30-Second Takeaway
- Vixarelimab provides rapid, dose-dependent itch relief and lesion improvement in moderate-to-severe prurigo nodularis with acceptable short-term safety.
- Topical 5% 5-fluorouracil offers long-term Bowen’s disease control comparable to surgery, whereas MAL-PDT performs less well.
- Biologic therapies appear as safe as conventional agents for cancer progression and serious infection in psoriasis patients with active or recent malignancy.
- Genetic evidence implicates higher BMI and inflammatory bowel disease as causal in hidradenitis suppurativa, supporting aggressive weight and comorbidity management.
- Dermatology practice should integrate subspecialty review and dermoscopy, given high variability in melanocytic diagnoses and dermoscopic clues for early MF.
Week ending December 20, 2025
Actionable updates in prurigo nodularis, keratinocyte cancer, complex nevi, and inflammatory dermatoses
Vixarelimab rapidly reduces itch in moderate-to-severe prurigo nodularis
In this phase 2b double-blind trial, 189 adults with moderate-to-severe prurigo nodularis received subcutaneous vixarelimab (120–540 mg) or placebo every 4 weeks for 16 weeks. All vixarelimab doses produced greater mean WI-NRS reductions at week 16 versus placebo (−56.2%, −51.0%, and −33.0% vs −14.5%). Clinically meaningful ≥4-point itch reduction occurred in 66.0% and 61.7% of high- and mid-dose patients versus 16.7% with placebo; low-dose achieved 29.8%. An open-label extension with vixarelimab 360 mg every 2 weeks suggested continued benefit with acceptable safety, though longer-term safety requires further study.
Topical 5-fluorouracil provides durable control for Bowen’s disease
This multicenter non-inferiority RCT followed Bowen’s disease patients 3–5 years after randomization to surgical excision, 5% 5-fluorouracil, or MAL-PDT. Four-year tumor-free survival was 97.5% for surgery, 86.2% for 5-fluorouracil, and 82.7% for MAL-PDT. 5-fluorouracil remained non-inferior to surgery for long-term control, whereas non-inferiority of MAL-PDT could not be concluded. No treated site developed cutaneous squamous cell carcinoma, and late additional recurrences were rare, supporting durable efficacy for surgery and 5-fluorouracil.
New Gorlin syndrome guidelines structure basal cell carcinoma management
A multidisciplinary panel developed evidence-based clinical practice guidelines for basal cell carcinoma management in Gorlin syndrome. Using systematic reviews, expert surveys, patient interviews, and Delphi consensus, they produced 47 recommendations across topical, systemic, surgical, and multimodal strategies. Specific therapies, including hedgehog inhibitors and field treatments, are recommended to reduce surgical fatigue and improve quality of life. The guidelines emphasize shared decision-making, comprehensive monitoring, and psychosocial support given the chronic, tumor-prone nature of Gorlin syndrome.
Biologics appear cancer-safe in psoriasis with active or recent malignancy
This surveillance cohort included 333 psoriasis patients with active cancer or cancer within 5 years, treated with biologics or conventional systemic agents. Over a median 6-year follow-up, progression or recurrence rates per 100 patient-years were similar between biologics (10.7) and conventional therapies (10.5). One-year progression- or recurrence-free survival was 86% in both groups, and biologics did not affect progression (HR 1.02; 95% CI 0.59–1.77). Severe infection incidence was comparable, and outcomes were mainly driven by functional status, cancer stage, and comorbidity rather than psoriasis treatment class.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.