Journal of Investigative Dermatology

ECM composition and organization are greatly altered during inflammation but it is still elusive if ECM dynamics may protect tissue stem cells against aberrant inflammation. Fibulin 7 (encoded by Fbln7) is part of the basement membrane ECM where epidermal stem cells (EpSCs) reside. It supports the long-term potential of fast-cycling EpSCs and moderates aging-related inflammatory markers in keratinocytes. Here, we assessed fibulin 7s role during imiquimod (IMQ)-induced inflammation in 1-year-old mouse dorsal skin. We found that loss of Fbln7 aggravates epidermal inflammation, marked by increased epidermal thickness, proliferation, and phosphorylation of JNK (c-Jun N-terminal kinase). Fast-cycling EpSCs labeled with Slc1a3-creER-TdTomato demonstrated that IMQ-induced proliferation in Fbln7 KO mice is contributed by cell divisions in the suprabasal layers, a hallmark of inflammatory epidermal responses. EpSC transcriptomes further reveal IMQ-modulated genes that are more substantially affected in Fbln7 KO mice, including IL-17 pathway-related genes known in psoriasis pathogenesis. Mechanistically, fibulin 7 directly binds to IL-17A and decreases IL-17A-mediated p38 MAPK activation. In public human psoriasis datasets, FBLN7 is reduced in lesional skin compared with non-lesional or normal skin, and it is significantly correlated with common psoriasis-associated genes. Altogether, fibulin 7 is potentially beneficial to protect against skin inflammation.

Vitiligo is an autoimmune disorder characterized by melanocyte destruction. We performed a rank-based meta-analysis of six independent transcriptomic studies (115 samples) spanning microarray, bulk and single-cell RNA-seq platforms to identify consensus signatures of lesional skin. Robust Rank Aggregation identified 114 differentially expressed genes (FDR < 0.05) with striking asymmetry: 108 downregulated versus 6 upregulated. Downregulated genes were dominated by melanocyte markers (MLANA, TYRP1, DCT, PMEL, KIT). Upregulated genes included interferon-stimulated genes (OAS1, OAS2, EPSTI1). Pathway-level meta-analysis confirmed uniform suppression of melanogenesis, while immune activation was heterogeneous across datasets. Single-cell data from three included studies confirmed melanocyte depletion. The 108 downregulated genes showed exclusive expression in melanocytes. These include neural genes (PLP1, GPM6B, NRXN3), consistent with melanocytes neural crest origin. We also identified candidate melanocyte markers such as CYB561A3 and QPCT with high melanocyte specificity and consistent downregulation in vitiligo. These findings reveal a robust melanocyte loss signature in vitiligo detectable across all platforms, and study-dependent immune activation possibly influenced by sampling method and disease characteristics.

Psoriasis is a chronic immune-mediated inflammatory skin disease characterized by excessive keratinocyte proliferation, immune cell infiltration and dysregulated inflammatory signaling. Despite the availability of biologic therapies targeting inflammatory cytokines, many patients experience incomplete responses or relapse, highlighting the need to better understand molecular regulators of cutaneous inflammation. CD109 is a glycosylphosphatidylinositol (GPI)-anchored protein previously identified by our lab as a co-receptor and negative regulator of Transforming Growth Factor-{beta} (TGF-{beta}) signaling that inhibits fibrotic responses. Emerging evidence suggests that CD109 also modulates immune and inflammatory pathways. In this study, we investigated whether epidermal CD109 overexpression influences cutaneous inflammatory responses. Transgenic (TG) mice overexpressing CD109 under the keratin-14 (K14) promoter were used to restrict transgene expression to the epidermis. TG and wild-type (WT) littermates were subjected to lipopolysaccharide (LPS)-induced skin inflammation. CD109 TG mice exhibited significantly reduced immune cell recruitment, including macrophages and neutrophils, along with decreased expression of the pro-inflammatory mediators IL-1 and MCP-1/CCL2 compared with WT mice. Transcriptomic analysis of primary keratinocytes revealed downregulation of multiple inflammatory signaling pathways in CD109-overexpressing cells, including TNF-/NF-{kappa}B, IL-2/STAT5, IFN-{gamma}, IFN-, and IL-6/JAK/STAT3 pathways. Together, these findings demonstrate that epidermal CD109 overexpression attenuates cutaneous inflammatory responses by suppressing key inflammatory signaling networks and limiting immune cell recruitment, suggesting that CD109 may represent an important regulator of inflammatory signaling in the skin and a potential target for inflammatory skin diseases such as psoriasis.

Lichen Planopilaris (LPP) is a lymphocyte-mediated scarring alopecia characterized by progressive follicular destruction and fibrosis. In this clinical trial, patients with biopsy proven LPP were treated with deucravacitinib (an oral inhibitor of tyrosine kinase 2 (TYK2)) 6 mg BID for 24 weeks (NCT-06091956). Bulk and single-cell RNA sequencing was performed on paired pre- and post-treatment scalp biopsies from baseline and week 4. Patients (N=10) demonstrated improvements in PGA (88.9%, p=0.008), LPPAI (-2.3 points, SD 1.1, p=0.002) and Skindex-16 (-21.0 points, SD 22.1, p=0.014) scores at week 24. Bulk transcriptomic analysis of untreated LPP revealed upregulation of type I Interferon (IFN)-stimulated genes and pathways related to inflammation, immune activation, keratinization, and extracellular matrix remodelling, with downregulation of immune and inflammatory pathways following treatment. Single-cell RNA-seq of LPP was characterized by enrichment of CD8+GZMK+ T cells which showed downregulation of T-cell receptor signaling as well as antiviral pathways with treatment. Basal keratinocytes exhibited reduced cytokine and interferon signaling and decreased communication with NK cells following treatment. CCL19+ fibroblasts were prominent in untreated disease was attenuated after treatment, with downregulation of type I IFN signaling. Selective TYK2 inhibition with deucravacitinib effectively suppresses these inflammatory circuits in LPP and represents a promising therapeutic strategy.

Peptidase inhibitor 16 (Pi16)-expressing fibroblasts are found across tissues and species, but their functional role is unclear. As fibroblasts and macrophages have been proposed to exist in a reciprocal circuit, we hypothesized Pi16+ fibroblasts may regulate macrophage homeostasis. Flow cytometry revealed [~]80% of skin fibroblasts express Pi16, leading us to investigate the role of these cells in maintaining a macrophage niche in this tissue. We generated an in vivo system where fibroblast-derived Colony Stimulating Factor 1 (Csf1) was constitutively eliminated in Pi16+ fibroblasts by crossing animals with a Csf1fl/fl allele to mice in which the gene Pi16 drives an IresCre cassette. Deletion of Csf1 in Pi16+ fibroblasts resulted in significant diminishment of CD64+ and CD11c+ macrophages alongside expansion of PDPN+YFP+ fibroblasts. Alterations in cell population dynamics coincided with thickening of both the dermis and fascial compartments of the skin. Deletion of Csf1 in Pi16+ fibroblasts delayed early wound healing in a unsplinted mouse model. Loss of PI16+ fibroblasts was observed in individuals with limited (lSSc) and diffuse (dSSc) systemic Scleroderma compared to healthy controls. These findings suggest that loss of Csf1 in Pi16+ fibroblasts elicit changes in the population dynamics of skin macrophages and modifications to tissue architecture.

Communication between various cell types following wounding is paramount for proper healing and regeneration of injured tissue. Endothelial cells and fibroblasts are critical cellular players involved in cutaneous wound repair, yet their communication mechanisms are not well understood. It has previously been shown that extracellular vesicles derived from endothelial cells (ECEVs) induce dermal fibroblasts to express a gene signature correlated with FGF2-mediated cancer associated fibroblast (CAF) activation, under the control of transcription factor ETV1. In this report, we utilize loss-of-function studies to define the mechanistic role of ETV1 in conferring this ECEV-induced transcriptomic shift and functional change in fibroblasts. Additionally, we identify highly expressed ECEV microRNAs and examine their potential contribution to the ECEV mechanism through downstream gene modulation. In summary, we describe a plausible mechanism by which both ETV1 and top ECEV microRNAs promote a genotypic and phenotypic shift in dermal fibroblasts that have taken up ECEVs.

miR-378a-3p has been reported to be upregulated in the lesional skin of patients with atopic dermatitis (AD); however, its function in AD remains unclear. Here, we demonstrate that miR-378a-3p expression is induced by IL-4 and live Staphylococcus aureus (S. aureus) in normal human epidermal keratinocytes (NHEKs) cultured in proliferative conditions or in a 3D epidermal culture model. Transcriptomic profiling and gene set enrichment analysis of miR-378a-3p-transfected NHEKs revealed positive enrichment of inflammatory response pathways alongside downregulation of genes associated with epidermal development. More specifically, miR-378a-3p enhanced expression of multiple NF-{kappa}B-dependent inflammatory mediators, accompanied by increased phosphorylation of p65, indicating activation of canonical NF-{kappa}B pathway. Notably, miR-378a-3p concomitantly reduced the expression of several NF-{kappa}B family members and upstream adaptor molecules, supporting a model in which miR-378a-3p promotes canonical NF-{kappa}B activity through coordinated modulation of multiple components within the NF-{kappa}B regulatory network. In NHEKs exposed to live S. aureus, miR-378a-3p significantly increased the secretion of IL-1{beta}, IL-1Ra, and IL-8, indicating that miR-378a-3p may amplify innate immune responses triggered by S. aureus colonization in AD. Collectively, these findings identify miR-378a-3p as a positive regulator of keratinocyte inflammatory responses that may contribute to AD exacerbation, particularly in the context of S. aureus colonization.

The microbial and biochemical landscape of clinically normal-appearing skin in individuals with acne remains uncharacterized. Here, we performed longitudinal multi-omics profiling of facial skin from 10 individuals with moderate acne and 10 healthy controls, integrating 16S rRNA gene sequencing, shotgun metagenomics, and untargeted metabolomics across lesional and non-lesional sites. Compositional tensor factorization revealed that non-lesional acne skin occupies a distinct intermediate state between healthy and lesional skin in both the microbiome and the metabolome. Machine learning models distinguished healthy from non-lesional acne skin with 70% accuracy, demonstrating that molecular dysbiosis occurs in areas of the skin without visible lesions. Non-lesional sites exhibited reduced microbial diversity, strain-level shifts in Corynebacterium and Lawsonella correlating with disease severity, and metabolic alterations, including elevated lipids and perturbed amino acid and dipeptide profiles. Microbe-metabolite co-occurrence network analyses revealed that healthy skin is enriched for protective metabolites such as urocanic acid, while acne-associated skin shows distinct co-occurrence patterns. These findings establish that acne represents a field effect disorder, with molecular alterations extending beyond visible lesions to encompass the entire facial skin ecosystem. This molecular signature of pre-lesional skin provides potential biomarkers for early intervention and suggests that effective acne treatment may require holistic approaches targeting the broader skin environment rather than individual lesions alone.

The pathogenesis of systemic sclerosis (SSc) involves immune system dysregulation and progressive multi-organ fibrosis. Aberrant interleukin-23 (IL-23) function is linked to many inflammatory conditions. Tildrakizumab, a humanized monoclonal antibody that binds to the p19 subunit of IL-23 to block its interaction with the IL-23 receptor, is FDA-approved for treating psoriasis. IL-23 levels are increased in SSc patients with lung involvement, but the pathogenic role of IL-23 in SSc fibrosis remains unclear. We examined IL-23 expression in SSc skin biopsies and assessed the effects of IL-23 inhibition in an in vivo fibrosis model. We found increased IL-23 expression in SSc compared to healthy skin biopsies. Pharmacological blockade of IL-23 signaling using tildrakizumab reversed experimental skin and lung fibrosis. Our findings support a pathogenic role of IL-23 in SSc and suggest that tildrakizumab could be a novel antifibrotic treatment strategy for SSc and related fibrotic disorders. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=162 SRC="FIGDIR/small/701821v1_ufig1.gif" ALT="Figure 1"> View larger version (37K): org.highwire.dtl.DTLVardef@777c8aorg.highwire.dtl.DTLVardef@9163f5org.highwire.dtl.DTLVardef@1399a54org.highwire.dtl.DTLVardef@c30ec2_HPS_FORMAT_FIGEXP M_FIG C_FIG

Despite a vast literature on the role of macrophages in wound healing, the role of dermal monocyte (Mo)-derived antigen presenting cells (APC) has received scant attention. Using scRNAseq and flow cytometry, we identify a population of APC that is prominent in wounds of non-diabetic mice but is reduced in wounds of diabetic mice. Using adoptive transfer experiments and Ccr2 knockout mice, we demonstrate that wound APC are derived primarily from Mo and that the diabetic wound environment inhibits differentiation of Mo into APC. We also show that Mo-specific Irf4 knockout mice exhibit reduced differentiation of Mo into APC, decreased levels of IL27 and numbers of activated Treg cells in wounds. and impaired wound healing. Importantly, adoptive transfer of bone marrow Mo that express Irf4 into wounds of Mo-specific Irf4 knockout mice rescued levels of wound APC and activated Treg, as well as wound healing. Local administration of recombinant IL27 into wounds of these mice also rescued levels of activated Treg in wounds, along with wound healing, Together, these findings identify a novel pathway in which IRF4 induces Mo differentiation into APC in wounds, which in turn produce IL27 that activates Treg to promote healing. This pathway is impaired in wounds of diabetic mice, which provides a novel target to improve diabetic wound healing.

BackgroundHuman leukocyte antigen (HLA)-C*06:02 is a major genetic risk factor for psoriasis and understanding the HLA-C*06:02-presented peptide antigen repertoire (immunopeptidome) in the skin of patients is crucial for identifying autoantigens. Yet, no skin immunopeptidome data from patients stratified by their HLA-C*06:02 status exists. ObjectiveWe analysed biopsies from lesional and non-lesional skin of patients with psoriasis vulgaris (n=12), guttate psoriasis (n=8), or from skin of healthy controls (n=16). MethodsHLA class I and class II peptide complexes were isolated by serial immunoprecipitation and HLA-bound peptides identified by liquid chromatography-tandem mass spectrometry. HLA-C*06:02 genotyping was performed by polymerase chain reaction. ResultsOver 99,000 non-redundant peptide ligands were identified across all samples. Substantially more HLA class I and class II peptides were detected in lesional psoriatic skin compared to matched non-lesional and healthy skin. Three peptides predicted to bind HLA-C*06:02, including MRASSFLIV from the known psoriasis marker peptidase inhibitor 3 (PI3), were identified in all lesions of HLA-C*06:02-positive patients but were rarely detected or absent in HLA-C*06:02-negative patient lesional skin and not detected at all in unaffected skin. Keratinocyte differentiation-associated protein (KRTDAP) was a notable source of lesion-specific HLA class II ligands contributing three out of six peptides detected in more than half of the lesional samples. ConclusionActive psoriatic lesions display an altered and expanded immunopeptidome compared to unaffected skin. We have identified numerous unreported, lesion-specific HLA-bound peptides and their source proteins. These findings offer insights into the pathobiology of psoriasis and provide a resource for future functional studies. CAPSULE SUMMARYA selection of immunopeptides is presented exclusively in lesional skin of HLA-C*06:02+ patients with psoriasis that may represent antigenic drivers of disease.

Stem cell niches are dynamic microenvironments that regulate tissue homeostasis. Epidermal stem cells (EpiSC) preferentially localize to concave regions of epidermal rete ridges, which serve as primary niches for stem cell maintenance. EpiSC number and functional integrity decline during chronological aging. A defining feature of aged skin is epidermal atrophy, in which the prominent rete ridges present in young skin become flattened. Whether such topographical alterations influence EpiSC homeostasis and differentiation remains unclear. To address this, we generated anatomically accurate rete ridge structures using 3D bioprinting of collagen matrices as an ex vivo model and compared EpiSC cultured within concave topography to those maintained on a flat matrix resembling aged skin. Transcriptomic analysis revealed that concave niches promoted keratinocyte differentiation, marked by increased type I and II keratin gene expression and downregulation of cell cycle-associated genes. ATAC-seq identified topography-dependent chromatin accessibility changes enriched for transcription factors regulating epidermal differentiation, including upregulation of KLF4 and GRHL3 and downregulation of SOX9, HOXA1, and ETS1. Consistently, aged human skin showed reduced KLF4 and GRHL3 and increased SOX9 compared with young skin. Our findings demonstrate that concave niche topography imposes a spatially defined EpiSC microenvironment that promotes differentiation, alters cell cycle, and when perturbed, potentially contributes to the aging process. We conclude that spatial localization within rete ridge regions significantly affects epidermal progenitor stemness properties as fundamental differences in the physical microenvironment appear to influence cell fate decisions, thus, form shapes function of EpiSC.

Neuropathic pain is a debilitating condition afflicting millions worldwide, still lacking a proper and effective treatment. Understanding the underlying mechanisms that lead to neuropathic pain may lead to the discovery of new targets. Previously, we found that PLC{square} is a key player in mechanical hypersensitivity triggered by either capsaicin or complete Freunds adjuvant induced inflammation. Here, we investigated the role of PLC{gamma} in neuropathic pain using a partial sciatic nerve ligation (PSNL) injury model in male mice and a peptide inhibitor of PLC{gamma} activation (TAT-pQYP) injected at different time points after injury. Mechanical hypersensitivity was reversed by TAT-pQYP at 7, 14, and 28 days post-injury (dpi). Furthermore, both TAT-pQYP and the TRPA1 inhibitor HC-030031, but not the TRPV1 inhibitor capsazepine, were able to reverse mechanical hypersensitivity at 14 dpi. In contrast, all three treatments significantly improved the mechanical threshold at 28 dpi. After a challenge with TRPV1 agonist capsaicin at 14 dpi, TAT-pQYP treated animals exhibited increased sensitivity. We also found decreased TRPV1 mRNA levels in the DRG of PSNL animals at 14 dpi that returned to baseline at 28 dpi. TAT-pQYP treatment normalized TRPV1 expression to sham levels at 14 days. Conversely, TRPA1 mRNA expression increased at 14 days and returned to baseline at 28 days, while TAT-pQYP reduced TRPA1 expression at 14 days. At this same time point, injection of a pan-PLC (U73122), or Trk (GNF-5837) inhibitor reduced mechanical hypersensitivity and decreased Trpa1 expression, whereas only PLC{square} inhibition by TAT-pQYP or Trk inhibition restored Trpv1 levels to Sham values. These findings indicate that PLC{gamma}, and Trk signaling are important for expression of Trpa1 and activity of Trpv1. Taken together, our results show that dynamic changes in Trpv1 expression in the PSNL model account for differential sensitivity to TRPV1 inhibition and suggest that clinically relevant pharmacological inhibitors targeting ion channels may vary in efficacy depending on the temporal regulation of expression during neuropathic pain development. Finally, we show that TAT-pQYP is able to reverse mechanical hypersensitivity arising from neuropathic pain, adding evidence that PLC{gamma} is a promising target to be explored for neuropathic pain management. Significance statementWe show that the efficacy of inhibiting TRPV1 or TRPA1 on neuropathic pain in a partial sciatic nerve ligation model and that pain mitigation depends on the dynamic changes of channel expression post-injury, in the dorsal root ganglion, emphasizing that temporal regulation of drug targets should be taken into account when choosing therapeutic strategies for pain treatment. Notably, we identify PLC{gamma} as a promising therapeutic target, as its inhibition with TAT-pQYP reverses mechanical hypersensitivity during different stages of injury progression by modulating expression and activity of TRP channels.

Background: Human papillomaviruses (HPVs) pose a severe threat to global public health by driving nonmelanoma skin cancer (NMSC) and cervical cancer, with NMSC being one of the most common cancers worldwide. Epidermodysplasia verruciformis (EV) is an inborn error of immunity characterized by an increased susceptibility to persistent infection of cutaneous HPV and a high risk of NMSC. The genetic basis remains unknown in many patients with EV. Methods: We collected four unrelated pedigrees with EV. Genetic analysis identified five variants in JAK1 encoding the Janus kinase 1. Ex vivo models and patient-derived tissue were employed to evaluate the functional effects of JAK1 variants and delineate the pathogenic mechanisms. Results: We identified different variants in JAK1 in four pedigrees with dominant EV. Genetic analysis revealed five novel variants in JAK1, three of which resulted in nonsense-mediated mRNA decay (NMD). Functional assays identified a decreased phosphorylation of the signal transducers and activators of transcription (STATs), impaired interferon responses, and defective T cell activation. Immune dysregulation in patients, characterized by a reduced CD4/CD8 T cell ratio, decreased CD8 naive T cell proportion, and accumulated memory T cells, implies impaired antiviral immunity against HPV. Conclusions: Our findings confirm that JAK1 loss-of-function (LOF) variants underlie susceptibility to cutaneous HPV infection. [Funded by the National Natural Science Foundation of China (81788101, 81230015, 82394420, and 82394423), the National Key Research and Development Program of China (2022YFC2703900), the CAMS Innovation Fund for Medical Sciences (2021-I2M-1-018), and the Regione Lombardia, Italy (Innovative Research Project 1137-2010)].

Neutrophilic skin diseases, including Behcet disease, Sweet syndrome, pyoderma gangrenosum (PG), and epidermolysis bullosa acquisita (EBA), are characterized by an exaggerated inflammatory response following mechanical skin stimulation, yet the underlying mechanisms remain unclear. We identify adenosine triphosphate (ATP) released from keratinocytes as a key mediator of this phenomenon, promoting neutrophil extracellular trap (NET) formation. Using an EBA murine model as a model of neutrophilic skin disease, where scratching (a prototypic mechanical stimulation) exacerbates lesional severity, we observed abundant NET deposition in lesional skin. Degradation of these NETs with DNase1 reduced clinical and histopathological severities. In vitro, purified NET components increased IL-8 secretion from keratinocytes and fibroblasts, suggesting that NETs amplify inflammation via a self-amplifying loop of neutrophil recruitment. In the EBA mouse, scratch restriction with neck collars not only attenuated clinical and histological disease severities but also decreased lesional NETosis and neutrophils. Mechanistically, keratinocytes released ATP in response to mechanical stress in vitro, and pharmacologic purinergic blockade in the EBA mice with suramin phenocopied the protective effects of scratch restriction. While ATP alone did not induce NETosis, ATP enhanced complement component 5a (C5a)-induced NET formation in vitro. These findings indicate that keratinocyte-derived ATP, released in response to mechanical stress, contributes to NETosis in a C5a-dependent manner, thereby exaggerating neutrophilic inflammation, leading to blistering and further NETosis. Histopathological analyses of EBA and PG cases also demonstrated NETs accumulation localized to the upper dermis, suggesting a conserved ATP-NET axis. Targeting this pathway may represent a promising therapeutic strategy for neutrophilic skin diseases.

Systemic sclerosis (SSc) is an autoimmune disease characterized by excessive fibrosis and tissue stiffness, in which monocytes and macrophages are increasingly recognized as key contributors to pro-fibrotic myofibroblast formation and activation, although the underlying mechanisms remain incompletely understood. Here, we used a three-dimensional (3D) skin model to study how CD14+ monocytes, M1 and M2-like macrophages induce (myo)fibroblasts activation/contraction in collagen type I hydrogels. We identified that co-culture of fibroblasts with monocytes displayed strong spontaneous hydrogel contraction, coupled with an upregulation of myofibroblasts activation-associated markers, such as -SMA and fibroblast activation protein. Using transcription-factor reporter constructs and small molecules inhibitors, we demonstrated that monocyte-fibroblast communication was mediated by JAK/STAT3 and TGF-{beta}/Smad2/3 signaling pathways. Flow cytometry analyses revealed that monocytes, after interacting with fibroblasts, differentiated into a mixed M1/M2 polarization phenotype, characterized by CD163, CD206, CD86, and HLA-DR expression. Both M1 and M2-like macrophages promoted significant myofibroblast contraction, which could be mimicked by supernatant transfer. TGF-{beta} neutralization but not IL-6 blocking abolished this effect. This study demonstrates that monocytes/macrophages can strongly induce (myo)fibroblasts activation/contraction. Together, our work contributes to elucidating pathways and mechanisms associated with skin fibrosis in SSc and paves the way for developing new platforms for targeted therapy testing.

Background: Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disease associated with clinical, psychosocial, and economic burden. Accurate severity assessment is essential for guiding treatment escalation and monitoring disease activity, yet clinician-based scoring systems such as the Eczema Area and Severity Index (EASI) are limited by subjectivity and considerable inter- and intra-rater variability. Erythema, a key driver of AD severity grading, is particularly prone to inconsistent evaluation due to differences in ambient lighting, device quality, skin tone, and rater experience, underscoring the need for objective, reproducible assessment tools. Objective: To develop and validate an artificial intelligence (AI) pipeline for grading erythema, excoriation, and lichenification severity in AD from clinical photographs. The study evaluated the level of agreement between AI severity ratings in each category against dermatologists, non-specialists, and a consensus reference standard, with erythema as the primary outcome of interest. Methods: A two-stage AI pipeline was developed using EfficientNet B7 convolutional neural networks (CNNs). The first CNN was trained as a binary AD classifier on 451 AD and 601 non-AD images for lesion detection and segmentation. The second CNN was trained on 173 dermatologist-annotated AD images which were scored on a 0-3 ordinal scale for erythema, excoriation, and lichenification. This CNN had a downstream feature extraction algorithms such red channel contrast for erythema, Law's E5L5 for excoriation, and S5L5 texture maps for lichenification. In a cross-sectional validation study, 41 independent test images were scored by two blinded dermatologists and two blinded physicians. AI predictions were compared to individual rater groups and mode-derived consensus scores using weighted Cohen's kappa, classification accuracy, confusion matrices, and error direction analyses. Results: On internal validation, the severity CNN achieved 84% overall accuracy (averaged across all three attributes), 86% sensitivity, 87% specificity, and a macro-averaged area under the receiver operating characteristic curve (AUC) of 0.90. In the external comparison with blinded human raters, erythema agreement between the AI and dermatologist consensus was substantial (accuracy 80.7%; kappa = 0.68), with no large (>2-point) misclassifications. Physician consensus agreement was lower (accuracy 54.8%; kappa = 0.34), reflecting greater variability among primary care physicians (non-specialists). For excoriation, AI-dermatologist agreement was moderate (accuracy 72.4%; kappa = 0.62); for lichenification, agreement was similar (accuracy 71.4%; kappa = 0.59). Across all features, disagreements were predominantly between adjacent severity categories. The AI was able to generate erythema severity grades for images of darker skin tones that dermatologists typically would not rate and were marked as "unable to assess". Limitations: The validation set was small (41 images), severe cases (score 3) were underrepresented, one rater participated in both training annotation and validation scoring, and sample size was insufficient for robust stratification by skin tone or body site. Conclusion: The AI pipeline demonstrated dermatologist-level accuracy for erythema scoring, consistent moderate agreement for excoriation and lichenification, and a potential advantage in assessing erythema on darker skin tones. These findings support its potential as a standardized, objective tool for AD severity assessment. Prospective validation in larger, more diverse cohorts is warranted.

Anchoring fibrils formed by collagen VII play a critical role in stabilizing the dermal-epidermal junction. The N-terminal non-collagenous (NC1) domain of collagen VII binds firmly to basement membrane components including collagen IV and has also been reported to interact with mesenchymal fibrillar collagens via its von Willebrand factor A-like domain 2 (A2 domain). To elucidate how collagen VII recognizes fibrillar collagen, we performed yeast two-hybrid screening using a triple-helical random peptide library, which resulted in the identification of a Met-Gly-{Phi} ({Phi}; aromatic amino acid residue) motif. Biochemical analysis with synthetic triple-helical peptides revealed a binding preference of Trp > Phe as the {Phi} residue by the A2 domain despite Trp being absent in native collagens. The crystal structure of the A2 domain in complex with the Nle (Met surrogate)-Gly-Trp-containing peptide revealed a unique mechanism by which two distinct hydrophobic pockets of the A2 domain accommodate the Nle and Trp residues corresponding to the Met-Gly-{Phi} motif, engaging all three chains of the triple helix. Subsequent molecular dynamics simulations demonstrated that the A2 domain recognizes the corresponding native Met-Gly-Phe motif in a similar manner, but with lower affinity, implying a transient interaction with mesenchymal collagens. The findings obtained in this work suggest models in which transient A2-triple helix interaction promotes the recruitment of collagen I and III fibrils into the arc-shaped structure of anchoring fibrils. This also provides a foundation for linking structural understanding to skin fragility diseases caused by collagen VII dysfunction.

Staphylococcus aureus plays a central role in the exacerbation of atopic dermatitis (AD), but the population structure and pathogenic determinants of strains colonizing AD patients remain poorly understood. It is unclear whether these strains mirror those circulating in the general community or whether specific clonal lineages are selectively adapted to the AD skin microenvironment. Data addressing this question are scarce, particularly in Portugal. In this study, we investigated the molecular epidemiology and pathogenic traits of S. aureus colonizing skin lesions in adult patients with AD in Portugal. We found that lesion-associated isolates belonged predominantly to the methicillin-susceptible S. aureus MSSA-ST398 clonal type, a lineage that is widely circulating in the Portuguese community, particularly among vulnerable populations, and that has also been implicated in severe human infections. Notably, isolates from this clonal type in AD harboured specific pathogenicity traits associated with skin barrier disruption, including hemolysin and urease production, which may contribute to their success as colonizers in AD. Our findings highlight that S. aureus colonization in AD arises from a dynamic interplay between community-level molecular epidemiology and disease-specific selective pressures. While circulating lineages provide the genetic background diversity, the AD skin microenvironment appears to shape which clones ultimately become dominant. Such an integrated perspective may help to inform future geographically tailored strategies aimed at limiting bacterial burden and preventing disease exacerbation in AD.

The continuous renewal of healthy epidermis depends on the finely regulated proliferation of basal keratinocytes and subsequent differentiation as the newly formed cells move upwards through the different layers of the epidermis. Perturbations in keratinocyte differentiation may lead to cornification disorders. We investigated seven dogs of different breeds belonging to four independent families that showed striking multifocal tree bark-like skin lesions. Histopathologically, lesional skin was characterized by pronounced epidermal and infundibular hyperkeratosis with epidermal and sebaceous gland hyperplasia. We therefore tentatively termed the phenotype phloiokeratosis, derived from the Greek word phloios for tree bark and keratosis indicating abnormal keratinization. Whole genome sequencing of DNA from affected dogs revealed four independent variants in the SUV39H1 gene encoding the SUV39H1 histone lysine methyltransferase, an H3K9 methyltransferase, which is involved in epigenetic silencing of chromatin. Phloiokeratosis is inherited as an X-chromosomal semi-dominant trait. Four of the affected dogs in our study were heterozygous females and had lesion patterns reminiscent of Blaschko lines. In two of them, trio analyses experimentally confirmed de novo mutation events in the SUV39H1 gene. Previously, Suv39h1-/- knockout mice had been reported to have normal skin. So far, no human patients with SUV39H1 loss-of-function variants have been reported. The findings in SUV39H1 mutant dogs with phloiokeratosis for the first time link SUV39H1 deficiency to a heritable skin phenotype. Our study highlights the essential role of SUV39H1-mediated epigenetic silencing during normal keratinocyte differentiation and provides a unique model for further investigations. Author SummaryThe integrity of the skin depends on a balanced equilibrium of keratinocyte proliferation, differentiation, and sloughing of terminally differentiated cells into the environment requiring finely regulated changes in the global transcriptome of differentiating keratinocytes. We investigated seven dogs belonging to four different families with a new disorder of cornification characterized by tree bark-like outgrowths of the epidermis. Histopathological examinations confirmed that the outermost layer of the epidermis was thickened in affected dogs. The genetic analysis yielded four different SUV39H1 loss-of-function variants in the affected dogs from the four families. The SUV39H1 gene encodes an enzyme that is involved in the epigenetic silencing of chromatin. The newly characterized inherited skin disease in dogs is the first clinical phenotype that has been linked to SUV39H1 deficiency. Most likely, SUV39H1 deficiency leads to delayed epigenetic silencing and consequently delayed differentiation of keratinocytes. Dogs with this rare skin disease provide an improved understanding of the essential role of SUV39H1 in the epigenetic control of gene expression in skin.