In an authoritative review, Gupta et al. summarise the evidence regarding the clinical and laboratory data on Trichophyton indotineae, a new pathogen responsible for widespread, resistant cases of tinea corporis or tinea cruris 1. T. indotineae belongs to the Trichophyton mentagrophytes/Trichophyton interdigitale complex (TMTIC) and exhibits significant resistance to terbinafine, fluconazole and griseofulvin. Treatment requires a regimen developed by expert dermatologists including itraconazole, voriconazole or posaconazole (Figure 1). These results were confirmed by Kong et al. in a survey from the China Antifungal Resistance Dermatophytes Surveillance Network study 2 (Figure 2). The authors analysed 230 TMTIC strains across nine Chinese hospitals. They observed a decreased susceptibility of TMTIC to azoles and the emergence of T. indotinea as a cause of tinea corporis and tinea cruris in eastern China. Dermatologists should be aware of the decreased susceptibility to azoles of TMTIC and screen for T. indotinea in patients returning from Asia and presenting with widespread tinea corporis/cruris 3. Metabolic and cardiovascular comorbidities have been linked to late-onset psoriasis. Although this association has been confirmed by many epidemiological studies, there is limited information on how changing ‘unhealthy’ behaviour influences psoriasis outcome. In a large-scale database study on the UK Biobank, Zhou et al. identified lifestyle-related metabolites significantly associated with the development of late-onset psoriasis and linked to lipid and glucose metabolism pathways. Machine learning that incorporates clinical, genetic and metabolomic data could enhance psoriasis risk prediction and motivate patients to change their lifestyle behaviour 4 (Figure 3). Similarly, smoking is a known risk factor for psoriasis. There is limited high-quality data on the effect of smoking cessation on psoriasis risk. In a nationwide study from Korea, Kim et al. showed that patients who stop smoking have a lower risk of developing psoriasis or palmar-plantar pustulosis 5 (Figure 4). This risk reduction is attenuated in patients who have gained weight, which is a major concern for those trying to quit smoking. These data should encourage dermatologists to advise patients at risk of psoriasis to adopt a healthy lifestyle and quit smoking. However, patients need appropriate dietary support to avoid weight gain when quitting smoking. The March issue of the JEADV, co-edited by Professor Jo Lambert and Professor Curdin Conrad, is dedicated to personalised medicine in dermatology. This special issue explores how advanced biological analyses, such as genetic studies, spatial transcriptomics and biomarker identification, help us to better understand skin diseases and pave the way for individually tailored treatments. This concept of personalised medicine has been amplified by the expansion of artificial intelligence (AI) and bioinformatics, which allow a massive amount of data to be processed rapidly. Reitmajer et al. have summarised how precision medicine improves early diagnosis and stratification of melanoma patients using imaging methods, clinical, genomic and molecular profiling in a comprehensive review 6 (Figure 5). For each patient with metastatic melanoma, the right therapeutic strategy is already being tailored based on clinical course and individual molecular/genetic testing to predict treatment response. For inflammatory skin diseases, clinical presentation and histopathology can sometimes fail to predict therapeutic response, particularly in patients with poorly defined lesions. Di Domizio et al. have created a transcriptomic platform enabling the detection of reference disease gene signatures corresponding to the major skin disease pathways 7 (Figure 6). This relatively straightforward analysis enables inflammatory skin lesions to be characterised based on the analysis of an 80-gene Nanostring panel. Preliminary data have shown that such characterisation can lead to better treatment selection and improved clinical outcomes. In summary, personalised medicine is a promising concept for improving early diagnosis and treatment outcomes 8. While its development is monitored with interest, the emotional connection between physicians and patients must be nurtured. Even if a future ‘digital companion’ could support patients, the human element of medicine lies at the heart of what we do. The author received no specific funding for this work. The author has nothing to report. C.P. has received grants and personal fees from Bristol-Myers Squibb, Boehringer, Galderma, Janssen, Lilly and Sanofi.
Carle PAUL (Sun,) studied this question.