This is a short critical review article on a study recently published in the New England Journal of Medicine, ‘Combined Oral Ivermectin and 5% Permethrin Cream to Treat Severe Scabies’, by Bernigaud et al.
BACKGROUND:Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are rare, chronic, potentially life-threatening, immunoglobulin (Ig)G-mediated, autoimmune skin and/or mucosal blistering diseases. Efgartigimod, a human IgG1 antibody Fc fragment, blocks the neonatal Fc receptor, decreasing IgG recycling and reducing both healthy and pathogenic IgG autoantibody levels. OBJECTIVES:To investigate the efficacy, safety and impact of subcutaneous efgartigimod PH20 (co-formulated with recombinant human hyaluronidase PH20) in conjunction with prednisone in the treatment of pemphigus. METHODS:Adult participants with newly diagnosed or relapsing moderate-to-severe pemphigus were recruited in this phase III, prospective, multicentre, randomised, double-blinded, placebo-controlled study (NCT04598451). Participants were randomised (2 : 1) to weekly subcutaneous efgartigimod PH20 or placebo. Subcutaneous efgartigimod PH20 2000 mg was administered on days 1 and 8, followed by 1000 mg weekly until complete remission on minimal prednisone therapy (CRmin) (≤ 10 mg daily). All participants received concomitant prednisone starting at 0.5 mg kg-1 daily. The primary outcome was the proportion of participants with PV who achieved CRmin by week 30, while receiving minimal prednisone, for ≥ 8 weeks. Pharmacodynamics and safety were also assessed. RESULTS:Overall, 222 participants (PV: n = 190; PF: n = 32) were randomised (subcutaneous efgartigimod PH20: n = 147; placebo: n = 75). The proportions of participants with PV achieving CRmin within 30 weeks were comparable between the subcutaneous efgartigimod PH20 and placebo groups, with no statistically significant difference observed [44/124 (35.5%) vs. 20/66 (30.3%); P = 0.60; odds ratio 1.19 (95% confidence interval 0.60-2.41)]. Total prednisone consumption over time was comparable between groups. Subcutaneous efgartigimod PH20 resulted in rapid reductions from baseline in total IgG and anti--desmoglein-1 and anti-desmoglein-3 autoantibody levels, but these did not translate to improvements in Pemphigus Disease Area Index scores. The rates of adverse events (AEs) in the subcutaneous efgartigimod PH20 and placebo groups were 89.1% (n = 131/147) and 76.0% (n = 57/75), respectively; most were mild to moderate [serious AEs: 12.2% (n = 18/147) and 13.3% (n = 10/75), respectively]. No deaths occurred. CONCLUSIONS:Subcutaneous efgartigimod PH20 in combination with systemic corticosteroids did not demonstrate clinical benefit over systemic corticosteroids alone in patients with moderate-to-severe pemphigus at 30 weeks, but it was well tolerated in this patient population.
The prevalance of AAGAB assosiated punctate palmoplantar epidermal differentiation disorder has only been estimated twice, in Slovenian and Croatian populations to 1.17 and 3.3 per100,000 respectively. This manuscript provides global and ancestry specific prevalance estimates, using large-scale genomic reference datasets. We estimate the global prevalance to a minimum of 12.4 per 100,000, suggesting previous underrecognition of the disease.
Abstract Background Traditional vitiligo assessment methods rely on subjective evaluation and two-dimensional photographic analysis, limiting consistency and accuracy in clinical practice. Objectives To develop and validate an artificial intelligence (AI)-assisted, three-dimensional (3D) reconstruction-based system to accurately and objectively quantify facial vitiligo lesions. Methods In this diagnostic study, standardized three-view clinical facial photographs from patients with facial vitiligo seen at a tertiary referral centre between 2022 and 2024 were retrospectively analysed. After excluding incomplete or poor-quality images, 329 patients were included. A deep learning segmentation model was trained to detect depigmented lesions and applied to 3D reconstructions with surface mapping to assess facial curvature. Performance was compared with manual assessments made by board-certified dermatologists, with and without AI guidance, across two sessions. Results The AI segmentation model achieved consistently high boundary delineation (F1 score > 0.98) and robust lesion identification accuracy (median Dice similarity coefficient approximately 0.85). When integrated into dermatologists’ evaluations, AI assistance markedly reduced mean absolute error in lesion quantification (3.13 vs. 6.71) compared with manual assessment alone. Correlation with reference lesion areas also showed a higher Pearson correlation coefficient (r = 0.92 vs. 0.84), indicating enhanced reliability. Bland–Altman analysis further revealed reduced systematic bias and narrower limits of agreement, supporting the reproducibility of AI-assisted quantification. Collectively, these findings indicate that AI guidance not only improves segmentation performance but also augments the accuracy and consistency of clinical interpretation. Conclusions This study demonstrates the potential clinical impact of AI-assisted 3D reconstruction. The system provides precise and standardized quantification of facial vitiligo lesions by incorporating surface curvature into lesion mapping. Compared with manual assessments, AI-based support improved diagnostic accuracy, reduced interobserver variability and offered consistent measurements across sessions. These findings highlight the promise of integrating AI-driven 3D tools into routine dermatological practice to enhance patient monitoring and optimize treatment planning.
The rise of articles published in biomedical and life sciences is staggering. The sheer numbers of biomedical publication make it impossible for a practising dermatologist to keep up with the literature and has ramifications for the entire medical publishing industry. Quantity does not equate to quality as evidenced by the rising number of retractions in dermatology. Of particular concern is the number of publications that are misleading or just wrong, yet evade scrutiny, and persist in the literature shaping clinical practice. Research-on-research (also known as meta-research or RoR) scrutinises these studies from a bird's-eye view.
