BACKGROUND: Advanced topical nonsteroidal therapies are expanding options for atopic dermatitis (AD) by providing targeted anti-inflammatory control without many limitations of long-term topical corticosteroids. As these...BACKGROUND: Advanced topical nonsteroidal therapies are expanding options for atopic dermatitis (AD) by providing targeted anti-inflammatory control without many limitations of long-term topical corticosteroids. As these agents become more available, practical guidance is needed on their use as first-line therapy, proactive maintenance, combination regimens, safety, and long-term management. OBJECTIVE: To develop expert consensus statements defining the clinical role of advanced topical nonsteroidal therapies in AD. METHODS: A seven-dermatologist expert panel used a structured Delphi process informed by a literature review. Statements were drafted, iteratively refined, and voted on across multiple rounds. Evidence quality and strength of recommendations were assessed using the Strength of Recommendation Taxonomy (SORT). Consensus was predefined as ≥75% agreement. RESULTS: The panel reached unanimous consensus on seven statements regarding advanced topical nonsteroidal therapies, including topical ruxolitinib, tapinarof, roflumilast, crisaborole, tacrolimus, pimecrolimus, and delgocitinib. These therapies were considered effective in reducing AD signs and symptoms, including pruritus, and appropriate as first-line agents for many patients. Their use was associated with longer disease control, fewer relapses, and reduced cumulative topical corticosteroid exposure. The panel agreed that these therapies improve patient-reported outcomes, including quality of life and sleep, and can be safely incorporated into combination regimens with other topical or systemic treatments. They demonstrated favorable safety and tolerability profiles without the need for baseline or ongoing laboratory monitoring. Compared with topical corticosteroids, nonsteroidal therapies were preferred for long-term management to avoid steroid-associated adverse effects, with simplified dosing and suitability for sensitive and high-impact sites supporting adherence. CONCLUSION: Advanced topical nonsteroidal therapies represent an important evolution in AD management and are appropriate first-line options across disease severities, supporting sustained disease control and improved quality of life.
BACKGROUND: Eyebrow madarosis, or eyebrow alopecia, has significant cosmetic and psychosocial implications. Nonscarring causes are diverse, including autoimmune, infectious, endocrine, genetic, nutritional, traumatic, an...BACKGROUND: Eyebrow madarosis, or eyebrow alopecia, has significant cosmetic and psychosocial implications. Nonscarring causes are diverse, including autoimmune, infectious, endocrine, genetic, nutritional, traumatic, and iatrogenic etiologies. Despite its frequency in dermatologic practice, guidance for evaluation and management remains limited. METHODS: A comprehensive PubMed search (1960–2025) was performed using terms related to "eyebrow alopecia," "eyebrow madarosis," and specific disease processes. English-language studies were included if they evaluated eyebrow involvement and provided data on etiology, diagnosis, or treatment. Review articles without new patient data and studies limited to scalp alopecia were excluded. RESULTS: Nonscarring eyebrow alopecia can be caused by autoimmune disorders such as alopecia areata, infections including syphilis and tinea faciei, endocrinologic conditions like hypothyroidism, and inflammatory dermatoses such as atopic or seborrheic dermatitis. Additional causes include nutritional deficiencies, trauma, and drug-induced alopecia. Reported treatments include corticosteroids, calcineurin inhibitors, JAK inhibitors, immunomodulators, antifungals, zinc supplementation, and behavioral therapy. Novel agents such as dupilumab and roflumilast have shown promise for inflammatory-related eyebrow loss. CONCLUSION: Nonscarring eyebrow madarosis encompasses a wide range of reversible causes. Early recognition and targeted therapy can lead to eyebrow regrowth and improve psychosocial outcomes. Further studies are needed to establish evidence-based treatment algorithms and validated tools to assess eyebrow regrowth.
BACKGROUND: Alzheimer's disease (AD) and dementia create major global health and economic burdens. Herpes simplex virus (HSV) infects over 3 billion people, and chronic infection is increasingly linked to neurodegenerati...BACKGROUND: Alzheimer's disease (AD) and dementia create major global health and economic burdens. Herpes simplex virus (HSV) infects over 3 billion people, and chronic infection is increasingly linked to neurodegeneration. OBJECTIVES: To evaluate whether antiviral therapy for oral, mucocutaneous, or anogenital HSV lowers the subsequent risk of AD and dementia. METHODS: A retrospective cohort study with propensity-score matching was performed in the TriNetX Research Network. On 24 May 2024, 615,324 individuals with HSV were identified; those with prior AD, intracranial injury, or cerebral infarction were excluded. Matching balanced age, sex, race, body-mass index, smoking, diabetes, and hypertension between antiviral-treated and untreated groups. Therapies included acyclovir, valacyclovir, penciclovir, ganciclovir, valganciclovir, and famciclovir. Incidences of AD and dementia were identified by ICD-10 codes, and relative risks (RR) with 95% confidence intervals (CI) were calculated. RESULTS: After matching, 231,277 patients per cohort (mean age 36.8 y; 67.7% female) were analyzed. Antiviral treatment for oral/mucocutaneous HSV significantly reduced the risk of AD (RR 0.87; 95% CI 0.73-0.92) and dementia (RR 0.83; 95% CI 0.77-0.90). No significant association was observed for anogenital HSV. CONCLUSIONS: Antiviral therapy for oral or mucocutaneous HSV was associated with a 13% to 17% reduction in risk for AD and dementia. These findings suggest that early antiviral management of HSV infections may represent a feasible preventive strategy against neurodegenerative disease, meriting prospective confirmation.  .
Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss on the scalp and body, leading to a reduced quality of life and psychosocial burden for patients. The only US Food and Drug Administrat...Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss on the scalp and body, leading to a reduced quality of life and psychosocial burden for patients. The only US Food and Drug Administration–approved treatments for severe AA are the Janus kinase inhibitors (JAKis) baricitinib, ritlecitinib, and deuruxolitinib. Herein, we discuss the efficacy, safety, and real-world aspects of JAKi treatment for patients with AA for an advanced practice provider audience. We review the clinical characteristics and diagnosis of AA and discuss treatment expectations for patients using JAKis.  .
BACKGROUND: Skin thinning, known as dermatoporosis, is an expected consequence of aging that involves structural weaknesses, barrier deficiencies, and cellular senescence, posing challenges for maintaining long-term skin...BACKGROUND: Skin thinning, known as dermatoporosis, is an expected consequence of aging that involves structural weaknesses, barrier deficiencies, and cellular senescence, posing challenges for maintaining long-term skin health. OBJECTIVE: To introduce Skin Activation as a dermatologic strategy for promoting skin longevity. It is supported by clinical and preclinical evidence, combining methods to remodel the extracellular matrix (ECM) and dermo-epidermal junction (DEJ), restore the barrier, and enhance hydration, along with reducing senescent cells. This improves the skin's functional resilience. METHODS: Data were generated from a multicenter dermatoporosis trial, a randomized controlled trial, and specific cohorts of sensitive skin patients, in addition to preclinical studies. Study endpoints included trans-epidermal water loss (TEWL), hydration levels, LC-Optical Coherence Tomography (LC-OCT), assessments of the DEJ, ultrasound measurements, senescent markers, and histology. The data also included measures of senescence, cytokine profiles, and biomarkers of cellular renewal. RESULTS: Among 400 participants, notable changes included a 20-40% reduction in TEWL, an 80% increase in hydration based on corneometer readings, a 5% rise in skin thickness, and improved DEJ integrity in 83% of subjects compared to 17% of controls. In preclinical ex vivo models, decreases in fibroblast senescence levels were observed, along with activation of the JAG/NOTCH pathway. CONCLUSION: A recently developed skin activator program shifts dermatologic skin health strategies from a broad anti-aging focus to a more targeted skin activation approach focused on structure, function, and cellular energy and renewal. This reinforces the ongoing commitment to dermatological innovation and establishes a more structured approach to skin longevity.  .
BACKGROUND: Alterations in fibroblast growth factor receptor (FGFR) signaling are present in many malignancies, including urothelial carcinoma, cholangiocarcinoma, and gastrointestinal cancers, and FGFR inhibitors (FGFRi...BACKGROUND: Alterations in fibroblast growth factor receptor (FGFR) signaling are present in many malignancies, including urothelial carcinoma, cholangiocarcinoma, and gastrointestinal cancers, and FGFR inhibitors (FGFRi) play an increasing role in the treatment of these malignancies. Nail toxicities, such as onycholysis, paronychia, and nail fragility are an important part of the adverse effect profile of FGFRi that remain underrecognized and poorly characterized. METHODS: We conducted a systematic literature review using PubMed and Google through March 2025, including case reports, trials, and retrospective studies reporting FGFRi-related nail disorders. Search terms included individual FGFRi (e.g., erdafitinib, pemigatinib, futibatinib) and nail-related adverse events. Data on incidence, severity (CTCAE v5.0), onset, management, and treatment impact were extracted. Statistical analyses included the Wilcoxon and Chi-square tests. RESULTS: Twenty-three studies with 1,561 patients were analyzed. Out of these, 540 patients experienced nail toxicity. Erdafitinib had the highest nail toxicity rate (43.3%) and derazantinib the lowest (5.3%). Grade 1–2 events were most common; Grade 3 events prompted dose reduction in three patients out of 540, though no treatment discontinuations were reported. Common management strategies included antiseptic soaks, topical steroids, oral antibiotics, and protective nail care practices. DISCUSSION/CONCLUSION: The incidence of FGFRi-associated nail toxicities varies by agent and can affect quality of life and treatment adherence. The pathogenesis remains unclear, and no predictive biomarkers exist. Further research into optimized management and preventative strategies is needed. Early recognition and proactive multidisciplinary management are essential to minimizing complications and maintaining oncologic treatment continuity.  .
BACKGROUND: Plaque psoriasis is a chronic immune-mediated disease driven by proinflammatory cytokines. Brodalumab—a recombinant, human monoclonal antibody that functions as an interleukin-17 receptor A blocker&mdas...BACKGROUND: Plaque psoriasis is a chronic immune-mediated disease driven by proinflammatory cytokines. Brodalumab—a recombinant, human monoclonal antibody that functions as an interleukin-17 receptor A blocker—was approved in 2017 in the United States for treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic or phototherapy and have failed to respond to/have lost response to other systemic therapies. While efficacy and safety of brodalumab for moderate-to-severe plaque psoriasis were demonstrated across phase 2 and 3 clinical trials, long-term data from these trials and several real-world studies have since been published. METHODS: In this review, we summarize efficacy/safety findings from long-term clinical trials and real-world studies. Updated US pharmacovigilance data collected over 8 years of clinical brodalumab usage are also provided. RESULTS: Across clinical trials and real-world studies, brodalumab consistently delivered rapid skin clearance, high rates of complete response, and sustained disease control, even among patients who have not achieved adequate benefit with other biologics. An integrated analysis of 5 clinical trials showed brodalumab was well tolerated and not associated with increased risk of malignancy, major adverse cardiac events, suicidal ideation/behavior, or fatal adverse events over 52 weeks. This, combined with 8 years of pharmacovigilance experience, affirms a stable safety profile, with no new safety signals and no demonstrated causal links to increased psychiatric events. CONCLUSION: These findings reinforce that brodalumab is an important, well-tolerated therapeutic option for achieving high levels of disease control in patients with moderate-to-severe psoriasis, including those with prior biologic exposure or difficult-to-treat disease manifestations.  .
BACKGROUND: Chronic hand eczema (CHE) is a common, heterogeneous inflammatory skin disease associated with substantial symptom burden, impaired hand function, reduced quality of life, and work-related disability. Despite...BACKGROUND: Chronic hand eczema (CHE) is a common, heterogeneous inflammatory skin disease associated with substantial symptom burden, impaired hand function, reduced quality of life, and work-related disability. Despite its clinical impact, evidence-based guidance for long-term, steroid-sparing topical management has been limited. OBJECTIVE: To develop expert consensus statements on the role of advanced topical nonsteroidal therapies in CHE management. METHODS: A panel of seven dermatologists with expertise in CHE conducted a structured literature review, prioritizing CHE-specific trials when available. Evidence was evaluated using the Strength of Recommendation Taxonomy (SORT). Draft statements were refined through a Delphi consensus process, with consensus predefined as ≥75% agreement. RESULTS: The panel reached consensus on six statements addressing advanced topical nonsteroidal therapies in CHE. These agents were recognized as important steroid-sparing options appropriate for long-term use. Delgocitinib cream is currently the only topical therapy with CHE-specific regulatory approval and is considered an appropriate first-line advanced topical treatment. Clinical trial data show that advanced topical nonsteroidal therapies provide rapid and sustained improvements in erythema, scaling, fissuring, pruritus, and pain. Delgocitinib demonstrated sustained improvements in patient-reported outcomes and superior health-related quality-of-life benefits compared with oral alitretinoin in severe CHE. Treatment has also been associated with improved work productivity and daily functioning. These therapies have favorable safety profiles, with adverse events largely limited to local reactions, minimal systemic exposure, and no requirement for routine laboratory monitoring. Other topical nonsteroidal agents may have a role in selected patients, although CHE-specific data remain limited. CONCLUSION: This consensus provides practical guidance supporting individualized, steroid-sparing CHE management while identifying areas for future research.  .
BACKGROUND: Androgenetic alopecia (AGA) is the most common cause of hair loss. To minimize systemic adverse effects of 5-alpha-reductase inhibitors, dutasteride mesotherapy has gained popularity. Although generally consi...BACKGROUND: Androgenetic alopecia (AGA) is the most common cause of hair loss. To minimize systemic adverse effects of 5-alpha-reductase inhibitors, dutasteride mesotherapy has gained popularity. Although generally considered safe, alopecia at injection sites has been increasingly reported. We describe three cases of persistent alopecia following dutasteride mesotherapy in women with AGA. CASE REPORTS: Three female patients with AGA underwent mesotherapy with dutasteride (0.025–0.05%). Case 1: A 44-year-old woman developed multiple alopecic patches 1 month after a single session, with trichoscopic and histologic features of scarring alopecia. Only partial improvement occurred, and surgical correction was later required. Case 2: A 30-year-old woman developed 4 alopecic patches after 2 sessions. Trichoscopy revealed mixed features of cicatricial alopecia and follicular miniaturization, with limited regrowth despite optimized medical therapy. Case 3: A 48-year-old woman developed numerous alopecic patches 3 months after a single session. Follicular openings were preserved, and miniaturized hairs predominated. Alopecia persisted long-term despite corticosteroids and adjunctive treatments. DISCUSSION: Reported cases of alopecia after mesotherapy include both scarring and non-scarring patterns, suggesting diverse mechanisms, such as mechanical injury, cytotoxicity from solvents, inflammation, or infection. In this series, none of the patients experienced full regrowth, highlighting the potential for lasting aesthetic sequelae. Published cases show similar variability but often lack detailed trichoscopic or procedural information, limiting interpretation. These findings underscore the importance of proper counseling, careful technique, and close follow-up when using dutasteride mesotherapy. This complication may be underrecognized, and clinicians should maintain vigilance for early detection and management.  .
Pseudo-psoriatic nail dystrophy, a form of allergic contact dermatitis (ACD) secondary to nail product use, often mimics nail changes associated with psoriasis, leading to diagnostic delays. This review focuses on identi...Pseudo-psoriatic nail dystrophy, a form of allergic contact dermatitis (ACD) secondary to nail product use, often mimics nail changes associated with psoriasis, leading to diagnostic delays. This review focuses on identifying dystrophic nail changes, particularly those resembling pseudo-psoriatic alterations, caused by cosmetic nail products and offers diagnostic and management strategies. Among the allergens listed as culprits, triethylene glycol dimethacrylate, hydroxyethyl acrylate, and hydroxyethyl methacrylate were the most common. This poses a challenge in differentiating between ACD and psoriatic onychodystrophy. Thus, enhanced diagnostic approaches emphasizing thorough history taking and appropriate patch testing recommendations are required. This study highlights the clinical overlap while emphasizing the absence of pathognomonic features like oil drops and salmon patches in PPND. Specialized patch testing for acrylates, often missing in standard panels, is crucial for accurate diagnosis. Findings show cessation of offending products significantly improves nail appearance within 3.5 months, reducing the need for systemic psoriasis treatments.  .
Androgenetic alopecia (AGA) is a common, progressive form of nonscarring hair loss, affecting both men and women. Its pathogenesis is largely driven by androgenic factors, including elevated dihydrotestosterone (DHT), le...Androgenetic alopecia (AGA) is a common, progressive form of nonscarring hair loss, affecting both men and women. Its pathogenesis is largely driven by androgenic factors, including elevated dihydrotestosterone (DHT), leading to follicular miniaturization. While FDA-approved treatments like minoxidil and finasteride are standard, off-label therapies and emerging treatments continue to evolve. This systematic review examines the current and emerging treatment landscape for AGA, focusing on various topical, oral, injectable, and non-pharmacological interventions.  .
INTRODUCTION: Alopecia areata (AA) is an autoimmune condition marked by non-scarring, patchy hair loss of the scalp which progresses in <10% of cases to alopecia totalis (AT), which is marked by complete hair loss fro...INTRODUCTION: Alopecia areata (AA) is an autoimmune condition marked by non-scarring, patchy hair loss of the scalp which progresses in <10% of cases to alopecia totalis (AT), which is marked by complete hair loss from the scalp, eyebrows, and eyelashes. AA is prevalent in pediatric patients and is associated with atopic dermatitis (AD). The interleukin (IL)-4 and IL-13 antagonist dupilumab is approved for use in both pediatric and adult patients with AD and asthma. However, in some cases, dupilumab has shown promising results in regrowing hair in patients with concurrent AA. CASE PRESENTATION: We report a 13-year-old male patient with a past medical history of AD and food atopy, who presented with AA to the scalp. The patient's hormonal lab work-up was within normal limits, and he was treated and failed typical therapies for AA. Within nine months of treatment, the hair loss progressed to AT of the scalp and eyebrows. Dupilumab was then initiated as monotherapy for the patient's AD and AT, leading to regrowth of hair on the scalp and eyebrows within several months and sustained complete hair regeneration after 17 months post dupilumab initiation. CONCLUSION: This case demonstrates the potential use of dupilumab, which has a well-established safety profile, for pediatric patients with AA and its ability to initiate and sustain hair growth for the long term. Dermatologists may consider dupilumab for patients with AA and comorbid AD that have failed a variety of treatments from several drug classes.  .