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A normal genital examination does not preclude sexual abuse.

Severe Facial Scar on a Young Girl: Was This Child Abused?

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier. The boy is otherwise healthy.

Clinical Topics

White Knuckles

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

What's This "Red Spot"?


These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite.

These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite. What creature did the biting?

Swollen Hands-What’s Biting?

 (Dupixent®; Sanofi, Regeneron) as the first targeted treatment for adults with bullous pemphigoid (BP). The approval is based on positive clinical trial findings from the ADEPT phase 2/3 clinical trial and marks the 

 in a disease with underlying type 2 inflammation.

“People affected by bullous pemphigoid endure unrelenting itch and painful blisters that can damage the skin. Until now, these primarily elderly patients have had limited therapeutic options available, with potential side effects that have often added to their burden,” Patrick Dunn, executive director, International Pemphigus and Pemphigoid Foundation, said in a June 20, 2025, press release. “The approval of Dupixent for bullous pemphigoid brings a novel treatment approach to patients and their caregivers.”

The FDA granted the approval following a priority review and had previously designated dupilumab an orphan drug for BP, a rare condition affecting fewer than 200 000 Americans. Additional regulatory applications for the indication are under review in the European Union, Japan, and China.

“By addressing two central drivers of the underlying type 2 inflammation that contributes to bullous pemphigoid, Dupixent is the first targeted medicine to allow patients the potential to achieve sustained remission and reduce itch,” Alyssa Johnsen, MD, PhD, global therapeutic area head, immunology and oncology development at Sanofi, said in the press announcement.

The randomized, double-blind, placebo-controlled ADEPT trial enrolled 106 adults with moderate-to-severe BP. Participants were randomized to receive either dupilumab 300 mg every 2 weeks (n = 53) or placebo (n = 53), both in combination with standard-of-care oral corticosteroids. Corticosteroids were tapered beginning between weeks 4 and 6 in patients achieving disease control, with the goal of complete discontinuation by week 16.

At week 36, 18.3% of dupilumab-treated patients achieved sustained disease remission compared with 6.1% in the placebo group—a 12.2% absolute difference (95% CI, –0.8 to 26.1), the trial’s primary endpoint. Additionally, 38.3% of patients in the dupilumab group experienced a clinically meaningful reduction in itch, defined as a ≥4-point improvement in Peak Pruritus Numerical Rating Scale score, compared with 10.5% in the placebo group. The cumulative median dose of oral corticosteroids was also lower in the dupilumab group (2.8 g) than in the placebo group (4.1 g) by week 36.

Adverse events reported more frequently in the dupilumab group (≥2%) included arthralgia, conjunctivitis, blurred vision, herpes viral infections, and keratitis. One case of acute generalized exanthematous pustulosis occurred in the treatment group. Dupilumab is administered as a subcutaneous injection and, for BP, is dosed at 300 mg every two weeks following a loading dose.

“Dupixent has shown the potential to improve the most challenging effects of bullous pemphigoid, while helping some patients achieve sustained disease remission and decreased oral corticosteroid use,” George D. Yancopoulos, MD, PhD, board cochair, president, and chief scientific officer at Regeneron, and a principal inventor of dupilumab, said in the press release. “Additionally, this approval further reinforces the demonstrated safety profile of Dupixent in a broad age range of patients, from infants to elderly people, and across dermatological, respiratory, and gastrointestinal diseases.”

Press Release: Dupixent approved in the US as the only targeted medicine to treat patients with bullous pemphigoid. News release. Sanofi. June 20, 2025. Accessed June 20, 2025. 

https://www.sanofi.com/en/media-room/press-releases/2025/2025-06-20-05-00-00-3102518

Dupilumab is the first targeted treatment for BP to receive FDA approval, showing improved remission rates, itch reduction, and lower steroid use in pivotal trial.

FDA News

FDA Approves Dupilumab for Treatment of Bullous Pemphigoid in Adults

Revolutionizing Atopic Dermatitis (RAD) 2025

in Nashville, Tennessee, offers important updates for primary care physicians managing this common chronic condition. From long-term safety data on biologics like dupilumab and upadacitinib to new findings on atopic dermatitis (AD) during pregnancy, social determinants of disease, and treatment delays due to insurance barriers, this year's abstracts underscore the growing complexity of care for both pediatric and adult patients.

Above, find 10 medical abstract titles from RAD 2025 that are most relevant to frontline clinicians, including insights on comorbid asthma management, topical innovations, growth trends in children with AD, and real-world effectiveness data.

Preview of 10 new studies on managing atopic dermatitis, including biologics, treatment barriers, and innovative care strategies for clinicians.

New Data on Atopic Dermatitis for Frontline Clinicians

Roflumilast cream 0.15% (ZORYVE) has received a strong recommendation in the American Academy of Dermatology’s (AAD) focused guideline update for the management of mild to moderate atopic dermatitis (AD) in adults, according to a June 26 announcement from Arcutis Biotherapeutics.

 Among newly evaluated branded topical therapies, roflumilast 0.15% is the only agent to receive a strong recommendation, the company noted, reflecting its demonstrated ability to reduce pruritus and disease severity while maintaining a favorable safety and tolerability profile.

The nonsteroidal, topical phosphodiesterase-4 (PDE4) inhibitor is indicated for use in adults and children aged 6 years and older, offering clinicians a targeted treatment option suitable for sensitive and difficult-to-treat areas of the body.

The AAD’s focused update integrates newly FDA-approved topical and biologic therapies into existing guidelines to ensure clinicians have access to the most current, evidence-based recommendations for this chronic inflammatory condition.

 Roflumilast cream 0.15% joins tapinarof cream, lebrikizumab, and nemolizumab (with concomitant topical therapy) as 1 of 4 new agents included in the latest guidance.

“The AAD’s focused update highlights therapies that meet rigorous standards for efficacy, safety, and tolerability for adults living with AD,” Patrick Burnett, MD, PhD, chief medical officer at Arcutis, said in the statement. “The inclusion of [roflumilast 0.15%] in these recommendations validates what healthcare professionals have already experienced with [the therapy] in their practice – a next-generation, steroid-free topical that delivers meaningful improvement for people with AD.”

Roflumilast is the only FDA-approved branded topical PDE4 inhibitor indicated for AD, plaque psoriasis, and seborrheic dermatitis. The strong recommendation in adult AD underscores its relevance in current dermatologic care.

 “The AAD’s strong recommendation helps guide clinicians and patients toward treatments that deliver clinically meaningful improvements in disease severity while being safe and well tolerated for long-term use,” Arcutis noted in the announcement.

 [Roflumilast 0.15%] was also recently awarded the National Psoriasis Foundation’s Seal of Recognition, the first FDA-approved prescription product to earn the honor.

Efforts to expand the approved use of [roflumilast 0.15%] in pediatric populations are ongoing. The FDA is currently reviewing a supplemental New Drug Application for the use of roflumilast cream 0.05% in children aged 2 to 5 years with mild to moderate AD.

The application is supported by pivotal phase 3 trials (INTEGUMENT-PED), long-term extension data (INTEGUMENT-OLE), and pharmacokinetic studies. A Prescription Drug User Fee Act target action date is set for October 13, 2025.

Burnett noted the particular treatment challenges in younger populations in an earlier statement

: “AD presents unique challenges in this youngest age group, not only because the skin is more sensitive, but also because the condition often covers a greater percentage of their total body surface area compared to older children and adults. In addition, long-term management of AD requires treatment that can deliver rapid relief of itch, sustained symptom improvement over time, and that is tolerable when applied to the skin.” He added, “Our goal is to address this unmet need by providing advanced targeted topical therapies that can manage symptoms effectively over the long-term, while also improving the quality of life for individuals and their families living with this chronic condition.”

Additionally, the phase 2 INTEGUMENT-INFANT study will evaluate the safety and efficacy of roflumilast in infants aged 3 months to under 2 years.

Roflumilast 0.15% is the only 1 of 4 newly evaluated branded topical therapies to receive the Academy's strong recommendation for AD management in adults.  

Roflumilast Cream 0.15% Receives Strong Recommendation for Atopic Dermatitis in AAD Guideline Update 

Gregory H. Wallace, DO

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