Discuss the pathogenesis and optimal management of psoriasis, atopic dermatitis and acne vulgaris

Update knowledge regarding recent advances in the safe and effective use of biologic agents for the treatment of dermatologic diseases

Enhance the ability to evaluate and incorporate new techniques and uses of dermal fillers and neurotoxins

Identify and describe the indications, contraindications, and evidence-based safety and efficacy profiles of new agents
approved for use in the dermatology setting Integrate prevention, diagnosis, and management of skin cancer into my clinical setting

Diagnose commonly presented dermatologic disorders


Improve my clinical interactions with patients

Integrate knowledge to enhance daily dermatologic care

2024 Virtual Grand Rounds Session 15: November 13, 2024 - What Did 2024 Bring to the Table in Dermatology? Best of FC24 Clinical Review

2024 Virtual Grand Rounds Session 14: November 6, 2024 - Highlights from Fall Clinical 2024: Your Questions Answered

Describe how to assess patients with diverse cultural backgrounds, SOC, and sexual orientation

Review treatment options for common dermatoses seen in diverse patient populations

Employ strategies to effectively communicate with patients with diverse cultural backgrounds, SOC, and sexual orientation 

'5 in 5' Five Tips to Improve Clinical Care for Diverse Patient Populations: An Online Activity

Enhance your ability to diagnose, manage, and treat with the most current treatment options

Identify patients who may benefit from new approaches to difficult to manage diseases

Apply best practices for enhancing patient communication and shared decision-making techniques

Decipher clinical trial data and guidelines and how to apply them to every day practice

2024 Virtual Grand Rounds Session 7: May 8, 2024 - 60 Tips in 60 Minutes

Recognize the clinical presentation of GPP and how to diagnose it

Be familiar with the current GPP treatment options such as the IL-36 pathway 

Discuss the implications of alternatives to oral antibiotics and hormonal therapies for moderate acne vulgaris 

Assess whether patients with moderate Acne Vulgaris can benefit from weekly isotretinoin therapy 

2024 Virtual Grand Rounds Session 5: April 3, 2024 -E-Journal Club Edition: What's New in SKIN, The Journal of Cutaneous Medicine

Discuss current management advancement in dermatology from rashes through tumors 

Compare strategies to manage dermatologic conditions from laser treatment through systemic therapies

Identify appropriate treatment options for dermatologic conditions based on patient and disease characteristics 

Recognize the nuances of managing dermatologic conditions in skin of color 

Underline strategies to optimize management in patients with dermatologic conditions

Illustrate strategies to manage dermatologic conditions effectively in clinical practice

2024 Virtual Grand Rounds Session 3: March 20, 2024 - Highlights from the San Diego Academy Meeting - Our Most Important Learnings

Discuss the treatment of psoriasis and related disorders with evolving therapies

Recognize the various therapies available for acne and their role in clinical practice

Translate the role of therapies for eczema in clinical practice

Describe the modalities for diagnosing and managing skin cancer

Identify optimal patients for the use of fillers and botulinum

Describe strategies to prepare and administer fillers and botulinum

2024 Virtual Grand Rounds Session 1: January 31, 2024 - WCH24 Your Questions Answered

Identify common dermatoses presentations in patients with skin of color (SOC)

Employ strategies to effectively communicate with patients with diverse cultural backgrounds, SOC, and sexual orientation

Difficult Dermatology Conversations: Improving Care for Diverse Patient Populations 

Identify optimal patients for the use of fillers and botulinum 

2023 Virtual Grand Rounds Session 14: November 15, 2023 - Fall Clinical 2023- Your Questions Answered

Recognize that IL-4 and IL-13 are signature cytokines of type 2 inflammatory response

Understand that Type 2 inflammatory response involves mast cells, eosinophils, and basophils 

Recognize the common signs and symptoms of Staph Scalded Skin Syndrome

Understand treatment of Staph Scalded Skin Syndrome

Recognize the rare benign vascular disorder of Achenbach Syndrome

Understand the differential diagnosis and workup of Achenbach Syndrome

2023 Virtual Grand Rounds Session 13: September 27, 2023 - Challenging Cases in Dermatology

Dermatology

WEDNESDAY, Nov. 6, 2024 -- Pain is prevalent among Mohs surgeons, most commonly at the neck, upper back, and lower back, according to a study published in the September issue of SKIN.Timothy J. Orlowski, M.D., from the University of Alabama at Birmingham, and colleagues conducted a cross-sectional survey study among members of the American College of Mohs Surgery to examine the prevalence and characteristics of pain and discomfort among trained Mohs surgeons. A total of 107 male and female surgeons responded.The researchers found that chronic pain was reported by 88.7 percent of participants, with the neck, upper back, and lower back the most common anatomic locations for pain (54.2, 38.2, and 33.6 percent, respectively). Compared with female respondents, male respondents less often complained of upper back pain but more often reported lower back pain (odds ratios, 0.349 and 2.462, respectively). Regular pain-relieving medication use was more likely to be reported when participants were suffering from neck or upper back pain (odds ratios, 4.665 and 3.366, respectively). The likelihood of reporting neck pain was lower for respondents regularly using sit-stand stools."Not only are Mohs surgeons at risk for musculoskeletal injury, but Mohs histology technicians and other ancillary staff also remain vulnerable," the authors write. "Future collaboration with current educators, occupational health professionals, and physical and occupational therapists may provide insight on future ergonomic education and modifications."

Male surgeons less often complain of upper back pain, but more often report lower back pain than female surgeons

Pain Prevalent Among Mohs Surgeons, Reported by 88.7 Percent

WEDNESDAY, Oct. 2, 2024 -- The incidence of epidermal necrolysis (EN) is 2.6 cases per million person-years, but overall mortality is 34 percent, according to a study published online Oct. 2 in JAMA Dermatology.Thomas Bettuzzi, M.D., M.P.H., from the Hôpital Henri Mondor in Créteil, France, and colleagues conducted a cohort study using French Health System data from Jan. 1, 2013, to Dec. 31, 2022, to assess the incidence of and compare factors associated with in-hospital and postdischarge mortality among patients with EN. Data were included for 1,221 adult patients with EN.The researchers found that the incidence was 2.6 cases per million person-years. The in-hospital and postdischarge mortality rates were 19 and 15 percent, respectively, for an overall mortality of 34 percent. Factors associated with in-hospital mortality included age (adjusted hazard ratio [AHR], 1.03 per year of age), history of cancer (AHR, 2.04), dementia (AHR, 1.85), liver disease (AHR, 1.81), and EN severity (AHR, 2.14 for toxic epidermal necrolysis versus Stevens-Johnson syndrome). There was no association observed for EN initial severity with mortality after hospital discharge, but the associations for acute complications persisted (AHRs, 2.14 and 2.44 for acute kidney injury and sepsis, respectively). Ophthalmologic and mood disorders were the main sequelae."Despite EN being a rare condition, it is associated with high in-hospital and postdischarge mortality and a high burden of sequelae," the authors write.

Factors associated with in-hospital mortality include age, history of cancer, dementia, liver disease, EN severity

Incidence of Epidermal Necrolysis 2.6 Cases Per Million Person-Years

WEDNESDAY, Oct. 2, 2024 -- An artificial intelligence (AI) model, VisualDx, demonstrates diagnostic bias for images in the Fitzpatrick I to III subgroup, according to a study published online Sept. 15 in SKIN.Katrina D. Cirone, M.D., from Western University in London, Ontario, Canada, and colleagues examined whether the AI model VisualDx performs differently when classifying conditions across different skin phenotypes. Sixteen common conditions were included in the image dataset. For each condition, there were three subgroups: "Fitzpatrick I to III," "Fitzpatrick IV to VI," and "Processed," which contained images from the Fitzpatrick I to III subgroup altered to resemble skin with rich pigmentation. A differential diagnosis list was obtained by processing images with VisualDx.The researchers found the highest sensitivity (97 percent) for hidradenitis suppurativa, prurigo nodularis, and tinea versicolor across all subgroups. The lowest sensitivity was seen for atopic dermatitis, postinflammatory hyperpigmentation, and basal cell carcinoma (23, 23, and 27 percent, respectively). For all conditions except acanthosis nigricans, melasma, and melanoma, significantly greater diagnostic sensitivity was noted in the Fitzpatrick I to III subgroup than the Fitzpatrick IV to VI and Processed subgroups. A reduction in sensitivity and specificity was seen for all conditions for the processed images."Future training of AI diagnostic tools should be done using more comprehensive databases so that diagnosis can be accurately performed across all skin phenotypes," the authors write.

VisualDX demonstrated significantly greater sensitivity for Fitzpatrick I to III subgroup than Fitzpatrick IV to VI and a processed image subgroup

AI Model Exhibits Diagnostic Bias Towards Fitzpatrick I to III Subgroup

WEDNESDAY, Aug. 28, 2024 -- Tranexamic acid and platelet-rich plasma (PRP) combined with microneedling are effective for the treatment of melasma, according to a study published in the July issue of SKIN.Masoumeh Roohaninasab, M.D., from the Iran University of Medical Sciences in Tehran, and colleagues examined the efficacy of PRP combined with microneedling versus tranexamic acid combined with microneedling for melasma. The study employed a split-face comparative design in 20 female patients with melasma (mean age, 41 years). Participants underwent four sessions of PRP with microneedling on one side of the face and 5 percent tranexamic acid with microneedling on the other side.The researchers observed a substantial decrease in the median ΔE (skin erythema) using Visioface during follow-up, reflecting color changes (mean difference, 6.66 and 1.90 in the tranexamic acid + microneedling group and in the PRP + microneedling group, respectively). A notable reduction in melanin was seen in the tranexamic acid + microneedling group. High patient satisfaction was seen with both treatments. Only minor transient side effects were seen, and both procedures were well tolerated."This study demonstrates that the combination of both PRP and tranexamic acid with microneedling significantly improves melasma," the authors write. "While no superiority was observed between these two approaches, they prove to be a promising combination or alternative for melasma treatment due to their high efficacy, safety, tolerability, and patient satisfaction levels."

Both platelet-rich plasma and tranexamic acid combined with microneedling improved melasma in split-face study

Platelet-Rich Plasma, Tranexamic Acid + Microneedling Beneficial for Melasma

FRIDAY, Aug. 16, 2024 (HealthDay News) -- Patients with skin of color may experience more adverse events from sclerotherapy, according to a study published online July 26 in the Journal of the American Academy of Dermatology.Michelle Lazar, from the Boston University School of Medicine, and colleagues characterized the incidence of common adverse events following sclerotherapy in various Fitzpatrick Skin Types. The analysis included data from 134 patient visits for sclerotherapy (treated with 0.5 to 1 percent Polidocanol).The researchers identified 12 adverse events across all visits, resulting in an 8.96 percent adverse event rate. Adverse events included blistering (six events), postinflammatory hyperpigmentation (PIH; five events), induration (three events), superficial thrombophlebitis (one event), and ulcer (one event). There was no evidence of acute deep venous thrombosis in Doppler ultrasound in the patient with superficial thrombophlebitis. Overall, the majority of the adverse events occurred in Fitzpatrick Skin Types of III or higher, while all PIH adverse events occurred in patients with Fitzpatrick Skin Types of IV or higher."Our data highlights that sclerotherapy is safe in populations with skin of color, though they do experience PIH at a higher rate as compared to those with lighter skin tones," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(24)02545-3/abstract">Abstract/Full Text (subscription or payment may be required)</a>

Postinflammatory hyperpigmentation seen more often versus lighter skin tones

Skin of Color Has More Adverse Events From Sclerotherapy

THURSDAY, Aug. 1, 2024 (HealthDay News) -- A relatively high proportion of dermatologists experience emergency complications during dermatological, surgical, or cosmetic procedures, according to a study published online July 20 in the Journal of Cosmetic Dermatology.Hilal Kaya Erdogan, M.D., from Eskişehir Osmangazi University in Turkey, and colleagues conducted a cross-sectional descriptive study among 240 dermatologists who were surveyed regarding emergency complications during dermatological, surgical, or cosmetic procedures and their level of knowledge regarding emergencies and basic life support.The researchers found that 53 and 43.2 percent of dermatologists reported emergency complications during dermatological and surgical procedures and during cosmetic procedures, respectively. Vasovagal syncope, hypotension/bleeding, and seizures were the most common complications. Emergency complications occurred more often among specialists, those with more than 5 years of professional experience, those working in their private clinics, and those performing an average of 10 to 50 dermatological/surgical procedures per week and fewer than 10 cosmetic procedures per week. Residents, dermatologists with zero to four years of professional experience, those working in university hospitals, and those who had both theoretical and practical training in basic life support had the highest level of knowledge. "Dermatologists should be competent and prepared to intervene in medical emergencies in daily practice," the authors write. "Theoretical and practical training programs on basic life support and emergencies at regular intervals after graduation should be provided for dermatologists."<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/jocd.16479">Abstract/Full Text</a>

53 percent of dermatologists reported emergency complications during dermatological and surgical procedures; 43.2 percent during cosmetic procedures

Relatively High Frequency of Emergency Complications Seen for Dermatological Procedures

WEDNESDAY, May 22, 2024 -- From 2015 to 2022, there was an increase in industry payments per dermatologist, according to a research letter published in the May issue of SKIN.Nicole J. Hardy, from the University of Connecticut School of Medicine in Farmington, and colleagues conducted a retrospective review of U.S. dermatologists appearing in the Open Payments database between 2015 and 2022 to examine trends in industry payments. The average annual percentage change (AAPC) was calculated across study years using a joinpoint analysis.A total of 2,616,289 payments totaling $494,271,790 made to dermatologists during the study period were included in the study. The researchers found that for the number of recipient dermatologists, total value of payments, and total number of payments, the AAPCs across the years were 1.5, 5.5, and 3.9 percent, respectively, with confirmed positive growth when data from 2020 to 2021 were excluded."The impact of physician-industry relationships on patient care in dermatology is debated and can have a positive effect by way of improved access to medications and more physician educational opportunities or a negative effect by influencing medical-decision making, leading to patient distrust," the authors write.One author disclosed ties to Nested Knowledge; a second author disclosed ties to AbbVie.

Average annual percentage change increased for number of recipient dermatologists, total value of payments

Industry Payments Per Dermatologist Have Increased Since 2015

FRIDAY, March 8, 2024 (HealthDay News) -- There are notable concerns relating to the use of currently available artificial intelligence (AI) dermatology mobile applications (apps), according to a study published online March 7 in JAMA Dermatology to coincide with the annual meeting of the American Academy of Dermatology, held from March 8 to 10 in San Diego.Shannon Wongvibulsin, M.D., Ph.D., from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues conducted a scoping review to identify and characterize current English-language AI dermatology mobile apps available for download.&nbsp;A total of 909 apps were identified initially; after removal of duplicates, 391 apps remained. A further 350 apps were excluded on subsequent review, yielding 41 apps available for detailed analysis. The researchers identified several concerning aspects relating to AI apps in dermatology. None of the apps were approved by the U.S. Food and Drug Administration; disclaimers for lack of regulatory approval were included in only two apps. The apps lacked supporting evidence, input from clinicians and/or dermatologists, and transparency in terms of development of algorithms, data usage, and user privacy.&nbsp;"The use of these apps has risks associated with a lack of consistent validation and transparent user communication," the authors write. "These findings are important to increase awareness of the current limitations and the need to further develop methods for creation of AI dermatology apps with effective regulation, validation, and standardized evaluation criteria."&nbsp;One author disclosed ties to the pharmaceutical and dermatology industries and has a related patent pending.&nbsp;<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2815800">Abstract/Full Text</a>&nbsp;<a target="_blank" rel="noopener noreferrer" href="https://www.aad.org/member/meetings-education/am24">More Information</a>

None of the apps are approved by the FDA; only two include disclaimers for lack of regulatory approval

AAD: Concerns Noted Relating to Use of AI Dermatology Apps

WEDNESDAY, March 6, 2024 (HealthDay News) -- Challenges relating to artificial intelligence (AI) in dermatology and its application to skin of color (SOC) are partly due to underrepresentation of SOC in datasets, according to research published online March 6 in the International Journal of Dermatology.Rebecca Fliorent, from the Rowan-Virtua School of Osteopathic Medicine in Stratford, New Jersey, and colleagues analyzed recent literature to assess current AI programs in use for dermatologic purposes to identify challenges with application of this technology to SOC. Literature from the last 10 years through October 2023 was analyzed.The researchers note that challenges relating to AI and its application to SOC come from the underrepresentation of SOC in datasets, as well as issues with quality and standardization of images. Current AI programs are worse at identifying lesions in SOC because of these issues. Furthermore, only 30 percent of the programs identified in the literature reported on their use in dermatology, specifically in SOC. For an accurate depiction of darker skin tone images in datasets, significant development of these applications is needed."Although the mentioned AI programs do not constitute a comprehensive list, many of these programs show promise in supporting clinical decision-making; however, they require modification to become reliable diagnostic aids for SOC patients," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/ijd.17076">Abstract/Full Text (subscription or payment may be required)</a>

Challenges in AI and its application to SOC stem from underrepresentation of SOC in datasets, issues with quality, standardization of images

Skin of Color Underrepresented in AI Programs in Dermatology

WEDNESDAY, Nov. 15, 2023 -- Religion should be integrated into existing cultural humility training in order to better address the unique needs of Muslim dermatology patients, according to a study published online Nov. 15 in JAMA Dermatology.Ghida El-Banna, M.D., from the Stanford University School of Medicine in Redwood City, California, and colleagues explored the perceptions of Muslim patients of their dermatology care in a qualitative mixed-methods study composed of surveys and semistructured interviews. Twenty-one patients participated in the study: five men and 16 women, including 10 who wore hijab.According to the researchers, the survey results demonstrated variation of the impact of Islamic practices on dermatology care. Based on interviews, dermatology care was not perceived as a priority by Muslim patients, and they expressed interest in community events highlighting general dermatology education. Stigmatization of their skin disease and cosmetic care was experienced. The Muslim patient-dermatologist relationship and disclosure of the need for accommodations was hindered by prior experiences with Islamophobia and colorism. Participants described instances of bias and poor cultural humility from dermatologists. Religious and cultural needs pertinent to their care, including clinician gender concordance, adjustment of medication timing while fasting, and halal medication ingredients, were unique to Muslim participants."Clinical and educational interventions to address gaps in the care of Muslim patients in dermatology are needed," the authors write. "Future research should focus on the epidemiology of skin disease in Muslim subpopulations and Muslim patients' health-seeking behaviors."

Incorporation of religion into cultural humility training recommended, as well as dermatology education at community events

How Can Dermatology Care Be Improved for Muslim Patients?

THURSDAY, Nov. 2, 2023 (HealthDay News) -- Skin diseases can cause a psychosocial burden and feelings of stigmatization, according to a study published online Oct. 8 in the Journal of the European Academy of Dermatology and Venereology.Paolo Gisondi, M.D., from the University of Verona in Italy, and colleagues evaluated the burden of the most common dermatological diseases in adult patients across Europe in terms of quality of life, work life, and stigmatization. The analysis included survey responses from 19,915 individuals.The researchers found that quality of life was particularly impaired in people with hidradenitis suppurativa and sexually transmitted diseases. A modest to extremely large effect on quality of life was seen in roughly half of participants with acne, alopecia, or chronic urticaria and about 40 percent of those with atopic dermatitis, skin cancers, or psoriasis. Overall, 88.1 percent of participants considered their skin disease as embarrassing slightly more in their personal life than in their work life (83 percent). Furthermore, roughly half of the respondents reported sleeping difficulty, feeling tired, and impact of the disease on taking care of themselves. Roughly one in seven (14.5 percent) believed they have been rejected by others because of the skin disease, and 19.2 percent believe they have been looked at with disgust. Across diseases, anxiety and depression were frequently reported."Our study highlights the psychosocial burden experienced by people with skin diseases, and the need to address their impact on quality of life and stigmatization in the context of patient management," the authors write.

Effect seen on patients' daily and work life

Skin Diseases Pose a Psychosocial Burden

WEDNESDAY, June 14, 2023 -- In 2021, more than 70 percent of populated zip codes with dermatologists had fewer than four dermatologists per 100,000 people, according to a brief article published in the May issue of SKIN.Christopher N. Nguyen, M.D., from Northside Hospital Gwinnett in Lawrenceville, Georgia, and colleagues retrieved the distribution of dermatologists in three-digit zip code areas using membership data from the 2021 American Academy of Dermatology database.The researchers found that 71.6 percent of the 712 populated zip codes with dermatologists had less than four dermatologists per 100,000 people compared with 72.3 percent in 2016 (compound annual growth rate, –0.19 percent). There was a significant difference observed in the dermatologist density of the 100 most versus least populated areas (median, 4.5 versus 1.6 dermatologists per 100,000)."Consistent with 2016, over 70 percent of areas do not meet that target density and nearly 60 percent have less than three per 100,000. These results may indicate that initiatives aimed at redistribution of dermatologists have not made a major difference," the authors write. "This complex issue likely needs a multifaceted solution with continual effort and thought from leaders in the field."

71.6 percent of 712 populated zip codes with dermatologists have fewer than four dermatologists per 100,000

Maldistribution of Dermatologists Persisted in 2021

Diversity gaps persist in the dermatology workforce pipeline, according to a study published online Nov. 16 in
 
 JAMA Dermatology
 
 .




 Yi Gao, M.D., from the University of Minnesota in Minneapolis, and colleagues conducted a secondary analysis of a repeated cross-sectional study involving 58,077 graduating allopathic medical students to examine their demographic characteristics and intended career goals.




 Of the graduating students, 49.0 percent were female, 14.5 percent were from racial and ethnic groups underrepresented in medicine (URM), and 6.3 percent were sexual minority (SM) students. The researchers found that the likelihood of identifying as URM or SM was lower for female students pursuing dermatology versus other specialties (11.6 versus 17.2 percent and 1.9 versus 5.7 percent, respectively). Students pursuing dermatology versus other specialties had reduced odds of intending to care for underserved populations, practice in underserved areas, and practice public health (adjusted odds ratios, 0.40, 0.40, and 0.44, respectively), but they had increased odds of intending to pursue research in their careers (adjusted odds ratio, 1.76). Female, URM, and SM identities were independently associated with increased odds of caring for underserved populations and practicing public health among students pursuing dermatology.




 "Addressing health inequities and improving care for underserved patients is the responsibility of all dermatologists, and efforts are needed to increase diversity and interest in careers focused on underserved care among trainees in the dermatology workforce pipeline," the authors write.




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Students pursuing dermatology have lower odds of intending to care for underserved populations, practice in underserved areas

Diversity Gaps Persist in Dermatology Workforce Pipeline

Significantly more adults with dermatomyositis receiving intravenous immune globulin (IVIG) versus placebo have a response of at least minimal improvement, according to a study published in the Oct. 6 issue of the
 
 New England Journal of Medicine
 
 .




 Rohit Aggarwal, M.D., from the University of Pittsburgh School of Medicine, and colleagues conducted a randomized, placebo-controlled trial involving patients with active dermatomyositis who were randomly assigned to receive either IVIG or placebo (47 and 48 patients, respectively) every four weeks for 16 weeks. Patients receiving placebo and those without confirmed clinical deterioration while receiving IVIG could enter a 24-week open-label extension phase. The primary end point was a response, defined as a Total Improvement Score (TIS) of at least 20 at week 16, indicating at least minimal improvement, and no confirmed deterioration.




 The researchers found that 79 and 44 percent of patients in the IVIG and placebo groups, respectively, had a TIS of at least 20 at 16 weeks. With respect to the secondary end points, including at least moderate improvement and major improvement, the results were generally in the same direction, except for the change in creatine kinase level, which did not differ meaningfully between the two groups. There were 282 treatment-related adverse events in the IVIG group over 40 weeks. Nine serious events that could be considered related to IVIG occurred.




 "Larger and longer trials to determine the long-term effects and risks of IVIG in patients with dermatomyositis are warranted," the authors write.




 The study was funded by Octapharma Pharmazeutika.




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More adults receiving IVIG versus placebo had Total Improvement Score of at least 20 at 16 weeks

IV Immune Globulin Bests Placebo for Dermatomyositis

The U.S. Food and Drug Administration on Tuesday issued warning letters to three companies, including Amazon, for selling unapproved products for removing moles and skin tags.




 No over-the-counter medications have FDA approval for that purpose, and the Food, Drug, and Cosmetic Act prohibits interstate sale of unapproved drugs and cosmetics.




 "It is the FDA's duty to protect public health from harmful products not approved for the U.S. marketplace," Donald Ashley, director of the compliance office in the FDA Center for Drug Evaluation and Research, said in a statement. "This includes where online retailers like Amazon are involved in the interstate sale of unapproved drug products. We will continue to work diligently to ensure that online retailers do not sell products that violate federal law."




 Besides Amazon, the FDA issued warning letters to Ariella Naturals and Justified Laboratories. The agency emphasized that it has not examined the mole and skin tag removal products sold by these companies for safety, effectiveness, or quality.




 The warning letters put the companies on notice that failure to address the violations cited by the FDA may result in legal action, including seizure. Once they receive the warning letter, the companies have 15 days to inform the agency of any corrective measures they have taken.




 The FDA said Tuesday that it will continue to use all the tools available to protect public health and remove fraudulent or unproven drug products from the American market. The warning letters were just the first step.




 <a class="rm-stats-tracked" href="https://www.fda.gov/news-events/press-announcements/fda-issues-warning-letters-three-companies-selling-unapproved-new-drugs-mole-and-skin-tag-removal" target="_blank">
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No over-the-counter medications have FDA approval for the removal of moles and skin tags

FDA Warns Amazon, Other Vendors About Sale of Skin Tag Removal Products

Edgewell Personal Care Co. has recalled three batches of its Banana Boat Hair &amp; Scalp Sunscreen Spray SPF 30 because trace levels of benzene were found in some samples during an internal review. Though this sunscreen product is not meant to contain benzene, it may have come from the propellant that sprays the product out of the can.




 The
 <a class="rm-stats-tracked" href="https://edgewell.com/pages/edgewell-personal-care-issues-voluntary-nationwide-recall-of-banana-boat-hair-scalp-sunscreen-due-to-the-presence-of-benzene" target="_blank">
 recall
 </a>
 is voluntary, and the U.S. Food and Drug Administration is aware of it, the company said. Specific batches are affected by the recall, which does not apply to other batches of the product. No other Banana Boat products are part of the recall. The products are packaged in aerosol cans and were distributed throughout the United States to retailers and online. Retailers have been alerted to the recall.




 Banana Boat said it will reimburse consumers who have purchased a recalled product. Consumers can determine whether their cans of sunscreen have been recalled by looking for the lot codes on the bottom of the can and comparing them to the recalled
 <a class="rm-stats-tracked" href="https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/edgewell-personal-care-issues-voluntary-nationwide-recall-banana-boat-hair-scalp-sunscreen-due" target="_blank">
 product list
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 .




 Edgewell said it has not received any reports of adverse events and noted that benzene is in the environment and humans are exposed to it regularly from multiple sources.




 Information is also available online at
 <a class="rm-stats-tracked" href="https://www.bananaboat.com/" target="_blank">
 www.bananaboat.com
 </a>
 . Consumers should contact their physician or health care provider if they have any questions or concerns or have experienced any problems related to using these aerosol sunscreen products.




 <a class="rm-stats-tracked" href="https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/edgewell-personal-care-issues-voluntary-nationwide-recall-banana-boat-hair-scalp-sunscreen-due" target="_blank">
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Company says it has not received any reports of adverse events

Banana Boat Sunscreen Recalled Due to Benzene

The chronic inflammatory skin condition, lichen sclerosus (LS), which primarily affects the anogenital area in women, is associated with depression and anxiety, according to a research letter published online June 15 in JAMA Dermatology.

 Ryan Fan, from the Yale School of Medicine in New Haven, Connecticut, and colleagues conducted a nested, matched, case-control study involving U.S. women aged 18 years or older to examine the association of LS with depression and anxiety. Using nearest-neighbor propensity score matching with replacement, each case patient was matched to four controls based on age, sex, and race and ethnicity. Data were included for 765 women with LS (mean age, 66.2 years) and 3,060 matched controls.

 The researchers found that compared with controls, women with LS were significantly more likely to have a diagnosis of depression (42.5 versus 24.4 percent) or anxiety (42.6 versus 22.6 percent). LS remained significantly associated with depression and anxiety in a multivariable analysis (odds ratios, 2.16 and 2.50, respectively).

 "Health professionals treating patients with LS should recognize the increased risk of depression and anxiety, consider mental health screening, and refer patients with LS to mental health professionals when appropriate," the authors write.

 <a href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2793096" class="rm-stats-tracked" target="_blank">Abstract/Full Text (subscription or payment may be required)</a>

Lichen sclerosus remained significantly associated with depression and anxiety in multivariable analyses

Lichen Sclerosus Linked to Depression, Anxiety in Adult Women

Adjunctive use of reflectance confocal microscopy (RCM) for suspect lesions reduces unnecessary excisions in a real-life setting, according to a study published online June 1 in
 
 JAMA Dermatology
 
 .




 Giovanni Pellacani, M.D., from the University of Modena and Reggio Emilia in Italy, and colleagues conducted a randomized clinical trial involving 3,165 patients enrolled from three dermatology referral centers in Italy, with a mean follow-up of 9.6 months. Patients were randomly assigned to standard therapeutic care with or without adjunctive RCM. A diagnostic analysis was included for 3,078 patients.




 The researchers found that adjunctive RCM was associated with a higher positive predictive value (18.9 versus 33.3), a lower benign-to-malignant ratio (3.7:1.0 versus 1.8:1.0), and a 43.2 percent reduction in the number needed to excise (5.3 versus 3.0) compared with standard therapeutic care alone. All 15 lesions with delayed melanoma diagnoses were thinner than 0.5 mm.




 "This randomized interventional trial assessed the applicability of adjunctive RCM for equivocal lesions suspected of melanoma in a clinical setting and proves that unnecessary excisions can be reduced by almost half, with greater accuracy of in vivo identification of benign lesions," the authors write.




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Adjunctive RCM associated with higher positive predictive value, lower benign-to-malignant ratio compared with standard therapeutic care alone

Can Reflectance Confocal Microscopy Reduce Unnecessary Excisions?

For pigmented skin lesions (PSLs), biopsy decisions made with electrical impedance spectroscopy (EIS) have increased sensitivity for melanomas/severely dysplastic nevi, according to a study published in the May issue of
 
 SKIN
 
 .




 Shayan Owji, from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues conducted a pilot study to examine the effect of EIS on clinical decisions for PSLs compared to traditional dermoscopy. Dermatologists, dermatology residents, and medical students completed an online survey providing their biopsy decisions for 24 PSLs: Half were presented as a clinical image with an associated dermoscopic image and half were presented as a clinical image with the corresponding EIS score.




 The researchers found that for melanomas/severely dysplastic nevi, decisions made with EIS had a mean sensitivity of 75 percent compared with 66 percent for decisions made with dermoscopy. Dermatologists biopsied with similar sensitivities when using EIS or dermoscopy (both 81 percent), while for residents and medical students, greater sensitivity in biopsies was seen when using EIS. The greatest improvement in sensitivity and specificity when using EIS versus dermoscopy was seen for respondents who reported rarely using dermoscopy.




 "Given that not all providers are trained in dermoscopy, and our finding that EIS particularly benefits those who infrequently use dermoscopy, EIS may complement dermoscopy by helping a broader range of providers make improved PSL diagnostic decisions," the authors write. "This will ultimately improve patient care and reduce the morbidity and mortality of a melanoma diagnosis."




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Sensitivity increased for biopsy decisions when using EIS versus dermoscopy, especially for those rarely using dermoscopy

Is Electrical Impedance Spectroscopy Beneficial for Pigmented Skin Lesions?

Many physician assistants (PAs) are employed in dermatology, with a larger annual increase seen for PAs in dermatology versus other specialties, according to a research letter published online May 4 in
 
 JAMA Dermatology
 
 .




 Justin D. Arnold, M.D., from the University of California in Irvine, and colleagues characterized the dermatology PA workforce in a cross-sectional study using deidentified longitudinal data from the National Commission on Certification of Physician Assistants from January 2013 to December 2018.




 Data were included for 98,554 certified PAs. The researchers found that in the study's final year, there were 3,938 PAs practicing in dermatology compared with 94,616 in all other fields. Compared with 3.7 percent in all other specialties, only 1.6 percent of PAs in dermatology identified as African American or Black. The rates of Hispanic ethnicity were similar for PAs in dermatology and other fields (6.0 and 6.5 percent, respectively). Compared with PAs in other specialties, PAs in dermatology mainly worked in office-based private practices (92.5 versus 37.7 percent) and more often resided in metropolitan geographic settings (94.7 versus 92.0). During the study period, dermatology added 164 to 539 PAs to the field annually, with a mean annual increase of 11.6 percent compared with a mean increase of 7.8 percent in all other specialties.




 "Although this study did not assess the reasons for the substantial increase of dermatology PAs, numerous factors, such as a potential physician shortage or the expansion of private equity-owned practices, may contribute to the accelerating use of PAs within the field," the authors write.




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Mean annual increase of 11.6 percent in number of PAs in dermatology reported compared with 7.8 percent in all other specialties

Physician Assistants Commonly Employed in Dermatology

Common occupationally related allergens include rubber accelerators, preservatives, and bisphenol A epoxy resin, and the occupations most commonly affected by occupational skin disease are service workers and machine operators, according to a study published in the April issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Joel G. DeKoven, M.D., from the University of Toronto, and colleagues analyzed the frequency of allergic reactions to a screening series of allergens among 38,614 North American patients undergoing patch testing between 2001 and 2016.




 The researchers found that 11.6 percent of the participants had occupational skin disease; 70.5 percent of those had allergic contact dermatitis. Rubber accelerators, preservatives, and bisphenol A epoxy resin were included as the most common occupationally related allergens. The most common sites of dermatitis were hands, arms, and face (75.8, 30.0, and 15.9 percent, respectively). Service workers and machine operators were the occupations most affected.




 "Important occupational allergens included rubber accelerators, bisphenol A epoxy resin, methylisothiazolinone, formaldehyde, and nickel," the authors write. "Knowledge of common occupational allergens, sources of exposure, and occupations/industries at risk is important to facilitate prevention and treatment."




 Several authors disclosed financial ties to the pharmaceutical industry.




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Common allergens include rubber accelerators, preservatives, bisphenol A epoxy resin; service workers, machine operators affected most often

What Are the Most Common Occupationally Related Allergens?

Debt valuation of dermatology private equity-backed groups (DPEGs) decreased prior to the COVID-19 pandemic and then decreased further during the pandemic, according to a study published online March 9 in
 
 JAMA Dermatology
 
 .




 Rohail Memon, from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a cross-sectional study from Aug. 1, 2016, to Aug. 31, 2021, and examined public financial statements filed by business development corporations (BDCs) lending to DPEGs before and during the COVID-19 pandemic. Ten BDCs contained data on nine unique DPEGs; overall, there were 15 trackable DPEG debt instruments.




 The researchers found that during the study period, the amortized cost of the loans for an individual DPEG varied from $1.7 million to $100 million. For many DPEGs, the valuation of debt instruments was stable until some were discounted starting in May 2018; a significant decrease was seen prior to the COVID-19 pandemic from May to August 2019 (−1.4 percent). During the pandemic, there was another significant decrease from February to June 2020 (−9.0 percent). A modest and significant improvement in debt valuations was seen after pharmaceutical companies announced effective COVID-19 vaccine candidates in November 2020 (2.3 percent), but they remained discounted.




 "Dermatologists should be aware of the financial health of DPEGs, and the risks involved when considering selling their practice to or working for a DPEG," the authors write.




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Valuation of debt instruments significantly decreased from May to August 2019, followed by further decrease during COVID-19

Debt Valuation of Private Equity-Backed Dermatology Groups Down

Body dysmorphic disorder (BDD) symptoms are more prevalent for patients with dermatological conditions compared with healthy-skin controls, according to a study published online Jan. 18 in the
 
 British Journal of Dermatology
 
 .




 Christina Schut, Ph.D., from the Justus-Liebig-University Gießen in Germany, and colleagues compared the prevalence of BDD symptoms between patients with different dermatological conditions and healthy-skin controls in a cross-sectional multicenter study involving 5,487 patients with different skin diseases, recruited at 22 dermatology outpatient clinics, and 2,808 healthy-skin controls.




 The researchers found that the prevalence of BDD symptoms was five times higher for patients with dermatological conditions compared with healthy-skin controls (10.5 versus 2.1 percent). The odds of having BDD symptoms were elevated more than 11-fold for patients with hyperhidrosis, alopecia, and vitiligo compared with healthy-skin controls (adjusted odds ratio, &gt;11), while the odds were increased more than sixfold for patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo, and bullous diseases (adjusted odds ratio, &gt;6). BDD symptoms were significantly associated with younger age, female sex, higher psychological stress, and feelings of stigmatization using a logistic regression model.




 "This study demonstrated that more than 10 percent of patients with dermatological conditions experience potentially distressing symptoms of BDD," the authors write. "This highlights that doctors should keep in mind this condition and refer patients not responding to treatment to an appropriate health care service for further psychological assessment."




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Odds of BDD increased more than 11-fold for patients with hyperhidrosis, alopecia, and vitiligo versus healthy-skin control

Body Dysmorphic Disorder Prevalent in Patients With Skin Conditions

Six Brut and Sure aerosol antiperspirant and deodorant sprays sold in the United States and Canada have been recalled by their maker due to the presence of the chemical benzene.




 "Benzene is classified as a human carcinogen. Exposure to benzene can occur by inhalation, orally, and through the skin and it can result in cancers including leukemia and blood cancer of the bone marrow and blood disorders which can be life-threatening," stated a news release from TCP HOT Acquisition LLC dba HRB Brands. "While benzene is not an ingredient in any of the recalled products, our review showed that unexpected levels of benzene came from the propellant that sprays the product out of the can," the company said. But it added that there have been no reports of adverse events related to the recall, which is being conducted out of an "abundance of caution."




 Similar recalls have been issued for other consumer products that surprisingly contained benzene in the past six months: Pantene/Herbal Essence dry spray shampoos; Old Spice spray deodorants; and Neutrogena/Aveeno spray sunscreens.




 Five of the recalled TCP products are: Brut Classic Antiperspirant Aerosol (4 oz; UPC 00827755070085); Brut Classic Antiperspirant Aerosol (6 oz; UPC 000827755070108); Brut Classic Deodorant Aerosol (10.0 oz; UPC 00827755070047); Sure Regular Antiperspirant Aerosol (6.0 oz; UPC 00883484002025); and Sure Unscented Antiperspirant Aerosol (6.0 oz; UPC 00883484002278). A sixth recalled product was sold only in Canada: Brut Classic Deodorant Aerosol (154 g; UPC 00827755070177).




 Consumers should stop using the recalled products immediately and dispose of them appropriately, said the company, which also advised consumers to contact a health care provider if they experience any problems that may be associated with use of the recalled products. For more information or to request a refund, consumers can contact the company at 1-866-615-0976 or go to its
 <a class="rm-stats-tracked" href="https://www.brutsurerecall2022.com/en" target="_blank">
 website
 </a>
 .




 <a class="rm-stats-tracked" href="https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/tcp-hot-acquisition-llc-dba-hrb-brands-issues-voluntary-nationwide-recall-sure-and-brut-aerosol" target="_blank">
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There have been no reports of adverse events related to the recall, which is being conducted out of an 'abundance of caution'

Brut, Sure Brand Deodorants Under Recall Due to Benzene

The Ichthyosis Scoring System (ISS) is reliable for measuring global ichthyosis severity in children and adults, according to a study published online Feb. 16 in
 
 JAMA Dermatology
 
 .




 Qisi Sun, M.D., from the Yale University School of Medicine in New Haven, Connecticut, and colleagues created and evaluated a comprehensive instrument to measure total body ichthyosis severity in adults and children. Using photographs of participants with ichthyosis, an 83-image teaching set was created. All test photographs were scored by two cohorts of dermatologists (11 dermatologists) to assess interrater and intrarater reliabilities. Creation of the ISS included participants of all ages, races, and ethnicities; raters had varying experience and areas of expertise.




 The researchers found that the intraclass correlation coefficients for total, scale, and erythema scores were greater than 0.90, greater than 0.91, and greater than 0.88, respectively, across both cohorts of 11 dermatologists. Moderate to good interrater reliabilities were exhibited by most body sites for scale and erythema. Good to excellent intrarater reliabilities were observed.




 "Scales, such as the ISS, that can reliably and accurately capture disease severity play an important role as outcomes in these studies," writes the author of an accompanying editorial. "They will enable us to differentiate what treatments provide meaningful clinical benefits for patients with ichthyoses and facilitate comparative effectiveness studies."




 Several authors disclosed financial ties to the pharmaceutical industry.




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Moderate to good interrater reliabilities exhibited by most body sites; good to excellent intrarater reliabilities also seen

Ichthyosis Scoring System Reliable for Measuring Disease Severity

A new multimodal learning algorithm can perform multilabel classification of skin lesions, according to a study published in the February issue of
 
 Medical Image Analysis
 
 .




 Peng Tang, from the Technical University of Munich, and colleagues proposed a novel two-stage multimodal learning algorithm for multilabel classification of skin diseases. A FusionNet, which exploits and integrates the representation of clinical and dermoscopy images at the feature level, was constructed at the first stage; a Fusion Scheme 1 was used to conduct the information fusion at the decision level. To further incorporate patients' meta-data, a Fusion Scheme 2 was proposed, which integrates the multilabel predictive information from the first stage and patients' meta-data information. The final diagnosis was formed by fusion of the predictions from both stages. The algorithm was assessed on the 7-point checklist dataset for multilabel classification of skin disease.




 The researchers found that the proposed FusionM4Net first stage achieved an average accuracy of 75.7 percent for multiclassification tasks and 74.9 percent for diagnostic tasks, without using the patient's meta-data; this was more accurate than other methods. The second stage of FusionM4Net, which included patients' meta-data increased average accuracy to 77.0 percent and diagnostic accuracy to 78.5 percent.




 "Future routine clinical use of algorithms with high diagnostic accuracy might help ensure that rare diseases are also detected by less experienced physicians and it might mitigate decisions affected by stress or fatigue," a coauthor said in a statement.




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New algorithm uses multistage fusion process that includes clinical images, dermoscopy images, and patient meta-data

Novel Algorithm May Help Classify Skin Diseases

For moderate-to-severe plaque psoriasis, treatment with the humanized immunoglobulin G1 monoclonal antibody that specifically binds to the p19 subunit of interleukin 23, risankizumab, is superior to fumaric acid ester (FAE) treatment, according to a study published in the January issue of the
 
 British Journal of Dermatology
 
 .




 Diamant Thaçi, M.D., Ph.D., from the University of Lübeck in Germany, and colleagues compared risankizumab to FAE treatment for psoriasis in a phase III randomized trial. Participants with chronic moderate-to-severe plaque psoriasis, who were naive to and candidates for systemic therapy, were randomly assigned to subcutaneous risankizumab 150 mg at weeks 0, 4, and 16 or oral FAEs at increasing doses from 30 to 720 mg daily (60 and 60 patients, respectively).




 The researchers found that at 24 weeks, significantly more patients randomly assigned to risankizumab achieved a ≥90 percent improvement in the Psoriasis Area and Severity Index (PASI) than those randomly assigned to FAEs (83.3 and 10.0 percent, respectively). Significantly more patients randomly assigned to risankizumab achieved ≥100 percent improvement in the PASI (50.0 and 5.0 percent, respectively); ≥75 percent improvement in the PASI (98.3 and 33.3 percent, respectively); ≥50 percent improvement in the PASI (100 and 53.3 percent, respectively); and the Static Physician's Global Assessment of clear/almost clear (93.3 and 38.3 percent, respectively). The FAE group had higher rates of gastrointestinal disorders, flushing, lymphopenia, and headache.




 "These results support the superiority of risankizumab to FAEs in producing clinically meaningful improvement in the extent and severity of psoriasis over time," the authors write.




 Several authors disclosed financial ties to AbbVie, which manufactures risankizumab and funded the study.




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Significantly more patients achieved ≥90 percent improvement in PASI at week 24 with risankizumab versus FAE

How Does Risankizumab Compare to Fumaric Acid Esters for Plaque Psoriasis?

Biosimilar drugs could drive down prices for biologic drugs and generate savings of about $38.4 billion between 2021 and 2025, according to a study published online Jan. 3 in the
 
 American Journal of Managed Care
 
 .




 Andrew Mulcahy, Ph.D., from RAND Corporation in Arlington, Virginia, and colleagues projected U.S. spending on biologics during a five-year period under three scenarios: (1) a baseline scenario holding quarter 4 (Q4) of 2020 market conditions constant; (2) under main assumptions allowing for biosimilar market growth and entry; and (3) an upper-bound scenario assuming greater biosimilar uptake, more robust price competition, and quicker biosimilar entry.




 The researchers found that estimated biosimilar savings from 2021 to 2025 under their main approach were $38.4 billion, or 5.9 percent of projected spending on biologics during the same period. An estimated $26.1 billion of savings was accounted for by biologics first facing biosimilar competition from 2021 to 2025, with $12.2 billion from evolving market conditions for already-marketed biosimilars. Under the main approach, $24.6 billion of savings were from downward pressure on reference biologic prices rather than lower biosimilar prices. Under the upper-bound scenario, savings were substantially higher ($124.5 billion).




 "Biosimilars have the potential to lower spending on biologic drugs that account for a rapidly increasing share of overall U.S. prescription drug spending," Mulcahy said in a statement.




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Increased market growth of biosimilars that are similar to brand-name biologic agents has the potential to reduce spending on prescription drugs

Biosimilars Could Cut Spending for Biologic Therapy in the U.S.

For patients receiving immune checkpoint inhibitors, cutaneous immune-related adverse events (cirAEs) are associated with survival, according to a study published online Jan. 12 in
 
 JAMA Dermatology
 
 .




 Kimberly Tang, from Massachusetts General Hospital in Boston, and colleagues examined the association of developing cirAEs following treatment with anti-programmed cell death 1 or anti-programmed cell death ligand 1 therapy with patient survival in a retrospective study. Data were included for 7,008 eligible patients who developed cirAEs after treatment for malignant neoplasms of digestive organs, bronchus or lung, melanoma of skin, and the urinary tract and 7,008 matched controls.




 The researchers found that using a Benjamini-Hochberg correction with a significance level of 0.05, pruritus, drug eruption, xerosis, nonspecific rashes, and appearance of any cirAE were significantly protective of mortality (hazard ratios, 0.695, 0.755, 0.626, 0.704, and 0.778, respectively). Psoriasis and lichen planus/lichenoid dermatitis were also significant (hazard ratios, 0.703 and 0.511, respectively). Strong protective clinical effects were seen for eczematous dermatitis, vitiligo, bullous pemphigoid, and Grover disease, but they did not reach statistical significance.




 "This cohort study suggests that cirAE development is a favorable clinical indicator and warrants further investigation into its underlying immunopathogenesis, which may provide further insights into immunotherapy response," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical industry.




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Improved survival associated with cirAEs for patients receiving anti-programmed cell death 1 or anti-programmed cell death ligand 1 therapy

Cutaneous Immune-Related AEs Linked to Survival After ICI Therapy

For patients with mild-to-severe actinic keratoses (AK) located on the extremities, trunk, and neck, nanoemulsion gel formulation containing 7.8 percent 5-aminolevulinic acid (BF-200 ALA) has superior efficacy compared with vehicle, according to a phase III study published in the December issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Martina Ulrich, M.D., from the CMB Collegium Medicum Berlin GmbH in Germany, and colleagues examined the efficacy and safety of BF-200 ALA compared to vehicle for the treatment of mild-to-severe AK located on the extremities, trunk, and neck in an intraindividual study conducted among 50 patients in six centers in Germany. Each patient received treatment with BF-200 ALA/red light photodynamic therapy (PDT) and vehicle/PDT on opposite sides, with a maximum of two PDTs.




 The researchers found that with respect to total lesion clearance rates (86.0 versus 32.9 percent) and patient complete clearance per patient's side (67.3 versus 12.2 percent), BF-200 ALA was superior to vehicle. The overall lesion recurrence rates at one year were 14.1 and 27.4 percent for BF-200 ALA and vehicle, respectively. Patient satisfaction with the cosmetic outcome was higher with BF-200 ALA/PDT than vehicle/PDT. Adverse events in association with BF-200 ALA/PDT were consistent with the known safety profile.




 "In line with our previous studies, the results demonstrated high efficacy with superiority to vehicle and confirmed good safety and tolerability and excellent cosmetic outcome," the authors write.




 Several authors disclosed financial ties to biopharmaceutical companies, including Biofrontera Bioscience GmbH, which funded the study.




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BF-200 ALA has high efficacy, excellent cosmetic outcome for patients with mild-to-severe actinic keratoses located on extremities, trunk, neck

Is BF-200 ALA Superior to Vehicle for Total Lesion Clearance in AK?

In CLEAR Derm consensus guidelines issued by the International Skin Imaging Collaboration Artificial Intelligence Working Group and published online Dec. 1 in
 
 JAMA Dermatology
 
 , recommendations are presented for imaging-based artificial intelligence (AI) algorithm development and assessment in dermatology.




 Roxana Daneshjou, M.D., Ph.D., from the Stanford School of Medicine in Redwood City, California, and colleagues guide developers and reviewers of dermatology AI by consolidating limited existing literature with expert opinion. Key recommendations were formulated and grouped into topics of data, technique, technical assessment, and application.




 The authors developed a checklist of items that outlined the best practices of image-based AI development and assessment. The checklist relating to data included image types, image artifacts, technical acquisition details, preprocessing procedures, synthetic images made public, adequate referencing of public images, patient-level metadata, skin tone information, potential biases, data set partitions, sample sizes, external test data, multivendor images, class distribution and balance, and images that are out of distribution. The checklist for techniques included labeling method, references to common/accepted diagnostic labels, histopathologic review for malignant neoplasms, and detailed description of the development of algorithms. Technical assessment included publicly evaluating algorithms; performance measures; benchmarking, technical comparison, and novelty; and assessment of bias. Finally, the application checklist included the use of cases and target conditions and potential impacts on the health care team and patients.




 "While we propose guidelines for clinical and peer-review evaluation of AI, these recommendations are also relevant for a regulatory framework and should be considered for any automated dermatology algorithm that may affect the wider community," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical, technology, and health care industries; one author holds several related patents.




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Checklist for evaluation of image-based AI reports grouped into topics of data, technique, technical assessment, application

Recommendations Developed for Dermatology Artificial Intelligence

In this episode of Cutaneous Miscellaneous, host Nicholas Brownstone, MD, welcomes Brad Glick, DO, to cover to an essential topic for residents and early-career dermatologists: practical approaches for incorporating the latest therapies and technologies into clinical practice.

In this episode of Cutaneous Miscellaneous, host Nicholas Brownstone, MD, welcomes Brad Glick, DO, to cover to an essential topic for residents and early-career dermatologists: practical approaches for incorporating the latest therapies and technologies into clinical practice.&nbsp;They begin with a board review on psoriatic arthritis. Dr Glick highlights the importance of early evaluation and preventive therapies, shares practical tips on critical questions to ask in clinic, and emphasizes utilizing screening tools to aid in diagnosis.&nbsp;The conversation then shifts to integrating new therapies and technologies into clinical practice. Dr Glick shares insights on adapting to advancements, from targeted biologics to precision tools like the Mind.Px patch, which uses molecular profiling to help dermatologists select the most effective psoriasis treatments for a given patient.&nbsp;Tune in to the full episode for an in-depth look at the evolving landscape of dermatologic care, from board review essentials to real-world strategies for residents looking to adopt breakthrough therapies and tools.

Brad Glick, DO

Cutaneous Miscellaneous Podcast

Staying Ahead of the Curve: Embracing New Dermatology Tools and Therapies

In this special live episode of Derms and Conditions, recorded at the Fall Clinical Dermatology 2024 Meeting, host Dr James Q. Del Rosso welcomes Dr April Armstrong, chief of dermatology at UCLA, to discuss key highlights from the conference. Together, they cover the latest in psoriasis treatments, promising developments for vitiligo, advances in hidradenitis suppurativa, and much more.

In this special live episode of Derms and Conditions, recorded at the Fall Clinical Dermatology 2024 Meeting, host Dr James Q. Del Rosso welcomes Dr April Armstrong, chief of dermatology at UCLA, to discuss key highlights from the conference. Together, they cover the latest in psoriasis treatments, promising developments for vitiligo, advances in hidradenitis suppurativa, and much more.&nbsp;The discussion kicks off with psoriasis, where exciting progress in oral TYK2, IL-23, and IL-17A inhibitors is providing potential for effective, safe options for moderate-to-severe cases. For atopic dermatitis, they review the recent approval of lebrikizumab and the real-world efficacy of tralokinumab for head and neck involvement. They also spotlight OX40/OX40 ligand inhibitors—amlitelimab and rocatinlimab—as promising long-acting treatments currently in development.&nbsp;In prurigo nodularis, the newly approved nemolizumab, an IL-31 inhibitor, offers antifibrotic benefits and has notably not shown evidence of conjunctivitis risk seen with other biologics. For vitiligo, BET inhibitors are creating new opportunities by targeting epigenomics, and several JAK inhibitors are pending phase 3 data. For hidradenitis suppurativa, focus has shifted from TNF inhibitors to IL-17 inhibitors like secukinumab, with bimekizumab and oral JAK inhibitors, including povarcitinib, in late-stage development.&nbsp;They round out the episode with chronic hand eczema, where topical ruxolitinib and delgocitinib—a pan-JAK inhibitor recently approved in Europe—show encouraging results.&nbsp;Tune in to the full episode for a full recap of these developments and other breakthroughs from the Fall Clinical Dermatology 2024 Meeting!This episode is supported by Sanofi. The content included in this episode is independently developed by the Derms and Conditions team and their guest speakers and reflects their own views and opinions.

Derms and Conditions Podcast

The Best of Fall Clinical 2024—Live from Las Vegas!

In episode 24 of Cutaneous Miscellaneous, our host, Nicholas Brownstone, MD, sits down with Sandra Lee, MD, aka Dr Pimple Popper.&nbsp;

In episode 24 of Cutaneous Miscellaneous, our host, Nicholas Brownstone, MD, sits down with Sandra Lee, MD, aka Dr Pimple Popper.&nbsp;The episode focuses on the state of the art concerning social media and dermatology and how resident dermatologists can create and improve their social media presence. Dr Lee discusses how to build a successful social media presence, including tips on the best kind of content to post and how to make the content compelling for your audience.&nbsp;Dr Lee and Dr Brownstone then focus on the issue of misinformation on social media within dermatology and skin care and how to address this problem. Dr Lee also discusses how to address and prevent criticism or counterattacks on social media and gives her thoughts on engaging in social media didactics during residency.&nbsp;The episode ends with Dr Lee giving clinical tips on how to perform tumescent anesthesia for resection of large skin lesions in clinic and advice on learning new procedures after graduating residency.&nbsp;You can’t miss hearing from one of the biggest stars in dermatology!&nbsp;Cutaneous Miscellaneous Board Booster!In this new feature, we’ll put your knowledge to the test with high-yield board review questions written by dermatology residents and fellows and sourced from key resources like Bolognia’s Dermatology, Andrews’ Dermatology, and Alikhan’s Review of Dermatology. These quiz questions will test your skills on the board review topic that’s discussed in each episode. Click <a href=" https://www.research.net/r/FNJY3YM?Email=[Email_value]" target="_blank" rel="noopener noreferrer">here</a><a href="" target="_blank" rel="noopener noreferrer"> </a>to begin.

Sandra Lee, MD

Dermatology Social Media: The State of the Art with Dr Sandra Lee

In this episode of Derms and Conditions, our host, James Q. Del Rosso, DO, interviews Cory Rubin, MD, dermatologist and owner of the Michigan Dermatology Institute, about the business side of running a practice, with specific focus on the buy-and-bill model.

In this episode of Derms and Conditions, our host, James Q. Del Rosso, DO, interviews Cory Rubin, MD, dermatologist and owner of the Michigan Dermatology Institute, about the business side of running a practice, with specific focus on the buy-and-bill model.&nbsp;Dr Rubin shares some of the challenges he has faced and explains the value of buy-and-bill for dermatologists, particularly in complex cases where medications may not be easily accessible through traditional pharmacies. They cover suitable medications, such as biologics for psoriasis, cutaneous T-cell lymphoma, and other conditions, as well as the financial benefits, clinical advantages, and patient convenience associated with in-office administration.&nbsp;The conversation dives into the practical aspects of implementing buy-and-bill. They explore the importance of understanding insurance processes, obtaining prior authorizations, and tracking patient outcomes. The pair emphasize the need to start small, gradually expanding buy-and-bill capabilities while ensuring proper documentation and reimbursement.&nbsp;Dr Rubin offers rich practical advice and reiterates the importance of mentorship and seeking assistance from experts in billing and reimbursement. He also extends an invitation for further consultation via email and expresses his willingness to support colleagues in navigating the complexities of practice management. This episode is a valuable listen for dermatologists looking to optimize their practice operations and enhance patient care through buy-and-bill.

Cory Rubin, MD

Prescribed Success: Navigating Buy-and-Bill Strategies in Dermatology Practice

In episode 23 of Cutaneous Miscellaneous, our host, Nicholas Brownstone, MD, speaks with Terrence A. Cronin Jr, MD, FAAD, and President of the American Academy of Dermatology for 2023-2024 term.

In episode 23 of Cutaneous Miscellaneous, our host, Nicholas Brownstone, MD, speaks with Terrence A. Cronin Jr, MD, FAAD, and President of the American Academy of Dermatology for 2023-2024 term.The episode focuses on policy issues affecting dermatology residents now and in the future. Dr Cronin specifically discusses the Medicare physician pay cuts, misinformation on social media, scope-of-practice creep, and truth in advertising. Dr Brownstone asks Dr Cronin what dermatology residents and dermatologists can do to help fix these frustrating issues within our field.Dr Cronin also gives some highlights of his term as AAD president and discusses what he enjoyed most while serving as the leader of the largest dermatology organization in the world.If you care about the field of dermatology and where it’s headed, you can’t miss this episode! See the links below to get involved today. We need your help!<a target="_blank" rel="noopener noreferrer" href="https://www.aad.org/member/advocacy/priorities/medicare-physician-payment/medicare-payment-reform-webinar">Join the AAD</a> for an update on advocacy regarding Medicare physician payment cuts on February 20 at 7 PM CT.Urge Congress to stop Medicare physician payment cuts.&nbsp;Use the AAD’s <a target="_blank" rel="noopener noreferrer" href="https://takeaction.aad.org/takeaction/alertid/2456/">easy-to-use tool</a> to send a letter to your representatives in less than 1 minute! <o:p></o:p>

Terrence A. Cronin Jr, MD, FAAD

Shaping the Future: Insights from the AAD President on Dermatology’s Critical Issues

In Episode 63 of Derms and Conditions, our host, James Q. Del Rosso, DO, sits down with Adam Friedman, MD, to discuss some important topics in dermatology, including a comprehensive resource for portraying skin conditions and his research findings relating to sensitive skin.

In Episode 63 of Derms and Conditions, our host, James Q. Del Rosso, DO, sits down with Adam Friedman, MD, to discuss some important topics in dermatology, including a comprehensive resource for portraying skin conditions and his research findings relating to sensitive skin.Dr Friedman begins by describing his atlas project, created to address a gap in dermatology in the limited way textbooks and atlases portray skin conditions. The Full Spectrum of Dermatology: A Diverse and Inclusive Atlas is a comprehensive resource that depicts dermatologic conditions across the full spectrum of skin tones to help dermatology professionals visualize the nuances in skin conditions.Next, Dr Friedman discusses his research on sensitive skin and how he puts his findings into practice with his patients. He details his global study that looked in-depth at sensitive skin and what factors trigger and exacerbate it, highlighting the importance of dermatologists having tools to assess the condition and provide management strategies. The pair also touch on guiding patients on the use of products for sensitive skin and utilizing samples.They conclude by discussing the importance of early intervention to prevent disease progression and the benefits of initiating more advanced therapies in earlier disease.Tune into this episode to hear more about what’s on Dr Adam Friedman’s mind!

Adam Friedman, MD

What is Dr Adam Friedman Up To Now?

National Healthy Skin Month: Maximizing Skin Health for Older Adults

For National Healthy Skin Month, we’re spotlighting skin health practices across all stages of life. In this segment, Daniel Butler, MD, Associate Professor at the University of Arizona College of Medicine, offers his expert guidance on caring for the skin of older adults. Highlighting the unique needs of this patient population, he provides actionable pearls for both patients and dermatology providers to maximize care and prioritize quality of life (QoL).Addressing skin care for older adultsOlder adults represent a significant portion of dermatology patients, with nearly 50% of all visits involving individuals over the age of 65. Dr Butler emphasizes that their skin requires targeted attention as it undergoes significant changes with aging.For patients, his advice is straightforward but impactful: advise them to moisturize frequently. As skin ages, it loses moisture and its natural barrier weakens, leading to increased dryness and sensitivity. &nbsp;Considerations for providersFor providers, Dr Butler underscores the importance of prioritizing quality of life when treating older patients. Often, there is no one-size-fits-all solution for this population, and treatment decisions frequently exist in a gray area. He encourages dermatologists to have open discussions with their patients about their daily activities and sleep, 2 critical factors for maintaining overall well-being.Additionally, he highlights the importance of encouraging patients to stay active. Citing input from geriatricians, Dr Butler stresses that older adults should not stop exercising or walking, even after surgeries. &nbsp;Key takeaways for dermatologistsDr Butler’s guidance centers on 2 essential points for caring for older adult patients:<ol><li>Encourage patients to moisturize frequently to bolster the skin barrier and combat age-related dryness</li><li>Prioritize quality of life in treatment decisions, focusing on maintaining sleep, activity levels, and overall well-being</li></ol>Through these approaches, dermatologists can provide meaningful care for this important and often underserved patient population.&nbsp;Watch Part 1 here for expert insights on caring for <a target="_blank" rel="noopener noreferrer" href="https://dermsquared.com/videos/topical-conversations/national-healthy-skin-month-supporting-healthy-babies">dermatology's youngest patients</a>, Part 2 here for tips on managing <a target="_blank" rel="noopener noreferrer" href="https://dermsquared.com/videos/topical-conversations/national-healthy-skin-month-managing-adolescent-and-young-adult-patients">adolescent and young adult patients</a>, and Part 3 here for strategies to optimize skin health in <a target="_blank" rel="noopener noreferrer" href="https://dermsquared.com/videos/topical-conversations/national-healthy-skin-month-expert-strategies-skin-health-middle-aged-adults">adults and middle-aged patients</a>—all for National Healthy Skin Month!

National Healthy Skin Month: Expert Strategies for Optimizing Skin Health in Middle-Aged Adults 

For National Healthy Skin Month, we’re spotlighting skin health practices across all stages of life. In this segment, board-certified dermatologist Dr Gabriela Maloney shares evidence-based strategies for managing skin health in adults and middle-aged patients. Highlighting preventative, therapeutic, and cosmetic interventions, Dr Maloney provides practical pearls for dermatologists to enhance outcomes and improve quality of life for their patients.&nbsp;Sun protection: the cornerstone of skin health&nbsp;Dr Maloney emphasizes that broad-spectrum sunscreen with an SPF of 30 or higher is essential for preventing photoaging and reducing the risk of nonmelanoma skin cancers. Evidence has demonstrated significant benefits, including a 40% reduction in the incidence of invasive squamous cell carcinoma and a 24% decrease in actinic keratoses over 4 years with daily SPF 30 use compared to SPFs of lower formulations. Educating patients on proper application techniques and the importance of reapplying every 2 hours, especially during outdoor activities, is critical.&nbsp;The "magic trifecta" for anti-aging&nbsp;Counseling this patient group on anti-aging, Dr Maloney recommends a simple yet effective regimen: sunscreen, vitamin C, and retinoids. She advises patients that vitamin C, known for its ability to neutralize free radicals, brighten skin, and boost collagen synthesis, is particularly effective when paired with sunscreen. Retinoids, including prescription tretinoin and over-the-counter retinols, promote epidermal turnover and dermal remodeling, reducing fine lines, hyperpigmentation, and acne. Counseling patients to start with low concentrations and gradually increase use minimizes irritation and ensures a positive experience.&nbsp;Expanding the toolbox with additional ingredients&nbsp;For patients seeking advanced options, Dr Maloney advises patients that they may benefit from ingredients like azelaic acid and glycolic acid. Azelaic acid offers anti-inflammatory, antimicrobial, and depigmenting properties, making it ideal for rosacea, melasma, and acne. Glycolic acid facilitates exfoliation, improves collagen production, and enhances skin tone and texture, providing versatile benefits.&nbsp;Chemoprevention and skin cancer surveillance&nbsp;In high-risk populations, Dr Maloney recommends proactive interventions such as nicotinamide supplementation, with evidence suggesting that 500 mg twice daily may help significantly reduce the incidence of new actinic keratoses and cutaneous squamous cell carcinoma. Regular full-body skin examinations and patient education on self-surveillance are essential for early detection of skin cancers, improving outcomes and survival rates.&nbsp;Integrating preventative, therapeutic, and aesthetic care&nbsp;Dr Maloney highlights the importance of combining evidence-based recommendations with personalized care to optimize patient outcomes. By integrating preventative measures, therapeutic treatments, and cosmetic enhancements, dermatologists can elevate patient satisfaction and quality of life.&nbsp;Key takeaways for dermatologists&nbsp;<ul><li>Prioritize sun protection: Educate patients on proper application and the importance of reapplication&nbsp;</li><li>Simplify anti-aging regimens: Recommend the "magic trifecta" of sunscreen, vitamin C, and retinoids for effective and evidence-based anti-aging benefits&nbsp;</li><li>Proactive interventions: Utilize nicotinamide supplementation for high-risk populations and ensure regular skin cancer screenings paired with patient education on self-surveillance&nbsp;</li><li>Integrate care approaches: Combine preventative, therapeutic, and aesthetic strategies to provide personalized, evidence-based care that enhances patient outcomes and quality of life&nbsp;</li></ul><a target="_blank" rel="noopener noreferrer" href="https://dermsquared.com/videos/topical-conversations/national-healthy-skin-month-supporting-healthy-babies">Check out Part 1 here</a> for expert insights on caring for the skin of dermatology's youngest patients, <a target="_blank" rel="noopener noreferrer" href="https://dermsquared.com/videos/topical-conversations/national-healthy-skin-month-managing-adolescent-and-young-adult-patients">Part 2</a>  for tips on managing adolescent and young adult patients, and <a target="_blank" rel="noopener noreferrer" href="https://dermsquared.com/videos/topical-conversations/maximizing-skin-health-for-older-adults">Part 4</a> for guidance on caring for the older adult patient population—all for National Healthy Skin Month!

National Healthy Skin Month: Managing Adolescent and Young Adult Patients 

For National Healthy Skin Month, we’re spotlighting skin health practices across all stages of life. In this segment, Dr Nicholas Brownstone shares his expertise on managing patients in the adolescent and young adult demographic—a pivotal stage where dermatologists must consider not only physical health but also mental well-being.&nbsp;Understanding the adolescent perspective&nbsp;Dr Brownstone highlights that skin changes throughout life, as do our psychology and worldview. These shifts are particularly pronounced during adolescence, a time when many patients first develop social anxieties tied to their appearance.&nbsp;At this stage, patients are still forming their sense of identity, and even minor skin issues can feel monumental. Dermatologists must recognize the unique emotional weight that acne carries for this group and avoid dismissing their concerns—a practice Dr Brownstone refers to as “empathetic failure.”&nbsp;The psychological impact of acne&nbsp;According to Dr Brownstone, adolescence is often the life stage where acne has the greatest psychological impact. He emphasizes that even a single pimple can feel like “the end of the world” for these patients. This perspective supports the importance of taking their concerns seriously and tailoring treatment approaches to meet their emotional as well as physical needs.&nbsp;Pearls for treating acne in adolescents&nbsp;Dr Brownstone advises dermatologists to approach acne treatment in adolescents differently than in pediatric or adult patients. Key considerations include:&nbsp;<ul><li>Empathy first: Understanding the adolescent perspective and avoiding dismissive responses that could alienate patients&nbsp;</li><li>Individualized treatment: Acknowledging that not all acne cases are equal and adjusting treatment plans accordingly&nbsp;</li><li>Aggressive treatment when needed: Dr Brownstone suggests that even one pimple may justify aggressive treatment options, including isotretinoin, if the acne is perceived as life-ruining by the patient.&nbsp;</li></ul>Key takeaways for dermatologists&nbsp;As dermatologists, it’s crucial to consider both the physical and emotional impacts of acne on adolescent patients. Dr Brownstone encourages his colleagues to view this demographic through a compassionate lens, understanding their unique challenges and tailoring care to meet their needs effectively.&nbsp;By fostering empathy and delivering personalized care, dermatologists can make a profound difference in the lives of their adolescent patients, helping them navigate this critical stage with confidence and better skin health.Watch Part 1 here for expert insights on caring for <a target="_blank" rel="noopener noreferrer" href="https://dermsquared.com/videos/topical-conversations/national-healthy-skin-month-supporting-healthy-babies">dermatology's youngest patients</a>, Part 3 here for strategies to optimize skin health in <a target="_blank" rel="noopener noreferrer" href="https://dermsquared.com/videos/topical-conversations/national-healthy-skin-month-expert-strategies-skin-health-middle-aged-adults">adults and middle-aged patients</a>, and Part 4 here for guidance on caring for the <a target="_blank" rel="noopener noreferrer" href="https://dermsquared.com/videos/topical-conversations/maximizing-skin-health-for-older-adults">older adult patient population</a>—all for National Healthy Skin Month!

Fall Clinical 2024 Welcome Reception

Watch highlights from the Fall Clinical 2024 Welcome Reception in beautiful Las Vegas!

What Did 2024 Bring to The Table in Dermatology? - Part 1

In this comprehensive 5-part lecture, Linda F. Stein Gold, MD, April W. Armstrong, MD, MPH, Boni E. Elewski, MD, Dirk M. Elston, MD, and Theodore Rosen, MD, provided updates on important developments in dermatology, focusing on a range of topics from acne treatment controversies to the latest in systemic therapies for chronic skin conditions.&nbsp;Linda F. Stein Gold, MD, began the session by addressing the controversy surrounding benzoyl peroxide (BPO) use in acne treatment. BPO can break down into benzene, with higher breakdown rates correlated to more benzene production. Benzene is a known carcinogen and is associated with an increased risk of leukemia, particularly acute myeloid leukemia (AML). Independent laboratory tests revealed that BPO-containing products stored at room temperature or higher could have 800 to 1200 times the FDA- and EPA-approved benzene limit for long-term exposure. Thus, there was a concern that BPO-containing products could be dangerous to the public. However, a study conducted on 2.3 million patients with acne showed that there was no increased risk of AML associated with BPO use. A retrospective cohort study from the TriNetX US Collaborative Network also confirmed no link between BPO and increased cancer risk. Dr Stein Gold concluded by recommending that BPO products be stored in refrigerators and replaced every 3 to 6 months to minimize benzene formation, particularly avoiding exposure to high temperatures.&nbsp;Next, April W. Armstrong, MD, MPH, provided an overview of newly FDA-approved treatments for psoriasis, atopic dermatitis (AD), and prurigo nodularis. She discussed bimekizumab, a monoclonal antibody targeting IL-17A and F, which showed promising results with 54.5% of patients with psoriatic arthritis achieving ACR50 and 65% of patients with psoriasis reaching PASI100 after one year. In the realm of AD treatment, she presented data on lebrikizumab, an IL-13 inhibitor, which demonstrated long-lasting efficacy in the ADvocate 1 and 2 trials, with patients maintaining significant skin clearance and itch relief for 52 weeks. The ADore trial confirmed its safety, with mild- to-moderate adverse events and low rates of conjunctivitis (8%), comparable to dupilumab. Lastly, Dr Armstrong covered the approval of nemolizumab for prurigo nodularis with 37.6% of patients reporting significant reductions in itch and severity.&nbsp;Boni Elewski, MD, turned the discussion toward fungal infections, specifically focusing on the emergence of drug-resistant strains such as T. indotineae, T. rubrum, and T. mentagrophytes genotype VII. These infections pose significant treatment challenges. Itraconazole was suggested as the preferred choice for the treatment of resistant fungal infections. Dr Elewski also addressed the management of generalized pustular psoriasis (GPP), noting that high loading doses of biologics—600 mg followed by 300 mg every 4 weeks—were effective in reducing the risk of flares.&nbsp;Dirk M. Elston, MD, followed with a detailed review of psoriasis treatments, emphasizing the variety of options available and selection of treatment plans that best fit individual patient needs. He highlighted the effectiveness of proactive use of combination therapies like calcipotriene and betamethasone over reactive management. Dr Elston elaborated on the pros and cons of various psoriasis medications, highlighting the complex decision-making required for psoriasis treatment. In addition, the presentation provided practical guidance on selecting biologics based on patient comorbidities such as obesity, demyelinating diseases, and pregnancy.&nbsp;Theodore Rosen, MD, concluded the session by discussing JAK inhibitors and their potential uses beyond their current FDA approvals. Through case presentations, he demonstrated the effectiveness of various JAK inhibitors—such as tofacitinib, baricitinib, abrocitinib, upadacitinib, and ruxolitinib—in treating conditions like granuloma annulare, sarcoidosis, and lichen planus. Tofacitinib was shown to not only resolve cutaneous symptoms but also address systemic effects of these disorders, making it a valuable tool in treating complex dermatologic conditions.

Evolving Therapies in the Treatment of Chronic Spontaneous Urticaria

Brad P. Glick, DO, MPH, David Lang, MD, and Dawn L. Merritt, DO, provided insights into chronic spontaneous urticaria (CSU). The conversation alternated between dermatology and allergist perspectives to provide a well-rounded idea of evolving therapies and integrating new treatments into clinical practice. CSU is a clinical diagnosis that may not present visibly but rather as a series of quality of life (QoL) changes. Because of the QoL changes, the team suggests having patients fill out a QoL-focused questionnaire through the CRUSE CONTROL application to measure treatment efficacy though symptom tracking.&nbsp;The presentation highlighted the existence of severe subtypes of CSU that require tailored treatment strategies, as antihistamines alone are generally insufficient for effective management. While a stepwise treatment plan for CSU is outlined, it currently overlooks the latest therapeutic options. Despite being part of the current recommendations, omalizumab remains underutilized in dermatology. Omalizumab has been shown to be effective in treating urticaria, especially in patients with elevated IgE levels. However, dermatologists are very familiar with dupilumab, which has also been shown to be an effective treatment for CSU. In addition, the team introduces a promising new agent under investigation for CSU treatment, remibrutinib, a novel BTK inhibitor, which has shown effectiveness in CSU and provides an alternative pathway to treat the condition.

What’s New in the Medicine Chest - Part 2

This presentation by James Q. Del Rosso, DO, focused on recent findings in dermatologic therapies. Starting with dupilumab, a study reported that dupilumab can be an effective treatment for AD when readministered after discontinuation. For patients who do not respond well to initial biologic treatments, small molecule alternatives like tralokinumab, upadacitinib, and abrocitinib have shown promise in achieving better skin clearance and itch relief. The LEVEL UP open-label comparison trial showed that upadacitinib may be even more effective for treating AD. Dr Del Rosso also highlighted new research on the pathogenesis of AD and thus the development of targeted therapies. TheOX40-OX40L-activated pathway has been shown to potentially play a role in AD, and there are several therapies currently in clinical trials that inhibit OX40-OX40L binding.&nbsp;He further discussed emerging information on various treatments for psoriasis, hidradenitis suppurativa (HS), and chronic spontaneous urticaria (CSU) treatments, which all aim to target specific factors in the evolving pathogenesis of these conditions.&nbsp;Lastly, the discussion touched on real-world challenges of recommending supplements with polypodium leucotomos (PL) or PL extract (PLE). PLE can have beneficial protective skin effects; however, it is noted that using the methods of extraction, production techniques, and extract use change the efficacy of the products.

Photoprotection: Where Are We Now?

Tasneem F. Mohammad, MD, delved into the current state of photoprotection, highlighting key advances and challenges in protecting the skin from harmful radiation. The presentation outlines various methods of photoprotection, including sun avoidance, sun-protective clothing, and the use of sunscreen. Tinted sunscreen is touted as the sunscreen that meets the criteria of broad-spectrum UVA and UVB coverage as well as visible light (VL) coverage. However, there are challenges to use like staining and color matching. The presentation also introduced the development of newer sunscreen filters, such as bemotrizinol, Mexoryl 400, and TriAsorB, which offer enhanced protection against UVA, UVB, and VL.&nbsp;The role of secondary photoprotective agents is also explored in the lecture. Antioxidants in sunscreens are discussed. Sunscreen with antioxidants has been shown to be similarly effective to tinted sunscreen. Oral photoprotection agents, such as nicotinamide and polypodium leucotomos extract, are mentioned as potential adjuvants for reducing UV-induced damage. The presentation concludes with a discussion on personalized photoprotection, tailored to an individual's skin type, condition, and specific needs, emphasizing the importance of using the right product for optimal skin health.

What Did 2024 Bring To The Table In Dermatology? - Part 2

This 4-part lecture series built on “What Did 2024 Bring to the Table in Dermatology – Part 1” and provided even more updates on dermatology advancements. Dr Lisa Swanson started the series with updates on several treatments for pediatric patients for seborrheic dermatitis, atopic dermatitis (AD), and psoriasis. Roflumilast was recently FDA approved for patients 9 years and above for the treatment of seborrheic dermatitis. In regards to dupilumab for AD treatment, studies have shown that it decreases the risk of atopic march for patients with AD and reduces risk of asthma development. Other studies have concluded that patients taking dupilumab can have vaccines (including live) while receiving treatment. Beyond dupilumab, there are more AD treatments on the horizon for pediatric patients. Lebrikizumab has been approved for patients with AD ages 12 and older, and trials for JAK inhibitors are beginning. Strides have also been made in the realm of pediatric psoriasis—apremilast (now in trials) and spesolimab (now FDA approved) are the latest medications for psoriasis and generalized pustular psoriasis. Overall, Dr Swanson provides inspirational patient stories that motivate providers to continue fighting for patients’ well-being.&nbsp;Next up, Dr David E. Cohen presented the updated Guidelines of Care by the American Academy of Dermatology for AD, which now include recommendations for new topical and systemic biologic therapies. For systemic therapy, several biologics and JAK inhibitors have a ‘strong’ strength of evidence rating for moderate-to-severe AD. When comparing the recommended systemic therapies for moderate-to-severe AD, upadacitinib had the best efficacy in achieving EASI-75 and -90. Of note, systemic corticosteroids were conditionally recommended against for use in AD. Dr Cohen noted that JAK inhibitors have some potential safety concerns, including serious side effects of cardiovascular disorders, blood clots, and cancer; therefore, JAK inhibitors should be started at the lowest dose and considered when other treatments have failed.&nbsp;Dr Laura K. Ferris presented the latest developments in melanoma and skin cancer treatment. Ferris discussed individualized neoantigen therapy with mRNA-4157 + pembrolizumab for melanoma, neoadjuvant therapy with ipilimumab and nivolumab (IPI + NIVO) for Stage III melanoma, and vismodegib and radiation for basal cell carcinoma. She also explored the role of advances in technology for melanoma diagnosis with 31-gene expression profiles (GEPs), 23-GEP, and electrical impedance spectroscopy (EIS) as the technologies with the highest strength of recommendation.&nbsp;Dr Emmy Graber rounded out the series by discussing advancements in acne and rosacea treatments. She discussed the FDA approval of a new triple combination topical gel for moderate-to-severe acne (clindamycin/adapalene/benzoyl peroxide). Comparison studies demonstrated higher efficacy of the triple therapy as compared to two-product combined therapies. Graber also presented the promising results of DFD-29, a modified-release minocycline capsule for rosacea, which outperformed doxycycline in clinical trials.

Topical Therapy Forum

The "Topical Therapy Forum" lecture series presented an in-depth look at advancements in topical treatments across several dermatologic conditions, with each expert delving into the latest innovations and their clinical applications.&nbsp;Dr James Q. Del Rosso started this series by focusing on treatments for seborrheic dermatitis (SD). SD is an inflammatory skin disorder that has a multifactorial pathogenesis caused by skin barrier dysfunction, Malassezia infection, host immunity dysregulation, sebaceous gland activity and skin microbiome changes. SD is highlighted as a distinct condition, rather than a continuation of atopic dermatitis or psoriasis, because of its unique clinical markers and distinct skin barrier disruption. Continued studies show evidence of skin barrier dysfunction due to ceramide composition and microbiome and microbial shifts and indicate a need to proactively prevent and protect the skin barrier as a means of treating SD. Treatment for seborrheic dermatitis includes corticosteroids, antifungal agents, calcineurin inhibitors, zinc and selenium-based shampoos. There are also emerging treatments for SD such as roflumilast (FDA approved in 2023 in foam form) and crisaborole (off-label). Roflumilast in both the foam and cream vehicles offers a promising nonsteroidal alternative for moderate-to-severe cases, demonstrating efficacy in reducing symptoms like redness, scaling, and itch, with a favorable safety profile.&nbsp;Next, Dr Linda Stein Gold delivered a detailed presentation on the latest topical treatments for psoriasis, focusing on 2 major breakthroughs: tapinarof and roflumilast. Tapinarof, a topical aryl hydrocarbon receptor modulating agent (TAMA), has shown significant efficacy in treating plaque psoriasis and intertriginous plaque psoriasis. Fifty-eight percent of patients achieved clear or almost clear skin within 4 months and a lasting effect of 115 days after treatment discontinuation. Dr Stein Gold also discussed roflumilast cream, a PDE4 inhibitor, for plaque psoriasis. Roflumilast has demonstrated strong results in reducing itch and improving skin clearance, particularly in areas like the scalp and intertriginous zones.&nbsp;Dr Lisa Swanson continued the discussion by covering new developments in the treatment of atopic dermatitis (AD). Swanson emphasizes the need for more treatments beyond the common combinations of topical corticosteroids and calcineurin inhibitors. She introduced the Aron regimen, a compounded mixture of betamethasone, mupirocin, and moisturizer, which has shown great success in treating persistent eczema in young children. She also discussed newly approved nonsteroidal topical therapies, including ruxolitinib cream, a topical JAK inhibitor, roflumilast 0.15% cream, a PDE-4 inhibitor, and tapinarof cream, an aryl hydrocarbon receptor modulator. Ruxolitinib is approved for patients aged 12 and older and has demonstrated rapid and sustained efficacy in reducing AD symptoms, particularly itch and inflammation, without stinging/burning or the side effects associated with steroids. Phase 3 studies are exploring the potential for ruxolitinib use down to the age of two. . Roflumilast 0.15% cream, approved for patients aged 6 and up, has also shown significant promise in treating mild-to- moderate AD, offering long-lasting effects (average: 281 days without treatment) with minimal irritation. Tapinarof, which has been previously approved for psoriasis, is now being studied for patients ages 2 and above for moderate-to-severe AD, and trials have shown significant efficacy over vehicle.

What’s New in JAMA Derm?

Dr April W. Armstrong’s presentation highlighted a series of impactful recent studies, covering a broad range of dermatologic conditions and treatments, published in JAMA Dermatology. She begins with a study examining the efficacy of combining oral acitretin with topical triamcinolone (TAC) for oral lichen planus. The combination therapy proved significantly more effective than topical TAC alone, leading to greater reductions in oral disease severity and longer-lasting symptom relief.&nbsp;Dr Armstrong then moved on to discuss bimekizumab’s role in treating severe palmoplantar pustular psoriasis and palmoplantar plaque psoriasis with pustules. The study showed that within 15 to 30 days, most patients experienced improvement, and within 1 to 4 months, significant clearance of skin and nail symptoms was achieved, alongside resolution of associated conditions like acrodermatitis continua of Hallopeau and SAPHO syndrome.&nbsp;She also presented promising results for upadacitinib in treating recalcitrant granulomatous cheilitis (GC), where 80% of patients achieved complete remission in just 4 months, with simultaneous control of Crohn’s disease.&nbsp;Next, Dr Armstrong discussed the potential of metformin in promoting hair growth for patients with central centrifugal cicatricial alopecia. A case series from JAMA Dermatology identified a positive relationship between metformin use and hair growth in these patients.&nbsp;Finally, she covers long-term follow-up data from the Ritux 3 trial, which showed that rituximab combined with short-term prednisone can offer sustained remission and reduce relapse rates in pemphigus, providing encouraging evidence for long-term management of this condition.

What’s New in JAAD?

Dr Dirk Elston presented a comprehensive review of the top JAAD articles and findings from 2024. Dr Elston truly highlighted the major impact of JAAD with a presentation of slide after slide of groundbreaking articles. His presentation began with an important finding linking dupilumab to an increased risk of mycosis fungoides. He then discussed a study on diagnosing centrally located alopecia in patients of African descent, emphasizing that while central centrifugal cicatricial alopecia is a common diagnosis, up to half of these patients may also have pattern alopecia, suggesting that differential diagnoses should include causes considered in other populations.&nbsp;The presentation continued with studies addressing a wide range of topics: lentigo maligna margins on the head and neck, the safety profile of guselkumab in patients with psoriasis and a history of neoplasms or hepatitis, crisaborole for stasis dermatitis, roflumilast for seborrheic dermatitis, spesolimab and imsidolimab for generalized pustular psoriasis, skin cancer risks in UV phototherapy without psoralens, noninvasive treatments for cutaneous neurofibromas, deucravacitinib for scalp psoriasis, propranolol duration for infantile hemangiomas, and the impact of dupilumab on patch testing.&nbsp;Dr Elston also covered ongoing research published in JAAD, including eblasakimab trials for atopic dermatitis, apremilast for genital psoriasis, orismilast for moderate-to-severe psoriasis, povorcitinib and other treatments for hidradenitis suppurativa, the relationship between solvent exposure and systemic sclerosis, hyperbaric oxygen therapy for calciphylaxis, dermoscopy findings for lentigo maligna, comparisons of treatments for Bowen’s disease and extramammary Paget’s disease, M-PDT and lasers for acne vulgaris, ALA-PDT for rosacea, alpha-gal syndrome, and cross-reactions with biologics.

What’s New in SKIN?

Dr Roger Ceilley provided a comprehensive overview of the past year for SKIN: The Journal of Cutaneous Medicine, highlighting the journal’s rapid growth and valuable contributions to the field of dermatology. As a peer-reviewed, open-access, and online-only journal, SKIN has surpassed 1.4 million reads since its launch while expanding its editorial team and fellow/medical student board and steadily increasing its monthly readership.&nbsp;Dr Ceilley also addressed significant advancements in dermatology research published in SKIN. He highlighted new consensus statements on psoriasis, which underscore the systemic impact of the disease and emphasize the importance of early intervention for patients with mild-to-moderate psoriasis. Additionally, he discussed the rising influence of artificial intelligence (AI) in dermatology, while drawing attention to the lack of pediatric-focused AI research and the potential for AI to improve access to care for underserved populations.&nbsp;In terms of therapeutic advancements, SKIN published an expert consensus report on bimekizumab, which demonstrated faster and more effective results compared to other biologics, though with a higher risk of oral candidiasis.&nbsp;Dr Ceilley also introduced a new section in the journal dedicated to medical education in dermatology. Recent articles in this section have explored topics like the diagnostic confidence of dermatology residents when treating patients with skin of color. Additionally, he highlighted one of the journal’s most popular sections, “SKINmages: Clinical Images in Dermatology,” which invites authors to submit rare and intriguing dermatologic observations. Several compelling images and corresponding cases were shared as examples of this unique feature.

What’s New in Dermatologic Surgery?

Dr Marc D. Brown’s presentation provided a detailed overview of recent studies shaping dermatologic surgery practices published in Dermatologic Surgery. One key topic addressed in the journal is the low incidence of bacteremia, infective endocarditis, and prosthetic joint infections in dermatologic surgery. Based on a systematic review, the findings suggest that prophylactic antibiotics may not be necessary for most cutaneous surgeries, as the risk of complications is minimal. Another study presented addressed the effect of preoperative chlorhexidine gluconate cleansing on reducing surgical site infections, particularly for lower extremity surgeries. In one retrospective cohort study, daily chlorhexidine washes for 14 days significantly reduced infection rates to 0% in Mohs surgeries.&nbsp;Brown discussed the use of novel oral anticoagulants (NOACs) in dermatologic surgery, which have become increasingly common. A study found that NOAC monotherapy does not lead to a significant increase in postoperative bleeding complications compared to patients not on antithrombotics. However, combining NOACs with aspirin greatly increased bleeding risk, highlighting the need for careful management of anticoagulated patients.&nbsp;The presentation also examined the off-label use of topical treatments like 5-fluorouracil (5-FU) and imiquimod for squamous cell carcinoma (SCC) in situ. While 5-FU was effective for smaller lesions, recurrence rates were higher for larger ones. Imaging techniques, such as MRI, CT, and PET scans, were highlighted for their effectiveness in detecting high-risk tumor features, such as perineural invasion and bone involvement, especially in SCC cases.&nbsp;Lastly, Dr Brown highlighted findings from Dermatologic Surgery showing that intraoperative immunohistochemistry during Mohs surgery significantly reduces local recurrence rates in invasive melanoma, making it a valuable tool for improving surgical outcomes.

World Mental Health Day: Dermatology's Role in Addressing Mental Health Impacts 

In this episode of Topical Conversations, Dr Nick Brownstone highlights the critical role dermatologists play in addressing the mental health impact of skin conditions. For World Mental Health Day on October 10, Dr Brownstone emphasizes the importance of raising awareness about how dermatologic diseases affect patients' mental well-being.&nbsp;Mental health and skin disease: a quality-of-life issue&nbsp;Dr Brownstone opened by reminding dermatologists that while skin conditions like acne, psoriasis, atopic dermatitis, alopecia areata, and vitiligo may not be life-threatening, they can drastically reduce a patient's quality of life and urging his colleagues to consider the potential mental toll these conditions can take on patients.&nbsp;He stressed the importance of dermatologists taking a moment to ask their patients a simple but impactful question: Is this condition significantly affecting your quality of life? Many patients may be hesitant to proactively raise this issue, and such a question can open the door to discussions about their mental health and how their skin condition impacts their daily life.&nbsp;The connection between dermatology and mental health&nbsp;Dr Brownstone cited recent studies that have confirmed the negative mental health impacts associated with dermatologic conditions. One finding, published in JAMA Dermatology, demonstrated that patients with atopic dermatitis had a higher prevalence of suicidal ideation and attempts compared to the general population. He noted the seriousness of this finding, emphasizing that dermatologists must be mindful of these risks when treating patients with chronic skin diseases.&nbsp;Another study discussed by Dr Brownstone was the Global Valiant Study on vitiligo, also published in JAMA Dermatology. The study found that patients with vitiligo often find difficulty with everyday activities, such as choosing clothing or going to the beach, due to the psychological burden of their condition. These daily limitations, often overlooked, can severely impact their quality of life, highlighting the need for dermatologists to acknowledge the emotional and psychological effects of skin diseases.&nbsp;Addressing mental health in dermatology: simple and effective steps&nbsp;Dr Brownstone advised dermatologists to take 2 simple steps when a patient expresses that their skin condition is negatively impacting their mental health:&nbsp;<ol><li>Offer more aggressive therapy: For patients whose current treatments may not be addressing their symptoms sufficiently, considering more intensive options could help improve both their physical and mental well-being.&nbsp;</li><li>Provide mental health support: If a patient's condition is having a severe psychological impact, dermatologists should not hesitate to recommend mental health resources. Dr Brownstone emphasized the value of referring patients to therapists or connecting them with patient support organizations. He mentioned several helpful resources, including the National Psoriasis Foundation, National Eczema Foundation, Vitiligo Research Foundation, and Global Vitiligo Foundation, all of which offer support and community for patients dealing with the emotional burden of their skin conditions.&nbsp;</li></ol>World Mental Health Day: a reminder for all healthcare providers&nbsp;Dr Brownstone concluded the discussion by urging his colleagues to always be mindful of the mental health aspects of skin conditions, reminding dermatologists to ask about mental health regularly and act when necessary. By addressing the often-overlooked psychological toll that skin diseases can take, dermatologists can help improve not only their patients' skin health but also their overall well-being, making a lasting difference in their quality of life.

Patient-First Communication Introduction

Addressing Touch Starvation: Strategies for Improving Patient Well-Being  

In this episode of Topical Conversations, dermatologists Nicholas Brownstone, MD, and Alexandra K. Golant, MD, address the critical yet often overlooked issue of touch starvation, particularly affecting patients with inflammatory skin conditions. This discussion highlights how touch starvation impacts patients' overall quality of life and offers practical advice for clinicians on how to address this issue.&nbsp;Understanding touch starvation&nbsp;Touch starvation, in the context of dermatology, is a multifaceted issue with significant implications for patients with inflammatory skin diseases. From a clinical perspective, touch starvation can manifest as patients feeling isolated and less engaged with their health care providers. This reduced interaction may hinder providers from fully assessing the severity of the disease and its impact on the patient’s quality of life. Consequently, patients may suffer silently, experiencing challenges that health care providers may not fully appreciate.&nbsp;Another dimension of touch starvation involves the social and emotional isolation that often accompanies inflammatory skin conditions. This isolation can lead to various negative outcomes, such as mental health issues, social anxiety, and withdrawal from daily activities. Addressing these concerns is crucial for improving the overall well-being of patients and ensuring that clinicians are more attuned to the broader impacts of these conditions.&nbsp;Impact of touch starvation on quality of life&nbsp;Touch starvation significantly affects the quality of life for patients with conditions like psoriasis and atopic dermatitis. Patients may experience a substantial burden, which is often underreported. If clinicians do not actively inquire about quality of life, they may miss crucial insights into how the disease affects the patient's mental health, self-esteem, and interpersonal relationships.&nbsp;Many patients are not proactive in discussing their emotional distress or the extent to which their condition impacts their lives. Therefore, it is essential for health care providers to proactively assess quality of life to better understand the severity of the disease and adjust treatment plans accordingly. Inadequate recognition of touch starvation can lead to undertreatment, leaving patients with a diminished quality of life.&nbsp;Identifying touch starvation in patients&nbsp;To effectively identify touch starvation and its impact on patients, clinicians can adopt several strategies:&nbsp;<ol><li>Frequent follow-ups: It is important to schedule more frequent visits for patients who appear to be struggling or whose condition may be worsening. Shorter follow-ups can help ensure that providers stay updated on the patient’s condition and make timely adjustments to treatment.&nbsp;</li><li>Intentional dialogue: During clinic visits, take the time to engage in meaningful conversations about the patient’s quality of life. Ask specific questions about how their disease affects their daily activities, sleep, and overall well-being. Open-ended questions, such as “What activities are you unable to do because of your condition?” can provide valuable insights.&nbsp;</li><li>Holistic care: Regular follow-ups are crucial for identifying mental health strain or comorbidities that may not be immediately apparent. A comprehensive approach to patient care can reveal underlying issues that need to be addressed alongside the primary skin condition.&nbsp;</li></ol>Supporting patients with low self-esteem and poor body image&nbsp;For patients experiencing low self-esteem or poor body image due to their disease, several strategies can help:&nbsp;<ol><li>Access to advanced therapies: The advent of new treatments has provided hope for many patients. Informing patients about advanced therapeutics can offer them a sense of optimism and encourage them to engage more actively in their treatment plan.&nbsp;</li><li>Support groups: Connecting patients with support groups, either through national organizations like the National Psoriasis Foundation or the National Eczema Association or through local and online communities, can provide valuable social support. These groups offer a space for patients to share experiences and find encouragement from others facing similar challenges.&nbsp;</li><li>Interdisciplinary team: Leveraging an interdisciplinary approach, including mental health professionals and primary care providers, can address the holistic needs of patients. This team-based care model ensures that patients receive comprehensive support, addressing both their physical and emotional health.&nbsp;</li></ol>Touch starvation is a significant issue for patients with inflammatory skin diseases, impacting their quality of life and overall well-being. By understanding and addressing this issue, clinicians can improve patient care and outcomes. Regular follow-ups, intentional dialogue, and access to advanced treatments and support resources are essential for effectively managing touch starvation and enhancing the quality of life for these patients. For more resources, the National Psoriasis Foundation and the National Eczema Association offer valuable support and information for both patients and providers.

Dermatology Condition Center

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