Innovation in prevention of poison oak contact dermatitis.

Poison oak-induced contact dermatitis poses a significant challenge due to its urushiol oil-induced allergic reactions. Conventional preventive measures like avoidance and post-exposure cleansing are often impractical, necessitating innovative strategies. This comprehensive review explores emerging technologies and formulations for preventing poison oak dermatitis. Literature search via PubMed and Covidence identified 13 relevant studies, with six discussing preventive measures. Barrier methods, including occlusive creams and protective clothing, showed promise in reducing dermatitis risk. Immunotherapy, although investigated, requires further development. Complete avoidance, while effective, is often impractical. The complexity of poison oak management underscores the need for ongoing research to develop more effective preventive measures. This review highlights the current landscape, identifies gaps in knowledge, and emphasizes the importance of continued research for improved prevention and management of poison oak-induced dermatitis.

Actinic keratosis metrics.

Actinic keratosis (AK) is a common precancerous skin condition predominantly affecting older males with fair skin and significant UV exposure. The clinical significance of AK is related to its potential for malignant transformation and progression to squamous cell carcinoma (SCC). Accurate diagnosis of AK is essential for adequate treatment, evaluation of therapeutic efficacy, and mitigating the risk of developing SCC. However, clinician variability due to the subjective nature of current diagnostic tools presents significant challenges to achieving consistent and reliable AK diagnoses. Thus, there is no universally accepted standard for measuring AK.This review evaluates current methods for evaluating and diagnosing AK, focusing on clinician variability through inter- and intraobserver agreement. Eight peer-reviewed studies investigating the reliability of various approaches for AK evaluation show substantial variability in interobserver or intraobserver agreement, with most methods demonstrating only slight to moderate reliability. Some suggest that consensus discussions and simplified rating scales can modestly improve diagnostic reliability. However, remaining variability and the lack of a universally accepted standard for measuring AK underscore the need for more robust and standardized diagnostic and evaluation methods.The review emphasizes the need for improved diagnostic tools and standardized methods to enhance the accuracy and reliability of AK assessments. It also proposes applying a novel examination approach using 1,3-dihydroxyacetone (DHA) staining which may improve the visualization and identification of AK lesions. Advancements in these areas have significant potential, promising better clinical practices and patient outcomes in AK management.

Diagnosing contact dermatitis using machine learning: A review.

BACKGROUND: Machine learning (ML) offers an opportunity in contact dermatitis (CD) research, where with full clinical picture, may support diagnosis and patch test accuracy. OBJECTIVE: This review aims to summarise the existing literature on how ML can be applied to CD in its entirety. METHODS: Embase, Medline, IEEE Xplore, and ACM Digital Library were searched from inception to February 7, 2024, for primary literature reporting on ML models in CD. RESULTS: 7834 articles were identified in the search, with 110 moving to full-text review, and six articles included. Two used ML to identify key biomarkers to help distinguish between allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD), three used image data to distinguish between ACD and ICD, and one used clinical and demographical data to predict the risk of positive patch tests. All studies used supervision in their ML model training with a total of 49 704 patients across all data sets. There was sparse reporting of the accuracy of these models. CONCLUSIONS: Although the available research is still limited, there is evidence to suggest that ML has potential to support diagnostic outcomes in a clinical setting. Further research on the use of ML in clinical practice is recommended.

Liposomes and Other Nanocarriers for the Treatment of Acne Vulgaris: Improved Therapeutic Efficacy and Skin Tolerability.

Acne vulgaris is a common dermatologic disorder that affects approximately 85% of teenagers, which significantly impacts the quality of life in adolescents. It is a chronic disease of the sebaceous follicles that is multifactorial in etiology. Topical treatment is the first choice for mild and moderate acne, while systemic therapy is reserved for severe and certain moderate cases. Topical treatments include retinoids (e.g., tretinoin and adapalene), antibiotics (e.g., clindamycine), and other agents (e.g., benzoyl peroxide and azelaic acid), often applied in combination. The mechanisms of action include antimicrobial, anti-inflammatory, and keratolytic activities, as well as sebum secretion reduction, and the normalization of follicular keratinization. However, these topical agents commonly induce side effects, such as dryness, burning, stinging, peeling, redness, erythema, and photosensitivity. Therefore, there is a need to reduce the side effects of anti-acne drugs, while maintaining or enhancing their therapeutic effectiveness. This article aims to comprehensively outline nanotechnology strategies, particularly the use of phospholipid-based nanocarriers like liposomes and related vesicles, to enhance therapeutic efficacy, skin tolerability, and patient compliance in the treatment of acne vulgaris. In addition, novel active ingredients encapsulated in vesicles beyond those recommended in official guidelines are discussed.

Overcoming False-Negative Patch Tests: A Systematic Literature Review.

Exogenous allergens, found in cosmetic products, jewelry items, antiseptics and antibacterials, plants, and solvents, can cause clinical allergic contact Dermatitis (ACD). To help identify and discern which allergen is causing ACD, clinicians use patch tests, but they can yield false-negative results at times. Examining potential reasoning for false negatives is particularly helpful when a patient's history and physical examination strongly suggest ACD, and the patch test is negative. A strong history and physical presentation suggestive of ACD warrants additional patch testing or other methods to verify a false-negative patch test result. We conducted a literature review to compile various reasonings and solutions for false-negative patch tests in suspected ACD patients. Utilizing EMBASE, Scopus, PubMed, and Google Scholars, 49 articles were included by using search terms such as "False negative patch test" or "False-negative patch test" and "allergic contact Dermatitis," or "ACD." Common factors that led to false-negative patch test results include low allergen concentration, inadequate percutaneous penetration, technique error, immunosuppressive therapy, and ultraviolet exposure. Potential solutions include using different vehicles, concentration, increasing reading time, repeating the patch test, intradermal testing, and repeat open application testing. If a false-negative patch test is suspected, then intradermal testing can be administered to ensure the specificity of the patch test result. Considering the main contributing factors and solutions to false-negative patch tests, clinicians can accurately diagnose ACD and administer proper treatment plans.

Patch Testing With Nickel, Cobalt, and Chromium in Patients With Suspected Allergic Contact Dermatitis.

Background: Allergic contact dermatitis is frequently caused by metals, including multiple metals simultaneously. Objectives: To assess characteristics and associations of positive and clinically relevant patch test (PT) reactions with solitary and concurrent metal sensitization. Methods: A retrospective analysis of PT results for nickel, cobalt, and/or chromium from the North American Contact Dermatitis Group between 2001 and 2018 (n = 43,522). Results: 18.0% had a positive/allergic reaction to nickel sulfate hexahydrate, 7.3% to cobalt chloride hexahydrate, and 3.0% to potassium dichromate. 87.9% patients had a currently relevant reaction to 0, 9.4% to 1, and 2.7% to multiple metals tested. Patients with 1 versus no currently relevant reactions to metal were more likely to have a primary dermatitis site of trunk, feet, and ears; patients with currently relevant reactions to multiple metals had more dermatitis affecting the trunk and ears. Metal sources varied by co-reacting metal, especially for patients with cobalt and chromium allergy. Jewelry was the most commonly identified source of nickel and cobalt for both solitary and concurrent metal allergy. Conclusions: Sensitization to multiple metals occurred in 6% of patients. Allergen sources varied between patients with sensitivity to 1 metal versus those who had concurrent sensitivity to cobalt and/or chromium.

Topical Delivery Systems Effectively Transport Analgesics to Areas of Localized Pain via Direct Diffusion.

Topical delivery systems (TDSs) enable the direct transport of analgesics into areas of localized pain and thus minimize the side effects of administration routes that rely on systemic drug distribution. For musculoskeletal pain, clinicians frequently prescribe topical products containing lidocaine or diclofenac. This study assessed whether drug delivery from a TDS into muscle tissue occurs mainly via direct diffusion or systemic transport. An investigational TDS containing 108 mg lidocaine (SP-103, 5.4% lidocaine), a commercially available TDS containing 36 mg lidocaine (ZTlido®, 1.8% lidocaine), and a topical pain relief gel (Pennsaid®, 2% diclofenac) were tested. Using open flow microperfusion (OFM), interstitial fluid from the dermis, subcutaneous adipose tissue (SAT), and muscle was continuously sampled to assess drug penetration in all tissue layers. Ex vivo and in vivo experiments showed a higher diffusive transport of lidocaine compared to diclofenac. The data showed a clear contribution of diffusive transport to lidocaine concentration, with SP-103 5.4% resulting in a significantly higher lidocaine concentration in muscle tissue than commercially available ZTlido® (p = 0.008). These results indicate that SP-103 5.4% is highly effective in delivering lidocaine into muscle tissue in areas of localized pain for the treatment of musculoskeletal pain disorders (e.g., lower back pain).

Efficacy and safety of combinational therapy using topical minoxidil and microneedling for the treatment of androgenetic alopecia: a systematic review and meta-analysis.

Androgenetic alopecia is a widespread condition that is the most common type of hair loss affecting approximately 58% and 40% of men and women by the age of 50, respectively. Patients have been known to experience severe distress due to androgenetic alopecia, including anxiety, low self-esteem, and depression. The objective of this study was to conduct a systematic review and meta-analysis to determine the efficacy of combination therapy using topical minoxidil and microneedling compared to topical minoxidil alone. This systematic review of randomized controlled trials was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The literature search was performed using Scopus, Cochrane, Embase, and the National Institutes of Health's United States National Library of Medicine from inception through January 20, 2023. Randomized controlled trials examining the efficacy of combinational therapy and monotherapy using microneedling and minoxidil on patients with clinically diagnosed androgenetic alopecia were included after screening titles, abstracts, and full texts. Two independent reviewers selected studies, extracted data, and appraised the risk of bias using the Cochrane risk of bias assessment tool. Ten randomized controlled trials, including 466 patients, were selected for this review and eight studies were ultimately included in the meta-analysis. All eight studies displayed a statistically significant increase in total hair count [standard mean difference (SMD) 1.76; 95% CI 1.26-2.26; P < 0.00001]; however, the evidence did not support a statistically significant increase in hair diameter (SMD 0.82; 95% CI - 0.01 to 1.65; P = 0.05). No scarring nor serious adverse events were reported in any of the studies. The findings of this meta-analysis strongly support the utilization of a multimodal therapeutic approach of minoxidil and microneedling for hair growth in patients with androgenetic alopecia. However, variations in factors such as rating scale measurements, microneedling methods, and areas of treatment may have resulted in confounding. Further randomized controlled, large-sample trials employing rigorous methodologies are needed to gain a more comprehensive understanding regarding treatment efficacy, namely the impact of combinational therapy on hair diameter.Clinical trial registrations This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and is registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42023391164) and the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) database (INPLASY202310031).

Non-invasive skin measurement methods and diagnostics for vitiligo: a systematic review.

Vitiligo is a multifaceted autoimmune depigmenting disorder affecting around 0.5 to 2.0% of individuals globally. Standardizing diagnosis and therapy tracking can be arduous, as numerous clinical evaluation methods are subject to interobserver variability and may not be validated. Therefore, there is a need for diagnostic tools that are objective, dependable, and preferably non-invasive. Aims: This systematic review provides a comprehensive overview of the non-invasive objective skin measurement methods that are currently used to evaluate the diagnosis, severity, and progression of vitiligo, as well as the advantages and limitations of each technique. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used for the systematic review. Scopus, Embase, Cochrane Library, and Web of Science databases were comprehensively searched for non-invasive imaging and biophysical skin measuring methods to diagnose, evaluate the severity of, or monitor the effects of vitiligo treatment. The risk of bias in included articles was assessed using the QUADAS-2 quality assessment scale. Results: An extensive literature search resulted in 64 studies for analysis, describing eight imaging techniques (reflectance confocal microscopy, computer-aided imaging analysis, optical coherence tomography, infrared photography, third-harmonic generation microscopy, multiphoton microscopy, ultraviolet light photography, and visible light/digital photograph), and three biophysical approaches (dermoscopy, colorimetry, spectrometry) used in diagnosing and assessing vitiligo. Pertinent information about functionality, mechanisms of action, sensitivity, and specificity was obtained for all studies, and insights into the strengths and limitations of each diagnostic technique were addressed. Methodological study quality was adequate; however, statistical analysis was not achievable because of the variety of methods evaluated and the non-standardized reporting of diagnostic accuracy results. Conclusions: The results of this systematic review can enhance clinical practice and research by providing a comprehensive overview of the spectrum of non-invasive imaging and biophysical techniques in vitiligo assessment. Studies with larger sample sizes and sound methodology are required to develop verified methods for use in future practice and research. Systematic review registration: (PROSPERO) database, (CRD42023395996).

Enigma of Intramuscular Triamcinolone Acetonide (Kenalog®) Efficacy.

Triamcinolone acetonide is a glucocorticosteroid used in standard clinical practice for its anti-inflammatory properties. Although it can be given via different routes of administration, the intramuscular route is unique compared with other corticosteroids-its effects remain potent over a longer period of time. We summarize the existing literature on the pharmacokinetic and pharmacodynamic mechanisms of intramuscular triamcinolone acetonide (Kenalog®). The fascinating nature of the purported efficacy of triamcinolone acetonide may be attributed to differing binding mechanisms, low solubility in blood, a low renal clearance rate, and various metabolites and other yet defined effects on skin. The enigma of the purported efficacy of triamcinolone acetonide may lie in the fact that it has a unique nature of having a long-term effect on dermatologic disease using a seemingly low dose compared with other routes of administration and other corticosteroids. Possible reasons for this may be binding differences at the intramuscular site, low solubility due to acetonide esters, a slow rate of absorption from the injected site, and a low renal clearance rate. There is still much to be learned about its mechanism of action, which may be of clinical and therapeutic significance.

Unmasking Racial Disparity in the Diagnosis and Treatment of Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is a chronic, profoundly incapacitating disease predominantly affecting the apocrine gland-rich areas of the human body. Although it affects 0.05% to 4% of the general population, there exists a significant racial disparity, with people of color, particularly Black individuals, experiencing a notably higher prevalence. Despite this disparity, the current literature lacks comprehensive analyses of HS concerning race and ethnicity, revealing a systemic blind spot in understanding and addressing the disease's racially disproportionate impacts. In this commentary, we aim to shed light on these racial disparities, focusing specifically on the stark inequities related to the timely diagnosis and subsequent dermatological care of HS in the United States. This commentary explores the racial bias in HS prevalence, severity, diagnostic delay, access to specialized care, and underrepresentation in clinical trials. By emphasizing the urgent need to address these disparities, we seek to foster an inclusive dialogue and drive proactive efforts toward achieving equitable care and research representation for all populations affected by this debilitating condition. Through this discussion, we aim to pave the way for a healthcare landscape that acknowledges and addresses the racial disparities inherent in HS, ensuring that advancements in the management of the disease cater to the needs of all populations, irrespective of their racial or ethnic background.