Ruxolitinib cream clears half of cutaneous lichen planus in a phase 2 trial; AAD says rethink the diagnosis before escalating refractory eczema

The edition in brief

In a phase 2 trial of 64 adults with cutaneous lichen planus covering up to 20% of body surface, ruxolitinib 1.5% cream twice daily achieved clear or almost clear skin in 50.0% versus 21.9% with vehicle at 16 weeks (difference 29.4 percentage points, 95% CI 7.6 to 51.3), and itch improved by at least 4 points in 48.4% versus 16.1%, with no serious adverse events. A US Delphi panel reached consensus on 40 statements for pseudofolliculitis barbae, putting changes to hair removal first and supporting laser hair removal; it did not agree on isotretinoin, peels or multiblade razors. In the phase 3 VALOR trial of 241 adults with dermatomyositis, brepocitinib 30 mg improved cutaneous activity (CDASI-A difference -3.0) from week 4, with itch remission in 38.3% versus 19.0%. In 46 transgender people on testosterone with mild androgenetic alopecia, sublingual minoxidil 1.35 mg twice daily increased midfrontal hair count by 15.7 hairs/cm² over placebo, without affecting testosterone levels. An American Academy of Dermatology workgroup issued a good practice statement: adults with presumed atopic dermatitis that does not respond to optimised treatment should have their diagnosis reassessed. The practical message: before adding a systemic agent for refractory eczema, check that it is eczema.