Energy-based body contouring is a rapidly emerging field across the United States. Capable of promoting targeted fat loss, skin tightening, cellulite reduction and increased lean muscle mass, these modalities can serve i...Energy-based body contouring is a rapidly emerging field across the United States. Capable of promoting targeted fat loss, skin tightening, cellulite reduction and increased lean muscle mass, these modalities can serve in some cases as safe and less invasive alternatives to surgical interventions. Given their rapidly growing prevalence, it is important for esthetic physicians to keep current with advances in these technologies and adapt their therapeutic toolkits to include them to effectively guide patients in achieving their desired body goals.
Microfocused ultrasound with visualization (MFU-V) represents a noninvasive energy-based modality for skin tightening and lifting. This technology delivers precise ultrasound energy to dermal and subdermal tissues, creat...Microfocused ultrasound with visualization (MFU-V) represents a noninvasive energy-based modality for skin tightening and lifting. This technology delivers precise ultrasound energy to dermal and subdermal tissues, creating thermal coagulation points that stimulate neocollagenesis and elastin regeneration. US Food Drug Administration-cleared for brow lifting, neck and submental tightening, and décolletage wrinkles, with recent 2025 clearance for abdomen and arms, MFU-V demonstrates efficacy across multiple anatomic regions with a favorable safety profile. The recent introduction of Ultherapy Prime offers enhanced visualization and processing capabilities, potentially improving treatment precision and patient comfort.
Onychomycosis is a chronic fungal infection of the nail apparatus that remains challenging to treat due to the poor permeability of the nail plate, prolonged treatment courses, and high recurrence rates. Device-based mod...Onychomycosis is a chronic fungal infection of the nail apparatus that remains challenging to treat due to the poor permeability of the nail plate, prolonged treatment courses, and high recurrence rates. Device-based modalities, including lasers, photodynamic therapy, plasma therapy, ultrasound, iontophoresis, and nail drilling, have emerged as potential adjunctive or alternative strategies to enhance therapeutic efficacy. While early studies suggest that these techniques may provide some clinical improvement and reduce fungal burden, the overall quality of evidence remains low. Nonetheless, device-based interventions represent a promising frontier in the management of onychomycosis.
Laser and energy-based devices play an expanding role in acne management by targeting sebaceous hyperactivity, vascular inflammation, and microbial colonization. While light-based systems provide modest benefit in mild d...Laser and energy-based devices play an expanding role in acne management by targeting sebaceous hyperactivity, vascular inflammation, and microbial colonization. While light-based systems provide modest benefit in mild disease, thermal near-infrared lasers offer indirect sebaceous suppression. Lipid-selective 1726 nm technology represents a biologically aligned advancement with promising clinical outcomes. Fractional and radiofrequency platforms remain primarily indicated for acne scar remodeling. This review critically examines mechanistic rationale, clinical evidence, safety considerations, controversies, and future directions within a phenotype-driven therapeutic framework.
Fractional laser therapy has emerged as a mechanistically targeted, device-based option for androgenetic alopecia (AGA), leveraging controlled dermal injury, wound-healing cascades, and laser-assisted drug delivery to pr...Fractional laser therapy has emerged as a mechanistically targeted, device-based option for androgenetic alopecia (AGA), leveraging controlled dermal injury, wound-healing cascades, and laser-assisted drug delivery to promote hair follicle regeneration. Non-ablative erbium:glass systems at 1550 to 1565 nm and ablative platforms at 2940 and 10,600 nm activate hair follicle stem cells, upregulate Wnt/β-catenin signaling, enhance perifollicular vascularity, and modulate chronic perifollicular inflammation, translating into clinically meaningful gains in hair density and shaft diameter across male and female AGA. Head-to-head data show 1565 nm non-ablative fractional laser achieving superior short-term improvements in hair density and terminal hair counts.
Microcoring is a minimally invasive technique with a unique mechanism that involves excess skin removal and promotion of dermal remodeling. Microcoring uses hollow needles connected to vacuum suction to mechanically remo...Microcoring is a minimally invasive technique with a unique mechanism that involves excess skin removal and promotion of dermal remodeling. Microcoring uses hollow needles connected to vacuum suction to mechanically remove precise columns of skin and induce scarless healing. It has shown clinical promise in rhytid reduction, skin rejuvenation, and scar revision. Unlike energy-based devices, microcoring does not involve heat, accounting for its improved safety profile, particularly in skin of color. Its safety and effectiveness make it a promising option for cosmetic and reconstructive procedures, and a viable alternative to higher risk and more invasive surgical interventions.
Melasma is a chronic pigmentary condition with a multifactorial pathophysiology, involving melanin overproduction, photoaging, and hormonal factors, making treatment challenging. Lasers and light-based devices, including...Melasma is a chronic pigmentary condition with a multifactorial pathophysiology, involving melanin overproduction, photoaging, and hormonal factors, making treatment challenging. Lasers and light-based devices, including intense pulsed light, photobiomodulation, Q-Switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, nanosecond laser, picosecond laser, nonablative fractional laser and ablative fractional laser have shown promise results, yet no single modality offers a definitive solution. Combination therapies, including oral or topical agents and lasers, yield better results. Maintenance treatment is crucial to prevent recurrence. Despite advancements, laser treatments must be approached cautiously due to risks like postinflammatory hyperpigmentation, especially in darker skin types.
Hyperdilute calcium hydroxylapatite ([CaHA]; Radiesse, Merz Aesthetics) has emerged as a versatile biostimulatory agent for skin rejuvenation across facial and body regions. By attenuating immediate volumizing effects wh...Hyperdilute calcium hydroxylapatite ([CaHA]; Radiesse, Merz Aesthetics) has emerged as a versatile biostimulatory agent for skin rejuvenation across facial and body regions. By attenuating immediate volumizing effects while enhancing product spread and fibroblast interaction, hyperdilution emphasizes long-term neocollagenesis, neoelastogenesis, and extracellular matrix remodeling over large treatment fields. Consensus recommendations and emerging clinical data demonstrate favorable safety and efficacy for addressing laxity in facial and off-face sites, including the glutes, arms, and abdomen. This article synthesizes current evidence, practical dosing and dilution strategies, and technique pearls for optimizing hyperdilute CaHA outcomes across anatomic regions.
Platelet-rich plasma (PRP) has become an important therapeutic tool in dermatology, with expanding applications in both medical and cosmetic practice. This article highlights the wide variety of PRP preparation and deliv...Platelet-rich plasma (PRP) has become an important therapeutic tool in dermatology, with expanding applications in both medical and cosmetic practice. This article highlights the wide variety of PRP preparation and delivery devices, emphasizing how centrifugation protocols, device design, and administration techniques influence platelet concentration, safety, and clinical outcomes. Options such as microneedling, mesotherapy, needleless systems, and supportive anesthetic devices allow for individualized treatment approaches, while emerging technologies like artificial intelligence promise more objective monitoring. Understanding these differences enables dermatologists to optimize PRP quality, enhance patient comfort, and achieve reproducible results in practice.
Androgenetic alopecia is the most common cause of progressive hair loss and has substantial impact on quality of life. Conventional treatments, including minoxidil and finasteride, are limited by variable response rates...Androgenetic alopecia is the most common cause of progressive hair loss and has substantial impact on quality of life. Conventional treatments, including minoxidil and finasteride, are limited by variable response rates and side effects. Exosomes, which are nanosized extracellular vesicles involved in cell-cell communications, have emerged as promising candidates in hair restoration. Preclinical studies indicate that exosomes can enhance hair follicle regeneration by promoting dermal papilla and outer root sheath cell proliferation and migration, increasing follicle bulb size and hair shaft elongation. Early clinical data are encouraging, but further trials are needed to establish optimal dosing and standardized protocols.
This article reviews the current state and future directions of digital dermatopathology, highlighting the role of whole-slide imaging (WSI) and artificial intelligence (AI). WSI can improve diagnostic accuracy, facilita...This article reviews the current state and future directions of digital dermatopathology, highlighting the role of whole-slide imaging (WSI) and artificial intelligence (AI). WSI can improve diagnostic accuracy, facilitate remote consultation, and enhance trainee education through virtual slide platforms. AI tools, particularly deep learning and convolutional neural networks, aid in diagnosis, triage, and prognostication, with accuracy often comparable to expert pathologists. Challenges remain, including high implementation costs, variability in image quality, and consequently, biases in algorithm learning. Continued real-world validation, cost analysis, and physician involvement are essential for integration into clinical practice.
Reemerging infectious diseases remain a growing global concern. Infections such as monkey pox and syphilis have resurfaced with changing clinical patterns and broader geographic spread. Surveillance data suggest that a s...Reemerging infectious diseases remain a growing global concern. Infections such as monkey pox and syphilis have resurfaced with changing clinical patterns and broader geographic spread. Surveillance data suggest that a significant number of suspected cases actually represent umbilicated lesions of herpetic origin, and histopathologic or other laboratory confirmation of the diagnosis is critical.
Primary cutaneous T-cell and B-cell lymphomas may occur at any age and are defined by specific clinical, histopathologic, and immunophenotypic features. Clinical correlation is critical to differentiate indolent and aggr...Primary cutaneous T-cell and B-cell lymphomas may occur at any age and are defined by specific clinical, histopathologic, and immunophenotypic features. Clinical correlation is critical to differentiate indolent and aggressive entities, such as the lymphomatoid papulosis subtypes, which may have histopathologic and immunophenotypic features that are indistinguishable from aggressive cutaneous T cell lymphomas. Awareness of mycosis fungoides variants that overlap with benign conditions may help prevent misdiagnosis. Lymphoproliferative disorders do not require aggressive treatment or extensive staging. Watchful waiting is often appropriate.
Onychopathology (nail unit pathology) is a niche area in dermatopathology. There is a lack of familiarity with nail unit pathology and basic anatomy in general among pathologists and dermatopathologists, because of the r...Onychopathology (nail unit pathology) is a niche area in dermatopathology. There is a lack of familiarity with nail unit pathology and basic anatomy in general among pathologists and dermatopathologists, because of the relative rarity of such specimens in practice, and the lack of exposure and teaching regarding these lesions in training. It is however a vibrant area of dermatopathology, with knowledge evolving rapidly. In this article, we explore new information in the analysis of melanocytic and epithelial lesions of the nail unit, as well as nail inflammatory disease.
Autoimmune blistering diseases (AIBD), an immunologically diverse group associated with intraepithelial or subepithelial blistering, can present with protean clinical or histopathologic findings. Accurate diagnosis is im...Autoimmune blistering diseases (AIBD), an immunologically diverse group associated with intraepithelial or subepithelial blistering, can present with protean clinical or histopathologic findings. Accurate diagnosis is important to predict clinical course, stratify risk for certain associated systemic conditions, and determine patient eligibility for various therapies. While helpful clues can be gleaned from microscopic evaluation of tissue, definitive diagnostic changes are not always present. Therefore, it is important for clinicians and dermatopathologists to recognize the various clinicopathologic manifestations of AIBD, as well as the value and limitations of legacy and novel ancillary testing modalities.
Disorders of pigmentation in individuals with skin of color (SOC) are frequently encountered in dermatologic practice and often pose diagnostic and therapeutic challenges. These conditions can lead to significant psychos...Disorders of pigmentation in individuals with skin of color (SOC) are frequently encountered in dermatologic practice and often pose diagnostic and therapeutic challenges. These conditions can lead to significant psychosocial distress and reduced quality of life. This review provides an in-depth analysis of pigmentary disorders in SOC, emphasizing their clinical manifestations, histopathologic features, and pathophysiologic mechanisms. Additionally, the review highlights pigmentary mimics of disorders, with inflammatory or systemic associations, and emphasizes histopathologic characterization to improve diagnostic precision and support patient-centered care.
In this article, we discuss the clinical and histopathologic findings of cutaneous adverse reactions to newer medications, including those recently approved to treat inflammatory skin diseases, such as dupilumab for atop...In this article, we discuss the clinical and histopathologic findings of cutaneous adverse reactions to newer medications, including those recently approved to treat inflammatory skin diseases, such as dupilumab for atopic dermatitis and IL-12/-23 and IL-23 specific inhibitors for psoriasis, as well as those with oncologic indications, including immune checkpoint inhibitors, mogamulizumab, and enfortumab vedotin.
This article reviews best practices and high-yield advances in the pathologic interpretation of alopecia. It emphasizes the use of horizontal sectioning and biopsy optimization utilizing trichoscopy within watershed zone...This article reviews best practices and high-yield advances in the pathologic interpretation of alopecia. It emphasizes the use of horizontal sectioning and biopsy optimization utilizing trichoscopy within watershed zones of alopecia. The evolving understanding of sebaceous gland atrophy is reviewed, and the paucifollicular unit is highlighted as a diagnostic feature of traction alopecia. Attention is focused on the underrecognized fibrosing alopecia in a pattern distribution and the classification of alopecic and aseptic nodules of the scalp. Finally, this article underscores the prevalence of multifactorial alopecia and the need for integrated clinical-pathologic correlation to improve diagnostic accuracy and patient outcomes.