Dermatology and venereology – highlights in research and patient care in 2021 (2021)

As we stand at the threshold of the New Year 2022, we are again surprised that Coronavirus infection still continues to be a threat affecting many aspects of our lives as well as of our specialty, dermatology. But our daily life goes on and looking back at the year 2021, we should not forget some highlights in research and patient care as they appeared in our Journal. We celebrated the 30-year anniversary of JEADV in November 2021 with special commentaries from our Associate and Section Editors on selected topics and the editorials from the founding editors, Derek Freedman and Torello Lotti, and the founding member Hans Rothenborg. Let me now invite you to my somewhat subjective guided tour through JEADV 2021. The survival of patients with metastatic melanoma has greatly improved due to the introduction of immunotherapeutical approaches like checkpoint inhibitors but also kinase inhibitors. Yet, the question of reliable predictive tests continues to be a critical question. Possibly the amount of cell-free DNA in plasma might serve as a prognostic marker in metastatic melanoma, as Varalijai et al. showed. They found that patients with elevated plasma levels of cell-free DNA had a significantly shorter overall survival and especially progression-free survival than patients in whom cell-free DNA was low.1 In Merkel cell carcinoma, metabolic reprogramming and angiogenesis were studied and found to go along with high expression of hypoxia-inducible factor (HIF)-1α and its downstream factors: In patients with positive expression of Merkel cell polyoma virus, the HIF-1α was significantly elevated as was the factor VEGFR-3.2 A public health study to the question which medical disciplines actually are involved in diagnosis and treatment of malignant melanoma in Europe found remarkable results in melanoma centres from 27 European countries comparing mortality-to-incidence rates (MIR) and correlating them to healthcare determinants. MIR was markedly lower – meaning better survival of patients – when countries had high health expenditure, high numbers of general practitioners and surgeons per number of inhabitants, when GPs and dermatologists were both involved in melanoma detection, when dermatologists were using dermatoscopy and were involved in the follow-up of all melanoma stages and finally when both medical oncologists and dermato-oncologists were administering systemic treatments.3 In a position statement, a new classification of basal cell carcinoma was suggested.4 The crucial role of photo-protection with regard to UV-induced occupational skin cancer was addressed in a position statement not only for doctors and healthcare professionals but also employers and policy makers.5 Photo-protection has to be selected carefully based on the skin phototypes according to Fitzpatrick. While it is obvious that the classic UVB protection is of particular importance in light-skinned individuals (phototypes 1 and 2), UVA protection is of equal importance for all skin phototypes; protection against harmful effects of high-energy visible light is especially important for darker skin types.6 With many new immunomodulatory treatments, including biologics, the development of antipsoriatic therapy in this century is a success story. While efficacy had been the focus for many years, now safety issues are more and more under the spotlight, as discussed in the latest European guidelines on systemic treatments of psoriasis.7 Although moderate improvements (PASI 75) were well accepted at the beginning, now the trend to complete clearance is growing as shown in a study that compares brodalumab and ustekinumab.8 Also in atopic dermatitis, the era of biologics has arrived with anti-interleukin 4 and 13 as well as JAK inhibitors. Dupilumab also has been shown to be effective and safe in small children of the age between 6 months and 6 years.9 A pooled safety analysis of baricitinib in adult patients from eight randomized clinical trials showed a good safety profile.10 An interesting case report described an eosinophilic glossitis due to mesalazine.11 The value of educational programs in chronic inflammatory skin diseases has been recognized more and more. The interdisciplinary character and the role of nurses have been reflected in a position statement.12 A possibly important sign so far under-recognized in patients with tuberous sclerosis complex has been described in the form of miliary fibromas.13 A position statement described the practical management of patients with epidermolysis bullosa.14 Tinea capitis is a worldwide problem and shows alterations in the types of causal elicitors over the last 20 years.15 Also, emerging antifungal treatment failure has been observed in dermatophytosis in Europe.16 A new update of a European guideline on the management of syphilis17 appeared as well as guidelines on the management of proctitis, proctocolitis and enteritis caused by sexually transmitted pathogens.18 Again Covid-19 was a continuous topic in the Journal with the JEADV COVID-19 Special Forum dealing with the manifold implications of this disease for dermatology and venereology, not only with descriptions of skin manifestations of the disease but also of adverse reactions following COVID-19 vaccination. Also, reactions to personal protective equipment, especially face masks, were discussed19 with a special focus on patients with atopic dermatitis. Some of them even found solace in wearing the mask because it hides affected skin on the face. The question of the risk of severe allergic or anaphylactic reactions for patients with atopic eczema was dealt with in a position statement of the European Task Force on Atopic Dermatitis (ETFAD). There is no generally increased risk for such complications except for patients with a history of clear-cut anaphylaxis to vaccines or ingredients of the respective COVID-19 vaccine preparation.20 Besides the monthly interviews with great personalities in our field, an article described skin conditions of 20th century politicians and world leaders.21 With this short reflection on last year's articles published in JEADV, we are looking forward to a selection of equally exciting and important articles in the New Year 2022. None declared. None.