The edition · Dermatology
In children with discoid lupus, a positive ANA was the strongest predictor of progression to SLE
A 17-site cohort found about one in seven children with skin-limited discoid lupus met SLE criteria within a year. A network meta-analysis favours longer scalp cooling for chemotherapy hair loss, and Korean data link air pollution to alopecia areata.
The edition in brief
Today's dermatology edition ends on a paediatric cohort with a clear monitoring message. In a 17-site retrospective study of children with skin-limited discoid lupus, published in June, 14.4% met classification criteria for systemic lupus within a year; a positive antinuclear antibody at baseline carried a hazard ratio of 3.71, and older age, antiphospholipid antibodies and cytopenias also predicted progression. Most progression was mild, with only 3% developing other organ disease. A network meta-analysis of 12 randomised trials (736 patients) ranked scalp cooling continued for more than 90 minutes after chemotherapy highest for preventing hair loss, but with high risk of bias and low to very low certainty. A Korean national screening cohort associated each 10 μg/m³ rise in long-term PM2.5 with a 45% higher hazard of alopecia areata, strongest for alopecia universalis; it is observational, with supporting cell work. A French reference-centre study of 373 patients with inborn errors of immunity with atopy found eczema in half, usually starting around four months and often years before the infections that lead to diagnosis. The pearl covers photoprotection and follow-up in discoid lupus.
Scalp cooling for more than 90 minutes ranked best against chemotherapy hair loss
Consider longer post-infusion scalp cooling where it is available, while recognising the evidence on duration is low certainty.
Long-term fine particle exposure was linked to more alopecia areata
Treat air pollution as a possible contributor to alopecia areata worth noting in the history, not a proven cause.
Eczema often appears years before infection in inborn errors of immunity
In an infant with atypical or severe early eczema, consider an inborn error of immunity before attributing it to atopic dermatitis.
Discoid lupus: protect the skin, and keep checking beyond it
In discoid lupus, make sun protection part of treatment and check for systemic features at every review.
Paediatric discoid lupus: one in seven met SLE criteria within a year, and ANA predicted it
Test ANA, blood count and antiphospholipid antibodies at diagnosis of paediatric discoid lupus, and review ANA-positive children closely in year one.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for dermatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free