[This corrects the article DOI: 10.1002/jvc2.70093.].
[This corrects the article DOI: 10.1002/jvc2.70093.].
Background: Chronic spontaneous urticaria (CSU) is a mast cell-driven condition defined by recurrent wheals and/or angioedema lasting over 6 weeks without an identifiable trigger. Though CSU is known to co-occur with atopic diseases and share Th2-dominant immunologic pathways, prior studies have not adequately addressed these relationships in diverse populations.
Objectives: To examine associations between CSU and atopic comorbidities in the All of Us (AoU) research program, a diverse, nationwide National Institutes of Health cohort focused on increasing enrollment from historically underrepresented groups.
Methods: We conducted a matched, case-control study of AoU participants aged ≧ 18 years enrolled between May 6, 2018 and October 1, 2023. CSU cases were identified using SNOMED codes 51611005 and 42265009. Controls were matched 4:1 by age, sex, race, ethnicity, and smoking status. We compared rates of atopic dermatitis, allergic rhinitis, asthma, nasal polyps, food allergy, and drug allergy. Multivariable logistic regression adjusted for hypothyroidism, systemic lupus erythematosus, and rheumatoid arthritis given known associations with CSU.
Results: We identified 1171 CSU cases and 4684 matched controls with no significant demographic differences. CSU patients had significantly higher rates of atopic dermatitis (12.6% vs. 1.7%, p < 0.001), allergic rhinitis (58% vs. 13.2%, p < 0.001), asthma (46.2% vs. 13.2%, p < 0.001), nasal polyps (3.8% vs. 0.7%, p < 0.001), and food and drug allergies (p < 0.001). These associations persisted after multivariable adjustment (p < 0.001).
Conclusions: This study demonstrates a strong association between CSU and atopic disease in a racially and socioeconomically diverse cohort. Our findings highlight shared Th2-driven pathways underlying CSU and atopy and reinforce the potential utility of type 2 targeted therapies (e.g., dupilumab) in patients with CSU and comorbid atopic disease. Clinicians should screen CSU patients for atopic disease to help guide comprehensive, targeted therapy.
A pre-meeting on the Organization of Care in Atopic Dermatitis was held on October 24, 2024, in Doha, Qatar, in the context of the 14th Georg Rajka Symposium on Atopic Dermatitis organized by the International Society of Atopic Dermatitis (ISAD). The objective was to break new ground in clinical practice and Patient-Centred care in Atopic Dermatitis. Focusing on the daily management of atopic patients, the program explored the specificities of patient care, using examples from Algeria, China, Germany, Brazil, Mali, Madagascar, the USA, and France. This exchange brought together individuals from diverse backgrounds, all united by their commitment to eczema care. For the second time, African representatives, including both experts and patients, were hosted after being invited by the International Society of Atopic Dermatitis.
Background: Advances in genetic testing allow clinicians to identify patients with pathogenic variants that increase their risk of skin cancer. Whether this information results in more frequent dermatology screening visits as recommended by the National Comprehensive Cancer Network (NCCN) guidelines is unknown.
Objectives: Our objective was to evaluate compliance with NCCN dermatology screening guidelines among patients with skin cancer-predisposing pathogenic variants and to determine whether visiting a Hereditary Cancer Clinic (HCC) would improve adherence to skin cancer screening.
Methods: We employed a retrospective observational cross-sectional design in a consecutive sample of 230 patients with pathogenic variants in BRCA1, BRCA2, Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2) and other variants (ATM, CDKN2A, FLCN, MITF, POT1, PTEN, TP53) at the HCC at the Medical University of South Carolina. The sample was predominantly female (80%), Caucasian (82%) and non-Hispanic/Latino (94%) with a bimodal age distribution showing peaks around age 40 and 70. Compliance with NCCN dermatologic screening guidelines with a 6-month buffer period was measured, both before and after an HCC visit. Statistical significance was determined using the chi-squared proportion test.
Results: Overall compliance with dermatology visits improved from 11.1% before HCC visits to 37% after visiting the HCC (p < 0.001). Factors associated with increased compliance included a personal (p = 0.09) and family history (p < 0.01) of non-melanoma skin cancer and age between 45 and 50 years old (p < 0.01). Among those receiving biopsies, 37.2% exhibited non-benign lesions. Lynch syndrome variants accounted for 50% of non-benign skin lesions.
Conclusions: HCC visits and personal and family history of skin cancer were associated with improved adherence to NCCN dermatology screening guidelines among patients with skin cancer-predisposing variants. Thus, dedicated HCCs could improve early detection and intervention of premalignant and malignant skin lesions. Additional studies that include a larger number of minority patients are required to confirm these findings.
In this article, Huang et al. describe the clinicopathologic features of 27 young adult patients in Taiwan with a peculiar eruption consisting of monomorphous, discrete, tiny, superficial pustules on the face and/or the neck. The number of lesions ranged from a few to hundreds and lasted 1–4 weeks, recurring in 80% of the patients. Itch was present in 45% of the cases. More than 90% of patients responded well to topical steroids with complete clearance of pustules. Histopathology in three cases showed infundibular pustules filled with neutrophils and a perivascular lymphohistiocytic infiltrate in the dermis. No microorganism was identified with Gram staining, and cultures in two patients yielded Cutibacterium acnes. The authors claim that this form of pustular eruption appears distinct from other facial dermatoses with follicular pustules.
In this article, Oh et al. analyze the gene transcriptomic expression of tumor and immune response genes, and provide a comprehensive profiling of virus in cutaneous squamous cell carcinoma (cSCC) and normal tissue in 53 Asian patients, comparing the results between organ transplant recipients and patients without an organ transplant. Organ transplant recipients are known to have an increased risk of cSCC. In comparison with normal skin, cSCC tissue was characterized by a protumorigenic immune environment, increased immune signaling, and tumor remodeling. Likewise, viruses were particularly enriched in cSCC tissue, as compared with normal skin. cSCCs of organ transplant recipients exhibited greater expression of tumor markers and reduced expression of T-cell cytokines, and enrichment of viruses including multiple virus types beyond HPV and EBV. The characterization of cSCCs holds potential for specific therapeutic approaches in high-risk populations.
In this article, Rosendahl et al. critically review the existing literature regarding the concept of “dysplastic nevus,” a term that has been used for over four decades, under the unsupported assumption that it is a melanoma precursor. Rather, with precise diagnostic criteria, the consideration of “dysplastic nevus” as a melanoma-associated nevus is hardly sustainable. Hence, the authors state that a histologic diagnosis of “dysplastic nevus” has no clinical relevance at all.
While the authors acknowledge that there are zones of diagnostic uncertainty between nevus and melanoma that can be classified as “borderline” or “indeterminate” lesions, a designation of “dysplastic nevus” lacks clinical relevance and may lead to inappropriate management options for patients.
The skin rejuvenation market is rapidly expanding, driven by demand for effective, minimally invasive solutions. Modern esthetic dermatology embraces a comprehensive approach combining evidence-based lifestyle practices, advanced procedures, and dermocosmetics to deliver personalized, natural-looking outcomes. This review focuses on minimally invasive procedures, which are increasingly favored for their rapid results and minimal recovery time. Key modalities include injectables, energy-based devices, chemical and mechanical treatments, often enhanced through combination protocols. Regenerative technologies show promise in esthetic dermatology, including advanced peptides, exosomes, stem cell-derived vesicles, nano collagen, and fat extracts. Dermatologists must consider patient-specific factors such as skin type and gender, while leveraging emerging tools like AI and social media to improve care and education. Despite growing popularity, more robust clinical evidence is needed to support practice. The future lies in holistic, patient-centered strategies that promote long-term skin wellness.
Universal dermatology represents a paradigm shift toward inclusive health that acknowledges and addresses the diverse manifestations of dermatological conditions, recognizing that skin and hair exhibit significant variations across global populations. Pigmentary disorders such as melasma and post-inflammatory hyperpigmentation are more prevalent in individuals with darker skin, while socioeconomic disparities, geographic gaps in specialist availability, and limited health literacy contribute to inequities in care. In this review, innovative solutions are explored, including inclusive classification models, culturally competent education, teledermatology, and AI tools designed to work across skin tones. Advances in noninvasive diagnostics and personalized sunscreen recommendations are also discussed. Community-centered programs and strategic workforce planning in resource-limited settings offer further avenues for change. Inclusive clinical trial design and global research collaborations are essential for the generation of data that is generalizable across diverse populations. Through inclusive educational materials, research, and technological advancements, the delivery of high quality and individualized care across global populations can be achieved.
Advances in dermatology are embracing a patient-centered, proactive approach through the ‘4P model’: Personalized, Predictive, Preventive, and Participatory care. This shift aims to improve treatment efficacy and safety as well as patient's quality of life. This review explores the applications of ‘4P medicine’ in dermatology, highlighting key concepts and examples like innovations in onco-dermatology and the skin microbiome. In onco-dermatology, molecular profiling guides targeted treatments, while genetic insights improve risk prediction and prevention. Genetic profiling, such as the identification of BRAF mutations in melanoma, has enabled targeted therapies like BRAF/MEK inhibitors to improve patient outcomes. Predictive technologies, including machine learning, are enabling early detection and risk assessment for both melanoma and non-melanoma skin cancers. Preventive strategies focus on proactive skin care, with public education campaigns and digital tools to increase sun protection behaviors and early detection. Participatory care engages patients in decision making, leading to better adherence and outcomes. This integrated approach optimizes outcomes and reduces the burden of skin cancer. Microbiome research has also transformed dermatology, enabling personalized treatments that target microbial imbalances in conditions such as atopic dermatitis, psoriasis and acne. Predictive dermatology uses microbiome signatures to forecast disease risk and response to treatment, enabling earlier intervention. Preventive strategies aim to maintain a healthy microbiome and prevent disease exacerbations. Participatory dermatology encourages patients to engage in microbiome-focused skin care to optimize outcomes. However, challenges remain in terms of treatment optimization, economic sustainability, ethical considerations and equitable access to care. Addressing these challenges requires innovative solutions, collaborative research, and strategies to ensure the accessibility and cost-effectiveness of dermatologic care.
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