This Week in Dermatology — Aug 7, 2026

Welcome to This Week in Dermatology. This week we're covering 10 notable papers spanning inflammatory disease classification and the economics of biologics, real-world outcomes in atopic dermatitis and psoriasis, and a cluster of practical papers on infection, hair loss, and melanocytic lesion surveillance. Let's dive in.

We'll start with two papers in JAMA Dermatology that tackle very different problems in neutrophilic and follicular inflammatory disease. The first is a modified Delphi consensus that finally puts some order into pyoderma gangrenosum [1]. Twenty-three board-certified dermatologists with specific expertise in pyoderma gangrenosum completed five rounds of anonymous iterative surveys between December 2023 and July 2025, and reached agreement, with 83 percent of experts endorsing the final framework. The scheme splits the disease into two major groups: pyoderma gangrenosum occurring within autoinflammatory syndromes, and nonsyndromic disease. Nonsyndromic disease is then subdivided into inflammatory bowel disease-associated, disease associated with haematologic malignancy and blood dyscrasias, drug-induced, and everything else including idiopathic cases. Layered on top are disease modifiers: involvement of special sites — head and neck, genital, or peristomal skin — and extracutaneous manifestations. This is descriptive rather than diagnostic, and it won't change what you prescribe on Monday, but it gives you a vocabulary for documentation and, more importantly, a scaffold for the trials and guidelines that this orphan disease badly needs. The second JAMA Dermatology paper turns to hidradenitis suppurativa and asks an uncomfortable question: are we getting value for money from monoclonal antibodies [2]? The authors built an efficiency frontier analysis using phase 3 trial data for adalimumab, secukinumab, and bimekizumab from six trials, combined with national drug prices from the United States, Canada, France, Germany, and Australia. Using both HiSCR-50 and HiSCR-75 as the outcome, weekly adalimumab 40 milligrams sat on the efficiency frontier in every single country examined. Secukinumab 300 milligrams every four weeks made the frontier only when United States wholesale acquisition costs were used, and bimekizumab did not. The price spread is the number that should stop you: annual therapy cost ranged from about eleven thousand dollars for weekly adalimumab in Australia to roughly four hundred and twelve thousand dollars for bimekizumab every two weeks in the United States. Adjusting for baseline disease severity didn't change the picture. The clinical read is not that newer interleukin-17 agents don't work — they do, and they matter for adalimumab failures — but that from a payer's perspective adalimumab remains the rational first step, and the enormous international price variation is a pricing problem rather than a pharmacology one.

Moving to real-world outcomes in the two diseases most of us treat every day, three papers give us actionable guidance on how to judge and sustain systemic therapy. In Acta Dermato-Venereologica, a retrospective multicentre cohort of 146 advanced therapy-naive patients with moderate-to-severe atopic dermatitis across two Madrid hospitals tracked drug persistence on dupilumab, anti-interleukin-13 agents, and JAK inhibitors [9]. Persistence fell steadily — about 83 percent at six months, 70 percent at twelve, and just under 55 percent at two years — with significant differences between drug classes. JAK inhibitors carried roughly a 1.8-fold higher risk of discontinuation than dupilumab, and men were more than twice as likely to stop treatment as women. But the strongest predictor was early response: every one percent additional EASI improvement at week 16 corresponded to a three percent lower risk of later discontinuation, and the same gradient held for patient-reported itch scores. Baseline biomarkers predicted nothing. The practical message is to formalise week 16 as your decision point, and to give equal weight to what the patient tells you about itch as to what you score on the skin. Alongside that, TREATgermany registry data, also in Acta Dermato-Venereologica, followed 633 adults on dupilumab and looked specifically at mental health [10]. Nearly half had clinically significant depressive symptoms at baseline and a similar proportion had significant fatigue. Notably, those patients did not have worse objective skin scores — EASI and objective SCORAD were similar — but they reported substantially worse quality of life, a reminder that severity in the chart underestimates severity in the person. Both depression and fatigue scores dropped markedly within the first three months of dupilumab, sleep and social functioning needs were more often met by twelve months, and drug survival was the same regardless of baseline psychological burden. The psoriasis counterpart comes from Dermatology, a retrospective multicentre study of 87 patients with psoriasis and a malignancy diagnosed within the preceding five years, treated with either risankizumab or apremilast [6]. Over a mean 30 months, there were no cancer recurrences or progressions in the 21 risankizumab patients and a single event among the 66 on apremilast — numbers far too small for any inferential claim, and the authors are explicit that the oncology analyses are purely descriptive. Risankizumab was more effective, with better quality-of-life gains. This is reassurance rather than proof, and it should be read as supportive of shared decision-making with oncology, not as a green light to drop surveillance.

Our third cluster is a set of pragmatic papers that could change a prescription or a follow-up interval this week. From the Journal of the American Academy of Dermatology, a multicentre prospective real-world study across 20 Chinese tertiary hospitals enrolled 819 patients with tinea capitis [3]. Microsporum canis accounted for nearly 70 percent of cases, and while about 82 percent of patients were cured with their initial systemic regimen, terbinafine underperformed badly where the pathogen was a Microsporum species — a success rate of only 58 percent in gray patch tinea capitis compared with roughly 92 percent for itraconazole and 91 percent for fluconazole, and just 59 percent against confirmed Microsporum canis. Where your local epidemiology is Microsporum-dominant, terbinafine monotherapy is the wrong reflex, and mycology matters before you write the script. In Pediatric Dermatology, a retrospective review of 58 children diagnosed with staphylococcal scalded skin syndrome through dermatology consultation in a paediatric emergency department over a decade found methicillin-resistant organisms in only one patient — this in an institution whose overall Staphylococcus aureus antibiogram showed methicillin resistance in around 40 to 47 percent of isolates [8]. In other words, the resistance rate in this specific syndrome may be far lower than your hospital-wide number suggests, and reflexive empiric anti-MRSA coverage may be unnecessary — though this is a single-centre series and the authors sensibly frame it as a prompt to examine your own local data rather than a universal rule. Two more. Also in the Journal of the American Academy of Dermatology, an ambispective cohort followed 1,923 melanocytic lesions with peripheral globules in 215 patients using sequential digital dermoscopy [4]. Peripheral globules are usually taught as a sign of benign radial growth, and indeed globules resolved completely in about 47 percent of lesions. But compared with resolution, globules that persisted unchanged or increased were associated with roughly a four-fold higher risk of a clinically significant histopathologic endpoint. Increasing pigmentation raised risk about six-fold, faster growth incrementally increased it, and a personal history of melanoma was the single largest factor at nearly eight-fold. Age was not associated. The limitations are real — single centre, referral bias, and no histology for lesions that weren't excised — but the concept is clinically usable: treat peripheral globules as a dynamic finding, and let the trajectory rather than the baseline snapshot drive whether you excise. Finally, from Clinical and Experimental Dermatology, a retrospective single-centre series of 123 men with androgenetic alopecia on topical finasteride 0.25 percent as monotherapy for 52 weeks showed significant videodermoscopic gains — about 22 additional hairs per square centimetre at the vertex and 29 in the temporal regions — along with improved shaft thickness and terminal-to-vellus ratio [7]. Just over 7 percent reported mild transient local irritation, and no sexual or mood adverse events were reported. It is uncontrolled and retrospective, so the effect size should be held loosely, but it supports topical finasteride as a legitimate option for men who refuse oral therapy. Rounding out the hair section, a systematic review and meta-analysis in Acta Dermato-Venereologica pooled 23 studies and 9,103 patients with central centrifugal cicatricial alopecia [5]. Dyslipidaemia was reported in roughly 58 percent and hypertension in about 52 percent, and in case-control analyses the disease was significantly associated with dyslipidaemia, uterine leiomyomas, and anxiety disorders, whereas hypertension, obesity, and thyroid disease were not consistently associated. Heterogeneity was substantial and most studies were retrospective and United States-based, so these are signals for holistic assessment rather than a screening mandate.

If you only have time for one paper this week, make it the hidradenitis suppurativa cost-efficiency analysis in JAMA Dermatology [2]. It reframes an increasingly crowded biologic market around value, and it gives you defensible language for prior authorisation conversations and formulary decisions in a disease where access is often the rate-limiting step.

Here are the key takeaways from this week in Dermatology. Adalimumab remains the most cost-efficient approved monoclonal antibody for hidradenitis suppurativa across five health systems, with newer agents priced far above the efficiency frontier. In moderate-to-severe atopic dermatitis, week 16 is your decision point — the magnitude of early EASI and itch improvement predicts whether the patient will still be on the drug two years later, while baseline biomarkers predict nothing. Dupilumab is associated with rapid improvement in depressive symptoms and fatigue within three months, and patients with high psychological burden often have deceptively unremarkable objective severity scores. Terbinafine should not be your automatic choice in tinea capitis where Microsporum species predominate, given cure rates near 58 percent versus over 90 percent for itraconazole or fluconazole. And in dermoscopic surveillance, peripheral globules that persist or increase, particularly alongside increasing pigmentation or a personal melanoma history, warrant a lower threshold for excision.

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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