Dermatology

Modeled trade-offs of biologics, phototherapy, and step-therapy in moderate–severe psoriasis

In this simulation of 500,000 adults with moderate–severe plaque psoriasis, biologics achieved the greatest mean PASI reduction, followed by step-therapy and phototherapy alone. QALY gains were similar across strategies, with modest advantages for biologics and step-therapy over phototherapy. Annual payer costs were far higher for biologics than for office or home phototherapy, yielding negative net willingness to pay for biologics. Home phototherapy produced the highest net willingness to pay from the payer perspective, outperforming office phototherapy and biologics. These data support home phototherapy and step-therapy as high-value options when biologic cost or access is limiting. 1

Systemic corticosteroid use in US atopic dermatitis remains frequent and often prolonged

Among 29,994 atopic dermatitis patients initiating systemic corticosteroids, about two-thirds had short-term exposure and nearly one-quarter received long-term treatment beyond three months. Intramuscular corticosteroids accounted for one-fifth of prescriptions, with most remaining courses oral. In a diagnosis-based cohort of 80,647 patients, 20% received systemic corticosteroids within six months of atopic dermatitis diagnosis. These findings indicate substantial, often extended systemic steroid exposure despite guideline recommendations and availability of steroid-sparing options. 2

Systematic review supports margin-sparing excision for many cutaneous melanomas

This review found no prospective trials comparing wide local excision with omission of wide excision for melanoma. Across 30 retrospective studies, narrower lateral margins than guidelines did not worsen local recurrence or survival for melanoma in situ and pT1–pT3 tumors up to 4 mm thick. Evidence for pT4 melanomas and desmoplastic melanoma was inconsistent, arguing against routine margin reduction for these subgroups. For acral melanoma, multiple series suggested that narrower and shallower margins, including plantar fat preservation, did not impair local control or survival. Limited pediatric data showed no overall survival disadvantage with narrow margins, though all evidence was observational and heterogeneous. 3

RMP–NRF2–PD-L1 axis dampens proportional PD-1 blockade response in HCC models

In hepatocellular carcinoma cell lines, enforced RMP expression increased NRF2 and PD-L1 levels and promoted clonogenic growth and migration. RMP-overexpressing tumors in mice grew faster and showed a proliferative, redox-adapted, PD-L1–high phenotype histologically. Under anti–PD-1 therapy, these tumors regressed but exhibited proportionally less inhibition than controls despite greater absolute shrinkage. Post-treatment specimens displayed increased CD8 T-cell infiltration alongside persistent RMP, NRF2, HO-1, and PD-L1 expression, consistent with adaptive immune resistance. The authors propose a combined RMP/NRF2/PD-L1 signature as a biomarker and rationale for pairing PD-1 blockade with redox-pathway modulation. 4