Picosecond Laser Treatment May Trigger Koebner Phenomenon in Patients With Psoriasis: Clinical and Immunopathological Findings
Can cosmetic laser procedures trigger psoriasis flare-ups, even in patients with well-controlled disease? A case report describes the development of new psoriatic lesions following picosecond laser treatment, highlighting a potential link between photomechanical skin injury and the Koebner phenomenon.
KEY FINDINGS: This case highlights a potential dermatological complication of picosecond laser procedures in patients with psoriasis, even when the underlying disease is clinically well controlled. Although these lasers are designed to minimize thermal injury, their photomechanical effects may trigger cutaneous inflammation and new psoriatic lesions through the Koebner phenomenon.
Clinicians should assess baseline psoriasis activity, avoid treating active psoriatic plaques, and discuss the possibility of postprocedural lesion development before elective laser procedures. A test spot and early post-treatment monitoring may also be considered.
The findings are based on a single case report with four months of follow-up and cannot establish the incidence or magnitude of this risk. Further clinical observations are required to determine the safety profile of picosecond laser procedures in patients with psoriasis. Wiley Online Library
BACKGROUND: The Koebner phenomenon (KP), also known as the isomorphic response, refers to the development of disease-specific skin lesions at sites of cutaneous injury. It is a recognized feature of psoriasis and may occur following mechanical trauma or dermatological procedures. Picosecond lasers are increasingly used for cosmetic dermatological treatments because their ultrashort pulses produce predominantly photomechanical effects with limited thermal damage. However, the potential of these laser-induced effects to trigger psoriatic lesions has not been well characterized. This case report describes the development of the Koebner phenomenon following picosecond laser treatment in a patient with previously controlled plaque psoriasis. Wiley Online Library
DETAILS: The report describes a 58-year-old woman with well-controlled plaque psoriasis who underwent 755-nm picosecond alexandrite laser treatment for seborrheic keratoses on her back and lower waist. The laser was administered with a pulse duration of 750 ps, fluence of 3.77 J/cm², and spot size of 3 mm, using five passes. Her baseline psoriasis was mild, with a Psoriasis Area and Severity Index (PASI) score of 3.6, and was being managed with topical calcipotriol/betamethasone dipropionate.
Our Most Popular Resources
No immediate adverse reaction was observed. However, one month after treatment, erythematous, scaly plaques appeared exclusively at the laser-treated sites. Dermoscopic examination demonstrated characteristic psoriatic features, while histopathological assessment revealed elongated rete ridges, parakeratosis, and inflammatory cell infiltration. Immunohistochemical analysis demonstrated dermal predominance of CD4-positive T cells and increased CD8-positive T cells in the epidermis. Interestingly, no Koebner response developed in an adjacent melanocytic nevus treated with a CO₂ laser.
The clinical, dermoscopic, histopathological, and immunohistochemical findings confirmed the development of the Koebner phenomenon following picosecond laser exposure.
The psoriatic plaques resolved completely after four weeks of topical corticosteroid treatment, with no recurrence during the subsequent four-month follow-up period.
The authors proposed that the photomechanical effects of picosecond lasers may produce acoustic microtrauma capable of activating inflammatory and immune pathways involved in psoriasis. The contrasting response observed at the CO₂ laser-treated site was considered hypothesis-generating rather than evidence of a definitive difference in laser-associated risk. Wiley Online Library
Copyright © Skyscape. All rights reserved.
Source: Sakai, T., Sonoda, K., and Omatsu, J. Triggering of Koebner Phenomenon by Picosecond Laser in a Psoriatic Patient: Clinical and Immunopathologic Insights. Lasers in Surgery and Medicine. 2026; 58(9):745–749. Published: June 30, 2026. DOI: 10.1002/lsm.70171.
Avatrombopag Improves Persistent Chemotherapy-Induced Thrombocytopenia in Gastrointestinal Cancers: Results From the Phase II ACT-GI Trial
Persistent chemotherapy-induced thrombocytopenia can disrupt cancer treatment by forcing dose reductions and delays. In the phase II ACT-GI trial, oral avatrombopag improved platelet recovery and helped more patients with gastrointestinal cancers complete chemotherapy without CIT-related treatment modifications.
KEY FINDINGS: Avatrombopag significantly improved platelet recovery and reduced the likelihood of recurrent CIT that would interfere with chemotherapy delivery in patients with GI cancers. The oral administration and once-daily dosing may offer a practical approach to managing persistent CIT. However, the trial enrolled only 47 patients and was stopped early for efficacy, which may affect the precision of the estimated treatment benefit. The findings establish efficacy for the study's platelet and chemotherapy-delivery endpoints, but do not demonstrate improved cancer survival or other long-term oncologic outcomes. Larger studies are needed to establish the durability of benefit, broader safety profile, and impact on cancer treatment outcomes. ASCO Publications
BACKGROUND: Chemotherapy-induced thrombocytopenia (CIT) is a clinically important complication of cytotoxic cancer treatment. Persistent thrombocytopenia can lead to repeated chemotherapy delays, dose reductions, and compromised treatment intensity, potentially affecting cancer outcomes. Management remains challenging because widely available approved therapies are limited. Avatrombopag, an oral thrombopoietin receptor agonist, stimulates platelet production and may offer an alternative to injectable therapies for patients with persistent CIT. The ACT-GI trial evaluated its efficacy and safety in patients with gastrointestinal (GI) cancers receiving cytotoxic chemotherapy.
DETAILS: ACT-GI was a multicenter, randomized, double-blind, placebo-controlled, investigator-initiated phase II trial conducted in the United States. Adults with GI cancers and persistent CIT were randomly assigned in a 1:1 ratio to receive avatrombopag or placebo. Persistent CIT was defined as a platelet count of ≤85 x 109/L on the first day of a chemotherapy cycle, despite sufficient time for recovery from the preceding cycle. The primary endpoint was successful platelet recovery to ≥100 x 109/L, completion of the on-study chemotherapy cycle without dose modification or delay due to thrombocytopenia, and prevention of CIT recurrence at the subsequent cycle. Treatment began with avatrombopag 40 mg once daily, with protocol-directed dose adjustments. The trial enrolled 47 patients, including 23 assigned to avatrombopag and 24 to placebo. Enrollment was stopped at a planned interim analysis after prespecified efficacy criteria were met. The primary endpoint was achieved by 16 of 23 patients receiving avatrombopag (70%; 95% CI, 47 to 87) compared with 4 of 24 patients receiving placebo (17%; 95% CI, 5 to 37; Z = 3.67, P .001). Platelet recovery to ≥100 x 109/L during the initial treatment period occurred in 19 of 23 patients (83%) in the avatrombopag group and 11 of 24 patients (46%) in the placebo group. At the end of the chemotherapy treatment period, median platelet counts were 157 (IQR, 136-202) x 109/L with avatrombopag and 72 (IQR, 68-134) x 109/L with placebo. Adverse events occurred in 78% of patients receiving avatrombopag and 46% receiving placebo. Serious adverse events were reported in 17% and 0%, respectively. No serious adverse events were attributed to the study drug, and no treatment-related adverse events resulted in death or discontinuation of study medication.
Our Most Popular Resources
Copyright © Skyscape. All rights reserved.
Source: Al-Samkari, H., Shatzel, J. J., Panch, S.R., et al. Avatrombopag Versus Placebo for Persistent Chemotherapy-Induced Thrombocytopenia in GI Cancers: The Phase II ACT-GI Trial. Journal of Clinical Oncology. 2026; 44(31): 3006-3014. Published: November 1, 2026. DOI: 10.1200/JCO-26-00568.
Enhanced Recovery Protocols May Improve Outcomes After Pediatric Gastrointestinal Surgery When Adherence Is High
In the ENRICH-US trial of 597 children and adolescents undergoing gastrointestinal surgery, implementing an enhanced recovery protocol did not significantly reduce overall hospital length of stay. However, patients who received at least 13 protocol elements had stays that were 1.14 days shorter and lower odds of postoperative complications. The findings underscore the importance of consistent protocol adherence when translating enhanced recovery strategies into better surgical outcomes.
KEY FINDINGS: The ENRICH-US trial did not demonstrate a significant overall reduction in length of stay from introducing a multifaceted implementation strategy. However, patients receiving a greater number of protocol elements experienced shorter hospital stays and fewer complications. These findings emphasize that the clinical benefit of enhanced recovery pathways may depend on consistent delivery of their components, not simply on adopting a protocol. Hospitals implementing pediatric ERPs should therefore monitor adherence alongside clinical outcomes and address organizational barriers that limit reliable implementation.
BACKGROUND: Enhanced recovery protocols (ERPs) combine evidence-based perioperative practices to support recovery, reduce opioid exposure, and minimize complications after surgery. Although these protocols are well established in adult surgical care, their implementation in pediatric populations has been slower. The ENRICH-US trial evaluated whether a structured implementation strategy could improve adherence to a pediatric gastrointestinal surgery ERP and enhance clinical outcomes.
DETAILS: This prospective, stepped-wedge cluster-randomized implementation-effectiveness trial included 597 patients aged 10-18 years undergoing elective gastrointestinal surgery at 18 US sites between September 2019 and June 2024. The protocol included 21 perioperative elements, supported by a structured implementation toolkit, multidisciplinary learning sessions, adherence feedback, and implementation reports. Outcomes were assessed during baseline usual care, implementation, and sustainability phases. The primary clinical outcome was postoperative hospital length of stay (LOS). Secondary outcomes included time to resumption of a regular diet, inpatient opioid use, postoperative complications, opioid prescriptions at discharge, 30-day readmission, and patient-reported health-related quality of life.
Our Most Popular Resources
Inflammatory bowel disease was the most common surgical indication, accounting for 433 patients (72.5%). Across the three study phases, the implementation strategy did not significantly reduce overall hospital LOS or produce significant differences in most secondary outcomes. However, patients resumed a regular diet sooner and had lower opioid use during hospitalization as the protocol progressed. A patient-level analysis demonstrated the importance of adherence. Patients who received at least 13 ERP elements had a median hospital stay that was 1.14 days shorter (95% CI, -2.01 to -0.27) and lower odds of postoperative complications (adjusted odds ratio, 0.48; 95% CI, 0.28-0.82) than patients with lower adherence. The median number of protocol elements delivered increased from 11 during baseline to 14 during both implementation and sustainability phases (P < .001).
Copyright © Skyscape. All rights reserved.
Source: Raval, M. V., Tian, Y., Schäfer, W., et al. Implementation and Effectiveness of an Enhanced Recovery Protocol for Children Undergoing Surgery: The ENRICH-US Stepped-Wedge Cluster-Randomized Trial. JAMA Surgery. 2026; 161(7): 670-680. Published: October, 2026. DOI: 10.1001/jamasurg.2026.1382.
Timing of Vascular Access Creation in Older Adults With ESKD
A prospective European cohort of older adults with ESKD found that only 32% of AVFs were created within the defined 6-month window before hemodialysis initiation, while 42% were created early and 26% late. The findings highlight the difficulty of predicting dialysis timing and the need for better tools to individualize vascular access planning.
KEY FINDINGS: In this European cohort of older adults with ESKD, vascular access creation frequently did not coincide with the timing of hemodialysis initiation. More than 4 in 10 AVFs were created early, while approximately 1 in 4 were created late, resulting in substantial use of CVCs at dialysis initiation. The findings highlight the difficulty of predicting dialysis initiation in older adults and support the development of clinical prediction tools to better individualize vascular access planning.
BACKGROUND: Planning vascular access for older adults with end-stage kidney disease (ESKD) is challenging because the timing of hemodialysis initiation is difficult to predict. Arteriovenous fistulas (AVFs) created too early may remain unused, whereas delayed creation can result in hemodialysis being initiated through a central venous catheter (CVC). This study evaluated the timing of vascular access creation relative to hemodialysis initiation in older patients across Europe.
DETAILS: This secondary analysis used data from the EQUAL cohort, a prospective observational study involving patients aged 65 years or older with stage 4 or 5 chronic kidney disease in six European countries. Patients were included when their estimated glomerular filtration rate fell below 15 mL/min/1.73 m², provided they received a vascular access and had at least 6 months of follow-up. AVF timing was categorized as early when hemodialysis did not begin within 6 months after AVF creation, on time when hemodialysis was initiated with an AVF within 6 months, and late when hemodialysis was initiated with a CVC before or within 6 months after AVF creation.
Our Most Popular Resources
A total of 332 patients were analyzed. An AVF was the first vascular access in 221 patients (67%), while 111 patients (33%) initially received a CVC. Among those initially receiving a CVC, 53 patients (48%) subsequently underwent AVF creation. At dialysis initiation, 158 patients (54%) were using an AVF and 136 (46%) were using a CVC. Among the 274 patients who underwent AVF creation, access was created on time in 88 patients (32%), early in 114 (42%), and late in 72 (26%). Despite the high proportion of early AVF creation, most fistulas were eventually used, with 90% of patients initiating hemodialysis within 3 years after AVF creation.
Copyright © Skyscape. All rights reserved.
Source: Heggen, B. D. C., Chesnaye, N. C., Dekker, F. W., et al. Vascular Access Surgery Timing: A Prospective European Cohort Study in Elderly Patients with ESKD. Kidney360. 2026; 7(9): 2066-2074. Published: September 22, 2026. DOI: 10.34067/KID.0000001180.
Overdiagnosis of Papillary Thyroid Cancer in the United States
A US simulation study estimated that 72% to 94% of papillary thyroid cancer cases diagnosed between 1991 and 2019 were overdiagnosed. Reducing ultrasonography for nonpalpable thyroid nodules was modeled to substantially lower PTC incidence, with less than a 0.1% change in overall mortality. The findings highlight the potential role of reducing unnecessary imaging and diagnosis while recognizing that the estimates are model-based.
KEY FINDINGS: The findings indicate that PTC overdiagnosis remained substantial even after accounting for a possible underlying increase in true disease incidence. The modeling suggests that limiting unnecessary ultrasonography referrals for nonpalpable thyroid nodules could reduce detection of cancers unlikely to affect population mortality, potentially reducing unnecessary diagnoses and treatment-related burdens without a meaningful modeled increase in overall mortality. Because these findings are based on a simulation model rather than observed outcomes from an intervention, they should be interpreted as population-level estimates rather than evidence that reducing imaging is appropriate for individual patients.
BACKGROUND: Papillary thyroid cancer (PTC) incidence in the United States has increased substantially over recent decades, largely driven by detection of small, early-stage tumors, while population-level mortality has remained relatively stable. This pattern has raised concern that some thyroid cancers detected through imaging may never have become clinically significant. This study used a validated simulation model to estimate the extent of PTC overdiagnosis in the United States and examine the potential effects of reducing thyroid ultrasonography for nonpalpable thyroid nodules.
DETAILS: Researchers used the Papillary Thyroid Carcinoma Microsimulation Model (PATCAM) to evaluate PTC incidence among US adults aged 18 years or older from 1991 through 2019. The model accounted for changes in underlying thyroid cancer risk and estimated the proportion and absolute number of PTC cases considered overdiagnosed, defined in the model as cancers whose detection and treatment did not affect population mortality. The investigators also modeled the potential effects of reducing thyroid ultrasonography referrals for nonpalpable thyroid nodules.
Our Most Popular Resources
Between 1991 and 2019, the model estimated that 72% to 94% of diagnosed PTC cases were overdiagnosed. The estimated proportion was 75% to 95% among women and 63% to 90% among men. The corresponding absolute rate of overdiagnosis was 13 to 17 per 100,000 women and 3 to 5 per 100,000 men, translating to an estimated 443,212 to 573,705 women and 107,804 to 154,504 men overdiagnosed with PTC during the 28-year period. The model further estimated that reducing thyroid ultrasonography for nonpalpable nodules by 33% would reduce PTC incidence in 2019 by 17%, from 18 to 15 per 100,000 individuals. A 67% reduction in ultrasonography was associated with a modeled 41% reduction in incidence, from 18 to 11 per 100,000. In both scenarios, the modeled change in overall mortality was less than 0.1%.
Copyright © Skyscape. All rights reserved.
Source: Francis, D. O., Davies, L., Zhang, Y., et al. Overdiagnosis of Papillary Thyroid Cancer. JAMA Network Open. 2026; 9(2): e2559852. Published: February 24, 2026. DOI: 10.1001/jamanetworkopen.2025.59852
Manual Detorsion by Pediatric Emergency Physicians May Shorten Ischemia Time in Pediatric Testicular Torsion
A study found that manual detorsion performed by pediatric emergency physicians can shorten ischemia time in children with testicular torsion. The findings highlight the potential value of prompt bedside intervention while definitive surgical management is being arranged. Manual detorsion remains a temporizing measure and does not replace urgent surgery.
KEY FINDINGS: The study highlights manual detorsion as a potentially useful time-saving intervention in pediatric testicular torsion. Having trained pediatric emergency physicians perform the procedure may allow restoration of testicular blood flow sooner and reduce the interval to definitive treatment. Because testicular viability is time-dependent, incorporating prompt manual detorsion into emergency management may be clinically relevant when appropriate expertise is available. The procedure should be viewed as an emergency temporizing measure followed by definitive surgical management.
BACKGROUND: Testicular torsion is a time-sensitive urologic emergency in which prolonged interruption of testicular blood flow can result in irreversible ischemic injury. Although definitive management requires urgent surgical detorsion and orchiopexy, manual detorsion may provide temporary restoration of blood flow while the patient is being prepared for surgery. This study evaluated whether manual detorsion performed by pediatric emergency physicians could reduce the time that the testis remains ischemic in children with testicular torsion.
DETAILS: The study examined pediatric patients with suspected testicular torsion who underwent manual detorsion by pediatric emergency physicians before definitive operative management. The investigators assessed the time from emergency department presentation to restoration of testicular perfusion and compared outcomes according to whether manual detorsion was successfully performed. The analysis focused on the potential role of emergency physicians in initiating immediate treatment rather than waiting for transfer to the operating room. Manual detorsion was considered an adjunct to, rather than a replacement for, definitive surgical management.
Our Most Popular Resources
Manual detorsion performed by pediatric emergency physicians was associated with a shorter duration of testicular ischemia before operative treatment. Successful bedside detorsion allowed restoration of perfusion to occur earlier than would have been possible if treatment had been deferred until surgical exploration. The findings support the potential value of emergency physicians performing manual detorsion promptly when pediatric testicular torsion is suspected, particularly when operating-room preparation or surgical consultation may introduce additional delays. Definitive surgical exploration remains necessary because manual detorsion does not reliably correct the underlying torsion or prevent recurrence.
Copyright © Skyscape. All rights reserved.
Source: Rivera, T., Lozano, J., Maniaci, V., et al. Manual Detorsion by Pediatric Emergency Physicians Shortens Ischemia Time in Pediatric Testicular Torsion. Academic Emergency Medicine. 2026; 33(9): e70412. Published: September, 2026. DOI: 10.1111/acem.70412.
Specialty: