This Week in Dermatology — Sep 25, 2026

This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.

Welcome to This Week in Dermatology. This week we're covering 10 notable papers spanning psoriasis across the lifespan, targeted small molecules moving into orphan inflammatory dermatoses, and the less glamorous but equally consequential business of timing, access, and risk stratification. Let's dive in.

We'll start with psoriasis, where two papers look at opposite ends of the treatment arc. In the British Journal of Dermatology, Magnolo and colleagues report the OptIMMize-1 phase three programme, which enrolled 137 paediatric patients with moderate-to-severe plaque psoriasis and tested risankizumab, the interleukin-23 inhibitor already approved in adults [1]. In the randomised portion, comparing risankizumab against ustekinumab over 16 weeks, the headline response rates were essentially superimposable — around four in five patients reached clear or almost clear on the physician's global assessment in both arms, and PASI 75 sat at about 85 percent either way. The separation appeared only at the top of the response curve, where complete clearance was reached by roughly 41 percent on risankizumab versus about 18 percent on ustekinumab, and responses were maintained or improved out to 52 weeks alongside gains in itch and quality of life. The safety profile mirrored adult experience. This is not a powered superiority comparison, so the complete-clearance difference should be read as descriptive; what the trial does establish is that an interleukin-23 inhibitor performs in children much as it does in adults, which meaningfully widens the paediatric evidence base.

The other side of that arc is what happens when biologics stop. In the Journal of the American Academy of Dermatology, Chiu and colleagues analysed nearly 1,200 treatment episodes across multiple centres in which patients who had responded to a biologic subsequently discontinued it [2]. A distinct pustular flare phenotype — painful, diffuse erythema with pustules and swelling, predominantly on the lower limbs — occurred in about seven percent of episodes. The risk was not random: a family history of psoriasis, concomitant psoriatic arthritis, a prior episode of the same phenotype, a longer time to achieve PASI 50 during treatment, and crucially a higher number of previous withdrawal-and-relapse cycles were each independently associated with it, and the risk climbed with each additional cycle. This is retrospective and non-randomised, without histological or molecular confirmation, so the phenotype remains clinically rather than mechanistically defined. Still, for clinicians who work with intermittent biologic use or drug holidays, it identifies a recognisable at-risk group, and the authors argue for vigilant monitoring and early resumption in those patients.

The second theme is targeted small molecules pushing into diseases that have never had a licensed therapy. The most substantial of these is in JAMA Dermatology, where Mangold and colleagues report a phase two, double-blind, vehicle-controlled trial of ruxolitinib 1.5 percent cream in 64 adults with predominantly cutaneous lichen planus [3]. At 16 weeks, half of the patients on active cream achieved treatment success on the investigator's global assessment — clear or almost clear with at least a two-grade improvement — compared with just over a fifth on vehicle, a statistically significant difference of roughly thirty percentage points, with further improvement through a 16-week open-label extension. Itch tracked the same way: close to half of the ruxolitinib patients achieved a four-point or greater drop on the itch rating scale, against about one in six on vehicle. There were no serious treatment-emergent adverse events and no discontinuations for adverse events. The caveats are the obvious ones — 64 patients, phase two, and enrolment restricted to 20 percent or less body surface area — but for a disease managed largely on habit and topical steroids, this is the first controlled evidence that topical JAK inhibition works.

Also in the British Journal of Dermatology, Gleeson and colleagues report JAKPPPOT, an open-label, assessor-blinded feasibility study of upadacitinib in 20 adults with moderate-to-severe palmoplantar pustulosis at a single UK specialist centre [4]. The primary endpoints here were feasibility, not efficacy — recruitment, adherence, and acceptability — and all were met, with 95 percent of participants adherent and nearly all rating treatment acceptable. The exploratory efficacy signal was striking: mean palmoplantar PASI fell from about 20 at baseline to under 5 at eight weeks, whereas historic placebo data barely moved, and PASI 75 was reached by 65 percent on upadacitinib versus about 3 percent on historic placebo. I'd underline historic: this is an uncontrolled comparison in 20 patients over eight weeks, so the effect size is a hypothesis, not a result. The authors' own conclusion is that a definitive multicentre randomised active-comparator trial is now justified.

That enthusiasm needs the counterweight of the third paper in this group, a clinical review in the Journal of the American Academy of Dermatology by Ezzat and colleagues synthesising what we actually know about JAK inhibitors in adults aged 65 and older across atopic dermatitis, alopecia areata, and psoriasis [5]. Their conclusion is that older adults are systematically underrepresented in the registration trials. Upadacitinib 15 milligrams and abrocitinib 100 milligrams appear effective in older patients with atopic dermatitis, with higher doses generally avoided; baricitinib has efficacy in small older cohorts with alopecia areata, while ritlecitinib data in this age group are too sparse for conclusions; and in psoriasis, deucravacitinib offers durable responses without the boxed warnings for major cardiac events or venous thromboembolism. The authors frame JAK inhibitors as a reasonable option for carefully selected older adults, contingent on baseline cardiovascular and oncologic risk and label-directed dosing, while stressing that age-stratified evidence remains thin.

The third theme is timing — when in a disease course an intervention lands, and whether it lands at all. In the Journal of the European Academy of Dermatology and Venereology, Bertold and colleagues ran a prospective bicentric interventional study in 51 patients with vitiligo, all treated identically with narrowband ultraviolet B plus twice-weekly oral mini-pulse corticosteroids for six months, but stratified by disease duration and activity [6]. The gradient was steep. A 75 percent improvement in vitiligo extent was achieved by 46 percent of patients diagnosed within six months, 16 percent of those with long-standing disease but recent lesions, and none of the patients with long-standing inactive disease. The histology supported the mechanism: mature epidermal melanocytes persisted in half of the newly diagnosed group, a fifth of the intermediate group, and none of the long-standing group, while melanocyte precursors remained in everyone. This was not a randomised comparison of early versus delayed treatment — the groups differ by disease biology as well as timing — but it is the clearest evidence yet for a window of opportunity in vitiligo.

Against that, a nationwide Finnish registry study in Acta Dermato-Venereologica by Sinikumpu and colleagues describes what delayed care looks like in chronic spontaneous urticaria [7]. Across more than 8,700 adults in secondary care, point prevalence was about 0.2 percent, and while 86 percent received antihistamines, more than a third also required systemic corticosteroids — a marker of inadequate control — and fewer than one in ten ever received omalizumab, with a long median lag from antihistamine initiation. The authors attribute much of this to reimbursement restrictions and referral pathway delays. Registry coding limits interpretation, particularly the implausibly low angioedema rate, but the treatment-pattern gap is hard to explain away.

Finally, three papers on standardisation and risk. In the Journal of the European Academy of Dermatology and Venereology, Gupta and colleagues report a four-round modified Delphi on Trichophyton indotineae, the globally spreading, frequently terbinafine-resistant dermatophyte, reaching consensus on about 81 percent of items [8]. The panel advised suspecting it in extensive or terbinafine-recalcitrant dermatophytosis, particularly with travel to or residence in endemic regions, using potassium hydroxide microscopy and culture initially with PCR or ITS sequencing for species confirmation, and favouring oral itraconazole at 100 to 200 milligrams daily for six to eight weeks, with luliconazole 1 percent cream adjunctively and posaconazole reserved as salvage. These are expert opinion, explicitly interim, and the authors call for randomised trials. In JAMA Dermatology, Alomary and colleagues report a three-round Delphi among board-certified dermatologists in the United States on pseudofolliculitis barbae, reaching consensus on 40 statements supporting behavioural modification of hair removal as first-line, targeted topical and systemic treatment, and procedural options including laser hair removal [9]. Notably, no agreement was reached on a standardised grading scale, on isotretinoin for refractory disease, on superficial chemical peels, or on multiblade razors — the unresolved items are as informative as the resolved ones, especially given the occupational and policy stakes. And in the Journal of Investigative Dermatology, Djalali and colleagues followed 395 Swedish solid organ transplant recipients through a three-tier risk stratification model [10]. Over a third developed invasive skin cancer. Compared with low-risk recipients, intermediate-risk patients had roughly six times the hazard and high-risk patients roughly twelve times the hazard of invasive skin cancer, and both groups also had higher mortality — about one and a half and two times respectively. It's retrospective and single-centre, but it supports stratified rather than uniform surveillance intervals in this population.

If you only have time for one paper this week, make it the ruxolitinib cream trial in cutaneous lichen planus in JAMA Dermatology [3]. It is the first controlled evidence of efficacy in a common, intensely pruritic disease that has never had an approved therapy, and it reframes lichen planus as a treatable interferon-driven target rather than a steroid-and-hope diagnosis.

Here is what this week's evidence adds up to in Dermatology. First, interleukin-23 blockade now has phase three paediatric data in psoriasis, with efficacy comparable to ustekinumab and a possible edge at complete clearance, though that comparison was not powered [1]. Second, JAK inhibition keeps expanding into orphan dermatoses — controlled and positive in cutaneous lichen planus, promising but only feasibility-grade in palmoplantar pustulosis — while the evidence in adults over 65 remains sparse enough that the review authors call for individualised, risk-weighted decisions rather than routine use [3,4,5]. Third, timing appears to be biologically consequential: early treatment in vitiligo was associated with far better repigmentation and preserved melanocytes, while repeated biologic withdrawal in psoriasis accumulated risk of a distinct pustular flare — both observational, both pointing the same direction [6,2]. Fourth, the Finnish urticaria data show that even where effective therapy exists, reimbursement and pathway delays keep a third of patients on systemic steroids [7]. And fifth, where trial evidence is absent — resistant dermatophytosis, pseudofolliculitis barbae — consensus is filling the gap, which is useful and explicitly provisional [8,9].

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