Primary cutaneous gamma-delta T-cell lymphoma (PCGDTCL) is a rare cytotoxic lymphoma with considerable clinicopathological heterogeneity. We report three patients with unusual presentations, including a TCR-silent phenotype with spontaneous regression followed by rapid progression, a granulomatous variant with a prolonged indolent course, and a lupus panniculitis-like form. Molecular studies demonstrated persistent clonal disease and identified recurrent alterations involving TET2, STAT3, CDKN2A, MAPK1, PDCD1 and TNFAIP3, with acquisition of additional mutations during disease evolution. These cases expand the recognized spectrum of PCGDTCL and highlight the importance of integrating clinicopathological and molecular findings in diagnostically challenging presentations.
Behçet's disease is a rare multisystem inflammatory disorder characterised by recurrent oral and genital ulceration with systemic involvement. Heterozygous mutations in NF-κB1 have been associated with Behçet's-like presentations. We present a woman with psoriasis, lichen sclerosus, non-small-cell lung cancer, anogenital ulcers and features of a Behçet's-like syndrome associated with a novel NF-κB1 mutation. She responded well to adalimumab after failed treatment with systemic and topical corticosteroids, antibiotics and colchicine.
Acquired bilateral naevus of Ota-like macules (ABNOM), also known as Hori's naevus, is a common dermal melanocytosis causing facial hyperpigmentation. While the 755-nm Q-switched alexandrite lasers (QSAL) are traditionally used, they are limited by moderate clearance and substantial risk of post-inflammatory hyperpigmentation (PIH). This systematic review and meta-analysis evaluate the efficacy and safety of the 755-nm picosecond alexandrite laser (PSAL) for ABNOM. Embase via Ovid, MEDLINE, PubMed, Scopus, Cochrane, Web of Science and CiNAHL were searched from inception to April 14, 2026, according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The review was prospectively registered on PROSPERO (CRD420261379083). Studies reporting efficacy or safety outcomes following PSAL treatment for ABNOM were included. Statistical analyses were performed using a random-effects model. Six studies comprising 318 patients (94.6% female, predominantly Fitzpatrick skin types III-IV) were included. After excluding studies at critical risk of bias from quantitative pooling, the pooled first-session near-complete (> 90%-95%) clearance rate was 8.8% (95% CI 5.9%-12.7%; I2 = 0%). Clearance rates improved progressively with additional sessions. The overall pooled PIH rate was 21.1% (95% CI 17.1%-26.1%; I2 = 0%), with all cases being transient. Hypopigmentation (0.6%) and scarring (0%) were rare. Numerically lower PIH rates were observed in the paediatric cohort (16.3%) compared with adults (22.2%). PSAL provides an effective treatment for ABNOM with progressive pigment clearance over multiple sessions and a favourable safety profile. Multiple sessions are typically required for optimal results. Further high-quality RCTs with standardised protocols and long-term follow-up are warranted.
BACKGROUND:Atopic dermatitis (AD) is a chronic inflammatory skin disease characterised by epidermal barrier dysfunction and type 2 immune dysregulation. Dupilumab was the first biologic approved for severe AD and has transformed management of moderate-to-severe disease. Although clinical trials and international real-world studies have demonstrated sustained efficacy and acceptable tolerability, Australian data describing patient-reported experience with dupilumab remain limited. METHODS:We conducted a cross-sectional survey study of adults receiving dupilumab for moderate-to-severe AD at the Royal Melbourne Hospital dermatology clinic. Over a two-month period, QR codes linked to an anonymous electronic questionnaire displayed in waiting areas and consultation rooms. Survey data were collected and managed using REDCap (Research Electronic Data Capture). The questionnaire examined treatment administration, perceived effectiveness, symptom change, treatment satisfaction, ocular and non-ocular adverse effects and concomitant therapy use. RESULTS:During the recruitment period, 68 patients receiving dupilumab attended clinic and were eligible to participate; 48 completed the survey, corresponding to a response rate of 70.6%. Most respondents reported marked clinical benefit, with 66.7% reporting significant improvement in eczema control and 22.9% reporting complete resolution. Overall satisfaction was high, with 83.3% reporting being satisfied or very satisfied with treatment. Dupilumab was perceived as more effective than previous therapies by 83.3% of patients. Ocular symptoms were common amongst the cohort. CONCLUSIONS:In this tertiary australian cohort, patients treated with dupilumab reported high satisfaction and Substantial improvement in disease control and quality of life. These findings support the real-world effectiveness of dupilumab and highlight the importance of proactive recognition and management of ocular adverse effects.
Lichen planus (LP) is a chronic inflammatory dermatosis with limited systemic treatment options, and prospective data on oral phosphodiesterase-4 (PDE4) inhibition are lacking. We conducted a prospective real-world case series of ten adults with clinically and/or histologically confirmed LP treated with oral roflumilast, assessing disease severity using the Investigator's Global Assessment (IGA), pruritus and sleep disturbance using Numeric Rating Scales (NRS) and quality of life using the Dermatology Life Quality Index (DLQI). At baseline, 90% of patients presented moderate-to-severe disease (IGA 3-4). By week 12, 7 of 9 evaluable patients (78%) achieved IGA 0-1, increasing to 6 of 7 evaluable patients (86%) at week 24. Mean pruritus NRS improved from 7.7 to 1.6, sleep disturbance NRS from 7.3 to 2.0 and DLQI from 12.0 to 3.6. Overall, eight patients (80%) achieved at least 75% clinical improvement and six (60%) complete remission. The most frequent adverse events were insomnia (50%) and loose stools (30%), and two patients (20%) discontinued treatment because of adverse events. These preliminary prospective real-world findings suggest that oral roflumilast may represent a potential therapeutic option for LP and support further controlled studies to define the role of PDE4 inhibition and optimal dosing in this condition.
Monkeypox (mpox) is a viral infection characterized by polymorphic cutaneous lesions and systemic symptoms, including fever, lymphadenopathy, headache and myalgia. Given its broad differential diagnosis, accurate recognition requires a high level of clinical suspicion; in this context, dermoscopy represents a potentially useful tool to improve diagnostic accuracy. We conducted a retrospective case series of six patients with RT-PCR-confirmed mpox and dermatologic involvement between July 2022 and July 2025. A total of six patients were included; three (50%) were evaluated in the macular/vesicular phase and three (50%) in the crusted phase. In the macular/vesicular phase, eight lesions were analysed. In the crusted phase, five lesions were analysed. In our series, we observed pinkish-yellow structureless areas during the macular/vesicular phase. Recognition of these dermoscopic features may increase clinical suspicion and support the diagnosis.
BACKGROUND/OBJECTIVE:Mitogen-activated protein kinase pathway inhibitors (MAPKi) are increasingly used as targeted therapies for paediatric central nervous system tumours and other malignancies. Cutaneous toxicities, including xerosis, dermatitis, follicular-based infections, acne, and paronychia, are common and may result in significant morbidity and treatment interruption. METHOD:In this 18-month ambispective observational cohort study, 24 consecutive children receiving MAPKi at a tertiary paediatric centre were included. Patients were followed prospectively, with retrospective data collected for those already receiving therapy at study commencement. The incidence and spectrum of cutaneous adverse events (AE), predisposing factors and management strategies were documented. RESULTS:Overall, 21/24 (87.5%) patients developed at least one cutaneous AE, most commonly xerosis, dermatitis, hair changes, paronychia, and pustular skin infections. Most events were Common Terminology Criteria for Adverse Events (CTCAE) grade 1-2; however, a small number of patients required dose modification or temporary treatment interruption. CONCLUSION:These findings support early dermatologic assessment and proactive management of MAPKi-associated cutaneous toxicities. We propose practical caregiver-directed skin care recommendations to be introduced at treatment initiation to reduce morbidity and improve treatment tolerability.
INTRODUCTION:The prevalence of adolescent and adult atopic eczema (AE) in New Zealand is not known. This study estimates the prevalence and epidemiology in Auckland, New Zealand, from 2017 to 2019, before the COVID-19 pandemic. METHOD:Every primary health care organisation in Auckland provided diagnostic codes for AE for those aged greater than 15 years. Codes were matched with dispensing records for topical eczema treatments. Active disease was defined as having at least two dispensing events for AE-related treatment within any 12-month period. Data were matched to the National Health Index, which is a unique health identifier assigned to each person receiving health care in New Zealand. Population estimates were derived by linear interpolation from census data for 2013, 2018, and 2023. RESULTS:From 2017 to 2019, the average annual prevalence of AE per 100,000 (95% CI) was 1991 (1968-2015) for all ethnicities, 4625 (4565-4685) for Pacific peoples, 3501 (3440-3561) for Māori and 1296 (1280-1311) for Europeans. Compared to the European population, prevalence rates were higher in Pacific, Māori, and Asian populations (p < 0.001). The most deprived individuals had a higher prevalence per 100,000 population (95% CI) of 3466 (3424-3509) compared with 1737 (1706-1767) in the least deprived, p < 0.001, and the prevalence was highest in the youngest age group, 15-29 years (2766/100,000). CONCLUSION:There is a higher prevalence of adult AE in Māori, Pacific, and Asian populations compared to the European population, particularly in poorer communities and younger age groups.
INTRODUCTION:Alopecia areata (AA) is a non-scarring, immune-mediated hair loss disorder with substantial psychosocial impact in children. Robust paediatric real-world evidence regarding Janus kinase inhibitors (JAKi) for this disease is limited. In this study, we describe real-world clinical outcomes and safety of JAKi for paediatric AA. METHODS:We conducted a retrospective, observational multicentre study across 11 Spanish hospitals including patients aged 0-18 years who initiated a first JAKi (baricitinib, tofacitinib, or ritlecitinib) in routine care. The primary outcome was Severity of Alopecia Tool (SALT)-50. Secondary outcomes included the absolute SALT trajectory, eyebrow/eyelash responses, adverse events, and switching to a second JAKi. RESULTS:Forty-six patients were included (baricitinib 22/46 [47.8%], tofacitinib 14/46 [30.4%], ritlecitinib 10/46 [21.7%]; mean age 11.3 ± 4.0 years). Eight patients (21.6%) achieved SALT-50 at weeks 4-8, 21 patients (58.3%) at week 16, 20 patients (80.0%) at week 48, and 14 patients (82.4%) at week 72. Eyebrow and eyelash responses improved concordantly. At week 16, higher baseline SALT reduced the odds of response (β = -0.061, SE 0.029; p = 0.034). Unadjusted response rates varied across drug groups; however, treatment allocation was non-random, and groups were markedly imbalanced at baseline, so drug-level comparisons are exploratory and likely confounded by indication. Response was lower in universalis (unadjusted p = 0.008). Adverse events occurred in 16 of 46 patients (34.8%), mostly mild, with two patients (4.3%) discontinuing treatment. A second JAKi was used in seven patients (15.2%): Three complete, two partial, and two absent responses occurred post-switch. DISCUSSION:In real-world paediatric practice, we observed improvements in scalp, eyebrow, and eyelash involvement with JAKi use, with a generally favourable tolerability profile. Given the observational design, baseline imbalances, and missing data, causal inference and between-drug comparisons are not supported.
Biopsy for reticulate eruptions such as livedo reticularis and livedo racemosa representing an underlying vasculitis or vessel occlusion presents a challenge for most clinicians. Sampling errors frequently occur due to the difficulty in selecting the most appropriate and histologically representative site for biopsy. Here we describe a new technique where ultrasound is used to guide the biopsy with pinpoint accuracy to the affected vessel.
The implementation of teledermatology, as with other telehealth services, varies across settings. The aim of this study was to use a modified realist review methodology to synthesise factors that lead to successfully implementing and running teledermatology services. PubMed was searched in July 2025 to identify articles published internationally from 2020 to 2025 that provided a description of a teledermatology service and contained the authors' interpretation as to what contributed to the success of the service. The search returned 992 articles and 100 were included in the review after screening. Data was extracted independently by two authors who discussed terminology and interpretation of the independent data extracts. The authors modified the extracted data to ensure consistency in concepts and wording. From the included articles, 45 success factors were identified and coded using qualitative methods into eight themes: (1) Technology and imaging; (2) Hybrid model-of-care; (3) Communication; (4) People and staffing; (5) Quality of information; (6) Education and training; (7) Optimisation; and (8) Funding. The top three factors from each theme are explained in detail in this paper, and a full list of all items attributed to successful services is included in Supporting Information. The most common factors mentioned were having high quality images and using a comprehensive referral template. Some factors, such as the broader funding landscape, were acknowledged as contributing to success and represent opportunities for further advocacy. Our findings can be used to develop guidance on future teledermatology service implementation and optimisation.
