Primary Care Dermatology Literature Sept/Oct 2025

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Skin Research in Primary Care

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Oct 17, 2025, 9:18:37 AM10/17/25

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With thanks to Kate Clement of CEBD for her assistance in compiling.

Varicella-zoster virus reactivation and the risk of dementia

Vitaly Polisky, Maria Littmann, Aleksei Triastcyn, Max Horn, Andreas Georgiou, Robyn Widenmaier, Bruno Anspach, Halima Tahrat, Sanjay Kumar, Carolyn Buser-Doepner, Pascal Geldsetzer, Cornelia M Van Duijn, Patrick Schwab

Nat Med. 2025 Oct 6. doi: 10.1038/s41591-025-03972-5. Online ahead of print.

Abstract: Varicella-zoster virus (VZV) is a neurotropic virus that establishes lifelong latency in humans. VZV reactivation is associated with a wide range of symptoms, including herpes zoster (HZ; also known as shingles), and has been implicated in the development of dementia, although to an unknown extent. Here we present a large-scale longitudinal analysis of health records from more than 100 million individuals in the United States that demonstrates a consistent relationship of VZV reactivation with dementia after controlling for nearly 400 measured characteristics (covering demographics, socioeconomic factors, comorbidities, medications, proxies for healthcare-seeking behavior, shifts in clinical guidelines and completeness of records). We found that recurrent HZ was associated with an increased risk of dementia compared to a single HZ episode. Additionally, exposure to HZ vaccines was associated with a reduced risk of dementia compared to the control 23-valent pneumococcal polysaccharide vaccine. Furthermore, the reduced risk of dementia after administration of the live-attenuated zoster vaccine waned over time and was highly correlated with a waning of the vaccine-mediated protection against HZ. The dementia risk reduction at 3 and 5 years postexposure was also stronger in individuals who received multiple as opposed to only one dose of the recombinant HZ vaccine and those at greater risk of HZ. Our findings strongly implicate VZV reactivation as a modifiable risk factor for dementia.

Assessing the Psychosocial Impact of Acne Scars on Individuals With Pigmented Skin: A Multicenter Observational Study

Marwa Majzoub, Eleonore Goubeau, Vivien Moris

Dermatol Res Pract. 2025 Sep 27:2025:6657441. doi: 10.1155/drp/6657441. eCollection 2025.

Abstract:

Acne scars, particularly in individuals with pigmented skin, can lead to significant psychosocial distress, yet the extent of this impact remains underexplored. This study aimed to assess the psychosocial effects of acne scars on patients with skin Phototypes IV-VI. This retrospective multicenter observational study involved 86 patients with acne scars who had previously consulted general practitioners. Scar severity was assessed using the Echelle d'évaluation Clinique des Cicatrices d'Acné (ECCA). Validated measures were used to evaluate psychological and quality-of-life impacts: the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms and the Dermatology Life Quality Index (DLQI) for quality of life. The study revealed that 62% of patients exhibited depressive symptoms according to the PHQ-9, and 84% reported a diminished quality of life according to the DLQI. A significant correlation was observed between acne scar severity and both psychosocial measures: ECCA and DLQI (r = 0.31, p=0.003), and ECCA and PHQ-9 (r = 0.27, p=0.010). Many participants had modified their clothing and daily activities due to their scars. The findings illustrate the profound psychosocial burden of acne scars, with a notable percentage of individuals experiencing depressive symptoms and reduced quality of life. The strong correlation between scar severity and psychosocial outcomes emphasizes the need for early, comprehensive care that addresses both dermatological and psychological aspects.

Comparative efficacy and safety of biologics and systemic immunomodulatory treatments for chronic urticaria: Systematic review and network meta-analysis

Alexandro W L Chu, Paul Oykhman, Xiajing Chu, Daniel G Rayner, Sukhdeep Bhangal, Andrew Dam, Janice Xu, Javed Sheikh, Kathryn P Trayes, Winfred T Frazier, David M Lang, Lisa A Beck, Sameer K Mathur, Susan Waserman, Lehana Thabane, Rachel N Asiniwasis, Lauren Runyon, Joseph Moellman, Eric T Oliver, Jeffrey Chan, Emily F Cole, Diane R Baker, David A Khan, Moshe Ben-Shoshan, Kathryn E Wheeler, Sanaz Eftekhari, Donna D Gardner, Tonya Winders, Maisie Flindall, Jamie Tattrie, Jonathan A Bernstein, Sarbjit S Saini, Derek K Chu

J Allergy Clin Immunol. 2025 Oct;156(4):1008-1023. doi: 10.1016/j.jaci.2025.06.004.

Abstract:

Background: Chronic urticaria is a common skin condition characterized by itchy wheals (hives), angioedema, or both, lasting for 6 weeks or more. Beyond antihistamines, multiple systemic treatments are available, but there is uncertainty regarding their comparative effects on chronic urticaria outcomes.

Objective: We systematically synthesized the comparative benefits and harms of systemic treatments for chronic urticaria.

Conclusions: Among individuals with chronic urticaria refractory to antihistamines, standard-dose omalizumab and remibrutinib are among the most effective drugs across multiple patient-important outcomes with a favorable safety profile across the studied duration. Cyclosporine may be effective but may be among the most harmful. Dupilumab improves itch and wheals, but it is uncertain whether it improves angioedema or quality of life. Lower doses of omalizumab are of intermediate effectiveness and favorable safety. The net benefit of conventional immunosuppressants is uncertain.

Psoriasis and the risk of 26 cancers: pooled population-based cohort studies from Denmark, England, Israel, and Taiwan

Alex M Trafford, Yochai Schonmann, Teng-Chou Chen, Alexander Egeberg, Rosa Parisi, Evangelos Kontopantelis, Ting-Chun Wang, Martin K Rutter, Li-Chia Chen, Tjeerd van Staa, Meng-Sui Lee, Khalaf Kridin, Arnon D Cohen, Kin-Wei A Chan, Alison K Wright, Christopher E M Griffiths, Darren M Ashcroft

Br J Dermatol. 2025 Oct 12:ljaf399. doi: 10.1093/bjd/ljaf399. Online ahead of print.

Abstract:

Background: Psoriasis is a chronic inflammatory skin disease, and the risk of developing cancer has been postulated due to the presence of several plausible underlying mechanisms. Understanding the association between psoriasis and cancer is imperative to the provision of optimal psoriasis care.

Conclusion: Psoriasis was associated with an increased risk of developing 14 of 26 investigated site-specific cancers, including cancers with poor prognosis, such as liver, lung, and oesophageal cancer. Our findings can be used to reinforce cancer prevention strategies in psoriasis care.

Implementation evaluation of a pharmacist prescribing service for the management of dermatological conditions: a study protocol

Noelia Amador-Fernandez, Shalom I Benrimoj, Francisco Martinez-Mardones, Simone Diamandis, Joanna C Moullin, Gill Schierhout, Maddie Heenan, Sarah Dineen-Griffin

BMC Health Serv Res. 2025 Oct 8;25(1):1333. doi: 10.1186/s12913-025-13128-3.

Abstract:

Background: The scope of practice for community pharmacists is evolving globally. Policy drivers are to increase access to primary care, due to the lack of accessibility to general medical practitioners or inappropriate demand on emergency departments. Most implementation studies in this space have reported on determinants for pharmacist prescribing services. There is a lack of comprehensive evaluations including investigation of the implementation process and outcomes.

Discussion: This study will contribute to the literature by generating new data on the implementation of pharmacist prescribing services with a detailed facilitation process to support implementers and a detailed process to assess tailored implementation strategies.

Teaching Pediatric Dermatology to Primary Care Residents: Valued in Principle, Undervalued in Practice