BACKGROUND: Background: The increasing use of long-term, low-dose isotretinoin for acne has raised concerns about a potential association with inflammatory bowel disease (IBD), including Crohn's disease and ulcerative co...BACKGROUND: Background: The increasing use of long-term, low-dose isotretinoin for acne has raised concerns about a potential association with inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. OBJECTIVE: To evaluate the association between isotretinoin therapy and the risk of IBD using a large real-world database. METHODS: We conducted a retrospective cohort study utilizing the TriNetX network. Patients with acne who received isotretinoin were compared to acne patients who were not exposed to isotretinoin. Propensity score matching (1:1) was performed to balance baseline characteristics. Patients were followed for 6 to 10 years post-exposure. Primary outcomes included incidence of IBD, Crohn's disease, and ulcerative colitis. Secondary outcomes included irritable bowel syndrome (IBS), fecal calprotectin elevation, and elevated lipid levels. Hazard ratios (HRs) were calculated using Cox proportional hazards models. RESULTS: Among 81,641 isotretinoin-exposed and 1,876,038 unexposed patients, 61,894 matched pairs were analyzed. Isotretinoin use was not associated with increased risk of IBD (HR: 0.88, 95% CI: 0.49–1.57) or ulcerative colitis (HR: 1.05, 95% CI: 0.78–1.41), and was associated with decreased risk of Crohn's disease (HR: 0.69, 95% CI: 0.51–0.94). IBS and fecal calprotectin elevation were not significantly different between groups. Lipid levels in the isotretinoin group were transiently elevated. CONCLUSION: Long-term isotretinoin therapy does not increase the risk of IBD in acne patients.  .
Warts have bothered people since the early Greek and Roman empires.5 For centuries, people have studied causes of and treatments for these irritating tumors. In recent history, treatments have stagnated. Warts are caused...Warts have bothered people since the early Greek and Roman empires.5 For centuries, people have studied causes of and treatments for these irritating tumors. In recent history, treatments have stagnated. Warts are caused by non-enveloped, circular, double-stranded DNA human papillomavirus (HPV).6 Most infections are subclinical, but clinically relevant disease ranges from warts to invasive carcinoma.6 Two-thirds of warts resolve spontaneously within 2 years, meaning that the stakes for treatments are high.4 Successful therapies need to have high resolution, few side effects, and act fast. The lack of radical antiviral HPV treatment represents a significant care gap. Although common warts are generally due to low-risk HPV strains, coinfection with higher-risk variants is not uncommon.  .
BACKGROUND: There is a notable lack of diversity in dermatologic studies, even concerning conditions that are known to have a higher prevalence in the skin of color (SOC) population, such as hidradenitis suppurativa (HS)...BACKGROUND: There is a notable lack of diversity in dermatologic studies, even concerning conditions that are known to have a higher prevalence in the skin of color (SOC) population, such as hidradenitis suppurativa (HS). This study updates the current literature on SOC representation in dermatology by analyzing the demographics and locations of HS clinical trials from 2020 to 2024, during which there were significant advancements in therapeutics. METHODS: A search of the term "hidradenitis suppurativa" was conducted on the ClinicalTrials.gov website for trials initiated between June 2020 and December 2024. RESULTS: Five clinical trials totaling 411 participants were included. Caucasian/White participants (n=281, 68.4%) comprised the majority, followed by African American/Black (n=93, 22.6%) participants. In comparison to HS trials from 2008 to 2020, the 5 recent trials between 2020 and 2024 demonstrated a significant (P<0.001) increase (14.9% vs 22.6%, respectively) in the percentage of Black participants. Most US clinical trial sites (n=38, 59.3%) were located in cities with moderate (12.6-49.9%) to high (>50%) Black populations. CONCLUSIONS: The increase in the proportion of Black participants in HS clinical trials from 2008-2020 to 2020-2024 demonstrates a promising outlook for improved representation in HS clinical trials. Nonetheless, an underrepresentation of Black participants in HS clinical trials continues to persist, highlighting the necessity for continued efforts in the inclusion of SOC individuals in clinical research.
BACKGROUND: The National Institutes of Health (NIH) funds a multitude of dermatology research. This study examines NIH funding for vitiligo studies and highlights key trends. METHODS: The NIH Research Portfolio Online Re...BACKGROUND: The National Institutes of Health (NIH) funds a multitude of dermatology research. This study examines NIH funding for vitiligo studies and highlights key trends. METHODS: The NIH Research Portfolio Online Reporting Tool database was used to identify vitiligo research projects funded between 1985 and 2024, with results limited to project titles containing "vitiligo." RESULTS/DISCUSSION: The NIH awarded 166 grants for vitiligo research between 1985 and 2024. This study analyzed 144 of these awards, totaling $22,343,119. The greatest increase occurred between 1998 and 1999, with the average funding per grant rising by $124,316, leading to a total funding increase from $269,102 to $1,149,554. The most common funding mechanism was Non-Small Business Innovation Research (SBIR)/Small Business Technology Transfer (STTR). The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) was the leading administering institute. Medical schools were the most awarded organization type. The most common grant types were R01 (n=59, 41%) and M01 (n=21, 15%). Among the 144 funded projects, 48 were unique, with most focusing on pathophysiology (n=36) and treatment (n=8). LIMITATIONS: Study limitations include incomplete data on NIH research funding, with 22 awards missing total cost information and 25 awards calculated using subproject sums. CONCLUSION: From 1985 to 2024, NIH funding for vitiligo research fluctuated with an upward trend in recent years. The most common funding mechanism was Non-SBIR/STTR. Among organization types, medical schools received the most awards. Most vitiligo research projects have been completed and have focused on understanding the pathophysiology and treatment of vitiligo.  .
INTRODUCTION: Lichen simplex chronicus is a debilitating condition characterized by lichenified skin secondary to intractable itch. Lichen simplex chronicus is challenging to treat, with current treatment options, such a...INTRODUCTION: Lichen simplex chronicus is a debilitating condition characterized by lichenified skin secondary to intractable itch. Lichen simplex chronicus is challenging to treat, with current treatment options, such as topical calcineurin inhibitors, gabapentinoids, and dupilumab, commonly being ineffective, leaving patients with worsening symptoms and poor quality of life. CASE PRESENTATION: We report a case of lichen simplex chronicus in the setting of neuropathic pruritus successfully treated with nemolizumab in a 52-year-old woman. The patient did not report any side effects but reported significant improvement in quality of life. CONCLUSION: Lichen simplex chronicus has a significant impairment on quality of life, as it has been linked to anxiety, depression, and poor sleep, underscoring the importance of proper disease management. Current treatment regimens for lichen simplex chronicus are often ineffective. Our observation suggests that nemolizumab may be effective in managing lichen simplex chronicus; larger studies are warranted to confirm these findings.
Antibiotics remain a cornerstone in the management of dermatologic conditions such as acne and hidradenitis suppurativa, underscoring the need for responsible antibiotic stewardship. This article explores the “dark...Antibiotics remain a cornerstone in the management of dermatologic conditions such as acne and hidradenitis suppurativa, underscoring the need for responsible antibiotic stewardship. This article explores the “dark side” of antibiotics, highlighting their role in disrupting the gut microbiome, elevating risks for infections like Clostridium difficile, and increasing resistance in Cutibacterium acnes and other microbes. Emerging evidence also links antibiotic use to reduced vaccine efficacy and diminished responses to cancer immunotherapy. To mitigate these risks, dermatologists should prioritize narrow-spectrum antibiotics and incorporate combination topical therapies containing benzoyl peroxide (BPO), such as the triple-combination of clindamycin, adapalene, and BPO, to help curb antibiotic resistance. Prudent antibiotic use, combined with topical regimens utilizing BPO, optimizes treatment outcomes while minimizing systemic adverse effects and resistance. Ongoing education and research are essential to refine prescribing practices that balance therapeutic benefits with long-term patient and public health.
Although data suggest that antibiotic use by dermatologists is decreasing, our specialty still has the highest rates of oral antibiotic prescribing across all fields of medicine...Although data suggest that antibiotic use by dermatologists is decreasing, our specialty still has the highest rates of oral antibiotic prescribing across all fields of medicine...
BACKGROUND: Rotation flaps are reliable pillars in reconstructive surgery that provide excellent cosmesis. They allow the recruitment of adjacent tissue with similar characteristics and redistribute tension vectors along...BACKGROUND: Rotation flaps are reliable pillars in reconstructive surgery that provide excellent cosmesis. They allow the recruitment of adjacent tissue with similar characteristics and redistribute tension vectors along an arcuate path to achieve low tension closure. They also readily conform to relaxed skin tension lines, resulting in good cosmesis. OBJECTIVE: To review the principles and designs of rotation flaps and provide reproducible examples for practical application by the reconstructive surgeon. MATERIALS AND METHODS: Various named and anatomic site-specific rotation flaps were selected to demonstrate their versatility, and surgical pearls are provided to achieve optimal results. CONCLUSIONS: Understanding the principles of rotation flaps is critical to reconstructive surgeons. Proper design, adequate undermining, strategic placement of standing cone deformities, and appreciation of pivotal restraint are necessary for the successful execution of rotation flaps. Mastering the application of rotation flaps will add to a surgeon's armamentarium and allow their application to other anatomic sites.  .
BACKGROUND: Recent guidelines within the dermatology literature have indicated that a methotrexate test dose may not be needed for patients at lower risk of toxicity. However, few clinical studies have specifically exami...BACKGROUND: Recent guidelines within the dermatology literature have indicated that a methotrexate test dose may not be needed for patients at lower risk of toxicity. However, few clinical studies have specifically examined the utility of a test dose with regard to detecting or preventing significant laboratory abnormalities. Other specialties, such as rheumatology, do not mention methotrexate test doses within their guidelines. OBJECTIVE: To determine the frequency of laboratory abnormalities in patients initiating low-dose, oral methotrexate with and without a test dose. METHODS: We conducted a retrospective cohort analysis of patients greater than or equal to 18 years of age initiating methotrexate, prescribed by a dermatology or rheumatology provider within the Kaiser Permanente Mid-Atlantic States health plan. A methotrexate test dose was defined as any initial dose less than or equal to 15 mg with one or more laboratory tests within 3 to 10 days after dispensing. Patients were assigned to either the test dose or the non-test dose group. The rate of any grade 2 and higher laboratory abnormality (leukopenia, anemia, thrombocytopenia, elevated aspartate aminotransferase, elevated alanine aminotransferase) over 4 months of treatment was compared between the two groups. For the test dose group, the rate of any grade 2 and higher laboratory abnormality occurring between 3 to 10 days after initial methotrexate dispensing was reported. RESULTS: 2,575 patients were included; 220 in the test dose group and 2,355 in the non-test dose group, with rheumatology patients making up 91.92% (2,367/2,575). Over 4 months, 6.82% (15/220) of patients in the test dose group had at least one grade 2 or higher laboratory abnormality, compared to 4.34% (91/2,097) in the non-test dose group (P=0.09). Within the test dose group, 2.73% (6/220) of patients had a grade 2 or higher laboratory abnormality occurring between 3 to 10 days after initiating treatment. CONCLUSIONS: When initiating methotrexate in dermatology and rheumatology patients, the use of a test dose may be of limited value in detecting or preventing significant laboratory abnormalities. These findings provide support for evolving guidelines and consensus statements in dermatology regarding methotrexate test dose use.  .
BACKGROUND: Adult female acne presents challenges, including increased prevalence, distinct clinical manifestations, heightened skin sensitivity, treatment-related intolerance, and reduced treatment adherence. Integratin...BACKGROUND: Adult female acne presents challenges, including increased prevalence, distinct clinical manifestations, heightened skin sensitivity, treatment-related intolerance, and reduced treatment adherence. Integrating skincare into acne management is essential, particularly in Nordic European countries, where environmental factors influence skin physiology. The Nordic European Countries Acne Skincare Algorithm (NECASA) II algorithm serves as an evidence-based practical tool for clinicians in this region to select appropriate skincare based on individual patients' needs to optimize acne care for adult females. METHODS: Dermatologists from six Nordic European countries met to develop the NECASA II algorithm, which builds on the NECASA I framework. The advisors conducted a structured literature review and, combined with their clinical experience, established best practice recommendations for integrating skincare into adult female acne treatment regimens. RESULTS: The NECASA II algorithm recommends integrating skincare into adult female acne management based on acne severity, subtype, and patient characteristics. The panel concluded that all acne regimens should incorporate a physiologic pH cleanser, an emollient with humectants and lipids, and SPF 50+ sunscreen. Skincare monotherapy is recommended for mild acne, adjunctive skincare for moderate-to-severe acne, and maintenance skincare to prevent relapse following treatment. CONCLUSIONS: Personalized skincare regimens, combined with prescription and nonprescription treatments, can mitigate adverse effects, improve treatment tolerance and adherence, and enhance overall outcomes.
BACKGROUND: Identifying the risk of atherosclerotic cardiovascular disease (ASCVD) is a cornerstone of preventive medical care. Despite its significance, limited research has explored ASCVD risk in individuals with fibro...BACKGROUND: Identifying the risk of atherosclerotic cardiovascular disease (ASCVD) is a cornerstone of preventive medical care. Despite its significance, limited research has explored ASCVD risk in individuals with fibrotic skin diseases. This study aims to evaluate the risk of ASCVD in patients diagnosed with fibrotic skin conditions. METHODS: We utilized the TriNetX platform to analyze ASCVD risk associated with fibrotic skin conditions. Propensity score-matched (PSM) cohorts were constructed to adjust for confounding. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression. RESULTS: Patients with fibrotic skin diseases demonstrated an elevated risk of ASCVD. Scleroderma was most strongly associated with ASCVD risk (HR 2.51 [95% CI: 1.97,3.21]), followed by hypertrophic scar (HR 1.40 [95% CI: 1.20,1.63]). Elevated risks were also observed for morphea (HR 1.36 [95% CI: 1.03,1.08]) and lichen sclerosis (HR 1.30 [95% CI: 1.04,1.62]). CONCLUSION: Individuals with fibrotic skin conditions, including scleroderma, hypertrophic scars, morphea, and lichen sclerosis, demonstrate an increased risk of ASCVD. These findings highlight the significance of recognizing fibrotic skin diseases as possible indicators of systemic inflammation.
BACKGROUND: The objective of this survey was to obtain feedback and insights from United States dermatology healthcare professionals on their perceptions of sunscreens. METHODS: This cross-sectional survey study launched...BACKGROUND: The objective of this survey was to obtain feedback and insights from United States dermatology healthcare professionals on their perceptions of sunscreens. METHODS: This cross-sectional survey study launched online via the Dermsquared® platform to US dermatology healthcare professionals (HCPs) comprised questions evaluating perceptions of sunscreen (eg, formulation, usage, active safety and efficacy, misinformation, and perceptions on sunscreen access). "Strongly agree" and "agree" responses were analyzed together and "strongly disagree" and "disagree" responses were analyzed together. The relationships between groups were evaluated using the chi-square test of independence (P<0.05). RESULTS: A total of 723 HCPs were surveyed. Most (98%) agreed that the "best sunscreen is the one that patients will consistently use." Significantly more dermatologists than physician assistants and nurse practitioners (P<0.05) agreed with this, and 99% of HCPs agreed that sunscreen helps lower skin cancer risk. Most HCPs (99%) agreed that sunscreens offering a better application and aesthetic experience are likely to be used by patients more often. Significantly more HCPs agreed that chemical/organic actives offer a better application experience than physical/inorganic actives compared with those who responded neutral or disagreed, and most HCPs agreed that both sunscreen types were safe and effective. Social media and social media influencers were believed to be the greatest source of misinformation for patients. CONCLUSION: The dermatology HCPs in this survey strongly support sunscreen use and believe that FDA-approved sunscreens are effective and safe. The social media findings highlight a continued need to improve education on sunscreen use and increase counseling from clinicians on sun protection behaviors.
BACKGROUND: Mohs micrographic surgery (MMS) has shown promising efficacy in female genital cancers, including Extramammary Paget’s disease (EMPD), dermatofibrosarcoma protuberans (DFSP), squamous cell carcinoma (SC...BACKGROUND: Mohs micrographic surgery (MMS) has shown promising efficacy in female genital cancers, including Extramammary Paget’s disease (EMPD), dermatofibrosarcoma protuberans (DFSP), squamous cell carcinoma (SCC), and basal cell carcinoma (BCC). However, limited consolidated research exists on the clinical outcomes following MMS in female genital cancers. The aim of this systematic review is to synthesize and evaluate recent literature on the application and utility of MMS in the management of female genital cancers. METHODS: A comprehensive search was conducted of the PubMed and EMBASE databases on October 16, 2024, using the keywords "Mohs surgery" or "Mohs micrographic surgery" and "female genital" or "vulvar cancer" or "vaginal cancer" or "genital cancer" or "vulva" or "vagina." Studies were included if they directly discussed MMS for female genital cancers, particularly EMPD, DFSP, SCC, and BCC, with attention to clinical outcomes, were of the correct study type, and were published in peer-reviewed journals in English. RESULTS: Our results identified a 95% curative rate following MMS for EMPD, DFSP, SCC, and BCC, following analysis of 166 treated cases. CONCLUSION: MMS provides superior outcomes as compared to traditional excisional approaches, potentially secondary to its precision-guided approach and histological analysis. Future studies should utilize larger patient cohorts and investigate rarer malignancies and combination therapies to optimize treatment guidelines for female genital cancers.
BACKGROUND: Roflumilast is a topical phosphodiesterase-4 inhibitor FDA-approved for treating plaque psoriasis and atopic dermatitis. Line-field confocal optical coherence tomography (LC-OCT) is a novel non-invasive imagi...BACKGROUND: Roflumilast is a topical phosphodiesterase-4 inhibitor FDA-approved for treating plaque psoriasis and atopic dermatitis. Line-field confocal optical coherence tomography (LC-OCT) is a novel non-invasive imaging method utilized to evaluate skin in vivo. OBJECTIVE: This study uses LC-OCT (Damae Medical, France) to visualize the effects of 0.3% roflumilast versus vehicle on healthy skin in vivo. METHODS: Three subjects (mean age: 26 years) with healthy skin applied roflumilast (right forearm) and vehicle (left forearm) daily for seven days. LC-OCT imaging was performed at multiple intervals: before cream application (T0A), after application (T0B), 15 minutes (T0C), 1 hour (T0D), 8-12 hours (T0E), 24 hours (T0F), 7 days (T7), and 7 days after the last application (T14). A dermatopathologist evaluated changes in morphology, and an AI algorithm calculated the changes in stratum corneum (SC) and epidermal thickness. RESULTS: At T0B, both creams showed a hyperreflective layer above the SC, which diminished over time. Roflumilast-treated skin exhibited increased dermal-epidermal junction (DEJ) demarcation, more organized keratinocytes, and a reduction in hyperreflective material. The algorithm showed increased SC thickness in both arms until T7, but only roflumilast's SC thickness continued increasing until T14, while the vehicle-treated arm decreased. Epidermal thickness increased in both arms but reversed at T14. CONCLUSION: LC-OCT visualized roflumilast's effects on healthy skin, including reduced hyperreflective material consistent with mottled pigmentation and normalized keratinocyte organization, suggesting the effects it has on healthy skin. The AI algorithm showed lasting effects on SC thickness, even after discontinuation of treatment.
BACKGROUND: While caffeine has been proposed to stimulate hair growth, its safety and efficacy remain unclear. This systematic review evaluates the effects of caffeine interventions on hair loss and growth outcomes. METH...BACKGROUND: While caffeine has been proposed to stimulate hair growth, its safety and efficacy remain unclear. This systematic review evaluates the effects of caffeine interventions on hair loss and growth outcomes. METHODS: A systematic review of seven databases, including PubMed, Medline, and Embase, was conducted in August 2023. Original studies investigating caffeine's effects on hair loss were included. Study quality was assessed using the National Institute of Health Study Quality Assessment Tools. Outcomes of interest included caffeine intervention types and their effects on hair growth. RESULTS: Of 587 citations, nine studies met the inclusion criteria: five randomized controlled trials, three prospective cohort studies, and one twin-twin cohort study. Most studies investigated topical caffeine; one assessed oral caffeine intake. Topical caffeine consistently demonstrated hair growth or reduced hair loss with minimal adverse effects. However, none of the studies used tattooed or marked scalp areas for hair counts. CONCLUSIONS: Caffeine appears to be a safe and promising potential treatment for hair loss. Topical caffeine shows potential as a therapeutic option, though further large-scale randomized controlled trials with standardized outcome measures are needed.