clearly defined. This study identified activating EGFR variants that were associated with a syndrome characterized by generalized acquired keratoderma accentuated at flexural sites, woolly hair, palmoplantar keratoderma, and pulmonary disease with lung nodules, and the results suggest EGFR inhibitor therapeutic efficacy.</p><p><strong>Objectives: </strong>To determine the genetic basis of early-onset, syndromic AN and assess response to pathogenesis-directed therapy.</p><p><strong>Design, setting, and participants: </strong>Patients included 2 individuals with normoglycemia with early-onset periorificial hyperpigmentation and flexural skin thickening that subsequently generalized and 1 individual with an original diagnosis of widespread epidermal nevus. Participants underwent whole-exome sequencing and studies of affected skin and keratinocytes.</p><p><strong>Main outcomes and measures: </strong>EGFR variant identification and assessment of pathway activation in lesional skin and keratinocytes, pulmonary function testing, lung imaging, and clinical response to EGFR inhibition.</p><p><strong>Results: </strong>All 3 participants (aged 8, 18, and 17 years; 2 male individuals and 1 female individual) had an EGFR L858R variant, which arose as either de novo in generalized cases or a somatic variant in mosaic disease. Lesional skin and cultured keratinocytes demonstrated increased EGFR pathway activity, which was suppressed by pharmacologic inhibition in vitro. Systemic treatment with EGFR inhibitors was associated with skin disease regression, improvement in pulmonary disease, and resolution or reduction of the number of pulmonary nodules.</p><p><strong>Conclusions and relevance: </strong>The findings of this case series study define a syndromic disorder with increased risk of pulmonary disease and lung nodules in patients with acquired, generalized AN that is associated with activating EGFR variants. Pulmonary nodules are precursor lesions for lung cancer, and treatment with EGFR inhibitions is associated with near-complete resolution of skin and pulmonary disease. Early recognition of syndromic EGFR AN will permit identification of individuals at risk for systemic disease who are candidates for EGFR-targeted therapy.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12805494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1001/jamadermatol.2025.5481
Ryan A Gall, Carly A Wooten, Willis H Lyford
{"title":"Effects of Photographic Image Processing in Dermatology.","authors":"Ryan A Gall, Carly A Wooten, Willis H Lyford","doi":"10.1001/jamadermatol.2025.5481","DOIUrl":"https://doi.org/10.1001/jamadermatol.2025.5481","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1001/jamadermatol.2025.5498
Edward L Kong, Arash Mostaghimi
{"title":"Advanced Practice Clinicians and Dermatology Drug Spending.","authors":"Edward L Kong, Arash Mostaghimi","doi":"10.1001/jamadermatol.2025.5498","DOIUrl":"10.1001/jamadermatol.2025.5498","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12805487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Importance: </strong>ICP-332 is a tyrosine kinase 2 inhibitor currently under investigation for the treatment of atopic dermatitis (AD).</p><p><strong>Objective: </strong>To evaluate the safety and efficacy of ICP-332 for moderate to severe AD.</p><p><strong>Design, setting, and participants: </strong>This double-blind, placebo-controlled, phase 2 randomized clinical trial was conducted between February 6 and November 7, 2023, across 19 centers in China. Individuals aged 18 to 75 years who had diagnosis of AD for 1 year or longer and a history of contraindication or inadequate response to topical therapies were included.</p><p><strong>Intervention: </strong>Participants were randomized 1:1:1 to receive ICP-332 at 80 mg or 120 mg, or placebo orally once daily for 4 weeks. Study participants and personnel were blinded to group assignment.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was safety. The key efficacy outcome was the percentage change from baseline in Eczema Area and Severity Index (EASI) at week 4. Other outcomes included percentages of patients achieving EASI-75 (a ≥75% improvement in EASI) and Validated Investigator Global Assessment for Atopic Dermatitis score of clear (0) or almost clear (1) with 2 or more points improvement.</p><p><strong>Results: </strong>This study included 75 patients (mean [SD] age, 37.3 [18.0] years in the ICP-332 groups and 44.5 [17.4] years in the placebo group; 21 women [28%] and 54 men [72%]). Among the 74 patients included in the safety set, 17 of 25 (68%) in the placebo group, 19 of 25 (76%) in the 80-mg ICP-332 group, and 18 of 24 (75%) in the 120-mg ICP-332 group experienced treatment-emergent adverse events, with all events being mild or moderate. The most common adverse event was decreased blood fibrinogen (1 of 25 [4%] in the placebo group, 6 of 25 [44%] in the 80-mg ICP-332 group, and 5 of 24 [21%] in the 120-mg ICP-332 group). Percentage reductions in EASI at week 4 were -78.2% (95% CI, -89.8% to -66.6%) in the 80-mg ICP-332 group, -72.5% (95% CI, -84.3% to -60.7%) in the 120-mg ICP-332 group, and -16.7% (95% CI, -28.7% to -4.6%) for those receiving placebo. Mean differences vs placebo for percentage reductions from baseline at week 4 in EASI were -61.6% (95% CI, -78.4% to -44.7%; P < .001) and -55.8% (95% CI, -72.8% to -38.9%; P < .001) for 80-mg ICP-332 and 120-mg ICP-332, respectively. There was a statistically significant higher EASI-75 response rate with both ICP-332 doses (64.0% for each; difference vs placebo, 56.0%; 95% CI, 34.4%-77.6%; P < .001) than with placebo and a greater percentage of Validated Investigator Global Assessment for Atopic Dermatitis score of 0 or 1 and improvement of 2 or more points at week 4 in the 80-mg ICP-332 group vs placebo (36.0%; difference vs placebo, 32.0%; 95% CI, 11.7%-52.3%; P = .005).</p><p><strong>Conclusions and relevance: </strong>In this phase 2 randomized clinical trial, ICP-332 demonstrated a favorable safety pro
{"title":"Safety and Efficacy of ICP-332 for Moderate to Severe Atopic Dermatitis: A Phase 2 Randomized Clinical Trial.","authors":"Jinhua Xu, Litao Zhang, Yunsheng Liang, Chao Ji, Ai'e Xu, Zhiming Li, Linfeng Li, Tiechi Lei, Chunlei Zhang, Rixin Chen, Xiaohua Tao, Ruzhi Zhang, Hong Fang, Jie Zheng, Wenlin Yang, Guoqiang Zhang, Xinsuo Duan, Yangfeng Ding, Wenhao Yin, Wei Zhou, Danbing Fan, Yue Du","doi":"10.1001/jamadermatol.2025.5295","DOIUrl":"10.1001/jamadermatol.2025.5295","url":null,"abstract":"<p><strong>Importance: </strong>ICP-332 is a tyrosine kinase 2 inhibitor currently under investigation for the treatment of atopic dermatitis (AD).</p><p><strong>Objective: </strong>To evaluate the safety and efficacy of ICP-332 for moderate to severe AD.</p><p><strong>Design, setting, and participants: </strong>This double-blind, placebo-controlled, phase 2 randomized clinical trial was conducted between February 6 and November 7, 2023, across 19 centers in China. Individuals aged 18 to 75 years who had diagnosis of AD for 1 year or longer and a history of contraindication or inadequate response to topical therapies were included.</p><p><strong>Intervention: </strong>Participants were randomized 1:1:1 to receive ICP-332 at 80 mg or 120 mg, or placebo orally once daily for 4 weeks. Study participants and personnel were blinded to group assignment.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was safety. The key efficacy outcome was the percentage change from baseline in Eczema Area and Severity Index (EASI) at week 4. Other outcomes included percentages of patients achieving EASI-75 (a ≥75% improvement in EASI) and Validated Investigator Global Assessment for Atopic Dermatitis score of clear (0) or almost clear (1) with 2 or more points improvement.</p><p><strong>Results: </strong>This study included 75 patients (mean [SD] age, 37.3 [18.0] years in the ICP-332 groups and 44.5 [17.4] years in the placebo group; 21 women [28%] and 54 men [72%]). Among the 74 patients included in the safety set, 17 of 25 (68%) in the placebo group, 19 of 25 (76%) in the 80-mg ICP-332 group, and 18 of 24 (75%) in the 120-mg ICP-332 group experienced treatment-emergent adverse events, with all events being mild or moderate. The most common adverse event was decreased blood fibrinogen (1 of 25 [4%] in the placebo group, 6 of 25 [44%] in the 80-mg ICP-332 group, and 5 of 24 [21%] in the 120-mg ICP-332 group). Percentage reductions in EASI at week 4 were -78.2% (95% CI, -89.8% to -66.6%) in the 80-mg ICP-332 group, -72.5% (95% CI, -84.3% to -60.7%) in the 120-mg ICP-332 group, and -16.7% (95% CI, -28.7% to -4.6%) for those receiving placebo. Mean differences vs placebo for percentage reductions from baseline at week 4 in EASI were -61.6% (95% CI, -78.4% to -44.7%; P < .001) and -55.8% (95% CI, -72.8% to -38.9%; P < .001) for 80-mg ICP-332 and 120-mg ICP-332, respectively. There was a statistically significant higher EASI-75 response rate with both ICP-332 doses (64.0% for each; difference vs placebo, 56.0%; 95% CI, 34.4%-77.6%; P < .001) than with placebo and a greater percentage of Validated Investigator Global Assessment for Atopic Dermatitis score of 0 or 1 and improvement of 2 or more points at week 4 in the 80-mg ICP-332 group vs placebo (36.0%; difference vs placebo, 32.0%; 95% CI, 11.7%-52.3%; P = .005).</p><p><strong>Conclusions and relevance: </strong>In this phase 2 randomized clinical trial, ICP-332 demonstrated a favorable safety pro","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12805489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1001/jamadermatol.2025.4892
Peyton V Warp, Karishma R Desai, Alvaro J Alencar, Jonathan J Cohen, Andrea D Maderal
{"title":"Zanubrutinib for Immunoglobulin A Vasculitis With Monoclonal Gammopathy.","authors":"Peyton V Warp, Karishma R Desai, Alvaro J Alencar, Jonathan J Cohen, Andrea D Maderal","doi":"10.1001/jamadermatol.2025.4892","DOIUrl":"https://doi.org/10.1001/jamadermatol.2025.4892","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1001/jamadermatol.2025.5205
Christopher Willy Schwarz, Nikolai Loft, Lars Erik Bryld, Christoffer Valdemar Nissen, Kawa Khaled Ajgeiy, Trine Bertelsen, Kasper Fjellhaugen Hjuler, Tomas Norman Dam, Lars Iversen, Mads Kirchheiner Rasmussen, Lone Skov
<p><strong>Importance: </strong>Drug survival is an important measure to help guide treatment selection. However, clinical evidence for newer biologics, including bimekizumab, is limited.</p><p><strong>Objective: </strong>To determine the drug survival of biologics used for treating psoriasis in a routine clinical practice setting.</p><p><strong>Design, setting, and participants: </strong>This cohort study was based on data from the DERMBIO registry, which includes all patients treated with biologics for psoriasis in Denmark. All adult patients enrolled in DERMBIO from its inception in May 2007 until June 2025 were assessed for eligibility. Data were extracted in June 2025 and analyzed separately among those without previous biologic exposure (bionaive patients) and those with previous biologic exposure (bioexperienced patients).</p><p><strong>Exposures: </strong>Adalimumab, secukinumab, and ustekinumab among bionaive patients and adalimumab, bimekizumab, brodalumab, guselkumab, ixekizumab, risankizumab, secukinumab, and ustekinumab among bioexperienced patients.</p><p><strong>Main outcomes and measures: </strong>The main outcome was standardized absolute risks of treatment discontinuation at 1, 2, and 5 years. Kaplan-Meier estimator was used to determine crude drug survival estimates and the Aalen-Johansen estimator was used to determine crude cause-specific absolute risks.</p><p><strong>Results: </strong>The study included 4438 unique patients with psoriasis (2717 [61.2%] male; mean [SD] age, 45.0 [14.6] years at the time of their first treatment included in the study), 1039 (23.4%) of whom had comorbid psoriatic arthritis. A total of 3790 treatment series from bionaive patients were analyzed: 2646 were with adalimumab, 377 with secukinumab, and 767 with ustekinumab. The 5-year standardized risk of discontinuing ustekinumab was 0.37 (95% CI, 0.33-0.41), which was significantly lower than the standardized risks for adalimumab (0.51; 95% CI, 0.49-0.54) and secukinumab (0.54; 95% CI, 0.48-0.60). A total of 3403 treatment series from bioexperienced patients were analyzed: 790 were with adalimumab, 376 with bimekizumab, 192 with brodalumab, 218 with guselkumab, 556 with ixekizumab, 78 with risankizumab, 466 with secukinumab, and 727 with ustekinumab. The 2-year standardized absolute risk of discontinuing ustekinumab was 0.39 (95% CI, 0.36-0.43). Only bimekizumab (0.27; 95% CI, 0.20-0.34), guselkumab (0.29; 95% CI, 0.22-0.36), and risankizumab (0.25; 95% CI, 0.15-0.36) were associated with a significantly lower standardized absolute risk of discontinuation compared with ustekinumab.</p><p><strong>Conclusions and relevance: </strong>In this cohort study in Denmark, among bionaive patients with psoriasis, ustekinumab had superior drug survival compared with adalimumab and secukinumab, and among bioexperienced patients with psoriasis, bimekizumab, guselkumab, and risankizumab had superior drug survival. These results offer insight into the performance o
{"title":"Drug Survival of Biologics in Bionaive and Bioexperienced Patients With Psoriasis.","authors":"Christopher Willy Schwarz, Nikolai Loft, Lars Erik Bryld, Christoffer Valdemar Nissen, Kawa Khaled Ajgeiy, Trine Bertelsen, Kasper Fjellhaugen Hjuler, Tomas Norman Dam, Lars Iversen, Mads Kirchheiner Rasmussen, Lone Skov","doi":"10.1001/jamadermatol.2025.5205","DOIUrl":"10.1001/jamadermatol.2025.5205","url":null,"abstract":"<p><strong>Importance: </strong>Drug survival is an important measure to help guide treatment selection. However, clinical evidence for newer biologics, including bimekizumab, is limited.</p><p><strong>Objective: </strong>To determine the drug survival of biologics used for treating psoriasis in a routine clinical practice setting.</p><p><strong>Design, setting, and participants: </strong>This cohort study was based on data from the DERMBIO registry, which includes all patients treated with biologics for psoriasis in Denmark. All adult patients enrolled in DERMBIO from its inception in May 2007 until June 2025 were assessed for eligibility. Data were extracted in June 2025 and analyzed separately among those without previous biologic exposure (bionaive patients) and those with previous biologic exposure (bioexperienced patients).</p><p><strong>Exposures: </strong>Adalimumab, secukinumab, and ustekinumab among bionaive patients and adalimumab, bimekizumab, brodalumab, guselkumab, ixekizumab, risankizumab, secukinumab, and ustekinumab among bioexperienced patients.</p><p><strong>Main outcomes and measures: </strong>The main outcome was standardized absolute risks of treatment discontinuation at 1, 2, and 5 years. Kaplan-Meier estimator was used to determine crude drug survival estimates and the Aalen-Johansen estimator was used to determine crude cause-specific absolute risks.</p><p><strong>Results: </strong>The study included 4438 unique patients with psoriasis (2717 [61.2%] male; mean [SD] age, 45.0 [14.6] years at the time of their first treatment included in the study), 1039 (23.4%) of whom had comorbid psoriatic arthritis. A total of 3790 treatment series from bionaive patients were analyzed: 2646 were with adalimumab, 377 with secukinumab, and 767 with ustekinumab. The 5-year standardized risk of discontinuing ustekinumab was 0.37 (95% CI, 0.33-0.41), which was significantly lower than the standardized risks for adalimumab (0.51; 95% CI, 0.49-0.54) and secukinumab (0.54; 95% CI, 0.48-0.60). A total of 3403 treatment series from bioexperienced patients were analyzed: 790 were with adalimumab, 376 with bimekizumab, 192 with brodalumab, 218 with guselkumab, 556 with ixekizumab, 78 with risankizumab, 466 with secukinumab, and 727 with ustekinumab. The 2-year standardized absolute risk of discontinuing ustekinumab was 0.39 (95% CI, 0.36-0.43). Only bimekizumab (0.27; 95% CI, 0.20-0.34), guselkumab (0.29; 95% CI, 0.22-0.36), and risankizumab (0.25; 95% CI, 0.15-0.36) were associated with a significantly lower standardized absolute risk of discontinuation compared with ustekinumab.</p><p><strong>Conclusions and relevance: </strong>In this cohort study in Denmark, among bionaive patients with psoriasis, ustekinumab had superior drug survival compared with adalimumab and secukinumab, and among bioexperienced patients with psoriasis, bimekizumab, guselkumab, and risankizumab had superior drug survival. These results offer insight into the performance o","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1001/jamadermatol.2025.5268
Debby Cheng, Nora Bensellam, Katherine Sanchez, Aurore D Zhang, Ursula Biba, Sherry Ershadi, Samantha Gregoire, Nikki Zangenah, Lorena A Acevedo-Fontanez, Anne Fladger, Nicholas Theodosakis, Arash Mostaghimi, John S Barbieri
<p><strong>Importance: </strong>Accurate classification of dermatologic conditions using International Classification of Diseases (ICD) codes is essential for research that uses large administrative datasets. Misclassification can be associated with biased epidemiologic estimates and misleading conclusions in population-based studies.</p><p><strong>Objective: </strong>To systematically identify and evaluate validated classification approaches for dermatologic conditions using ICD codes in US-based administrative, claims, or electronic health record data.</p><p><strong>Evidence review: </strong>A systematic review was conducted that was registered with PROSPERO (CRD420250654233) and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of Ovid MEDLINE, Embase, Web of Science, and CINAHL was conducted for studies published from January 1, 2000, to October 21, 2025. The data were analyzed in October 2025. Eligible studies evaluated International Classification of Diseases, Ninth Revision (ICD-9) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes used to identify dermatologic conditions in US-based datasets and reported at least 1 classification metric (eg, positive predictive value). To minimize selection and extraction bias, all screening and data extraction were performed independently by 2 reviewers, with discrepancies resolved by consensus.</p><p><strong>Findings: </strong>A total of 59 studies met inclusion criteria. Most reported positive predictive value, with few reporting sensitivity or specificity. Classification accuracy varied widely by condition and coding strategy. Studies included inflammatory and autoimmune conditions (eg, acne vulgaris, perioral dermatitis, psoriasis, palmoplantar pustulosis, hidradenitis suppurativa, atopic dermatitis, prurigo nodularis, dermatomyositis, cutaneous lupus erythematosus, pyoderma gangrenosum, cutaneous sarcoidosis, pemphigus, pemphigoid, granuloma annulare, alopecia areata, and vitiligo), actinic keratosis and skin cancer, pigmentary and hair disorders (eg, androgenic alopecia, cicatricial alopecia, lichen planopilaris, and melasma), drug reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis), and infections (eg, herpes zoster, herpes simplex virus, and cellulitis or abscess). Classification algorithms that incorporated 2 or more codes, dermatologist attribution, or treatment/procedural data often achieved the highest accuracy. Conditions lacking validated algorithms included seborrheic dermatitis, rosacea, fungal infections, and specific alopecia subtypes.</p><p><strong>Conclusions and relevance: </strong>This systematic review provides a summary of the most accurate classification approaches to identify various dermatologic conditions in large administrative datasets. These results may inform study designs when using these datasets. In addition, some com
重要性：使用国际疾病分类（ICD）代码对皮肤病进行准确分类对于使用大型管理数据集的研究至关重要。在基于人群的研究中，错误分类可能与有偏见的流行病学估计和误导性结论有关。目的：系统地识别和评估在美国行政、索赔或电子健康记录数据中使用ICD代码的皮肤疾病的有效分类方法。证据回顾：系统回顾已在PROSPERO注册（CRD420250654233），并根据系统回顾和荟萃分析指南的首选报告项目进行报告。对2000年1月1日至2025年10月21日期间发表的研究进行了Ovid MEDLINE、Embase、Web of Science和CINAHL的综合检索。这些数据是在2025年10月进行分析的。符合条件的研究评估了用于识别美国数据集中皮肤病的国际疾病分类第九版（ICD-9）或国际疾病和相关健康问题统计分类第十版（ICD-10）代码，并报告了至少1个分类指标（例如，阳性预测值）。为了尽量减少选择和提取的偏倚，所有筛选和数据提取均由2位审稿人独立完成，差异通过共识解决。结果：共有59项研究符合纳入标准。大多数报告阳性预测值，很少报告敏感性或特异性。分类精度因条件和编码策略的不同而有很大差异。研究包括炎症和自身免疫性疾病（如：寻常痤疮、口周皮炎、银屑病、掌跖脓肿、化脓性汗腺炎、特应性皮炎、结节性痒疹、皮肌炎、皮肤红斑狼疮、坏疽性脓皮病、皮肤结节病、天疱疮、类天疱疮、环状肉芽肿、斑秃和白癜风）、光化性角化病和皮肤癌、色素和头发疾病(如：雄激素性脱发、瘢痕性脱发、扁平苔藓、和黄褐斑)、药物反应（如史蒂文斯-约翰逊综合征、中毒性表皮坏死松解）和感染（如带状疱疹、单纯疱疹病毒、蜂窝织炎或脓肿）。包含2个或更多代码、皮肤科医生归因或治疗/程序数据的分类算法通常达到最高的准确性。缺乏有效算法的条件包括脂溢性皮炎、酒渣鼻、真菌感染和特定的脱发亚型。结论和相关性：本系统综述总结了在大型管理数据集中识别各种皮肤病的最准确分类方法。当使用这些数据集时，这些结果可以为研究设计提供信息。此外，一些常见情况缺乏经过验证的分类方法，这突出了未来研究的重要领域。随着行政和电子健康记录数据越来越多地支持皮肤病学研究，使用严格验证的算法对于产生可信的发现至关重要。
{"title":"Validation of International Classification of Diseases Codes for Dermatologic Conditions: A Systematic Review.","authors":"Debby Cheng, Nora Bensellam, Katherine Sanchez, Aurore D Zhang, Ursula Biba, Sherry Ershadi, Samantha Gregoire, Nikki Zangenah, Lorena A Acevedo-Fontanez, Anne Fladger, Nicholas Theodosakis, Arash Mostaghimi, John S Barbieri","doi":"10.1001/jamadermatol.2025.5268","DOIUrl":"https://doi.org/10.1001/jamadermatol.2025.5268","url":null,"abstract":"<p><strong>Importance: </strong>Accurate classification of dermatologic conditions using International Classification of Diseases (ICD) codes is essential for research that uses large administrative datasets. Misclassification can be associated with biased epidemiologic estimates and misleading conclusions in population-based studies.</p><p><strong>Objective: </strong>To systematically identify and evaluate validated classification approaches for dermatologic conditions using ICD codes in US-based administrative, claims, or electronic health record data.</p><p><strong>Evidence review: </strong>A systematic review was conducted that was registered with PROSPERO (CRD420250654233) and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of Ovid MEDLINE, Embase, Web of Science, and CINAHL was conducted for studies published from January 1, 2000, to October 21, 2025. The data were analyzed in October 2025. Eligible studies evaluated International Classification of Diseases, Ninth Revision (ICD-9) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes used to identify dermatologic conditions in US-based datasets and reported at least 1 classification metric (eg, positive predictive value). To minimize selection and extraction bias, all screening and data extraction were performed independently by 2 reviewers, with discrepancies resolved by consensus.</p><p><strong>Findings: </strong>A total of 59 studies met inclusion criteria. Most reported positive predictive value, with few reporting sensitivity or specificity. Classification accuracy varied widely by condition and coding strategy. Studies included inflammatory and autoimmune conditions (eg, acne vulgaris, perioral dermatitis, psoriasis, palmoplantar pustulosis, hidradenitis suppurativa, atopic dermatitis, prurigo nodularis, dermatomyositis, cutaneous lupus erythematosus, pyoderma gangrenosum, cutaneous sarcoidosis, pemphigus, pemphigoid, granuloma annulare, alopecia areata, and vitiligo), actinic keratosis and skin cancer, pigmentary and hair disorders (eg, androgenic alopecia, cicatricial alopecia, lichen planopilaris, and melasma), drug reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis), and infections (eg, herpes zoster, herpes simplex virus, and cellulitis or abscess). Classification algorithms that incorporated 2 or more codes, dermatologist attribution, or treatment/procedural data often achieved the highest accuracy. Conditions lacking validated algorithms included seborrheic dermatitis, rosacea, fungal infections, and specific alopecia subtypes.</p><p><strong>Conclusions and relevance: </strong>This systematic review provides a summary of the most accurate classification approaches to identify various dermatologic conditions in large administrative datasets. These results may inform study designs when using these datasets. In addition, some com","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1001/jamadermatol.2025.4097
Daniel R Mazori, Ruth Ann Vleugels, Alisa N Femia
{"title":"Eosinophilic Fasciitis.","authors":"Daniel R Mazori, Ruth Ann Vleugels, Alisa N Femia","doi":"10.1001/jamadermatol.2025.4097","DOIUrl":"https://doi.org/10.1001/jamadermatol.2025.4097","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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