Summary

[Posted 7/Jul/2025]

AUDIENCE: Dermatologists, Gynecologists, Primary Care Physicians, and other healthcare professionals involved in women's health.

KEY FINDINGS:

• Vulvovaginal itching is a common, often under-recognized condition with diverse etiologies, necessitating a comprehensive diagnostic approach.
• Causes span infectious, inflammatory, hormonal, neoplastic, neuropathic, systemic, and genetic factors, often requiring a multidisciplinary assessment.
• Chronic vulvovaginal pruritus significantly impacts patients' physical and emotional quality of life, leading to embarrassment, frustration, and avoidance of care.
• Effective management involves a multimodal strategy, combining lifestyle modifications, topical therapies (e.g., corticosteroids, antifungals, calcineurin inhibitors), systemic treatments (e.g., oral corticosteroids, anticonvulsants, biologics for refractory cases), and non-pharmaceutical interventions.
• There remains a critical need for further research to develop comprehensive, evidence-based guidelines and understand the holistic impact of female-specific pruritus.

BACKGROUND: Vulvovaginal itching is a prevalent yet frequently under-recognized complaint affecting women across all age groups. Despite its commonality, many dermatologists receive limited training in vulvar diseases, contributing to delayed diagnoses and prolonged patient discomfort. Patients often attempt self-treatment with over-the-counter products, which can exacerbate symptoms and complicate accurate diagnosis. The complex nature of vulvovaginal pruritus often demands a multidisciplinary approach for effective diagnosis and treatment, highlighting the need for improved understanding and management strategies.

DETAILS:

Pathophysiology Vulvovaginal itching can arise from various mechanisms, including compromised skin barrier integrity, elevated skin pH activating proteases, and hormonal fluctuations impacting epithelial health and microflora. Psychogenic factors can also initiate or aggravate itch through an itch-scratch cycle.

Causes

• Infectious Common acute causes include fungal (e.g., *Candida albicans*), bacterial (e.g., bacterial vaginosis, Group A ß-hemolytic streptococcus), parasitic (e.g., trichomoniasis, pinworms, scabies, pubic lice), and viral infections (e.g., HSV, HPV).
• Inflammatory Dermatological conditions like atopic dermatitis, irritant/allergic contact dermatitis (from hygiene products, fabrics), psoriasis, lichen simplex chronicus, lichen sclerosus, and lichen planus are frequent culprits.
• Neoplastic Though rare, vulvar malignancies (e.g., squamous cell carcinoma, melanoma, extramammary Paget's disease) can present with persistent itching, often as an early symptom. Benign tumors like syringomas can also be pruritic.
• Neuropathic Damage or dysfunction of nerve fibers in the vulvar region (e.g., from burns, scars, radiation, spinal nerve compression, small fiber polyneuropathy, vulvodynia) can lead to abnormal, often intense, sensory experiences.
• Systemic Conditions like diabetes (predisposing to infection and neurogenic itch), HIV, hepatic, and renal diseases can cause generalized or localized vulvar pruritus due to circulating pruritogens or altered immune responses.
• Genetic Rare genodermatoses such as Darier disease and Hailey-Hailey disease can cause itchy lesions in the vulvovaginal area. Genetic predispositions may also increase susceptibility to conditions like atopic dermatitis or recurrent candidiasis.

Evaluation A thorough history (onset, duration, severity, timing, aggravating/relieving factors, environmental exposures, hygiene, sexual history, medications, medical history) and physical examination are crucial. This includes inspecting the vulvovaginal area for lesions, discharge, and tissue changes. Diagnostic tools may include wet mount microscopy, STI testing, pH testing, vulvoscopy, and biopsy for persistent or suspicious lesions.

Treatment Strategies

• Lifestyle & Environment Wearing breathable cotton underwear, avoiding irritants (scented products, harsh soaps), gentle hygiene, proper toilet habits, and addressing psychological factors (stress, anxiety) are fundamental.
• Topical Therapies Corticosteroids (mid- to high-potency for acute inflammation, lower for maintenance), calcineurin inhibitors (tacrolimus, pimecrolimus) for chronic management, local estrogen for atrophy, antifungals for fungal infections, lactic acid products for pH balance, emollients for barrier support, and topical anesthetics (lidocaine, pramoxine) for symptomatic relief, especially in neuropathic itch. Novel topical agents like tofacitinib are emerging for inflammatory conditions.
• Systemic Treatments Oral corticosteroids for severe inflammation, anticonvulsants (gabapentin, pregabalin) and antidepressants (TCAs, SSRIs, SNRIs) for neuropathic/psychogenic itch, opiate receptor antagonists (naltrexone) for some cases, and systemic immunotherapies (methotrexate, mycophenolate mofetil) for refractory inflammatory conditions. Biologics (ixekizumab, dupilumab, tralokinumab) show promise for specific inflammatory and autoimmune causes. Antibiotics are used for bacterial infections.
• Non-pharmaceutical Sitz baths, cold compresses, Transcutaneous Electrical Nerve Stimulation (TENS), acupuncture, and physical therapy can offer symptomatic relief.

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Source: Mashoudy, K. D., Tomlinson, A.F., Kim, S. et al. Scratching the Surface: A Comprehensive Guide to Understanding and Managing Vulvovaginal Itching. Am J Clin Dermatol. 26: 361-378 (2025); Published: March 25, 2025. DOI: 10.1007/s40257-025-00939-7.

Summary

[Posted 28/Aug/2026]

AUDIENCE: Dermatology, Family Medicine

KEY FINDINGS: Clinicians should consider Pso-Ec when an adult patient has persistent lesions showing simultaneous psoriasiform and eczematous clinical and histopathologic characteristics, particularly when there is no clear dominant inflammatory pathway. In this study, the phenotype was associated with dual Th2/Tc2 and Th17/Tc17 activity and involvement of JAK1-STAT2/6 signaling. Prior Pso- or AD-directed biologics were often inadequate, whereas JAK1 inhibitors achieved minimal disease activity with BSA ≤2 and NRS ≤1 during a median 17-month follow-up. The findings support recognition of Pso-Ec as a distinct phenotype and suggest JAK1 inhibition as a mechanism-based therapeutic approach. The study's interpretation is limited by its small sample size and the fact that immunologic analyses were performed in a representative subset of patients.

BACKGROUND: Psoriasis (Pso) and atopic dermatitis (AD) are generally characterized by different dominant inflammatory pathways. However, some patients present with lesions containing both psoriasiform and eczematous features, creating diagnostic and therapeutic challenges. This prospective study characterized a distinct psoriasis–atopic dermatitis overlapping phenotype, termed Pso-Ec, with particular attention to its clinical, histopathologic, immunologic, and treatment characteristics.

DETAILS: The two-center prospective study enrolled 30 patients with Pso-Ec between January 2021 and December 2025. Reference cohorts consisted of 150 patients with typical Pso and 150 with AD. The Pso-Ec group included patients aged 13-72 years, with a mean age of 49.7 ± 17.7 years and a male-to-female ratio of 19:11. None had a previous history of Pso or AD. Notably, 63.3% had associated atopic diseases, compared with 2.7% of patients with typical Pso and 47.3% of those with AD (P < .001). Pso-Ec lesions were characterized clinically by ill-defined erythematous plaques, thin scales, excoriation, and prominent pruritus. Histopathologic examination demonstrated concurrent psoriatic and eczematous features within the same lesions. Immunologic assessment of lesional skin and peripheral blood identified simultaneous type 2 and type 3 inflammatory activity, represented by Th2/Tc2 and Th17/Tc17 populations. JAK1-STAT2/6 signaling was also implicated in the inflammatory profile.

Treatment histories indicated that conventional pathway-directed biologic therapy was frequently inadequate in this phenotype. Among the Pso-Ec patients, 18 had previously received Pso-targeted biologics and 15 had received AD-targeted biologics, with responses described as often inadequate. In contrast, treatment with JAK1 inhibitors was associated with achievement of minimal disease activity, defined as body surface area (BSA) ≤2 and numerical rating scale (NRS) ≤1. This response was maintained during a median follow-up of 17 months. During follow-up, none of the patients progressed to a classic Pso or AD phenotype.

The investigators concluded that Pso-Ec represents a distinct, predominantly adult-onset inflammatory phenotype rather than simply a transitional presentation between psoriasis and atopic dermatitis. Its defining immunologic characteristic is the concurrent presence of type 2 and type 3 inflammation, which may explain the limited effectiveness of therapies directed primarily against either pathway. JAK1 inhibition emerged as an effective treatment option in this cohort.

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Source: Chen, M., Shen, C., Chen, C. B., et al. A Distinct Psoriasis–Atopic Dermatitis Overlapping Phenotype in Adults With Dual Type 2 and Type 3 Immune Features and Favorable Response to Janus Kinase 1 Inhibition. Journal of the American Academy of Dermatology. 2026; Published: September 22, 2026. DOI: 10.1016/j.jaad.2026.05.042.

Summary

[Posted 12/Aug/2026]

AUDIENCE: Oncology, Dermatology

KEY FINDINGS: FDA approval of Tudriqev introduces an engineered viral immunotherapy option for adults with treatment-resistant advanced melanoma. By combining direct tumor destruction with immune activation, this therapeutic approach expands the available immunotherapy landscape for patients with limited options after progression on standard treatments. Continued evaluation through confirmatory studies will determine its long-term clinical role in melanoma management.

BACKGROUND: Patients with advanced melanoma whose disease progresses despite available systemic therapies have limited treatment options and significant unmet clinical needs. The U.S. Food and Drug Administration (FDA) approved a new engineered viral immunotherapy designed to provide a treatment option for adults with advanced melanoma that is resistant to prior therapies.

DETAILS: The FDA approved Tudriqev (vusolimogene oderparepvec, formerly RP1), an engineered oncolytic viral immunotherapy developed by Replimune, for adults with unresectable or metastatic melanoma that has progressed following treatment with an anti–PD-1 therapy and, when appropriate, targeted therapy for BRAF-mutated disease. Tudriqev is an engineered herpes simplex virus type 1 (HSV-1)-based therapy administered through intratumoral injection. The treatment is designed to selectively replicate within tumor cells, promote tumor cell destruction, and stimulate an immune response against cancer cells. The FDA approval was based on clinical evidence demonstrating tumor responses in patients with advanced melanoma who had limited therapeutic alternatives. The therapy represents an additional immunotherapeutic approach that uses direct tumor targeting combined with immune system activation. In clinical evaluation, Tudriqev demonstrated tumor reduction or elimination in 24.2% of treated patients, with a median duration of response of 14.1 months. The FDA approval provides a new treatment option for patients with advanced melanoma whose disease has become resistant to prior immunotherapy approaches. A confirmatory Phase III study is ongoing to further evaluate the therapy’s clinical benefit and long-term outcomes.

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Source: FDA Approves New Engineered Viral Immunotherapy for Patients with Treatment-Resistant Advanced Melanoma. Food and Drug Administration. 2026; Published: August 6, 2026.

Summary

[Posted 30/Jul/2026]

AUDIENCE: Allergy and Immunology, Dermatology, Internal Medicine

KEY FINDINGS: Unique Pharmaceutical Laboratories has initiated a voluntary nationwide recall of four lots of Cetirizine Hydrochloride Tablets USP 5 mg because of potential cross-contamination with ranitidine. The affected product was distributed nationwide in 100-count HDPE bottles under the Rising Pharma Holdings Inc. brand. Patients with hypersensitivity to ranitidine ingredients may be at risk for serious reactions, including severe hypersensitivity and life-threatening anaphylaxis. No adverse events related to the recalled product had been reported at the time of the announcement.

The recall was initiated after a pharmacy technician identified a discrepancy while counting tablets during dispensing. A product complaint described red dots and discoloration on some cetirizine tablets. The recalled lots are GY825029, GY825030, GY825031, and GY825032, each with an expiration date of 10/2028 and NDC 16571-401-10.

The manufacturer and distributor are arranging the return of the affected products. Clinicians should consider the recall when evaluating patients who may have received the affected medication and should assess and manage any suspected adverse reactions appropriately.

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Source: Unique Pharmaceutical Laboratories (A Div. of J. B. Chemicals & Pharmaceuticals Ltd.) Issues Voluntary Nationwide Recall of Cetirizine Hydrochloride Tablets USP 5 mg Due to Potential Cross Contamination with Ranitidine. FDA. Published: July 20, 2026.

Summary

[Posted 29/Jul/2026]

AUDIENCE: Dermatology, Family Medicine

KEY FINDINGS: In this randomized controlled non-inferiority trial, adding 1 g/day fish oil to 10 mg/day isotretinoin for 3 months produced acne improvement comparable to isotretinoin alone while offering potential safety advantages. Fish oil supplementation preserved skin hydration, as reflected by smaller reductions in corneometer values, and attenuated increases in serum triglycerides during therapy. These findings suggest that fish oil may be a useful adjunct to low-dose isotretinoin by improving treatment tolerability without reducing clinical effectiveness, although longer-term studies are needed to confirm sustained benefits.

BACKGROUND: Oral isotretinoin is an established treatment for moderate-to-severe acne vulgaris, but its use is frequently limited by mucocutaneous adverse effects and metabolic abnormalities, particularly hypertriglyceridemia. Fish oil possesses anti-inflammatory and lipid-lowering properties that may help mitigate these treatment-related toxicities. This study evaluated whether adding fish oil to low-dose isotretinoin preserves therapeutic efficacy while improving safety.

DETAILS: This randomized, double-masked, controlled, non-inferiority trial enrolled 80 participants aged 18-25 years with moderate-to-severe acne (Investigator's Global Assessment [IGA] score >=3). Participants received either 10 mg isotretinoin plus 1 g fish oil daily (n = 40) or 10 mg isotretinoin plus placebo daily (n = 40) for 3 months. Outcomes included changes in acne lesion counts, IGA scores, skin biophysical parameters, mucocutaneous adverse effects, serum triglyceride (TG) concentrations, and liver transaminase levels. Combination therapy with fish oil was noninferior to isotretinoin monotherapy in reducing total acne lesion counts. The between-group mean difference in total acne count reduction was -6.0 (95% CI, -16.5 to 4.5), meeting the predefined non-inferiority criteria. In addition to maintaining comparable clinical efficacy, patients receiving fish oil experienced smaller reductions in corneometer values, indicating better preservation of skin hydration, and smaller increases in serum triglyceride levels compared with placebo. The study therefore demonstrated that fish oil supplementation improved selected safety outcomes without compromising acne treatment efficacy.

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Source: Sungkhasunya, P., Asawanonda, P., Kumtornrut, C.. et al. Efficacy and Safety of Fish Oil Supplementation Combined With Low-Dose Isotretinoin for Moderate-to-Severe Acne Vulgaris: A Randomized Controlled Non-Inferiority Trial. Journal of the American Academy of Dermatology. 2026; 95(2): 416-422. Published: June 22, 2026. DOI: 10.1016/j.jaad.2026.03.001

Summary

[Posted 13/Jul/2026]

AUDIENCE: Infectious Disease, Internal Medicine

KEY FINDINGS: This review underscores the expanding pipeline of therapeutic strategies targeting Candida auris, ranging from repurposed medications and next-generation antifungal agents to vaccines, antimicrobial peptides, nanoparticle formulations, and innovative environmental control measures. Although no single therapy has emerged as a definitive solution, compounds such as ibrexafungerp (SCY-078), ATI-2307, and fosmanogepix, together with drug repurposing and bioinspired approaches, represent promising avenues for addressing multidrug-resistant C. auris infections. Continued translational research and clinical evaluation remain essential to establish safe and effective treatment options for this increasingly important fungal pathogen.

BACKGROUND: Candida auris has rapidly emerged as a multidrug-resistant fungal pathogen of global concern since its first identification in 2009. The organism is associated with healthcare-associated outbreaks, high transmissibility, frequent misidentification, and severe invasive infections, with reported mortality rates ranging from 35% to 72%. Resistance to currently available antifungal agents further complicates treatment, with approximately 90% of isolates resistant to fluconazole, around 30% resistant to amphotericin B, and fewer than 5% resistant to echinocandins. These challenges have accelerated efforts to identify novel antifungal therapies and alternative treatment strategies.

DETAILS: This publication is a comprehensive narrative review that summarizes advances in antifungal research targeting C. auris over the preceding decade. The authors evaluated emerging therapeutic approaches from a medicinal chemistry perspective, including drug repurposing, combination therapy, novel antifungal agents, natural products, metal-based compounds, nanoparticles, vaccines, antimicrobial peptides, and environmental decontamination strategies. The review also examined chemical and physicochemical characteristics of promising compounds, including lipophilicity and topological polar surface area, to identify structural features that may facilitate future antifungal drug development. The review highlights several promising therapeutic candidates with activity against multidrug-resistant C. auris. Drug repurposing identified multiple agents with antifungal or antibiofilm activity, including sertraline, miltefosine, iodoquinol, octenidine dihydrochloride, taurolidine, and bensulfuron methyl. Miltefosine demonstrated fungicidal and antibiofilm activity, while encapsulation within alginate nanoparticles reduced toxicity and improved survival in an infected Galleria mellonella model. The NDV-3A vaccine generated cross-reactive antibodies against C. auris and protected neutropenic mice, with additive efficacy when combined with micafungin.

Among novel antifungal agents, SCY-078 (ibrexafungerp), an orally available 1,3-ß-D-glucan synthesis inhibitor, demonstrated potent activity against C. auris, with an MIC90 of 1 mg/L and MIC50 and MIC90 values of 0.5 µg/mL and 1 µg/mL, respectively, across 100 isolates representing the four major clades. More than 150 strains with diverse resistance profiles were subsequently shown to be uniformly susceptible to SCY-078, and the agent remained active against pan-resistant isolates while also exhibiting antibiofilm activity.

Additional investigational therapies also demonstrated encouraging preclinical activity. The arylamidine T-2307 (ATI-2307) exhibited in vitro MIC values ranging from 0.125 to 4 µg/mL and improved survival while reducing kidney fungal burden in murine infection models following 3 mg/kg once-daily subcutaneous treatment. Other experimental approaches included antimicrobial peptides, ceragenins, fluorinated hydrazone derivatives, and novel chemical scaffolds designed to overcome existing resistance mechanisms.

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Source: Billamboz, M., Fatima, Z., Hameed, S., et al. Promising Drug Candidates and New Strategies for Fighting against the Emerging Superbug Candida auris. Microorganisms. 2021; 9(3): 634. Published: March 18, 2021. DOI: 10.3390/microorganisms9030634.