Dermatology

Updated pediatric AD guideline endorses modern topicals, biologics, and JAK inhibitors

This guideline issues 27 GRADE-based recommendations for topical, phototherapy, and systemic treatment of pediatric atopic dermatitis. It strongly recommends moisturizers, topical corticosteroids, topical calcineurin inhibitors, crisaborole, roflumilast, ruxolitinib, and tapinarof for skin-directed therapy. Strong systemic recommendations include dupilumab, tralokinumab, lebrikizumab, nemolizumab with topical therapy, and oral JAK inhibitors upadacitinib, abrocitinib, and baricitinib. Conditional recommendations favor bathing, bleach baths, wet dressings, phototherapy, methotrexate, mycophenolate, azathioprine, and cyclosporine when needed. They recommend against topical antimicrobials and PUVA and strongly recommend against systemic corticosteroids for pediatric AD. Most trials are short, limiting certainty about long-term safety and durability of newer biologics and JAK inhibitors. 1

Pediatric AD prevention guideline narrows effective strategies to moisturizing skin care

This companion guideline provides 14 recommendations on primary prevention of pediatric atopic dermatitis and 29 statements on comorbidities. It conditionally recommends moisturizing skin care to reduce AD occurrence in pediatric populations. It conditionally recommends against early food introduction, human milk consumption, and probiotic or vitamin D supplementation for AD primary prevention. The guideline describes associations between pediatric AD and multiple comorbidities but offers no screening or management recommendations. Clinicians should counsel families that skin-focused prevention is reasonable, whereas dietary and supplement strategies lack supportive evidence. 2

Picankibart achieves rapid, durable psoriasis clearance with infrequent maintenance dosing

In this phase III trial, Chinese adults with moderate-to-severe plaque psoriasis received picankibart or placebo followed by every-12-week maintenance dosing. At week 16, 80.3% of patients on picankibart 200 mg achieved PASI90 versus 2.0% on placebo, and 93.5% versus 13.1% achieved sPGA 0/1. All key secondary endpoints significantly favored picankibart over placebo, with p<0.0001 for each comparison. Clinical improvements were maintained through week 52 with both 100 mg and 200 mg every-12-week regimens, with no new safety signals observed. The trial included only Chinese participants and lacked an active comparator, limiting generalizability across populations and biologic classes. 3

Terbinafine-resistant Trichophyton indotineae emerges rapidly in New York

This study identified 135 Trichophyton indotineae, 39 T. mentagrophytes genotype VII, and 14 genotype II* infections in New York between 2022 and 2024. Antifungal susceptibility testing showed 57% of T. indotineae isolates had high terbinafine MICs, with 38%–52% also demonstrating elevated azole MICs. All T. mentagrophytes genotype VII and II* isolates had low MICs to terbinafine and azoles, indicating preserved susceptibility. A deep-learning model using ITS sequences enabled rapid, accurate identification of 28 Trichophyton interdigitale/T. mentagrophytes complex genotypes. Whole-genome sequencing revealed both clonal transmission and independent introductions, highlighting the need for surveillance and infection control. 4