This month’s news from across the specialty

August 1, 2025

In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.  

Researchers at the Clear Clinical Communications group at the University of Minnesota studied children’s understanding of medical terminology. Previous studies have shown that physicians and non-physician providers are often oblivious to their use of medicine-specific terms that are not understood outside the medical community. For example, “febrile” is a word people often hear on TV shows, but 0% of teenagers and only 9% of adults know what it means. Most think it had something to do with how much fiber is in their diet or that they are fertile. Most adults think a nephrologist is either a “foot doctor” or “doctor of death.” It is important to clearly communicate with patients and families because when they leave the office, they are the ones who will manage their health conditions based on their interpretations of what’s going on with their bodies.

The current study surveyed children aged 4-12 years old and had several interesting findings about terms we might not consider jargon. For example, many children thought that “surgery is going to come by to see you today” means that that they will be operated on that day, not that the surgeon is going to do a consult. Most children thought that being “transferred to the floor” meant they were being asked to sleep on the floor. Less than 25% of children understood the phrase “we are going to do a test,” with many thinking it meant something “like a test at school.”

The authors recommend regularly using teach-back to confirm comprehension and provide real-time feedback on how well we are being understood. Misunderstandings are a signal to use different phrasing, age-appropriate metaphors, or even visual aids. The study shows that we are more oblivious to miscommunication than we think and that even children as young as four years old are interested and interpreting what we are saying. The authors’ final advice to clinicians who want to improve their communication skills is “when in doubt, ask a kid what they think it means.”

Of the many cutaneous reactions caused by immune checkpoint inhibitors (ICIs), lichenoid dermatitis is one of the most (if not the most) frequently biopsied. While ICI-associated lichenoid dermatitis may be indistinguishable from conventional lichen planus (LP), some histopathologic features are helpful for dermatopathologists to diagnose ICI-associated lichenoid dermatitis even in the absence of clinical information. In clinical practice, ICI-associated lichenoid dermatitis tends to show a patchy, less-intense inflammatory infiltrate in the superficial dermis when compared to the dense band-like infiltrate of conventional LP. A small study published by Meier-Schiesser and colleagues (JAAD Int. 2024. 15:157-164) supports this observation. In their study of 40 patients, 14 individuals were diagnosed with ICI-associated lichenoid dermatitis or immune-related lichen planus (irLP), and 23 individuals had diagnoses of conventional LP. The authors quantified lymphocytes in the biopsy specimens and found that there were smaller numbers of lymphocytes in irLP vs. LP. irLP was also more likely to show lymphocyte exocytosis and increased eosinophils compared to LP. Gene expression analysis revealed higher expression of IFNG in irLP than LP, which the authors suggested was in line with prior research showing that IFN-γ enhances cell-mediated cytotoxicity against keratinocytes via JAK2/STAT1 in lichenoid processes and may be responsible (at least in part) for apoptotic cell death. These findings provide not only more evidence for dermatopathologists to suspect ICI-associated lichenoid dermatitis, but also suggest that targeting JAK/STAT signaling and IFN-γ may be potential treatment strategies for refractory lichenoid dermatitis.

A recent study published in JAMA Dermatology explores IL-5 inhibition as a steroid-sparing therapy for drug-induced hypersensitivity syndrome (DIHS), previously known as drug reaction with eosinophilia and systemic symptoms (DRESS) (doi: 10.1001/jamadermatol.2025.0441). DIHS is a rare but potentially life-threatening delayed hypersensitivity reaction. While a prolonged course of high-dose corticosteroids is currently considered the first-line treatment, prolonged use of steroids carries significant toxicities and present alternative immunomodulators are often poorly tolerated or ineffective. This retrospective case series evaluated the clinical course for 16 patients treated with IL-5 inhibitors in the inpatient setting. All patients had a possible or definite case of DIHS by RegiSCAR criteria in which steroids were ineffective or contraindicated.

Patients received either mepolizumab and benralizumab, anti-IL-5 and anti-IL-5-receptor monoclonal antibodies, respectively. Treatment with mepolizumab and benralizumab led to rapid resolution of eosinophilia (mean 1.4 days) and clinical improvement (mean 16 days). There were no reported adverse effects. Curiously, one patient relapsed on mepolizumab but responded to benralizumab, highlighting potentially important clinical differences between anti IL-5 therapies. Benralizumab may offer more potent immunologic suppression due to its ability to deplete eosinophils directly via antibody-dependent cell-mediated cytotoxicity, whereas mepolizumab and its cousin reslizumab binds circulating IL-5.

This study adds exciting evidence supporting the use of IL-5 inhibitors for eosinophilic conditions beyond asthma and hypereosinophilic syndromes. For dermatologists managing severe cutaneous adverse drug reactions, anti-IL-5 therapy may represent a promising, targeted strategy to mitigate the morbidity of systemic steroids. However, larger prospective studies are needed to validate these findings, clarify the ideal agent and timing, and determine long-term outcomes.

Vulvovaginal pruritus is a high-morbidity condition that severely impacts quality of life. It is a fairly common and embarrassing condition that will affect most women at some point in their lives, leading to reduced self-esteem and diminished intimacy. Despite its prevalence, many dermatologists have limited experience diagnosing and treating the conditions that could cause vulvovaginal itching.

A recent comprehensive review explored the diverse etiologies of this condition including but not limited to inflammatory (lichen sclerosus, lichen planus, lichen simplex chronicus, genital psoriasis, dermatitis), infections (fungal, bacteria, parasites), neuropathic, psychogenic, neoplastic disorders, and systemic illnesses (Am J Clin Dermatol. 2025. 26: 361–378). Personal hygiene, hormonal changes, and external allergens must also be considered in vulvovaginal pruritic disease.

The complex nature of vulvovaginal pruritus requires a multidisciplinary approach for accurate diagnosis and effective management. The emotional strain associated with it can lead patients to avoid health care appointments and turn to self-treatment and misuse of over-the-counter medications, leading to complications. A thorough, sensitive, and empathic history and physical examination to identify the exact location of the itch and any associated lesions will help build a broad differential.

Treatment typically begins with lifestyle modification, topical anti-infection agents such as antifungals, and topical anti-inflammatory medications such as corticosteroids and calcineurin inhibitors. Severe and resistant cases frequently need systemic intervention. Educate the patients and involve them in the management process to prevent recurrence and ensure treatment adherence. Further research is urgently required to characterize female-specific vulvovaginal itch and develop comprehensive, evidence-based guidelines for diagnosing and treating this condition.

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