The edition · Dermatology
A single IL-36 antibody infusion cleared pustules in generalised pustular psoriasis within a week
In a phase 2 Chinese trial, 86.4% of patients given one dose of recibokibart reached a pustulation sub-score of 0 or 1 by day 8, against 9.1% on placebo, with improvement visible at 24 hours. Plus a laser endpoint that cuts post-inflammatory hyperpigmentation five-fold in pigmented skin.
The edition in brief
Generalised pustular psoriasis flares are dermatological emergencies with few reliable options. This multicentre, randomised, double-blind, placebo-controlled phase 2 trial in China randomised 33 patients with moderate-to-severe acute flares 2:1 to a single 1050 mg intravenous dose of recibokibart, an interleukin-36 receptor antibody, or placebo. At day 8, a pustulation sub-score of 0 or 1 was achieved by 86.4% versus 9.1% (between-group difference 77.3%, 95% CI 42.5 to 88.9, p<0.0001). Complete pustule clearance was 54.5% versus 0%, and improvement was visible within 24 hours. The commonest adverse events were hypoproteinaemia, hypertriglyceridaemia, hyperlipidaemia and pruritus. A randomised split-face trial in 30 Asian patients with Fitzpatrick skin types III to V compared a model-guided non-whitening endpoint with the conventional immediate-whitening endpoint for 755-nm picosecond laser treatment of acquired bilateral nevus of Ota-like macules. Clearance was equivalent, but post-inflammatory hyperpigmentation fell from 22.6% to 4.8% and scabbing from 61.9% to 9.5%. REZOLVE-AD, a phase 2b trial in 393 adults with moderate-to-severe atopic dermatitis, found rezpegaldesleukin — a regulatory T cell-expanding IL-2 receptor agonist — reduced EASI by 61% at the highest dose versus 31% on placebo, at the cost of injection-site reactions in 70%. The American Academy of Dermatology has issued a Good Practice Statement on reassessing the diagnosis in adults whose atopic dermatitis does not respond, and a US Delphi panel has placed oral JAK inhibitors as primary therapy for severe alopecia areata.
Recibokibart cleared pustules in a week in generalised pustular psoriasis
A single intravenous dose of an interleukin-36 receptor antibody cleared pustulation in 86.4% of generalised pustular psoriasis flares by day 8 versus 9.1% on placebo, with improvement visible at 24 hours.
Stop using immediate whitening as the laser endpoint in pigmented skin
In pigmented skin, treat to a non-whitening endpoint with a larger spot and lower fluence — clearance is equivalent and post-inflammatory hyperpigmentation falls from 23% to 5%.
Two consensus documents: reassess refractory eczema, and JAK inhibitors lead in severe alopecia areata
No drug regulatory action today; when adult eczema fails optimised treatment reconsider the diagnosis rather than escalating, and in severe alopecia areata oral JAK inhibitors are now the consensus primary therapy.
REZOLVE-AD: expanding regulatory T cells cuts eczema severity, at the cost of injection-site reactions
Rezpegaldesleukin, an IL-2 receptor agonist that expands regulatory T cells, cut EASI by 61% against 31% on placebo in phase 2b, with injection-site reactions in 70%.
A consensus position for severe alopecia areata, and what it leaves out
For severe adult alopecia areata, oral JAK inhibitors are the consensus primary long-term therapy with dupilumab as an atopy-comorbid alternative; everything else is supplemental.
In darker skin, the complication is the pigment, not the lesion
Warn every patient with type IV skin or above about post-inflammatory hyperpigmentation before the procedure, use larger spots at lower fluence, and prescribe a tinted iron oxide sunscreen with instructions to reapply.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for dermatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free