News and Trends: Dermatology Updates and More

Psoriasis and Type 2 Diabetes: Review Highlights Bidirectional Inflammatory Link and Need for Integrated Management

Jessica Garlewicz

A systematic review, published in Minerva Medica, has reinforced the strong bidirectional relationship between psoriasis and type 2 diabetes mellitus, emphasizing the importance of multidisciplinary strategies that address both dermatologic and metabolic components of care. The findings highlight the role of shared inflammatory pathways and the potential for integrated treatment approaches to improve patient outcomes. 

“Evidence consistently showed an increased prevalence of type 2 diabetes among psoriasis patients,” the authors reported, underscoring a well-established epidemiologic link. The review analyzed observational studies and clinical trials across all age groups and genders, with a focus on inflammatory mechanisms and therapeutic interventions relevant to both conditions.¹ 

Central to the pathophysiologic connection is the IL-23/IL-17 axis, which contributes to chronic inflammation in psoriasis and simultaneously drives insulin resistance. “The IL-23/IL-17 axis plays a critical role in the inflammation driving both psoriasis and insulin resistance,” the study stated.¹ Inflammatory cytokines not only contribute to psoriatic lesions but also promote components of metabolic syndrome, such as obesity. In turn, obesity and insulin resistance exacerbate systemic inflammation, forming a feedback loop that perpetuates both diseases.¹ 

This cycle has critical implications for long-term disease progression and comorbidity management. According to the authors, “Insulin resistance and obesity amplify systemic inflammation, creating a vicious cycle in psoriasis patients.”¹

The review also identified promising approaches for simultaneous management. Integrated therapeutic strategies—combining targeted pharmacologic treatments like biologics with lifestyle modifications such as diet and exercise—showed benefit in addressing both cutaneous and metabolic disease features. These combined strategies offer dual benefits: controlling skin symptoms while improving glycemic control and metabolic health.¹

“Integrated treatment approaches, combining targeted pharmacologic therapies with lifestyle modifications, demonstrated potential in managing both conditions effectively,” the authors wrote.¹ The findings strongly support a collaborative care model, involving multiple subspecialties.

For practitioners, the study reinforces the importance of screening patients with psoriasis for metabolic risk factors and working in partnership with other specialties. The authors concluded, “Integrated therapeutic strategies that include lifestyle changes and targeted drug interventions show promise in improving outcomes for individuals affected by both conditions.”

The review calls attention to the clinical need for proactive, cross-disciplinary care in managing the systemic burden of psoriasis, especially in patients with or at risk for type 2 diabetes. 

Editor’s Note: This piece is modified from its original appearance in The Dermatologist and is shared with permission.The original can be found at https://tinyurl.com/2kbnau82.  

Reference

1. De Luca DA, Papara C, Hawro T, Thaçi D. Psoriasis and diabetes: a review of the pathophysiological and therapeutic interconnections. Minerva Med. 2025;116(3):195-222. doi:10.23736/S0026-4806.24.09570-3

A Rare Presentation of Severe Pedal Epithelial Desquamation 

Lindsey M. Kanno, DPM and Katherine M. Perscky, DPM, FACFAS

Invasive candidiasis is a serious fungal infection most often affecting immunocompromised individuals, typically targeting internal organs or mucosal sites. However, cutaneous manifestations are rare, particularly those involving extensive epithelial desquamation. A recent case report presented as a poster at the American Podiatric Medical Association (APMA) National 2025 describes an unusual dermatologic presentation of invasive
candidiasis affecting the foot and underscores the importance of early identification and aggressive management in vulnerable patients.¹

This poster presentation highlights a rare presentation of invasive candidiasis manifesting as full-thickness epithelial shedding of the right foot of a 50-year-old immunocompromised male with multiple comorbidities, including diabetes and a history of organ transplantation. The patient presented with severe desquamation, erythema, edema, and skin sloughing, along with superimposed gangrene and osteomyelitis of the first and second digits. His labs showed mild leukocytosis, and mild elevations in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) but had no fever or systemic symptoms. Immediate intervention included culture (which was positive for Candida parapsilosis), surgical source control and coordinated medical treatment and monitoring.¹ 

The authors noted that the initial presentation was not unlike toxic epidermal necrolysis. The patient received systemic liposomal amphotericin B treatment, as well, and oral fluconazole once sensitivities were available. That antifungal course plus local postoperative wound care eventually resulted in resolution of inflammation and infection, along with wound healing. Over 18 months of follow-up, he did not experience any recurrences or additional complications.¹ 

The researchers emphasize that extensive desquamation in an immunocompromised patient served as a critical diagnostic clue. They advocate for early diagnosis, histopathological confirmation, and prompt, aggressive antifungal therapy, along with appropriate local wound care and/or surgical intervention as necessary to prevent systemic spread. Maintaining a broad differential that includes exfoliative dermatoses is also an important takeaway from the poster. 

Reference

1. Kanno LM, Perscky KM. Invasive candidiasis presenting as severe desquamation of the
epithelial layer of the foot: a rare cutaneous manifestation. Poster presented at the APMA National. July 24-26, 2025, Grapevine, TX.

Challenging the Paradigm of the Parabola Post-Transmetatarsal Amputation

Craig J. Verdin, DPM, DABPM, AACFAS

A recent award-winning oral abstract presented at the 2025 American Podiatric Medical Association National conference showcased findings after investigating if the residual parabola post-transmetatarsal amputation truly has an impact on patient function and final outcomes.¹ Craig J. Verdin, DPM, DABPM, AACFAS, lead author of the study, shares his team’s thinking, research details, and how they feel this knowledge could impact treatment choices.

The idea of this study was largely inspired by the current paradigm shift we are seeing within the limb salvage literature in which function is becoming recognized as an important tenet in limb salvage and preservation decision making. At Georgetown University, we are beginning to see improved outcomes when decision making is function-driven as opposed to length-driven through the use of patient reported outcome measures (PROMs), gait, and biomechanical assessments. With this in mind, as a fellow, I wanted to replicate landmark articles within the limb salvage literature, but from a functional perspective. 

My main inspiration for this article was an article by Bik and colleagues² that challenged the dogmatic belief that residual parabola shape in transmetatarsal amputations (TMAs) is related to outcomes. While that study found no relationship between residual parabola shape and clinical outcomes, the authors did not evaluate the functional effects of the residual parabolic shape. As a result, we wanted to confirm the findings from the aforementioned paper and challenge the historical and time-tested belief that length and a residual parabola that replicates the normal pedal parabola (Type 1) is superior, functionally and clinically. 

Details on the Research Process

To conduct this research, we performed a retrospective analysis over a 2-year period using our available PROM database at Georgetown University. In our study, we included patients with TMAs seen and evaluated at Georgetown University Hospital if they met inclusion criteria. In total, we identified 57 patients with unilateral TMAs who had the targeted functional and clinical complications data. All 57 TMAs were substratified based on parabola shape as demonstrated by Bik and team² and on length based on if the residual TMA apex was greater than or less than 50% of the preoperative length.

We subdivided clinical outcomes into major and minor complications and the 2 targeted PROMs were function as
assessed by the Lower Extremity Function Scale (LEFS) and quality of life (QoL) via the Short Form-12 (SF-12) questionnaire, both routinely administered to every patient seen within our clinic. Our team defined major complications as those requiring a return to the operating room and minor complications as clinically managed scenarios. 

With respect to complications, our findings showed that differing parabolic shapes had no significant effect on major complications.¹ However, in contrast to the findings by Bik and colleagues, we did find a weak but significant correlation between minor complications with TMAs, in which we noted that the residual second metatarsal was significantly longer than the neighboring metatarsals (Type 4). Based on a few studies within the ray amputation literature, these findings aren’t surprising, because there is a poor distribution of residual plantar pressures in the setting of an unbalanced residual parabola, which ultimately results in increased adverse outcomes as shown by Hong and team.³ 

In addition, we found that length had no significant impact on complications, major or minor. With respect to our targeted PROMs that assessed function and quality of life, it appears there is no relationship between residual TMA shape or length and increased access to function or QoL. 

Final Thoughts and Next Steps

Our research challenges the dogmatic and long-held belief that parabolic shape and length is as important as previously believed. As a result of this study, we believe that a “balanced” parabola, regardless of residual length and shape, should be targeted in an effort to encourage optimal functional and clinical outcomes. Even further, these findings raise the question of whether or not TMA variants/alternatives with maximal preservation of musculotendinous insertions such as a pandigital or “ray-preserving” TMAs as proposed by Suh and colleagues would be a more functional and superior means of midfoot amputation as opposed to the traditional technique as proposed by McKitrick and team in 1949.⁴ Regardless, we hope this information will be of value to the limb salvage community and can help shape existing function-based treatment algorithms all in an effort to optimize functional outcomes and help clinicians better understand the functional impact of limb salvaging interventions. 

References

1. Verdin CJ, Ply C, Lava C, et al. Radiographic predictors of functional and clinical outcomes in transmetatarsal amputations: Does the residual parabola structure truly matter? Oral abstract presented at the APMA National, July 24-27, 2025, Grapevine, TX.

2. Bik PM, Heineman K, Levi J, Sansosti LE, Meyr AJ. The effect of remnant metatarsal parabola structure on transmetatarsal amputation primary healing and durability. J Foot Ankle Surg. 2022;61(6):1187-1190.

3. Hong CC, Saha S, Pearce CJ. Does a shorter residual first metatarsal length after first ray amputation in diabetic patients leads to poorer outcomes - A risk factor study. Foot Ankle Surg. 2023;29(3):228-232.

4. Suh YC, Kushida-Contreras BH, Suh HP, et al. Is reconstruction preserving the first ray or first two rays better than full transmetatarsal amputation in diabetic foot?. Plast Reconstr Surg. 2019;143(1):294-305.

Systematic Review Examines Contributors to the Success of 3D-Printed Talar Implants 

Camellia Russell, MBA

What contributing factors play a role in outcomes for 3D-printed talar implants? A recent oral abstract presented at the 2025 American Podiatric Medical Association National conference addressed this question.The lead author, Camellia Russell, MBA, shared her teams’ findings with Podiatry Today.

Ms. Russell and colleagues designed their systematic review to investigate whether patient-specific factors (age, sex, and comorbidities) are predictors of success with 3D-printed talus implants.¹

“The role of 3D models in ankle reconstruction has been well studied, but the published data are frequently not stratified to account for patient-specific variables,” she noted. “We wished to analyze whether the “custom-fit” leads to a “better fit” regardless of the patient population, or if certain subsets of patients have better or worse surgical results and rates of complications.” 

She shared that they systematically reviewed the literature in PubMed, the Journal of Foot and Ankle Surgery, the Journal of the American Podiatric Medical Association, and the Cochrane and Scopus databases with key terms including “3-D talus modeling,” “total ankle replacement,” “patient outcomes,” and other variants.¹ They included literature between 2010 and 2024, focusing on randomized controlled trials, cohort, and case-control studies. They then extracted and collated themes around the comparison of recovery rates by age groups, anatomical differences by sex, and impaired healing in patients with various comorbidities.¹

“Our review identified that patient-specific factors play a crucial role in the success of 3D-printed talus implants,” said Ms. Russell. “Younger patients with healthier tissue and fewer comorbidities exhibited improved surgical outcomes and quicker recovery times. Conversely, older individuals and those with comorbid conditions such as diabetes, osteoporosis, or cardiovascular disease experienced higher complication rates. Furthermore, anatomical variations between male and female taluses affected implant fit and performance. These insights underscore that 3D modeling’s impact on customization and outcomes is not uniform across different patient demographics, underscoring the importance of tailored surgical planning.”

Utilizing this information, Ms. Russell and team advocated for DPMs to implement a more patient-centric approach to both surgical planning and ultimately to 3D-printed talus implant application.

“DPMs should not view 3D modeling as an automated process that is completely devoid of surgeon input,” she explained. “During the preoperative planning phase, a podiatric surgeon should consider several important demographic and health-related variables (such as the study factors of age, sex, and comorbidities). This can allow the surgeon to create a more patient-tailored design (if necessary), predict healing rates, and account for potential postop risk factors. This information can then be used to provide the highest standard of evidence-based, patient-centric care, while also reducing the risks of these complex surgical procedures.”

Reference

1. Russell C, Russell M; Birdwell T. The Effectiveness of 3-D Talus Modeling Varies By Patient Factors Like Age, Sex, and Comorbidities: A Systematic Review. Oral abstract presented at the APMA National, July 24-27, 2025, Grapevine, TX.