This Week in Dermatology — Jun 20, 2026

Welcome to This Week in Dermatology. This week we're covering nine notable papers spanning clinical screening strategies, advanced therapeutics for severe autoimmune and inflammatory conditions, and emerging prognostic models in patient care. Let's dive in.

We begin with a focus on screening and clinical prediction, starting with a retrospective cohort study published in the Journal of the American Academy of Dermatology that evaluates the clinical utility of dermatologist-performed total body skin examinations [1]. While early detection is known to improve skin cancer outcomes, the diagnostic yield of these examinations in unselected populations has remained unclear. Researchers analyzed three thousand one hundred and twenty-seven encounters from one thousand five hundred and seventy-two University of Miami employees and their spouses who underwent annual total body skin examinations between January 2019 and June 2024. The study found that premalignant lesions, such as actinic keratoses, were detected in eleven percent of examinations, while in-situ lesions were found in just under one-quarter of a percent, and malignant lesions were identified in over two and a half percent of exams. Specifically, among the screenings with malignant findings, sixty-nine cases of basal cell carcinoma and twelve cases of squamous cell carcinoma were diagnosed. Interestingly, the yield was highest among older adults and individuals with a history of nonmelanoma skin cancer. Furthermore, patient-reported spots of concern demonstrated remarkably low predictive value, with a positive predictive value of less than three percent for premalignant lesions and just over one percent for malignant lesions. Crucially, the overall number needed to biopsy was under five, and this metric improved significantly from over six in the first round of screening to under three across subsequent rounds, suggesting that longitudinal screening by dermatologists becomes increasingly efficient over time. However, the authors note several limitations, including the voluntary nature of participation which introduces selection bias, variations in biopsy practices, and the potential that external procedures were missed. Remaining within the realm of prognosis and risk prediction, a systematic review in the Journal of the European Academy of Dermatology and Venereology evaluated prognostic prediction models for identifying psoriatic arthritis in patients with psoriasis [9]. Psoriatic arthritis affects up to twenty-two percent of patients with psoriasis, and early identification offers a vital window of opportunity to initiate treatments that limit disease progression. The review analyzed fifteen studies comprising four hundred and ninety individual models. The most frequently utilized predictors across these models included demographic variables like age, gender, and body mass index, genetic markers such as HLA-B27, HLA-B08, and HLA-C*06, clinical features, lifestyle factors, and clinician- and patient-reported outcomes like the Psoriasis Area and Severity Index and the Dermatology Life Quality Index. While nine of the studies utilized machine learning techniques, such as Bayesian probabilistic methods and random forest, and others used traditional regression, the discriminative performance varied widely, with C-statistics ranging from point-five-three to point-nine-nine. Alarmingly, only three studies performed external validation, which consistently resulted in reduced performance, raising significant concerns regarding the generalizability of these models. In a related clinical context, a multi-institutional cross-sectional study in the Journal of the American Academy of Dermatology investigated the association of autoimmune disease in patients with central centrifugal cicatricial alopecia, highlighting another area where systemic risk assessment is critical for dermatologists [6].

Moving on to advanced therapeutics and complex disease management, we look at a highly challenging clinical scenario: rituximab-recalcitrant pemphigus. In a study published in The Journal of Investigative Dermatology, researchers explored the use of daratumumab, an anti-CD38 monoclonal antibody that targets plasma cells, as a therapeutic option for patients who do not respond to standard first-line therapy [8]. While rituximab combined with short-term corticosteroids is the standard of care, some patients remain refractory. The authors report on two cases of life-threatening pemphigus refractory to rituximab and other alternative therapies. Immunological monitoring revealed that rituximab failure in these patients was associated with incomplete B-cell depletion, marked by the persistence of memory B cells and plasmablasts. Treatment with daratumumab induced rapid clinical improvement, depletion of CD38-positive plasma cells, and a substantial reduction in anti-desmoglein antibodies. Although one patient experienced a relapse after daratumumab was discontinued and subsequently developed anti-rituximab antibodies, combining daratumumab with belimumab led to a sustained complete remission by complementary targeting of plasma cells and preventing autoreactive B-cell reconstitution. The second patient achieved remission with daratumumab, which was then consolidated with additional rituximab. Notably, no treatment-related adverse events were observed, suggesting that targeting CD38-positive plasma cells is a promising strategy for refractory cases. Next, we examine pain management in acute infectious dermatology. A randomized, double-blind, double-dummy, active-controlled, multicenter exploratory trial in the Journal of the American Academy of Dermatology compared intramuscular Cobratide injection to oral Pregabalin for moderate-to-severe acute herpes zoster neuralgia in eighty patients aged fifty to seventy years [2]. Managing acute zoster pain is critical to improving quality of life and potentially reducing the progression to postherpetic neuralgia, but traditional analgesics often carry significant side-effect burdens for older adults. Over a twenty-eight-day treatment period, both groups showed substantial reductions in their average Numeric Rating Scale pain scores, with a mean reduction of six points in the Cobratide group compared to five point six three points in the Pregabalin group. This difference was not statistically significant. At week twelve, postherpetic neuralgia occurred in none of the twenty-seven evaluable patients in the Cobratide group compared to three of the twenty-seven patients in the Pregabalin group, a difference that also did not reach statistical significance. However, treatment-emergent adverse events were lower in the Cobratide group, occurring in roughly thirty-six percent of patients compared to over fifty-one percent in the Pregabalin group. While the study is limited by its small sample size and exploratory design, Cobratide demonstrated a favorable tolerability profile and a similar magnitude of pain reduction to Pregabalin, warranting larger, adequately powered trials. In other therapeutic and safety updates, the Journal of the European Academy of Dermatology and Venereology highlighted an emerging safety signal regarding OX40 pathway inhibition and the development of Kaposi sarcoma in patients treated for atopic dermatitis [3]. Meanwhile, a Danish register-based cohort study published in the Journal of the American Academy of Dermatology provided reassuring safety data, demonstrating that isotretinoin is not associated with an elevated risk of pseudotumor cerebri [4]. For infectious disease management, the Journal of the American Academy of Dermatology published a clinical review on the diagnosis and management of acyclovir-resistant herpes simplex virus, offering practical guidance for dermatologists facing resistant viral strains [5]. Finally, in dermatologic surgery, a brief report of four hundred and ninety-three surgical defects evaluated the utility and performance of barbed suture-assisted high-tension cutaneous closure, expanding our procedural toolkit for challenging closures [7].

If you only have time for one paper this week, make it the retrospective cohort study on dermatologist-performed skin cancer screening from the Journal of the American Academy of Dermatology [1]. This paper provides invaluable, real-world data showing that longitudinal, dermatologist-led screenings not only yield high detection rates of early-stage malignancies but also become significantly more efficient over time, as evidenced by a near-halving of the number needed to biopsy across successive screening rounds.

Here are the key takeaways from this week in Dermatology. First, dermatologist-performed total body skin examinations are highly effective at identifying early-stage skin cancers, with the highest yield in older adults and those with a history of skin cancer, and their biopsy efficiency improves with repeated annual screenings [1]. Second, patient-reported spots of concern have a very low positive predictive value, emphasizing the necessity of comprehensive, clinician-led examinations rather than relying solely on patient spotting [1]. Third, for patients with life-threatening pemphigus who fail standard rituximab therapy, targeting plasma cells with the anti-CD38 antibody daratumumab, either alone or combined with belimumab, represents a highly promising and well-tolerated rescue strategy [8]. Fourth, in patients with acute herpes zoster neuralgia, intramuscular Cobratide injection offers a magnitude of pain reduction comparable to oral Pregabalin with a potentially superior safety and tolerability profile [2]. And finally, existing prognostic models for predicting psoriatic arthritis in psoriasis patients suffer from a significant lack of external validation, meaning clinicians should exercise caution when using these models to guide treatment decisions in daily practice [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.