Clearing the autoantibodies did not clear the blisters

The edition in brief

Today's dermatology edition leads with ADDRESS, a global phase III trial of subcutaneous efgartigimod added to prednisone in moderate-to-severe pemphigus. Despite rapid falls in total IgG and in anti-desmoglein-1 and anti-desmoglein-3 antibodies, complete remission on minimal prednisone by week 30 was reached by 35.5% on efgartigimod against 30.3% on placebo — odds ratio 1.19, confidence interval 0.60 to 2.41 — and steroid consumption was no lower. It is a clean demonstration that lowering the autoantibody does not by itself heal the skin. A meta-analysis of nine randomised trials favours fractional laser over microneedling for non-acne scars, with a standardised mean difference of −0.99 on scar scores and no difference in adverse events, though heterogeneity was substantial and the confidence interval reaches close to zero. A phase 2 dose-optimisation trial of deuruxolitinib in 57 adults with severe alopecia areata found 8 mg twice daily clearly better than 16 mg once daily on Severity of Alopecia Tool score at 24 weeks, a split-dosing result rather than a dose-size one. A proteomic study of 34 patients with moderate-to-severe atopic dermatitis found a circulating signature distinct from psoriasis that tracked with carotid and femoral plaque, with a composite score discriminating plaque at an area under the curve of 0.94 — research-stage, not a test to order. The edition closes with a practical review of Janus kinase inhibitors in paediatric alopecia areata, where ritlecitinib is the only agent approved down to age 12 and everything else is off-label use with real regrowth behind it.