Aaron Mark Drucker

Background: Approximately 15% to 25% of adult dermatomyositis cases are associated with underlying cancers. To date, no study has comprehensively synthesized the available evidence on mortality in cancer-associated dermatomyositis. Objective: To explore the clinical characteristics, mortality, and survival outcomes of cancer-related dermatomyositis. Methods: MEDLINE, Embase, and PubMed were searched from inception to August 5, 2025 (PROSPERO CRD420251269785). Observational studies including at least 10 cases and reporting mortality outcomes among adults with cancer-associated dermatomyositis were eligible. Risk of bias and certainty of evidence were assessed using the Grading of Recommendations Assessment, Development, and Evaluation. Random-effects meta-analysis was used to estimate pooled survival outcomes. Results: Twenty-three studies including 974 patients were analyzed with a mean age of 58 years and a female predominance. Head and neck cancers were the most frequently reported malignancies, reflecting population patterns. Muscle weakness, heliotrope rash, and dysphagia were common. Across 16 studies including 605 patients, cancer was diagnosed in the majority of cases (82%) within 2 years of dermatomyositis onset. Patients with cancer-associated dermatomyositis had higher mortality rates than those without malignancy, with worse 1- and 5-year survival (low certainty of evidence). Only 2 studies assessed mean survival time, with a pooled estimate of 4.57 years from dermatomyositis diagnosis (95% CI, 2.08-7.05; I ² = 0%). Conclusions: This review synthesizes the available evidence on cancer-associated dermatomyositis and reinforces its association with poor prognosis. Larger studies with standardized reporting of serological profiles and mortality outcomes are needed to better characterize survival and prognostic factors.

Inconsistent outcome reporting in randomized controlled trials (RCTs) of topical anti-inflammatory treatments for atopic dermatitis (AD) limits comparability. We evaluated uptake and reporting of Harmonising Outcome Measures for Eczema (HOME) core instruments [Eczema Area and Severity Index (EASI), Patient-Oriented Eczema Measure (POEM), itch numerical rating scale (NRS) and Dermatology Life Quality Index (DLQI)] in RCTs of topical AD treatments published from 2018 onward. Among 49 RCTs, EASI was most frequently reported (83.7%), followed by DLQI (34.7%), itch NRS (30.6%) and POEM (26.5%). Inadequate reporting led to substantial participant-level data waste, reaching up to 67.2% for DLQI. In summary, HOME core outcome uptake and standardized reporting remain limited.

Facial and neck erythema (FNE) is a bothersome adverse effect associated with dupilumab treatment for atopic dermatitis (AD). It is unclear how to optimally manage this condition. To systematically review and summarize cases of dupilumab-associated FNE and to identify reported etiologies and management strategies. A search was conducted on EMBASE and MEDLINE databases to update a systematic review published in 2021. We identified 867 cases of dupilumab-related FNE, of which 54.9% were de novo 39.2% were worsening of preexisting FNE. Reported etiologies of dupilumab-induced FNE included allergic contact dermatitis (21.2%, 184/867), Malassezia furfur hypersensitivity (13.5%, 117/867), and residual AD (2.8%, 24/867). Reported management strategies included topical monotherapy (28.4%, 253/892; most commonly, topical corticosteroids (TCS) with topical calcineurin inhibitors [TCIs]), oral monotherapy (21.3%, 190/892; most commonly oral antifungals and upadacitinib), and combination of topical/oral treatments (8.1%, 72/892; most commonly TCS/TCI/oral antifungal combination). Complete resolution (CR) was seen with topical antifungals (69.6%, 16/23), oral antifungals (66.1%, 82/124), and upadacitinib (100%, 35/35). Of patients who continued dupilumab with no subsequent intervention, 27.7% (13/47) had CR. This study is limited by a lack of standardized reporting, a lack of head-to-head or placebo comparison, and potential publication bias. Dupilumab-associated FNE has the potential to resolve with topical and oral medications. Prospective, controlled studies are indicated to elucidate optimal management strategies.

Background: Validated case definitions are essential for reliable epidemiological research using routinely collected health data. The extent to which population-based studies on autoimmune blistering diseases (AIBDs) use validated case definitions is uncertain, and variability in definitions may limit the generalizability of findings. Objective: To describe definitions of AIBDs used in population-based epidemiologic studies and whether these definitions have been validated. Methods: MEDLINE and Embase were searched for epidemiologic studies on pemphigoid, pemphigus and their variants, dermatitis herpetiformis (DH), epidermolysis bullosa acquisita (EBA), and linear IgA bullous dermatosis (LABD). Eligible studies reported case definitions using routinely collected data. Two reviewers independently screened studies and extracted data, with discrepancies resolved by consensus. Results: Ninety-two studies met the inclusion criteria. Among 63 pemphigoid studies, the majority used International Classification of Diseases (ICD) codes, and 26 studies validated case definitions using combinations of clinical diagnosis, histopathology, and direct or indirect immunofluorescence, often with scoring systems. The majority of 39 pemphigus studies used ICD codes or electronic medical records to identify cases; of the 5 studies that validated cases, most used chart review requiring 2 or more confirmatory clinical or laboratory findings. Two of 6 DH studies used validated definitions with clinical and immunopathological criteria. Among 8 EBA studies, none reported formal validation. One LABD study was included without case validation. Conclusion: Most population-based studies of AIBDs rely on administrative coding or electronic medical records, but few use formally validated case definitions. Improving and standardizing validation practices is important to enhance the accuracy and comparability of epidemiological findings in AIBDs.

Background: Ultraviolet B (UVB) phototherapy is recommended in clinical guidelines for atopic dermatitis, but it is uncertain whether narrowband or broadband UVB is more effective and better tolerated. Objectives: To compare, in a parallel-group randomized clinical trial, the efficacy and safety of broadband with narrowband UVB for the treatment of moderate-to-severe atopic dermatitis. Methods: Participants were aged ≥ 18 years and had moderate-to-severe atopic dermatitis that was refractory to topical corticosteroid treatment. Participants were randomized 1 : 1 via a centralized computer randomization scheme to full-body broadband or narrowband UVB phototherapy, with ongoing concomitant topical therapy. Participants were blinded to the treatment, but the treating and assessing clinicians were not. The primary outcome was change in Eczema Area and Severity Index (EASI) at 12 weeks. Secondary outcomes included achieving 0 or 1 and an improvement of ≥ 2 on the validated Investigator Global Assessment for Atopic Dermatitis scale (vIGA-ADTM) and change in Patient-Oriented Eczema Measure (POEM), Peak Pruritus Numeric Rating Scale (PP-NRS), Dermatology Life Quality Index (DLQI) and Recap of atopic eczema (RECAP). Efficacy analyses were conducted on a modified intention-to-treat (ITT) population, including all randomized participants who received at least one dose of phototherapy. The trial was registered with ClinicalTrials.gov (NCT04818138). Results: Thirty-four participants were randomized to broadband UVB and 35 to narrowband UVB. Thirty-two participants received at least one dose of broadband UVB and 34 received at least one dose of narrowband UVB and were included in the modified ITT analysis. The mean (SD) patient age was 37.1 (15.9) years in the broadband UVB arm and 33.2 (12.1) in the narrowband UVB arm. The mean change in EASI score in the broadband UVB arm was –8.1 [95% credible interval (CrI) –12.1 to –4.1] and in the narrowband UVB arm it was –8.9 (95% CrI –13.0 to –4.9). In the adjusted analysis, the difference between arms in change in EASI was –0.7 (95% CrI –5.6 to 4.1). There were no significant differences between arms for vIGA, POEM, PP-NRS, DLQI or RECAP. Four patients withdrew from phototherapy due to adverse events in the broadband arm; none withdrew from the narrowband arm. Conclusions: In this study, broadband and narrowband UVB were similarly effective for the treatment of moderate-to-severe atopic dermatitis. Narrowband UVB was better tolerated.