Journal of Clinical and Aesthetic Dermatology最新文献

Objective: Patients with acne are increasingly using social media platforms such as Reddit to seek medical information. Skincare subreddits such as r/SkinCareAddiction, r/Skincare_Addiction, r/SkincareAddicts, and r/Acne have become important hubs of discussion for acne treatments, including the recently US Food and Drug Administration (FDA)-approved drug clascoterone (Winlevi). The objective of this study was to analyze questions and information needs of Reddit users with acne related to clascoterone.

Methods: The authors analyzed all clascoterone-related questions posted on the r/SkinCareAddiction, r/Skincare_Addiction, r/SkincareAddicts, and r/Acne subreddits. Questions were categorized and subcategorized for analysis.

Results: A total of 301 questions from 223 posts were analyzed. The largest proportion of questions were about concurrent use with other medical interventions or skincare regimens (25.9%) and adverse effects (17.3%). General experiences (14.0%) and usage instructions (12.0%) also made up a significant number of questions.

Limitations: A limitation of this study is that Reddit users may not accurately represent the general population of patients with acne using clascoterone.

Conclusion: This Reddit analysis of clascoterone therapy reveals key themes in questions and gaps in knowledge among people with acne that may not be readily apparent in clinical settings. This information can guide physicians to better address patient needs and improve patient outcomes.

Objective: Infantile hemangioma (IH) is the most common benign childhood tumor. Timolol is a widely used treatment for IH due to its efficacy and safety. Although systemic absorption is rare, timolol has been detected in urine and blood, raising concerns about potential adverse effects. This study aims to systematically review the literature on reported adverse effects associated with topical timolol for IH treatment.

Methods: A systematic review following 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. PubMed and MEDLINE databases (2000-2024) were searched. Studies reporting treatment-related adverse effects of topical timolol for IH treatment were included.

Results: Twenty articles met inclusion criteria, comprising 1780 patients. Local adverse effects occurred in 4.7% of patients, including irritation, scaling, ulceration, and pruritus. Systemic adverse effects occurred in 1.2% of cases, including bradycardia, bronchospasm, wheezing, hypothermia, and sleep disturbances. There was no evidence that the severity or frequency of local adverse effects predisposed patients to systemic ones. Similarly, there was no pattern to suggest that longer treatment durations were associated with increased systemic effects.

Limitations: Limitations include heterogeneity of included studies and the exclusion of studies that did not report complications, which may overestimate the frequencies of local and systemic adverse effects.

Conclusion: Topical timolol is generally well tolerated for IH treatment, with systemic adverse effects occurring infrequently. Preterm infants and those with ulcerated or deep IHs may be at increased risk for complications. Further research is warranted to better define risk factors for systemic absorption and establish optimal dosing guidelines for safe use in infants.

Objective: Ultraviolet (UV) radiation is a major cause of nonmelanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Due to its demographics and geographic location, Florida's population is at increased risk of NMSC. While historical epidemiology suggests BCC has a significantly greater incidence than SCC, a 2012 study in South Florida reported a reverse in this ratio, with significantly higher SCC rates, warranting further investigation.

Methods: A South Florida dermatology database was analyzed for confirmed NMSC biopsy results from 2024. Lesions were categorized into BCC (superficial and nonsuperficial subtypes) and SCC (in situ SCC [isSCC] and invasive subtypes).

Results: Among 856 NMSC lesions, 247 (28.9%) were BCC and 609 (71.1%) were SCC. Subtypes included 54 superficial BCC (6.3%), 193 nonsuperficial BCC (22.5%), 268 isSCC (31.3%), and 341 invasive SCC (39.8%).

Discussion: These results align with earlier findings, contradicting the belief that BCC is the most common NMSC. SCC subtypes represented more than 70% of cases, suggesting a shift in incidence patterns. This trend may be linked to the early use of UV-B protection-dominant sunscreens, which offer less protection against UV-A, a significant factor in the development of SCC. Additionally, treating SCC-suspicious lesions as actinic keratoses in favor of biopsy for BCC-suspicious lesions may have contributed to prior findings.

Conclusion: Our findings challenge traditional epidemiologic teachings, showing a higher incidence of SCC than BCC. These trends may reflect historical photoprotection and/or changing biopsy practices.

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer worldwide. Treatments of locally advanced cSCC (laCSCC) and metastatic cSCC (mCSCC) have been evolving with the introduction of immunotherapies, which target the programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) pathway. Recently, cosibelimab was the first PD-L1 antibody approved by the United States Food and Drug Administration for the treatment of patients with laCSCC or mCSCC who are not candidates for curative surgery or radiation. Cosibelimab not only offers blockade of PD-L1 but also induces antibody-dependent cellular cytotoxicity. In its pivotal clinical trial, the objective response rate for patients with mCSCC treated with cosibelimab was 47.4%. Due to the different mechanisms of action, differences have been noted in the safety between PD-1 inhibitors and PD-L1 inhibitors, with PD-L1 inhibitors having a lower occurrence of Grade 3 or higher treatment-related adverse events, including immune-related adverse events. Additional real-world studies are needed to further evaluate its efficacy and safety. Cosibelimab is a novel immune checkpoint inhibitor and represents a promising therapeutic option for patients with advanced cSCC.

Objective: Dermatologists face multiple ethical challenges, but prior publications have studied these through case-based reporting. This study evaluates what ethical issues dermatologists find most pressing through a qualitative analysis of open-ended survey responses from dermatologists.

Methods: We surveyed American Academy of Dermatology (AAD) members via email (n=3999) and asked respondents to describe, in one paragraph, a recent case or scenario that was ethically challenging in their practice of dermatology. Participants also answered multiple-choice questions about which types of ethical issues they found most challenging and common, as well as several other general queries about ethics in dermatology. We then conducted qualitative analysis on the free responses (n=188) and inductively found themes and subthemes.

Results: Ethical dilemmas faced by AAD members reflect numerous subthemes. The most reported ethical challenges were requests for insurance dishonesty, insurance barriers, unscheduled patients, overutilization of procedures, inappropriate medication or paperwork requests, and patient disrespect. To our knowledge, this study is the first to demonstrate the range of reported ethical challenges faced by dermatologists through qualitative analysis.

Limitations: As a qualitative study, the results are not fully representative of all ethical issues faced in dermatology and do not quantify their prevalence.

Conclusion: These results could direct future wider-scale, quantitative studies to gain further understanding of the ethical challenges dermatologists face and how those challenges may vary based on practice demographics. Wider ethical analysis, particularly of the financial aspects of modern dermatologic care, may benefit the dermatology workforce.

Atopic dermatitis (AD), a chronic inflammatory skin condition affecting up to 20% of children and 7% of adults in the United States, significantly impacts quality of life through recurrent flares and persistent symptoms. This commentary introduces the ESTAR framework-Efficacy, Safety, Tolerability, Accessibility, and Remission/Remittive Effects-as a modernized tool for shared decision-making in AD management. By addressing critical factors such as efficacy (onset speed, depth, durability, and reliability), safety, tolerability, and remission potential, this framework can aid in evaluating emerging therapies with a patient-centered approach. The ESTAR framework emphasizes balancing immediate symptom relief with sustainable long-term disease control, offering tools such as a radar chart to help clinicians and patients navigate complex treatment options, improve adherence, and optimize outcomes in AD care.

This article explores the concept of perceptual congruence, the alignment between an individual's internal self-image and their external appearance, and its impact on self-esteem and wellbeing. It discusses how self-perception is shaped by internal and external factors, including the influence of social media and cultural beauty standards. The article argues that aesthetic procedures can address perceptual incongruence by helping individuals achieve a closer match between their perceived and idealized selves, leading to enhanced self-regard and improved mental health outcomes.

Objective: We sought to characterize skin injuries following layperson application of chemical peel products (CPPs).

Methods: Cases of skin injuries following layperson application of CPPs from August 31, 2018 through August 31, 2023 were retrieved from the United States Food and Drug Administration (FDA) Adverse Event Reporting System, the Human Foods Complaint System, the literature, and Amazon.com consumer product reviews with images.

Results: We identified 18 skin injuries following layperson application of CPPs, including several cases using products labeled with concentrations typically used by healthcare professionals. Injuries involved burns with associated wounds, pain, swelling, and scars. Consequences included disfiguring scarring, reduced mobility, and need for emergency department, dermatologic, or surgical care. Analysis of Amazon.com demonstrated that CPPs are sold under many names with numerous therapeutic claims, list a variety of concentrated agents, and have thousands of reviews.

Limitations: Limitations include underreporting of adverse events to the FDA and incomplete clinical information. With consumer product reviews, there was potential bias and poor replicability due to the dynamic nature of the Amazon website.

Conclusion: Laypersons who apply CPPs of any strength without guidance from licensed and trained healthcare professionals may experience skin injury and long-term sequelae. Dermatologists are positioned to advise against application of CPPs without professional supervision.