Applications of nitric oxide-releasing nanomaterials in dermatology: Skin infections and wound healing.

Nitric oxide (NO) is produced in most cells in the skin and is an important regulator of essential cutaneous functions, including responses to UV irradiation, microbial defense, wound healing, melanogenesis and epidermal permeability barrier homeostasis. Harnessing the physiological activities of NO for therapeutic use is difficult because the molecule is highly reactive and unstable. A variety of exogenous NO delivery platforms have been developed and evaluated; however, they have limited clinical applications in dermatology due to instability and poor cutaneous penetration. NO-releasing nanomaterials overcome these limitations, providing targeted tissue delivery, and sustained and controlled NO release. This review provides a comprehensive and up-to-date evaluation of the use of NO-releasing nanomaterials in dermatology for the treatment of skin and soft tissue infections and wound healing.

Topical Nanoencapsulated Cannabidiol Cream as an Innovative Strategy Combatting Ultraviolet A-Induced Nuclear and Mitochondrial DNA Injury: A Pilot Randomized Clinical Study.

BACKGROUND: Ultraviolet-A radiation (UVA) contributes to photoaging/photocarcinogenesis by generating inflammation and oxidative damage. Current photoprotective strategies are limited by availability/utilization of UVA filters, highlighting an unmet need. Cannabidiol (CBD), having anti-inflammatory/antioxidant properties via regulation of NFR-2, HMOX1, and PPAR-y, could potentially mitigate damage from UVA exposure. OBJECTIVE/METHODS: Prospective, single-center, pilot clinical trial (NCT05279495). Nineteen participants applied nano-CBD (nCBD) or vehicle (VC) cream to randomized, blinded buttock sites twice-daily for 14-days, then treated sites were irradiated with ≤3x UVA minimal erythema dose. After 24-hours, punch biopsies were obtained for histology, immunohistochemistry, real-time PCR. RESULTS: At 24-hours, 21% of participants had less observed erythema on CBD-treated skin than VC skin. Histologically, nCBD-treated skin had reduced UVA-induced epidermal hyperplasia than VC (p=0.01). Immunohistochemistry detected reduced cytoplasmic/nuclear 8-oxo-guanine glycosylase 1 staining in nCBD-treated skin compared to VC (p<0.01). Quantitative mtDNA PCR demonstrated UVA-induced deletion of ND4 (proxy:4977bp deletion; p=0.003) and ND1 (proxy:3895bp deletion; p=0.002) were significantly reduced by in vivo nCBD treatment compared to VC. LIMITATIONS: Sample size. CONCLUSION: Topically applied nCBD cream reduced UVA-induced formation of a frequent mutagenic nuclear DNA base lesion and protected against mtDNA mutations associated with UVA-induced skin aging. This trial is the first to identify UV-protective capacity of CBD-containing topicals in humans.

Survey of Dermatology Practitioners' Opinions and Prescribing Habits of Oral Minoxidil for the Treatment of Androgenetic Alopecia.

BACKGROUND: Utilization of low-dose oral minoxidil has increased in recent years in association with several clinical studies that have shown its efficacy in treating androgenetic alopecia (AGA).  Objective: To assess dermatology providers' attitudes and recommendation behaviors of oral minoxidil for the treatment of AGA. METHODS: An online survey gauging the professional opinions, prescribing behaviors, and use of oral minoxidil was sent using the Orlando Dermatology Aesthetic and Clinical Conference email listserv which included multiple levels of dermatology practitioners including MD/DOs, NPs, and PAs across the United States. RESULTS: Overall, the survey was sent to 2200 providers, and 201 (9.1%) responses were collected. 81% (n=139) of respondents supported the use of oral minoxidil for AGA. Support varied significantly (P=.03) by providers' number of years in practice with those in practice for greater than 30 years with the least amount of support. 92% of respondents (130, n=141) reported feeling comfortable prescribing oral minoxidil, and 83% (116, n=140) found oral minoxidil to be better than its topical formulation. 78% (108, n=139) felt their patients were satisfied with their results, and 89% (124, n=140) felt oral minoxidil was well tolerated by their patients. CONCLUSIONS: This study found that most prescribers use oral minoxidil as a treatment for AGA and find it to be an effective and tolerable option for patients. Support for oral minoxidil was significantly impacted by providers' years in practice. J Drugs Dermatol. 2024;23(3): doi:10.36849/JDD.7519.

Sensitive Skin: A Survey of Dermatology Resident Physicians' Perspectives and Educational Exposures.

Sensitive skin (SS) is a common patient complaint presenting to the dermatology office, but there exists a lack of consensus on defining criteria and evidence-based management approaches. Furthermore, incorporation of SS training into the dermatology residency curriculum is unknown, and therefore the authors herein sought to determine dermatology resident physicians' exposure to education about SS, perspectives on SS, and management approaches. Ninety-nine percent of residents believe that SS should be included in some capacity in their dermatology residency training. However, less than half of responding residents received education specifically about SS during their training and less than one-fourth of residents reported feeling very knowledgeable about SS diagnosis, clinical evaluation, or management. Residents who had received specific education about SS were significantly more likely to self-describe as "very knowledgeable" about all queried topics. Residents reported challenges with all aspects of SS patient care, and cited heterogenous approaches to SS patients. These data highlight a gap in residency education, as indicated by limited consensus over diagnostic and management approaches to SS.J Drugs Dermatol. 2024;23(2):85-89.   doi:10.36849/JDD.7830.

The Representation of Skin Tones in Google Images of Skin Cancers.

Skin self-examinations play a vital role in skin cancer detection and are often aided by online resources. Available reference photos must display the full spectrum of skin tones so patients may visualize how skin lesions can appear. This study investigated the portrayal of skin tones in skin cancer-related Google Images, discovering a significant underrepresentation of darker skin tones. J Drugs Dermatol. 2024;23(5):e132-e133.     doi:10.36849/JDD.7886e.

Skin Tone Representation on Patient-Facing Skin Cancer Education Websites.

When patients self-detect suspicious skin lesions, they often reference online photos prior to seeking medical evaluation. Online images must be available in the full spectrum of skin tones to provide accurate visualizations of disease, especially given the increased morbidity and mortality from skin cancer in patients with darker skin tones. The purpose of this study was to evaluate the representation of skin tones in photos of skin cancer on patient-facing websites. Six federally-based and organization websites were evaluated, and of the 372 total representations identified only 49 depicted darker skin tones (13.2%). This highlights the need to improve skin tone representation on patient-facing online resources. J Drugs Dermatol. 2024;23(5):e137-e138.     doi:10.36849/JDD.7905e.

Perceptions, Utilization, and Cost Assessment of Sebaceous Hyperplasia Treatment Modalities: A Pilot Survey.

BACKGROUND: Sebaceous hyperplasia (SH) is a common, benign but cosmetically bothersome skin condition preferentially affecting older adults. Despite multiple treatment options, there is no universally accepted first-line treatment for SH nor standard pricing for said approaches.  Methods: A survey aimed at evaluating treatment approaches and their respective costs was disseminated on the Orlando Dermatology Aesthetic and Clinical Conference email listserv.  Results: Out of 224 dermatologists who participated in the survey (response rate 9.2%), most treated patients with SH (95.98%). In-office procedures were used more than pharmacologic treatments (P=<0.05). Treatments most used by respondents included electrodesiccation (ED; 83.9%), cryosurgery (35.3%), oral isotretinoin (32.6%), and carbon dioxide (CO2) laser (19.2%). Cryosurgery and ED priced between <$200 to $400. Most reported 1 to 2 sessions to achieve lesion clearance for ED, CO2 laser, and cryosurgery. Twenty-one percent reported 3-4 sessions with cryosurgery. Chemical peels, diode lasers, and photodynamic therapy required between 2-4 sessions. Respondents indicated lesions were most unlikely to recur with ED and CO2 laser. Most dermatologists (86.39%) agreed or strongly agreed that they were exposed to new treatments methods for SH through this survey and 86.49% of dermatologists were interested in learning about treatments employed by others. CONCLUSION: SH is a common issue that presents in the dermatologist's office. These data highlight the perception that ED is the most common approach employed, associated with lower costs, and requiring fewer sessions to achieve resolution. More data is needed and wanted to better determine best practices for the management of SH.J Drugs Dermatol. 2024;23(2):29-37.  doi:10.36849/JDD.7734.

Assessing the Impact of Prior Authorizations on Dermatology Residents.

INTRODUCTION: Prior authorizations (PAs) are administrative tasks commonly required by insurers to approve medications or therapies for patients. Dermatology practices frequently employ coordinators to focus on completing PAs, among other solutions. The degree to which this support is offered in academic centers and, importantly, how much time dermatology residents spend on PAs over educational pursuits is largely unknown. The authors sought to identify the impact of PAs on dermatology residents. METHODS: An IRB-approved (#NCR213814) 13-question survey was distributed nationwide to dermatology residents regarding the impact of PAs on aspects of clinical and scholarly activities.  Results: 150 of 1462 dermatology residents, 10.3%, responded to the survey. 70% of responding residents contribute to obtaining PAs. 58.7% indicated that their program employed a PA coordinator; though, of these, 63.6% still relied on residents for PAs. 84% indicated that for the following month they feared the burden of PAs would lead to a lapse in treatment for patients. 72.7% avoided prescribing certain medications due to PAs. 64% indicated the PA burden impedes their ability to perform scholarly activities. 80.7% indicated the PA burden contributed to burnout or decreased morale. CONCLUSION: Our data highlight that dermatology residents are negatively impacted by the burden of PAs, resulting in reduced time to study, research, and best care for their patients. Dermatology residents and patients would benefit from reducing the burden of PAs, especially on residents by reforms or regulations that reduce dermatologic PAs, or by academic institutions removing these responsibilities from residents as best as possible. Drugs Dermatol. 2024;23(6):485-488.    doi:10.36849/JDD.7617.

Evaluation of a Moisturizing Cream with 20% Urea for Keratosis Pilaris.

BACKGROUND: Keratosis pilaris (KP) is a benign dermatosis consisting of folliculocentric keratotic papules or pustules with surrounding erythema, often on proximal extensor surfaces of extremities. Management strategies for KP largely center on moisturization and exfoliation. Urea, a well-established ingredient in topical skincare, is a component of the natural moisturizing factors with concentration-dependent humectant, emollient, and exfoliative properties.  Given the overlap of urea’s properties and management goals of KP, a 4-week, open-label, noncomparative clinical study was conducted to evaluate a moisturizing cream formulated with 20% urea for use in KP.  Thirty participants aged 18 to 65 years with KP completed this study. After a 5-day washout period, study participants applied a 20% urea cream once daily to areas of KP for 4 weeks. At baseline, 1-week, and 4-week visits, clinical grading of skin texture, adverse event monitoring, and participant satisfaction questionnaires were conducted. After 1 week and 4 weeks of product use, the percent change in skin smoothness/texture from baseline was significant (P≤0.001). Furthermore, after 4 weeks of use, the majority of participants indicated satisfaction with the feel of their skin, as well as improved confidence and decreased embarrassment related to their skin. No significant adverse events were reported. Overall, the results of this study support that 20% urea cream is generally well tolerated and suitable for use in treating KP. J Drugs Dermatol. 2024;23(1):1274-1277.     doi:10.36849/JDD.7806.

Nano-encapsulated anandamide reduces inflammatory cytokines in vitro and lesion severity in a murine model of cutaneous lupus erythematosus.

Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune skin disease which occurs independently and in conjunction with systemic lupus erythematosus. Drug development for CLE is severely lacking. Anandamide (AEA) is a primary endocannabinoid which exhibits immunomodulatory effects through mixed cannabinoid receptor agonism. We evaluated AEA as topical treatment for CLE and assessed benefits of nanoparticle encapsulation (AEA-NP) on cutaneous drug penetration, delivery and biological activity. Compared to untreated controls, AEA-NP decreased IL-6 and MCP-1 in UVB-stimulated keratinocytes (p < 0.05) in vitro. In BALB/c mice, AEA-NP displayed improved cutaneous penetration, extended release and persistence of AEA in the follicular unit extending to the base after 24 h. Utilizing the MRL-lpr lupus murine model, twice weekly treatment of lesions with topical AEA-NP for 10 weeks led to decreased clinical and histologic lesion scores compared to unencapsulated AEA and untreated controls (p < 0.05). Prophylactic application of AEA-NP to commonly involved areas on MRL-lpr mice similarly resulted in decreased clinical and histologic scores when compared to controls (p < 0.05), and reduced C3 and IBA-1 in lesional tissue (p < 0.05). The demonstrated clinical and immunomodulatory effects of treatment with AEA support its potential as therapy for CLE. This work also suggests that encapsulation of AEA improves penetration and treatment efficacy. Future studies will be conducted to assess full therapeutic potential.

Keratosis Pilaris: Treatment Practices of Board-Certified Dermatologists.

Keratosis pilaris (KP) is a chronic disorder of follicular hyperkeratinization and perifollicular erythema with lesions affecting the extensor surfaces of arms, upper legs, and buttocks. While there is some evidence that laser therapies and topical therapies such as lactic acid reduce the follicular papules of KP, support is limited with respect to which topical treatments dermatologists utilize and their perception of efficacy. A 16-question survey was distributed to a random sampling of the ODAC Conference listserv to determine which topical treatments dermatologists utilize the most, the duration of therapy needed with various treatment modalities, and the effectiveness of topical and laser therapy for treating KP. Our study found topical lactic acid is the most used first-line therapy for KP (43.63% of survey respondents), followed by salicylic acid (20.72%). Laser therapy is only utilized by 8.76% of survey respondents, with a lack of insurance coverage and proper equipment limiting its use. KP is often recalcitrant to treatment, and our study demonstrated that over 60% of respondents found recurrence of KP lesions within three months of stopping salicylic acid treatment and OTC moisturizer treatment. The data herein can be used to better utilize the selection of topical and laser therapies for the treatment of KP. J Drugs Dermatol. 2023;22(10):985-989 doi:10.36849/JDD.7534.

EXTRA, EXTRA, Treatment Approaches for EXTRAmammary Paget Disease.

Desai S, McCormick E, Nelson K, et al. EXTRA, EXTRA, treatment approaches for EXTRAmammary Paget disease. J Drugs Dermatol. 2023;22(8):844-845. doi:10.36849/jdd.NVRN0823.

Insight Into Dermatology Providers' Perspectives on Approaches to Sensitive Skin: A Pilot Survey.

Sensitive skin (SS) is a common patient complaint; however, there are no consistent guidelines to guide dermatologists' approaches to diagnosis and management of SS. Attendees of an international dermatology conference were surveyed to gauge dermatology providers' experiences and perspectives on SS. Survey results suggest that although the definition and diagnosis of SS are ambiguous, SS is increasingly being considered as a unique condition. Patients are commonly seeking dermatologic care for SS; however, dermatologists identified challenges with diagnosis, counseling patients, selecting products or medications, and assessing clinical improvement. These data highlight both a significant demand and a current need for improved provider resources for SS. Citation: McCormick ET, Desai S, Friedman A. Insight into dermatology providers’ perspectives on/and approaches to sensitive skin: a pilot survey. J Drugs Dermatol. 2023;22(9):950-951. doi:10.36849/JDD.7450.

Shining a Light on Vitiligo and Associated Comorbidities: What Is the Evidence?

CITATION: Desai S, McCormick E, Sodha P, et al. Shining a light on the vitiligo and associated comorbidities: What is the evidence? J Drugs Dermatol. 2023;22(4):428-430. doi:10.36849/JDD.NVRN0423.

Updates in the Treatment of Body-Focused Repetitive Disorders.

Body-focused repetitive disorders (BFRBs) are psychocutaneous disorders that are underrecognized and undertreated.

Non-adherence to Labeling Standards Can Misrepresent Safety of Ingredients in Cosmetic Cleansers.

US Labeling requirements for cosmetic products are established by the US Food and Drug Administration (USFDA) and detailed in the Code of Federal Regulations (21 CFR 701.3).1 Over 16,000 cosmetic ingredients names have been documented and ingredient nomenclature resources are recommended by the USFDA for use by manufacturers and suppliers.

Fractional Laser for Prevention of Non-melanoma Skin Cancer.

CITATION: McCormick ET, Desai S, Nelson K, et al. Fractional laser for prevention of non-melanoma skin cancer. J Drugs Dermatol. 2023;22(9):953-954. doi:10.36849/JDD.NVRN0923.

Participant Satisfaction of a Community-based Telehealth Clinic for Atopic Dermatitis.

Atopic dermatitis (AD), a chronic, relapsing inflammatory disease that affects more than 30 million children and adults in the US, disproportionally impacts African American (AA) and Hispanic children, with a higher prevalence of severe AD in these populations than in white children.1,2 Visits to urgent care, emergency departments, and hospitalizations for AD in the United States were more common among AA and Hispanic adults, and those with lower socioeconomic status.1,3 In Washington DC, outcomes and access to care among the District's poor and underrepresented minorities lag far behind other groups. Ward 8, for example, which is 89% Black, has the District's highest per capita rate of coronavirus-related deaths - 6 for every 10,000 residents.4 These disparities have been long-lived and pervasive in all areas of medicine, including dermatology.5.

Assessing Dermatology Provider Perceptions and Attitudes About the Unique Needs of Older Adult Patients.

Geriatric dermatology is an emerging field of dermatology, focused on the unique needs of older adults with dermatological diagnoses. Previous research identified important principles to consider in older adults with skin disease, including cognition, polypharmacy, mobility, social support and sleep disturbance.

mTOR Inhibitor-Induced Transient Acantholytic Dermatitis.

A 61-year-old Caucasian male with a medical history of metastatic carcinoid presented to dermatology with a new onset severely pruritic “breakouts” on the arms, neck, and chest. Approximately ten years prior, he was diagnosed with a small bowel carcinoid tumor and liver metastases treated with a combination of resection and ablation.