When adult eczema will not settle, question the diagnosis before escalating

The edition in brief

An American Academy of Dermatology workgroup, using GRADE methods, issued a Good Practice Statement supporting diagnostic reassessment in adults with presumed atopic dermatitis that does not respond to optimised treatment. It rests on indirect evidence and consensus, but the clinical point is practical: misdiagnosis and coexisting conditions are common reasons for failure. A meta-analysis of 24 studies (3,518 patients) of dual immune checkpoint inhibition for melanoma brain metastases found pooled intracranial response of 42.5% and intracranial progression-free survival of 44.1% at one year, with better outcomes in asymptomatic patients (3-year survival 52.3% vs 31.5%). Survival favoured dual therapy over monotherapy up to two years, but grade 3 or higher toxicity reached 48.2%. A Delphi consensus of 53 Spanish dermatologists agreed on 34 of 47 scalp psoriasis recommendations, placing high-potency topical corticosteroids first, with vitamin D analogue combinations for maintenance and IL-17 or IL-23 inhibitors preferred when systemic therapy is needed. A small randomised trial in 35 surgical nurses found a ceramide-based emulsion improved hand barrier measures within a week. The pearl covers getting scalp treatments onto the scalp.