Journal of Clinical and Aesthetic Dermatology最新文献

Recent years have witnessed significant growth in aging research due to groundbreaking discoveries in gerotherapeutics and an ever-increasing interest in longevity. Such advances beg the question, what if the physical and functional declines we associate with aging were no longer inevitable, but instead treatable through the next frontier of medical innovation? In this article, we explore the broader social and ethical implications of advancing healthspan and mitigating age-related decline. We also highlight dermatology's unique role as a catalyst of aging research, serving as a model for integrating aesthetic and functional innovations. Finally, we discuss the curious role and the ethical challenges of the aesthetic dermatology industry in the healthspan debate.

Introduction: It has been proposed that some cases of refractory atopic dermatitis are caused by an overgrowth of Malassezia spp. This study aimed to compare the colony-forming units of Malassezia spp. in patients with AD who were grouped based on their responsiveness to systemic treatment.

Methods: This prospective, cross-sectional, and comparative study was conducted in patients with AD who were treated with prednisone, cyclosporine, and methotrexate, and separated in two groups, those with and those without response to their treatments, and who had not received treatment with antifungals (topical or systemic) within the prior six months. Scoring Atopic Dermatitis (SCORAD) was determined to evaluate disease severity and therapy response. A sample of epidermal cells from the glabellar region was obtained by scraping for direct examination with methylene blue and m-Dixon agar culture in search of colony-forming units. Fisher's exact test and Mann-Whitney U test were performed to compare the groups.

Results: A total of 15 patients were included in each group. The majority of the group who were refractory to treatment were women (60%), while the non-refractory group were predominantly men (66.7%). In addition, 73.3 percent of subjects with therapeutic resistance presented fungal growth in the cultures compared to 40 percent in the non-resistant group. A significant difference was found between direct examination (p=0.000) and colony-forming units of Malassezia spp. (p=0.016) in patients with AD resistant to systemic treatment.

Conclusion: Patients with AD resistant to systemic treatment had a higher count of colony-forming units of Malassezia spp. Therefore, we propose intentionally seeking this fungus in patients with therapeutic failure to eliminate its overpopulation.

Introduction: This study highlights the experiences and clinical outcomes of Black women treated with compounded topical minoxidil (CTM), containing a steroid and retinoid, compared to over the counter (OTC) minoxidil.

Methods: A retrospective chart review included 66 Black women treated at Johns Hopkins Hospital between 2020 and 2024. Patients previously used OTC minoxidil and were currently using CTM. Data collected included patient demographics, formulation, side effects, follow-up visits, and patient-reported outcomes. Adherence was assessed at follow-up appointments based on self-reported CTM use.

Results: Of the 66 patients, 33.3 percent had traction alopecia (TA), 37.9 percent had androgenetic alopecia (AGA), and 28.8 percent had combined AGA and TA. Side effects from OTC minoxidil were reported by 21.2 percent of patients, with scalp irritation being the most common. Only 10.6 percent of patients reported side effects while using CTM, with 4.5 percent reporting scalp irritation and four reporting hypertrichosis. After receiving treatment with CTM for at least six months, patients had an overall adherence rate of 84.7 percent, compared to only 44.7 percent of patients who adhered to OTC minoxidil (p<0.001). Clinical improvement was reported by 69.6 percent of patients using CTM, compared to 45.0 percent of patients using OTC minoxidil (p<0.001).

Discussion: CTM was associated with higher adherence, fewer side effects, and clinical improvement in majority of patients treated with CTM compared to their previous OTC minoxidil use.

Limitations: This is a single institution study.

Conclusion: When treating AGA or TA in Black women, special consideration should be taken when selecting minoxidil formulation, as it may have an impact on adherence and efficacy.

Objective: Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer. Advanced cSCCs encompass locally advanced cSCC (laCSCC), including primary or recurrent tumors that are not amenable to curative surgery or radiation therapy, and metastatic (locoregional or distant) cSCCs (mCSCC). With the development of immunotherapies (eg, PD-1 inhibitors), there may be an enhanced opportunity to effectively treat advanced cSCC. We aim to review the current literature on therapeutic options and outline treatment strategies to optimize care for patients with advanced cSCC.

Methods: A comprehensive literature search was completed using the keywords "advanced cutaneous squamous cell carcinoma," "treatment," "surgery," "radiotherapy," "immunotherapy," "PD1-inhibitor," "cemiplimab," and "pembrolizumab". The authors reviewed all studies and included those which addressed the topic of the review.

Results: Advanced cSCCs may not be amenable to surgery or radiotherapy due to size, location, and other aggressive features. Identifying advanced cSCCs and managing patients with multiple tumors and/or those with high tumor burden can be challenging and utilizing current evidence-based guidelines and staging systems can help selection of appropriate therapeutic options. Systemic immunotherapies such as cemiplimab and pembrolizumab have growing evidence for use as a first-line treatment for advanced cSCCs. It is important to understand the adverse event profile of these immunotherapies as utility may be limited by adverse events.

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: Advanced cSCCs can be difficult to manage and involving a multidisciplinary team is essential. For laCSCCs and mCSCCs not amenable to surgery or radiotherapy, cemiplimab and pembrolizumab can be effective therapeutic options.

Objective: We sought to evaluate changes in skin microbiome biodiversity and correlation with rosacea improvement of microencapsulated benzoyl peroxide (E-BPO) versus vehicle cream in rosacea patients in a 12-week crossover study with a no-treatment period of four weeks (Week 16).

Methods: This was a randomized, double-blind, single-center, crossover, vehicle-controlled evaluation of E-BPO on the skin microbiome in rosacea. Thirty-one participants had facial rosacea with global severity of 3 or 4 on the Investigator's Global Assessment (IGA) scale. Participants were randomly assigned to two groups. The E-BPO/vehicle group applied E-BPO for eight weeks, then vehicle for four weeks. The vehicle/E-BPO group applied vehicle for eight weeks, then E-BPO for four weeks. Clinical assessments were performed using IGA, inflammatory rosacea scale, and erythema scale. Determination of change in skin microbiome was based on facial swab sampling.

Results: Shifts in the microbiome correlated with improvements in IGA, inflammatory rosacea, and erythema. At Week 8, similar bacterial species diversity profiles were observed among all participants. After crossover of the vehicle/E-BPO group at eight weeks to E-BPO, the relative abundance of Staphylococcus epidermidis was markedly lowered, and the relative abundance of Cutibacterium acnes was slightly increased. In the E-BPO/vehicle group, the relative abundance of S. epidermidis and C. acnes at Weeks 12 and 16 remained at the level observed at Week 8.

Limitations: The study had a short duration, which may not fully capture the long-term effects and durability of E-BPO in real-world clinical practice.

Conclusion: Even after withdrawal at 16 weeks, efficacy and shifts in the skin microbiome were maintained over the duration of the study period with demonstrated clinical improvement and a well-tolerated safety profile.

Ultraviolet-induced fluorescence dermoscopy (UVFD) is a novel diagnostic and visualization technique that enhances visualization of skin dermatoses with ultraviolet (UV) light. UVFD has been used to diagnose dermatoses including bacterial and fungal infections, pigmentary disorders, and skin neoplasms. We present five cases-pitted keratolysis, porokeratosis, molluscum, biopsy site identification, and lentigo maligna-where UVFD alone, compared to traditional polarized dermoscopy (PD) or the unaided clinical exam, served as a "game-changer" in diagnosis and management. Polarized and UV images were captured using a DL5 dermatoscope coupled to a smartphone. In the cases of pitted keratolysis, porokeratosis, and molluscum, we highlight distinct patterns of fluorescence that were readily visualized with UVFD and aided efficient diagnosis, in contrast with more subtle features that were seen under PD. We also demonstrate the utility of UVFD in identification and confirmation of a prior biopsy site in a patient who presented for excision of a skin cancer. Finally, we describe the advantage of UVFD in presurgical margin delineation in a patient with lentigo maligna. In these cases, we show that UVFD facilitates prompt and accurate diagnosis, streamlines appropriate treatment, and has the capacity to reduce the need for unnecessary biopsies. Given the convenience and practicality of a dermatoscope equipped with a UV light, we propose that clinicians would benefit from the use of UVFD as a supplementary tool alongside conventional dermoscopy, rather than as a substitute.

Basal cell carcinoma (BCC) is the most common skin cancer in the United States. Common treatment approaches for superficial, small, and/or low grade BCCs include topical therapy or curettage plus electrodesiccation and cryotherapy. For larger, high-grade, and/or certain subtypes of BCC, surgical therapy is typically pursued, occasionally under anesthesia for large lesions. While surgical therapy provides good clearance rates, it is not feasible for all patients. Therefore, it is important for physicians to understand alternative, less invasive approaches to treating BCC in order to provide patients with the best possible evidence-based care. In this case, we describe a combination topical treatment approach for a large nodular BCC in an elderly patient in a tough to excise inguinal region.

Hidradenitis suppurativa (HS) is a chronic skin condition characterized by nodules, abscesses, and tunnels that may develop in various parts of the body, particularly in the axillary, gluteal, and inguinal regions.¹ Treatment for HS varies based on clinical presentation and disease progression and encompasses antibiotics, hormonal therapy, biologics, topical treatments, and surgical procedures. Despite the array of available treatment options, patients typically require multiple treatment modalities to alleviate symptoms, which can include antimicrobial cleansers and washes, though there is limited evidence regarding their effectiveness in managing HS. Here, we evaluated real-world patient-assessed efficacy of sodium hypochlorite body wash in the management of hidradenitis suppurativa. Of the 165 participants enrolled, 145 completed a four-week study evaluating daily use of sodium hypochlorite body wash for hidradenitis suppurativa (HS), representing all Hurley stages and a wide range of disease durations. Significant improvements were observed across key symptoms, with the greatest reduction in pain (3.52 to 1.62, p<0.001), and over 60 percent of participants reported fewer and shorter flares. Most participants found the wash beneficial, with 88.8 percent recommending it, and there was strong support for the dab method among those who used it. These data support clinical utility of hypochlorite washes in the chronic management of HS.

The rising popularity of over-the-counter red-light therapy (RLT) devices has sparked interest in their efficacy and consumer behavior, particularly as they are increasingly promoted on social media. This cross-sectional study analyzed responses from a survey of 226 participants, with 88.5 percent identifying as female and 83.6 percent of Hispanic or Latino origin. The majority (60.4%) reported learning about RLT devices through social media, and 90.0 percent were willing to purchase one, with most respondents willing to spend between $101 to $300 USD (48.9%). The top motivations for use included anti-aging (50.2%), improving skin texture (37.9%), and reducing dark spots (30.8%). Significant associations were found between Hispanic ethnicity, male gender, and increasing age with a higher likelihood of considering RLT devices (p<0.001). Respondents were also skeptical of the value of higher-priced devices, with 58.8 percent doubting their superior efficacy. These findings highlight significant demographic influences on the interest in RLT devices, emphasizing the need for transparent product information and realistic consumer expectations to ensure satisfaction and trust in the technology.