Topical Treatments in Atopic Dermatitis: An Expansive Review.

Atopic dermatitis (AD) is a common inflammatory skin condition found worldwide. It impacts patient quality of life (QoL) and is thought to arise as an inflammatory response to epidermal barrier dysfunction and hypersensitivity. AD can lead to large out-of-pocket costs and increased healthcare expenses over a lifetime. An analysis of all randomized control trials conducted since 1990 on topical therapies for AD were reviewed, including 207 trials in the final analysis. It was found that an average of 226 patients were enrolled over 2.43 arms. Common topical treatments included corticosteroids, calcineurin inhibitors, JAK inhibitors, and phosphodiesterase inhibitors. The most utilized tools to identify treatment efficacy were the EASI, IGA, SCORAD, and PGA. There was a paucity of data on trials that evaluated efficacy, QoL, and cost of treatment simultaneously. This review highlights the need for comprehensive trials that evaluate multiple aspects of treatment, including financial cost and QoL impact, to ensure each patient has the best treatment modality for the management of their AD.

Effects of the COVID-19 Pandemic On Patient Social Media Use and Acceptance of Cosmetic Procedures.

Objective: We sought to explore facets of social media usage and the effect of the COVID-19 pandemic on the acceptance of cosmetic procedures. Methods: At an outpatient dermatology clinic from October 2019 to June 2022, 175 subjects who were English and Spanish speaking and aged 18 years or older were recruited. Participants completed a questionnaire including demographic information, social media usage, perceptions of cosmetic procedures, and desire to have a cosmetic procedure. Results were grouped into a pre-COVID-19 pandemic group and post-COVID-19 pandemic group due to a natural experiment that arose. Data were analyzed to ascertain the effect of social media usage and other factors that impact desire to undergo a cosmetic procedure between patients before and after the COVID-19 pandemic. Results: Factors resulting in differences in desire to have a cosmetic procedure included using photo editing applications (p=0.002), following celebrities and influencers on social media (p<0.001), and following social media accounts showing cosmetic results (p=0.013). There was a statistically significant change in number of participants that: followed social media accounts showing results of cosmetic procedures (pre-COVID: 31.9%, post-COVID: 50.6%, p=0.036); had thought about having a cosmetic procedure done (pre-COVID: 63.8%, post-COVID: 86.4%, p<0.001); had discussed cosmetic procedures with a physician, dermatologist, or other professional (pre-COVID: 43.6%, post-COVID: 67.9%, p=0.001); and believed that a cosmetic procedure would help their self-esteem (pre-COVID: 47.9%, post-COVID: 77.8%, p<0.001). Limitations: Limitations of this study include response bias, recall bias, and single institution study design, limiting generalizability. Conclusion: Our findings suggest that time spent on social media and use of photo-editing applications significantly contributes to desire to undergo a cosmetic procedure and contributed to the rise of cosmetic consultations during the COVID-19 pandemic.

Vascular cutaneous manifestations of COVID-19 and RNA viral pathogens: a systematic review.

BACKGROUND: COVID-19, the widely recognized and highly contagious respiratory tract infection, has had a substantial impact on the field of dermatology since its emergence in 2019. SARS-CoV-2, the causative virus of COVID-19, is classified as an RNA virus. Various skin-related symptoms have been reported in patients with COVID-19, most notably the distinctive purple-red acral rash resembling chilblain lesions, commonly referred to as 'COVID toe'; similarly, skin-related symptoms have been observed in connection with other RNA viruses. OBJECTIVES: To explore the relationship between RNA viruses and their associated vascular cutaneous manifestations vs. those observed in patients infected with SARS-CoV-2. METHODS: A systematic literature review was conducted using PubMed and medical subject heading terms related to RNA viruses and related skin manifestations. RESULTS: In total, 3994 patients diagnosed with COVID-19 presenting with skin rashes were included. Chilblain-like lesions were most frequently observed (30.2%), followed by erythematous maculopapular/morbilliform rashes (9.1%) and urticarial rashes (4.7%). Of 8362 patients diagnosed with RNA viruses, more than half of the skin findings reported were erythematous/maculopapular/morbilliform rashes (52.3%), followed by unspecified (11.3%) and purpuric rashes (10.6%). CONCLUSIONS: When comparing RNA viral infections with COVID-19 infection, we observed similarities in the reported skin manifestations and their presumed pathways, with many implicated in the proinflammatory response. Owing to the wide range of cutaneous symptoms associated with RNA viruses and our currently limited understanding of the underlying mechanisms, additional research is warranted to investigate the pathology behind viral-induced skin lesions.

Exogenous Ochronosis: Characterizing a Rare Disorder in Skin of Color.

Exogenous ochronosis is a rare dyschromia that primarily impacts those with skin of color. It is characterized by blue-black pigmentation and is associated with the long-term application of skin-lightening creams containing hydroquinone. Commonly confused with other dyschromias, the use of skin lightening topicals can cause paradoxical skin darkening in patients with known exogenous ochronosis. This is highly distressing to patients, often worsening the underlying dyschromia and making treatment more difficult. A 10-year retrospective analysis was conducted that revealed 25 patients with exogenous ochronosis. The average patient used a skin lightening cream for 9.2 years, with exogenous ochronosis most commonly arising on the cheeks (68%), forehead (24%), and temples (20%). Furthermore, this study identified that patients with exogenous ochronosis may respond well to treatment with Q-switched Alexandrite laser and microneedling. The incidence of exogenous ochronosis is likely to increase as demographics shift and access to a wide range of over-the-counter topicals becomes more available, both in the United States and worldwide. Therefore, it is imperative to better characterize exogenous ochronosis to identify best treatment practices for all patients.

Allergic Contact Dermatitis and Patch Testing in Skin of Color Patients.

Objective: Skin of color patients face important health issues relevant to dermatologists, such as allergic contact dermatitis; however, there is a lack of information surrounding common allergens causing contact dermatitis that disproportionately affect skin of color patients, as well as interpreting patch testing in this population. Methods: Covidence, Embase, MEDLINE, PubMed, Web of Science, and Google Scholar were searched to identify relevant articles studying allergic and irritant contact dermatitis in skin of color patients. Results: The most common positive reactions in African American patients included PPD, balsam of Peru, bacitracin, fragrance mix, and nickel. The most common positive reactions in Hispanic patients included Carba mix, nickel sulfate, and thiuram mix. The most common positive reactions in Asian patients included nickel sulfate, fragrance mix, and potassium dichromate. When interpreting patch test results in patients with higher Fitzpatrick skin types, positive patch tests presented with lichenification and hyperpigmentation, rather than erythema and vesicles. Furthermore, characteristic bright red or pink hues for positive results may appear violaceous or faint pink. Conclusions: Awareness of the common allergens associated with allergic contact dermatitis in patients of skin of color can help guide patch testing as an important diagnostic tool. Further research must be conducted regarding contact dermatitis in this patient population, especially given the relative lack of data surrounding Hispanic, Asian and Pacific Islander, and Native American patients.

Needs and Gaps in Resident Trainee Education, Clinical Patient Care, and Clinical Research in Cosmetic Dermatology: Position Statement of the Association of Academic Cosmetic Dermatology.

Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.

The Association of Academic Cosmetic Dermatology: improving cosmetic dermatology education through collaboration, research, and advocacy.

Cosmetic and laser procedures are increasingly popular among patients and are skills in which dermatologists are regarded as well trained. Most dermatology residents intend to incorporate cosmetic procedures into their practice and prefer to learn such procedures during residency through direct patient care. However, there are notable challenges in optimizing how residents are trained in cosmetic and laser dermatology. To address these barriers and elevate the practice of cosmetic dermatology in academic medicine, the Association of Academic Cosmetic Dermatology (AACD) was founded in 2021 as the lead professional society for dermatologists who direct the education of resident trainees in cosmetic and laser dermatology. The AACD, a group of board-certified dermatologists who teach cosmetic and laser dermatology to residents, aims to improve cosmetic dermatology education through collaboration, research, and advocacy.

Shifting the Standard of Beauty: Beginning of the Body Inclusive Model.

BACKGROUND: While the American standard of beauty idolizes unattainable thinness, social media exposure has been instrumental in crafting a more inclusive perception of beauty. METHODS: Using several websites with public data on models, we gathered body measurements and characteristics of both plus-size and the overall top 10 paid mainstream models. We then collected social media data for these models using the social media analytics tool called Social Blade. We compared social media data between plus-size and mainstream models. RESULTS: While plus-size models have increased BMI, the waist/hip ratio was 0.74 on average, compared to 0.71 in mainstream models. The average social media following among the top 10 plus-size models was 3.8 million compared to 38 million amongst the top 10 mainstream models (p = 0.039). There was no significant difference between the average likes per post, average comments per post, and total posts between the top mainstream models and top plus-size models (p-values 0.11, 0.12, and 0.15, respectively). CONCLUSION: With the changing societal body image in America, plus-size models have gained in popularity and positively impacted a body-inclusive model of beauty. However, the mainstream model still prevails as the social media powerhouse of influence.

Pityriasis Lichenoides et Varioliformis Acuta as a Complication of COVID-19 Infection.

Pityriasis lichenoides is an acute and/or chronic skin disease associated with recurrent erythematous papules that self-resolve. While its etiology is unknown, preceding viral infection may play a role. We present an atypical case of a 40-year-old woman with pityriasis lichenoides et varioliformis acuta as a complication of a COVID-19 infection.

Tinted Sunscreens: Consumer Preferences Based on Light, Medium, and Dark Skin Tones.

Visible light (VL) has been shown to increase tyrosinase activity and induce immediate erythema in light-skinned individuals and long-lasting pigmentation in dark-skinned individuals. Tinted sunscreens (TSs) formulated with iron oxides (IOs) and/or pigmentary titanium dioxide (PTD) provide functional and cosmetic benefits and are a safe, effective, and convenient way to protect against both UV and high-energy VL. We conducted an analysis of over-the-counter TSs with the objective of investigating the factors that influence consumer preference when choosing TS depending on underlying skin tone. Descriptive data for each product were collected from an online supplier that provides reviewer information. The top 10 most helpful reviews were analyzed and coded by a consensus qualitative coding scheme, which included positive and negative descriptors in 5 major categories. Most products provided only one color shade, and tone incompatibility was the most commonly cited negative feature, with the vast majority of these comments being from consumers of dark skin tones. Top recommended products corresponded with increased shade options, indicating the dearth of shade diversity in products to be a potential area of improvement in tinted sunscreen options.

The communicative paradigm shift of the digital age: The skinny on social media.

In this editorial, we explore several relevant issues pertaining to social media use including influencers and photo-editing software. The aforementioned topics are discussed vis-à-vis their profound positive and negative effects on both patients and aesthetic physicians. The reader is invited to appreciate the importance of social media use in aesthetic medicine and the pitfalls its use presents.

The lipstick effect during COVID-19 lockdown.

Although consumer spending typically declines during times of crisis, some observers have noted the tendency of consumers to spend more on less costly luxury goods instead, calling it the "lipstick effect." E-commerce sales in beauty and personal care categories, compared to pre-COVID-19, saw an increase. The mass lockdowns across many states in the United States resulted in hospitals and cosmetic clinics suspending many services. We present several patients who developed complications following home-administered cosmetic procedures and presented via telemedicine clinic at the Department of Dermatology at Boston Medical Center in May 2020. The first case follows a patient who had platelet-rich plasma concentrate injected into her face by an unauthorized, presumed aesthetician in training. The second and third cases follow patients purchasing products from unregulated e-commerce retailers to self-administer injectable fillers and perform trichloroacetic acid chemical peels, respectively. We discuss the impact of social media in conjunction with extensive misinformation along with easily accessible products available on the Internet, and how this combination has encouraged self-injurious behavior and its consequences while lacking any means of accountability. This paper aims to encourage the spread of patient education and limit personal harm from self-administration of potentially injurious procedures.

Impact of Direct-to-Consumer Advertising of Cosmetic Procedures on Consumers.

BACKGROUND: Direct-to-consumer (DTC) advertising is a prominent type of health care communication. OBJECTIVE: This study aims to determine the impact of DTC advertisements on consumer opinion. METHODS: A total of 203 participants were recruited from dermatology clinics at an urban academic center. Participants viewed 2 cosmetically oriented DTC advertisements, and prequestionnaires and postquestionnaires were administered to assess consumer opinion. RESULTS: Postquestionnaire data highlight a 18.8% and 24.6% increase in participants reporting using commercials as an information source (p < .001) and seeking out additional medical knowledge (p < .001), respectively. After watching the advertisements, there was a 14.4% increase in participants who believed advertisements facilitate better discussions between patients and physicians (p < .001) and a 33% increase in patients reporting they would discuss the procedures with their doctors (p < .001). Of the participants, 60% believed the advertisements did not provide enough information about the possible risks of the product and 39.4% believed a physician was not required to perform cosmetic procedures. CONCLUSION: Direct-to-consumer advertisements instill meaningful information to patients and promote patient-physician communication. They also seem to exaggerate the benefits while making the procedures seem simple and without risks, suggesting trained medical professionals are not needed for administration.

Skin-Lightening Products: Consumer Preferences and Costs.

Disorders of skin hyperpigmentation have an appreciable impact on quality of life, carrying social and cultural importance that influences widespread consumer demand for cosmetic lightening products. We sought to investigate product factors that may influence consumer preference when choosing an over-the-counter cream for skin-lightening purposes. The keyword "lightening cream" was searched in the "Beauty and Personal Care category" of online retailer Amazon.com. The top fifth percentile of products was determined by filtering the search results for a minimum of four out of five stars from customer reviews, and then further filtered by products with over 100 reviews. Number of reviews, rating, price per unit, vehicle, application instructions, ingredients, and review attributes were evaluated. Over 2,900 products were catalogued as "lightening cream" on Amazon.com. There were 40 products rated >4 stars and >100 reviews, constituting the top 1.34% of entries. Tocopheryl was present in 58% of the top 40 products, ascorbic acid in 40%, and niacinamide in 20%. Notably, 22.5% of the top 40 products contained no known skin-lightening ingredient. There was a moderate positive correlation (R2=0.378) between price and consumer rating, with kojic acid being the most expensive per ounce ($24.89) and salicylic acid being the most highly rated (4.54 stars; $15.00/oz). This study provides insight on the factors influencing the choice, preferences, and satisfaction of consumer that sought Amazon for the purchase of lightening products.