Journal of Drugs in Dermatology最新文献

Background: Minoxidil is an anti-hypertensive vasodilator increasingly used off-label for the treatment of alopecia. It is associated with an increased risk of pericardial effusions, with recent reports even in patients on low-dose oral minoxidil (LDOM) therapy.

Objective: To evaluate whether LDOM is associated with increased prevalence of pericardial effusions in patients with alopecia.

Methods: In this cross-sectional study, point-of-care ultrasound was used to screen alopecia patients at dermatology appointments. Scans were evaluated by two independent cardiologists for the presence and size of effusions. The prevalence of effusions was compared between patients on LDOM therapy and patients not on minoxidil therapy.

Results: A total of 100 patients were evaluated for pericardial effusion: 51 LDOM patients and 49 control patients. The two groups were similar in terms of age (53.7 vs 54.1; P=0.91), sex (86% vs 73% female; P=0.14), and race. Small pericardial effusions (<1 cm) were identified in 5.8% of LDOM patients and 6% of control patients (P=1), none of which were symptomatic.

Limitations: This is a small, cross-sectional study with limitations on speculation of causality in confirmed cases.

Conclusion: We did not find evidence of increased prevalence of pericardial effusions in a small group of alopecia patients on LDOM. J Drugs Dermatol. 2024;23(9):725-728. doi:10.36849/JDD.8029.

Background: Cutaneous melanoma (CM) is associated with a higher mortality rate than most other skin cancers. The purpose of this expert consensus panel was to review the published literature on new technological advancements for the diagnosis and prognosis for CM and provide updated guidance on their usage.

Methods: A comprehensive literature search of PubMed, Scopus, and Google Scholar was completed for English-language original research articles on the topics of non-invasive diagnostic and prognostic testing for CM, including gene expression profiling (GEP) and electrical impedance spectroscopy (EIS). A panel of 10 dermatologists with significant expertise in the treatment of CM gathered to review the articles and create consensus statements. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned using widely recognized Strength of Recommendation Taxonomy criteria.

Results: The literature search produced 200 articles that met the criteria. A screening of the studies resulted in 19 articles. These were distributed to all panelists for review prior to a roundtable discussion. The panel unanimously voted to adopt 7 consensus statements and recommendations, 5 of which were given a strength of "A", 1 of which was given a strength of "B," and 1 of which was given a strength of "C".

Conclusion: The 2-GEP test and EIS can aid in the precise diagnosis of clinically indeterminate lesions and the 23-GEP test can be used when histopathology is equivocal. The 31-GEP test can enhance prognostic assessment beyond AJCC8 staging and improve clinical decision-making. J Drugs Dermatol. 2024;23(9):774-781. doi:10.36849/JDD.8365R1.

Platelet-rich concentrates (PRCs), derived from a patient's blood, are being used in various fields of medicine, including dermatology, for an increasing number of indications. Although considered a generally safe procedure for dermatologic indications, there have been reports in the last several years linking this treatment to cases of blood-borne infections including HIV and hepatitis.1 Patient safety should always be the primary focus for physicians and other health care professionals, and systems-based protocols should exist within care settings to minimize errors. Herein, we review our protocol to decrease the risk of complications related to transmission of blood-borne infections and other medical errors related to PRCs. J Drugs Dermatol. 2024;23(9)790-791. doi:10.36849/JDD.8166.

Background: Acne vulgaris is a multifactorial dermatosis primary of the face and trunk. Erythema, pruritus, and xerosis are frequent adverse effects of first-line acne treatment and, if not appropriately counseled and managed, can exacerbate, leading to regimen nonadherence and poor outcomes.

Methods: A panel of 6 dermatologists (five from the Nordic European Countries and one from the UK) employed a modified Delphi method and reached a consensus on a practical acne treatment and maintenance algorithm integrating skincare based on the best available evidence, and the panels' clinical experience, and opinions.

Results: The Nordic European Countries Acne Skincare Algorithm (NECASA) recommends integrating skincare and nonprescription acne treatment into acne regimens, addressing the relative lack of standardized guidance on their use as mono or adjunctives to acne treatment. The algorithm uses stratification by acne subtype and discusses management approaches per type of acne (comedonal, papulopustular, and nodulocystic acne), severity (mild to moderate and severe), and maintenance treatment. Skincare monotherapy may reduce acne lesions and maintain clearance in patients with mild acne. Adjunctive skincare may enhance the efficacy and improve tolerability of acne treatment, reduce pigmentary alterations, and improve skin barrier function.

Conclusions: The NECASA algorithm may serve as a roadmap for integrating skincare in managing acne patients and tailoring acne treatment to improve adherence and tolerance to treatment and patient outcomes. J Drugs Dermatol. 2024;23(9):782-788. doi:10.36849/JDD.8472.

Background: The treatment of rosacea is complicated as there are multiple pathogenic factors in play resulting in a myriad of clinical signs and symptoms including facial redness.

Objective: The primary objective was to evaluate the efficacy and tolerability of a non-prescription anti-redness regimen in patients with rosacea.

Methods: Thirty subjects with rosacea-induced facial erythema were enrolled in this single site, monadic study. The test regimen consisted of a treatment serum, redness-reducing moisturizer, and sunscreen. The test products are formulated with ingredients curated to address the multifactorial pathogenesis of facial redness. Investigator and subject self-assessment for efficacy and tolerability were performed at baseline, weeks 4 and 8. Non-invasive assessments for facial redness and skin hydration were conducted at all time points.

Results: Investigator grading showed significant improvement in facial redness of 21% at week 4 and 32% at week 8. Skin's appearance improved as early as 4 weeks while at 8 weeks there was statistically significant improvement in fine lines 15%, radiance/brightness 37%, tactile roughness 44%, visual roughness 41%, and 26% in overall appearance. Non-invasive assessments showed statistically significant improvement in skin hydration of 28% at week 4 and facial redness of 21% by week 8. No tolerability issues were identified by the investigator.

Conclusion: Patients with rosacea often turn to over-the-counter products to reduce facial redness and improve skin's appearance. In this study, a cosmetic skincare regimen designed to reduce facial redness demonstrated efficacy and tolerability in subjects with rosacea. J Drugs Dermatol. 2024;23(9):757-763. doi:10.36849/JDD.8460.

Lipids play an essential role in skin barrier health. With age, there is a natural reduction of physiological lipids such as fatty acids, ceramides, and cholesterol. The triple lipid restore cream is a moisturizer that contains an optimized lipid ratio for aging skin. The cream contains a 2:4:2 ratio of ceramides, cholesterol, and fatty acids that have been shown to best support aging skin. The triple lipid restore cream has been used in combination with energy-based procedures, to provide patients with comprehensive integrated skincare regimens. With limited clinical data and guidelines available in regenerative medicine, real-world cases serve as an invaluable guide for patients and dermatologists in navigating rejuvenation treatment plans. J Drugs Dermatol. 2024;23:9(Suppl 1):s3-14.

Background: Dermatoporosis (DP) is a condition associated with thinning skin layers and resultant fragility. Much of the thinning is related to fibroblast dysfunction, production of destructive inflammatory cytokines, breakdown of the extracellular matrix (ECM), and weakening of the dermo-epidermal junction. A major contributor to this change in the ECM milieu, previously under-considered, is cellular senescence, particularly involving the papillary dermal fibroblasts.

Methods: A series of experiments were undertaken to explore the impact of a combination of known actives on senescent cell status. Human keratinocytes and fibroblasts were cultured, and cytotoxicity tests were performed to determine the ideal concentration to avoid cell toxicity. Microdoses of Centella asiatica (0.005%) and mandelic acid (0.05%) were found to be ideal in avoiding any cytotoxicity. However, the challenge was then to assess the efficacy of these actives in this microdosed form. After exposing the cells to the compounds, RNA was isolated and sequenced. Moreover, a well-described ex vivo model using photodamaged skin was subjected to immunofluorescence to identify senescent cells (via p16INK4a), particularly in the papillary dermis, using the microdose formulation compared to untreated skin. In addition, JAG/NOTCH expression in the epidermal basal cells was evaluated to further understand the cellular senescence signaling mechanism.

Results: Microdosing these two well-known agents had surprisingly significant synergistic effects in vitro, decreasing senescence-associated secretory phenotype (SASP) cytokines and the associated inflammation involved in the process. The ex vivo model revealed a significant (P<0.05) decrease in senescent cells in the papillary dermis and a significant increase (P<0.001) of JAG/NOTCH expression in the basal cells of the epidermis.

Conclusion: Using microdoses of two known agents, a novel approach produced an unexpected effect of reversal of dermal senescent cells and promoting an anti-inflammatory milieu. A gene expression analysis of the individual and combined actives validated these observations, followed by full formulation testing in an ex vivo model. The approach of limiting cellular senescence in dermal fibroblasts for managing DP is novel and provides an exciting new direction to address dermatoporosis. Clinical studies will follow. J Drugs Dermatol. 2024;23(9):748-756. doi:10.36849/JDD.8388.

Background: Regenerative aesthetics has garnered significant attention. In this toolkit, exosomes are small extracellular vesicles derived from various sources such as platelets.

Objective: To characterize the cosmetic effect and tolerability of topical human platelet-derived extract (HPE), Intense Serum (Rion Aesthetics, Inc., Rochester, MN), on facial skin rejuvenation after 12 weeks of twice daily use without any confounding aesthetic procedures.

Materials and methods: This prospective, single-arm, non-randomized, evaluator-blinded clinical study evaluated subjects at baseline and 12 weeks using participant questionnaires and photo-documentation with Canfield VISIA-CR 3D PRIMOS. The histological evaluation included Masson's Trichrome for collagen and Verhoeff-Van Gieson staining for elastin. Electron microscopy characterized collagen bundle thickness.

Results: Fifty-six participants (mean age: 54 years old) were enrolled. Following topical HPE use, 87.3% of subjects reported improvement in facial skin aging including sustained pigment reduction and improvement in luminosity and color evenness at 12 weeks (P≤0.001). Histology revealed a significant increase in collagen fibril thickness at 12 weeks (P≤0.0001). No serious adverse effects.

Conclusion: This study demonstrates improvement in facial skin health after topical HPE use, supported by collagen and elastin formation in the dermis. The product is well-tolerated, and participants were satisfied with the overall cosmetic outcome. J Drugs Dermatol. 2024;23(9):735-740. doi:10.36849/JDD.8162.