Clinical interventions aimed at expanding access to dermatologic care.

In the United States access to healthcare continues to be a major issue. Although "top down" public policy approaches hold promise for expanding access, a lack of political consensus has hindered progress. A review of the literature was conducted to investigate the efficacy of clinical interventions aimed at expanding access to care from the "bottom up." The greatest improvements in access to care over the past decade have harnessed teledermatology, shared care, appointment scheduling strategies, and team-based care. Optimization of these approaches will require additional population-based, dermatology-specific research. It is clear that dermatologists, using a "bottom up approach," can significantly expand access to care in their communities in a manner that is economically viable and maintains quality of care and patient satisfaction.

The Use of Natural Ingredients in the Treatment of Alopecias with an Emphasis on Central Centrifugal Cicatricial Alopecia: A Systematic Review.

BACKGROUND: Central centrifugal cicatricial alopecia (CCCA), a scarring alopecia that commonly affects women of African descent, can be challenging to manage, and there are limited treatment modalities available. The use of natural ingredients for nonscarring hair loss has gained popularity among patients, but has not been previously studied for CCCA. OBJECTIVE: We sought to review clinical studies evaluating the use of natural ingredients in the treatment of CCCA. METHODS: Systematic searches of the PubMed and SCOPUS databases were performed in March 2018 using various ingredient names and the terms alopecia, scarring alopecia, Central Centrifugal Cicatricial alopecia, and CCCA. Specific ingredients included azelaic acid, peppermint oil, pumpkin seed oil, garlic supplements/shampoo, Black castor oil, jojoba oil, argan oil, olive oil, horsetail plant oil, lavender oil, coconut oil, chamomile oil, thyme oil, tea tree oil, sulfur oil, menthol, and rosemary oil. Two reviewers independently screened titles, leading to the selection of eight clinical studies. RESULTS: A review of the literature revealed no clinical trials that evaluated the treatment of CCCA with natural ingredients. Despite limited evidence-based research for CCCA, several natural ingredients showed efficacy in alopecia areata, androgenetic alopecia, and psoriatic alopecia. CONCLUSION: Upon review of the literature, there were no randomized, controlled studies evaluating the use of natural ingredients or aromatherapy in the management of CCCA. Despite this, several botanical and natural ingredients do show promise in treating androgenetic alopecia and alopecia areata. More clinical studies need to be performed to evaluate treatment options as a whole, including natural modalities, to better serve these patients.

Are Natural Ingredients Effective in the Management of Hyperpigmentation? A Systematic Review.

BACKGROUND: Hyperpigmentation disorders are commonly encountered in dermatology clinics. Botanical and natural ingredients have gained popularity as alternative depigmenting products. OBJECTIVE: We sought to review clinical studies evaluating the use of different natural products in treating hyperpigmentation so clinicians are better equipped to educate their patients. Specific ingredients reviewed include azelaic acid, aloesin, mulberry, licorice extracts, lignin peroxidase, kojic acid, niacinamide, ellagic acid, arbutin, green tea, turmeric, soy, and ascorbic acid. METHODS: Systematic searches of PubMed and SCOPUS databases were performed in March 2016 using the various ingredient names, "melasma"and "hyperpigmentation." Two reviewers independently screened titles, leading to the selection of 30 clinical studies. RESULTS: Review of the literature revealed few clinical trials that evaluated the treatment of hyperpigmentation with natural ingredients. Despite the limited evidence-based research, several natural ingredients did show efficacy as depigmenting agents, including azelaic acid, soy, lignin peroxidase, ascorbic acid iontophoresis, arbutin, ellagic acid, licorice extracts, niacinamide, and mulberry. CONCLUSION: The aforementioned ingredients show promise as natural treatments for patients with hyperpigmentation disorders. These agents might also provide clinicians and researchers with a way to further characterize the pathogenesis of dyschromia. However, the paucity of clinical studies is certainly a limitation. Additionally, many of the in-vivo studies are limited by the short length of the trials, and questions remain about the long-term efficacy and safety of the ingredients used in these studies. Lastly, we suggest a standardized objective scoring system be implemented in any further comparative studies.