Background: Cutaneous wounds are common in outpatient care, but national patterns of who manages them and how antimicrobials are used remain unclear. Objectives: To characterize outpatient specialty involvement and antimicrobial use for acute and chronic cutaneous wound visits in the United States. Methods: We conducted a retrospective cross-sectional analysis of 2011-2019 National Ambulatory Medical Care Survey (NAMCS) data. Cutaneous wound visits were identified using prespecified ICD-9-CM and ICD-10-CM codes and classified as acute (open or traumatic wounds and burns) or chronic (pressure injuries and lower-limb ulcers). Survey weights were applied to estimate national visit volumes, specialty shares, and antimicrobial utilization patterns. Results: We identified 45.1 million cutaneous wound visits, representing 0.8% of all outpatient visits, of which about two thirds were acute and one third chronic. Primary care physicians accounted for the largest share of wound visits, while dermatologists managed 3.9% of overall wound visits, 2.4% of acute visits, and 7.4% of chronic visits. Among 156.6 million medications recorded at wound visits, antimicrobials represented 13.1% overall, 14.9% in acute visits, and 10.2% in chronic visits. Cephalexin accounted for 32.1% of antimicrobial medications overall and 39.2% in acute visits, whereas chronic wound visits had a more heterogeneous antimicrobial profile that included topical mupirocin, cephalexin, trimethoprim-sulfamethoxazole, and topical nystatin. Conclusions: Outpatient cutaneous wound care in the United States is delivered predominantly by primary care clinicians and relies heavily on a small set of systemic and topical antimicrobials, highlighting opportunities to strengthen antimicrobial stewardship and expand dermatology's role in chronic wound management.

Advances in cutaneous immunology, human genetics, and molecular pharmacology have transformed the dermatologic treatment landscape, yet translation from biologic insight to effective therapy remains uneven. Skin disease creates development challenges that generic drug-discovery frameworks often underemphasize. These include the skin barrier, differences between epidermal, dermal, follicular, and systemic disease biology, overlapping inflammatory and neuroimmune pathways, and the need for endpoints that capture both visible disease and patient symptoms. Programs can fail despite persuasive biology when cutaneous exposure is inadequate, local tolerability is unacceptable, endpoints are insensitive, or the selected route and modality are poorly matched to disease severity and intended clinical use. A dermatology-specific approach is presented for target identification, modality and delivery selection, translational evidence generation, and early clinical proof-of-concept. Core principles include human-relevant target validation, explicit positioning of targets within the disease process, early alignment of mechanism with delivery strategy, early integration of skin-specific pharmacokinetic and pharmacodynamic tools, and selection of translational models according to the decision they are intended to inform. This primer is intended for translational scientists, clinician-investigators, and drug developers seeking guidance specific to skin disease rather than templates adapted from other therapeutic areas.

Melanoma survival has improved nationally, yet state-level disparities remain underexplored. We assessed melanoma burden across U.S. states from 2010 to 2021 using Global Burden of Disease 2021 data, calculating age-standardized rates for incidence, prevalence, mortality, and disability-adjusted life years (DALYs). States were stratified by sociodemographic index (SDI). In 2021, the U.S. recorded 90,445 incident cases and 9996 deaths. Age-standardized incidence decreased 27.7

BACKGROUND:Atopic dermatitis (AD) disproportionately affects diverse patient populations, and complex factors influence access to treatment among different racial and ethnic groups. OBJECTIVE:This study aimed to assess racial and ethnic differences in AD severity and access to treatment in clinical practice. METHODS:The study included patients aged 6 and older with AD enrolled in TARGET-DERM AD, an observational, longitudinal study utilizing electronic medical records from 43 academic and community centers across the United States. RESULTS:The analysis included 1,928 participants: 577 children (30%) and 1,351 adults (70%), with 42% identifying as Non-White. Non-Hispanic (NH) Asian participants exhibited the highest percentage of moderate-to-severe AD at 63%, followed by NH-Black (61%), Hispanic (49%), and NH-White (48%) participants. Over half (56%) of NH-Asian patients reported comorbid asthma. NH-Black and Hispanic individuals were less likely to receive advanced systemic therapies compared to NH-White individuals, with odds ratios of 0.71 and 0.66, respectively, both statistically significant (P<0.01). CONCLUSION:Despite having moderate-to-severe AD, NH-Black and Hispanic patients had significantly lower odds of receiving advanced systemic therapy compared to NH-White patients, highlighting potential disparities in access to advanced treatments for AD. &nbsp.

Itch, skin pain, and eczematous lesions are features of atopic dermatitis (AD). Skin pain is increasingly recognized as both a common and burdensome symptom of AD, reported by 61% of patients, that can impair daily activities, sleep, and mental health.Upadacitinib (UPA) is an oral selective Janus kinase 1 inhibitor approved for the treatment of AD and multiple other conditions. In this study, we assessed the efficacy of UPA in reducing skin pain in adults and adolescents with moderate-to-severe AD. This analysis evaluated integrated data from patients with moderate-to-severe AD treated with UPA monotherapy in two studies: Measure Up 1 and Measure Up 2. Patients were randomized to receive UPA 15mg (UPA15), UPA 30mg (UPA30), or placebo for 16 weeks in the double-blind, placebo-controlled period. At week 16, patients randomized to UPA groups continued treatment, and placebo groups were re-randomized to UPA15 or UPA30 for the double-blind, long-term extension period. Skin pain (SP) was assessed using a validated patient-reported outcome (PRO) measure, the Atopic Dermatitis Symptom Scale (ADerm-SS) Skin Pain numerical rating scale (NRS); the optimal outcome was defined as an SP-NRS score of 0 or 1 (SP-NRS 0/1), indicating no/minimal skin pain. Among patients who achieved SP-NRS 0/1 at week 16, long-term maintenance of response was evaluated through week 140. Patient-reported impacts of achieving SP-NRS 0/1 on sleep, daily activities, and quality of life (QOL) outcomes were assessed. Response rates were based on non-responder imputation (NRI) through week 16 and observed cases (OC) through week 140. At baseline, 85% of patients reported skin pain. Compared with placebo (n=531), patients treated with UPA15 (n=524) and UPA30 (n=543) achieved higher rates of SP-NRS 0/1 as early as day 2 (the day after treatment initiation), with response rates increasing through day 28 (UPA15: 43.7%, UPA30: 57.6%; both p<0.001). Both UPA15 and UPA30 groups had greater achievement of SP-NRS 0/1 compared with placebo at week 16 (UPA15: 41.9%; UPA30: 58.0%; placebo: 10.8%; NRI, both p<0.001). Response rates were sustained through week 140 in the overall population (UPA15: 63.8%; UPA30: 72.3%; OC) and among patients who achieved SP-NRS 0/1 at week 16 (UPA15: 78.9%; UPA30: 83.0%). Achieving SP-NRS 0/1 was associated with meaningful improvements across PROs, including sleep quality, daily functioning, and overall QOL. In summary, UPA-treated patients experienced rapid (by day 2) and durable reductions in skin pain, with most patients maintaining the optimal target (SP-NRS 0/1) through week 140. Reduction of skin pain was associated with improvements in PROs across multiple dimensions of patients’ lives, reinforcing skin pain as a meaningful and actionable therapeutic target in AD.

Space-related dermatoses are among the most frequently reported medical issues during long-duration spaceflight. These conditions can impair crew comfort, performance, and postflight recovery, raising concerns for upcoming Mars missions and commercial space tourism. A systematic search of PubMed, Scopus, Web of Science, Embase, and Cochrane databases identified studies published through December 2024 using terms such as "space dermatoses," "microgravity and skin," and "spaceflight dermatology." Gray literature, NASA/ESA documents, and reference lists were also reviewed. Screening followed the preferred reporting items for systematic reviews and meta-analyses guidelines, and study quality was assessed using the Oxford Centre for Evidence-Based Medicine framework. Twentythree studies met the inclusion criteria, encompassing observational, experimental, and animal/in vitro research. Reported space-related dermatoses included xerosis, rashes, hypersensitivity, and impaired wound healing. Contributing factors included radiation, nutritional deficits, microgravity, alterations in the microbiome and immune system, stress, hygiene limitations, and environmental contaminants. Preventive measures include personalized skincare, immune profiling, barrier technologies, and teledermatology. Evidence remains limited by small cohorts and a lack of standardized dermatologic assessment. Collaborative research on dermatology in space is essential to clarify underlying mechanisms, develop mitigation strategies, and ensure skin health in future long-duration and commercial missions. (c) 2025 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Clinical guidelines recommend against routine use of systemic corticosteroids in atopic dermatitis (AD) due to associated adverse effects. Real-world adherence to these guidelines is unclear. This retrospective cohort study evaluated US healthcare claims using Optum’s Clinformatics Data Mart Database. We included two cohorts: exposure and diagnosis-based cohorts. Index was defined as the date of first systemic corticosteroid use post-AD diagnosis in the exposure cohort (AD diagnosis must have occurred within 6 months preceding index) or as the date of the first AD diagnosis in the diagnosis-based cohort. Follow-up began on index and continued until end of available data, health insurance discontinuation, death, or systemic corticosteroid discontinuation (exposure cohort) or initiation (diagnosis-based cohort). Patients were aged ≥ 12 years with diagnosed AD between 2017 and 2024 and had continuous health insurance enrollment ≥ 1 year before and after index. Patients were excluded if they had other immune-mediated inflammatory diseases within the 6 months preceding index or had history of malignancy, organ transplant, or HIV/AIDS. Systemic corticosteroid exposure duration was categorized as short term (≥ 1 day to < 30 days), medium term (> 1 month to ≤ 3 months), or long term (continuous/intermittent use for > 3 months). Categorization was informed by expert recommendations and observed prescription patterns. Exposure duration and treatment patterns were assessed in the exposure cohort. Prevalence of systemic corticosteroid use within 6 months post-AD diagnosis was evaluated in the diagnosis-based cohort. The exposure cohort included 29,994 patients; 67.7

Cutaneous T-cell lymphomas (CTCLs) comprise a heterogeneous group of skin-homing T-cell malignancies with limited curative options. Recent genomic studies have identified recurrent alterations in tyrosine kinase signaling pathways in aggressive CTCL subtypes, particularly primary cutaneous aggressive epidermotropic cytotoxic T-cell lymphoma (PCAETL) and primary cutaneous gamma/delta T-cell lymphoma (PCGDTL). Changes include kinase fusions and activating mutations involving JAK/STAT and FGFR pathways and provide a rationale for targeted therapy. Early clinical experience with tyrosine kinase inhibitors (TKIs) such as ruxolitinib, cerdulatinib, and pemigatinib demonstrated meaningful but frequently transient responses. Acquired resistance commonly arises through secondary kinase domain mutations, including canonical gatekeeper substitutions and cooperative mutations across paralogous kinases, with adverse events preventing continued treatment. Structural modeling supports steric interference and altered ATP affinity as key mechanisms limiting drug efficacy. Collectively, these findings reveal kinase addiction as a therapeutic vulnerability in selected CTCL subtypes but also underscore predictable adaptive resistance. Durable responses will likely require molecular stratification, longitudinal genomic monitoring, and local application of rational combination strategies. Aggressive CTCL thus represents a model for precision oncology in dermatology, where mechanistic insight can guide next-generation therapeutic approaches.

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by intense itch and eczematous skin lesions. Upadacitinib, a selective oral Janus kinase inhibitor, and dupilumab, a monoclonal antibody, are both approved treatments for moderate-to-severe AD. In period 1 of the LEVEL UP phase 3b/4 head-to-head study, upadacitinib-treated patients demonstrated higher simultaneous achievement of near complete skin clearance and little to no itch compared with dupilumab after 16 weeks of treatment in adults and adolescents with moderate-to-severe AD. The objective of period 2 of the LEVEL UP study was to assess the efficacy and safety of switching from dupilumab to upadacitinib in patients with inadequate response to dupilumab. Following period 1 of the LEVEL UP study, patients not achieving ≥ 75

Importance Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C–related burden is critical for guiding prevention and treatment strategies. Objectives To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends. Design, Setting, and Population This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals. Exposure Population-level LDL-C concentrations. Main Outcomes and Measures Population-attributable fractions, counts, and rates (all ages and age standardized per 100 000) of LDL-C–attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals. Results In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C–attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings. Conclusions and Relevance Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.

This study evaluated the prevalence, incidence, and relative risk of comorbid atopic dermatitis (AD) among patients with alopecia areata (AA) using data from the Merative MarketScan Research Databases. Eligible patients had ≥1 inpatient or ≥2 outpatient claims for AA between January 1, 2017 and October 31, 2023; were aged ≥12 years; and were continuously enrolled during the ≥5-year baseline period through the 6-month follow-up period; index date was the earliest date of AA diagnosis. AD prevalence (%) and incidence (cases per 1000 person-years) among patients with AA are reported and stratified by disease severity; a subgroup analysis was performed among adolescents (aged 12-17 years). Adjusted hazard ratios for being diagnosed with AD are reported for patients with moderate-to-severe versus those with mild AA. Prevalence of AD among patients with AA at baseline was 3.2% (overall prevalence in database: 12.1%), with most having moderate-to-severe AD; prevalence was higher among adolescents with AA (7.6%). Incidence of AD increased with AA disease severity, regardless of age. Those with moderate-to-severe AA had 78% higher risk of being diagnosed with AD than those with mild disease. Dermatologist-diagnosed patients had higher rates of comorbid AD regardless of AA severity. These data demonstrate the importance of increased risk of comorbid AD when making treatment decisions for patients with AA.

Nonmelanoma skin cancer (NMSC) risk may be increased in patients with immune-mediated inflammatory disorders. Although atopic dermatitis (AD), an inflammatory immune-mediated chronic skin disease, has been associated with the risk of skin cancer, data on the underlying risk of NMSC in patients with AD in the USA are unclear. The objective of this analysis was to evaluate NMSC incidence and risk in patients with AD generally and those with moderate-to-severe disease specifically compared with a non-AD matched control cohort and patients with rheumatoid arthritis (RA). This retrospective observational study examined US claims data (2017–2023) from Optum’s de-identified Clinformatics® Data Mart Database of adults with AD and RA, as well as non-AD control cohorts matched 1:1 to patients with AD and patients with moderate-to-severe AD. This analysis included data from 391,753 patients with AD and 97,445 patients with RA. The matched AD and non-AD cohorts each included 381,221 patients. Patients with AD had a higher NMSC incidence rate (cases/100 person-years [95