Potent or prolonged topical steroid use was associated with a higher risk of type 2 diabetes

The edition in brief

In 685,389 South Korean adults, topical corticosteroid use overall was not associated with type 2 diabetes. But potent steroids (adjusted HR 1.15, 95% CI 1.04–1.26), ten or more prescriptions (1.26, 1.12–1.42) and six months or more of cumulative use (1.45, 1.25–1.67) were. This was observational and residual confounding is possible, but the gradient with dose is a reason to review long-term potent steroid users, which matters in India where potent steroid combination creams are widely misused. A US good practice statement advises re-examining the diagnosis in adults with presumed atopic dermatitis that does not respond to optimised treatment; it rests on expert consensus and indirect evidence. In the phase 3 VALOR trial in dermatomyositis, brepocitinib 30 mg improved skin disease activity from week 4 (CDASI-A difference −3.0, −4.6 to −1.4) and doubled itch remission (38% vs 19%). The EORTC COLUMBUS-AD trial of adjuvant encorafenib and binimetinib in resected BRAF-mutant stage IIB/IIC melanoma closed early after 110 patients; 12-month recurrence-free survival was 86% versus 70%, with wide intervals, and a third stopped treatment for adverse events. A review of lasers in skin types IV–VI supports low-fluence Q-switched or picosecond Nd:YAG for pigment, conservative non-ablative fractional settings, and strict photoprotection. The pearl: prescribe steroids in fingertip units so the quantity is deliberate.