Volume 192, Issue 5, May 2025

This review explores the immunopathogenesis of vitiligo, focusing on the role of regulatory T cells (Tregs) in autoimmune mechanisms affecting melanocytes. We systematically analyse Treg dysfunction, including their reduced frequency and instability in patients with vitiligo. Additionally, we discuss emerging insights into Treg modulation through metabolic changes, post-translational modifications and interactions with other immune cells. The review highlights current and innovative Treg-targeted therapies, with the aim of enhancing the understanding of and treatment strategies for vitiligo.

Melanoma is the fifth most common cancer in the UK. It accounts for 4% of all new cases of cancer, with a predicted 7% increase in incidence between 2014 and 2035. In advanced disease, effective therapies have allowed a de-escalation of surgery, changing the role and sequencing of local therapies. In this context, this article seeks to summarize the most relevant of the recent updates to the National Institute for Health and Care Excellence guidelines.

We conducted a scoping review on randomized controlled trials of systemic medication in atopic dermatitis included in a living systematic review. We found that most trials adequately reported the allowance or prohibition of concomitant topical treatments (n = 64/67; 96%), but this clarity was less prevalent with regard to rescue topical treatments (n = 49/67; 73%). All trials permitting concomitant treatments consistently reported the type used, although details on potency, duration and quantity were less frequently reported. Similarly, trials that allowed rescue treatments often specified the type but provided limited other information.

ABP 654 is a biosimilar to ustekinumab reference product (RP), a biologic agent used in the treatment of certain chronic immune-mediated inflammatory diseases. The result of this randomized double-blinded active-controlled single-transition comparative clinical study demonstrated that ABP 654 and ustekinumab RP are clinically similar in efficacy, safety and immunogenicity in patients with moderate-to-severe plaque psoriasis.

In Japanese children aged 6–12 years with atopic dermatitis (AD) and inadequately controlled moderate-to-severe pruritus, 16 weeks of nemolizumab treatment (30 mg every 4 weeks) was shown to be clinically effective and tolerable. During a long-term extension period (weeks 16–68), the 5-level itch score, Average Pruritus Numerical Rating Scale and Eczema Area and Severity Index showed a sustained tendency toward improvement, patient quality of life continued to improve, rates of caregiver fatigue decreased and no late-onset treatment-emergent adverse events were seen. These data confirm that long-term (68 weeks) treatment with nemolizumab provides continuing clinical efficacy for paediatric patients with AD and pruritus, with no new treatment concerns.

Therapeutic options for mild hidradenitis suppurativa (HS) represent a significant gap in the current treatment landscape, with no FDA-approved therapies for early-stage HS. Six individuals completed the study, with five successfully achieving HiSCR through 16 weeks of treatment. Importantly, topical treatment not only resolved epidermal inflammation, but also cleared deeper inflammatory infiltrate. The efficacy observed in this trial provides promise for topical JAK inhibitors and other novel topical treatments in HS.

We examined mean age at diagnosis of invasive melanoma for the White population of men and women in the USA and for the population in Queensland, Australia, over two decades, by anatomical site, thickness and histological subtype of melanoma. We found that, on average, women are diagnosed with invasive melanoma 3–8 years earlier than men. This sex difference was observed across most body sites and thickness categories, with the most significant difference for thinner melanomas and melanoma of the trunk. Our findings suggest that sex may be a factor that influences melanocytic progression.

Despite the high risk of xerosis and dyspigmentation in patients with skin of colour who have atopic dermatitis (AD), no patient-reported instruments exist to assess these disease sequelae in this population. We report on the development of patient-reported outcome questionnaires for the self-assessment of AD-related xerosis and dyspigmentation in patients with skin of colour. In meetings with clinical experts and interviews with patients with skin of colour who have AD, the questionnaires were easily understood and accurately reflected the experience of patients with AD.

We developed a novel three-dimensional (3D) model of infantile haemangioma (IH) to investigate angiogenesis in IH at a molecular level. The 3D model enabled investigation of the antiangiogenic properties of drugs, offering a viable alternative to in vivo models. It also offers a valuable tool for decoding IH pathogenesis, molecular analysis and high-throughput drug screening.

We present evidence that the MHC class II chaperone CD74 is widely and robustly expressed in cutaneous T-cell lymphoma (CTCL) of all common subtypes, including clinically challenging entities. Targeting CD74 in CTCL is highly effective in vitro and in vivo, even against TP53-defective CTCL cells.

We identified a novel autosomal dominant disease, SLURP1-palmoplantar keratoderma (PPK)/progressive symmetric erythrokeratoderma (PSEK), with variants affecting the signal peptide sequence of SLURP1. SLURP1–PPK/PSEK A22 variants led to an alternative signal peptide cleavage site and increased differentiation-induced expression and secretion of SLURP1. In cases of PSEK, we found increased nuclear factor-κB signalling and innate immune activity.

The current management of psoriasis does not differentiate between younger and older patients in selecting the safest and/or most effective biologic. We explored the effect of age at treatment initiation in response to biologics in patients with moderate-to-severe psoriasis in the UK and Eire. Data from patients registered in BADBIR from 2007 to 2024 on a first course of tumour necrosis factor (TNF), interleukin (IL)-12/IL-23, IL-17 and IL-23 inhibitors were analysed. Results from 14 294 patients showed that those aged 16–24 years are more likely to stop TNF inhibitors due to ineffectiveness, whereas those aged ≥ 55 years are more likely to stop biologics due to adverse events. These real-world findings provide important information for clinicians treating people with psoriasis across all age groups.

Recessive dystrophic epidermolysis bullosa (RDEB) is a genetic disorder caused by pathogenic variants in COL7A1. Data from 236 North American patients with RDEB support the categorization of genotypes into low-, medium- and high-impact groups based on the type of DNA mutation. Patients in the high-impact group had worse clinical outcomes.

From June 2025 all topical steroids licensed in the UK will be labelled on the container and packaging as ‘Mild steroid’, ‘Moderate steroid’, ‘Strong steroid’ or ‘Very strong steroid’. The designation will match the legal pharmaceutical category. The British National Formulary has previously classified a few products differently and has now altered those designations to match the new labels.

A-STAR is a prospective, longitudinal register study aimed at evaluating short- and long-term effectiveness, safety and cost-effectiveness of systemic treatments. This letter presents the baseline characteristics of the cohort and describes future directions of the register’s development.

This research utilizes whole metagenomic shotgun sequencing to analyse the skin microbiome in patients with psoriasis, comparing lesional and nonlesional skin with those of healthy individuals. The study identifies significant differences in the microbial composition and functionality between psoriatic and healthy skin, revealing distinct microbial patterns and disruptions in psoriatic skin. These findings highlight the complex role of skin microbiota in psoriasis, emphasizing variations in bacteria and their functional characteristics beyond mere species identification.

Using genome sequencing, we identified novel structural variants in the IKBKG gene in two patients affected by incontinentia pigmenti (IP). As a large proportion of patients with IP do not have a molecular diagnosis, and new variants remain to be identified. Emerging technologies, such as long-read sequencing, hold promise for further advancing the molecular diagnosis of IP.

This international study assesses the impact of menstrual irregularity on skin disorders in women aged between 18 and 55 years across 20 countries. The results reveal that menstrual irregularities are significantly associated with an increase in the prevalence of acne, rosacea, seborrhoeic dermatitis and melasma. The results underline the importance of an integrated, personalized approach to dermatology for women with irregular menstrual cycles.

Approximately 30% of patients with hidradenitis suppurativa (HS) report a positive family history of the disease. Currently, there are limited data available on familial HS. To address this gap, we conducted a retrospective analysis at our centre to identify differences between patients with and without a positive family history of HS.

Molecular profiling on biopsies from 31 patients with Grover disease (GD) shows increased expression of interleukin 13 (a T helper 2 cell cytokine) to be a hallmark of GD. In a supportive retrospective series of nine patients with treatment-refractory GD, all improved with dupilumab. This work helps establish GD as a type 2 immune disorder.

Grover disease, while rare, significantly impacts quality of life due to its symptomatic pruritic papules and lack of definitive treatment strategy. Our study provides evidence of the effectiveness of dupilumab in the treatment of Grover disease, especially in patients with a history of atopic disease.

Two measurement tools are currently used to assess skin disease activity in dermatomyositis (DM) clinical trials: the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) and the Cutaneous Dermatomyositis Investigator Global Assessment (CDM-IGA). This cross-sectional study assessed variability in erythema presentation across DM subtypes and among racial groups by comparing these two measurement tools: the CDASI and the CDM-IGA. With the increasing need to standardize DM trial outcome measures for cutaneous disease, our findings support the use of the CDASI as the primary scoring tool to determine cutaneous trial outcomes.

This research letter holds particular significance for a global health and equity dermatology journal as it addresses critical considerations for continuing medical education and relevant epidemiology of the Caribbean. The aim of our survey was to determine the perspectives and needs of Caribbean dermatologists to better support this community. Our focus was to identify common conditions seen in clinical practice and the educational interests of the group. We hope our data help guide local and international efforts to identify and address the needs of this diverse and unique region.

Pachyonychia congenita has a significant impact on the Foot Function Index (FFI) comparable with that seen in rheumatoid arthritis. Some genotypes have a greater impact than others. The FFI will be a helpful tool for clinical research in this area.

Diagnosis of subcutaneous infection caused by Parathyridaria percutanea, a rare and emerging tropical fungal pathogen identified in an immunocompromised woman using clinical shotgun metagenomics.

This retrospective study assessed the melanoma miss rate of dermatology clinicians working in a secondary care NHS hospital. Nine of 428 primary invasive melanomas (2.1%) diagnosed over a 2-year period had been dismissed as benign in the same service within the preceding year (missed diagnosis). A further four cases (0.9%) were classed as possible misses and a final four (0.9%) as delayed diagnosis.

Earth’s changing climate is affecting the health of people worldwide. Dermatology is particularly affected by climate change due to the skin’s direct contact with the environment. The majority of physicians do not feel prepared to address climate change’s impact on health or to take action.

Dowling–Degos disease (DDD) is a rare hyperpigmentation disorder with autosomal-dominant inheritance. To date, work by our group and others has identified a total of four DDD sub-phenotypes, which arise secondary to variants in KRT5, POFUT1, POGLUT1 and PSENEN. We postulate that GLMN is a novel fifth gene for DDD that contributes to a hitherto unrecognized DDD sub-phenotype.

Our case demonstrates significant improvement in autoantibody levels and clinical outcomes, suggesting that telitacicept could be an alternative treatment for patients with mild pemphigus [Pemphigus Disease Area Index (PDAI) ＞9] who are not recommended for treatment with rituximab (PDAI ＜15), and especially for those unresponsive to conventional treatments or with treatment-resistant scalp lesions in pemphigus.

We describe a middle-aged female patient who presented with a 1-year history of a thick-crusted plaque on an erythematous base of the left heel. Twenty years earlier, the patient was diagnosed with lichen planus and received treatment, leaving residual erythema on the heel. Over the past year, she noticed a progressive enlargement and desquamation of the erythema with a newly formed brown-yellow, hyperkeratotic and thick-crusted plaque in the centre, which was recalcitrant to empirical topical glucocorticoids, antibiotics and antifungals. Based on the clinical and typical histological findings, a diagnosis of squamous cell carcinoma arising from lichen planus was made.

We report a case of facial lymphocutaneous sporotrichosis, which is a relatively uncommon infection and may lead to misdiagnosis if not properly recognized.

We describe a patient with extramammary Paget disease. We think these clinical and pathological pictures are typical, interesting and educational.