This Week in Dermatology — Jul 31, 2026

Welcome to This Week in Dermatology. This week we are covering five notable papers spanning therapeutic advances and laboratory monitoring in alopecia areata, demographic variations in contact allergen sensitivities, multidimensional success metrics in hidradenitis suppurativa, and a critical update to the global naming system for biological therapies. Let's dive in.

We begin with major clinical insights into the management of alopecia areata, focusing on the real-world performance and monitoring of Janus kinase inhibitors. A retrospective study published in the Journal of the American Academy of Dermatology evaluated the long-term efficacy and safety of upadacitinib [3]. Following thirty patients, including children, adolescents, and adults, who took upadacitinib continuously for at least twelve months, researchers observed highly encouraging results. By the twelfth month, the proportion of patients achieving at least fifty percent, seventy-five percent, and ninety percent improvement in their Severity of Alopecia Tool score—commonly known as the SALT score—reached ninety percent, eighty percent, and roughly fifty-seven percent, respectively. The data also revealed that patients with an underlying atopic background achieved their efficacy targets faster during the early stages of treatment compared to those without an atopic background. Reassuringly, no serious adverse events were reported over the entire study period, supporting the long-term safety of upadacitinib in clinical practice. While these efficacy numbers are promising, the practicalities of prescribing Janus kinase inhibitors require careful attention to safety monitoring. Addressing this concern, a prospective cohort study also published in the Journal of the American Academy of Dermatology investigated the clinical yield of laboratory monitoring during ritlecitinib therapy [1]. Tracking one hundred and sixty-two patients representing over sixty-two patient-years of exposure, the investigators found that while treatment-emergent laboratory abnormalities were common—occurring in roughly sixty-one percent of patients, with over two-thirds of first events occurring within the first three months—they were overwhelmingly mild. Ninety-seven patients experienced only grade one abnormalities, two patients had grade two abnormalities, and not a single patient developed a grade three or higher abnormality. Although having a history of prior systemic treatment was associated with a higher hazard of laboratory abnormalities on univariable analysis, this association did not remain significant after multivariable adjustment. Because these laboratory changes were mild and almost never required clinical intervention, these findings suggest that clinicians may want to reconsider the intensity of routine laboratory monitoring for patients on ritlecitinib, potentially reducing the testing burden without compromising safety.

Our second theme highlights how optimizing patient outcomes requires us to refine our diagnostic approaches and treatment metrics. In contact dermatitis, a large retrospective cross-sectional study in the Journal of the American Academy of Dermatology analyzed patch test results from over thirty-two thousand patients across the United States and Canada to determine how allergen sensitivities vary by race and ethnicity [2]. The researchers found that positive patch test reactions to thirteen of fifty common allergens differed significantly among White, Black, Asian, and Hispanic patients. For example, White patients had the highest rates of positive reactions to balsam of Peru, neomycin, quaternium-15, and fragrance mix two. Black patients had the highest proportion of reactions to p-phenylenediamine and disperse dyes. Asian patients demonstrated the highest sensitivity to nickel, cobalt, and thiuram mix, while Hispanic patients showed the highest rate of positive reactions to propylene glycol. Recognizing that race and ethnicity are social constructs, the authors note that these variations are likely linked to sociocultural differences in allergen exposures rather than genetic differences. For practicing dermatologists, these findings are highly actionable, allowing for more targeted allergen identification and personalized avoidance counseling in diverse patient populations. Moving from contact allergies to chronic inflammatory disease, a comprehensive review in the Journal of the European Academy of Dermatology and Venereology addresses how we measure treatment success in hidradenitis suppurativa [4]. The authors emphasize that relying solely on the widely used Hidradenitis Suppurativa Clinical Response, or HiSCR, has major drawbacks, as it excludes patients with fewer than three abscess-nodule lesions and fails to capture improvements in draining tunnels. Instead, the International Hidradenitis Suppurativa Severity Score four is highlighted as a robust dynamic tool that weights draining tunnels fourfold, with its derivative, the IHS4-55, providing a meaningful response threshold regardless of baseline lesion count. For patient-reported outcomes, the Hidradenitis Suppurativa Quality of Life index is the preferred disease-specific tool, showing a validated minimal clinically important difference of twenty to twenty-one points. Crucially, the review details how advanced technologies, including ultrasound-based fibrosis grading, ultra-high-frequency imaging, and long-wave infrared thermography, are transforming how we assess deep tissue damage and subclinical inflammation. Integrating these objective imaging tools with dynamic clinical scores and patient-reported measures is essential for the emerging treat-to-target frameworks aimed at achieving true disease remission.

Our final paper focuses on clinical literacy and patient safety, highlighting a fundamental shift in how we talk about and prescribe biological therapies. A review published in the Journal of the American Academy of Dermatology highlights that the World Health Organization International Nonproprietary Names system underwent its most radical revision in over two decades during twenty-one and twenty-two [5]. The universal "mab" suffix for monoclonal antibodies has been officially retired and replaced with four structure-based stems: "tug", "bart", "ment", and "mig". Concurrently, new naming conventions have been established for small molecules and oral peptides, such as "citinib" for Janus kinase inhibitors, "brutinib" for Bruton tyrosine kinase inhibitors, and "kinra" for oral peptide receptor antagonists. These nomenclature changes are not yet widely integrated into dermatology education, yet they carry major clinical and pharmacokinetic implications. For instance, two currently prescribed agents, sonelokimab and certolizumab pegol, are technically misclassified under their legacy "mab" names. Because dermatologists prescribe a highly diverse array of biologics, mastering this updated naming system is a critical competency for ensuring accurate adverse event reporting, making informed biosimilar substitution decisions, and evaluating pipeline therapies.

If you only have time for one paper this week, make it the prospective cohort study on laboratory monitoring during ritlecitinib treatment for alopecia areata [1]. This study provides highly reassuring, real-world evidence that treatment-emergent laboratory abnormalities are almost exclusively mild and rarely require clinical intervention, offering a strong argument for reducing the frequency and cost of routine blood draws for our patients on this Janus kinase inhibitor.

Here are the key takeaways from this week in Dermatology. First, long-term upadacitinib therapy is highly effective for alopecia areata in real-world settings, with patients who have an atopic background showing faster initial improvement. Second, routine laboratory abnormalities during ritlecitinib therapy are common but overwhelmingly mild and rarely actionable, suggesting we can safely consider reducing monitoring intensity. Third, patch test sensitivities vary significantly by race and ethnicity due to sociocultural exposure patterns, with Black patients showing high reactivity to p-phenylenediamine and disperse dyes, and Asian patients showing high reactivity to nickel and cobalt. Fourth, hidradenitis suppurativa management is moving toward a multi-dimensional approach that combines dynamic clinician scores like the IHS4, disease-specific patient quality of life tools, and objective ultrasound imaging to assess deep tissue damage. And finally, the World Health Organization has retired the "mab" suffix for new monoclonal antibodies, replacing it with structure-based stems like "tug" and "bart" which carries major implications for prescribing safety and biosimilar substitution.

That's your roundup for This Week in Dermatology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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