The Derm 5 - November 3, 2026
The Derm 5 - November 3, 2026
Your daily digest of must-read dermatology research, curated for clinicians.
Quick question: tap your role below so I can pick studies that matter most for your practice. Answer by Friday for a chance to win a $100 Starbucks gift card (no purchase necessary; U.S. 18+; winner drawn at random Nov 9).
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Spironolactone versus Bicalutamide for Female Pattern Hair Loss: A 24-Month Unicenter Retrospective Comparative Study of Effectiveness and Safety
Summary: This single-center retrospective study from Madrid compared spironolactone (n=128) with bicalutamide (n=59) for female pattern hair loss in 187 women completing 24 months of follow-up. At month 24, 54.4% of spironolactone patients achieved at least a one-grade Sinclair improvement versus 37.3% with bicalutamide (p=0.030), with baseline-adjusted analysis favoring spironolactone (OR 2.08, 95% CI 1.07–4.02). Spironolactone doses above 100 mg/day (median 130 mg/day) produced approximately 0.4 grades greater improvement than bicalutamide 50 mg/day (p=0.040). Overall adverse events were comparable (35.2% versus 32.2%), but bicalutamide was associated with elevated liver enzymes in 5.1% versus 0% and required more laboratory tests over two years (3.5 versus 0.5 per patient). Nearly 94% received concomitant oral minoxidil, and only 187 of 387 treatment initiators completed the efficacy analysis, limiting conclusions about independent drug effects.
How this may change your practice: For women with FPHL who need an off-label systemic antiandrogen (in addition to PO minox), spiro is a reasonable first choice before bicalutamide, provided there are no contraindications. (This study was done in Europe). Consider doses >100 mg/day only when appropriate and tolerated, monitor blood pressure, renal function, and potassium according to patient risk, and allow adequate time to assess hair response. Keep bicalutamide as a backup though, with liver monitoring and appropriate pregnancy prevention counseling.
Device-Free Auricular Acupressure for Rosacea: A Randomized Clinical Trial
Summary: This single-center, assessor-masked, sham-controlled RCT randomized 204 patients with rosacea receiving doxycycline 100 mg daily and topical azelaic acid 15% twice daily to additional bilateral auricular acupressure over vagally innervated conchal sites or sham ear sites for eight weeks. Patients pressed nurse-applied Vaccaria seeds for 30 seconds three times daily, with additional sessions permitted during flares. At week 8, 56.9% achieved IGA 0/1 with active acupressure versus 35.3% with sham (RR 1.61, 95% CI 1.18–2.20; NNT 5). Immediate vascular improvement was reported in 59.3% versus 7.4%, alongside greater reductions in LL-37, CGRP, TNF-α, and IL-6; clinical improvements in erythema and IGA persisted through week 20. Adverse events were mild (6.9% versus 9.8%), with no serious events. The single-center design, 17.6% dropout during treatment, and professionally assisted seed placement limit generalizability, particularly to unsupervised home treatment.
How this may change your practice: Was added on top of doxycycline and azelaic acid rather. Vagal signaling is known to suppress macrophage TNF, and LL-37 and CGRP are the two molecules most central to rosacea.
Tocilizumab for severe and refractory mucous membrane pemphigoid
Summary: This French translational study used Olink proteomics (40 MMP, 40 bullous pemphigoid, and 40 healthy controls) and Luminex analysis (63 MMP, 31 bullous pemphigoid, and 24 healthy controls) to identify inflammatory pathways associated with mucous membrane pemphigoid (MMP). Serum IL-6, IL-8, MIP-1α/CCL3, and MIP-1β/CCL4 were significantly elevated in MMP, with lower baseline levels associated with subsequent complete remission compared with persistent disease activity. Based on these findings, nine patients with severe, treatment-refractory MMP received compassionate-use tocilizumab, predominantly 8 mg/kg intravenously every four weeks, following failures of therapies including rituximab. Mean MMPDAI scores decreased from 14.8 ± 6.6 to 4.2 ± 3.2 (p = 0.009), with seven patients (78%) achieving partial remission, one (11%) complete remission, and one (11%) disease control after a median nine-month follow-up. All three patients with normal baseline IL-6 levels improved, while four non-severe adverse events occurred, including two cases of neutropenia, one thrombocytopenia, and one hepatic cytolysis. The small, uncontrolled case series, concurrent treatments, and limited follow-up prevent definitive conclusions regarding efficacy and long-term safety.
How this may change your practice: Consider tocilizumab as a potential off-label rescue option for severe refractory MMP, particularly ocular or pharyngolaryngeal disease that continues to progress despite established treatments. Normal baseline IL-6 should not automatically exclude consideration, although predictive biomarkers remain unvalidated. Coordinate care with ophthalmology and ENT specialists when appropriate, and monitor blood counts, liver enzymes, and infectious complications during treatment.
52-week ivarmacitinib in moderate-to-severe atopic dermatitis: A phase 3 trial
Summary: This multicenter, double-blind phase 3 trial randomized 336 patients aged 12–75 years with moderate-to-severe atopic dermatitis to once-daily oral ivarmacitinib 4 mg, 8 mg, or placebo for 16 weeks, followed by a 36-week extension in which placebo recipients switched to active treatment. Of 336 patients, 258 completed 52 weeks. Among patients receiving ivarmacitinib continuously, Week 52 IGA 0/1 responses were 42.3% with 4 mg and 40.2% with 8 mg, EASI-75 responses were 60.6% and 55.9%, and clinically meaningful itch responses were 59.6% and 45.1%, respectively. Treatment-emergent adverse events occurred in 87.5% and 85.5% of patients, with serious events in 5.6% and 4.4%; common events included respiratory infections, COVID-19, and elevated creatine phosphokinase. Improvements were generally maintained through one year, although the absence of a placebo control after Week 16 limits conclusions about long-term comparative efficacy.
How this may change your practice: Main takeaway is: If you are going to start oral JAK1 treatment, screen for infection and thrombotic risk. Ivarmacitinib is approved in China..not US, but numbers are at the bottom of the oral JAKi: EASI-75 of ~58% at week 52 against roughly 80% for Rinvoq and ~70% for Cibinqo (these are not head to head numbers).
PARP1 as a biomarker for differentiating melanoma from benign melanocytic lesions
Summary: This single-center diagnostic biomarker study at Memorial Sloan Kettering Cancer Center evaluated PARP1 and PRAME immunohistochemistry in archived melanocytic lesions, with 116 evaluable for PARP1 and 103 for PRAME. Both markers showed progressively higher expression from benign nevi through dysplastic and borderline lesions to melanoma. At study-optimized thresholds, PARP1 demonstrated 98.5% sensitivity and 52.8% specificity for detecting malignant lesions, compared with 88.1% sensitivity and 69.4% specificity for PRAME. PARP1 missed only one malignant lesion versus eight missed by PRAME, including four invasive melanomas, and had a higher negative predictive value (95% vs 75.8%). Combining either positive marker increased sensitivity to 100% but reduced specificity to 44.4%, while PARP1-targeted fluorescent imaging was feasible in three fresh metastatic melanoma specimens. The retrospective single-institution design, absence of clinical outcome data, and potential PARP1 staining in inflammatory infiltrates limit immediate diagnostic application.
How this may change your practice: PRAME is what you may have been seeing recently. It missed 8 malignant lesions here including 4 invasive melanomas, which fits its known blind spots in desmoplastic, acral, and mucosal melanoma, so a PRAME-negative report on a lesion you’re clinically worried about is not reassurance and is worth a conversation with your dermatopathologist. PARP1 had 52.8% specificity it flags about half of benign nevi, and it stains inflammatory infiltrates.
That’s 5 articles for today! See you tomorrow for another 5.
Editor’s Note: This summary was generated with the assistance of AI and personally reviewed for accuracy and clinical relevance. While it is designed to highlight key takeaways and save you time, it is not a substitute for the full text or professional clinical judgment. Please refer to the original source (linked above) for full data and protocols.
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