See also the Commentary by Geller and Swetter

What's already known about this topic?

• In the skin of colour population, facial hyperpigmentation is a common and growing concern when presenting to the physician.
• Facial hyperpigmentation can cause significant cosmetic disfigurement with subsequent emotional impact. Therapy continues to be challenging as there is no universally effective treatment. Existing agents have varying degrees of efficacy and potential risk of postinflammatory hyperpigmentation with different treatment protocols.

What does this study add?

• Persons of colour will soon comprise a majority of the international and domestic populations.
• A comprehensive knowledge and approach to assessment and treatment is necessary to care properly for skin of colour patients.
• This review thoroughly discusses aetiologies of facial hyperpigmentation and categorizes appropriate treatment strategies.

What’s already known about this topic?

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  Acne is a common disease affecting all to a degree, manifesting in adolescence with significant psychosocial and socioeconomic consequences.

What does this study add?

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  This review elucidates the risk factors for the development of and severity of acne vulgaris leading to improved understanding.

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  We highlight the need for universal outcome measures and important areas such as the natural history of acne and relationship between foodstuffs and acne where more high‐quality studies would be valuable.

What's already known about this topic?

• Patients with atopic dermatitis that is inadequately controlled with topical therapy have few systemic treatment options.
• Ciclosporin A (CsA) is a systemic immunosuppressant approved for atopic dermatitis in most European countries and Japan, but not all patients respond, and side‐effects limit its use.
• Dupilumab (monoclonal antibody against interleukin‐4 receptor‐alpha) with/without topical corticosteroids (TCS) is approved in the U.S.A. and the European Union for the treatment of adults with inadequately‐controlled moderate‐to‐severe atopic dermatitis.

What does this study add?

• In this 16‐week trial in adults with atopic dermatitis and history of inadequate response or intolerance to CsA, or for whom CsA treatment was medically inadvisable, dupilumab administered weekly or every 2 weeks with concomitant TCS significantly improved signs and symptoms and quality of life, with no new safety signals.
• These data support the use of dupilumab in this difficult‐to‐treat population.

Linked Editorial: Schmitt. Br J Dermatol 2018; 178:992–993.

Linked Letter: Thyssen. Br J Dermatol 2018; 178:1220.

Plain language summary available online

Respond to this article

What's already known about this topic?

• Interleukin (IL)‐23/IL‐17 is the major pathway that drives the chronic inflammation underlying the pathophysiology of psoriasis.
• Ustekinumab is a monoclonal antibody targeting IL‐12 and IL‐23 and is currently approved for patients with plaque psoriasis.
• Guselkumab is a novel anti‐IL‐23 monoclonal antibody and has demonstrated high efficacy in patients with plaque psoriasis in two recent phase III trials.

What does this study add?

• Guselkumab demonstrated greater efficacy compared with ustekinumab among patients who failed to achieve an Investigator's Global Assessment score of 0 or 1 with ustekinumab therapy.
• The types of adverse events (AEs) with guselkumab and ustekinumab were similar, with infections being the most common.
• A slightly higher incidence of AEs was reported in the guselkumab group, primarily driven by AEs of back pain, psoriatic arthropathy and mild injection site reactions.

Linked Comment: Albrecht and Gerdes. Br J Dermatol 2018; 178:20.

Plain language summary available online