This month’s news from across the specialty
What’s hot
July 1, 2025
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
Although management options for chronic spontaneous urticaria (CSU) improved with the introduction of the anti-IgE monoclonal antibody omalizumab in 2014, novel oral therapeutics have remained elusive. Recently, two phase 3 trials examined the efficacy of remibrutinib, an oral, highly selective Bruton’s tyrosine kinase inhibitor, in 925 patients with CSU who remained symptomatic during treatment with second-generation H1-antihistamines (NEJM. 2025;392: 984-994). Patients were randomized to twice-daily oral remibrutinib or placebo for one year. After 12 weeks, mean itch and hive scores were significantly lower with remibrutinib compared to placebo. Improvements in weekly urticaria activity scores were observed as early as week one and were sustained to one year. Adverse events were similar in frequency in the groups, although petechiae occurred more often with remibrutinib. The FDA approval of remibrutinib for CSU would represent an attractive therapy for patients who dislike monthly subcutaneous injections or who fail omalizumab.
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The incidence of nonmelanoma skin cancer in the 10 years after solid-organ transplant is approximately 35%, and skin cancer is the most common malignancy affecting solid-organ transplant recipients (SOTRs). A Delphi consensus panel of dermatologists and transplant surgeons concluded that all high-risk SOTRs (male, age >50, thoracic organ recipient) should be screened by a dermatologist within two years of transplant; all other SOTRs (with exception of ‘low-risk African American SOTRs,’ for which no consensus was reached) should be screened by a dermatologist within five years of transplant (doi: 10.1111/tri.13520).
As skin cancers are identified via appropriate dermatologic surveillance of SOTRs, many of these patients will undergo Mohs micrographic surgery (MMS) or other dermatologic surgeries for definitive treatment. Recently, O’Donnell-Capelli and coauthors examined the risk of postoperative complications in SOTRs undergoing MMS (doi: 10.1097/DSS.0000000000004386). The group’s retrospective cohort analysis utilized a population database including over 106 million individuals in the United States. They analyzed two age, race, and sex-matched cohorts of 5,555 patients — one cohort of SOTRs, the second cohort of immunocompetent patients — to investigate the risks of common postoperative complications following MMS. SOTRs had a 2x increased risk of infection following MMS, compared to matched immunocompetent patients. SOTRs also had a 2.5x increased risk of postoperative wound disruption and a >3x increased risk of postoperative swelling after MMS as compared to matched immunocompetent patients. No difference in postoperative bleeding risk was found between cohorts.
As dermatologists and dermatologic surgeons continue to play a critical role in the long-term medical and surgical care of SOTRs, we must be aware not only of their increased lifetime risk of skin cancer, but also of their increased risk for postoperative complications. Careful preoperative counseling and postoperative monitoring of SOTRs are important for timely identification and treatment of any potential complication.
In recent years, dermatopathologists have utilized a Treponema pallidum immunoperoxidase stain to assist in the diagnosis of syphilis in skin biopsies. Similar to other immunoperoxidase stains, this test is not perfect as it may yield false positive and false negative results. In a recent study in the Journal of Cutaneous Pathology, the authors shared their experience on the diagnostic accuracy of the T. pallidum stain. The final cohort of their study included 26 patients who had both skin biopsies with staining as well as rapid plasma reagin (RPR) serology. The T. pallidum stain showed a sensitivity of 80% and a specificity of 90%. This finding is similar to what exists in the literature with reported sensitivities between 64% and 94%. False positive results have previously been reported to be caused by other spirochetal organisms, including Borrelia burgdorferi, as well as the Brachyspira spirochetes; the latter frequently populate the gastrointestinal tract. When Brachyspira are present in skin biopsies, they can be confused with the diagnosis of condyloma lata. Rarely, this stain can cross-react with Mycobacterium leprae. It is important for dermatologists to confirm positive and negative Treponema pallidum staining with serological testing for syphilis when clinically indicated.
More What’s Hot!
Check out more What’s Hot columns from the DermWorld Editorial Advisory Workgroup.
April showers bring May flowers. Lots of rain might cause something else as well: an uptick in coccidioidomycosis. As described in a JAMA article on climate change and health, record-high numbers of coccidioidomycosis occurred in California in 2023. This occurred after numerous atmospheric rivers drenched the state, which prior to then had experienced several years of drought.
Similar epidemiologic patterns have occurred previously. Extremes of dry and wet weather create ideal conditions for spread of Coccidioides, in what the authors term a “grow and blow” phenomenon. Precipitation allows the fungus to multiply in soil. Drought, combined with wind, enables dispersal of fungal spores, which infect humans through inhalation.
Climate change contributes to more extreme and more frequent wet and dry cycles, while also expanding the geographic range suitable for Coccidioides. Now endemic in the U.S. in Arizona, California, New Mexico, west Texas, and Utah, the fungus is projected, according to climate-change modeling, to be endemic by 2100 also in Idaho, Montana, Nebraska, North Dakota, South Dakota, and Wyoming.
Dermatologists should remain vigilant for coccidioidomycosis, which CDC modeling shows is currently substantially underdiagnosed even in endemic areas. The JAMA article also includes a useful review of coccidioidomycosis presentation, diagnosis, treatment, reporting, and prevention. Important for dermatologists: approximately 40% of patients develop symptoms; approximately 50% of patients with pulmonary infection have erythema nodosum; and up to 10% of patients have disseminated infection, including in the skin.
