Editor's Picks October 2024

Carle Paul

In this review from the EADV and Body Art Task Force, Giulbudagian and colleagues provide a comprehensive and well-organized overview of the possible complications of tattooing including infections, granulomatous reactions and allergic inflammatory reactions (Figure 1).

Evidence behind tattoos remains complex yet under-researched. Moreover, product standardization and regulation are challenging as tattoo inks are industrial products with many impurities and contaminants, including insoluble particles. Toxicological studies, particularly regarding risks of carcinogenicity, organ exposure, allergy and photosensitivity, and standardization of tattoo ink production with health regulatory assessment are warranted at both the European and global levels to ensure consumer safety.

Giulbudagian M, Battisini B, Bäumler W, Blass Rico AM, Bocca B, Brungs C, et al. Lessons learned in a decade: medical-toxicological view of tattooing. J Eur Acad Dermatol Venereol. 2024;38:1926-1938. https://doi.org/10.1111/jdv.20072

Clinical diagnosis of nail unit lesions remains a challenge for most of us. In this systematic review, Slawinska et al. present 19 studies including over 200 patients, summarizing the clinical utility of intraoperative dermoscopy of the nail unit after nail plate avulsion. They suggest that this technique may help to better define the most appropriate surgical diagnostic procedure and may improve our diagnostic capabilities. Further prospective studies are needed to confirm these preliminary findings and to demonstrate the truth lying behind the nail plate (Figure 2).

Sławińska M, Żółkiewicz J, Ribereau-Gayon E, Maińska U, Sobjanek M, Thomas L. Intra-operative dermoscopy (onychoscopy) of the nail unit- a systematic review. J Eur Acad Dermatol Venereol. 2024;38:1988-1996. https://doi.org/10.1111/jdv.20078

In this population-based cohort study, Buja et al. provide insight into the epidemiology of melanoma in adolescent and young adults, describing the steady increase in melanoma incidence from 1990 to 2019 (Figure 3). They also show gender differences, with males having less advanced lesions and the trunk as the primary site, while women are affected on the lower limbs as the most common primary site.

Such important elements could influence specific prevention campaigns for this population and may influence the fashion industry to cover sites most at risk with UV-protective clothes.

Buja A, Rugge M, Trevisiol C, Zanovello A, Brazzale AR, Zorzi M, et al. Cutaneous melanoma in adolescents and young adults. J Eur Acad Dermatol Venereol. 2024;38:1997-2004. https://doi.org/10.1111/jdv.20077

Diagnosing cutaneous T-cell lymphoma in adults may be challenging for dermatologists. Kook et al. reviewed records of 46 patients who were non-responders to dupilumab. Among those re-evaluated, slightly over half (54%) were diagnosed with cutaneous T-cell lymphoma (CTCL) (Figure 4).

These findings suggest that we should consider skin biopsy and testing for T-cell clonality in patients who do not respond to dupilumab as well as patients with atypical adult-onset atopic dermatitis. In the future, can lesion analysis with artificial intelligence aid the clinician's eye to differentiate between atopic dermatitis and cutaneous T-cell lymphoma?

Kook H, Gwag HE, Park SY, Hong N, Lee JH, Jung HJ, et al. Detecting T-cell receptor clonality in patients with severe atopic dermatitis refractory to dupilumab. J Eur Acad Dermatol Venereol. 2024;38:1939-1946. https://doi.org/10.1111/jdv.20053