The oozing nail is the one to worry about

The edition in brief

Four findings for dermatology. A multinational retrospective series of 269 nail squamous cell carcinomas in 261 patients found the tumour mostly on the right index and middle fingers and both thumbs, 72.4% in men, typically in the sixth decade. Subungual ooze independently predicted invasive rather than in situ disease, odds ratio 3.98 (95% CI 1.19 to 13.2); pain and nail plate loss were associated on univariate analysis. Koilocytosis suggesting human papillomavirus was found in 32.2% and was commoner in in situ disease. Mohs surgery was the commonest treatment at 39.5%, and overall recurrence was 9.7% with no difference between modalities. A meta-analysis of 33 randomised trials and 2382 placebo-treated participants found the pooled placebo CLASI-A50 response at the primary endpoint was 42% (95% CI 35 to 50), rising from 21% at week 8 to 46% at week 52; trials started after 2016, longer follow-up and required stable background therapy all predicted higher placebo response. The FDA approved a supplement to Pfizer's abrocitinib application (CIBINQO, NDA 213871) on 2 September; the record does not state what changed, and the JAK inhibitor class warnings are unaltered. A randomised field trial in Melbourne found autodissemination stations cut Aedes notoscriptus egg counts by 70% across six intervention areas, with an ad hoc analysis suggesting fewer Buruli ulcer notifications. A two-part review sets out the cardiometabolic effects of retinoids, anthracyclines, antifungals, oral minoxidil, methotrexate, phototherapy and colchicine, with monitoring recommendations.