Pub Date : 2026-01-28DOI: 10.1001/jamadermatol.2025.5644
Nawar Tarafdar, Meghna Varambally, Nima Karimi, Edgar Akuffo-Addo, John R Ingram, Vincent Piguet
<p><strong>Importance: </strong>Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with high psychosocial burden. Despite growing use of patient-reported outcome measures (PROMs) in HS trials, variance in quality and validation of existing instruments remains to be studied.</p><p><strong>Objective: </strong>To systematically review HS-specific PROMs using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) framework, evaluating development quality and psychometric evidence, and to perform a meta-analysis of key properties to summarize the evidence base and provide recommendations for clinical and research use.</p><p><strong>Data sources: </strong>MEDLINE, Embase, and PubMed were searched from inception to October 23, 2025, for English-language studies.</p><p><strong>Study selection: </strong>Articles describing the development or validation of HS-specific PROMs that evaluated at least 1 psychometric property were included. Generic instruments (eg, Dermatology Life Quality Index, pain numeric rating scale) were excluded. Screening was conducted by 2 independent reviewers.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently extracted data, appraised risk of bias with the COSMIN checklist, and graded quality of evidence using COSMIN-modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Random-effects meta-analysis pooled Cronbach α and correlation coefficients; heterogeneity was quantified using I2.</p><p><strong>Main outcomes and measures: </strong>COSMIN-guided appraisal and graded quality of evidence of PROM measurement properties, including content validity, structural validity, internal consistency, reliability, responsiveness, and measurement error.</p><p><strong>Results: </strong>Of 504 records screened, 26 studies (14 developmental, 12 validation) met the criteria (total number of patients across 26 studies was 5811; age ranged from median 33.9 [range, 25-41] to mean [SD] 46.9 [14.1] years), identifying 15 unique HS-specific PROMs (10 health-related quality of life, 4 symptom, 1 treatment benefit). Fourteen achieved sufficient content validity and 8 met the highest standards for rigorous instrument development. Meta-analysis demonstrated strong internal consistency and construct validity for the 17-item Hidradenitis Suppurativa Quality of Life (HiSQOL-17) PROM (pooled Cronbach α = 0.94; I2 = 81.3%; pooled Pearson r = 0.84; I2 = 74%; pooled Spearman r = 0.88, I2 = 29%). Of 7 evaluated PROMs, 2 displayed sufficient internal consistency. The remainder were indeterminate due to absent or low-quality evidence for unidimensionality. Test-retest reliability was sufficient in 9 PROMs, and responsiveness was rated sufficient in 5. No studies evaluated measurement error. Seven PROMs met COSMIN criteria for recommendation.</p><p><strong>Conclusions and relevance: </strong>In this study, 7 PROMs demonstrated sufficiency of both content
{"title":"Hidradenitis Suppurativa Patient-Reported Outcome Measures: A Systematic Review and Meta-Analysis.","authors":"Nawar Tarafdar, Meghna Varambally, Nima Karimi, Edgar Akuffo-Addo, John R Ingram, Vincent Piguet","doi":"10.1001/jamadermatol.2025.5644","DOIUrl":"10.1001/jamadermatol.2025.5644","url":null,"abstract":"<p><strong>Importance: </strong>Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with high psychosocial burden. Despite growing use of patient-reported outcome measures (PROMs) in HS trials, variance in quality and validation of existing instruments remains to be studied.</p><p><strong>Objective: </strong>To systematically review HS-specific PROMs using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) framework, evaluating development quality and psychometric evidence, and to perform a meta-analysis of key properties to summarize the evidence base and provide recommendations for clinical and research use.</p><p><strong>Data sources: </strong>MEDLINE, Embase, and PubMed were searched from inception to October 23, 2025, for English-language studies.</p><p><strong>Study selection: </strong>Articles describing the development or validation of HS-specific PROMs that evaluated at least 1 psychometric property were included. Generic instruments (eg, Dermatology Life Quality Index, pain numeric rating scale) were excluded. Screening was conducted by 2 independent reviewers.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently extracted data, appraised risk of bias with the COSMIN checklist, and graded quality of evidence using COSMIN-modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Random-effects meta-analysis pooled Cronbach α and correlation coefficients; heterogeneity was quantified using I2.</p><p><strong>Main outcomes and measures: </strong>COSMIN-guided appraisal and graded quality of evidence of PROM measurement properties, including content validity, structural validity, internal consistency, reliability, responsiveness, and measurement error.</p><p><strong>Results: </strong>Of 504 records screened, 26 studies (14 developmental, 12 validation) met the criteria (total number of patients across 26 studies was 5811; age ranged from median 33.9 [range, 25-41] to mean [SD] 46.9 [14.1] years), identifying 15 unique HS-specific PROMs (10 health-related quality of life, 4 symptom, 1 treatment benefit). Fourteen achieved sufficient content validity and 8 met the highest standards for rigorous instrument development. Meta-analysis demonstrated strong internal consistency and construct validity for the 17-item Hidradenitis Suppurativa Quality of Life (HiSQOL-17) PROM (pooled Cronbach α = 0.94; I2 = 81.3%; pooled Pearson r = 0.84; I2 = 74%; pooled Spearman r = 0.88, I2 = 29%). Of 7 evaluated PROMs, 2 displayed sufficient internal consistency. The remainder were indeterminate due to absent or low-quality evidence for unidimensionality. Test-retest reliability was sufficient in 9 PROMs, and responsiveness was rated sufficient in 5. No studies evaluated measurement error. Seven PROMs met COSMIN criteria for recommendation.</p><p><strong>Conclusions and relevance: </strong>In this study, 7 PROMs demonstrated sufficiency of both content ","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063361","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 : 2026-01-28DOI: 10.1001/jamadermatol.2025.5449
Elise Edwards, Ladonya Jackson-Cowan, Nicole Khalil, Qai Ven Yap, Gil Yosipovitch
{"title":"Sleep Disturbance as a Mediator Between Itch and Quality of Life.","authors":"Elise Edwards, Ladonya Jackson-Cowan, Nicole Khalil, Qai Ven Yap, Gil Yosipovitch","doi":"10.1001/jamadermatol.2025.5449","DOIUrl":"10.1001/jamadermatol.2025.5449","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063391","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 : 2026-01-28DOI: 10.1001/jamadermatol.2025.5331
Heba Ahmed, Sarah Elsayed, Ghada El-Kamah, Heba El-Sayed, Khalda Amr, Randa M A M El-Mofty, Mohamed H M El-Komy
{"title":"Novel Sodium-Dependent Multivitamin Transporter Variant Mimicking Acrodermatitis Enteropathica.","authors":"Heba Ahmed, Sarah Elsayed, Ghada El-Kamah, Heba El-Sayed, Khalda Amr, Randa M A M El-Mofty, Mohamed H M El-Komy","doi":"10.1001/jamadermatol.2025.5331","DOIUrl":"https://doi.org/10.1001/jamadermatol.2025.5331","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063422","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 : 2026-01-28DOI: 10.1001/jamadermatol.2025.5662
Elena C de Rosas, Justin C Wang, Christina K Zigler, Kathryn S Torok
<p><strong>Importance: </strong>Currently, there are no treatments approved by the US Food and Drug Administration for juvenile localized scleroderma (JLS), a rare disease. While methotrexate (MTX) is regularly used as a first-line therapy, emerging data from case series and applications in systemic sclerosis suggest that mycophenolate mofetil (MMF) may be clinically comparable, with potential benefits in tolerability and adherence.</p><p><strong>Objective: </strong>To compare clinical outcomes of patients with JLS treated with MTX and MMF using standardized clinical outcome measures.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study of patients with clinician-diagnosed JLS who were enrolled in the National Registry of Childhood Onset Scleroderma was conducted at UPMC Children's Hospital of Pittsburgh. Data were from January 2010 to January 2023 and first analyzed in April 2023. All patients were evaluated and followed up by the same physician. Patients were included if they had disease onset before age 18 years and a localized scleroderma diagnosis and enrollment in the National Registry of Childhood Onset Scleroderma before age 21 years. Patients were required to be receiving MTX monotherapy, MMF monotherapy, or combination therapy (CT) of the 2 for their localized scleroderma.</p><p><strong>Exposures: </strong>Patients were treated with MTX, MMF, or CT as prescribed by the examining physician.</p><p><strong>Main outcomes and measures: </strong>This study measured comparative medication treatment response through associations with disease activity, as measured using the Localized Scleroderma Cutaneous Assessment Tool.</p><p><strong>Results: </strong>Of 114 patients, 77 (67.5%) were female, and the median (IQR) age at onset was 8.3 (5.4-11.2) years. The MTX, MMF, and CT groups included 68 (59.6%), 28 (24.6%), and 18 patients (15.8%), respectively. There were no significant differences in baseline demographic characteristics, disease subtype, or disease severity between groups, but patients in the MMF group had longer disease duration. Mixed-effects modeling showed statistically significant decreases in activity across all groups (β = -0.14; 95% CI, -0.62 to 0.33). A Kaplan-Meier analysis showed no significant difference in disease flare rate over the follow-up interval (hazard ratio, 0.85; 95% CI, 0.51-1.33). However, patients treated with MTX compared with those treated with MMF had significantly higher rates of fatigue (47% vs. 11%, P = .001) and nausea (60% vs. 7%; P = .001).</p><p><strong>Conclusions and relevance: </strong>The study results suggest that MMF demonstrated a similar response to treatment as MTX in reducing disease activity in JLS, with comparable flare rates and improved tolerability. These initial findings support MMF as a potential candidate for first-line treatment of JLS. Prospective, randomized, noninferiority trials are warranted to confirm these results and guide future treatment
{"title":"Methotrexate and Mycophenolate Mofetil and Clinical Response in Juvenile Localized Scleroderma.","authors":"Elena C de Rosas, Justin C Wang, Christina K Zigler, Kathryn S Torok","doi":"10.1001/jamadermatol.2025.5662","DOIUrl":"10.1001/jamadermatol.2025.5662","url":null,"abstract":"<p><strong>Importance: </strong>Currently, there are no treatments approved by the US Food and Drug Administration for juvenile localized scleroderma (JLS), a rare disease. While methotrexate (MTX) is regularly used as a first-line therapy, emerging data from case series and applications in systemic sclerosis suggest that mycophenolate mofetil (MMF) may be clinically comparable, with potential benefits in tolerability and adherence.</p><p><strong>Objective: </strong>To compare clinical outcomes of patients with JLS treated with MTX and MMF using standardized clinical outcome measures.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study of patients with clinician-diagnosed JLS who were enrolled in the National Registry of Childhood Onset Scleroderma was conducted at UPMC Children's Hospital of Pittsburgh. Data were from January 2010 to January 2023 and first analyzed in April 2023. All patients were evaluated and followed up by the same physician. Patients were included if they had disease onset before age 18 years and a localized scleroderma diagnosis and enrollment in the National Registry of Childhood Onset Scleroderma before age 21 years. Patients were required to be receiving MTX monotherapy, MMF monotherapy, or combination therapy (CT) of the 2 for their localized scleroderma.</p><p><strong>Exposures: </strong>Patients were treated with MTX, MMF, or CT as prescribed by the examining physician.</p><p><strong>Main outcomes and measures: </strong>This study measured comparative medication treatment response through associations with disease activity, as measured using the Localized Scleroderma Cutaneous Assessment Tool.</p><p><strong>Results: </strong>Of 114 patients, 77 (67.5%) were female, and the median (IQR) age at onset was 8.3 (5.4-11.2) years. The MTX, MMF, and CT groups included 68 (59.6%), 28 (24.6%), and 18 patients (15.8%), respectively. There were no significant differences in baseline demographic characteristics, disease subtype, or disease severity between groups, but patients in the MMF group had longer disease duration. Mixed-effects modeling showed statistically significant decreases in activity across all groups (β = -0.14; 95% CI, -0.62 to 0.33). A Kaplan-Meier analysis showed no significant difference in disease flare rate over the follow-up interval (hazard ratio, 0.85; 95% CI, 0.51-1.33). However, patients treated with MTX compared with those treated with MMF had significantly higher rates of fatigue (47% vs. 11%, P = .001) and nausea (60% vs. 7%; P = .001).</p><p><strong>Conclusions and relevance: </strong>The study results suggest that MMF demonstrated a similar response to treatment as MTX in reducing disease activity in JLS, with comparable flare rates and improved tolerability. These initial findings support MMF as a potential candidate for first-line treatment of JLS. Prospective, randomized, noninferiority trials are warranted to confirm these results and guide future treatment ","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063426","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 : 2026-01-28DOI: 10.1001/jamadermatol.2025.5700
Kirstine Duffau, Louise Baandrup, Kirsten Frederiksen, Tatiana Hansen, Allan Jensen, Nina L Mårtensson, Merete Hædersdal, Susanne K Kjær
<p><strong>Importance: </strong>Cutaneous squamous cell carcinoma (cSCC), cSCC in situ (CIS), and keratoacanthoma (KA) pose growing public health challenges, due to their associated morbidity, health care burden and costs. However, many countries lack systematic registration of these extremely frequent keratinocyte neoplasms.</p><p><strong>Objective: </strong>To estimate incidence rates and trends of first-time, histologically confirmed cSCC, CIS, and KA in Denmark (2005-2023) by sex, age, and anatomical site.</p><p><strong>Design, setting, and participants: </strong>A nationwide, population-based study using data from the Danish Pathology Registry and Cancer Registry was conducted, including individuals 20 years or older receiving a first-time diagnosis of cSCC, CIS, or KA from January 1, 2005 to December 31, 2023. Data analyses were conducted from January to July 2025.</p><p><strong>Main outcomes and measures: </strong>Age-standardized incidence rates (ASIRs) as well as age-specific incidence rates per 100 000 person-years with corresponding estimated annual percentage changes (EAPCs) and 95% CIs were calculated.</p><p><strong>Results: </strong>A total of 109 787 histologically confirmed cases were identified in 95 352 unique individuals (55 891 male individuals [50.9%], 53 896 female individuals [49.1%]) 20 years or older in Denmark, receiving a first-time diagnosis of cSCC (n = 54 563), CIS (n = 31 712), or KA (n = 23 512). From 2005 to 2023, cSCC ASIRs increased (EAPC for male individuals, 2.6%; EAPC for female individuals, 3.1%), reaching 131.6 and 77.7 per 100 000 person-years in male individuals and female individuals, respectively. CIS increased markedly (EAPC, for male individuals, 6.4%; EAPC for female individuals, 5.8%), and KA declined. Stratified analyses showed distinct sex-specific anatomic patterns. Predilection sites for cSCC and CIS were the face, scalp, and neck, with particular predominance among male individuals. Female individuals exhibited higher ASIRs on the lower limbs compared with male individuals (male vs female individuals: cSCC, 7.63 vs 12.32 per 100 000; CIS, 6.21 vs 12.63 per 100 000; KA, 3.47 vs 7.20 per 100 000, respectively). KA primarily affected the extremities. Female individuals aged 40 to 59 years showed higher incidence rates than male individuals across all keratinocyte neoplasms (male vs female individuals: cSCC, 131.6 vs. 77.7 per 100 000; CIS, 89.4 vs. 78.6 per 100 000; KA 28.6 vs. 27.6 per 100 000, respectively). Trends among individuals younger than 50 years with cSCC and KA were stable.</p><p><strong>Conclusions and relevance: </strong>In this nationwide cohort study presenting the most comprehensive dataset of incident cSCC, CIS, and KA, with 109 787 histologically confirmed patient cases, covering nearly 2 decades and spanning across all Danish health care sectors, incidence of cSCC and CIS continued to rise, consequently affecting more people, and sex differences diminished. Stabilizing trends i
{"title":"Incidence Trends of Cutaneous Squamous Cell Carcinoma, Carcinoma In Situ, and Keratoacanthoma By Sex, Age, and Anatomical Site.","authors":"Kirstine Duffau, Louise Baandrup, Kirsten Frederiksen, Tatiana Hansen, Allan Jensen, Nina L Mårtensson, Merete Hædersdal, Susanne K Kjær","doi":"10.1001/jamadermatol.2025.5700","DOIUrl":"10.1001/jamadermatol.2025.5700","url":null,"abstract":"<p><strong>Importance: </strong>Cutaneous squamous cell carcinoma (cSCC), cSCC in situ (CIS), and keratoacanthoma (KA) pose growing public health challenges, due to their associated morbidity, health care burden and costs. However, many countries lack systematic registration of these extremely frequent keratinocyte neoplasms.</p><p><strong>Objective: </strong>To estimate incidence rates and trends of first-time, histologically confirmed cSCC, CIS, and KA in Denmark (2005-2023) by sex, age, and anatomical site.</p><p><strong>Design, setting, and participants: </strong>A nationwide, population-based study using data from the Danish Pathology Registry and Cancer Registry was conducted, including individuals 20 years or older receiving a first-time diagnosis of cSCC, CIS, or KA from January 1, 2005 to December 31, 2023. Data analyses were conducted from January to July 2025.</p><p><strong>Main outcomes and measures: </strong>Age-standardized incidence rates (ASIRs) as well as age-specific incidence rates per 100 000 person-years with corresponding estimated annual percentage changes (EAPCs) and 95% CIs were calculated.</p><p><strong>Results: </strong>A total of 109 787 histologically confirmed cases were identified in 95 352 unique individuals (55 891 male individuals [50.9%], 53 896 female individuals [49.1%]) 20 years or older in Denmark, receiving a first-time diagnosis of cSCC (n = 54 563), CIS (n = 31 712), or KA (n = 23 512). From 2005 to 2023, cSCC ASIRs increased (EAPC for male individuals, 2.6%; EAPC for female individuals, 3.1%), reaching 131.6 and 77.7 per 100 000 person-years in male individuals and female individuals, respectively. CIS increased markedly (EAPC, for male individuals, 6.4%; EAPC for female individuals, 5.8%), and KA declined. Stratified analyses showed distinct sex-specific anatomic patterns. Predilection sites for cSCC and CIS were the face, scalp, and neck, with particular predominance among male individuals. Female individuals exhibited higher ASIRs on the lower limbs compared with male individuals (male vs female individuals: cSCC, 7.63 vs 12.32 per 100 000; CIS, 6.21 vs 12.63 per 100 000; KA, 3.47 vs 7.20 per 100 000, respectively). KA primarily affected the extremities. Female individuals aged 40 to 59 years showed higher incidence rates than male individuals across all keratinocyte neoplasms (male vs female individuals: cSCC, 131.6 vs. 77.7 per 100 000; CIS, 89.4 vs. 78.6 per 100 000; KA 28.6 vs. 27.6 per 100 000, respectively). Trends among individuals younger than 50 years with cSCC and KA were stable.</p><p><strong>Conclusions and relevance: </strong>In this nationwide cohort study presenting the most comprehensive dataset of incident cSCC, CIS, and KA, with 109 787 histologically confirmed patient cases, covering nearly 2 decades and spanning across all Danish health care sectors, incidence of cSCC and CIS continued to rise, consequently affecting more people, and sex differences diminished. Stabilizing trends i","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063424","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 : 2026-01-21DOI: 10.1001/jamadermatol.2025.5545
Varshini Babu, Daniel B Shin, Lynn Onstad, Joseph A Pidala, George Chen, Catherine J Lee, Carrie L Kitko, Paul A Carpenter, Corey Cutler, Najla El Jurdi, Alison W Loren, Joel M Gelfand, Stephanie J Lee, Emily Baumrin
<p><strong>Importance: </strong>Clinician-reported and patient-reported outcomes are critical measures of therapeutic efficacy in cutaneous chronic graft-vs-host disease (cGVHD) but are not always correlated. Discordance in treatment response between clinicians and patients hinders interpretation of outcomes in clinical trials and complicates therapeutic decision-making in clinical practice.</p><p><strong>Objective: </strong>To identify factors associated with discordance in clinician-reported and patient-reported treatment response assessments and to evaluate the association of clinician-reported and patient-reported responses with survival.</p><p><strong>Design, setting, and participants: </strong>This multicenter longitudinal cohort study included adults 18 years and older with cutaneous cGVHD at study enrollment, assembled from 2 observational studies and 1 randomized clinical trial. Data were collected from August 2007 to March 2024, and data were analyzed from July 2024 to May 2025.</p><p><strong>Main outcomes and measures: </strong>A global 8-point cutaneous cGVHD treatment response assessment (with 1 indicating resolved and 8 indicating very much worse) was reported by clinicians and patients 3 to 6 months after study enrollment. Clinician-reported and patient-reported treatment responses were categorized into improved, stable, and worse from the 8-point scale, and discordance was defined as a difference in response between clinicians and patients. Positive clinician discordance indicates the clinician reported a better response than the patient, and negative clinician discordance indicates the clinician reported a worse response than the patient. The association of clinician-reported and patient-reported responses with survival was measured by nonrelapse mortality.</p><p><strong>Results: </strong>Of 489 adults with cutaneous cGVHD, 192 (39.3%) were female, 297 (60.7%) were male, and the median (IQR) age was 55 (43-62) years. A total of 321 adults (65.6%) had concordant responses and 168 (34.4%) had discordant responses between clinician-reported and patient-reported treatment responses. Patients with sclerotic cGVHD had greater odds of discordance compared with those without sclerosis, with clinicians reporting both better and worse treatment response than patients (positive clinician discordance: adjusted odds ratio, 3.14; 95% CI, 1.41-6.95; P = .005; negative clinician discordance: adjusted odds ratio, 2.33; 95% CI, 1.19-4.56; P = .01). Worsening compared with improved overall cutaneous cGVHD was associated with nonrelapse mortality when reported by clinicians (adjusted hazard ratio, 2.28; 95% CI, 1.46-3.54; P < .001) and patients (adjusted hazard ratio, 1.86; 95% CI, 1.12-3.08; P = .02), while only patient-reported worsening was significantly associated with nonrelapse mortality in patients with sclerotic disease (adjusted hazard ratio, 2.00; 95% CI, 1.02-3.90; P = .04).</p><p><strong>Conclusions and relevance: </strong>In this cohort
{"title":"Discordance in Treatment Response Assessment Between Clinicians and Patients With Skin Chronic Graft-vs-Host Disease.","authors":"Varshini Babu, Daniel B Shin, Lynn Onstad, Joseph A Pidala, George Chen, Catherine J Lee, Carrie L Kitko, Paul A Carpenter, Corey Cutler, Najla El Jurdi, Alison W Loren, Joel M Gelfand, Stephanie J Lee, Emily Baumrin","doi":"10.1001/jamadermatol.2025.5545","DOIUrl":"10.1001/jamadermatol.2025.5545","url":null,"abstract":"<p><strong>Importance: </strong>Clinician-reported and patient-reported outcomes are critical measures of therapeutic efficacy in cutaneous chronic graft-vs-host disease (cGVHD) but are not always correlated. Discordance in treatment response between clinicians and patients hinders interpretation of outcomes in clinical trials and complicates therapeutic decision-making in clinical practice.</p><p><strong>Objective: </strong>To identify factors associated with discordance in clinician-reported and patient-reported treatment response assessments and to evaluate the association of clinician-reported and patient-reported responses with survival.</p><p><strong>Design, setting, and participants: </strong>This multicenter longitudinal cohort study included adults 18 years and older with cutaneous cGVHD at study enrollment, assembled from 2 observational studies and 1 randomized clinical trial. Data were collected from August 2007 to March 2024, and data were analyzed from July 2024 to May 2025.</p><p><strong>Main outcomes and measures: </strong>A global 8-point cutaneous cGVHD treatment response assessment (with 1 indicating resolved and 8 indicating very much worse) was reported by clinicians and patients 3 to 6 months after study enrollment. Clinician-reported and patient-reported treatment responses were categorized into improved, stable, and worse from the 8-point scale, and discordance was defined as a difference in response between clinicians and patients. Positive clinician discordance indicates the clinician reported a better response than the patient, and negative clinician discordance indicates the clinician reported a worse response than the patient. The association of clinician-reported and patient-reported responses with survival was measured by nonrelapse mortality.</p><p><strong>Results: </strong>Of 489 adults with cutaneous cGVHD, 192 (39.3%) were female, 297 (60.7%) were male, and the median (IQR) age was 55 (43-62) years. A total of 321 adults (65.6%) had concordant responses and 168 (34.4%) had discordant responses between clinician-reported and patient-reported treatment responses. Patients with sclerotic cGVHD had greater odds of discordance compared with those without sclerosis, with clinicians reporting both better and worse treatment response than patients (positive clinician discordance: adjusted odds ratio, 3.14; 95% CI, 1.41-6.95; P = .005; negative clinician discordance: adjusted odds ratio, 2.33; 95% CI, 1.19-4.56; P = .01). Worsening compared with improved overall cutaneous cGVHD was associated with nonrelapse mortality when reported by clinicians (adjusted hazard ratio, 2.28; 95% CI, 1.46-3.54; P < .001) and patients (adjusted hazard ratio, 1.86; 95% CI, 1.12-3.08; P = .02), while only patient-reported worsening was significantly associated with nonrelapse mortality in patients with sclerotic disease (adjusted hazard ratio, 2.00; 95% CI, 1.02-3.90; P = .04).</p><p><strong>Conclusions and relevance: </strong>In this cohort","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010569","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 : 2026-01-21DOI: 10.1001/jamadermatol.2025.5443
Maria C Schneeweiss, Richard Wyss, Priyanka Anand, Yinzhu Jin, Arash Mostaghimi, John Barbieri, Joseph F Merola, Jonathan I Silverberg, David M Rosmarin, Robert J Glynn, Sebastian Schneeweiss
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Pub Date : 2026-01-21DOI: 10.1001/jamadermatol.2025.5597
Courtney A Smith, Oumaima Kaabi, Amita K Manatunga, Timothy L Lash, Michael J Silverberg, Darios Getahun, Suma Vupputuri, Courtney E McCracken, Suephy C Chen, Vin Tangpricha, Michael Goodman, Howa Yeung
<p><strong>Importance: </strong>Acne commonly affects transgender individuals prescribed gender-affirming hormone therapy, yet population-level incidence data remain limited.</p><p><strong>Objective: </strong>To compare the incidence of acne and moderate to severe acne in transgender individuals, including those initiating gender-affirming hormone therapy, with matched cisgender individuals.</p><p><strong>Design, setting, and participants: </strong>A retrospective matched cohort study of electronic health record data was carried out across 4 Kaiser Permanente health plan regions. Index dates were the earliest documentation of transgender status, ranging from January 2006 to February 2022, with up to 5 years of follow-up. Participants included individuals without baseline acne, transmasculine individuals, and transfeminine individuals matched with cisgender male and female individuals. Analyses were conducted from November 2024 to November 2025.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was incident acne (first acne-coded visit after the index date). The secondary outcome was moderate to severe acne (incident acne followed by prescription fill for isotretinoin or 30 or more days of oral antibiotics). Exploratory analyses compared acne care utilization by transgender status.</p><p><strong>Results: </strong>Overall, 280 997 individuals without baseline acne, including 11 234 transmasculine and 9486 transfeminine individuals, were matched to 132 462 cisgender men and 127 815 cisgender women on age, self-reported race and ethnicity (25 340 Asian [9.0%]; 23 234 non-Hispanic Black [8.3%]; 56 876 Hispanic [20.2%]; 153 666 non-Hispanic White [54.7%]; 6989 other [2.5%]), enrollment year, and region. Of these, 12 156 transgender individuals initiated gender-affirming hormone therapy after the index date. The mean (SD) age at index date was 27.7 (10.0) years for transmasculine individuals and 33.2 (13.5) years for transfeminine individuals. Cumulative incidence of acne at 5 years was 15.8% in transmasculine individuals, 3.8% in matched cisgender male individuals, and 10.5% in matched cisgender female individuals and was 6.0% in transfeminine individuals, 2.9% in matched cisgender men, and 8.4% in matched cisgender women. Acne risk in transmasculine individuals was highest in the first year after testosterone initiation (vs matched cisgender male individuals: hazard ratio (HR), 8.29; 95% CI, 7.11-9.68; vs matched cisgender female individuals: HR, 2.63; 95% CI, 2.33-2.97) and remained higher in subsequent years than among cisgender men (HR, 5.29; 95% CI, 4.45-6.28) and cisgender women (HR, 1.69; 95% CI, 1.46-1.96). Acne risk was higher in transfeminine individuals after starting estradiol than cisgender men (HR, 1.56; 95% CI, 1.31-1.84) and lower than cisgender women (HR, 0.53; 95% CI, 0.46-0.62). Moderate to severe acne incidence followed similar patterns.</p><p><strong>Conclusions and relevance: </strong>This study revealed disti
{"title":"Acne Incidence and Severity in Transgender Individuals.","authors":"Courtney A Smith, Oumaima Kaabi, Amita K Manatunga, Timothy L Lash, Michael J Silverberg, Darios Getahun, Suma Vupputuri, Courtney E McCracken, Suephy C Chen, Vin Tangpricha, Michael Goodman, Howa Yeung","doi":"10.1001/jamadermatol.2025.5597","DOIUrl":"10.1001/jamadermatol.2025.5597","url":null,"abstract":"<p><strong>Importance: </strong>Acne commonly affects transgender individuals prescribed gender-affirming hormone therapy, yet population-level incidence data remain limited.</p><p><strong>Objective: </strong>To compare the incidence of acne and moderate to severe acne in transgender individuals, including those initiating gender-affirming hormone therapy, with matched cisgender individuals.</p><p><strong>Design, setting, and participants: </strong>A retrospective matched cohort study of electronic health record data was carried out across 4 Kaiser Permanente health plan regions. Index dates were the earliest documentation of transgender status, ranging from January 2006 to February 2022, with up to 5 years of follow-up. Participants included individuals without baseline acne, transmasculine individuals, and transfeminine individuals matched with cisgender male and female individuals. Analyses were conducted from November 2024 to November 2025.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was incident acne (first acne-coded visit after the index date). The secondary outcome was moderate to severe acne (incident acne followed by prescription fill for isotretinoin or 30 or more days of oral antibiotics). Exploratory analyses compared acne care utilization by transgender status.</p><p><strong>Results: </strong>Overall, 280 997 individuals without baseline acne, including 11 234 transmasculine and 9486 transfeminine individuals, were matched to 132 462 cisgender men and 127 815 cisgender women on age, self-reported race and ethnicity (25 340 Asian [9.0%]; 23 234 non-Hispanic Black [8.3%]; 56 876 Hispanic [20.2%]; 153 666 non-Hispanic White [54.7%]; 6989 other [2.5%]), enrollment year, and region. Of these, 12 156 transgender individuals initiated gender-affirming hormone therapy after the index date. The mean (SD) age at index date was 27.7 (10.0) years for transmasculine individuals and 33.2 (13.5) years for transfeminine individuals. Cumulative incidence of acne at 5 years was 15.8% in transmasculine individuals, 3.8% in matched cisgender male individuals, and 10.5% in matched cisgender female individuals and was 6.0% in transfeminine individuals, 2.9% in matched cisgender men, and 8.4% in matched cisgender women. Acne risk in transmasculine individuals was highest in the first year after testosterone initiation (vs matched cisgender male individuals: hazard ratio (HR), 8.29; 95% CI, 7.11-9.68; vs matched cisgender female individuals: HR, 2.63; 95% CI, 2.33-2.97) and remained higher in subsequent years than among cisgender men (HR, 5.29; 95% CI, 4.45-6.28) and cisgender women (HR, 1.69; 95% CI, 1.46-1.96). Acne risk was higher in transfeminine individuals after starting estradiol than cisgender men (HR, 1.56; 95% CI, 1.31-1.84) and lower than cisgender women (HR, 0.53; 95% CI, 0.46-0.62). Moderate to severe acne incidence followed similar patterns.</p><p><strong>Conclusions and relevance: </strong>This study revealed disti","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010580","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}
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