Oral Tranexamic Acid for Prevention and Treatment of Postinflammatory Hyperpigmentation.

BACKGROUND: Postinflammatory hyperpigmentation (PIH) is a skin disorder characterized by hyperpigmentation resulting from heightened inflammation and/or damage to the basement membrane, melanocytes, and keratinocytes, leading to abnormal and excessive pigment deposition. Oral tranexamic acid (TXA), originally used as an antifibrinolytic for managing excessive bleeding, has garnered attention for its demonstrated safety and efficacy in treating melasma. There is a growing body of evidence regarding the use of TXA in the treatment of PIH. OBJECTIVE: To review the mechanism of action of oral TXA in treating PIH and examine the use of oral TXA in preventing and/or treating PIH associated with laser-based and light-based treatments in individuals with skin color. METHODS: Review of relevant articles from 2000 to present found in the Cochrane Library, PubMed, Embase, and Google Scholar, regarding the use of oral TXA in the treatment of PIH. RESULTS: Studies reviewed investigated the efficacy of oral tranexamic acid (TXA) in treating postinflammatory hyperpigmentation (PIH) and use in preventing PIH when used in conjunction with other treatments. All studies demonstrated significant improvement in PIH without significant adverse effects and side effects. CONCLUSION: Oral tranexamic acid is emerging as a safe and effective treatment in the prevention and treatment of postinflammatory hyperpigmentation.

Advancing Dermatology Education and Care in Rwanda: The Impact of a New Academic Partnership.

It is the realization of a long-dreamed aspiration to create a university that would advance global health delivery by training a new generation of global health leaders who are equipped to not just build, but sustain effective and equitable health systems.

Melatonin and 5-fluorouracil combination chemotherapy: opportunities and efficacy in cancer therapy.

Combined chemotherapy is a treatment method based on the simultaneous use of two or more therapeutic agents; it is frequently necessary to produce a more effective treatment for cancer patients. Such combined treatments often improve the outcomes over that of the monotherapy approach, as the drugs synergistically target critical cell signaling pathways or work independently at different oncostatic sites. A better prognosis has been reported in patients treated with combination therapy than in patients treated with single drug chemotherapy. In recent decades, 5-fluorouracil (5-FU) has become one of the most widely used chemotherapy agents in cancer treatment. This medication, which is soluble in water, is used as the first line of anti-neoplastic agent in the treatment of several cancer types including breast, head and neck, stomach and colon cancer. Within the last three decades, many studies have investigated melatonin as an anti-cancer agent; this molecule exhibits various functions in controlling the behavior of cancer cells, such as inhibiting cell growth, inducing apoptosis, and inhibiting invasion. The aim of this review is to comprehensively evaluate the role of melatonin as a complementary agent with 5-FU-based chemotherapy for cancers. Additionally, we identify the potential common signaling pathways by which melatonin and 5-FU interact to enhance the efficacy of the combined therapy. Video abstract.

Who Is Holding the Syringe? A Survey of Truth in Advertising Among Medical Spas.

BACKGROUND: The degree of supervision and level of expertise required for performing cosmetic procedures differs significantly from state to state. Medical spas providing cosmetic procedures have seen exponential growth since 2020. OBJECTIVE: To provide a representative sample of the medical spa industry in the Unites States regarding the expertise among providers performing cosmetic procedures and the degree of oversight at medical spas offering these procedures. MATERIALS AND METHOD: Descriptive study based on a standardized telephone interview performed by a secret shopper in Chicago and surrounding suburbs. Data were then extracted and analyzed. RESULTS: Of 127 medical spas reviewed, a supervising physician was not on-site at 81.1% of the facilities. Patients were informed of this at 64.6% of the surveyed medical spas. CONCLUSION: There is considerable variation in the oversight and in the training among those performing cosmetic procedures at surveyed medical spas. As cosmetic procedures become increasingly popular among the public, further regulation of medical spas is warranted to protect patient safety.

Underrepresented Groups and Perceived Educational Barriers for Residency and Fellowship Success.

BACKGROUND: The study aimed to compare barriers perceived by medical students and resident physicians identifying as of underrepresented groups in medicine (UIM) and/or as sexual and gender minorities (SGM) to individuals not identifying with these groups, especially for trainees with an interest in dermatology. METHODS: Cross-sectional survey of medical students and resident physicians based in the United States from February 2021 to July 2021, with subgroup analysis of trainees with interest in dermatology. FINDINGS: Among trainees interested in dermatology, the most notable barriers for the UIM group were 1) lack of home program in specialty/fellowship of interest (4.71±1.73); 2) lack of connections/networking opportunities (4.14±1.29); 3) lack of opportunity to obtain AOA membership (4.00±1.96); 4) obtaining mentorship (4.00±1.47); and lack of diversity in specialty/fellowship of interest (3.93±1.14). CONCLUSIONS AND RELEVANCE: Increasing focused mentorship programs and fostering environments that embrace diversity are key to reducing perceived barriers for minority candidates. J Drugs Dermatol. 2023;22(12):1210-1215. doi:10.36849/JDD.7528R1.

Surgical Dermatology and Private Equity: A Review of the Literature and Discussion.

BACKGROUND: While there has been substantial investment in dermatology by private equity (PE), the relevance of this trend to the dermatologic surgeon has not been assessed. OBJECTIVE: The literature on PE investment in medicine was reviewed to provide interdisciplinary data relevant to the dermatologic surgeon. MATERIALS AND METHODS: The PubMed database was queried for all peer-reviewed articles containing the term "private equity" and identified 70 unique articles across 18 medical specialties, comprising 20 original research articles and 50 commentary articles. RESULTS: Significant PE growth across multiple medical specialties occurred in the 2010s. Private equity ownership was associated with higher levels of nonphysician providers relative to physicians. Pooled data suggest that PE ownership is associated with lower staffing levels, particularly for non-revenue-generating staff, as well as potentially lower levels of medical supplies on hand. Data on financial performance suggests that PE-ownership results in higher profits, revenues, and costs. Surveys of physicians demonstrate concern about autonomy, ethics, and career prospects. CONCLUSION: For the dermatologic surgeon, issues related to consolidation, provider scope of practice, support staff availability, and supply management are important due to the nature of procedural intervention and the increased risk of adverse events.

Perceptions of Australian and New Zealand clinicians caring for neonates born at the borderline of viability have changed since the 2005 consensus guideline.

AIM: To determine whether clinician and consumer considerations have changed regarding the resuscitation and support of neonates born at the borderlines of viability since the 2005 New South Wales (NSW) and Australian Capital Territory (ACT) consensus guidelines were developed. METHODS: A prospective survey based on the hypotheses and scenarios developed in the original NSW and ACT consensus workshop on perinatal care at the borderlines of viability was sent to neonatologists, fetal medicine specialists, clinical midwife and clinical neonatal consultants and consumer representatives in Australia and New Zealand. Four scenarios and 16 questions were used to explore the respondent's views towards different aspects of the management of neonates born at the borderlines of viability. Australian and New Zealand Neonatal Network data from 2013 or NSW/ACT Neonatal Intensive Care Units (NICUS) data from 1998 to 2004 were used to provide outcome data for each scenario. RESULTS: A total of 87% or more of respondents advocated for resuscitation of neonates at 24 and 25 weeks' gestation in 2015. Only 29% (49/169) would agree to parental request not to resuscitate at 25 weeks and only 10% (17/170) at 260-6 weeks. The number of perinatal clinical care providers considering resuscitation at 235 weeks' gestation increased from 23% in 2005 to more than 50% in 2015. CONCLUSION: These findings support the development of updated guidelines for the management of neonates in Australia and New Zealand born at the borderlines of viability to reflect the changes in clinical perceptions and management.

Challenges to laser-assisted drug delivery: Applying theory to clinical practice.

BACKGROUND: The percutaneous penetration of topically applied compounds can be enhanced using external chemical or physical sources and thus laser-assisted drug delivery is a burgeoning area of interest within the field of dermatology. OBJECTIVES: This article briefly discusses the mechanism of laser-assisted drug delivery and expands upon the challenges and safety issues that may arise in the clinical implementation of this modality. RESULTS: The existing literature demonstrates that investigators and clinicians in dermatology have successfully delivered anti-inflammatory, anti-neoplastic, and anti-oxidative medications transdermally for the treatment of a variety of conditions including scarring, photoageing, and cutaneous neoplasia. Despite growth of the field, much remains to be learned about the applicability of laser-assisted drug delivery in humans, and practitioners are faced with new safety concerns that may be associated with this treatment modality. CONCLUSIONS: Challenges in laser assisted drug delivery include unpredictability of dosing and response to therapy, possibility of inducing local and systemic reactions, and variability in treatment regimens. Lasers Surg. Med. 50:20-27, 2018. © 2017 Wiley Periodicals, Inc.

Updates on the understanding and treatment of cellulite.

Cellulite is a common dermatologic condition and frequent cause of cosmetic concern among women. This paper aims to update what is known about the pathogenesis of cellulite and reviews targeted treatment modalities that address its underlying components of microvascular dysfunction, endocrine-mediated inflammation, and connective tissue fibrosclerosis.

Microneedling: a new approach for treating textural abnormalities and scars.

Microneedling is a minimally invasive procedure wherein small holes are created across the stratum corneum while keeping the epidermis partially intact. This produces microchannels that increase skin permeability and simultaneously stimulate growth factor release. Since the epidermis is retained, microneedling has less risk of infection, postinflammatory hyperpigmentation, and scarring compared to other resurfacing modalities. This is a review of the literature on microneedling in the treatment of textural abnormalities, specifically rhytides, scars, and striae.

Evolution of skin and hair in African Americans.

Current demographic trends in the United States highlight the growing population of those who identify as having "skin of color." As such, dermatologists must have a greater comfort level and knowledge in treating some of the unique skin and hair conditions seen in this population. Understanding the scientific basis for the evolution of skin color and hair texture is necessary in order to understand the variations in the characteristics of skin and hair seen among racial and ethnic groups. This review seeks to highlight the current scientific explanation of skin color and hair texture, with special attention to people of African descent, in an attempt to give insight into the clinical presentations of hair and skin disorders seen in this group.

Adrenergic urticaria: review of the literature and proposed mechanism.

Adrenergic urticaria is a rare type of stress-induced physical urticaria characterized by transient outbreaks of red papules surrounded by halos of hypopigmented, vasoconstricted skin. First described in 1985, there are 10 reported cases of adrenergic urticaria in the English-language medical literature. Episodes are caused by various triggers, including emotional upset, coffee, and chocolate, during which serum catecholamines and IgE are elevated, whereas histamine and serotonin levels remain within normal limits. The precise mechanisms leading to the pathogenesis of adrenergic urticaria have yet to be elucidated. Diagnosis can be made by intradermal injection of epinephrine or norepinephrine, which reproduces the characteristic rash, or by clinical observation. Trigger avoidance and oral propranolol are currently the best known treatments for adrenergic urticaria. Nonspecific therapies, including tranquilizers and antihistamines, may also ease symptoms. This article explores the pathophysiology of adrenergic urticaria and proposes a mechanism by which propranolol treats the condition.

Declining child mortality and continuing racial disparities in the era of the Medicaid and SCHIP insurance coverage expansions.

OBJECTIVES: We investigated trends in national childhood mortality, racial disparities in child mortality, and the effect of Medicaid and State Children's Health Insurance Program (SCHIP) eligibility expansions on child mortality. METHODS: We analyzed child mortality by state, race, and age using the National Center for Health Statistics' multiple cause of death files over 20 years, from 1985 to 2004. RESULTS: Child mortality continued to decline in the United States, but racial disparities in mortality remained. Declines in child mortality (ages 1-17 years) were substantial for both natural (disease-related) and external (injuries, homicide, and suicide) causes for children of all races/ethnicities, although Black-White mortality ratios remained unchanged during the study period. Expanded Medicaid and SCHIP eligibility was significantly related to the decline in external-cause mortality; the relationship between natural-cause mortality and Medicaid or SCHIP eligibility remains unclear. Eligibility expansions did not affect relative racial disparities in child mortality. CONCLUSIONS: Although the study provides some evidence that public insurance expansions reduce child mortality, future research is needed on the effect of new health insurance on child health and on factors causing relative racial disparities.

Low-Dose Naltrexone Treatment of Familial Benign Pemphigus (Hailey-Hailey Disease).

Importance: Familial benign pemphigus, or Hailey-Hailey disease (HHD), is a rare and debilitating genetic dermatosis characterized by chronic, recurrent vesicles, erosions, and maceration in flexural areas. Despite the reported therapeutic modalities, such as topical and systemic corticosteroids, systemic immunomodulators, topical and systemic retinoids, and laser, HHD can still be markedly difficult to control. Objective: To assess low-dose naltrexone hydrochloride in the treatment of recalcitrant HHD. Design, Setting, and Participants: In this case series, 3 patients with biopsy-proven recalcitrant HHD were evaluated in the outpatient dermatology clinic at the Cleveland Clinic. Each patient was treated with low-dose naltrexone hydrochloride at a dosage of 1.5 to 3.0 mg per day. No laboratory monitoring was necessary. Clinical response (healing of erosions, improvement in erythema, and alleviation of pain), adverse effects, and subjective quality of life were monitored throughout the treatment. The study dates were January 2016 to January 2017. Main Outcomes and Measures: Objective clinical response as assessed by the treating dermatologist, subjective quality of life as reported by the patient, and recorded adverse effects were monitored throughout the treatment at intervals of 2 to 3 months. Results: The 3 patients included a woman in her 40s and 2 men in their 60s. Each patient exhibited at least an 80% improvement in extent of disease, with one patient demonstrating 90% clearance. All 3 patients had substantial improvement in quality of life, with one patient reporting improvement in his depression. No adverse effects were recorded. Conclusions and Relevance: Low-dose naltrexone may represent a low-cost and low-risk alternative or adjunct in the treatment of HHD.

Impact of heart disease and quality of care on minority populations in the United States.

Heart disease is a leading cause of death across all populations in the United States. In 1985, the Secretary's Task Force on Black and Minority Health recognized the existence of widespread health disparities for heart disease and related risk factors among minorities in America. Inequalities in heart health and healthcare continue to exist. This review compares measures of heart disease and healthcare for white, African-American, Asian/Pacific Islander, American-Indian/Alaska-Native and Hispanic/Latino populations. Lack of healthcare data for minorities continues to be a barrier to understanding the nature and extent of heart disease and related risk factors for these groups. In combination with programs that address preventive measures to reduce risk factors for heart disease, the integration of quality improvement measures has developed as an important strategy for reducing cardiovascular health disparities. Improved data collection and reporting, enhanced use of information technology, and promotion of cultural competency hold potential for improving the quality of cardiac care and reducing health disease for all Americans.