This Week in Dermatology — May 21, 2026

Welcome to This Week in Dermatology. This week we're covering 8 notable papers spanning acne management, new approaches to inflammatory skin disease, drug-induced bullous pemphigoid, and the standardization of teledermatology. Let's dive in.

Acne Management: Addressing Patient Concerns We begin with two papers that address common and persistent questions in acne management. First, a major study tackles the long-standing concern about isotretinoin and linear growth. Published in *JAMA Dermatology*, this nationwide Danish study provides powerful reassurance [7]. Investigators analyzed data from over 379,000 individuals eligible for military conscription, linking their prescription records to their final adult height. They compared those who had used isotretinoin during adolescence to those who used other acne treatments or no treatment at all. The results were clear: isotretinoin use was not associated with reduced adult height. The adjusted mean difference in height was less than half a centimeter, a value far below the 5-centimeter threshold considered clinically important. These findings held true even when stratified by the age at which isotretinoin was started or the cumulative dose received. For clinicians, this robust, population-level evidence is immediately practice-affirming, allowing us to confidently counsel adolescent patients and their parents that isotretinoin treatment for acne will not make them shorter.

While one concern may be put to rest, another area of acne management remains complex: the role of diet. A review in the *Journal of the European Academy of Dermatology and Venereology* summarizes the facts and controversies [8]. The authors acknowledge the consistent patient interest in how food affects their skin. The review highlights the current evidence, which primarily consists of observational studies pointing to associations between acne and high glycemic load diets, skim or low-fat milk, whey protein supplements, and an unbalanced omega-6 to omega-3 fatty acid ratio. However, the paper also stresses a critical limitation: the scarcity of high-quality, controlled interventional studies. This makes it difficult to draw firm conclusions or recommend specific, restrictive diets. The clinical takeaway for now is to provide patients with sensible advice aimed at balanced nutrition and a healthy body weight, while avoiding potentially harmful restrictive regimens until more definitive trial data becomes available.

Advances in Inflammatory Disease Next, we turn to a trio of papers highlighting new therapeutic strategies and clinical insights for inflammatory skin diseases. First, from the *Journal of the American Academy of Dermatology*, a study defines a distinct psoriasis-atopic dermatitis overlapping phenotype, or Pso-Ec [2]. Researchers prospectively studied 30 adult patients who presented with a challenging clinical picture: ill-defined erythematous plaques with thin scales, intense itching, and mixed histology. Immunologic profiling revealed a unique signature with co-existence of both Type 2 and Type 3 inflammation. Critically, these patients often had inadequate responses to biologics targeted at either psoriasis or atopic dermatitis alone. However, treatment with JAK1 inhibitors led to minimal disease activity in a majority of patients over a median follow-up of 17 months. This paper helps characterize a difficult-to-treat population and suggests that for patients with this dual inflammatory signature, JAK1 inhibition may be a particularly effective strategy.

For patients with more classic atopic dermatitis, a post-hoc analysis of the ADvocate phase 3 trials, published in *Acta Dermato-venereologica*, offers a clinically practical view of lebrikizumab's efficacy [5]. While clinical trials often use percent improvement in the Eczema Area and Severity Index, or EASI, to compare study arms, clinicians often think in terms of absolute EASI scores to gauge an individual's disease state. This analysis did just that, assessing the proportion of patients who achieved absolute EASI scores of 7 or less, 5 or less, and so on. At week 16, significantly more patients on lebrikizumab monotherapy achieved these low absolute EASI scores compared to placebo, regardless of their baseline disease severity. Furthermore, the responses were durable through week 52. This helps translate trial data into a more tangible measure of clinical success, confirming that lebrikizumab can bring patients, even those with severe disease at baseline, to a state of clear or almost clear skin.

Finally, in the realm of lichen planus, we now have head-to-head data comparing a JAK inhibitor to a conventional systemic therapy. An assessor-blind randomized clinical trial in *Clinical and Experimental Dermatology* pitted baricitinib against hydroxychloroquine for cutaneous lichen planus [6]. Thirty-two patients were randomized to either baricitinib 4 milligrams daily or hydroxychloroquine 200 milligrams twice daily for 12 weeks. While both groups showed significant improvement, the baricitinib group did better. The mean Lichen Planus Activity and Damage Index, or LiPADI, score decreased more substantially with baricitinib. Baricitinib was also superior for relieving pruritus, with the average itch score dropping from 8.3 to just 0.2, compared to a drop from 8.8 to 3.3 with hydroxychloroquine. Patients on baricitinib also reported higher satisfaction. While the study is limited by its small size and short duration, it provides the first randomized evidence suggesting that baricitinib offers greater and faster improvement for cutaneous lichen planus than hydroxychloroquine.

Drug-Induced Bullous Pemphigoid Our next theme covers new insights into the diagnosis and treatment of drug-induced bullous pemphigoid. First, a prospective case-control study in the *Journal of the American Academy of Dermatology* sheds light on gliptin-associated BP [1]. The study confirms a strong association between gliptin exposure and BP, but with a crucial distinction among drugs: linagliptin was a significant risk factor, whereas sitagliptin did not show a comparable effect. Furthermore, patients with gliptin-associated BP, particularly those on linagliptin, often presented with a distinctive phenotype: milder, often non-inflammatory disease, and, importantly, seronegativity on standard ELISAs for BP180-NC16A and BP230. This can cause diagnostic delays. The study found that a broader ELISA targeting the entire BP180 ectodomain improved diagnostic performance in these seronegative patients. The clinical implications are twofold: first, in elderly patients, sitagliptin may be a safer choice than linagliptin, and second, if you suspect gliptin-induced BP but standard serologies are negative, seeking out this alternative ectodomain-based assay could clinch the diagnosis.

Shifting from a common diabetes drug to cancer immunotherapy, a Spanish multicenter case series in *Acta Dermato-venereologica* reports on the successful use of dupilumab for immune checkpoint inhibitor-induced bullous pemphigoid, or ICI-BP [3]. This is a challenging condition, as conventional immunosuppressants may compromise the anti-tumor effect of the ICI. In this series of 19 patients, dupilumab was highly effective. Nearly 95% of patients had a clinical response, with 84% achieving complete remission. Among the 17 patients who were on systemic corticosteroids before starting dupilumab, over 82% were able to discontinue them completely. Most importantly, this effective control of the autoimmune side effect allowed over 60% of patients to continue or reintroduce their life-saving ICI therapy. With a favorable safety profile, this study positions dupilumab as a key therapeutic option for managing ICI-BP, helping both the skin and the underlying cancer treatment.

Standardizing Teledermatology Finally, we have a practical paper from *Acta Dermato-venereologica* aimed at improving the quality of teledermatology, particularly for the assessment of suspicious skin tumors [4]. Recognizing that the utility of a remote consultation is highly dependent on the quality of the information provided, a European expert panel conducted a three-round Delphi study to establish a consensus on essential variables for referrals. After starting with 47 proposed variables, the group ultimately reached consensus on a core dataset of 12. Notably, variables related to image quality were found to be the most robust and essential across all analyses. This work provides a focused, clinically practical blueprint for standardizing teledermatology referrals. Adopting such standards can improve diagnostic accuracy and efficiency for human dermatologists and will be critical for validating and implementing future artificial intelligence-assisted workflows.

If you only have time for one paper this week, make it the nationwide study on isotretinoin and adult height in *JAMA Dermatology* [7]. Its large scale and robust, reassuring findings provide definitive evidence to counter a long-standing patient and parental concern, which will be immediately useful in your next acne clinic.

Here are the key takeaways from this week in Dermatology. First: Reassure your adolescent acne patients and their parents: a large, nationwide study shows isotretinoin does not impair adult height. Second: For patients with overlapping features of psoriasis and atopic dermatitis who fail standard biologics, consider it a distinct phenotype and know that JAK1 inhibitors appear to be an effective option. Third: In patients with cancer on immune checkpoint inhibitors who develop bullous pemphigoid, dupilumab is a highly effective and safe treatment that can spare steroids and often allow for continuation of their cancer therapy. Fourth: When managing drug-induced BP, be aware that linagliptin carries a higher risk than sitagliptin and may present with a seronegative, milder phenotype requiring specialized testing for diagnosis. And finally: For cutaneous lichen planus, a new head-to-head trial suggests baricitinib offers greater short-term improvement in disease activity and pruritus compared to hydroxychloroquine.

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.