Systematic review of randomized controlled trials of topicals for actinic keratosis field therapy.

Cutaneous field cancerization in dermatology describes the anatomic region of photodamaged skin with actinic keratoses (AKs) or cutaneous squamous cell carcinoma (cSCC) that is surrounded by cellular atypia, forming a dysplastic field. The concept of field cancerization is especially relevant in dermatology, as actinic keratoses and the surrounding dysplastic region can progress to carcinomas, necessitating the treatment of the field. Recent research has focused on field-directed therapy using topical agents. This study aims to systematically review randomized controlled trials on topical treatments for actinic keratosis field cancerization, following the PRISMA guidelines. Clinical recommendations were based on the Oxford Centre for Evidence-Based Medicine. We identified 20 original randomized controlled trials for topical cutaneous field therapy. 0.5% 5-Fluorouracil/salicylic acid and 0.5% 5-fluorouracil received a clinical recommendation grade of A, while diclofenac sodium received a clinical recommendation grade of B. Calcipotriol/5-fluorouracil, Imiquimod, sunscreen combination therapies, and tirbanibulin received a recommendation grade of C. This review provides a framework for clinicians when considering topical treatments for patients with field cancerization.

Blue light aminolevulinic acid photodynamic therapy downregulates cell division and proliferation pathways in cutaneous squamous cell carcinoma.

5-Aminolevulinic acid (5-ALA) photodynamic therapy (PDT) is a treatment for actinic keratosis (AK) and has been studied as a treatment for noninvasive cutaneous squamous cell carcinoma (cSCC). PDT induces apoptosis and necrosis in AKs and cSCC. 5-ALA blue light PDT may modulate gene expression and pathways in surviving cells. In this study, differential gene expression and pathway analysis of cSCC and human dermal fibroblasts were compared before and after 5-ALA blue light PDT using RNA sequencing. No genes were differentially expressed after correcting for multiple testing (false discovery rate < 0.05). As a result, transcription factor, gene enrichment, and pathway analysis were performed with genes identified before multiple testing (p < 0.05). Pathways associated with proliferation and carcinogenesis were downregulated. These findings using 5-ALA blue light PDT are similar to previously published studies using methyl-aminolevulinic and red light protocols, indicating that surviving residual cells may undergo changes consistent with a less aggressive cancerous phenotype.

Photobiomodulation CME Part I: Overview and Mechanism of Action.

Photobiomodulation (PBM), previously known as low-level laser light therapy, represents a non-invasive form of phototherapy that utilizes wavelengths in the red light (RL, 620-700 nm) portion of the visible light (VL, 400-700 nm) spectrum and the near-infrared (NIR, 700-1440 nm) spectrum. PBM is a promising and increasingly used therapy for the treatment of various dermatologic and non-dermatologic conditions. Photons from RL and NIR are absorbed by endogenous photoreceptors including mitochondrial cytochrome C oxidase (COX). Activation of COX leads to the following changes: modulation of mitochondrial adenosine triphosphate (ATP), generation of reactive oxygen species (ROS), and alterations in intracellular calcium levels. The associated modulation of ATP, ROS and calcium levels promotes the activation of various signaling pathways (e.g., insulin-like growth factors, phosphoinositide 3-kinase pathways), which contribute to downstream effects on cellular proliferation, migration and differentiation. Effective PBM therapy is dependent on treatment parameters (e.g., fluence, treatment duration and output power). PBM is generally well-tolerated and safe with erythema being the most common and self-limiting adverse cutaneous effect.

Photobiomodulation CME part II: Clinical applications in dermatology.

Photobiomodulation (PBM) is an emerging treatment modality in dermatology with increasing office and home-based use. PBM is the use of various light sources in the red light (620-700 nm) and near-infrared (700-1440 nm) spectrum as a form of light therapy. PBM is often administered through low-level lasers or light-emitting diodes. Studies show that PBM can be used effectively to treat conditions secondary to cancer therapies, alopecia, ulcers, herpes simplex virus, acne, skin rejuvenation, wounds, and scars. PBM offers patients many benefits compared to other treatments. It is noninvasive, cost-effective, convenient for patients, and offers a favorable safety profile. PBM can be used as an alternative or adjuvant to other treatment modalities including pharmacotherapy. It is important for dermatologists to gain a better clinical understanding of PBM for in-office administration and to counsel patients on proper application for home-use devices to best manage safety and expectations as this technology develops. PBM wavelengths can induce varied biological effects in diverse skin types, races, and ethnicities; therefore, it is also important for dermatologists to properly counsel their skin of color patients who undergo PBM treatments. Future clinical trials are necessary to produce standardized recommendations across conditions and skin types.

Near-infrared light does not induce DNA damage in human dermal fibroblasts.

Photobiomodulation (PBM) can be used to treat a range of conditions in dermatology. PBM refers to the changes induced by red (RL, 620-700 nm) and near-infrared (NIR, 700-1440 nm) light. Light radiation-induced DNA damage is a major contributor to aging and skin cancer. It is crucial to study the effects of PBM on DNA to ensure safety. Our lab previously demonstrated that RL (633 ± 6 nm) did not result in human dermal fibroblasts (HDFs) DNA damage. This study employed similar methods to investigate NIR effects. Commercially available LED-NIR (830 ± 5 nm) panels (66, 132, and 264 J/cm2 ) did not result in DNA damage measured by cyclobutane pyrimidine dimers and pyrimidine-6,4-pyrimidone photoproducts in HDFs compared to temperature-matched controls immediately, 3 h, and 24 h following irradiation and compared to positive and negative controls. This demonstrates that LED-NIR does not damage DNA in HDFs in vitro.

The potential cutaneous benefits of Carthamus tinctorius oleosomes.

Safflower (Carthamus tinctorius) oleosomes are unique organelles that house triglycerides and fatty acids and demonstrate a natural resilience to environmental stresses. There is recent growing interest in safflower oleosomes due to their potential applications in dermatology, especially as a carrier technology to improve drug penetration through the skin. This paper explores various aspects of safflower oleosomes, including their production, safety, absorption, and applications in photoprotection and epidermal remodeling. Oleosomes have shown encouraging results in targeted drug delivery in in vitro and in vivo animal models; however, human clinical research is required to determine their efficacy and safety in dermatology. Oleosomes are comprise a novel biotechnology that has the potential to transform sustainable and natural treatments in dermatology by utilizing their unique structure. Safflower oleosomes are stable lipid molecules that can deliver small and large molecules with high efficacy. This review will examine the current research findings and prospective future applications of oleosomes.

Evaluation of curcumin for dermatologic conditions: a systematic review.

There is increasing demand for natural and sustainable products for the treatment of dermatologic conditions. This systematic review aims to critically analyze published randomized controlled trials (RCTs) and provide evidence-based recommendations on the therapeutic use of curcumin for a variety of dermatological diseases. A systematic search of published literature was performed on July 18, 2023 using PRISMA guidelines for turmeric or curcumin for the treatment of skin diseases. Clinical recommendations were made based on the Oxford Centre for Evidence-Based Medicine guidelines. We identified 18 original randomized controlled trials for use of turmeric or curcumin for psoriasis, radiation dermatitis, oral lichen planus, pruritis, vitiligo, tinea capitis, facial erythema, and scarring. Psoriasis, cesarean section scar, and pruritus received grade of recommendation B. Radiation dermatitis, oral lichen planus, vitiligo, tinea capitis, and facial redness received grade of recommendation C or D. Curcumin was demonstrated to have an excellent safety profile in all clinical trials analyzed. Further research is required to determine optimal dosing and treatment parameters of turmeric. Additional, larger, RCTs and non-RCTs should be conducted to further investigate the safety and efficacy of curcumin as a treatment option for dermatological diseases.

Hypohidrotic Ectodermal Dysplasia Milia Treatment With Fractional Carbon Dioxide Laser and Laser-Assisted Drug Delivery of Triamcinolone.

Hypohidrotic ectodermal dysplasia (HED) is a genetic disorder characterized by hypohidrosis, hypodontia, and hypotrichosis. Skin manifestations, including dyspigmentation and milia-like papules that coalesce into plaques, are difficult to treat. There is no cure for HED, therefore treatment is focused on managing symptoms and improving quality of life. There is limited evidence in the literature for safe and effective treatments improving HED-related facial skin aesthetics. The facial skin rashes caused by HED demonstrate an unmet clinical need in dermatology. Current therapies are limited to prevention methods such as keeping the skin cool by avoiding heat and applying topical moisturizers to help treat dry, pruritic skin. Herein we present a method for successful treatment of a 34-year-old African American male using fractional carbon dioxide CO2 ablative laser with laser-assisted drug delivery of triamcinolone 0.1% ointment that resulted in decreased milia-like papules, improved dyspigmentation, smoother skin tone, and high patient satisfaction. J Drugs Dermatol. 2023;22(11):1130-1132    doi:10.36849/JDD.7650.

Poroma in a Patient With Fitzpatrick Type V Skin.

This case detailing a poroma in Fitzpatrick Type V skin presents gross, dermatoscopic, and histopathologic images that have not been adequately represented in the literature. Diagnosing poroma can be challenging and misdiagnoses can have tragic consequences. The scarcity of published poroma images in darker skin types can further complicate this problem. Mineroff J, Jagdeo J, Heilman E, et al. Poroma in a patient with Fitzpatrick type V skin. J Drugs Dermatol. 2023;22(7):690-691. doi:10.36849/JDD.7371.

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 potential cutaneous benefits of Tremella fuciformis.

Tremella fuciformis, also known as snow mushroom, is an edible mushroom that has historically been popular in herbal and Asian medicine and cuisine. The main polysaccharide ingredients have been extracted and used as treatment in a variety of conditions, demonstrating positive effects in a range of biological functions including those involved in antioxidation, antitumor, antidiabetic, immunomodulatory, and neuroprotective pathways. Studies have demonstrated the role this extract may play in skin antiaging, photoprotection, wound healing, and barrier protection. Most studies have been limited to in vitro and in vivo animal models. Future clinical research is needed to further understand the role of T. fuciformis in dermatology. This review will discuss the existing research findings and potential future applications for T. fuciformis as a treatment in skin conditions.

Cutaneous effects of photobiomodulation with 1072 nm light.

Photobiomodulation, also known as low-level light therapy, has gained popularity in treating a variety of dermatologic and non-dermatologic conditions. The near-infrared (NIR) portion ranging from 700 to 1440 nm has a broad spectrum but most current research focuses on relatively shorter wavelengths. To date, clinical research regarding the application of 1072 NIR is limited to treatments for infections and photorejuvenation treatment in females. However, 1072 NIR light therapy may benefit male patients. This theoretical application is based on the biological properties of this subgroup having increased cutaneous density and thickness and the physical properties of 1072 NIR allowing it to penetrate increased depth. 1072 NIR can reach more cells throughout the epidermis and dermis compared to other parts of the electromagnetic spectrum traditionally used in phototherapy to provide unique and targeted benefits. 1072 NIR light-emitting diodes are commercially available and therefore hold tremendous potential to become accessible, affordable treatment options. Given the increased demand and market size for aesthetics for men that remains untapped, there is opportunity for future research to elucidate the potential for this wavelength as a safe and effective treatment.