The edition · Dermatology
Dupilumab outperformed methotrexate and ciclosporin in children of every skin colour
Four years of registry data put 13 to 14 EASI points behind dupilumab against 4.5 to 10 for the older systemics, with adverse event rates no higher in non-White children. Plus JAK inhibitors in paediatric alopecia areata, a baricitinib supplement, and what MITF E318K is worth in a melanoma clinic.
The edition in brief
The PEDISTAD registry followed 314 White and 186 non-White children under 12 with moderate-to-severe atopic dermatitis on systemic treatment for four years. Eczema area and severity index improved by 13.6 points with dupilumab, 8.2 with methotrexate and 9.2 with ciclosporin in non-White children, and by 14.2, 10.1 and 4.5 points respectively in White children. Itch improved significantly with dupilumab in both subgroups; ciclosporin was least effective for itch. Exposure-adjusted adverse event rates were higher in White children, reaching 58.33 events per 100 person-years on ciclosporin against 28.72 in non-White children. A clinical review of Janus kinase inhibitors in paediatric alopecia areata notes that ritlecitinib is the only agent approved by the FDA for this indication, and only from age 12, so most paediatric use is off-label. Regrowth has been reported with abrocitinib, baricitinib, deuruxolitinib, ritlecitinib, ruxolitinib, tofacitinib and upadacitinib, with heterogeneous outcome reporting across reports. The FDA records a supplemental application on baricitinib (NDA 207924, Eli Lilly) dated 25 September 2026. The entry does not state what the supplement covers. A meta-analysis of 11 case-control studies across 8,606 melanoma patients and 17,953 controls found the germline MITF E318K variant in 2.1% against 0.8%, giving a melanoma odds ratio of 2.55 (95% CI 1.90-3.43), stronger in multiple primary melanoma and enriched among people with more than 200 naevi. A continuing education review concludes that most excisional dermatological surgery is clean, does not need systemic prophylaxis, and does not need topical antibiotics on clean wounds.
Dupilumab led in children of every skin colour, and ciclosporin varied most
Dupilumab gave the largest improvement in severity, itch and quality of life in both subgroups; skin colour is not a reason to expect a different response.
Most JAK inhibitor use in paediatric alopecia areata is off-label, and that is the whole problem
Only ritlecitinib is approved for paediatric alopecia areata and only from age 12; every other JAK inhibitor in children is off-label, which belongs in the consent conversation and the notes.
A baricitinib supplemental application is recorded, with no stated scope
An FDA supplemental application on baricitinib is recorded for 25 September 2026 with no stated scope; check the prescribing information rather than inferring an indication change.
MITF E318K is a moderate-penetrance melanoma allele, and it travels with naevus count
MITF E318K carries roughly two-and-a-half times the melanoma odds and clusters with multiple primaries and very high naevus counts; it does not justify surveillance of other organs.
A skin examination that stops at the lesion the patient pointed to is not a skin examination
Examine the sites the patient cannot see — scalp, soles, web spaces, nails, perineum — and write down an actual naevus count.
Most skin surgery is clean, and most of it needs no antibiotic at all
Stop the reflex antibiotic after skin surgery: no systemic prophylaxis for routine clean excisions, and petrolatum rather than a topical antibiotic on a clean wound.
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