Recurrent Fluconazole-Induced Fixed Drug Eruption of the Digit with Nail Matrix Involvement: A Case Report and Review of the Literature.

Introduction: Fixed drug eruptions (FDEs) are cutaneous hypersensitivity reactions due to an offending drug and are rarely associated with nail involvement. Moreover, FDEs associated with fluconazole use are sparsely reported in literature. Case Presentation: We report a case of a recurrent FDE with involvement of one finger and corresponding Beau's lines due to fluconazole use. The diagnosis of FDE secondary to fluconazole use was confirmed histopathologically, with improvement after the application of twice daily 0.05% clobetasol propionate ointment. Conclusion: FDEs are hypersensitivity reactions that occur after exposure to an offending drug. FDEs uncommonly affect the nail matrix and are often not caused by fluconazole. It is important for dermatologists to assess for changes in the nail plate when evaluating a patient with FDE and evaluate all medications a patient is taking.

A Cost-Based Analysis of Anti-aging Products Across Four Major United States Retailers.

Background In the field of aesthetic dermatology, there is currently very little data on affordability and cost analysis regarding cosmeceuticals as more demand from patients showing interest in cosmeceutical products to reduce and prevent aging continues to grow. Photoaging, a form of extrinsic aging from sun exposure, can be ameliorated by applying sunscreen and retinol products. Topical ascorbic acid and niacinamide have been shown to target the oxidative stress process that contributes to photoaging. These four products have been identified as the cosmeceutical ingredients with the most evidence-based data on photoaging prevention and treatment. Objective Given the demand for effective skin care, the paucity of data on cost differentiation, and the availability of cosmeceutical products, we analyzed the unit cost of four anti-aging products from major online and physical retailers in the United States. Such a cost comparison may facilitate more economically appropriate recommendations on skin care to consumers. Methods and materials We analyzed sunscreen, topical vitamin C (ascorbic acid), topical vitamin B3 (niacinamide), and topical vitamin A (retinol) products sold by four major United States retailers: Walmart, Ulta, Walgreens, and Amazon. The average cost in dollars per ounce (dollar/oz) was calculated for each product category at each retailer. Statistical analyses were done to determine statistical significance for each product category between retailers as well as between each category of product. Results Between the four retailers, Walmart offered the lowest cost per ounce for every product. In contrast, Amazon offered the highest cost per ounce for every product except for sunscreen. We also found that sunscreen products are less expensive per ounce as compared to retinol, ascorbic acid, and niacinamide products. Conclusion Dermatologists should be knowledgeable of product costs when providing patients with anti-aging product recommendations. Our study provides data on the financial cost by retail location of evidence-based anti-aging cosmeceuticals to better guide physicians in patient consulting and economical resource sharing.

Acne treatment review and future perspectives.

Acne affects approximately 9% of people worldwide and is the most common skin condition in the USA. There are abundant topical and oral treatment options available for patients with acne. First-line agents include topical retinoids, azelaic acid, benzoyl peroxide, and combinations of these agents. For recalcitrant or more severe acne, oral medications, including oral antibiotics, isotretinoin, or hormonal therapy, may be considered. This review will also discuss the many advances being made in the treatment of acne vulgaris, from the development of microencapsulated medications to targeted treatments.

Analysis of fibroblast pen usage amongst TikTok social media users.

Social media networks serve as convenient platforms for the dissemination of information, including that which pertains to healthcare. However, social media networks may also disseminate incorrect information, and may even propagate potentially harmful skincare trends. Since its inception in 2016, TikTok, a social media platform wherein users can create and share videos, has served as a tool for the propagation of multiple, potentially dangerous cosmetic trends, most recently the usage of fibroblast pens. Fibroblast pens, also known as plasma pens, are toted to produce a variety of skincare benefits. However, many of the pens being sold commercially, and subsequently used on TikTok, are not FDA-regulated. Potential adverse effects include the development of dyspigmentation, scarring, and mechanical burns of the skin. This study assessed social media content to improve our understanding of fibroblast pen usage amongst TikTok creators. An initial search of public TikTok posts tagged with "#PlasmaPen," "#PlasmaPenTreatment," "#FibroblastPlasma," or "#FibroblastPlasmaPen" identified 200 posts, of which 78 were eliminated after accounting for overlapping posts between hashtags, posts that were later deleted by the user, and those in languages other than English. We analyzed posts according to creator type and classified them into four main themes. The 78 videos were later re-viewed to provide more detailed subdivisions within the four main themes. Analysis showed that 36% of the posts were created by lay-person TikTok users, followed by 25% of posts being created by self-proclaimed fibroblast skin tightening specialists. Major themes include advertisement of the fibroblast pen (61%), experience with the fibroblast pen (26%), education on the fibroblast pen's uses and benefits (6.5%), and warnings related to usage of the pen (6.5%). TikTok users are more likely to encounter a post regarding fibroblast pen usage from uncredentialled, non-medical professional accounts. Only 6.5% of posts were created with the intention of serving as a warning to users, with most of these posts being created by medical doctors. Dermatologists should be aware of the misinformation regarding fibroblast pens and consider posting on social media to raise awareness about this potentially dangerous skincare trend.

Basal cell carcinoma: An updated review of pathogenesis and treatment options.

Basal cell carcinoma (BCC) remains the most common malignancy worldwide. BCC pathogenesis is a result of the interplay between one's environment, genetics, and phenotypic factors. BCC has a low mortality but given its increasing incidence and potential to cause local destruction thus resulting in significant morbidity, it is vital for dermatologists to remain up to date with recent updates in this malignancy's pathogenesis and treatment. This article provides a comprehensive review of the pathogenesis of BCC as well as the current treatments available and clinical trials underway. We also touch upon the updated National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology in respect to BCC's recommended treatment modalities.

Merkel cell carcinoma: An updated review of pathogenesis, diagnosis, and treatment options.

Merkel cell carcinoma is a rare neuroendocrine carcinoma that typically appears in sun-exposed areas of the elderly. It has a poor prognosis and with its incidence projected to increase, it is vital for dermatologists to remain up to date with recent updates in this malignancy's pathogenesis and treatment. In the past few decades Merkel cell carcinoma's pathogenesis, more specifically its relation to the Merkel cell polyomavirus, has sparked further interest in the study of this carcinoma. Most cases are attributed to malignant transformation secondary to the Merkel cell polyomavirus, with a minority derived from DNA damage resulting from ultraviolet radiation. Investigators have also determined that there are immunologic influences in the development and prognosis of Merkel cell carcinoma, as individuals with HIV, solid organ transplants, and lymphoproliferative malignancies are at a greater risk of developing this carcinoma. In addition, this immunologic link carries treatment value, as immunologic therapies are currently being investigated. This article provides a comprehensive review of the epidemiology and pathogenesis of Merkel cell carcinoma as well as the current treatments available and clinical trials underway. We also touch upon the updated National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology in respect to its diagnosis and recommended treatment modalities.

The Functional Network Processing Acute Electrical Itch Stimuli in Humans.

The posterior insula (pIns) is a major brain region that receives itch-related signals from the periphery and transfers these signals to broad areas in the brain. Previous brain imaging studies have successfully identified brain regions that respond to itch stimuli. However, it is still unknown which brain regions receive and process itch-related signals from the pIns. Addressing this question is important in identifying key functional networks that process itch. Thus, the present study investigated brain regions with significantly increased functional connectivity with the pIns during itch stimuli with 25 healthy subjects by using functional MRI. Electrical itch stimuli was applied to the left wrist. Similar to previous brain imaging studies, many cortical and subcortical areas were activated by itch stimuli. However, not all of these regions showed significant increments of functional connectivity with the pIns during itch stimuli. While the subjects perceived the itch sensation, functional connectivity was significantly increased between the right pIns and the supplementary motor area (SMA), pre-SMA, anterior midcingulate cortex (aMCC), anterior insula (aIns), secondary somatosensory cortex (SII), and basal ganglia (BG), suggesting that this is a key network in processing itch. In particular, intensity of functional connectivity between the pIns and BG was negatively correlated with itch rating. The functional pIns-BG pathway may play an important role in regulation of subjective itch sensation. This study first identified a key brain network to process itch.