INTRODUCTION: JAK inhibitors are increasingly being utilized for the treatment of diseases beyond their nonclassical indications, and the highly selective JAK1 inhibitor abrocitinib may represent a promising therapeutic...INTRODUCTION: JAK inhibitors are increasingly being utilized for the treatment of diseases beyond their nonclassical indications, and the highly selective JAK1 inhibitor abrocitinib may represent a promising therapeutic option for dystrophic epidermolysis bullosa (DEB). CASE PRESENTATION: The first case was a 39-year-old male with DEB in whom conventional therapy was ineffective. After one month of abrocitinib treatment, marked improvement in both pruritus and skin lesions was observed, with no adverse drug reactions during six months of therapy. The second case involved a 46-year-old female DEB patient in whom conventional therapy resulted in mild improvement of skin lesions but no significant relief of pruritus. CONCLUSION: The present two cases provide comparative evidence suggesting the superior efficacy of abrocitinib relative to conventional therapies for DEB.
Hyperpigmentation and pigmentary alterations are common dermatologic concerns that remain difficult to treat. The modernized topical tranexamic acid serum (TNXA-SHOT) is a novel, patent-pending serum that contains 5% tra...Hyperpigmentation and pigmentary alterations are common dermatologic concerns that remain difficult to treat. The modernized topical tranexamic acid serum (TNXA-SHOT) is a novel, patent-pending serum that contains 5% tranexamic acid, 1% amino acid, and 3% endophytol, which have been shown to mediate various biological pathways of the mechanism of action involved in the pigment production process. These three active ingredients aim to fight key hyperpigmentation triggers: inflammation, hormonal imbalance, and environmental pollution. The following real-world case series aims to demonstrate the use of TNXA-serum under real-world conditions in a split-face, integrated skincare regimen with a procedure. Eight expert dermatologists shared their experience pairing the new serum with pigment-targeting procedures (eg, non-ablative laser, microneedling, and salicylic acid peel) to improve patient pigmentary outcomes. The real-world cases demonstrate that application of TNXA-serum to the face after in-office procedures may accelerate improvement in dyspigmentation while offering added benefits of improved skin texture and radiance. These real-world cases serve as a valuable guide for patients and dermatologists to help form targeted, effective, and safe pigment-targeting integrated skincare plans.  .
BACKGROUND: Janus kinase (JAK) inhibitors represent promising therapies for dermatologic conditions, including psoriasis, hidradenitis suppurativa (HS), atopic dermatitis (AD), systemic lupus erythematosus (SLE), and vit...BACKGROUND: Janus kinase (JAK) inhibitors represent promising therapies for dermatologic conditions, including psoriasis, hidradenitis suppurativa (HS), atopic dermatitis (AD), systemic lupus erythematosus (SLE), and vitiligo. There are little data available evaluating the composition of research cohorts for this emerging treatment modality. Adequate racial representation in clinical trials is essential. OBJECTIVE: To characterize the study populations of clinical trials for Janus kinase inhibitors for dermatologic indications. METHODS: Clinical trials were identified from January 2000 to March 2025 through PubMed using the following keywords: "Janus kinase inhibitor," "JAK inhibitor," "alopecia areata," "atopic dermatitis," "hidradenitis suppurativa," "systemic lupus erythematosus," "systemic sclerosis," "psoriasis," and "vitiligo." Additional trials were retrieved from ClinicalTrials.gov using the search term "JAK inhibitor." Each trial was reviewed for demographic data, including race and ethnicity. Additional variables collected included Fitzpatrick skin type and quality-of-life measures. The distribution of race among trial participants was compared to the current US population and the condition-specific prevalence data where available. RESULTS: Of 399 identified studies, 207 clinical trials were included in our analysis, including 57,112 study participants were analyzed. Among studies reporting race (57.5%), representation was predominantly White (75.1%), followed by Asian (13.2%), Black (6.6%), American Indian/Alaska Native (0.48%), Native Hawaiian (0.11%), and multiple races (0.43%). Underrepresentation was pronounced among Black participants in psoriasis (1.3%), SLE (1.0%), and vitiligo trials (5.1%), although higher in HS (27.9%). Representation in these trials significantly differed from the racial distribution of US patients with vitiligo (P=0.012) and AD (P=0.00088). White patients were overrepresented in vitiligo and AD trials (Pearson residual=1.06, 2.71), while Black patients were underrepresented in these trials (Pearson residual=-2.66, -2.14). Additionally, a minority of studies (28.98%) reported on QoL metrics, which are essential tools for measuring disease burden and impact on patients. CONCLUSION AND RELEVANCE: Reporting on racial data, Fitzpatrick skin type, and quality of life measures is lacking in clinical trials for Janus kinase inhibitors. These factors play a key role in addressing comorbidities and mitigating disease burden. These findings highlight a need for improved recruitment strategies targeting underrepresented populations in dermatologic clinical research.  .
BACKGROUND: In pre-clinical studies, exosomes activate dermal repair mechanisms, and they may show regenerative potential for skin rejuvenation, pigmentation, scarring, hair loss, and inflammatory dermatoses. However, th...BACKGROUND: In pre-clinical studies, exosomes activate dermal repair mechanisms, and they may show regenerative potential for skin rejuvenation, pigmentation, scarring, hair loss, and inflammatory dermatoses. However, the clinical landscape and its safety remain undefined, despite commercial availability. OBJECTIVE: To map and summarize clinical studies evaluating exosome-based dermatologic therapies, clarifying evidence, safety, and regulatory context. METHODS: A scoping review was conducted in accordance with PRISMA-ScR. Searches of MEDLINE, Embase, CENTRAL, PubMed, U.S. and E.U. trial registries, and grey literature were performed. Eligible studies involved human participants. RESULTS: Seventeen studies between 2020-2025 were identified, including cohort studies, comparative trials, and case series. Indications included skin rejuvenation, psoriasis, acne scars, and atopic dermatitis. Exosome sources were predominantly mesenchymal stem cell-derived, delivered through topical application, microneedling, fractional CO2 laser, or injection. 76% of studies recorded improvements in wrinkles, pigmentation, elasticity, hydration, or scars. Adverse events were uncommon but included granulomas, necrosis, and allergic reactions post-injection. CONCLUSIONS: Exosome-based therapies demonstrate promise for skin rejuvenation and inflammatory dermatoses. Limitations include small sample sizes and short follow-up. Interpretation is further limited by non-randomized, single-arm designs and potential conflicts of interest.  .
BACKGROUND: There is an unmet demand for a post-inflammatory hyperpigmentation (PIH) treatment and prevention that is not only effective and accessible, but also safe to use in darker skin tones. OBJECTIVE: To evaluate t...BACKGROUND: There is an unmet demand for a post-inflammatory hyperpigmentation (PIH) treatment and prevention that is not only effective and accessible, but also safe to use in darker skin tones. OBJECTIVE: To evaluate the safety and efficacy of a comprehensive investigator-developed skincare regimen in reducing post-inflammatory hyperpigmentation (PIH) and improving patient-reported satisfaction in skin of color patients. MATERIALS AND METHODS: In this single-center, prospective, non-blinded, non-randomized 12-week study, ten participants with a diagnosis of PIH and identified as skin of color received two SkinCeuticals Pigment Balancing Peel treatments at baseline and week 6, Discoloration Defense Serum, Hydrating B5 Gel, LHA Cleanser Gel, and Daily Brightening ultraviolet (UV) Defense Sunscreen. Assessments were conducted at baseline, week 6, and week 12. The primary endpoint was the change in satisfaction with overall facial appearance post-treatment. Secondary endpoints included changes in the Dermatology Life and Quality Index (DLQI), FACE-Q social and psychosocial functioning, erythema and melanin index, and expectations and satisfaction with treatment. RESULTS: Participants reported significantly greater satisfaction with overall facial appearance at 12 weeks post-treatment compared to baseline (P<0.001). Improvements were also observed in quality of life, with Dermatology Life Quality Index scores decreasing significantly (P<0.001). Patients reported enhancements in skin texture and tone, social confidence, and psychological functioning. High levels of satisfaction with the treatment regimen and minimal adverse effects were noted across participants. CONCLUSION: This investigator developed a comprehensive skincare regimen that combines a series of chemical peels with a daily at-home treatment regimen is a safe and effective approach for improving post-inflammatory hyperpigmentation, enhancing satisfaction with facial appearance, and promoting psychosocial well-being in individuals with skin of color.  .
Hydroquinone has long served as the gold standard for hyperpigmentation treatment, but safety concerns, regulatory changes, and growing interest in non-hydroquinone therapies have prompted reevaluation of its role in der...Hydroquinone has long served as the gold standard for hyperpigmentation treatment, but safety concerns, regulatory changes, and growing interest in non-hydroquinone therapies have prompted reevaluation of its role in dermatology. This review outlines the clinical use, safety profile, and evolving regulations surrounding hydroquinone, as well as emerging alternatives and combination therapies. We aim to offer an updated review on best practices for depigmenting treatment protocols and highlight ongoing debates on dermatologic safety and efficacy.  .
BACKGROUND: Many patients with psoriasis suffer from post-inflammatory pigmentary alteration (PIPA), which remains an unmet treatment need. Eruptive lentiginosis (EL) is a rare form of PIPA where multiple dark brown macu...BACKGROUND: Many patients with psoriasis suffer from post-inflammatory pigmentary alteration (PIPA), which remains an unmet treatment need. Eruptive lentiginosis (EL) is a rare form of PIPA where multiple dark brown macules arise within a resolving psoriatic plaque. We present a case of a 68-year-old male with a history of chronic plaque psoriasis and prothrombin deficiency, who developed extensive EL following ixekizumab treatment. In addition, this article will discuss the current literature on risk factors, clinical outcomes, and treatments for EL. METHODS: The systematic literature review, conducted in accordance with PRISMA guidelines, utilized three databases, PubMed, SCOPUS, and CINAHL Plus, using search terms "psoriasis" and "lentigines" or "lentiginosis". A total of 26 articles were identified and included. RESULTS: EL was reported in a diverse patient population with various Fitzpatrick skin types and ages ranging from 5 to 74 years old. Additionally, EL has developed in a wide array of treatments, including PUVA, NB-UVB, cyclosporine, acitretin, methotrexate, topicals, and biologics, with TNF inhibitors being the most common. DISCUSSION: The mechanism of EL is likely multifaceted, with potential mediators, such as UV radiation and inflammatory cytokines (TNF-α, IL-17, and IL-23), which may stimulate melanocyte proliferation. Additionally, our patient’s history of prothrombin deficiency suggests possible interplay between the coagulation cascade and melanogenesis in EL development. Patients and providers alike should be aware of the clinical course of EL, which, unlike other forms of PIPA, tends to persist without treatment. Potential treatment options for EL include the Q-switched ruby laser, which can lead to partial improvement.  .
BACKGROUND: Dermatologists remain unevenly distributed throughout the United States (US), leading to disparities in access to dermatologic care. OBJECTIVE: To evaluate geographic variation in patient interest in dermatol...BACKGROUND: Dermatologists remain unevenly distributed throughout the United States (US), leading to disparities in access to dermatologic care. OBJECTIVE: To evaluate geographic variation in patient interest in dermatology services and compare it to dermatologist supply to identify areas of potential unmet need. METHODS: An ecological, cross-sectional study was conducted using Google Trends data from 2004 to 2023 to assess relative search volume (RSV) for "dermatologist" across US states. RSV was normalized and combined with dermatologist density data from the AAMC to generate a Relative Demand Index (RDI) for each state. Spearman's rank correlation assessed associations between RDI, dermatologist supply, urbanization, and population size. RESULTS: States with high RDI, such as Alabama and Mississippi, had high patient interest but low dermatologist density, suggesting workforce shortages. Conversely, states like Massachusetts and the District of Columbia had low RDI and high provider density. RDI showed a strong inverse correlation with dermatologist density (rs = -0.76, P<0.0001). LIMITATIONS: This study relied on a keyword, Google-only search data, and assumed internet access. County-level nuances were not captured. CONCLUSION: Significant geographic disparities in dermatologist availability and demand exist, highlighting the need for targeted workforce distribution strategies to ensure equitable access to dermatologic care.  .
BACKGROUND: Artificial intelligence is increasingly applied to dermatology, yet its reliability in clinically high-stakes subspecialty domains such as nail disease remains poorly understood. This study evaluated the abil...BACKGROUND: Artificial intelligence is increasingly applied to dermatology, yet its reliability in clinically high-stakes subspecialty domains such as nail disease remains poorly understood. This study evaluated the ability of widely available Vision Language Models (VLMs), ChatGPT-3.5, ChatGPT-4o, and Google Gemini, in diagnosing common nail disorders using clinical images. METHODS: A total of 110 clinical images across 11 nail conditions (10 images per diagnosis) were compiled from peer-reviewed sources and confirmed by a board-certified dermatologist. Disorders included infectious, inflammatory, and neoplastic entities. Each VLM was queried with a standardized prompt requesting the top three differential diagnoses and confidence (1–10 scale) for the top choice. RESULTS: Across the models, Google Gemini achieved 34% top-1 accuracy and 51% top-3 accuracy, followed by ChatGPT-4o (33%; 51%) and ChatGPT-3.5 (31%; 45%). VLMs performed best on onychomycosis (sensitivity 0.80; specificity 0.63), green nail syndrome (sensitivity 0.83; specificity 0.98), and onychocryptosis (sensitivity 0.50; specificity 1.00). Furthermore, onychomycosis was the most common incorrect guess across misclassified cases, often appearing as a default diagnosis across a wide range of unrelated presentations. Overall, current VLMs demonstrate poor performance in diagnosing common nail disorders, with moderate accuracy for select conditions, such as onychomycosis. Notably, periungual warts, while frequently encountered in clinical practice, were routinely missed across all models. CONCLUSIONS: These findings support the potential role of VLMs as adjunctive tools for pattern recognition but reaffirm that clinical judgment remains essential, especially in cases where diagnostic accuracy has critical implications for patient outcomes.  .
BACKGROUND: Dermatoporosis (DP) or chronic cutaneous fragility syndrome has traditionally been linked to extracellular matrix (ECM) dehydration, reduced cellular turnover, epidermal thinning, and vascular fragility. Howe...BACKGROUND: Dermatoporosis (DP) or chronic cutaneous fragility syndrome has traditionally been linked to extracellular matrix (ECM) dehydration, reduced cellular turnover, epidermal thinning, and vascular fragility. However, recent imaging methods and clinical evidence indicate that the dermoepidermal junction (DEJ) might be the earliest change reflecting DP reversal. OBJECTIVE: To propose a new mechanistic process in which the DEJ acts as the initiation point for reversing the DP. The process is supported by clinical and imaging evidence, as well as independent literature on DEJ biology. METHODS: A combination of clinical and investigational findings, published theoretical models, and evidence from wound-healing, skin-longevity reports, ex vivo model analyses, and device-based interventions formed the basis for the scientific narrative. RESULTS: Cumulative evidence suggests that an initial change in the DEJ, along with structural restoration, appears to trigger or initiate regenerative processes in the ECM and epidermis. These include the renewal of basal stem cells following adhesion signaling in the basement membrane; ECM remodeling through improved communication between the dermis and epidermis, along with enhanced fibroblast interactions involving collagen and elastin; and finally, ECM remodeling and stabilization of basement membrane anchoring provides support and stability to blood vessels, protecting them from recurrent injury. CONCLUSION: The DEJ acts as a bridge between the epidermis and dermis, providing structural support while also triggering signaling cascades that promote a regenerative environment, contributing to DEJ reversal. Targeting the DEJ could be a logical therapeutic approach, establishing a new paradigm for biomarker analysis and an intervention site for regenerative initiation.  .
BACKGROUND: Since January 2022, the United States Medical Licensing Examination (USMLE) Step 1 discontinued reporting a 3-digit score. The objective of this study is to share survey results and to communicate the changes...BACKGROUND: Since January 2022, the United States Medical Licensing Examination (USMLE) Step 1 discontinued reporting a 3-digit score. The objective of this study is to share survey results and to communicate the changes Dermatology residency program directors (PDs) will make to evaluate candidates. METHODS: The research team conducted an online survey of PDs and analyzed the responses using R programming and MATLAB scripts. Chi-squared tests were used to identify significant differences in responses to multiple-choice questions, while paired t tests were utilized to compare pre- and post-values for criteria ranking questions. RESULTS: Following the implementation of a pass/fail grading system for Step 1, many PDs will place greater emphasis on Step 2 CK (Clinical Knowledge) scores to differentiate among candidates. Some believe that medical schools should also disclose National Board of Medical Examiners (NBME) shelf exam scores and factor in a student's medical school ranking. CONCLUSION: The added emphasis on Step 2 CK scores, NBME shelf exam scores, a student's medical institution, and class rank may cloud the positive impacts of this change, providing an opportunity for programs to evaluate students more holistically.  .
OBJECTIVE: Chronic spontaneous urticaria (CSU) is a chronic, debilitating condition characterized by recurrent wheals and/or angioedema. Several cytokines have been linked to CSU, including Bruton tyrosine kinase (BTK),...OBJECTIVE: Chronic spontaneous urticaria (CSU) is a chronic, debilitating condition characterized by recurrent wheals and/or angioedema. Several cytokines have been linked to CSU, including Bruton tyrosine kinase (BTK), providing the rationale for emerging targeted therapies. Remibrutinib is an oral, highly selective BTK inhibitor that is in clinical development for CSU as well as several other dermatologic diseases. METHODS: A comprehensive literature search was completed using the keywords "chronic spontaneous urticaria," "pathogenesis," "Bruton tyrosine kinase," "remibrutinib," and "mechanism of action". The authors reviewed all studies and included those that addressed the topic of the review. RESULTS: Remibrutinib has completed phase 3 trials for the treatment of CSU. Remibrutinib-treated patients experienced a significantly greater decrease in 7-day Urticaria Activity Score at week 12 compared to placebo in REMIX-1 (-20.0 remibrutinib vs -13.8 placebo, P<0.001) and REMIX-2 (-19.4 remibrutinib vs -11.7 placebo, P<0.001). Clinically meaningful effects were seen after one week. The rate of adverse effects was similar between remibrutinib and placebo groups. Remibrutinib is also being evaluated in clinical trials for hidradenitis suppurativa, with a phase 2 clinical trial reporting 72.7% of remibrutinib-treated patients with 25 mg twice daily achieved simplified HS clinical response score vs 34.7% in the placebo group. LIMITATIONS: This is a review article and is limited by the information available in the published literature. In addition, comparison between studies is limited as varying methodologies were used. CONCLUSION: BTK inhibitors are promising therapeutic candidates given their central role in multiple inflammatory pathways and the pathogenesis of diverse immunologic disorders. Remibrutinib has demonstrated clinical efficacy for the treatment of CSU with an acceptable safety profile.
BACKGROUND: Although most dandruff shampoos are effective, many leave hair dry and unmanageable, potentially impacting patient compliance and treatment outcomes. OBJECTIVE: This study compared the efficacy, tolerability,...BACKGROUND: Although most dandruff shampoos are effective, many leave hair dry and unmanageable, potentially impacting patient compliance and treatment outcomes. OBJECTIVE: This study compared the efficacy, tolerability, and cosmetic benefits of 0.6% micronized selenium disulfide shampoo (SeS2) to 2% ketoconazole shampoo. METHODS: Eighty-seven male and female subjects with moderate to severe dandruff participated in a single-center, 6-week, randomized, double-blind study comparing the benefits and attributes of the shampoos. RESULTS: After 6 weeks of use, Total Scale Score (TSS) decreased by 69.5% in the ketoconazole group, and 77.9% in the SeS2 group, and Symptomatic Scale of Seborrheic Dermatitis (SSSD) decreased by 68.0% in the ketoconazole group and 74.5% in the SeS2 group (all P<0.001). Pruritus severity score decreased by 76.2% and 75.9% in the ketoconazole and SeS2 groups, respectively, and global efficacy and satisfaction, as assessed by blinded dermatologic evaluation, showed significant improvement with both products (all P<0.001). There was no significant difference between the two groups for these outcomes at any time point. Tolerability was excellent for both products. In terms of cosmesis, subjects across diverse curl types favored the SeS2 shampoo with significantly more agreeing that the SeS2 shampoo leaves hair soft, supple, glossy, natural appearing, and was suitable for their hair type when compared to ketoconazole (P<0.001). CONCLUSION: This micronized 0.6% SeS2 shampoo is as effective as 2% ketoconazole shampoo for treating moderate to severe scalp seborrheic dermatitis and provides superior cosmetic benefits across diverse curl types.  .
BACKGROUND: Lichen planus (LP) is an auto-inflammatory idiopathic condition affecting skin, mucous membranes, hair follicles, and nails that presents as pruritic, violaceous papules and plaques. No FDA-approved treatment...BACKGROUND: Lichen planus (LP) is an auto-inflammatory idiopathic condition affecting skin, mucous membranes, hair follicles, and nails that presents as pruritic, violaceous papules and plaques. No FDA-approved treatments exist for LP. CASE PRESENTATION: A 70-year-old female presented with scalp pruritus and pruritic eruption on bilateral shins. She was treated for presumed seborrheic and contact dermatitis; however, after 2 months, she had no improvement. On biopsy, scalp and right shin samples were consistent with lichen planopilaris and LP, respectively. The patient was treated with hydroxychloroquine, pimecrolimus, fluocinonide, and tofacitinib 2% creams, and intralesional Kenalog. Four months later, she had complete resolution of the scalp rash, but the rash on the shins persisted. We discontinued tofacitinib, fluocinonide, and pimecrolimus and prescribed tapinarof 1% cream once daily. After 1 month, her scalp condition remained in remission, and the LP on the shins completely resolved with minimal post-inflammatory hyperpigmentation. CONCLUSION: To our knowledge, this is the first report in the literature showing successful treatment of LP with tapinarof. Further studies are required to determine if tapinarof is beneficial for the treatment of lichenoid diseases such as LP, lichen planopilaris, and others.  .