Journal Digest: May 6, 2026

Pediatric Dermatology | Social Media and Direct-to-Consumer Treatments in Pediatric and Young-Adult Patients With Alopecia: Variable Use and Mixed Perceptions

A cross-sectional survey conducted at Boston Children's Hospital examined how social media and direct-to-consumer (DTC) treatments influence alopecia management in patients aged 25 years and younger. Among 115 respondents with physician-diagnosed alopecia, 65% reported social media use, increasing with age. Of these users, 59% had encountered hair loss–related content, most commonly on platforms such as TikTok, Instagram, and YouTube. Notably, many participants were uncertain about the credibility of content creators, and nearly one-quarter rarely or never questioned the accuracy of online information. Exposure to social media influenced treatment behaviors, with 28% of those viewing content reporting use of a product seen online. Overall, 60% of respondents had tried at least one DTC treatment, though only 30% were current users. Reported outcomes were mixed, with low satisfaction, variable costs, and side effects such as dryness, itching, and increased shedding. These findings highlight the need for clinicians to proactively address social media exposure and guide patients toward evidence-based care.¹

Health Science Reports | Combined Use of Botulinum Toxin A and Profhilo for Upper Face Rejuvenation: A Randomized Clinical Trial

In this small prospective clinical trial, investigators evaluated whether adding Profhilo, a high-concentration hyaluronic acid formulation, enhances outcomes of Botulinum toxin A (BTX-A) for frontal wrinkle reduction. Twenty adults with horizontal forehead lines were randomized to receive either BTX-A alone or BTX-A plus two subsequent Profhilo treatments. Both groups demonstrated significant improvement in wrinkle severity from baseline (p < 0.001), confirming the efficacy of BTX-A for upper facial lines. However, there were no statistically significant differences between groups (p = 0.633), indicating that the addition of Profhilo did not enhance short-term clinical outcomes. Similarly, ultrasound assessments showed no meaningful changes in skin thickness or elasticity in either group. Patient satisfaction improved in both arms, with no between-group differences. Treatments were well tolerated, with only minor adverse effects such as bruising and discomfort. Overall, the findings suggest that combining Profhilo with BTX-A does not provide additional short-term benefit for frontal rejuvenation but larger studies with longer follow-up are needed to assess potential delayed effects.²

Dermatologic Therapy | Early Diagnostic Barriers and Practical Strategies in Anti-MDA5 Dermatomyositis: Insights From Six Misdiagnosed Cases

This small retrospective case series highlights diagnostic challenges in anti-MDA5 dermatomyositis (MDA5-DM), a subtype of dermatomyositis often marked by prominent skin findings and a high risk of interstitial lung disease (ILD). Across 6 patients, all were initially misdiagnosed—most commonly as eczema, lupus, or other inflammatory dermatoses—reflecting the nonspecific and variable early cutaneous presentation. Classic features such as Gottron’s papules, palmar papules, and periungual erythema were inconsistently present, and minimal or absent muscle involvement further complicated recognition. Five patients developed ILD, including one fatal case of rapidly progressive disease. Anti-Ro-52 antibodies were associated with ILD in this cohort. Diagnostic delays were driven by low suspicion, benign-appearing skin findings, and misattribution of respiratory symptoms to infection. The authors emphasize a process-based approach: careful skin examination, early antibody testing (anti-MDA5, anti-Ro-52), and prompt chest imaging when respiratory symptoms arise. Multidisciplinary collaboration is critical to enable earlier diagnosis and timely immunosuppressive treatment.³

International Journal of Dermatology | Regulatory Divergence Between United States and European Direct-to-Consumer Skin Cancer Platforms Shapes Patient Safety and Follow-Up Pathways

This comparative analysis evaluated 11 DTC digital skin cancer platforms across the US and Europe, highlighting key differences in regulation, performance reporting, and clinical integration. US-based platforms largely function as educational tools or teledermatology services operating without formal FDA clearance, often relying on company-reported accuracy metrics and leaving follow-up decisions to patients. In contrast, several European platforms carry CE marking under the Medical Device Regulation, enabling AI-driven risk assessment with more structured follow-up pathways and, in some cases, insurer reimbursement. Across both regions, clinician oversight varies, with some platforms offering optional or no dermatologist involvement. AI-only models raise concerns about false reassurance, particularly given variable accuracy and inconsistent validation methods. For dermatology NPs and PAs, these findings underscore the importance of asking patients about DTC tool use, clarifying limitations of AI-based assessments, and reinforcing appropriate follow-up for suspicious lesions.⁴

Clinical and Translational Science | Evaluation of a Therapeutic Drug Monitoring Strategy for Adalimumab in Psoriasis: A Prospective Pharmacokinetic-Pharmacodynamic Study

In this large real-world pharmacokinetic–pharmacodynamic study of 543 patients with psoriasis treated with adalimumab, investigators evaluated a proactive therapeutic drug monitoring (TDM) strategy to optimize outcomes. Using 946 serum samples and 1700 PASI measurements, a PKPD model linked drug exposure to clinical response and simulated dose adjustments based on trough levels within a target range of 3.2–7.0 μg/mL. Compared with standard dosing, proactive TDM improved 6-month PASI90 and PASI75 response rates by 37.5% and 12.8%, respectively, though with a 25.9% increase in drug costs. Early low drug levels triggered dose escalation, while high levels with good response allowed de-escalation. Notably, TDM helped identify patients unlikely to achieve optimal response despite adequate exposure, suggesting a role for earlier biologic switching. These findings support TDM as a potential strategy to individualize adalimumab therapy, with future integration into Bayesian dosing tools to guide real-time clinical decision-making.⁵

References

1. Lee S, Conza A, Aigbekaen I, Chang J, Damji Y. Social Media and Direct-to-Consumer Treatments in Pediatric and Young-Adult Patients With Alopecia: Variable Use and Mixed Perceptions. Pediatr Dermatol. Published online April 29, 2026. doi:10.1111/pde.70226

2. Saffarian Z, Rahimnia A, Ehsani A, et al. Combined Use of Botulinum Toxin A and Profhilo for Upper Face Rejuvenation: A Randomized Clinical Trial. Health Sci Rep. 2026;9(5):e71973. Published 2026 Apr 28. doi:10.1002/hsr2.71973

3. Shi W, Wang H, Wu T, et al. Early Diagnostic Barriers and Practical Strategies in Anti-MDA5 Dermatomyositis: Insights From Six Misdiagnosed Cases, Dermatologic Therapy. 2026, 3307542, 10 pages, 2026. https://doi.org/10.1155/dth/3307542

4. Sharifi I, Kraft G, Nouri K. Regulatory Divergence Between United States and European Direct-to-Consumer Skin Cancer Platforms Shapes Patient Safety and Follow-Up Pathways. Int J Dermatol. Published online April 29, 2026. doi:10.1111/ijd.70453

5. Pan S, Tsakok T, Wei R, et al. Evaluation of a Therapeutic Drug Monitoring Strategy for Adalimumab in Psoriasis: A Prospective Pharmacokinetic-Pharmacodynamic Study. Clin Transl Sci. 2026;19(5):e70563. doi:10.1111/cts.70563