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Maddi Hebebrand is an associate editor of 

and joined the MJH Life Sciences team in May 2024. She attended Baldwin Wallace University, studying Media Production and Film, and is now finishing her Masters in Digital Media through Ohio University. When she's not writing, Maddi loves to read, attend concerts and spend time with her family.

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The study identified 2 fungal profiles in AD patients, with 1 subgroup exhibiting distinct fungal dysbiosis.

The Mycobiome Connection: How Fungi Influence AD

Kaitlyn Bader is the assistant managing editor of 

 and joined the MJH Life Sciences team in June 2022. She attended Otterbein University in Westerville, Ohio, and earned a Bachelor of Arts degree in literary studies with minors in creative writing and film studies. Prior to health care news, Kaitlyn worked in industrial marketing. She enjoys cooking, reading, and tending to her house plants.

Asha Patel Shah, MD, MBA, FAAD, discusses recent research on retinol and retinoid bioactivity when layered with moisturizers highlighted at AAD 2025.

“Open Sandwich” Moisturization Regimen Does Not Affect Bioactivity of Retinols and Retinoids 

Marie Bosslett is the assistant editor of 

 and joined the MJH Life Sciences team in October 2024. She attended Loyola University Maryland in Baltimore and earned a Bachelor of Arts in Communication with minors in marketing and writing. When she’s not writing, Marie enjoys going to concerts, reading on the beach, and spending time with friends and family.

Participants from the parent DELTA 1 and 2 studies maintained their disease control and observed a decrease in pain and itch over 52 weeks of treatment.

DELTA 3 Showcases Long-Term Safety and Efficacy of Delgocitinib for Chronic Hand Eczema

Researchers have identified elevated eosinophil levels as a potential marker for chronic urticaria in pediatric patients.

New Study Reveals Risk Factors for Persistent Urticaria

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Medical practices must go beyond simply offering competitive salaries and benefits packages to attract new talent and keep their best clinicians and administrative staff working for them.

Best Practices for Recruiting Talented Staff for Your Practice

Final Thoughts: The Importance of Comparative Studies in AD

Panelists offer concluding insights and emphasize the critical role of comparative studies in advancing atopic dermatitis treatment strategies.

clinical

Video Series

 explored the association between commonly prescribed photosensitizing drugs and the risk of developing skin cancer in women.

Photodermatology, Photoimmunology & Photomedicine

, the study found that estrogen therapy and certain diuretics significantly increased the risk of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and cutaneous malignant melanoma (cM).

Previous research has examined the link between photosensitizing medications and skin cancer, but findings have often been inconsistent.

 Given this uncertainty, researchers conducted a large-scale, population-based cohort study to evaluate the potential carcinogenic effects of these drugs.

The study analyzed prospectively collected data from a large cohort of women, incorporating detailed information on sun exposure, phenotypic traits, and pharmaceutical treatments. Skin cancer diagnoses were identified using national registries. Researchers categorized photosensitizing medications into nine groups based on the Anatomical Therapeutic Chemical classification system and assessed associations using multivariable Cox regression analysis. Additionally, the number of retrieved daily doses was analyzed to determine any dose–response relationship.

The study analyzed data from 21,062 women, with 1,875 participants developing at least 1 type of skin cancer: BCC, cSCC, or cM. The vast majority (89%) were diagnosed with only 1 form, while 140 participants had both BCC and cSCC, and 11 developed all 3 concurrently. 

Researchers also evaluated the role of photosensitizing drug use in skin cancer risk, noting that individuals diagnosed with cM had a slightly higher prevalence of photosensitizing drug use compared to other groups.

Analysis of medication exposure revealed that female hormone therapies, particularly estrogen, were significantly associated with increased risk across all 3 cancer types. Estrogen alone demonstrated the strongest link, with hazard ratios of 1.25 for BCC, 1.23 for cSCC, and 1.35 for cM, with only the BCC association remaining statistically significant after Bonferroni correction.

Additionally, thiazide diuretics were linked to higher BCC and cM risk, while loop diuretics were strongly associated with cSCC. 

Photosensitizing antibiotics and proton pump inhibitors showed weaker associations, with some losing statistical significance after adjustment. A dose-dependent effect was observed for estrogen, with higher doses increasing BCC risk by up to 60%. 

While the study provides insights into the association between photosensitizing medications and skin cancer risk, certain limitations should be considered. The study’s applicability may be limited since all participants were drawn from a single geographic region, and researchers could not confirm whether the prescribed medications were consistently taken. Furthermore, grouping certain drug classes together made it difficult to determine the effects of individual medications, according to study authors Christensen et al.

Researchers emphasized the importance of considering medication history when evaluating skin cancer risk, urging clinicians to integrate these findings into patient counseling and preventive care strategies.

"We do not recommend discontinuation of any of the medications studied in this paper," study authors wrote. "Future well-designed prospective studies are warranted to further investigate the relationships between common photosensitizing drugs and the risk of skin cancer."

Christensen GB, Kappelin J, Sandgren J, Nielsen K, Ingvar Å. Photosensitizing drugs and risk of skin cancer in women-a prospective population-based study. 

Robinson SN, Zens MS, Perry AE, Spencer SK, Duell EJ, Karagas MR. Photosensitizing agents and the risk of non-melanoma skin cancer: a population-based case-control study. 

A prospective study investigated the link between photosensitizing drugs and skin cancer risk in women, revealing that estrogen therapy and certain diuretics significantly increase the risk of basal cell carcinoma, cutaneous squamous cell carcinoma, and cutaneous malignant melanoma. The study analyzed data from over 21,000 women, identifying a dose-dependent effect for estrogen. While the findings highlight the importance of considering medication history in skin cancer risk assessment, limitations include geographic constraints and the inability to confirm medication adherence. Further research is recommended to explore these associations.

Estrogen therapy and certain diuretics may increase skin cancer risk, highlighting the need for careful patient counseling and sun exposure management.

Photosensitizing Drugs, Estrogen, and Diuretics Linked to Increased Skin Cancer Risk

Dermatology Times spoke with Paul Yamauchi, MD, PhD, a lead investigator on the trial.

New Research Confirms Effective Therapy for Nail Psoriasis

, Paul Yamauchi, MD, PhD, a board-certified dermatologist at the Dermatology Institute and Skincare Center in Santa Monica, California, spoke about his involvement in a clinical trial evaluating the efficacy of tildrakizumab, a biologic therapy, in treating moderate to severe nail psoriasis. In addition to his private practice, Yamauchi has conducted over 200 clinical trials through the Clinical Science Institute, a research center he founded.

During the interview, Yamauchi emphasized the importance of specific trials for these subgroups of psoriasis patients, stating, "Placebo-controlled trials provide more accurate and reliable data than post hoc analysis."

The study focused on 2 primary endpoints measured at week 28, given that nails grow slowly and require extended observation periods for assessment. The first endpoint was the modified Nail Psoriasis Severity Index (NAPSI) score, which evaluates characteristics such as pitting, nail separation, thickening, and discoloration. According to Yamauchi, a 75% improvement in the modified NAPSI score was observed in 25% of subjects receiving tildrakizumab, compared to only 4.2% in the placebo group The second endpoint was the Visual Index for Severity of Nail Psoriasis (VISNAP), a 5-point scale developed by Sun Pharmaceuticals. Yamauchi explained, "For the VISNAP response at week 28, 29% of subjects attained clear or almost clear nails, compared to a placebo rate of 4.2%." This significant separation between the treatment and placebo groups suggests that tildrakizumab is effective for treating nail psoriasis.

Yamauchi previously investigated tildrakizumab for scalp psoriasis, another high-impact area, which also met its primary endpoints. Yamauchi noted that Sun Pharmaceuticals is planning further trials for genital, hand, and foot psoriasis. He mentioned that topical therapies are typically the first-line treatment for nail and scalp psoriasis. However, if topical treatments fail, systemic options such as pills or injections become necessary. He highlighted tildrakizumab’s advantage, stating, "Since it is administered every3 months, it is very convenient for the patient and a safe product, making it a good choice as a first-line systemic agent."

Safety was another crucial aspect discussed in the trial. Tildrakizumab demonstrated a favorable safety profile, with the most common adverse effects being minor infections. The drug had no significant warnings beyond this, reinforcing its potential as a viable treatment option.

Yamauchi's insights underscore the promising role of tildrakizumab in treating nail psoriasis. The placebo-controlled trial's strong efficacy results, combined with the drug’s safety and convenience, make it a compelling option for patients who do not respond adequately to topical therapies. Additionally, ongoing research may expand its indications to other challenging psoriasis-affected areas, providing further therapeutic options for patients.

Tildrakizumab, a biologic therapy, shows promise in treating moderate to severe nail psoriasis, as demonstrated in a clinical trial led by Dr. Paul Yamauchi. The trial's primary endpoints, the modified Nail Psoriasis Severity Index (NAPSI) and the Visual Index for Severity of Nail Psoriasis (VISNAP), revealed significant improvements in patients receiving tildrakizumab compared to placebo. The drug's favorable safety profile and convenient administration every three months enhance its appeal as a first-line systemic treatment. Further research may extend its use to other psoriasis-affected areas, broadening therapeutic options.

Nail psoriasis affects 50% of plaque psoriasis patients, making effective treatments crucial.


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The Power of Mohs Surgery for Dermatofibrosarcoma Protuberans

A 30-year-old patient with dermatofibrosarcoma protuberans faced a recurrence after initial surgery. Mohs micrographic surgery was used for precise excision, reducing recurrence risk and improving outcomes.

Multidisciplinary Approaches to Managing Challenging Basal and Squamous Cell Carcinomas

John Strasswimmer, MD, PhD, spoke on the difficulty of managing adverse effects, the role of interdisciplinary clinical relationships, and the challenges in complex and older patients.

Phase 1 Trial of PKM2 Modulator SYX-5219 for Atopic Dermatitis Underway

The phase 1a study is a first in-human trial evaluating SYX-5219 for AD.

Dupilumab and AD: Pediatric Ocular Adverse Effects

A recent study highlights the need for ophthalmologic monitoring in pediatric dupilumab therapy.

Long-Term Safety and Efficacy of Ixekizumab in Japanese Patients with Psoriasis

This real-world data explores the use of the IL-17A blocker for up to 3 years in several subtypes of psoriasis.

Nail psoriasis affects 50% of plaque psoriasis patients, making effective treatments crucial.

Review Findings Suggest Melanoma and Hidradenitis Suppurativa Are Risk Factors for Completed Suicide

The review also found that female patients with non melanoma skin cancer demonstrated a greater risk of completed suicide compared to members of a control group.

Mohs micrographic surgery offers precise excision for dermatofibrosarcoma protuberans, reducing recurrence risk. Multidisciplinary approaches are crucial for managing complex basal and squamous cell carcinomas, especially in older patients. A phase 1 trial of SYX-5219 for atopic dermatitis is underway. Pediatric patients on dupilumab require ophthalmologic monitoring due to potential ocular adverse effects. Long-term data supports the safety and efficacy of ixekizumab in Japanese psoriasis patients. Effective treatments for nail psoriasis are essential. Melanoma and hidradenitis suppurativa are identified as risk factors for completed suicide.

Catch up on dermatology news, highlights, and insights from the past 24 hours.

Daily Derm Times: March 20, 2025

 reported that both melanoma and hidradenitis suppurativa (HS) are risk factors for completed suicide.

Journal of the European Academy of Dermatology and Venereology

, the review also found that female patients with non melanoma skin cancer (NMSC) demonstrated an increased risk of completed suicide when compared to a control group.

While numerous studies have explored the psychological burden of skin diseases,

 much of the existing research focuses on suicidality,

 which includes suicidal ideation and attempts rather than completed suicide. Given this gap, researchers conducted a systematic review and meta-analysis to clarify the relationship between specific dermatologic conditions and the risk of completed suicide.

The study systematically reviewed data from PubMed, Embase, and PsycINFO, covering studies from their inception until June 2023. Eligible studies included at least 10 adult patients and specifically examined completed suicide in individuals with dermatologic conditions. A total of 37 studies met the inclusion criteria, representing over 3.8 million patients with skin disease and more than 33 million controls. 

Investigators utilized a random-effects model to account for variability between studies, and the Newcastle-Ottawa Scale assessed study quality. Meta-analyses were conducted separately for 13 identified skin diseases, including psoriasis, dermatitis, melanoma, non-melanoma skin cancer, and HS, to determine their association with completed suicide.

In total, 14 studies investigated psoriasis and completed suicide, including 3 case-control and multiple cohort studies. The meta-analysis pooled data from 6 studies and found no increased risk of suicide in patients with psoriasis (OR: 1.42; 95% CI: 0.76–2.68). Further analysis of psoriasis severity also showed no significant association with suicide risk.

Eight studies assessed atopic dermatitis (AD), eczema, and contact dermatitis in relation to suicide. Five studies contributed to the meta-analysis, which found no increased suicide risk for patients with AD (OR: 1.54; 95% CI: 0.57–4.17). One study suggested a potential seasonal variation in suicides among patients with atopic conditions.

Five studies examined HS and suicide, with 2 providing sufficient data for meta-analysis. Results indicated a significant increase in completed suicide risk among patients with HS compared to the general population (OR: 2.86; 95% CI: 1.56–5.24). Additional studies supported this finding, showing elevated suicide rates when combining psychiatric disease and suicide-related mortality.

A total of 12 studies explored the link between skin cancers and suicide, with mixed findings. Four studies included in the meta-analysis found a higher suicide risk among patients with melanoma (SMR: 2.89; 95% CI: 1.97–3.81). The first year post-diagnosis was identified as a particularly vulnerable period. Two cohort studies found an elevated suicide risk among women with NMSC, but stratification by gender yielded inconclusive results for men. A single study assessing conditions such as Merkel cell carcinoma and dermatofibrosarcoma found no significant association with suicide.

Limited data were available for other dermatologic diseases. One study of prurigo nodularis reported no increased suicide risk. Acne was linked to a possible increased suicide risk in women, though statistical significance was not established. Alopecia areata was associated with suicide and self-inflicted injury in one inpatient study.

The study has limitation, including inconsistencies in inclusion criteria, data sources, and diagnostic definitions, which contributed to selection bias and variability in findings. Differences in health care systems, access to treatments, and coding methods further affected the results, with most data coming from economically developed regions.

However, the meta-analysis highlights the heightened suicide risk among patients with HS and melanoma, particularly within the first year after melanoma diagnosis. While psoriasis and AD showed no increased risk, further research is warranted to clarify associations in other dermatologic conditions, according to study authors Hrvatin et al.

"Suicidality should be considered by physicians when treating dermatological disease, especially when treating patients with hidradenitis suppurativa and melanoma," review authors wrote.

Hrvatin Stancic B, Henning MAS, Eriksen N, Emilie Dornonville de la Cour J, Saunte DML, Jemec GBE. Completed suicide in patients with skin disease: A systematic review and meta-analysis. 

Connor CJ. Management of the psychological comorbidities of dermatological conditions: practitioners' guidelines. 

. 2017;10:117-132. Published 2017 Apr 20. 

Pronizius E, Voracek M. Dermatologists' perceptions of suicidality in dermatological practice: a survey of prevalence estimates and attitudes in Austria. 

A systematic review and meta-analysis examined the association between dermatologic conditions and completed suicide risk. The study found that melanoma and hidradenitis suppurativa (HS) significantly increase the risk of completed suicide, particularly within the first year post-melanoma diagnosis. Non-melanoma skin cancer (NMSC) in women also showed an elevated risk. In contrast, psoriasis and atopic dermatitis (AD) did not demonstrate a significant association with suicide risk. The study highlights the need for physicians to consider suicidality when treating patients with specific skin diseases, especially HS and melanoma.

Atopic dermatitis (AD) is characterized by a dysregulated T-helper 2 immune response and an impaired epidermal barrier, leading to pruritic skin lesions.

 Dupilumab, a monoclonal antibody that inhibits interleukin (IL)-4 and IL-13 signaling, is the first biologic approved for moderate to severe AD treatment in patients aged 6months and older. While dupilumab is clinically effective with a favorable safety profile, dupilumab-associated ocular surface disease (DAOSD) is a notable adverse effect. DAOSD incidence in pediatric patients varies between 5.6% and 17.3% in real-world studies and 8.8%to14.6% in clinical trials, but long-term real-world studies remain limited.

In adult patients with AD, DAOSD incidence reaches up to 39.6%, with nearly half of affected individuals reporting no symptoms.

 The difficulty in recognizing DAOSD symptoms in pediatric patients, particularly young children, poses a challenge, increasing the risk of delayed diagnosis and severe ocular surface disease (OSD). Persistent OSD may lead to long-term complications such as limbitis and irreversible visual impairment. Moreover, young children (<6 years) face an increased risk of keratoconus, which can contribute to amblyopia. Interestingly, DAOSD is less common in patients receiving dupilumab for other type 2 inflammatory disorders, such as asthma or chronic rhinosinusitis, suggesting a unique interplay between AD and DAOSD development.

Although the pathogenesis of DAOSD remains unclear, hypotheses include IL-4 and IL-13 inhibition reducing conjunctival goblet cells and a pre-existing eyelid epithelial barrier dysfunction in patients with AD. Pre-existing ocular pathology and severe AD are established risk factors in adults, but pediatric risk factors remain unknown. A recent study aimed to assess DAOSD incidence and potential risk factors in pediatric patients with AD treated with dupilumab.

A prospective observational cohort study was conducted, including pediatric patients with AD (ages 3 to 17 years) treated with dupilumab at the Wilhelmina Children's Hospital (Netherlands) from August 2019 to March 2024. Patients were monitored through the BioDay registry, with written informed consent obtained from participants' guardians. Treatment was administered subcutaneously per recommended dosing schedules, with modifications for adverse events.

Clinical assessments included baseline AD severity (EASI, IGA), laboratory markers (IgE, eosinophil counts, TARC), and follow-up visits every 12 weeks. Patients reporting ocular symptoms were evaluated to distinguish DAOSD from allergic conjunctivitis. Severe ocular symptoms warranted referral to an ophthalmologist, with severity graded using the UTOPIA scoring system. Ocular treatment ranged from lubricating eye drops to corticosteroids or immunomodulatory therapies.

Among 104 patients (mean age 11.7 years; 41.3% men), DAOSD incidence was 34.6% (36 out of 104). Most cases (69.4%) were managed with lubricating eye drops and topical treatments, while 30.6% required anti-inflammatory ocular therapy. DAOSD onset occurred at a median of 13 weeks and resolved at a median of 24.5 weeks. Notably, DAOSD incidence was highest in adolescents (39.0%) compared to children (28.6%) and young children (30.0%), though no significant age correlation was found.

Patients with DAOSD exhibited higher baseline IgE levels (≥3000 kU/L) and increased prior ocular medication use, indicating potential pre-existing pathology. Ocular symptoms included pruritus (75.0%), redness (72.2%), and tearing (58.3%), with ophthalmological findings commonly revealing tarsal conjunctivitis, meibomian gland dysfunction, and blepharitis. Severe DAOSD cases (5.8%) exhibited limbitis. Dupilumab discontinuation due to DAOSD occurred in 11.1% of affected patients, with symptom resolution in all cases.

This study's 34.6% DAOSD incidence in pediatric AD patients aligns with adult real-world data but exceeds previously reported pediatric rates. Factors contributing to higher rates include increased physician awareness, proactive symptom assessment, and extended follow-up durations. Elevated IgE levels emerged as a significant independent predictor of DAOSD development. Additionally, pre-existing ocular pathology appeared to influence DAOSD severity, as patients with prior ocular medication use were more likely to require intensive treatment.

While most cases were manageable with conservative therapy, the study stated DAOSD remains a burdensome adverse effectnecessitating early recognition and intervention. The findings highlight the importance of routine ophthalmologic screening in pediatric AD patients on dupilumab, particularly those with elevated IgE or prior ocular conditions. Researchers suggested future research should explore preventative strategies and refine DAOSD management protocols to optimize treatment outcomes while minimizing adverse effects.

DAOSD is a prevalent yet manageable adverse effect of dupilumab in pediatric patients with AD, with an incidence of 34.6%. Baseline IgE levels and prior ocular medication use are key risk factors for DAOSD development. Increased clinical awareness and proactive ophthalmologic evaluation can mitigate disease severity, improving patient outcomes. Long-term real-world studies remain necessary to further elucidate risk factors and refine management strategies for DAOSD in pediatric populations.

Achten R, Van der Rijst L, Piena M, et al. Economic and Humanistic Burden in Paediatric Patients with Atopic Dermatitis.

2023;103:adv00881. Published 2023 Mar 8. doi:10.2340/actadv.v103.4842

Blauvelt A, Guttman-Yassky E, Paller AS, et al. Long-term efficacy and safety of dupilumab in adolescents with moderate-to-severe atopic dermatitis: Results through week 52 from a phase III open-label extension trial (LIBERTY AD PED-OLE). 

2022;23(3):365-383. doi:10.1007/s40257-022-00683-2

Achten R, Thijs J, van der Wal M, et al. Dupilumab-associated ocular surface disease in atopic dermatitis patients: Clinical characteristics, ophthalmic treatment response and conjunctival goblet cell analysis. 

 2023; 78: 2266-2276. doi:10.1111/all.15717

Liang L, Sheha H, Li J, Tseng SC. Limbal stem cell transplantation: new progresses and challenges. 

2009 Oct;23(10):1946-53. doi: 10.1038/eye.2008.379. Epub 2008 Dec 19. PMID: 19098704; PMCID: PMC2853891.

van der Rijst LP, van LuijkCM, van der Kamp S, et al. Dupilumab-associated ocular surface disease in paediatric atopic dermatitis patients: Resultsfrom the BioDay registry. 

Atopic dermatitis (AD) involves a dysregulated T-helper 2 immune response and impaired epidermal barrier, leading to pruritic skin lesions. Dupilumab, a monoclonal antibody, is effective for moderate to severe AD but can cause dupilumab-associated ocular surface disease (DAOSD). In pediatric patients, DAOSD incidence is 34.6%, with higher rates in adolescents. Elevated IgE levels and prior ocular medication use are key risk factors. Early recognition and intervention are crucial for managing DAOSD, emphasizing the need for routine ophthalmologic screening and further research on preventative strategies.

Amanda Piwonka

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