This Week in Dermatology — May 14, 2026

Welcome to This Week in Dermatology. This week we're covering 8 notable papers spanning advances in the management of inflammatory skin disease, innovations in diagnostics and procedures, and a key paper on health disparities in pediatric dermatology. Let's dive in.

First up, we have several papers that refine our approach to managing common and complex dermatologic conditions, from inflammatory diseases to hair loss and procedural care. Systemic Inflammatory Disease We begin in the Journal of the European Academy of Dermatology and Venereology with a large, real-world study on a phenomenon many of us are starting to see in clinic: treatment-associated phenotype switching between psoriasis and atopic dermatitis [6]. This 'flip-flop' phenomenon was examined in a cohort of 148 patients from 17 centers. The study found that about two-thirds of cases involved patients treated for psoriasis who developed persistent eczematous features. This switch predominantly occurred in patients on interleukin-17 or interleukin-23 inhibitors. The other third of cases involved patients treated for atopic dermatitis who developed psoriasiform disease, a switch seen exclusively in those on biologics targeting type 2 inflammation, most commonly dupilumab. The investigators note that this appears to be a true reflection of immune plasticity rather than a paradoxical drug reaction. For management, a key finding was that Janus kinase, or JAK, inhibitors emerged as a frequently used and effective strategy for patients who experienced a switch in either direction. This paper provides a crucial framework for recognizing and managing these increasingly common clinical scenarios.

While we manage the skin in psoriasis, a paper in JAMA Dermatology reminds us of the importance of systemic comorbidities, particularly cardiovascular risk [7]. This randomized clinical trial evaluated a simple, scalable intervention called TEXTME PSO. Over six months, 111 adults with psoriasis received either standard care or four automated text messages per week focused on tobacco, exercise, and diet. The results were significant. The intervention group showed a major improvement in patient activation, which is a measure of a patient's knowledge, skills, and confidence in managing their own health. They also had statistically significant improvements in adherence to a Mediterranean diet, increased weekly physical activity by over two hours, better medication adherence, and a greater understanding of the link between psoriasis and cardiovascular disease. This translated to a one-point drop in BMI. While there were no significant changes in biomarkers like lipids or hemoglobin A1c, the study demonstrates that a low-touch digital tool can be a powerful adjunct in our clinics to empower patients and improve cardiovascular risk behaviors.

Rounding out our section on inflammatory disease, another study in JAMA Dermatology addresses a common clinical concern: the risk of increased intraocular pressure with corticosteroid use [8]. This report analyzed data from three separate randomized clinical trials in Denmark. The studies examined short-term steroid exposure, including four weeks of periocular hydrocortisone cream for atopic dermatitis, two weeks of whole-body betamethasone followed by twice-weekly application, and a 10-day course of 50 milligrams of oral prednisolone. Across all three trials, which included 84 participants, there was no evidence that short-term topical or systemic corticosteroid use increased intraocular pressure. In fact, in patients with periocular atopic dermatitis, treatment was associated with a small but statistically significant decrease in IOP compared to untreated controls. These findings provide strong, trial-based evidence supporting the ocular safety of the short-term corticosteroid courses we frequently prescribe. Hair and Nails Shifting gears to hair and nails, the Journal of the American Academy of Dermatology brings us a randomized, double-blind, placebo-controlled trial on treating androgenetic alopecia in transgender people receiving testosterone therapy [1]. This is an important group, as standard treatments like 5-alpha-reductase inhibitors can interfere with desired masculinization. The study randomized 46 participants to either sublingual minoxidil at 1.35 milligrams twice daily or placebo for 24 weeks. The co-primary endpoints were changes in hair counts at the mid-scalp and vertex. At 24 weeks, the minoxidil group had a significant increase in midfrontal hair counts, with about 16 more hairs per square centimeter compared to placebo. There was no significant difference at the vertex at this time point. However, in an open-label extension phase where all participants received minoxidil, significant hair gains were seen at the vertex by week 48. The treatment was well-tolerated and, crucially, had no effect on testosterone concentrations. This trial provides solid evidence that sublingual minoxidil is a safe and effective option for this specific patient population.

And for our proceduralists, the same journal has published an international Delphi consensus statement on the perioperative management of nail surgery [2]. Recognizing that practices vary widely due to a lack of comprehensive guidelines, a panel of 10 international experts came together to provide recommendations. Through a multi-round Delphi process, they achieved consensus on key aspects of nail surgery, including antibiotic prophylaxis, management of bleeding risk, anesthesia techniques, tourniquet use, postoperative analgesia, and dressing strategies. The goal is to support safer, more standardized care and reduce practice variability. While the authors note that these recommendations are based on expert opinion in an area with limited high-quality evidence, they provide a much-needed practical framework for clinicians performing nail procedures and identify areas for future research. Our next theme focuses on technology and new techniques aimed at making our diagnoses more accurate and our procedures more efficient. A paper in the Journal of the American Academy of Dermatology explores a technology that could accelerate Mohs surgery [4]. Two-photon fluorescence microscopy, or TPFM, is a slide-free technique that can generate H&E-like images from fresh tissue specimens in real-time. In this study, two Mohs surgeons evaluated TPFM images from 133 specimens taken from patients with basal cell carcinoma, after the surgery was already complete. Their reads were compared to the standard consensus frozen section analysis. The initial results showed an average sensitivity of about 94% and specificity of 82%. However, after excluding cases where discordance was due to differences in the plane of section or tissue fragmentation from the frozen sectioning process, the accuracy improved to a sensitivity of 95% and a specificity of 94%. The authors conclude that, with minimal training, Mohs surgeons can interpret these TPFM images with an accuracy comparable to traditional frozen sections, suggesting a potential future where this real-time technology could be integrated into the Mohs workflow.

Moving from surgical pathology to medical dermatopathology, The Journal of Investigative Dermatology introduces a new quantitative method for assessing T-cell clonality, a key step in diagnosing cutaneous T-cell lymphoma, or CTCL [3]. The diagnosis of early CTCL is notoriously challenging, as it can mimic benign inflammatory dermatoses. This study developed a novel 'TRBC1-Clonality Score' based on immunofluorescence staining for the T-cell receptor beta constant 1, or TRBC1. By quantifying the polarization of this marker, the score can help differentiate the clonal proliferation of neoplastic T-cells in CTCL from the polyclonal infiltrate of inflammation. When validated in an independent cohort and compared to traditional PCR-based clonality assays, this new TRBC1 score demonstrated superior specificity and positive predictive value. The paper positions this method as a practical and highly specific tool to aid in the difficult diagnosis of CTCL from standard skin biopsies. Finally, a study in Pediatric Dermatology highlights the impact of social determinants of health on a challenging pediatric condition. The study investigated the influence of neighborhood socioeconomic status on new diagnoses of hidradenitis suppurativa, or HS, in children [5]. Researchers conducted a cross-sectional analysis of nearly 9,700 pediatric HS patients within a single United States health system. The findings were stark. Even after adjusting for age, sex, race, and ethnicity, pediatric patients living in neighborhoods with the lowest socioeconomic status had significantly greater odds of a new HS diagnosis. Specifically, children in the lowest quintile of neighborhood SES had about four times the odds of an HS diagnosis compared to those in the highest quintile. The trend was linear, with odds decreasing as neighborhood SES increased. These findings strongly suggest that neighborhood-level factors, beyond individual patient characteristics, contribute to the diagnosis of HS, highlighting the urgent need to identify and address these modifiable environmental and social factors. If you only have time for one paper this week, make it the study on treatment-associated phenotype switching from the Journal of the European Academy of Dermatology and Venereology [6]. This large, real-world cohort study provides a much-needed framework for understanding and managing the 'flip-flop' phenomenon between psoriasis and atopic dermatitis, highlighting the emerging role of JAK inhibitors in these complex cases. Here are the key takeaways from this week in Dermatology. First: Be aware of phenotype switching with new biologics. IL-17 and IL-23 inhibitors can trigger eczema in psoriasis patients, while dupilumab can trigger psoriasis in atopic dermatitis patients. Consider a JAK inhibitor as a potential management strategy for these cases [6]. Second: For transgender patients on testosterone seeking treatment for androgenetic alopecia, sublingual minoxidil is a safe and effective option that improves hair density without interfering with hormone therapy [1]. Third: You can reassure patients that short-term courses of corticosteroids—up to four weeks for topical or ten days for oral prednisolone—do not appear to increase intraocular pressure and are generally safe from an ocular perspective [8]. Fourth: Consider simple, scalable interventions like a structured text-messaging program for your psoriasis patients. It can significantly improve cardiovascular risk behaviors, patient activation, and medication adherence [7]. And finally: Remember that social determinants of health matter. Children living in lower socioeconomic status neighborhoods have significantly higher odds of being diagnosed with hidradenitis suppurativa, pointing to environmental or systemic factors we need to address [5]. 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.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.