EADV Symposium 2025 - Session Highlights
The annual EADV Symposium stands as a premier international gathering devoted to dermatology and venereology, offering a dynamic platform for exchanging knowledge, collaboration, and presenting cutting-edge research findings.
This event features a comprehensive programme comprising interactive and specialised scientific sessions that span the entire spectrum of dermatological and venereological topics.
Saturday
24 May 2025
Today's hot topics
Hair and nails
Dermoscopic excellence: Visual diagnostics for hair, scalp, and nail disorders
Hair Loss
Prof. Dr. Lidia Rudnicka (Warsaw, Poland) highlighted diagnostic value of trichoscopy, showing how subtle vascular patterns, follicular changes, and surface clues can shift clinical impressions. Autoimmune scarring alopecias can be distinguished from dermatitis and alopecia areata, guiding the use of systemic immunosuppressants, while features like triangular hairs and yellow dots support the diagnosis of non-scarring autoimmune forms.
In rarer cases, serpentine, polymorphic vessels reveal scalp metastases from breast cancer. For tinea capitis, UV-enhanced trichoscopy (UVET) improves detection of comma and Morse-code hairs, while in systemic lupus erythematosus, arborising vessels and “lupus hair” provide key diagnostic clues.
Scalp diseases
Dr. Juan Jimenez Cauhe (Madrid, Spain) used real-time diagnostic polling to demonstrate the role of trichoscopy, biopsy, and supporting tools in diagnosing scalp disorders and determining the best treatment pathway. Fibrosing alopecia in a pattern distribution was differentiated from seborrheic dermatitis by trichoscopic features and treatment response.
Tinea capitis was identified by characteristic hair shaft findings and supported by mycological culture. Subtle papules were ultimately diagnosed as scalp metastases through dermoscopy, biopsy, imaging, and panendoscopy. Inflammatory conditions such as acne keloidalis nuchae and erosive pustular dermatosis were also explored. The session reinforced a multimodal, case-based approach to diagnosis and management.
Trichoscopy is highly accurate for diagnosing tinea capitis and useful for differentiating it from alopecia areata and trichotillomania
Dr. Juan Jimenez
Nail tumours
Dr. Miroslav Důra (Prague, Czech Republic) presented six clinical nail cases using diagnostic polling to explore the diverse presentations of nail tumours. Cases ranged from benign lesions like subungual exostosis to invasive melanoma and a rare adnexal adenocarcinoma with late metastasis. One melanonychia case involved an intraepidermal melanocytic lesion of uncertain behaviour, managed with re-excision and long-term follow-up.
The session highlighted the importance of biopsy, dermoscopy, and clinicopathological correlation in distinguishing tumours from trauma or pigmentary changes.
Adnexal adenocarcinoma, NOS, is a diagnosis of exclusion reached only after ruling out other clear cell neoplasms and metastatic disease
Dr. Miroslav Důra
Inflammatory nail diseases
Dr. Francesca Pampaloni (Bologna, Italy) illustrated the diagnostic and management value of onychoscopy alongside biopsy, culture, patch testing, and clinical history, in inflammatory nail disorders. in inflammatory nail disorders. Pustular nail psoriasis was identified by glomerular capillaries, lichen striatus by isolated nail dystrophy, and acrylate-induced contact dermatitis confirmed by patch testing in a patient with onycholysis following gel nail use.
In other cases, psoriasis was distinguished from onychomycosis using splinter haemorrhages and yellow-orange discoloration, while long-standing nail changes were confirmed as onychomycosis through combined clinical and onychoscopic findings.
Key Takeaways:
- Trichoscopy is an essential tool for diagnosing hair and scalp disorders, allowing clinicians to identify autoimmune, infectious, and malignant conditions through subtle vascular and follicular patterns.
- Onychoscopy is invaluable in diagnosing both inflammatory and neoplastic nail disorders, helping distinguish benign from malignant lesions and inflammatory changes from infection or trauma.
Psoriasis
Pustular psoriasis and beyond: Innovations in precision dermatology
Pustular psoriasis
Prof. Dr. Johann Gudjonsson (Ann Arbor, United States) opened the session with an overview of what’s new in the field of pustular psoriasis. He highlighted that psoriasis exists on a spectrum of clinical phenotypes, with pustular psoriasis (PP) (innate/neutrophil-driven) responses at the opposite end to plaque psoriasis (T-cell driven). Of the different PP variants (localised/generalised PP [GPP], pustulosis palmoplantaris and acrodermatitis continua of hallopeau), GPP is the most acute with an explosive onset often requiring hospitalisation.
Genes that predispose to developing PP amplify interleukin (IL)-36 response pathways have been identified and include increased/unopposed signaling; insufficient inhibition of IL-36 activation, increased neutrophil activity and processing of IL-36.
Molecular and single-cell profiling has helped to define GPP as a neutrophil–keratinocyte-based condition, with crosstalk that drives and amplifies inflammatory activity, and a key driver of pathophysiology.
In terms of therapeutics, novel biologics targeting the IL-36 axis appear to be highly effective in controlling and stabilising GPP, particularly in regulating the associated relapses upon flare.
Disease modification
Dr. Satveer Mahil (London, United Kingdom) provided insights into modifying the disease course for psoriasis patients.
For patients with moderate-severe plaque psoriasis, disease modification can be defined as sustained disease control (clear/nearly clear skin) for at least 12 months following treatment cessation.
Biological therapies have helped to raise the bar with 12 agents now approved, which have been shown high levels of skin clearance in clinical trials, emphasising that clearance is a realistic treatment goal.
In the current climate…access to care is a major challenge and this means that in turn, this may impact the long-term outcomes… particularly in terms of limiting the chances of later disease modification
Dr. Satveer Mahil
While effective, outcomes can be improved further with early intervention. Recent studies using this approach (e.g. GUIDE) demonstrated that greater proportions of patients achieved clear skin, with a ‘super-response’ in those in whom the treatment was started within 2 years of psoriasis onset or who were biologic-naïve.
Current barriers include patient awareness and associated multiple morbidities where skin problems are often deprioritised, and that access to biologics is restricted to those with the most severe forms of the disease.
Biomarkers may be useful to access risk of severe disease, so that intervention can be initiated early to induce remission, with tailoring to reduce the dose and stop treatment in the longer-term. Data driven models and platforms, such as the PLAN-psoriasis feasibility trial are evaluating patient-led and data-led approaches to therapeutic guided treatment, may offer clinicians the opportunity to deliver personalised care and precision management to reduce long-term drug burden.
Novel treatments
Prof. Jo LW Lambert (Ghent, Belgium) presented her perspectives on novelties are still needed for psoriasis treatment.
It can be difficult to find innovative drugs, and clinicians should be mindful that Th17 is the predominant pathway in psoriasis, although there is some overlap in some patients (e.g. psoriasis and vertigo). Patient stratification is still very important.
Novel oral treatments are the next generation after biologicals, but they need to be effective. Drugs such as the janus kinase inhibitors (with emphasis on tyrosine-kinase 2), phosphodiesterase-4 inhibitors, selective IL-23 inhibitors, an A3 adenosine receptor agonist and a novel, chemically engineered peptide are in clinical development. For all, once-daily administration is preferred. Other pathways include the aryl hydrocarbon receptor, whose role was to defend against pollutants and toxins, and topical creams are being investigated.
Biomarker-aided therapy offers benefits in terms of the right treatment being administered early in the disease course, with proven clinical utility and cost savings.
Patient profiling and disease interception with biologics has helped to reduce the risk of developing psoriatic arthritis. There is a shift towards patients wanting a cure, and chimeric antigen receptor T cell therapy has been shown to induce remission, although further research is needed. Stem cell harvesting may also provide opportunities for immunomodulation
A healthy diet has been shown to be beneficial in patients with psoriasis, as ultra-processed food consumption and obesity are risk factors for disease development.
Personalised dosing and dose reduction approaches have been shown to be non-inferior to standard dosing standard, highlighting that many patients are overdosed. There is a need to target concentrations to attain a good clinical effect, and personalised dashboards and models are on the horizon. Emerging datasets using artificial intelligence will help to tailor medications and personalise therapy, to select the optical dose and right treatment, with value outcomes to enable better access.
Tailored treatment approaches
In the last presentation of this session, Prof. Michel Gilliet (Lausanne, Switzerland) provided compelling evidence of the use of molecular profiling to psoriasis therapy.
A profiling approach may be used to identify key pathways in the skin in order to test for and stratify other clinical subtypes. While Th17 is common to all, other subtypes have been shown to possess different interferon-1 (IFN-1) or neutrophilic signatures, which characterise their pathogenesis. Three molecular endotypes (Th17, chronic plaque; IFN-1, acute inflammatory forms; neutrophilic, pustular forms) were described.
Precision medicine is the future for psoriasis
Prof. Michel Gilliet
These different endotypes and predominant inflammatory pathways can be used to help treat the patient accordingly. In patients who are non-responders, profiling helps to question whether the right diagnosis was made, and therefore, the correct therapeutic target for treatment. There is a need to move from stratification to a precision-medicine based approach using molecular cartography. Using this technique, analysis of different patient biopsies can be used for ‘clustering’ to confirm that the diagnosis is correct, and to characterise the molecular profile of misdiagnosed patients.
Immune shifts, for example, where a Th17 dominant profile may shift to a Th2 dominant profile (and vice versa) can occur, making effective treatment difficult. Targeted therapy can help to displace these imbalances, and it has been shown, even in cases with multiple comorbidities, that effective targeting can lead to clearance in these patients.
Key takeaways
- Novel biologics targeting IL-36 appear to be highly effective in controlling GPP flares
- Initiaing treatment within 2 years of onset or in biologic-naïve individuals may improvs outcomes
- Biomarker-aided therapy will enable the right treatment to be administered early in the disease course
- Molecular profiling can characterise non-responders and correct misdiagnosis, with targeting to treat immune shifts
Friday
23 May 2025
Today's hot topics
Hidradenitis suppurativa
Inside hidradenitis suppurativa: Imaging, immunology, and impact
Pathophysiology and endotypes
Assoc. Prof. Francesca Prignano (Florence, Italy) offered a compelling reappraisal of hidradenitis suppurativa (HS), framing it as a spectrum of immune-mediated disorders rather than a single disease entity.
Two primary endotypes have been proposed, including one marked by Th1/Th17 hyperactivation and strong links to obesity and systemic inflammation.
Mechanistically, tertiary lymphoid structures (TLSs) support chronic autoantibody production, while lesional fibroblasts sustain inflammation through TNF-α–driven feedback loops.
Environmental and genetic influences, such as microbial dysbiosis, smoking, and hereditary predisposition, modulate disease course.1 Prignano underscored that understanding these endotypes is critical for developing truly targeted, precision therapies.
Reference
- Sabat, R., Alavi, A., Wolk, K. et al. (2025). Hidradenitis suppurativa. Lancet (London, England), 405(10476), 420–438. https://doi.org/10.1016/S0140-6736(24)02475-9.
Clinical outcomes of importance
Prof. Thrasyvoulos Tzellos (Bodø, Norway) discussed the evolution of outcome measures in hidradenitis suppurativa (HS), stressing the importance of early immunomodulatory treatment during a “window of opportunity” to prevent irreversible damage.
He compared current tools, highlighting IHS4’s validity and sensitivity to disease dynamics. The newer IHS4-55 measure, which includes weighted scoring of nodules, abscesses, and tunnels, offers improved detection of deep inflammation and drug effects in fistulising disease.
Tzellos also underscored the value of patient-reported outcomes, including pain, QoL, work impairment, and depression, advocating for their routine integration in both trials and practice.
We need outcomes that reflect not just what physicians see, but what patients live, capturing both disease control and human impact
Prof. Thrasyvoulos Tzellos
Imaging-guided surgery
Dr. Alessandra Michelucci (Pisa, Italy) presented new insights into how ultrasound-guided imaging are reshaping clinical and surgical decision-making in hidradenitis suppurativa (HS).
Standard evaluation often misses subclinical dermal tunnels, which can sustain inflammation and predict treatment failure.
In contrast, ultra-high-frequency ultrasound (UHFUS) improves detection of these microtunnels, revealing that many patients classified as “mild” may actually have moderate disease.
UHFUS also enhances surgical planning through precise pre-operative mapping, reducing recurrence—especially when paired with biologics.1 Doppler imaging further aids in post-op monitoring by detecting early inflammation or tunnel relapse in clinically healed areas.
Ultrasound doesn’t just guide the hand; it sharpens the eye. In the operating room, it becomes the surgeon’s second sight
Dr. Alessandra Michelucci
Reference
- Cuenca-Barrales, C., Salvador-Rodríguez, L., Arias-Santiago, S. et al. (2020). Pre-operative ultrasound planning in the surgical management of patients with hidradenitis suppurativa. Journal of the European Academy of Dermatology and Venereology: JEADV, 34(10), 2362–2367. https://doi.org/10.1111/jdv.16435
Biologics and small molecules
Prof. Dr. Christos C. Zouboulis (Dessau, Germany) delivered a comprehensive update on biologics and small molecules for hidradenitis suppurativa (HS), aligning emerging therapies with transcriptomic-driven targets.
He framed HS as a systemic condition with both inflammatory and non-inflammatory phenotypes, underscoring the importance of early treatment during a defined “window of opportunity.”
TNF-α inhibitors remain foundational, while IL-17 agents demonstrate robust effects on IHS4 reduction and tunnel resolution. Additional pathways of interest include IL-1, IL-36, IL-12/23, and JAK-1.
Key Takeaways:
- Hidradenitis suppurativa is now recognised as a spectrum of immune-mediated endotypes, paving the way for more targeted, personalised therapies based on disease biology.
- Advances in outcome measures like IHS4-55 and imaging tools such as ultra-high-frequency ultrasound are improving disease assessment and guiding more precise treatment decisions.
Adverse anti-cancer drug reactions
Managing skin toxicities in cancer therapy
Immune checkpoint inhibitor-related reactions
Prof. Dr. Lukas Flatz (Tübingen, Germany) opened the session by sharing 10-year survival data with immune checkpoint-inhibitor (ICI) therapy, in which 50% of melanoma patients were still alive. He noted that while ICIs correlate with positive outcomes, their use is limited due to immune-related adverse events (irAEs), which can lead to death, treatment pauses/intervals, or immunosuppression.
ICI-related toxicity may have different clinical presentations, including vitiligo, bullous pemphigoid and lichen ruber.
Self-antigens that are tumour-specific, (e.g. BRAFV600E), tumour-associated (e.g. melanocyte differentiation antigens) or microenvironment-related (e.g. fibronectin) can have potent anti-tumour properties but can also mediate irAEs during immunotherapy.
Melanoma differentiation antigens mediate anti-tumour responses as well as vitiligo in melanoma patients, where vitiligo is associated with improved survival.
Keratinocyte differentiation antigens have been shown to mediate anti-tumour responses, and autoimmune skin toxicity, in patients with non-small cell lung cancer and cutaneous squamous-cell carcinoma. Research has led to the identification of shared T cell clones, in blood, skin and the tumour itself, and may provide new tumour-destroying antigens (e.g. keratin 14).
Both self-reactive T cells and autoantibodies are thought to play a role in the development of irAEs relating to ICI therapy, where T cells proliferate from an early-stage in the development of toxicity.
Tumour-associated-antigens, shared between tumours and the skin, particularly carcinoma, and keratinocyte-associated antigens may represent new antigen targets.
Targeted therapy-related reactions
Prof. Dr. Rolland Gyulai (Szeged, Hungary) gave the audience a broad overview of targeted-therapy related reactions to help clinicians better identify and treat these reactions, which have many clinical forms.
Targeted therapy identifies mutations (and mutated proteins) to kill or deactivate tumour cells, including the cell membrane (e.g. monoclonal antibodies) or blocking downstream intracellular signalling pathways (e.g. tyrosine kinase inhibitors and other molecules).
You should always consult with the treating oncologist (to determine) whether the skin symptoms necessitate treatment cessation, or the patient can continue on the drug
Prof. Dr. Rolland Gyulai
Four mechanisms have been identified that can lead to adverse reactions, including on-target (e.g. keratinocytes), and off-target effects (e.g. BRAF-inhibitors affecting other pathways), immune-mediated (e.g. immunogenic molecules), and barrier disruption and dysfunction.
Adverse effects can have different clinical forms. Severe cutaneous adverse reactions (SCARs) are rare but require immediate cessation of treatment, and systemic therapy. The ‘PRIDE’ complex comprising papulopustular rash, paronychia, regulatory changes in hair, itching, and dryness caused by epidermal growth factor receptor (EGFR) inhibitors, are the most common and treatment is usually continued. Hand-foot-skin reactions are rare but more difficult to manage. BRAF/MEK inhibitors may cause multiple reactions, mainly RASopathies, or similar to those with EGFR inhibitors. Hedgehog pathway inhibitors and other drugs may also cause alopecia. Prof. Dr. Gyulai noted that importantly, skin lesions can be a sign of improved survival.
Chemotherapy-related reactions
Dr. Barbara Meier-Schiesser (Zurich, Switzerland) provided a visual overview of chemotherapy-related reactions.
Chemotherapy interferes with the cell cycle and attacks rapidly dividing cells and tissues. However, other tissues such as the skin, hair and nails can be affected, which has an impact on a patient’s psycho-social burden and quality of life.
With this we hope to improve the patient’s quality of life
Dr. Barbara Meier-Schiesser
Hair-related changes may involve alopecia (diffused or non-scarring) and in eyelashes, eyebrows and body hair. Scalp-cooling devices, wigs, alongside topical or oral treatment are effective and usually transitory, as hair growth typically returns.
Lines and hyperpigmentation are common in the nail which can be difficult to manage under chemotherapy, although cool packs, nail trimming and antiseptics and corticosteroids have shown some effects.
Multiple chemotherapy-related skin reactions were presented, including radiation recall dermatitis (where previously eradiated areas of skin are triggered by certain systemic drugs), hyperpigmentation (serpentine supravenous form), neutrophilic eccrine hidradenitis (a self-limiting inflammatory dermatosis affecting the sweat glands) and acral erythema (a painful condition of the palms and soles).
The pathogenesis of severe adverse drug reactions differs and may involve toxic epidermal necrolysis or toxic erythema of chemotherapy. While more research is needed, molecules that block interactions to prevent skin toxicity and topical JAK inhibition might be useful.
It is crucial to work in an interdisciplinary manner with the oncologist, who are treating the patient with chemotherapy, and to step in very early on to treat skin toxicities, with patient education and a customised skin care regimen.
Management: to stop or not to stop the anti-cancer treatment
In the last presentation of this session, Dr. Maria Inês Coutinho (Coimbra, Portugal) gave a compelling insight into the management and treatment decisions for chemotherapy-related adverse reactions.
Chemotherapy is associated with numerous cutaneous adverse events, which are the most frequently-reported reactions; however, most are generally not severe enough to stop treatment. Interventions, when required, typically involve dose reduction or widening the treatment interval, with cooling devices which can be used to counter the effects of some treatments (e.g. taxanes).
Sharing of knowledge is crucial, not only with the treating oncologist but also with the patient to ensure better outcomes
Dr. Maria Inês Coutinho
For chemotherapy-related hypersensitivity reactions, associations with infusions, premedication may be possible desensitise the patient but should only be carried out by specialised allergy experts.
Severe cutaneous reactions associated with ICIs were also presented and Dr. Coutinho noted that some patients presenting with mucosal pain could be a sign of Stevens–Johnson syndrome.
There may be clinical phenotype overlap among reactions. The patterns of cutaneous reactions correlate well with their underlying physiopathology and treatment may be more effective when taking this in consideration.
More prospective clinical trials are needed to define the best way to treat or prevent cutaneous adverse events, particularly for the many new cancer treatments available.
Oncology is becoming an increasingly complex setting and dermatologists, particularly dermato-oncologists, should be taking a front-line approach to help characterise, treat and report these side effects.
Key takeaways
- Tumour-associated-antigens and keratinocyte-associated antigens may represent new antigen targets
- Targeted-therapy related skin lesions may be an indicator of improved survival
- Dermatologists should work closely with treating oncologists to identify and treat skin toxicities appropriately to ensure patient quality of life
Cutaneous reaction patterns correlate with physiopathology and may help to guide effective therapy.
Focus on new targeted treatment: New technologies
The future of dermatology through targeted drug innovation
Novel drug technologies
Prof. Dr. Kristian Reich (Hamburg, Germany) presented an overview of nanobody technology as a next-generation platform for targeted treatment in immune and inflammatory diseases.
In inflammatory skin conditions such as psoriasis, hidradenitis suppurativa, and palmoplantar pustulosis, nanobodies targeting IL-17A and IL-17F have demonstrated potent cytokine inhibition and improved clinical outcomes.
A trivalent nanobody that engages IL-17A, IL-17F, and albumin has shown high-affinity binding to all IL-17 dimers, enabling efficient tissue penetration.1
Preclinical models further support the nanobody platform, showing up to 10-fold higher target engagement at inflammatory sites compared to conventional monoclonal antibodies.2
References
- Papp, K. A., Weinberg, M. A., Morris, A. (2021). IL17A/F nanobody sonelokimab in patients with plaque psoriasis: a multicentre, randomised, placebo-controlled, phase 2b study. Lancet (London, England), 397(10284), 1564–1575. https://doi.org/10.1016/S0140-6736(21)00440-2
- Oyama, S., Ebina, K., Etani, Y. et al. (2022). A novel anti-TNF-α drug ozoralizumab rapidly distributes to inflamed joint tissues in a mouse model of collagen induced arthritis. Sci Rep12, 18102. https://doi.org/10.1038/s41598-022-23152-6
Cell therapy
Dr. Su Lwin (London, United Kingdom) presented emerging data on cell therapy for immune-mediated skin diseases.
Mesenchymal stromal cells (MSCs), which are multipotent, immunomodulatory, and well tolerated, have shown promise in psoriasis and epidermolysis bullosa. In severe, biologic-resistant psoriasis, MSCs led to clinical improvement or restored response to previously ineffective biologics, indicative immune recalibration.
While MSCs have not yet demonstrated definitive evidence of a deep immune reset, sustained responses point to meaningful modulation. By contrast, CAR T-cell therapy has shown clearer immune reset in other autoimmune diseases, highlighting its future potential in dermatology.
We must move forward with curiosity and collaboration to unlock the full potential of cell therapies in transforming how we treat chronic inflammatory diseases.”
Dr. Su Lwin
Targeted topicals
Prof. Dr. Christoph Schlapbach (Bern, Switzerland) outlined the evolution of topical therapies from traditional formulations to precision-engineered agents with defined molecular targets.
These new topicals, such as JAK inhibitors, PDE4 inhibitors, and AHR agonists, offer selective modulation of disease-relevant pathways with limited systemic exposure.1
Topical JAK inhibitors have demonstrated efficacy in vitiligo, atopic dermatitis (AD), and chronic hand eczema, with pharmacokinetic profiles showing high epidermal concentrations and minimal systemic absorption.2
Together, these targeted topicals represent a new era of precision dermatology, delivering biologic-like mechanism with the practicality of creams and ointments.
Targeted topicals allow us to modulate immune pathways directly at the site of inflammation without systemic exposure
Prof. Dr. Christoph Schlapbach
References
- Zhang, C., Merana, G. R., Harris-Tryon, T. (2022). Skin immunity: dissecting the complex biology of our body’s outer barrier. Mucosal immunology, 15(4), 551–561. https://doi.org/10.1038/s41385-022-00505-y
- Persaud, I., Diamond, S., Pan, R. et al. (2020). Plasma pharmacokinetics and distribution of ruxolitinib into skin following oral and topical administration in minipigs. International journal of pharmaceutics, 590, 119889. https://doi.org/10.1016/j.ijpharm.2020.119889
Gene therapy
Prof. Johann Bauer (Salzburg, Austria) offered an update on recent advances in gene and cell therapies for rare genetic skin diseases, focusing on epidermolysis bullosa (EB).
Historically considered untreatable, EB is now entering a new therapeutic era, with multiple gene-based approaches progressing into clinical use. Episomal gene delivery using modified herpes simplex virus vectors has led to the approval of topical treatments such as B-VEC for dystrophic EB, showing durable wound closure in trials.1,2
Other strategies include retroviral vector integration to enable long-term skin regeneration from autologous, genetically corrected epidermal stem cells, and early-phase applications of CRISPR/Cas for in situ gene editing.
References:
- Gurevich, I., Agarwal, P., Zhang, P. et al. (2022). In vivo topical gene therapy for recessive dystrophic epidermolysis bullosa: a phase 1 and 2 trial. Nature medicine, 28(4), 780–788. https://doi.org/10.1038/s41591-022-01737-y
- Guide, S. V., Gonzalez, M. E., Bağcı, I. S., Agostini, B., Chen, H., Feeney, G., Steimer, M., Kapadia, B., Sridhar, K. (2022). Trial of Beremagene Geperpavec (B-VEC) for Dystrophic Epidermolysis Bullosa. The New England journal of medicine, 387(24), 2211–2219. https://doi.org/10.1056/NEJMoa2206663
Key Takeaways:
- New platforms spanning nanobodies, topicals and gene therapies are raising the bar in dermatology, offering biologic-level precision with better delivery, tolerability, and ease.
- Cell and gene therapies are advancing care for hard-to-treat and genetic skin diseases.
Thursday
22 May 2025
Today's hot topics
Plenary session
Welcome to the EADV Spring Symposium!
In the Plenary Session, Prof. Branka Marinovic (EADV President) welcomed delegates to the event. “Participants can explore a rich programme curated by the Scientific Programming Committee, with scientific content specifically focussing on viral infections and on new targeted treatments for inflammatory diseases. Moreover, ‘What’s new’ sessions will cover the latest updates in the main fields of dermatology and venereology, such as skin cancer, psoriasis, STIs, hidradenitis suppurativa and lupus.”
The anticipated Plenary lecture was delivered by Prof. Bohdan Pomahac, from Yale University, who explored the ‘many faces’ of full-face transplantation.
Outside of the Plenary, six further sessions were delivered on the opening day of the event, covering a range of topics from keratinocytic skin cancer to new targeted treatments in inflammatory skin diseases.
Melanoma
Prevention to Precision: Advances in Melanoma Awareness, Imaging, and Therapy
Impact of prevention campaigns
Prof. Dr. Ana-Maria Forsea (Bucharest, Romania) opened the session by reiterating that health promotion and prevention are key to improving health outcomes.
For melanoma, the focus is on primary prevention (i.e. healthy people with risk factors) alongside risk factor identification, which can be non-modifiable (e.g. genotype, phenotype, phototype and history) or modifiable (e.g. ultraviolet [UV] exposure).
UV protection forms the basis of a multicomponent approach. To date, the most complete targeted educational, behavioural, and environmental campaigns and prevention strategies (including the well-established ‘Slip! Slop! Slap! Seek! Slide!’ and SunSmart programmes) were initiated in Australia over the last three decades. Other countries and regions, including in Europe (Euromelanoma and EADV ‘Beyond the Glow’), global programmes (‘UV-selfies’) have since established many educational and skin checking programmes.
Increased awareness and knowledge of the risks of sun exposure (particularly sunbathing and use of sun beds) substantially impact behavioural change. Since SunSmart, melanoma incidence has declined in younger populations alongside a three-fold increase in sun-protection measures in Australia; however, continued awareness is needed.
While primary prevention can save lives, reduce healthcare costs and improve quality of life, several challenges remain. This includes a lag-time between awareness and modest behaviour change; engaging challenging teenage populations; tanning implications (e.g. perceive wealth, status, etc) and conflicting messaging (e.g. a ‘healthy protective tan’).
To date, the most successful campaigns have been multicomponent, interactive and repeated over the long-term. More research and acknowledgement is needed for the psychological, social and cultural determinants of sun protection and exposure, with social platform use and artificial intelligence assistance.
Novel imaging techniques
Prof. Mariano Suppa (Brussels, Belgium) updated the audience on what’s new in terms of imaging techniques for melanoma.
Reflectance confocal microscopy (RCM) represents the most established technique for non-invasive skin imaging of melanocytic lesions, with high precision and instantaneous in vivo imaging of horizontal sections of the skin. RCM can be useful for the diagnosis of pigmented lesions and melanoma; however, not all cases are easy to diagnose.
Line-field confocal optical coherence tomography (LC-OCT) represents the ‘new kid on the block’ in this field, combining the advantages of both RCM and OCT with live horizontal, vertical, and three-dimensional views and more recently, integrated and colocalised dermoscopy.
Studies confirm that there is a high correlation with histopathology, RCM and dermoscopy for pigmented lesions. LC-OCT is also useful to easily differentiate between malignant and benign tumours and particularly, ‘clefting’, a new criterion where floating cells can be detected that correspond to histopathology, representing a strong diagnosis for melanoma.
Further advances have included the integration of artificial intelligence, which has shown to have high clinical impact for detection of epithelial tumours, with encouraging data for melanocytic tumours (including guidance for surgery) and other skin conditions.
Management of lentigo maligna
Prof. Dr. Eduardo Nagore (Valencia, Spain) outlined the current treatments for lentigo maligna (LM).
The incidence of LM, a type of melanoma in situ that occurs on sun-damaged skin, has continued to increase in recent years particularly among older patients. With a variable clinical presentation of tumours, in terms of lesion characteristics, site and the individual (e.g. comorbidities, life expectancy and preferences), there is need to consider many clinical aspects.
Two key issues of treatment include: the potential progression to an invasive tumour and the presence of invasive component at the time of diagnosis.
Surgery remains the first-choice treatment for LM and modalities that include assessment of 100% of the margins are preferred.
Immunohistochemistry, preferably with nuclear staining (e.g. microphthalmia transcription factor [MiTF] or Sry-related HMG-BOX gene 10 [SO-X10]), is highly recommended to increase the accuracy of margin assessment. Employing imaging techniques may also help to simplify the surgical procedure.
Non-surgical treatment, particularly with imiquimod or radiotherapy (if an invasive component is suspected), can be considered in selected cases. However, compared with lesions on the face, lesions in the scalp/nasal area are associated with increased risk and are not considered to be good candidates for imiquimod treatment. This approach may be useful where surgery is difficult or the definition of the border isn’t well-defined. Neo-adjuvant therapy has been proposed to reduce tumour size and simplify surgery.
Adjuvant, neoadjuvant treatment and beyond
In the final presentation of this session, Prof. Dr. Petr Arenberger (Prague, Czech Republic) summarised the use of adjuvant vs neo-adjuvant therapies for malignant melanoma.
Adjuvant therapy, administered after the primary surgery, is typically used in patients with a high risk of recurrence, to remove the tumour and initiate immunotherapy. Possibilities include systemic treatment with immunotherapy and targeted therapy (e.g. based on BRAF status).
The overall goal of these (neo-adjuvant and adjuvant) multimodal treatment approaches is to increase the effectiveness of local definitive therapy, as well as to minimise the adverse effects patients experience during primary treatments
Prof. Dr. Arenberger
Neo-adjuvant therapy includes treatments that are used before surgical excision. While this approach is still relatively new, immunotherapy has been shown to be superior to targeted therapy in this setting. Although oncologists use this approach to reduce the size of inoperable tumours before surgery, dermatologists aim for a complete treatment.
Recent studies to investigate different doses in different subpopulations underline that neo-adjuvant therapy is superior to standard adjuvant therapy, with the latter not needed in some patients.
Key takeaways
- Sustained health promotion and prevention campaigns are needed to improve UV protection awareness and reduce melanoma incidence
- LC-OCT, ‘the new kid on the block’, combines the advantages of RCM and OCT and can differentiate between malignant and benign tumours
- Surgery remains the first-choice treatment for LM with immunohistochemistry to increase the accuracy of margin assessment
- The overarching goal of adjuvant and neo-adjuvant therapy is to improve treatment efficacy
Focus on new targeted treatment: Inflammatory diseases
Next-gen treatments: From injectables to ingestibles
Oral IL-17 and IL-23 inhibitors
Dr. Tiago Torres (Porto, Portugal) highlighted the growing interest in oral therapies for psoriasis, particularly those targeting the IL-17 and IL-23 pathways. Oral small molecules targeting either cytokine receptors or intracellular signalling are showing promising results in clinical trials, with several achieving notable skin clearance rates. ¹
Tyrosine kinase 2 inhibitors and oral IL-23 receptor antagonists are emerging as key classes due to their favourable efficacy and tolerability profiles.2˒3 Dr. Torres noted that oral therapies may offer greater convenience for patients while also reducing concerns around immunogenicity and administration complexity.
References
- Armstrong, A. W., Gooderham, M., Warren, R. B., et al. (2023). Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: Efficacy and safety results from the 52-week, randomized, double-blinded, placebo-controlled phase 3 POETYK PSO-1 trial. Journal of the American Academy of Dermatology, 88(1), 29–39. https://doi.org/10.1016/j.jaad.2022.07.002
- Baker, K. F., & Isaacs, J. D. (2018). Novel therapies for immune-mediated inflammatory diseases: What can we learn from their use in rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus, psoriasis, Crohn’s disease and ulcerative colitis?. Annals of the rheumatic diseases, 77(2), 175–187. https://doi.org/10.1136/annrheumdis-2017-211555
- Papp, K., Gordon, K., Thaçi, D., et al. (2018). Phase 2 Trial of Selective Tyrosine Kinase 2 Inhibition in Psoriasis. The New England journal of medicine, 379(14), 1313–1321. https://doi.org/10.1056/NEJMoa1806382
New TH-2-targeting drugs
Dr. Patrick Brunner (New York, United States) presented an evolving landscape for atopic dermatitis (AD) treatment, centred on therapies that target Th2-driven inflammation. IL-4, IL-5, and IL-13 remain key targets, but emerging approaches include IL-31 receptor blockers and broader-acting cytokine modulators. He also addressed rare reports of cutaneous T-cell lymphoma during Th2-pathway inhibition, stressing the need for clinical vigilance, especially in patients with atypical features.
New avenues include agents that block multiple cytokines, such as IL-13 and IL-32, which may offer broader efficacy but with less specificity.
One very interesting avenue is combining IL-13 with IL-32—developing drugs that block multiple cytokines. These agents may offer broader efficacy with less specificity.
Dr. Patrick Brunner
JAK-inhibitors the answer for alopecia areata and vitiligo?
Dr. Brett King (Fairfield, United States) explored the growing role of JAK inhibitors in alopecia areata (AA) and vitiligo. In AA, patients with some residual hair and shorter disease duration respond best.1
For vitiligo, he described a two-step approach: suppress the autoimmune response with JAK inhibition and then trigger re-pigmentation, the latter of which often requires light therapy. While monotherapy has limited effect, combining oral JAK inhibitors with phototherapy has led to re-pigmentation levels not seen before.
Topical JAK and calcineurin inhibitors remain first-line, but oral JAK inhibitors with light therapy are emerging as promising options.
References
- King, B., Ohyama, M., Kwon, O., et al. (2022). Two Phase 3 Trials of Baricitinib for Alopecia Areata. The New England journal of medicine, 386(18), 1687–1699. https://doi.org/10.1056/NEJMoa2110343
Are JAK inhibitors the answer for alopecia areata and vitiligo? Yes—if you know how to use them
Dr. Brett King
New interferon and plasmacytoid dendritic cells targeted treatments for autoimmune diseases
Prof Dr. Claudia Günther (Dresden, Germany) reviewed emerging treatment strategies in autoimmune skin diseases that focus on inhibiting type I interferon signalling and targeting plasmacytoid dendritic cells (pDCs).1 She explained that pDCs are key producers of type I interferon and play a central role in the pathogenesis of conditions such as cutaneous lupus erythematosus (CLE), systemic lupus erythematosus (SLE), dermatomyositis (DM), and systemic sclerosis (SSc).
Strategies discussed included blocking the type I interferon receptor, depleting pDCs, using JAK or TYK2 inhibitors to modulate downstream signalling, and developing cGAS inhibitors to suppress interferon production at its source. Early trial results suggest these approaches can reduce disease activity in both skin and systemic manifestations.
References
- Günther, C., Wolf, C., Fennen, L., et al. (2023). Case Report: Response of cutaneous lupus lesions in SLE to interferon receptor blockade parallels reduction of interferon score in blood. Frontiers in immunology, 14, 1253279. https://doi.org/10.3389/fimmu.2023.1253279
Key Takeaways:
- Targeted cytokine therapies are advancing efficacy and convenience across inflammatory diseases, with oral agents and multi-cytokine blockers offering new options beyond injectables
- Strategic immune modulation that considers timing, combinations, and upstream targeting is key to durable outcomes in conditions like alopecia areata, vitiligo, and autoimmune skin diseases
