Brodalumab is a fully human monoclonal antibody targeting interleukin-17 receptor A (IL-17RA), providing a mechanistically distinct approach to inhibiting IL-17–mediated inflammation in plaque psoriasis and psoriat...Brodalumab is a fully human monoclonal antibody targeting interleukin-17 receptor A (IL-17RA), providing a mechanistically distinct approach to inhibiting IL-17–mediated inflammation in plaque psoriasis and psoriatic arthritis (approved in Japan). Across pivotal randomized trials and extensive real-world studies, brodalumab demonstrates a rapid onset of action, high rates of complete skin clearance, durable efficacy, and consistent effectiveness across diverse patient subgroups, while randomized and real-world data also support meaningful improvements in joint outcomes among patients with concomitant psoriatic arthritis. This review synthesizes clinical trial and real-world evidence to contextualize the efficacy, safety, and clinical positioning of IL-17RA blockade with brodalumab across the spectrum of psoriatic disease.
BACKGROUND: Malassezia folliculitis (MF), commonly referred to as "fungal acne" is a dermatological condition caused by colonization of the commensal fungus Malassezia, which turns pathogenic under certain conditions. MF...BACKGROUND: Malassezia folliculitis (MF), commonly referred to as "fungal acne" is a dermatological condition caused by colonization of the commensal fungus Malassezia, which turns pathogenic under certain conditions. MF presents as pruritic, erythematous papules and pustules and is often mistaken for other dermatological conditions, including acne vulgaris (AV). Interest in MF has intensified in recent years, likely due to social media trends, leading to concern regarding patients inappropriately applying antifungals without a confirmed diagnosis. METHODS: This narrative review summarizes the prevalence of MF, risk factors for the condition, MF pathogenesis, diagnosis, and treatment options. RESULTS: MF prevalence varies by geographic region and is higher in patients diagnosed with AV versus the general population. Risk factors include hot, humid weather, hair follicle occlusion, and immunocompromise. Increased sebum production, lipase activity, and inflammation contribute to the pathogenesis of both MF and AV. MF diagnosis includes clinical presentation and confirmatory tests such as direct microscopy and histopathology. The mainstay of treatment is antifungal medication, though given shared pathogenic mechanisms between AV and MF, acne topicals that target pathogenesis of both conditions, including benzoyl peroxide and retinoids, may be beneficial. CONCLUSION: Clinical presentation of MF resembles that of AV and other skin conditions, leading to misdiagnosis, delays in treatment, and persistence of MF in patients for years. This underscores the need for appropriate diagnosis and timely treatment. Given shared pathogenic mechanisms between AV and MF, further investigation of acne topicals that target the pathogenesis of both conditions for the treatment of MF is warranted.
BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) represents a significant clinical challenge in patients with locally advanced (laCSCC) or metastatic (mCSCC) disease who are not candidates for surgery or radiation. I...BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) represents a significant clinical challenge in patients with locally advanced (laCSCC) or metastatic (mCSCC) disease who are not candidates for surgery or radiation. In addition to PD-1 inhibitors, pembrolizumab and cemiplimab, cosibelimab, a PD-L1 inhibitor, has been recently approved by the US Food and Drug Administration (FDA) for laCSCC and mCSCC. Given its recent approval, practical guidance is needed to support clinician decision-making regarding cosibelimab's efficacy and safety. METHODS: A comprehensive literature review of PubMed and Google Scholar was completed for studies related to cosibelimab efficacy and safety in la and mCSCC. An expert panel of nine dermatologists with significant expertise in the treatment of cSCC gathered to review the articles and create consensus statements on the role of cosibelimab in managing laCSCC and mCSCC. A modified Delphi process was used to approve each statement, and the strength of recommendation was assigned using the Strength of Recommendation Taxonomy (SORT) criteria. RESULTS: The literature search produced over 200 articles that met the criteria, and a screening of the studies for relevance resulted in 13 articles. The panel developed six consensus statements, with five unanimously adopted with a strength of "A". CONCLUSION: Available data suggests that cosibelimab is an effective treatment for patients with laCSCC and mCSCC who are not candidates for surgery or radiation. Cosibelimab demonstrates a unique and favorable safety profile with no reported grade 4 or 5 immune-related adverse events after more than 2 years of follow-up.
Modern skin cleansers have evolved from basic soaps to advanced cleansing formulations that also provide moisturization and skin barrier support. Surfactants work by emulsifying oils and reducing surface tension, but the...Modern skin cleansers have evolved from basic soaps to advanced cleansing formulations that also provide moisturization and skin barrier support. Surfactants work by emulsifying oils and reducing surface tension, but they may disrupt essential lipids in the skin, leading to barrier damage and sensitivity. Advances in surfactant technology have enabled the development of cleansers that combine efficacy with improved tolerability, foaming aesthetics, and reduced environmental impact. This review summarizes the evolution of modern mild skin cleansing technologies with a focus on polymeric cleansing technologies (PCTs) and the preclinical and clinical evidence of their efficacy and tolerability in sensitive skin. In vitro and in vivo studies have demonstrated that hydrophobically modified polymers (HMPs) and sodium hydrolyzed potato starch dodecenylsuccinate (SHPSD; NATRASURF™ PS-111) reduce irritation potential and surfactant penetration into the skin relative to commercial mild cleansers, while providing effective cleansing performance with favorable tolerability. In a 4-week clinical study involving participants with sensitive skin, a combination of the PCTs HMP and SHPSD demonstrated good tolerability and improved aesthetic skin parameters without compromising cleansing efficacy. Properly formulated cleansers incorporating PCTs can provide superior tolerance, improved skin and aesthetic outcomes, and effective cleansing. The complementary properties of HMP and SHPSD enable flexible formulation strategies that optimize cleansing results in healthy and sensitive skin.
BACKGROUND: Squamous cell carcinoma in situ (isSCC) is an early-stage cutaneous malignancy that requires effective treatment to prevent progression to invasive SCC. Aminolevulinic acid photodynamic therapy (ALA-PDT) is a...BACKGROUND: Squamous cell carcinoma in situ (isSCC) is an early-stage cutaneous malignancy that requires effective treatment to prevent progression to invasive SCC. Aminolevulinic acid photodynamic therapy (ALA-PDT) is a noninvasive treatment that selectively targets neoplastic cells. This study evaluated the effectiveness, safety, and tolerability of ALA-PDT for the treatment of patients with facial isSCC. METHODS: In this single-center, investigator-initiated, open-label study (NCT06159842), adult patients with biopsy-confirmed facial isSCC received 2 treatments with 20% ALA and blue light exposure, administered 28 days (± 3 days) apart. Lesions were excised for histopathological assessment 8 weeks after the second treatment. The primary endpoint was complete histological clearance at the end of treatment (EOT). Secondary outcomes included clinical clearance and tolerability. RESULTS: A total of 32 patients were enrolled in this study, of whom 30 completed the study. All patients achieved complete histological clearance at EOT. Clinical clearance was observed in all patients prior to excision, with 40% achieving clearance by day 49 and the remainder by day 69. Local skin reactions, including erythema and flaking, were mild and resolved over time. Only 1 patient experienced temporary hyperpigmentation. Pain scores remained low (mean, 2.71/10). Two patients reported adverse events considered unrelated to treatment. CONCLUSIONS: ALA-PDT achieved 100% complete histological and clinical clearance with minimal adverse effects, demonstrating its potential as a safe, effective, and cosmetically favorable alternative to surgical excision for the treatment of facial isSCC. Further studies are needed to assess long-term recurrence rates and broader applications.
BACKGROUND: Melasma is an acquired pigmentary disorder characterized by symmetrical hyperpigmented macules and patches on sun-exposed areas, primarily the face. Kligman's formula, or "triple combination cream," is widely...BACKGROUND: Melasma is an acquired pigmentary disorder characterized by symmetrical hyperpigmented macules and patches on sun-exposed areas, primarily the face. Kligman's formula, or "triple combination cream," is widely used but has potential side effects. Metformin, an oral anti-diabetic agent, possesses anti-inflammatory and anti-oxidative properties, suggesting its possible role in melasma treatment. This study aims to compare the efficacy and safety of topical Metformin with Kligman’s formula in melasma treatment through a split-face design study. METHODS: This non-randomized, double-blind, split-face, comparative study included 57 patients with melasma over 12 weeks. Participants applied Kligman's formula to the right side of the face and topical metformin on the left side of the face at bedtime. Efficacy was assessed using melanin index measurements, physician global assessment, and patient satisfaction rates. Safety was evaluated by monitoring erythema, burning, and itching on both sides of the face. RESULTS: Of the 57 participants, 49 (86%) were female, and 8 (14%) were male. At baseline, the mean Hemi-MASI scores were 7.60 ± 3.44 (right) and 7.72 ± 3.45 (left). At month 3, scores significantly decreased to 3.30 ± 2.30 (right) and 3.81 ± 2.38 (left) (P<.001). The percentage reduction was significant on both sides, with 60.53 ± 15.65% (right) and 53.33 ± 14.88% (left). CONCLUSIONS: While Kligman’s formula demonstrated slightly better efficacy, both treatments reduced hyperpigmentation. Topical metformin could be an alternative for melasma patients with a lower risk of side effects.
BACKGROUND: Melanoma is the leading cause of skin-cancer-related mortality worldwide. Anti-programmed cell death protein-1 therapies, including pembrolizumab, play a critical role in treating advanced melanoma. However,...BACKGROUND: Melanoma is the leading cause of skin-cancer-related mortality worldwide. Anti-programmed cell death protein-1 therapies, including pembrolizumab, play a critical role in treating advanced melanoma. However, the optimal treatment duration remains undetermined. OBJECTIVE: To evaluate whether longer durations of pembrolizumab therapy improve overall mortality in stage III and stage IV melanoma. METHODS: We conducted a retrospective cohort study using the TriNetX platform, including 234 patients who received 24+ months of therapy (long-term) and 796 patients who received 12 to 24 months (intermediate-duration). A cohort of 746 patients who received pembrolizumab for 7 to 10 months (short-term) served as the comparison group. Mortality, hospitalizations, serum lactate dehydrogenase (LDH) levels, and adverse events were analyzed over 10 years using Cox proportional hazards regression with propensity score matching. RESULTS: Long-term therapy significantly reduced overall mortality (HR = 0.41, 95% CI: 0.27-0.62) compared with short-term therapy. Intermediate-duration therapy also reduced mortality (HR = 0.47, 95% CI: 0.37-0.60) and hospitalizations (HR = 0.74, 95% CI: 0.68-0.93). Differences in LDH levels and adverse events did not reach statistical significance. CONCLUSIONS: Longer durations of pembrolizumab therapy reduces overall mortality in stage III and stage IV melanoma, reinforcing its safety and utility. Prospective studies are needed to confirm these findings.
BACKGROUND: Dynamic lines in the periorbital region are the first signs of aging. Dynamic lines show only when emoting, possibly becoming static lines present with worsening with age. OBJECTIVE: This research was aimed a...BACKGROUND: Dynamic lines in the periorbital region are the first signs of aging. Dynamic lines show only when emoting, possibly becoming static lines present with worsening with age. OBJECTIVE: This research was aimed at developing a novel methodology with the sensitivity to effectively evaluate the improvement of dynamic lines in the periorbital region by applying a topical cosmetic eye formulation. METHOD: Female subjects aged 28-65 years with mild to moderate photoaging of all Fitzpatrick skin types were enrolled in a 12-week monadic study with evaluations at baseline and 2, 4, 8, and 12 weeks. A topical eye formulation was applied twice daily. Dermatologist evaluations of dynamic lines at maximum smile, static lines at neutral expression, and tactile evaluations of firmness and elasticity were obtained in addition to clinical photographs, subjective assessments, and instrumental noninvasive measurements of hydration and elasticity. RESULTS: After 12 weeks of twice-daily application, there was a statistically significant increase of 52% in cutaneous hydration, 183% improvement in viscoelasticity, 48% reduction in retraction time, and 58% in Young’s modulus, demonstrating improved elasticity in the crow’s feet area. 12-week investigator assessments revealed statistically significant improvements in the appearance of periorbital static lines (53%) and dynamic lines (33%). The tactile assessment methodology produced a 39% improvement in crow’s feet pinch and 47% improvement in pinch recoil as measures of elasticity/hydration, and a 45% improvement in touch rebound as an assessment of firmness/hydration. CONCLUSIONS: This research established the value of a novel dynamic line evaluation methodology to assess a topical cosmetic.
BACKGROUND: Rapid and intentional weight loss can result from bariatric surgery, pharmacologic agents such as glucagon-like peptide-1 receptor agonists, and intensive lifestyle changes. Although effective in lowering bod...BACKGROUND: Rapid and intentional weight loss can result from bariatric surgery, pharmacologic agents such as glucagon-like peptide-1 receptor agonists, and intensive lifestyle changes. Although effective in lowering body weight, these interventions often produce broader physiologic effects. Patients may experience changes beyond size, including decreased skin firmness, muscle loss, and reduced bone density. OBJECTIVE: To describe the dermatologic and structural consequences of rapid weight loss and review current and emerging management strategies. METHODS AND MATERIALS: A narrative review was conducted using PubMed and Google Scholar to identify English-language literature published between 2000 and 2025 on soft tissue changes associated with rapid weight loss. RESULTS: Rapid weight loss impacts collagen, elastic fibers, adipose tissue, muscle mass, and skeletal integrity. Management strategies include nutritional optimization, resistance-based physical activity, energy-based devices, biostimulatory injectables, and, in advanced cases, surgical procedures. Regenerative therapies are also under investigation. CONCLUSION: As rapid weight loss becomes increasingly common, dermatologists are encountering a broader range of cosmetic and structural concerns. A multidisciplinary, evidence-informed approach is critical for addressing these issues and improving patient outcomes.
BACKGROUND: Metformin, widely used for type 2 diabetes mellitus, has demonstrated antitumor effects through modulation of metabolic and immune pathways. This review explores its potential role in the prevention and treat...BACKGROUND: Metformin, widely used for type 2 diabetes mellitus, has demonstrated antitumor effects through modulation of metabolic and immune pathways. This review explores its potential role in the prevention and treatment of skin cancers, including melanoma and nonmelanoma skin cancers (NMSCs). METHODS: A structured PubMed search was conducted in April 2025 to identify English-language, peer-reviewed original research articles evaluating the effects of metformin on melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). Experimental, observational, and clinical studies were included; reviews and meta-analyses were excluded. RESULTS: Twenty studies met the inclusion criteria. In melanoma models, metformin inhibited tumor proliferation, suppressed epithelial-mesenchymal transition, and enhanced immune responses. Observational studies reported improved recurrence-free survival and treatment outcomes, although findings were inconsistent. In NMSC studies, metformin use was associated with reduced incidence of BCC and SCC. Preclinical models demonstrated delayed tumor development and an enhanced response to photodynamic therapy following metformin treatment. DISCUSSION: Mechanistic and preclinical data support a biologically plausible role for metformin in skin cancer prevention and therapy. Evidence is strongest for BCC, particularly in enhancing photodynamic therapy and reducing incidence in at-risk populations. Melanoma studies suggest synergy with immunotherapy, but clinical results remain variable. CONCLUSION: Metformin shows promise as a low-cost, well-tolerated adjunctive therapy in dermatologic oncology. Further prospective and controlled studies are needed to clarify its efficacy, optimize dosing, and identify populations most likely to benefit.
INTRODUCTION: Confluent and reticulated papillomatosis (CARP) is a rare, non-systemic disease usually treated using oral antibiotics. CASE PRESENTATION: We present a 15-year-old male with CARP for whom initial treatment...INTRODUCTION: Confluent and reticulated papillomatosis (CARP) is a rare, non-systemic disease usually treated using oral antibiotics. CASE PRESENTATION: We present a 15-year-old male with CARP for whom initial treatment with doxycycline, ketoconazole shampoo, and topical minocycline was ineffective. He was subsequently treated with a combination of fixed-dose triple-combination clindamycin phosphate 1.2% / adapalene 0.15% / benzoyl peroxide 3.1% (CAB) gel and a sodium hypochlorite-based body wash, resulting in complete clearance after 3 months. DISCUSSION: CARP is most often treated with oral or topical antibiotics. This case highlights the successful use of topical combination therapy with CAB, which is FDA approved for acne, plus a sodium hypochlorite-based body wash as a safe and effective alternative. CONCLUSION: This case supports the potential role of CAB in CARP management and highlights the value of non-systemic options for treatment-resistant cases.
UNLABELLED: of Case: We report an atypical case of cutaneous angiosarcoma presenting as unilateral nasal swelling in an elderly male. The lesion was unresponsive to topical and antibiotic therapy. Diagnosis was confirmed...UNLABELLED: of Case: We report an atypical case of cutaneous angiosarcoma presenting as unilateral nasal swelling in an elderly male. The lesion was unresponsive to topical and antibiotic therapy. Diagnosis was confirmed after surgical excision, and disease control was ultimately achieved through radiation and off-label use of pembrolizumab. Patient Info: A 79-year-old male with a history of squamous cell carcinoma presented with a 1–2 month history of erythematous, scaly swelling of the left nasal tip and ala. Family history was notable for nonmelanoma skin cancer. DIAGNOSIS: Initial differential diagnoses included contact dermatitis, rosacea, and rhinophyma. A shave biopsy revealed actinic damage but no malignancy. Following persistent symptoms and referral to plastic surgery, debulking surgery was performed. Histopathology confirmed cutaneous angiosarcoma. TREATMENT: The patient declined wide local excision and instead underwent a 4-week course of hypofractionated radiation. Subsequent imaging showed regional lymph node recurrence. He declined biopsy and surgery, and was started on off-label pembrolizumab immunotherapy for disease control. OUTCOME: Following immunotherapy, the patient experienced sustained remission with no clinical or radiographic evidence of disease four years post-treatment. DISCUSSION: Cutaneous angiosarcoma is a rare, aggressive malignancy with a poor prognosis. This case illustrates the importance of considering angiosarcoma in atypical facial lesions and demonstrates disease control using a non-traditional, patient-centered treatment strategy. Immunotherapy with pembrolizumab may offer a promising option in select patients, particularly those with contraindications to extensive surgery.
BACKGROUND: Hyperpigmentation disproportionately affects skin of color, often exacerbated by visible light (VL) exposure. Photoprotection in these populations remains underused due to the cosmetic incompatibility of suns...BACKGROUND: Hyperpigmentation disproportionately affects skin of color, often exacerbated by visible light (VL) exposure. Photoprotection in these populations remains underused due to the cosmetic incompatibility of sunscreens and the lack of targeted education. Iron oxides have emerged as essential VL blockers in tinted sunscreens for hyperpigmentation management. OBJECTIVES: To evaluate the role of iron oxide in tinted sunscreens for hyperpigmentation and assess commercial sunscreen product labeling regarding iron oxide content. METHODS: A literature review was conducted using PubMed and Google Scholar to assess clinical studies on iron oxide for hyperpigmentation. A product analysis of 37 tinted sunscreens was also performed, including ingredient review and direct manufacturer contact regarding iron oxide content. RESULTS: Literature supports that iron oxide-containing sunscreens improve VL-induced pigmentation outcomes. Most products (97.3%) did not list iron oxide as an active ingredient, and only 9.6% of responding brands disclosed iron oxide percentages when contacted, with disclosed concentrations ranging from <1.4% to 10.4%. Although 6 brands (19.3%) claimed their product protects against VL, only one brand publicly detailed any specific corresponding testing performed. CONCLUSION: Iron oxides enhance VL protection in sunscreens for skin prone to hyperpigmentation. Standardized reporting of iron oxide content and/or measurement of VL protection is essential to guide evidence-based photoprotection.