Journal Digest: October 14, 2026

This week’s Journal Digest highlights new research on undeclared potent corticosteroids in over-the-counter skin products, prenatal diet and infant eczema, melanoma prevention in children at elevated familial risk, prognostic tools for advanced cutaneous lymphoma, and sustained dupilumab response in pediatric atopic dermatitis.

Undeclared Potent Corticosteroids Identified in OTC Skin Products

JAMA Network Open | Undeclared Pharmacologically Active Ingredients in Over-the-Counter Skin Products

A study published in JAMA Network Open identified undeclared pharmacologically active ingredients in several over-the-counter (OTC) skin products marketed online for conditions including eczema, psoriasis, dermatitis, and hyperpigmentation. Investigators purchased 18 products selected on the basis of therapeutic claims, lack of disclosed clinically proven ingredients, and consumer engagement, then screened them for 28 corticosteroids and antifungal agents.

Undeclared active ingredients were detected in 6 of the 18 products (33.3%). All 6 contained the superpotent prescription corticosteroid clobetasol propionate, while 2 also contained an antifungal agent. Clobetasol concentrations ranged from approximately 0.01% to 0.46%, with the highest concentration more than 9 times the 0.05% concentration used in FDA-approved topical clobetasol formulations. None of the active ingredients identified through testing appeared on product labels.

For clinicians: The findings underscore the importance of asking patients with persistent or unexplained skin findings about OTC and online products—not just prescription medications. Undisclosed exposure to superpotent topical corticosteroids may contribute to skin atrophy, acne, dyspigmentation, and systemic effects and may complicate the assessment of treatment response or disease severity.

Prenatal Diet Quality Associated With Infant Eczema and Colic

JAMA Network Open | Maternal Prenatal Diet and Colic and Eczema Among Infants

Maternal dietary patterns during pregnancy may be associated with the combined development of eczema and colic during infancy, according to a prospective cohort study. Investigators evaluated 1324 mother-child pairs from Project Viva and assessed prenatal diet using the Mediterranean Diet Score (MDS), Dietary Inflammatory Index (DII), and consumption of commonly allergenic foods.

Among the infants, 11.5% developed eczema alone, 20.6% experienced colic alone, and 4.6% had both conditions. Each 1-point increase in mean MDS was associated with 15% lower odds of having both eczema and colic, whereas each 1-point increase in DII was associated with 34% higher odds. Greater seafood consumption was also associated with lower odds of the combined outcome. Neither dietary score was associated with eczema alone, and dairy and egg intake were not significantly associated with the outcomes.

For clinicians: The observational findings do not establish that changing maternal diet prevents eczema. The findings instead add to research exploring whether broader maternal dietary patterns may influence early-life immune and atopic outcomes.

Telehealth Intervention Improves Sun Protection Behaviors in Children at Elevated Melanoma Risk

JAMA Dermatology | Melanoma Prevention Among Children of Melanoma Survivors: A Randomized Clinical Trial

A family-based telehealth intervention improved sun-protective behaviors among children of melanoma survivors, although it did not significantly reduce sunburn over time compared with an active control. The randomized clinical trial included 364 melanoma survivor-child dyads, with children aged 8 to 17 years who had experienced at least 1 sunburn during the previous year.

Participants were randomized to either the family, lifestyles, actions, and risk education (FLARE) intervention or a control program. Although investigators found no significant between-group difference in the primary outcome of change in sunburn occurrence over time, children in the FLARE group reported fewer sunburns at the first postintervention assessment and demonstrated significantly greater improvements in sun-protective behaviors through the second assessment.

For clinicians: Children of melanoma survivors have an elevated lifetime melanoma risk, making early prevention particularly important. These findings suggest structured telehealth education can improve protective behaviors, although behavioral gains may not necessarily translate into sustained reductions in sunburn.

Prognostic Index Refines Risk Stratification in Advanced Mycosis Fungoides and Sézary Syndrome

JAMA Dermatology | Cutaneous Lymphoma International Prognostic Index and Risk Stratification in Advanced Mycosis Fungoides and Sézary Syndrome

The Cutaneous Lymphoma International Prognostic Index (CLIPI) may provide prognostic information beyond conventional clinical staging for patients with advanced mycosis fungoides (MF) and Sézary syndrome (SS). Investigators analyzed 277 patients with stage IIB to IVB MF/SS enrolled across 46 referral centers and classified patients as low, intermediate, or high risk using CLIPI.

Median progression-free survival declined substantially as CLIPI risk increased, from 4.64 years in the low-risk group to 2.72 years among intermediate-risk patients and 0.89 years among those at high risk. Compared with low-risk patients, those in the high-risk group had a 3.84-fold greater hazard of progression or death. Models incorporating CLIPI also outperformed baseline stage alone in predicting progression-free survival.

For clinicians: Conventional TNMB staging remains central to MF/SS assessment, but patients within the same stage can experience markedly different disease courses. CLIPI may provide clinicians with additional information for counseling, treatment planning, and identifying patients who warrant closer monitoring.

Dupilumab Demonstrates Sustained Disease Control in Pediatric Atopic Dermatitis

British Journal of Dermatology | Sustained Efficacy of Dupilumab in Paediatric Patients With Moderate-to-Severe Atopic Dermatitis Over 1 Year

One-year findings suggest dupilumab can provide sustained improvements in skin lesions, itch, and sleep among pediatric patients with moderate to severe atopic dermatitis (AD). The analysis included patients ranging from 6 months to 17 years of age and evaluated disease control over time rather than relying exclusively on responses measured at individual study visits.

Researchers reported that the majority of pediatric patients experienced sustained improvements during 1 year of dupilumab treatment across measures of skin disease, pruritus, and sleep disturbance. Sustained disease control was evaluated using thresholds including Eczema Area and Severity Index (EASI) scores of 7 or lower, SCORing Atopic Dermatitis (SCORAD) pruritus visual analog scale scores below 4, and SCORAD sleep-loss scores below 4.

For clinicians: Because AD severity fluctuates, evaluating whether patients maintain clinically meaningful improvement across multiple visits may offer a more realistic picture of treatment effectiveness than response at a single time point. The findings add to long-term evidence supporting dupilumab for pediatric AD across a broad age range.

References

1. Abilov Z, James MJ, Porter ML, Popov YV. Undeclared pharmacologically active ingredients in over-the-counter skin products. JAMA Netw Open. 2026;9(10). doi:10.1001/jamanetworkopen.2026.38654. Published October 8, 2026.
   https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854974
2. Oken E, Rifas-Shiman SL, Switkowski KM, et al. Maternal prenatal diet and colic and eczema among infants. JAMA Netw Open. Published October 12, 2026. doi:10.1001/jamanetworkopen.2026.38472.
   https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855219
3. Wu YP, Stump TK, Deboeck PR, et al. Melanoma prevention among children of melanoma survivors: A randomized clinical trial. JAMA Dermatol. Published online October 7, 2026. doi:10.1001/jamadermatol.2026.3877.
   https://jamanetwork.com/journals/jamadermatology/fullarticle/2854942
4. Roccuzzo G, Bashir A, Evison F, et al. Cutaneous Lymphoma International Prognostic Index and risk stratification in advanced mycosis fungoides and Sézary syndrome. JAMA Dermatol. Published online October 7, 2026. doi:10.1001/jamadermatol.2026.3856.
   https://jamanetwork.com/journals/jamadermatology/fullarticle/2854943
5. Siegfried EC, et al. Sustained efficacy of dupilumab in paediatric patients with moderate-to-severe atopic dermatitis over 1 year. Br J Dermatol. 2026;195(4):677-680. doi:10.1093/bjd/ljag261.
   https://academic.oup.com/bjd/article/195/4/677/8237824