Skin of Color Sun Protection: Reddit Analysis Reveals Perceptions, Preferences, Unmet Needs, and Knowledge Gaps.

BACKGROUND: Patients are increasingly seeking medical advice, recommendations, and general information through online forums and social media. In June 2021 Reddit reported 430 million active monthly users globally and is the most popular mobile social app in the United States. Skincare is a popular forum topic and a space for patients to source information regarding photoprotection. Skin of color patients have specific needs regarding sun protection that remain underserved. OBJECTIVE: To uncover perceptions, preferences, unmet needs, and knowledge gaps regarding sun protection for skin of color patients. METHODS: The authors analyzed posts from August 1, 2019, through August 1, 2022, related to sun protection in skin of color. Search terms were based on National Institutes of Health (NIH) racial and ethnic categories. A total of 208 posts were analyzed and sorted into categories and subcategories to elucidate common themes.   Results: The three most common categories of posts included seeking recommendations (57.7%), seeking/providing general information (25.5%), and product reviews (13.5%). The remaining 3.3% of posts were categorized as miscellaneous.  Limitations: Reddit users may not adequately reflect the general population and their perceptions, preferences, and knowledge. CONCLUSIONS: Analysis of Reddit posts regarding photoprotection in skin of color yields valuable insights into the perceptions, preferences, unmet needs, and knowledge gaps regarding sun protection for this group of patients. Physicians can use this information to better educate patients and improve photoprotection adherence. This information is also valuable for pharmaceutical and sun protection industries that can use these insights to fill unmet sunscreen needs for patients of color.  Mineroff J, Kurtti A, Jagdeo J. Skin of color sun protection: reddit analysis reveals perceptions, preferences, unmet needs, and knowledge gaps. J Drugs Dermatol. 2023;22(7):673-677. doi:10.36849/JDD.7233.

The Role of Hormone Therapy in Female Aesthetic Rejuvenation.

Hormones are intricately involved in age-related aesthetic changes. Declining levels of several hormones in the postmenopausal period are associated with unwanted changes in appearance, including weight gain, fat redistribution, aged skin, and hair thinning. Hormone therapies may prevent or reverse these changes. In this article, we explore the role of estrogen, progesterone, testosterone, dehydroepiandrosterone, and melatonin in female aesthetics. Based on our current understanding of the literature, dermatologists may safely and efficaciously incorporate several hormone formulations in their repertoire of treatments for female aesthetic rejuvenation. J Drugs Dermatol. 2022;21(9):954-960. doi:10.36849/JDD.6232.

A case of pleomorphic dermal sarcoma with perineural invasion treated with Mohs micrographic surgery and adjuvant radiation therapy.

Pleomorphic dermal sarcoma (PDS) was recognized in the 2013 World Health Organization Classification of Tumors of Soft Tissue and Bone as a clinical entity with adverse histopathologic features compared to the more superficial and less aggressive atypical fibroxanthoma (AFX). Although the gold standard treatment of AFX is Mohs micrographic surgery (MMS), the optimal treatment for PDS has yet to be determined. We report the case of a 71-year-old man with a PDS with perineural invasion on the scalp, with no recurrence one-year post-treatment with MMS and adjuvant radiation therapy. In contrast to wide local excision, MMS offers complete margin control and tissue preservation, which helps minimize scarring and morbidity. The comparative efficacy of MMS versus wide local excision in the treatment of PDS with and without radiation remains unknown and warrants further investigation.

Analysis of Reddit Reveals Dupilumab Questions Among Atopic Dermatitis Patients.

BACKGROUND: Atopic dermatitis patients are turning to social media to seek guidance and source medical information. Reddit, the seventh most visited website in the US, contains the popular "eczeMABs" subreddit, a forum dedicated to discussing monoclonal antibody therapy for atopic dermatitis. OBJECTIVE: To uncover atopic dermatitis patients' dupilumab-related information needs. METHODS: The authors analyzed all questions posted on the "eczeMABs" subreddit. Each question was then separated into categories and subcategories for analysis. RESULTS: 262 questions from 189 posts were analyzed. The greatest proportion of questions was related to side effects (36.3%), with patients most frequently inquiring about flares (25/95), ocular effects (17/95), and dry skin (10/95). Usage instructions (13.4%) and general experience (8.0%) were common question categories as well. LIMITATIONS: The questions of the "eczeMABs" subreddit subscribers may not reflect the questions of all atopic dermatitis patients. CONCLUSION: Reddit provides valuable insight into atopic dermatitis patient gaps in knowledge regarding dupilumab therapy. Physicians can use this knowledge to better address the information needs of patients, potentially leading to better outcomes and more informed, empowered patients. J Drugs Dermatol. 2022;21(3):292-294. doi:10.36849/JDD.5942.

Combination Facial Aesthetic Treatment in Millennials.

BACKGROUND: There is growing demand for minimally invasive cosmetic procedures in the millennial population, with botulinum toxin and dermal fillers among the most popular products. OBJECTIVE: To evaluate patient satisfaction and psychosocial impact of multimodal aesthetic treatment in a millennial cohort. METHODS AND MATERIALS: In this single-center, prospective, rater-blinded, pilot study, 20 millennial participants received a samevisit combination facial aesthetic treatment using botulinum toxin and dermal fillers, with an optional botulinum toxin touch-up at 2 weeks. Assessments were conducted at baseline and 2 months post-treatment. The primary endpoint was change in satisfaction with overall facial appearance post-treatment. Secondary endpoints included changes in satisfaction with various facial areas, social and psychosocial functioning, self-perceived age, and blinded clinician assessment. RESULTS: Participants reported significantly greater satisfaction with overall facial appearance 2 months post-treatment when compared to pre-treatment (P<0.001). Participants self-reported numerous improvements in appearance, including greater satisfaction with various properties of the lips, cheeks, and overall facial lines, self-perceived age, and social and psychological functioning. CONCLUSION: Combination botulinum toxin and dermal filler treatment is a safe and effective means of improving millennial satisfaction with overall facial appearance and various facial areas, decreasing self-perceived age, and improving aspects of psychosocial functioning. J Drugs Dermatol. 2022;21(1)37-42. doi:10.36849/JDD.6425.

Home-based devices in dermatology: a systematic review of safety and efficacy.

There is increasing demand for home-based devices for the treatment of dermatologic conditions and cosmesis. Commercially available devices include intense pulsed light, laser diodes, radiofrequency, light-emitting diodes, and ultraviolet B phototherapy. The objective of this report is to evaluate the current evidence regarding the efficacy and safety of home-based devices for the treatment of skin conditions. A systematic search of PubMed, Embase, and Cinahl was conducted on November 9, 2020 using PRISMA guidelines. Original research articles that investigated the efficacy and safety of home-based devices for dermatologic use were included. Bibliographies were screened for additional relevant articles. Strength of evidence was graded using the Oxford Centre for Evidence-Based Medicine guidelines. Clinical recommendations were then made based on the quality of the existing literature. After review, 37 clinical trials were included-19 were randomized controlled trials, 16 were case series, and 2 were non-randomized controlled trials. Ultimately, from our analysis, we recommend the home-based use of intense pulsed light for hair removal, laser diodes for androgenic alopecia, low power radiofrequency for rhytides and wrinkles, and light-emitting diodes for acne vulgaris. Trials investigating ultraviolet B phototherapy for psoriasis revealed mixed evidence for home treatments compared to clinic treatments. All devices had favorable safety profiles with few significant adverse events. Limitations to our review include a limited number of randomized controlled trials as well as a lack of data on the long-term efficacy and safety of each device.

Delayed Metastatic Polypoid Nodular Melanoma Diagnosis During COVID-19 Pandemic, Successful Treatment With Surgery and Nivolumab.

Patients with polypoid (pedunculated) melanoma have the poorest 5-year survival rate compared with all other variants of nodular melanoma, presenting with increased thickness, incidence of metastasis, and rates of ulceration. There are few published reports regarding the pathogenesis and treatment of polypoid melanomas. We report the successful treatment of a rapidly developing red nodular polypoid melanoma with metastasis using surgery followed by anti-PD-1 antibody nivolumab in a SARS-CoV-2-positive patient who delayed seeking care due to the COVID-19 pandemic. J Drugs Dermatol. 2021;20(12):1343-1345. doi:10.36849/JDD.6071.

Novel Vitamin C and E and Green Tea Polyphenols Combination Serum Improves Photoaged Facial Skin.

BACKGROUND: Skin aging is a multifactorial process induced by intrinsic factors such as metabolic processes and senescence as well as environmental factors, including smoking, air pollution, and solar radiation. UV-induced production of reactive oxygen species induces skin photoaging. Antioxidants, including vitamin C and E and green tea polyphenols represent a promising strategy for the aesthetic improvement of clinical features associated with aging. OBJECTIVE: To assess the safety, tolerability, and efficacy of a novel vitamin C and E and green tea polyphenols (CE-GTP) combination serum on photoaged facial skin. METHODS: 31 healthy females aged 43 to 65 years (mean age, 57.9) participated in this single-center, 12-week clinical trial. Subjects applied CE-GTP serum twice daily for the duration of the study. Clinical grading of efficacy parameters, safety and tolerability evaluations, ultrasound measurements, and self-assessment questionnaires were conducted at several study milestones. RESULTS: Statistically significant improvements were observed in all clinically graded efficacy parameters. Highlights include reduction in fine lines around the eye area and facial wrinkles and enhanced skin smoothness and radiance. Ultrasound measurements showed a statistically significant increase in skin density at week 12 compared with baseline, indicating thickening of the epidermal and dermal tissue, associated with youthful, healthier skin. Subjects self-reported numerous improvements, including reduction of fine lines and wrinkles, improved skin tone and texture, diminished look of dark spots, and improved skin elasticity. CONCLUSION: Novel CE-GTP serum is safe and effective, as shown by statistically significant improvements in multiple aesthetically important objective, subjective, and patient reported outcomes. J Drugs Dermatol. 2021;20(9):996-1003. doi:10.36849/JDD.5818.

Analysis of Reddit Reveals Atopic Dermatitis Patient Questions.

BACKGROUND: Reddit, the seventh most visited website in the United States, has become an exceedingly popular platform for patients to source medical information and discuss chronic conditions. OBJECTIVE: To uncover patient questions regarding atopic dermatitis, as physicians can use this knowledge to better address patient concerns and more comprehensively educate patients. METHODS: The authors analyzed 1,000 questions posted on the “Hot” section of the “eczema” subreddit. Each question was then separated into categories and subcategories for analysis. RESULTS: 1,000 questions from 881 posts were analyzed. The highest proportion of questions (29.5%) were non-pharmacologic management focused, with patients inquiring about diet, over the counter skincare products, personal hygiene practices, clothing, and supplements. Non-specific management (19.1%), uncertainty about symptoms (14.6%), medications (14.3%), cause and triggers (10.3%), and mental health (6.9%) were common categories as well. LIMITATIONS: The questions of the eczema subreddit subscribers may not reflect the questions of all atopic dermatitis patients. CONCLUSION: This analysis demonstrates that atopic dermatitis patients require greater management guidance, especially non-pharmacologic strategies, and more comprehensive discussions regarding the range of symptoms, trigger avoidance, and mental health resources. Addressing these gaps in knowledge may lead to improved outcomes and more informed, empowered patients. J Drugs Dermatol. 2021;20(6):653-658. doi:10.36849/JDD.5734Visit the Atopic Dermatitis Resource Center.

New Diagnostic Tools to Evaluate Hair Loss.

The precise and reliable diagnosis of hair loss disorders is essential for developing a successful management plan. It is, thus, the responsibility of the dermatologist to select the appropriate diagnostic tools to effectively evaluate patients presenting with hair loss concerns. Fortunately, there is a growing body of noninvasive and invasive diagnostic resources, each with advantages and disadvantages. For the practicing dermatologist, tactile assessments and direct visualization are enhanced with scoring instruments, questionnaires, handheld trichoscopy, and scalp biopsy. For research and clinical study purposes, the more precise, high-resolution tools such as videodermoscopy, optical coherence tomography, and phototrichograms, may be useful.

Light emitting diode-red light for reduction of post-surgical scarring: Results from a dose-ranging, split-face, randomized controlled trial.

Scarring has significant esthetic and functional consequences for patients. A need exists for anti-scarring therapeutics. Light emitting diode-red light (LED-RL) has been shown to modulate skin fibrosis. The aim of this study is to evaluate the safety and efficacy of LED-RL to reduce post-operative scarring. Cutaneous Understanding of Red-light Efficacy on Scarring was a randomized, mock-controlled, single-blind, dose-ranging, split-face phase II clinical trial. Starting 1 week post-surgery, patients received LED-RL irradiation and temperature-controlled mock therapy to incision sites at fluences of 160, 320 or 480 J/cm2 , triweekly for 3 weeks. Efficacy was assessed at 1, 3 and 6-12 months. The primary endpoint was difference in scar pliability between LED-RL-treated and control sites. Secondary outcomes included Patient and Observer Scar Assessment Scale, collagen and water concentration, and adverse events. There were no significant differences in scar pliability between treated and control scars. At certain fluences, treated scars showed greater improvements in observer rating and scar pliability, reflected by greater reductions in induration, from baseline to 6 months compared to control scars. Treatment-site adverse events included blistering (n = 2) and swelling (n = 1), which were mild and resolved without sequelae. LED-RL phototherapy is safe in the early postoperative period and may reduce scarring.