This Week in Dermatology — Sep 11, 2026

Welcome to This Week in Dermatology. This week we're covering 10 notable papers spanning immune-targeted therapy — where one major trial failed and several others refine how we use the drugs we already have — plus skin cancer surgery and systemic comorbidity, and a final group on infection, prevention and how care gets delivered. Let's dive in.

We start with immunotherapy, and with a negative result that matters. In the British Journal of Dermatology, Joly and colleagues report ADDRESS, a global phase three, double-blind, placebo-controlled trial of subcutaneous efgartigimod — the neonatal Fc receptor blocker that accelerates immunoglobulin G clearance — added to prednisone in 222 adults with moderate-to-severe pemphigus [1]. Participants were randomised two to one to weekly subcutaneous efgartigimod or placebo, everyone starting prednisone at half a milligram per kilogram daily, and the primary endpoint was complete remission on minimal prednisone by week 30 in the pemphigus vulgaris group. Roughly a third of patients reached that endpoint in each arm, with no statistically significant difference, and total steroid consumption was essentially the same. What makes this instructive is the mechanistic dissociation: efgartigimod did exactly what it was designed to do, driving rapid falls in total immunoglobulin G and in both anti-desmoglein-1 and anti-desmoglein-3 autoantibodies, yet Pemphigus Disease Area Index scores did not improve in parallel. Adverse events were more common on active drug, at about 89 percent versus 76 percent, but serious events were similar and there were no deaths. The practical message is that lowering circulating pathogenic autoantibody is not, by itself, sufficient to change the clinical course of pemphigus at 30 weeks — and it is a reminder to be cautious when a surrogate biomarker looks convincing.

Staying with immune-targeted therapy, two papers in the Journal of the American Academy of Dermatology address Janus kinase inhibition in alopecia areata. King and colleagues report a phase two dose-optimisation trial of deuruxolitinib, a JAK 1/2 inhibitor, in 57 adults with severe disease, comparing 8 milligrams twice daily against 16 milligrams once daily [2]. At week 24, the twice-daily schedule produced a mean relative improvement in Severity of Alopecia Tool score of about 46 percent, compared with about 18 percent for the same total daily dose given once — and more patients on the split schedule reached a SALT score of 20 or below and of 10 or below. Treatment-emergent adverse events were mild to moderate. The sample is small, but the signal is a pharmacodynamic one: for this drug, sustained daily exposure appears to matter more than peak concentration, which is why the twice-daily regimen carried forward into later development. Alongside that, Hill and colleagues offer a clinical review of JAK inhibitors in paediatric alopecia areata, and the central tension is regulatory rather than biological [3]. Ritlecitinib is the only agent approved in the United States for patients aged 12 and over, so most paediatric use — abrocitinib, baricitinib, deuruxolitinib, ruxolitinib, tofacitinib, upadacitinib — is off-label. The authors synthesise reports showing meaningful regrowth in children with generally favourable safety, and they suggest JAK inhibitors may be particularly useful where there is concomitant atopic or autoimmune disease, or elevated immunoglobulin E and eosinophilia. They also argue that early-onset and severe disease should prompt earlier consideration of systemic therapy rather than prolonged topical trials. The honest caveat is heterogeneous outcome reporting across the underlying literature, so this is practical guidance rather than trial-grade evidence.

Two systematic reviews in JAMA Dermatology tackle durability and safety of biologics in chronic inflammatory skin disease. Altayf and colleagues pooled eight studies covering more than 4,500 patients with chronic urticaria to estimate drug survival on omalizumab, reconstructing patient-level time-to-event data from published Kaplan-Meier curves [4]. Median drug survival was about 3.1 years, and over seven years of follow-up patients remained on treatment for a mean of just under four years. Crucially, the dominant reason for stopping was that the disease was well controlled, not toxicity — discontinuation for adverse events was uncommon. Survival was higher in chronic inducible urticaria than in chronic spontaneous urticaria, and the predictor worth remembering is autoimmune comorbidity, mainly thyroid disease, which roughly doubled the risk of stopping for lack of efficacy. An atopic background, by contrast, predicted stopping because the disease had settled. That is a clean, clinic-ready stratification message: the patient with autoimmune thyroid disease is the one to counsel about a possible inadequate response and an early alternative plan. In the same journal, Cutrona and colleagues addressed the persistent worry about interleukin-17 inhibitors unmasking or precipitating inflammatory bowel disease in hidradenitis suppurativa [5]. Across ten randomised trials, new-onset inflammatory bowel disease occurred in 6 of 2,572 patients on an interleukin-17 inhibitor and in none of 1,066 on placebo through week 16, with no statistically significant difference between groups. Non-randomised studies gave a pooled incidence of around 4 percent, which reflects the elevated baseline gastrointestinal risk in hidradenitis populations as much as anything about the drug. Events were rare and reporting inconsistent, so this is reassurance rather than exoneration — take a careful bowel history before starting, and keep the differential open if diarrhoea or bleeding appears.

Turning to skin cancer surgery, the British Journal of Dermatology publishes what is probably the largest prospective comparison we have of Mohs micrographic surgery versus standard excision for primary cutaneous squamous cell carcinoma. Eggermont and colleagues followed 761 patients with 903 completely excised tumours across six Dutch centres, with recurrences captured through the national pathology databank [6]. Mohs was, as expected, used selectively for higher-risk disease — over half the Mohs tumours were stage T2 or above versus a quarter of excisions, and about three quarters sat in the H-zone. Five-year cumulative recurrence was low in both arms, 1.7 percent after standard excision and 3.3 percent after Mohs, and after adjustment for stage there was no significant difference; metastasis rates were around one percent in both. Where Mohs clearly won was tissue preservation — the ratio of final defect to initial tumour size was 1.2 compared with 3.0. The authors are appropriately careful: this is non-randomised with few events, so it cannot establish equivalence. But for counselling, the defensible framing is that Mohs is chosen for functional and cosmetic preservation on the face, not on a demonstrated recurrence advantage.

On comorbidity, the Journal of Investigative Dermatology carries a cross-sectional proteomic study from Berna-Rico and colleagues comparing 34 patients with moderate-to-severe atopic dermatitis against 34 with psoriasis and 20 healthy controls, with carotid and femoral ultrasound to detect subclinical plaque [7]. Atopic dermatitis showed elevated T-helper-2 markers alongside innate and T-helper-1 and -17 signals, plus cardiovascular-associated proteins including CCL19, FGF21, hepatocyte growth factor and P-selectin, with enrichment of atherosclerosis-related pathways. A composite proteomic score discriminated patients with plaque well, with an area under the curve of 0.94, outperforming traditional risk factors — and importantly, the plaque-associated signature differed markedly from that seen in psoriasis. This is small, cross-sectional and hypothesis-generating, but it argues that atopic dermatitis is not simply psoriasis-lite when it comes to vascular risk.

Finally, three papers on everyday practice. The BMJ publishes a clinical review from Long and colleagues on skin and soft tissue infections, reinforcing that laboratory testing adds little in most patients, that point-of-care ultrasound is the tool of choice when you cannot tell cellulitis from abscess, and that incision and drainage remains the core of abscess care with antibiotics reserved for selected patients [8]. They flag decolonisation for recurrent infection as genuinely controversial, and position newer agents such as tedizolid, delafloxacin, omadacycline and ceftaroline as selective options. In Dermatology, Couteau and colleagues compared sunscreen formulations marketed for babies and children against adult products [9]. Baby conventional and organic creams contained significantly fewer ingredients and fewer allergens than conventional adult products, and organic creams contained fewer filters still; the number of allergens did not differ significantly between organic and conventional baby products, so the organic label is not, in itself, an allergen-avoidance claim. And in the Journal of Investigative Dermatology, Peracca and colleagues surveyed more than ten thousand Veterans who had received dermatologic care, with about 1,881 completing every willingness item [10]. Mean willingness to use home-based teledermatology and artificial intelligence was modest, around 3.6 on a five-point scale, and was highest — just under 4 — for care delivered by a primary care physician guided by a smart computer, rather than fully automated self-care. Younger age and health literacy predicted greater willingness. The implication is that patients accept artificial intelligence more readily as clinician support than as clinician substitute.

If you only have time for one paper this week, make it the Dutch prospective cohort of Mohs versus standard excision for cutaneous squamous cell carcinoma [6]. It reframes the conversation you have in clinic every week — the defensible argument for Mohs here is tissue sparing, not a proven reduction in five-year recurrence.

Here are the key takeaways from this week in Dermatology. First, blocking the neonatal Fc receptor lowered pathogenic autoantibodies in pemphigus without improving clinical remission at 30 weeks, so do not treat antibody titres as a substitute for disease activity. Second, in alopecia areata, dosing schedule matters — split daily dosing of deuruxolitinib outperformed the same total dose given once — and most paediatric JAK inhibitor use remains off-label outside ritlecitinib. Third, omalizumab is durable in chronic urticaria, with most stopping because disease is controlled, but autoimmune thyroid comorbidity flags a higher chance of inadequate response. Fourth, interleukin-17 inhibitor-associated inflammatory bowel disease in hidradenitis suppurativa appears rare, with no significant excess over placebo in randomised data, though event numbers are low. And fifth, moderate-to-severe atopic dermatitis carries a systemic inflammatory signature linked to early atherosclerosis that is distinct from psoriasis — worth factoring into cardiovascular risk discussions.

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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