Summary

A Cohort Study

[Posted 27/Feb/2023]

AUDIENCE: Dermatology, Oncology

KEY FINDINGS: Microsatellites were associated with other adverse melanoma prognostic factors. A multivariate Cox regression analysis showed that they are an independent risk factor for worse OS, MSS, and disease-free survival. Patients with stage IIIB melanoma with microsatellites had worse OS and MSS, whereas patients with stage IIIC melanoma had worse OS but not MSS.

BACKGROUND: There is limited information on microsatellite survival outcomes in patients with melanoma. Purpose of this study is to evaluate survival outcomes in patients with microsatellites, assess their role within stage III stratification of the American Joint Committee on Cancer classification, and assess the results of sentinel lymph node biopsies in patients with microsatellites.

DETAILS: A retrospective bicenter cohort study from 1998 to 2019 included patients with a diagnosis of invasive cutaneous melanoma. Of a total of 5216 patients, 108 (2.1%) had microsatellites at initial staging. Survival analysis showed that microsatellites were an independent risk factor with decreased overall survival (OS), melanoma-specific survival (MSS), and disease-free survival, with hazard ratios of 1.57, 1.76, and 1.76, respectively. Stratified analysis in patients with stage III melanoma showed a 5-year OS of 35% (95% CI, 17.3%-73.4%) and a MSS of 45% (95% CI, 23.1-87.5) for patients with stage IIIB melanoma with microsatellites.

Copyright © Elsevier Ltd. All rights reserved.

Source: Riquelme-Mc Loughlin, C., Sandoval-Clavijo, A., Blnco de Tord, M., et al. (2023). Prognostic Role Of Microsatellites In Melanoma and Implications In The American Joint Committee On Cancer Classification System: A Cohort Study. Journal of the American Academy of Dermatology. 2023; 88(2): 338-347. Published: February, 2023. DOI: 10.1016/j.jaad.2022.10.027.

Summary

Results From the BE BRIGHT Open-Label Extension Trial

[Posted 10/Sep/2025]

AUDIENCE: Dermatology, Family Medicine

KEY FINDINGS: Almost two-thirds of bimekizumab-treated patients achieved and maintained complete skin clearance through 4 years, making bimekizumab an effective, rapid, and durable long-term treatment option.

BACKGROUND: Patients with moderate to severe psoriasis experience significant burden on quality of life. Long-term management with latest-generation biologics can facilitate sustained complete skin clearance and improved patient well-being. Aim of this study is to report 4-year end-of-study bimekizumab efficacy and safety in patients with moderate to severe psoriasis.

DETAILS: Data were pooled from 3 phase 3 trials (BE VIVID, BE READY, and BE SURE) and their open-label extension (OLE; BE BRIGHT). Efficacy is reported for patients who received bimekizumab continuously from baseline into the OLE. Safety is reported for patients who received >=1 bimekizumab dose. Seven hundred seventy-one patients received bimekizumab from baseline into the OLE. A high proportion achieved complete skin clearance (100% improvement from baseline in Psoriasis Area and Severity Index) at Week 52 (76.2%) and maintained this to Week 196 (64.7%). The rate of treatment-emergent adverse events over 4 years was 169.8/100 patient-years (N = 1495) and did not increase with longer exposure. The most common treatment-emergent adverse events were nasopharyngitis, oral candidiasis, and upper respiratory tract infection, consistent with bimekizumab's known safety profile.

Copyright © Elsevier Ltd. All rights reserved.

Source: Blauvelt, A., Langley, R. G., Lebwohl, M., et al. (2024). Bimekizumab Durability of Efficacy Through 196 Weeks and Safety Through 4 Years in Patients With Moderate to Severe Plaque Psoriasis: Results From the BE BRIGHT Open-Label Extension Trial. Journal of the American Academy of Dermatology. 2025; 93: 644-653. Published: September, 2025. DOI: 10.1016/j.jaad.2025.04.038.

Summary

[Posted 28/Aug/2025]

AUDIENCE: Neurology, Pediatric, Neurosurgery

KEY FINDINGS: Infants up to 6 weeks of age with genetically diagnosed SMA who were treated with risdiplam before the development of clinical signs or symptoms appeared to have better functional and survival outcomes at 12 and 24 months than untreated infants in natural history studies. Larger, controlled studies with longer follow-up are needed to further understand the relative efficacy and safety of presymptomatic treatment of SMA with risdiplam.

BACKGROUND: Risdiplam, an oral pre–messenger RNA splicing modifier, is an efficacious treatment for persons with symptomatic spinal muscular atrophy (SMA). The safety and efficacy of risdiplam in presymptomatic disease are unclear.

DETAILS: Authors conducted an open-label study of daily oral risdiplam (with the dose adjusted to 0.2 mg per kilogram of body weight) in infants 1 day (birth) to 42 days of age with genetically diagnosed SMA but without strongly suggestive clinical signs or symptoms. The primary outcome, assessed in infants with two SMN2 copies and a baseline ulnar compound muscle action potential (CMAP) amplitude of at least 1.5 mV, was the ability to sit without support at month 12. Natural history studies have shown that the majority of infants with two SMN2 copies who are untreated would have a severe SMA phenotype (type 1), would never sit independently, would receive permanent ventilation and feeding support, or would die by 13 months of age. Secondary outcomes that were assessed over a period of 24 months included survival, ventilatory support, motor milestones, the development of clinically manifested SMA, feeding, and growth. A total of 26 infants with two, three, or four or more copies of SMN2 were enrolled. After 12 months of treatment, 21 infants (81%) could sit unsupported for 30 seconds, 14 (54%) could stand alone, and 11 (42%) could walk alone. A total of 4 of 5 infants (80%; 95% confidence interval, 28 to 100) with two SMN2 copies and a baseline ulnar CMAP amplitude of at least 1.5 mV were able to sit without support for at least 5 seconds. Three infants were withdrawn from the study by a parent or caregiver after the month 12 visit. Of 23 infants who completed 24 months of treatment, all were alive without the use of permanent ventilation or feeding support. Over a period of 24 months, nine treatment-related adverse events were reported in 7 infants; none of these events were serious.

Copyright © Massachusetts Medical Society. All rights reserved.

Source: Finkel, R. S., Servais, L., Vlodavets, D., et al. (2024). Risdiplam in Presymptomatic Spinal Muscular Atrophy. N Engl J Med. 2025; 393(7): 671-682. Published: August 13, 2025. DOI: 10.1056/NEJMoa2410120.

Summary

A Histological Study in a Porcine Model.

[Posted 26/Aug/2025]

AUDIENCE: General Surgery, Dermatology, Family Medicine

KEY FINDINGS: MRF predominantly promotes the synthesis of Collagen I and Collagen III, increasing the Collagen I/III ratio, and regulates the expression of MMP-1, MMP-3, MMP-9, TGF-ß, and EGF. These factors collectively drive fibroblast activation, migration, and ECM remodeling. These changes are indicative of the potential for MRF to support skin regeneration and rejuvenation. Preliminary findings suggest that ADSCs may contribute to these regenerative processes.

BACKGROUND: Microneedle radiofrequency (MRF) is a promising skin rejuvenation treatment. However, the mechanisms underlying its effects on extracellular matrix (ECM) remodeling remain unclear. This study aimed to investigate the immediate histological effects of MRF under varying settings, its short-term impact on collagen and elastin synthesis, and the roles of fibroblasts and adipose-derived stem cells (ADSCs).

DETAILS: Porcine abdominal skin was treated with an MRF device containing 49 insulated microneedles using varying energy parameters (8-12 W; 100-300 ms). Immediate histological responses to treatment were evaluated through hematoxylin and eosin (H&E) staining. Short-term changes in collagen and elastin synthesis at Days 7 and 28 posttreatment were assessed via picrosirius red and Victoria blue staining. Additionally, expression and distribution of ECM remodeling-related proteins (MMPs, TGF-ß, EGF, Ki67) and ADSCs were analyzed by multiplex immunohistochemistry (mIHC) and western blot analysis. H&E staining revealed thermal coagulation zones in the dermis immediately after MRF treatment, with zone size increasing with higher power and longer pulse durations (p < 0.05). By Day 28, Collagen I and III densities and organization significantly improved, with the Collagen I/III ratio rising to 7.05 ± 1.21 in the treatment area (p < 0.01) and 3.90 ± 0.37 in the surrounding dermis (p < 0.001). Elastic fibers also showed increased density. mIHC staining demonstrated significant upregulation of MMP-1, MMP-3, and MMP-13 expression in treated and surrounding dermal regions by Day 7 (p < 0.01); however, by Day 28, MMP-1, MMP-9, and MMP-13 expression significantly decreased (p < 0.05), whereas MMP-3 remained elevated. Furthermore, expression levels of TGF-ß, EGF, and Ki67 significantly increased by Day 28 (p < 0.05). mIHC analysis of the fibroblast marker FSP-1 coexpression, along with Western blot analysis of Collagen I, Collagen III, MMP-1, MMP-3, TGF-ß, and EGF, revealed similar trends. Notably, significant expression of ADSC markers was detected at Day 7 posttreatment (p < 0.01).

Copyright © John Wiley & Sons, Inc or related companies. All rights reserved.

Source: Yidan, X., Yi, Z., Hao, W., et al. (2025). Microneedle Radiofrequency Induces Extracellular Matrix Remodeling Through Fibroblast Activation: A Histological Study in a Porcine Model. Lasers Surg. Med.. 2025; 57(6): 528-543. Published: August, 2025. DOI: 10.1002/lsm.70033.

Summary

[Posted 7/Jul/2025]

AUDIENCE: Dermatologists, Gynecologists, Primary Care Physicians, and other healthcare professionals involved in women's health.

KEY FINDINGS:

• Vulvovaginal itching is a common, often under-recognized condition with diverse etiologies, necessitating a comprehensive diagnostic approach.
• Causes span infectious, inflammatory, hormonal, neoplastic, neuropathic, systemic, and genetic factors, often requiring a multidisciplinary assessment.
• Chronic vulvovaginal pruritus significantly impacts patients' physical and emotional quality of life, leading to embarrassment, frustration, and avoidance of care.
• Effective management involves a multimodal strategy, combining lifestyle modifications, topical therapies (e.g., corticosteroids, antifungals, calcineurin inhibitors), systemic treatments (e.g., oral corticosteroids, anticonvulsants, biologics for refractory cases), and non-pharmaceutical interventions.
• There remains a critical need for further research to develop comprehensive, evidence-based guidelines and understand the holistic impact of female-specific pruritus.

BACKGROUND: Vulvovaginal itching is a prevalent yet frequently under-recognized complaint affecting women across all age groups. Despite its commonality, many dermatologists receive limited training in vulvar diseases, contributing to delayed diagnoses and prolonged patient discomfort. Patients often attempt self-treatment with over-the-counter products, which can exacerbate symptoms and complicate accurate diagnosis. The complex nature of vulvovaginal pruritus often demands a multidisciplinary approach for effective diagnosis and treatment, highlighting the need for improved understanding and management strategies.

DETAILS:

Pathophysiology Vulvovaginal itching can arise from various mechanisms, including compromised skin barrier integrity, elevated skin pH activating proteases, and hormonal fluctuations impacting epithelial health and microflora. Psychogenic factors can also initiate or aggravate itch through an itch-scratch cycle.

Causes

• Infectious Common acute causes include fungal (e.g., *Candida albicans*), bacterial (e.g., bacterial vaginosis, Group A ß-hemolytic streptococcus), parasitic (e.g., trichomoniasis, pinworms, scabies, pubic lice), and viral infections (e.g., HSV, HPV).
• Inflammatory Dermatological conditions like atopic dermatitis, irritant/allergic contact dermatitis (from hygiene products, fabrics), psoriasis, lichen simplex chronicus, lichen sclerosus, and lichen planus are frequent culprits.
• Neoplastic Though rare, vulvar malignancies (e.g., squamous cell carcinoma, melanoma, extramammary Paget's disease) can present with persistent itching, often as an early symptom. Benign tumors like syringomas can also be pruritic.
• Neuropathic Damage or dysfunction of nerve fibers in the vulvar region (e.g., from burns, scars, radiation, spinal nerve compression, small fiber polyneuropathy, vulvodynia) can lead to abnormal, often intense, sensory experiences.
• Systemic Conditions like diabetes (predisposing to infection and neurogenic itch), HIV, hepatic, and renal diseases can cause generalized or localized vulvar pruritus due to circulating pruritogens or altered immune responses.
• Genetic Rare genodermatoses such as Darier disease and Hailey-Hailey disease can cause itchy lesions in the vulvovaginal area. Genetic predispositions may also increase susceptibility to conditions like atopic dermatitis or recurrent candidiasis.

Evaluation A thorough history (onset, duration, severity, timing, aggravating/relieving factors, environmental exposures, hygiene, sexual history, medications, medical history) and physical examination are crucial. This includes inspecting the vulvovaginal area for lesions, discharge, and tissue changes. Diagnostic tools may include wet mount microscopy, STI testing, pH testing, vulvoscopy, and biopsy for persistent or suspicious lesions.

Treatment Strategies

• Lifestyle & Environment Wearing breathable cotton underwear, avoiding irritants (scented products, harsh soaps), gentle hygiene, proper toilet habits, and addressing psychological factors (stress, anxiety) are fundamental.
• Topical Therapies Corticosteroids (mid- to high-potency for acute inflammation, lower for maintenance), calcineurin inhibitors (tacrolimus, pimecrolimus) for chronic management, local estrogen for atrophy, antifungals for fungal infections, lactic acid products for pH balance, emollients for barrier support, and topical anesthetics (lidocaine, pramoxine) for symptomatic relief, especially in neuropathic itch. Novel topical agents like tofacitinib are emerging for inflammatory conditions.
• Systemic Treatments Oral corticosteroids for severe inflammation, anticonvulsants (gabapentin, pregabalin) and antidepressants (TCAs, SSRIs, SNRIs) for neuropathic/psychogenic itch, opiate receptor antagonists (naltrexone) for some cases, and systemic immunotherapies (methotrexate, mycophenolate mofetil) for refractory inflammatory conditions. Biologics (ixekizumab, dupilumab, tralokinumab) show promise for specific inflammatory and autoimmune causes. Antibiotics are used for bacterial infections.
• Non-pharmaceutical Sitz baths, cold compresses, Transcutaneous Electrical Nerve Stimulation (TENS), acupuncture, and physical therapy can offer symptomatic relief.

Copyright © [Your Name/Institution, if applicable]. All rights reserved.

Source: Mashoudy, K. D., Tomlinson, A.F., Kim, S. et al. Scratching the Surface: A Comprehensive Guide to Understanding and Managing Vulvovaginal Itching. Am J Clin Dermatol. 26: 361-378 (2025); Published: March 25, 2025. DOI: 10.1007/s40257-025-00939-7.

Summary

Results From an Observational Cross-Sectional Multicenter European Study in 17 Countries

[Posted 22/Apr/2025]

AUDIENCE: Dermatology, Family Medicine

KEY FINDINGS: CPG patients have high levels of perceived stress, perceived stigmatization and body dysmorphic, which are partly related to sociodemographic factors like younger age or lower income as well as to other psychological and disease-related factors.

BACKGROUND: Anxiety, depression and suicidal ideation are frequent in patients with chronic prurigo (CPG). Purpose of the study is to analyze perceived stress, stigmatization, body dysmorphia, anxiety, depression and itch-related quality of life in CPG patients and compare them to controls, and then to identify variables/predictors of them. This study is part of a cross-sectional multicenter study in 17 European countries including 5487 consecutive patients and 2808 controls. CPG patients were older than controls and had significantly more comorbidities. However, multivariate analysis allowed controlling for these differences by including them as a covariate.

DETAILS: One hundred twenty-seven individuals with prurigo were included in the analyses. They reported higher levels of stress, stigmatization, and body dysmorphia than controls. In the patient group, stigmatization was associated with higher stress and having a severe disease, stress with younger age and lower income, depression and anxiety with lower income and higher itch intensity, body dysmorphia with younger age, and dissatisfaction with appearance.

Copyright © Published by Elsevier Inc. on behalf of the American Academy of Dermatology, Inc. All rights reserved.

Source: Ficheux, A., Brenaut, E., Schut, C., et al. (20245). Predictors of Perceived Stress, Perceived Stigmatization, and Body Dysmorphia in Patients With Chronic Prurigo/Prurigo Nodularis: Results From an Observational Cross-Sectional Multicenter European Study in 17 Countries. Journal of the American Academy of Dermatology. 2025; 92(5): 1056-1063. Published: May, 2025. DOI: 10.1016/j.jaad.2024.12.043.