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Autoimmune Skin Diseases: Innovations, Challenges, and Opportunities

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dermatology".

Deadline for manuscript submissions: 25 October 2026 | Viewed by 10894

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Editor

Prof. Dr. Shany Sherman

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Guest Editor

Department of Dermatology, Rabin Medical Center, Petah Tikva 4941492, Israel
Interests: vitiligo; hidradenitis suppurativa; psoriasis; population-based studies; immunology of skin diseases

Special Issue Information

Dear Colleagues,

The advent of biologic therapies has transformed the management of common inflammatory skin diseases such as psoriasis, atopic dermatitis, and hidradenitis suppurativa, leading to significant changes in drug utilization. While these treatments have greatly improved patient outcomes, they also present challenges, including an increasing economic burden on healthcare systems. This Special Issue will explore these challenges while addressing specific shifts in healthcare access, such as hospitalization rates, physician visits, and the emergence of comorbid conditions. Additionally, we will examine novel approaches to photodermatoses, such as solar urticaria and collagen vascular diseases, driven by advances in research on immunopathogenesis. A key focus will also be placed on recent developments in targeted therapies for immunobullous disorders and graft-versus-host disease, opening up new avenues for precision medicine. By integrating research on disease mechanisms, innovative treatment strategies, and healthcare impacts, this Special Issue will foster conversations around optimizing patient care and resource allocation in autoimmune dermatology.

Prof. Dr. Shany Sherman
Guest Editor

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Keywords

healthcare utilization
inflammatory skin diseases
photodermatoses
collagen vascular disease
immunobullous disorders
graft-versus-host disease

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Published Papers (6 papers)

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Research

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16 pages, 812 KB

Open AccessArticle

The Efficacy of an Optimized, Low-Intensity Photodynamic Therapy Protocol with 10% 5-ALA Nanoemulsion in Refractory Vulvar Lichen Sclerosus: Impact on Quality of Life and Sexual Function

by Katarzyna Beutler, Alina Jankowska-Konsur and Danuta Nowicka

J. Clin. Med. 2026, 15(8), 3155; https://doi.org/10.3390/jcm15083155 - 21 Apr 2026

Viewed by 514

Abstract

Background: Treatment options for vulvar lichen sclerosus (VLS) remain limited; therefore, therapies that improve quality of life and reduce neoplastic risk are needed. Photodynamic therapy (PDT) is a potential option. This study aimed to evaluate quality of life and sexual function in patients treated according to the protocol used at our institution. Methods: Forty patients with refractory VLS underwent PDT using a 10% 5-aminolevulinic acid nanoemulsion (Ameluz^®) applied to lesions under an occlusive aluminum foil dressing. Patients received 1–6 sessions of 10 min illumination (LED: 37 J/cm², ~77 mW/cm²) at 4–6-week intervals. The Dermatology Life Quality Index (DLQI) and Female Sexual Function Index (FSFI) were used for assessment. Results: Thirty-seven participants answered DLQI, while 20 declared themselves to be sexually active and were included in the analysis. Greater number of PDT sessions was associated with a lower DLQI score (τ = −0.583; adjusted p < 0.001). The number of PDT sessions and the total FSFI score (p = 0.014), as well as desire (p = 0.016), arousal (p = 0.020), orgasm (p = 0.020), and satisfaction (p = 0.016) domains were significantly correlated. Age correlated positively with DLQI scores (p = 0.016), indicating greater disease burden in older patients. Longer disease duration was also associated with poorer quality of life (p = 0.020). Conclusions: PDT can be considered an effective treatment for patients with VLS refractory to standard topical corticosteroid and calcineurin inhibitor therapies when delivered using a refined, patient-centered protocol. This optimized approach used in our institution is based on short irradiation time and precise light delivery, providing a favorable balance between therapeutic efficacy, patient comfort, and treatment feasibility. Our findings also suggest that the cumulative number of PDT sessions is a key factor for clinical response. Further studies should address long-term outcomes. Full article

(This article belongs to the Special Issue Autoimmune Skin Diseases: Innovations, Challenges, and Opportunities)

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9 pages, 192 KB

Open AccessArticle

Healthcare Service Utilization and Medication Use in 128,239 Children with Atopic Dermatitis in Israel—A Cross-Sectional Case-Control Study

by Naama Tova Cohen, Amit Iton-Schwartz, Doron Comaneshter and Yulia Valdman-Grinshpoun

J. Clin. Med. 2025, 14(18), 6402; https://doi.org/10.3390/jcm14186402 - 10 Sep 2025

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Abstract

Background: Atopic dermatitis (AD) is a chronic inflammatory disease requiring topical and systemic treatments. This study examines healthcare service utilization and medication use in children with AD in a large healthcare organization during the year 2024. Methods: A cross-sectional case-control study was conducted comparing 128,239 children with AD to 128,239 matched controls regarding healthcare utilization and medication use. Multivariate analysis assessed differences between the groups. Results: Children with AD had increased healthcare utilization compared to the control group, with higher rates of visits to pediatricians, general practitioners, and dermatologists. A total of 144 children (0.11%) with AD were treated by immunosuppressive drugs, as compared to 78 children (0.06%) in the control group (OR 1.8, 95% CI 1.4–2.4, p-value < 0.001). A total of 410 children (0.32%) were treated with biologic drugs as compared to 12 children (0.01%) in the control group (OR 34.3, 95% CI 19.3–60.9, p-value < 0.001). A total of 34 children (0.03%) were treated with Janus kinase (JAK) inhibitors as compared to 2 children (0.002%) in the control group (OR 17, 95% CI 4.1–70.8, p-value < 0.001). Conclusions: Increased utilization of healthcare services was observed in pediatric patients with AD compared to the control group. As only a small proportion of the children with AD received immunosuppressants, biologic treatments, and JAK inhibitors, we suggest that the use of systemic medications should be strongly considered in pediatric patients with moderate to severe AD. Full article

(This article belongs to the Special Issue Autoimmune Skin Diseases: Innovations, Challenges, and Opportunities)

11 pages, 460 KB

Open AccessArticle

Type 1 Diabetes/Hidradenitis Suppurativa Comorbidity—A Population-Based Study

by Shany Sherman, Ron Slama, Danielle Bar, Yochai Schonmann, Arnon D. Cohen, Yossef H. Taieb, Daniel Mimouni, Alon Peretz and Hadar Duskin-Bitan

J. Clin. Med. 2025, 14(8), 2625; https://doi.org/10.3390/jcm14082625 - 11 Apr 2025

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Abstract

Background: Type 1 diabetes (T1D) and hidradenitis suppurativa (HS) share several metabolic and inflammatory dysfunctions. Prior studies of the potential link between the diseases either lacked validated T1D diagnoses or established only an indirect association. This study sought to determine the odds of HS developing in patients with a validated diagnosis of T1D and to characterize the clinical features of HS/T1D comorbidity. Methods: A population-based nested case-control study was conducted including patients with HS and controls matched 5:1 for age, sex, and primary care clinic. T1D was diagnosed using a specialized algorithm, achieving 90% accuracy. Diagnostic validity was confirmed by diabetes specialists who manually reviewed a random subset of the files. Unadjusted and adjusted odds ratios (OR/aOR) were calculated to determine the odds of incident HS in patients with T1D. Results: The study included 10,919 patients with HS and 53,314 controls. A history of T1D was associated with an elevated odds of new-onset HS (OR 1.80 95% CI (1.30–2.40), p < 0.001), even after adjusting for demographics and metabolic and autoimmune comorbidities (aORs > 1.7, p < 0.001). Patients with HS/T1D comorbidity had higher proportions of autoimmune conditions than patients with HS alone (p < 0.001) and a higher mean Charlson Comorbidity Index score than both patients with HS alone (3.5 vs. 0.9, p < 0.001) and T1D alone (3.5 vs. 2.2, p = 0.004). Conclusions: T1D is associated with higher odds of the subsequent development of HS. Awareness of HS/T1D comorbidity is recommended owing to the elevated burden of metabolic and autoimmune conditions. Full article

(This article belongs to the Special Issue Autoimmune Skin Diseases: Innovations, Challenges, and Opportunities)

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Review

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15 pages, 883 KB

Open AccessReview

Hyperglycemia—A Driver of Cutaneous Severity in Dermatomyositis: A Narrative Review

by Rachel Dombrower, Alyssa McKenzie, Olga Gomeniouk, Savannah Kidd, Shannon Saed, Sophia Saed, Erin Onken and Juwairiah Mohammad

J. Clin. Med. 2026, 15(2), 734; https://doi.org/10.3390/jcm15020734 - 16 Jan 2026

Cited by 1 | Viewed by 822

Abstract

Dermatomyositis (DM) is an idiopathic inflammatory myopathy (IIM) characterized by distinctive chronic cutaneous manifestations. Although immune-mediated and microvascular mechanisms are well established, the role of metabolic dysfunction, particularly hyperglycemia, is underexplored in dermatological conditions. This review synthesizes mechanistic, clinical, and translational evidence to explore the relationship between dysglycemia and cutaneous disease severity in DM. Hyperglycemia is associated with oxidative stress, advanced glycation end-product formation, endothelial injury, and proinflammatory cytokine signaling. These processes may plausibly amplify DM-associated vasculopathy, impair wound healing, and worsen cutaneous inflammation. Limited DM-specific studies demonstrate increased insulin resistance and a higher prevalence of diabetes compared with healthy controls. Meanwhile, case reports suggest that poor glycemic control can exacerbate cutaneous disease. Evidence from other inflammatory dermatoses supports a biologically plausible role for dysglycemia in increasing flare frequency, infection risk, and delayed tissue repair. Dietary patterns characterized by high glycemic index and coexisting metabolic syndrome may further intensify systemic and cutaneous inflammation. Collectively, these findings suggest hyperglycemia as a biologically plausible contributor to cutaneous disease severity in DM that warrants further investigation. These observations highlight the need for future studies to evaluate whether metabolic screening, dietary patterns, and interdisciplinary care influence cutaneous disease activity and wound healing in DM. Prospective clinical investigation is needed to determine whether targeted glycemic optimization is associated with changes in cutaneous and systemic outcomes in DM. Full article

(This article belongs to the Special Issue Autoimmune Skin Diseases: Innovations, Challenges, and Opportunities)

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Other

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16 pages, 1436 KB

Open AccessSystematic Review

Efficacy of Therapies for Solar Urticaria: A Systematic Review and Meta-Analysis

by Maya Engler Markowitz, Yehonatan Noyman, Israel Khanimov, Itay Zahavi, Batya Davidovici, Riad Kassem, Daniel Mimouni and Assi Levi

J. Clin. Med. 2025, 14(16), 5736; https://doi.org/10.3390/jcm14165736 - 13 Aug 2025

Cited by 4 | Viewed by 3908

Abstract

Background: Solar urticaria is a rare and disabling photodermatosis. Due to its low prevalence, most available data regarding treatment are derived from observational studies and case series, and a systematic evaluation of treatment efficacy is lacking. This systematic review and meta-analysis aims to assess therapeutic outcomes across treatment modalities in order to guide clinical care. Methods: We conducted a systematic literature search across PubMed, ScienceDirect, the Cochrane Library, and ClinicalTrials.gov. Studies reporting treatment outcomes in patients with solar urticaria were included. Pooled response rates were calculated for each treatment modality. Results: Out of 508 studies initially identified, 38 met the inclusion criteria. Antihistamines were evaluated in 21 studies (376 patients), with a pooled response rate (partial or complete) of 83.0% (95% CI, 70.4–91.1%) and a complete response rate of 7.7% (95% CI, 1.7–28.3%). Phototherapy was assessed in 11 studies (145 patients), showing a similar overall response (89.8%; 95% CI, 77.9–95.3%) but a higher complete response rate (39.8%; 95% CI, 18.3–66.1%). Omalizumab, evaluated in nine studies (76 patients), demonstrated the highest efficacy, with 93.2% (95% CI, 73.8–98.5%) achieving response and 68.4% (95% CI, 48.5–83.2%) complete remission. Limited data on IVIG, cyclosporine, and plasmapheresis suggested partial efficacy in selected refractory cases. Conclusions: This meta-analysis may support clinical decision-making by clinicians. A stepwise approach is suggested: high-dose H₁ antihistamines as first-line therapy, phototherapy as an alternative option in patients with access to treatment centers, and omalizumab for those with insufficient response. In refractory cases, additional options might be considered. Full article

(This article belongs to the Special Issue Autoimmune Skin Diseases: Innovations, Challenges, and Opportunities)

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17 pages, 921 KB

Open AccessSystematic Review

Bullous Pemphigoid as a Manifestation of Graft-Versus-Host Disease Following Allogeneic Hematopoietic Stem Cell Transplantation: A Systematic Review and Report of a Novel Case

by Sapir Glazer Levavi, Moshe Yeshurun, Pia Raanani, Mor Frisch, Meital Oren-Shabtai, Lev Pavlovsky, Daniel Mimouni and Anna Aronovich

J. Clin. Med. 2025, 14(12), 4068; https://doi.org/10.3390/jcm14124068 - 9 Jun 2025

Cited by 2 | Viewed by 1790

Abstract

Background/Objective: Bullous Pemphigoid (BP) is a well-recognized autoimmune subepidermal blistering disease. However, its occurrence following allogeneic hematopoietic stem cell transplantation (HSCT) is extremely rare. The objective of this study is to systematically review the available data on BP following an allogeneic HSCT with focus on treatment options. Methods: A systematic review of studies evaluating BP following allogeneic HSCT, incorporating a highly treatment-resistant case from our graft-versus-host disease (GvHD) dermatology clinic, of a 47-year-old patient, notable as the only reported instance of BP following HSCT in a patient with chronic lymphocytic leukemia (CLL) that transformed into diffuse large B-cell lymphoma (DLBCL) and GvHD due to HSCT. The review yielded 15 publications that met the eligibility criteria. Including our case, a total of 16 cases were analyzed. Results: Nearly all patients (14/16) in this review had chronic GvHD due to their HSCT. Twelve patients were males, and six were of Japanese origin. The mean age for BP diagnosis was 38 years (a range of 5–67). On average, BP developed one year post-HSCT. The most common treatment for BP in these patients was prednisolone, with the majority experiencing complete resolution of symptoms. Conclusions: BP following HSCT is an exceptionally rare condition with an unclear underlying mechanism. Full article

(This article belongs to the Special Issue Autoimmune Skin Diseases: Innovations, Challenges, and Opportunities)

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