BACKGROUND: Nicotinamide (niacinamide) is the water-soluble form of vitamin B3. Nicotinamide plays a crucial physiological role as a catalyst for various molecular reactions in the body and is a common over-the-counter s...BACKGROUND: Nicotinamide (niacinamide) is the water-soluble form of vitamin B3. Nicotinamide plays a crucial physiological role as a catalyst for various molecular reactions in the body and is a common over-the-counter supplement. In dermatology, oral nicotinamide has a long history of diverse applications. Oral nicotinamide mitigates ultraviolet-induced immunosuppression, serves as adjunctive therapy for blistering skin disorders, reduces inflammation and sebum in acne vulgaris, and has been used for pruritic disorders. Recent studies indicate that terminal metabolites of nicotinamide may contribute to vascular inflammation and elevate the risk of cardiovascular disease, particularly at doses exceeding therapeutic recommendations of 500 mg. Given the wide range of applications of nicotinamide in dermatology, we aim to investigate the effects of oral nicotinamide on cardiovascular health. METHODS: A review of the literature was conducted to assess the dermatological benefits of oral nicotinamide as well as its potential cardiovascular risks, particularly at high doses. Evidence from clinical trials and meta-analyses was evaluated to synthesize current knowledge on its safety and efficacy. RESULTS: Oral nicotinamide has demonstrated significant benefits in dermatological practice, including reducing the incidence of non-melanoma skin cancers in immunocompetent individuals and improving outcomes in various inflammatory skin conditions. However, recent evidence suggests that increased serum levels of nicotinamide's terminal metabolites N1-methyl-2-pyridone-5-carboxamide and N1-methyl-4-pyridone-3-carboxamide leads to increased risk of major adverse cardiovascular effects. CONCLUSION: While oral nicotinamide remains a valuable option in dermatological practice, clinicians should exercise caution in prescribing this at high doses due to the potential cardiovascular risks.
Primary biliary cholangitis (PBC) can present with overlapping features of limited systemic sclerosis, commonly known as calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST)...Primary biliary cholangitis (PBC) can present with overlapping features of limited systemic sclerosis, commonly known as calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST). Here, we discuss the case of a PBC patient with CREST who experienced treatment-resistant and progressively worsening pruritic dermatitis that responded to upadacitinib with associated improvement of her liver enzymes and symptoms. This is the first documented report of a Janus kinase (JAK) inhibitor used to treat cutaneous symptoms in the setting of an autoimmune liver disease.
INTRODUCTION: Benign Familial Pemphigus (Hailey-Hailey Disease [HHD]) is a rare chronic condition, with treatments focusing on managing disease symptoms. CASE PRESENTATION: We present a case of a 72-year-old female with...INTRODUCTION: Benign Familial Pemphigus (Hailey-Hailey Disease [HHD]) is a rare chronic condition, with treatments focusing on managing disease symptoms. CASE PRESENTATION: We present a case of a 72-year-old female with refractory HHD. Despite management with standard HHD treatments, such as antibiotics and corticosteroids, the patient's flares persisted. She was started on ruxolitinib 1.5% cream, with improved symptoms. DISCUSSION: This case demonstrates the difficulties a patient with refractory HHD may experience, and the significance of exploring novel treatment options to improve disease response and patient quality of life. CONCLUSION: Ruxolitinib may be an effective treatment option for HHD management, but further investigation is necessary.
BACKGROUND: DermmunityTM is a Los Angeles-based community service program established in 2020 at the University of Southern California Department of Dermatology to provide dermatologic education to local underserved comm...BACKGROUND: DermmunityTM is a Los Angeles-based community service program established in 2020 at the University of Southern California Department of Dermatology to provide dermatologic education to local underserved communities. METHODS: This study characterized the impact of Dermmunity through retrospective analysis and a prospective survey given over a one-year period (2023-2024). RESULTS/DISCUSSION: From 2020 to 2024, Dermmunity reached 406 participants. Faculty and trainees led lectures on dermatologic health topics including how to access a dermatologist. Survey results demonstrated most participants were female (85.6%), Hispanic/Latinx (74.8%), and insured (88.2%). The largest age group were 35–44-year-olds (33.1%), and the most common highest education level was high school (39.8%). Most respondents found the information presented useful (92.3%), and half (50.9%) felt it would affect their skincare practices. Despite over half having prior skin, hair, or nail conditions, 61.3% had never seen their primary doctor for dermatologic issues. Less had been to a dermatologist (43.7%), nearly a third citing challenges accessing a dermatologist (30.5%). After presentations, the majority felt educated on when to see a dermatologist (79.5%), and 74.3% reported knowing how to schedule an appointment. LIMITATIONS: Small sample size and non-response bias. CONCLUSION: Community outreach programs like Dermmunity increase the dermatologic knowledge of participants' and their confidence in when and how to access a dermatologist. Findings highlight how community-based educational outreach can bridge gaps to care in underserved communities and help improve health equity.
Hidradenitis suppurativa (HS) is a complex skin condition influenced by both genetic and environmental factors. Increasing evidence points to diet as a key contributor to disease severity through systemic inflammatory pa...Hidradenitis suppurativa (HS) is a complex skin condition influenced by both genetic and environmental factors. Increasing evidence points to diet as a key contributor to disease severity through systemic inflammatory pathways. A review of recent literature was conducted to evaluate the relationship between dietary patterns and advancement of HS. Pro-inflammatory diets such as the Western diet, leucine-rich diets, and brewer's yeast were associated with HS exacerbation through mTOR activation and hormonal dysregulations. In contrast, anti-inflammatory agents such as the Mediterranean diet, very low-calorie ketogenic diet, and dairy-free diets showed promising results in mitigating HS flares. Supplementation with vitamin D and zinc also demonstrated clinical improvement in patients with documented deficiencies. Recent research suggests that fasting may help reduce inflammation and ease HS symptoms. This review seeks to synthesize recent literature, offer diet-specific management insights, and identify existing gaps in research and literature regarding diet and HS.
Ghannoum M, Eltokhy A, Sewake J
… +10 more, McCormick T, Bhatia N, Baldwin H, Gold LS, Harper JC, Zeichner JA, Lain ET, Callender VD, Guenin E, Draelos ZD
BACKGROUND: The only approved triple-combination acne treatment – clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (CAB) gel - demonstrated efficacy/safety in 12-week clinical trials. However, real-...BACKGROUND: The only approved triple-combination acne treatment – clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (CAB) gel - demonstrated efficacy/safety in 12-week clinical trials. However, real-world treatment may require 6 months for maximum benefits in some cases. Since long-term antibiotic use can lead to resistance in the causative Cutibacterium acnes (C. acnes), this analysis evaluated the effect of long-term CAB use on C. acnes. METHODS: Pooled data from 2 identical, 24-week, single-center, open-label studies evaluated once-daily CAB in participants aged ≥12 years with moderate/severe acne (Investigator's Global Assessment [IGA] of 3/4). Plates inoculated with central forehead swabs were monitored for C. acnes colony formation. Clindamycin susceptibility was assessed via minimum inhibitory concentration (MIC) values using Epsilometer tests; MIC ≥8 μg/mL indicated resistance. RESULTS: Of 50 participants enrolled, 45 completed the studies. At baseline, C. acnes strains were isolated from 82% (37/45) of participants. After 24 weeks, CAB-treated participants with cultivable isolates decreased by nearly half to 44% (20/45). For susceptible strains isolated at week 24, MIC values remained low (mean, 0.19 μg/mL). Only 1 participant without growth at baseline had cultivable C. acnes at week 24, deemed clindamycin-susceptible. Only the 5 participants (11%) with resistant C. acnes isolates at baseline had resistant isolates at study end, though all 5 had acne improvements at week 24 (IGA decrease, 1-3 points; lesion reductions, 40%-100%). CONCLUSIONS: Long-term CAB gel treatment did not lead to antibiotic resistance development and was efficacious in participants with resistant isolates at baseline, suggesting CAB is well suited for long-term acne treatment.
Chronic hand eczema (CHE) affects up to 10% of the general population and is associated with significant physical discomfort, impaired hand function, and reduced quality of life, yet effective long-term treatment options...Chronic hand eczema (CHE) affects up to 10% of the general population and is associated with significant physical discomfort, impaired hand function, and reduced quality of life, yet effective long-term treatment options remain limited. Delgocitinib cream, a nonsteroidal topical pan-JAK inhibitor, has demonstrated high efficacy and safety in adult Phase 3 pivotal trials, significantly improving clinical signs, symptoms, and quality of life for patients across diverse CHE subtypes. Comparative studies suggest delgocitinib offers superior or similar benefits to systemic therapies like the oral retinoid alitretinoin and the biologic dupilumab, with negligible systemic exposure. These findings support delgocitinib cream as an innovative and promising topical therapy addressing a critical unmet need in CHE patient management.
Management of CHE can be complicated by numerous factors, including the possibility that contact irritants or allergens–including occupational exposures–contribute to the condition. Additionally, there have b...Management of CHE can be complicated by numerous factors, including the possibility that contact irritants or allergens–including occupational exposures–contribute to the condition. Additionally, there have been few effective directed treatment options available for the condition, and some of the most widely used treatments have potential limitations, including systemic exposure or tolerability concerns.
BACKGROUND: Dupilumab has demonstrated benefits in patients with atopic dermatitis (AD), but there is limited information on real-world rates of dupilumab persistence and supplementation with topical and systemic treatme...BACKGROUND: Dupilumab has demonstrated benefits in patients with atopic dermatitis (AD), but there is limited information on real-world rates of dupilumab persistence and supplementation with topical and systemic treatments beyond adult populations. OBJECTIVE: This retrospective cohort study evaluated real-world dupilumab use among children (<13 years), adolescents (13–17 years), and adults (≥18 years) with moderate-to-severe AD, who initiated dupilumab (March 2017 to September 2021) in the United States. METHODS: The OM1 PremiOM™ AD dataset was used to assess dupilumab treatment persistence and treatment supplementation over a 24-month period. RESULTS: Of 5200 eligible patients who initiated dupilumab, 208 were children, 430 were adolescents, and 4562 were adults. Dupilumab persistence decreased consistently over 24 months of follow-up. The probability of dupilumab persistence at 12 and 24 months was 79.8% and 70.8% in children, 81.9% and 63.1% in adolescents, and 73.2% and 55.7% in adults, respectively. Across all patients, treatment supplementation increased over time; 31.5% received supplemental systemic therapy, and 62.1% received topical medications at 24 months. CONCLUSIONS: Over a 2-year period, dupilumab persistence generally decreased while treatment supplementation increased for all patient groups, indicating a considerable proportion of patients with AD have unaddressed treatment needs.
BACKGROUND: Atopic dermatitis (AD) is a common heterogeneous disorder that typically starts in infancy and early childhood, is associated with the development of comorbidities, and may persist into adulthood. Skin barrie...BACKGROUND: Atopic dermatitis (AD) is a common heterogeneous disorder that typically starts in infancy and early childhood, is associated with the development of comorbidities, and may persist into adulthood. Skin barrier dysfunction is a pivotal contributor to AD and is impacted by S. aureus colonization and immunological, genetic, and environmental (SAIGE) factors. Managing AD in clinical practice remains challenging due to multiple contributing SAIGE factors. METHODS: A global expert panel of 7 pediatric dermatologists and dermatologists used a modified Delphi process comprising face-to-face discussions and an online follow-up to define five consensus statements providing recommendations based on the literature, clinical experience, and the panel’s opinion for healthcare providers treating pediatric patients with AD. RESULTS: The panel defined SAIGE factors that compromise skin barrier function and contribute to AD development. The recommendations focus on the impact of SAIGE factors in pediatric AD development, reducing exposure to modifiable risk factors to mitigate skin barrier dysfunction. Continuous skincare that is initiated from birth may delay and mitigate AD, specifically in high-risk populations. CONCLUSIONS: According to panel consensus, recognizing and mitigating SAIGE factors and initiating ceramide-containing skincare from birth are important. The panel recommendations underscore the need for clinician education to improve knowledge of the impact of SAIGE factors and therapeutic mitigation strategies to delay flare development and reduce AD severity.
BACKGROUND: A novel topical cream moisturizer was designed to deliver immediate and long-lasting skin barrier improvements and to improve skin tolerability when used as adjunctive/complementary care by patients with atop...BACKGROUND: A novel topical cream moisturizer was designed to deliver immediate and long-lasting skin barrier improvements and to improve skin tolerability when used as adjunctive/complementary care by patients with atopic dermatitis (AD), rosacea, or cosmetic intolerance syndrome (CIS), reducing symptoms of skin irritation and sensitivity. OBJECTIVE: To evaluate the cream moisturizer’s biological effects on critical epidermal proteins, lipids, genes, and clinical improvements in skin barrier strength and tolerability. METHODS: Preclinical and clinical studies assessed the cream moisturizer’s effects on filaggrin, hyaluronic acid, and lipid levels; gene expression; skin barrier strength; skin surface hydration, texture/appearance, and tolerability; and patient quality of life (QoL) in the aforementioned conditions. RESULTS: In preclinical studies, the cream moisturizer demonstrated significant increases in filaggrin (+77%), hyaluronic acid (+157%), and lipid (+30%) levels vs untreated controls (P<0.05), and upregulated key epidermal lipid pathways for skin barrier function. Clinical studies demonstrated progressive improvements in surface hydration, reductions in transepidermal water loss over 4 weeks, and sustained improvements in hydration after a 3-day regression period. Furthermore, daily application on clinically sensitive skin yielded significant improvements in skin look and feel without significant increases in irritation over 4 weeks. CONCLUSION: The cream moisturizer improved skin barrier strength, skin tolerability, and patient QoL (with favorable aesthetics). These findings support the cream moisturizer as a preferred topical adjunctive product to support skin barrier health, particularly in AD, rosacea, and CIS.
Thinning hair affects the quality of life of affected men and women but has limited treatment options. A novel technology refines exosomes from stem cells to create a concentrated complex that is quickly absorbed into th...Thinning hair affects the quality of life of affected men and women but has limited treatment options. A novel technology refines exosomes from stem cells to create a concentrated complex that is quickly absorbed into the scalp to deliver growth factors, peptides, coenzymes, minerals, amino acids, and vitamins (Exosome Regenerative Complex+®. BENEV, Inc.; Mission Viejo, CA). This study assessed the efficacy and safety of the Exosome Regenerative Complex applied following microneedling on the scalp of subjects with self-perceived thinning hair. Enrolled subjects were male (n=15) and female (n=15) with a mean (SD) age of 50.2 (10.9) years (range, 26-65 years). Subjects were treated on days 0, 30, 60, and 90, with a final assessment on day 120. Trichoscopy assessments showed this treatment significantly increased terminal and vellus hair counts (P<0.0001) and decreased hair shedding on day 120 (P<0.01), increased mean follicular units per cm² (P<0.0001), and decreased inter-follicular distance (P<0.0001). On day 120, the investigator rating for improved hair quality was 97% and improved hair growth was 83%. Subject satisfaction with treatment results was high with no reported adverse events. The combined use of an Exosome Regenerative Complex combined with RF microneedling appears to be an effective and well-tolerated treatment for hair loss in men and women. ClinicalTrials.gov NCT06571799.
BACKGROUND: Atopic dermatitis (AD) is a skin disorder characterized by reduced skin barrier function, which often leads to recurring infections, predominantly by Staphylococcus aureus and methicillin-resistant S. aureus,...BACKGROUND: Atopic dermatitis (AD) is a skin disorder characterized by reduced skin barrier function, which often leads to recurring infections, predominantly by Staphylococcus aureus and methicillin-resistant S. aureus, that exacerbate disease severity. Managing these infections is made challenging by antibiotic resistance and biofilm formation. Nitric oxide (NO) has emerged as a promising antimicrobial treatment that can disperse biofilm and may provide an alternative treatment for AD infections. METHODS: This study evaluated the antimicrobial efficacy of 3 topical NO-releasing formulations at various concentrations against established MRSA infections, from an AD-derived isolate, in a porcine wound infection model. Partial thickness wounds were inoculated and, after 48 hours of biofilm formation, were treated daily with NO formulations or vehicle control, or left untreated. Wounds were recovered for baseline, day 4, or day 7 bacterial enumeration. RESULTS: All tested NO-releasing formulations substantially reduced MRSA burden compared with baseline counts, and most effectively with the highest concentrations. 20% NO+GEL resulted in a significant reduction of 99.23% compared with baseline at day 7. The 16% NO+UNG treatment, compared with the untreated control, had bacterial reductions on day 4 and day 7 of greater than 99.5%. The greatest reduction of 99.97% (>3 Log CFU/mL) was observed for 6% NO+CREAM compared with the untreated control group at day 7. CONCLUSIONS: NO-releasing treatments have considerable efficacy against MRSA infections and biofilm. These findings support the potential of NO as an antimicrobial treatment for AD patients, and further evaluation should be conducted to assess clinical efficacy.
BACKGROUND: Influenza vaccination represents one of the most widespread public health interventions. Localized cutaneous reactions, including nodules and pruritus, may occur rarely following vaccination, particularly whe...BACKGROUND: Influenza vaccination represents one of the most widespread public health interventions. Localized cutaneous reactions, including nodules and pruritus, may occur rarely following vaccination, particularly when administered improperly. Our clinic observations suggest the potential development of lipomas following intramuscular vaccination. OBJECTIVE: This study evaluates the risk of subcutaneous nodules and lipoma development in the upper arm after intramuscular influenza vaccination. METHODS: We utilized the TriNetX platform to assess the risk of a subcutaneous nodule on the arm and lipoma development in patients who received intramuscular formulations of the annual influenza vaccine compared to those who never received the vaccine. A propensity score-matched cohort analysis was conducted to adjust for potential confounders. RESULTS: Our analysis demonstrated that individuals who received influenza vaccines were at an increased risk of developing a subcutaneous nodule of the arm, with a hazard ratio (HR) of 1.32 [95% confidence interval (CI): 1.28-1.37], or a lipoma of the upper arm, with an HR of 1.57 [95% CI: 1.28-1.93]. CONCLUSIONS: Intramuscular influenza vaccination administration is associated with an elevated risk of subcutaneous nodule and lipoma development in the upper arm. These findings highlight the importance of proper vaccine administration techniques to minimize adverse events.
BACKGROUND: Our dermatology department consistently receives the largest proportion of internal on-call referrals from the Hematology-Oncology Department. Individuals with hematological malignancies are particularly susc...BACKGROUND: Our dermatology department consistently receives the largest proportion of internal on-call referrals from the Hematology-Oncology Department. Individuals with hematological malignancies are particularly susceptible to dermatologic conditions secondary to immunosuppression and multi-agent exposure, which can impact cancer therapy, leading to morbidity and mortality. METHODS: Our primary objective was to analyze the range of dermatologic conditions observed in patients with hematologic malignancies and to identify potential associations with anticancer therapies. We conducted a retrospective, single-center review of acute hematology-oncology referrals to our on-call service between August 2020 and November 2022. Consultations were identified retrospectively through the on-call referral log. RESULTS: One hundred and thirty-four (134) patients were included. The most common diagnoses were cutaneous adverse drug eruptions (22%), leukemia or lymphoma cutis (13%), infections (13%), and acneiform eruptions (10%). Notably, cutaneous drug reactions were more prevalent in patients with myeloid neoplasms (32%). Acneiform eruptions predominantly occurred in patients with myeloid lineage malignancies. CONCLUSION: Dermatology plays a vital role in providing consultative services to patients with hematology-oncology conditions. With the emergence of novel therapies, the landscape of dermatologic complications in this population is evolving. Consequently, the demand for dermatology expertise is expected to increase to facilitate prompt diagnosis and management and to ensure optimal patient outcomes.
BACKGROUND AND OBJECTIVE: Atopic dermatitis (AD) affects 15% to 20% of children. Evidence supporting the effectiveness of colloidal oatmeal-based moisturizers in improving mild-to-moderate AD is accumulating. Data on use...BACKGROUND AND OBJECTIVE: Atopic dermatitis (AD) affects 15% to 20% of children. Evidence supporting the effectiveness of colloidal oatmeal-based moisturizers in improving mild-to-moderate AD is accumulating. Data on use with a bathing routine, where compromised skin could be affected, is lacking. This study evaluated the effectiveness and tolerability of 1% colloidal oatmeal-containing cream and gentle baby wash in children with AD. METHODS: In this open-label, single-arm study of children 3 to 72 months old with mild-to-moderate AD, 1% colloidal oatmeal-containing cream was applied twice daily, and a gentle baby wash was used ≥3 times/week for 4 weeks. PRIMARY ENDPOINT: mean change from baseline at day 28 in the Eczema Area Severity Index (EASI) and Atopic Dermatitis Severity Index (ADSI) total scores. Adverse events (AEs), tolerability, skin barrier (SB), Infant Dermatitis Quality of Life (IDQoL), sleep (Brief Infant Sleep Questionnaire-Revised; BISQ-R), and pruritus were evaluated. Assessments were performed at baseline and on days 1, 3, 7, and 28. RESULTS: Twenty-nine of 31 enrollees completed the study. At all visits, improvements from baseline in EASI, ADSI, IDQoL, and pruritus were significant (P<0.05). SB significantly improved at most visits. Two AEs were reported and led to study discontinuation (papular rash; contact dermatitis). CONCLUSIONS: The study regimen was effective and well-tolerated in this pediatric population with AD. Improvements occurred as early as day 1, with a rapid reduction in pruritus and increased well-being.