Nontraditional Healing Utilization and Disclosure Among Dermatology Patients: A National Cross-Sectional Survey Study.

Nontraditional healing (NTH) consists of spiritual and religious healing (SRH) and complementary and alternative medicine (CAM). SRH includes faith healing, prayer, and meditation. CAM includes use of nonprescribed medications or behaviors such as supplements, plant-based remedies, and behavioral changes.

Psychosocial Burden of Verruca Vulgaris: A Cross-Sectional Survey.

Although medically benign, common warts, or verruca vulgaris, may negatively affect emotional wellbeing and quality of life (QoL). The various treatment options, such as liquid nitrogen cryotherapy or Candida antigen injection, can be painful, and repeat trials for wart resolution can be burdensome. Because the psychosocial burden of verruca is likely underestimated, we surveyed adult patients diagnosed and treated with warts at a single academic institution in an urban setting to assess the reported effects on QoL and satisfaction with the different treatment modalities. In domains such as anxiety, social activities, and interpersonal relationships, patients rated impact of warts on a scale of 1-100, with a score of 1 representing “minimal impact” and 100 representing “severe impact.” These numerical ratings were then converted to the validated Dermatology Life Quality Index (DLQI) parameters for consistency with other QoL studies. Our results indicate that patients are “A little” self-conscious or embarrassed by their warts and that their warts caused “A little” anxiety. Although patients reported more discomfort with Candida antigen than with cryotherapy, overall patient satisfaction for the two procedures was identical. Notably, 52% of respondents endorsed attempting home remedies before seeking clinical care, suggesting room for improvement in patient education for initiating dermatologic care. Future studies should examine patients with recalcitrant verruca and patient satisfaction with other management options. J Drugs Dermatol. 2022;21(6):614-617. doi:10.36849/JDD.6773.

The Use of Bakuchiol in Dermatology: A Review of In Vitro and In Vivo Evidence.

The plant Psoralea corylfolia contains compounds such as psoralens that are useful for the treatment of psoriasis and vitiligo, and the plant is used in Chinese and Indian traditional medicine for diseases such as psoriasis and leprosy. Bakuchiol, a meroterpene phenol in Psoralea corylfolia, has similar functional properties to topical retinoids, which are commonly used to treat acne, post-inflammatory hyperpigmentation, and wrinkles. Bakuchiol’s anti-inflammatory and anti-proliferative properties also may lead to improvement in psoriasis and skin cancers, yet more clinical evidence is needed to elucidate these effects. Notably, bakuchiol does not cause common adverse effects seen with topical retinoids such as burning and scaling, permitting wider use in patients with sensitive skin. This review will detail the current evidence for bakuchiol as an alternative treatment in dermatologic conditions. J Drugs Dermatol. 2022;21(6):624-629. doi:10.36849/JDD.6740.

Supporting Underrepresented in Medicine (UIM) and non-UIM Trainees Applying into Dermatology: A Qualitative Analysis.

BACKGROUND: Recently, there have been calls to improve diversity among the dermatology workforce, with emphasis placed on the resident selection process and trainee pipeline. However, there is limited data on the perspectives of dermatology applicants, especially among UIM trainees, and the support that they need and want to successfully apply in dermatology. METHODS: To assess trainee perspectives, we disseminated a survey to medical students, interns (matched into dermatology), and dermatology residents asking how dermatology residency programs can best support trainees through the dermatology application process. We developed a codebook drawing upon grounded theory methodology, and consensus coded all qualitative responses. RESULTS: We received 224 qualitative responses from underrepresented in medicine (UIM) (65, 29.0%) and non-UIM trainees (159, 70.9%). UIM trainees were more likely to mention diversity and inclusion initiatives (46.2% vs 3.8%, P<0.001), transparency in program information (40.0% vs 24.5%, P=0.021), holistic review (30.8% vs 6.3%, P<0.001), UIM student outreach/pipeline programs (23.1% vs 0.6%, P<0.001), and mentorship (21.5% vs 8.2%, P=0.009). CONCLUSION: Improving programmatic efforts to address unique challenges UIM trainees face when applying into dermatology is instrumental to mitigating barriers. We highlight opportunities for dermatology residency programs to create a more fair and equitable dermatology application process and support a more diverse pipeline of future dermatologists. J Drugs Dermatol. 2021;20(7):795-797. doi:10.36849/JDD.6043.

Perceptions and recommendation behaviors of dermatologists for medical cannabis: A pilot survey.

OBJECTIVES: Evidence suggests that cannabinoids may provide therapeutic benefit to patients with dermatologic conditions. The recommendation behaviors of dermatologists with regards to recommending medical cannabis are unknown. We administered a pilot survey to evaluate dermatologists' recommendation behaviors including dermatologic indications and formulation preferences. DESIGN: A cross-sectional study was done to sample dermatologists using a 24-question survey. SETTING: Online survey through SurveyMonkey® that was distributed via Orlando Dermatology Aesthetic and Clinical Conference's mailing list, including thousands of practicing dermatologists. MAIN OUTCOME MEASURES: Descriptive data of dermatologists' recommendation behaviors of medical cannabis are described. Fisher's exact test and Chi-Square tests were used to compare recommendation behaviors by gender, age, years in practice, and residency legality. RESULTS: The survey was sent to 7176 individuals; of the 28.7 % who opened the email, 2.2 % completed the survey (N = 145). 91 % of dermatologists were in support of medical cannabis use and 13.8 % have recommended it for a dermatologic condition. Atopic dermatitis (45 %) and psoriasis (40 %) were the most common. The most common form of administration was topical (75 %). The main reasons for not recommending medical cannabis were limited knowledge (56 %) and lack of experience (48 %). CONCLUSIONS: Cutaneous inflammatory and pruritic conditions such as psoriasis and atopic dermatitis were the most common reasons dermatologists recommended medical cannabis in our survey. Respondents' recommendation patterns may have been limited by limited by lack of knowledge or experience with medical cannabis. The small sample size of our survey limits generalizability to the dermatology field and warrants further investigation.

ARTICLE: Colloidal Oatmeal Part I: History, Basic Science, Mechanism of Action, and Clinical Efficacy in the Treatment of Atopic Dermatitis.

Colloidal oatmeal has a long-standing history in the treatment of dermatologic disease. It is composed of various phytochemicals, which contribute to its wide-ranging function and clinical use. It has various mechanisms of action including direct anti-inflammatory, anti-pruritic, anti-oxidant, anti-fungal, pre-biotic, barrier repair properties, and beneficial effects on skin pH. These have been shown to be of particular benefit in the treatment of atopic dermatitis. In Part 1 of this two-part series, we will explore the history of colloidal oatmeal, basic science, mechanism of action, and clinical efficacy in the treatment of atopic dermatitis. J Drugs Dermatol. 2020;19:10(Suppl):s4-7.

ARTICLE: Colloidal Oatmeal Part II: Atopic Dermatitis in Special Populations and Clinical Efficacy and Tolerance Beyond Eczema.

Colloidal oatmeal has a diverse array of applications, clinical benefits, and uses beyond atopic dermatitis. First and foremost, it has been shown to be of benefit in the treatment of atopic dermatitis in skin of color. It has also been shown to be of benefit in the treatment of hand dermatitis, xerosis, psoriasis, skin manifestations of diabetes, and in the treatment of cutaneous adverse effects associated with oncologic therapies. In Part II of this 2-part series, we examine the efficacy, safety, and expansive clinical applications of colloidal oatmeal. J Drugs Dermatol. 2020;19:10(Suppl):s8-11.

Pseudofolliculitis Barbae: A Review of Current Treatment Options

The purpose of this review is to discuss the disease process and wide variety of treatment options for psuedofolliculitis barbae (PFB), or razor bumps. PFB is caused by hair follicles penetrating the skin and causing an inflammatory response. PFB can occur to anyone who shaves, and is more likely in those with curly hair. PFB can cause significant hyperpigmentation and scarring, more noticeable in darker skin types. PFB can be treated with a variety of topical, systemic, or light/laser therapies. Minimal progress has been made in treating PFB in recent years, partially due to the success of well-established current treatments discussed in this review. The most effective treatments involve a multifaceted approach including behavioral changes in shaving habits as well as the use of topical therapies. J Drugs Dermatol. 2019;18(3):246-250.

Applications of Topical Oak Bark Extract in Dermatology: Clinical Examples and Discussion

The versatility of wound healing and anti-inflammatory agents can be assets to dermatologists when other therapies lack appropriate mechanisms of action, or when the risk to benefit ratio may be in question. Bensal HP ointment is a broad-spectrum antimicrobial agent with in vitro activity against important pathogens such as MRSA and gram-negative bacteria, some fungal strains, and yeasts.1 Based on the physiochemical composition of Bensal HP ointment, and its impact after application to skin, there are many potentially benefits derived from the formulation stability. While there have been several animal and human studies characterizing the antibacterial, wound healing, and anti-inflammatory properties of Bensal HP, they do not provide real world clinical experience and guidance on potential utilization in dermatology. The goal of this article is to present a variety of clinical cases for which Bensal HP was utilized as a means of translating the pre-clinical and trial data. J Drugs Dermatol. 2019;18(2):203-206.

A systematic review of evidence-based treatments for prurigo nodularis.

Prurigo nodularis is a chronic dermatologic condition involving the development of multiple cutaneous nodules in the setting of intractable pruritus. Given emerging treatment options for this difficult-to-treat condition, a current review of therapeutics is needed. A systematic review was performed for clinical studies investigating prurigo nodularis treatment published from 1990 to present including ≥5 subjects. A total of 35 articles were assigned a level of evidence according to the Oxford Center for Evidence-based Medicine. All 5 studies investigating topical agents, including corticosteroids, calcineurin inhibitors, calcipotriol, and capsaicin, conveyed some beneficial effect with level of evidence 2b or higher. Six of 8 reports investigating photo- and photochemotherapy achieved levels of evidence 2b or greater and showed good partial response rates. Thalidomide was studied by 6 reports providing evidence of good symptom response, only 2 of which were rated level 2b or greater. Cyclosporine and methotrexate have demonstrated benefit in 4 combined studies, albeit with level 4 evidence. Pregabalin, amitriptyline, paroxetine, fluvoxamine, and neurokinin-1 receptor antagonists have demonstrated promising evidence in 5 level 2b studies. Higher-powered studies and additional randomized controlled trials are needed for the evaluation of safe and efficacious systemic treatment options for prurigo nodularis.

The Therapeutic Potential of Cannabinoids in Dermatology

Cannabinoids have demonstrated utility in the management of cancer, obesity, and neurologic disease. More recently, their immunosuppressive and anti-inflammatory properties have been identified for the treatment of several dermatologic conditions. This review thus assesses the therapeutic potential of phytocannabinoids, endoocannabinoids, and chemically synthetic cannabinoids in the management of cutaneous disease. The PubMed® and Scopus® databases were subsequently reviewed in December 2017 using MeSH and keywords, such as cannabinoid, THC, dermatitis, pruritus, and skin cancer. The search yielded reports on the therapeutic role of cannabinoids in the management of skin cancer, acne vulgaris, pruritus, atopic and allergic contact dermatitis, and systemic sclerosis. While cannabinoids have exhibited efficacy in the treatment of inflammatory and neoplastic skin conditions, several reports suggest pro-inflammatory and pro-neoplastic properties. Further investigation is necessary to understand the complexities of cannabinoids and their therapeutic potential in dermatology.

Nitric Oxide Releasing Nanoparticles as a Strategy to Improve Current Onychomycosis Treatments.

Topical antimicrobials are the ideal mode of onychomycosis treatment for efficient drug delivery and avoidance of sytemic effects associated with oral medications. However, high treatment costs, tissue penetration limitations, and low cure rates have continued to pose major challenges. To capitalize on the progress made by topical efinaconazole solution, efinaconazole was combined with inexpensive, previously-characterized nitric oxide releasing nanoparticles (NO-np), which have been shown to offer sustained nitric oxide release over time and enhanced barrier penetration, while exerting broad spectrum antimicrobial and immunomodulating properties. NO-np were combined with efinaconazole in varying concentrations and applied against reference strains of Trichophyton rubrum using a checkerboard method. Results demonstrated synergism of NO-np+efinaconazole against T. rubrum, which is noteworthy given the barriers present in the topical treatment of onychomycosis, and the multiple potential benefits offered by NO-np. Overall, this study illustrates the untapped potential of nanotechnology in the treatment of disorders of the skin, hair, and nails where drug delivery remains a challenge. J Drugs Dermatol. 2018;17(7):717-720.

Atopic dermatitis: addressing allergy, infection, itch and complementary therapies.

Atopic dermatitis (AD) is a complex condition that results from the dynamic interplay between genetic predisposition, skin barrier defects, environmental factors, and a dysfunctional immune system. As a result, AD can be complicated by irritant and allergic contact dermatitis and imbalances in the skin microbiome, which can subsequently exacerbate the severity and complicate the course of preexisting atopic disease. Itch is an important symptom of AD, as it plays a large role in the quality of life of patients and their families. Since AD is a chronic, inflammatory disease that recrudesces throughout life, many have utilized alternative and/or complementary therapies, as monotherapy or in conjunction with conventional therapies, as a form of management.

Bensal HP for Second Intention Healing Following Mohs Micrographic Surgery or Shave Skin Biopsy: An Open-label Pilot Study.

Dermatologists frequently create cutaneous defects that heal by second intention, yet there is no universal protocol for wound care in this setting. Several ointments commonly used for wound healing are not cost effective as they contain known contact allergens, contribute to antimicrobial resistance, and do not enhance the healing process. Recent studies indicate that Bensal HP, a commercially available ointment used for a variety of dermatologic conditions, may be useful for wound healing; although clinical data is currently limited. In this single-center open-label pilot study, Bensal HP was evaluated for second intention healing over 8 weeks following either Mohs micrographic surgery or shave skin biopsy in 20 patients. Results indicate that Bensal HP is effective for second intention healing as demonstrated by increased Global Assessment of Efficacy scores and decreased wound measurements, with 16 patients achieving full closure. Patient symptoms overall improved over the study period, and Bensal HP was well tolerated with no adverse effects associated with its use. By providing critical data regarding the safety and efficacy of Bensal HP, this study may provide useful information to guide further assessment in future large-scale comparative wound healing studies.

J Drugs Dermatol. 2016;15(10):1197-1202.

Bensal HP Attenuates the Inflammatory Response in Hair Shaving Associated Dermatitis.

Shaving is an ubiquitous practice, and cutaneous irritation and inflammation are common sequelae, which may be worsened by underlying skin conditions or poor hair removal techniques. Moisturizing shaving creams and aftershaves are available to help maintain or restore the epidermal barrier; however, many continue to suffer from post-shave redness, itching, and pain. To reduce post-shave inflammation, some products have included botanical and other natural ingredients, which are often favored by consumers. We evaluated Bensal HP, an ointment containing 3% oak bark extract, 3% salicylic acid, and 6% benzoic acid, which has documented anti-inflammatory and antimicrobial properties, in a murine model of shave irritation to determine whether it would be useful in this clinical setting. Shaving dermatitis was simulated using a depilatory agent and electric clippers, and the shaved area was photographed and treated with Bensal HP daily for four days. Compared to untreated controls, mice treated with Bensal HP experienced a visible reduction in skin irritation and inflammation. These findings were mirrored on histology, as Bensal HP-treated areas demonstrated increased epidermal integrity and decreased dermal inflammatory infiltrate compared to untreated skin. Using immunohistochemistry, fewer neutrophils and macrophages were noted, and cytokine analysis also revealed decreased IL-6 in Bensal HP-treated skin at 24 and 96 hours after shaving. These results highlight the potential of Bensal HP as an anti-inflammatory treatment for shave irritation. Given the product's application against a variety of inflammatory and infectious skin disorders, its use against shave irritation may also improve comorbid skin conditions, such as pseudofolliculitis barbae.

J Drugs Dermatol. 2016;15(7):836-840.

Hyperspectral imaging of nanoparticles in biological samples: Simultaneous visualization and elemental identification.

While engineered nanomaterials (ENMs) are increasingly incorporated into industrial processes and consumer products, the potential biological effects and health outcomes of exposure remain unknown. Novel advanced direct visualization techniques that require less time, cost, and resource investment than electron microscopy (EM) are needed for identifying and locating ENMs in biological samples. Hyperspectral imaging (HSI) combines spectrophotometry and imaging, using advanced optics and algorithms to capture a spectrum from 400 to 1000 nm at each pixel in an enhanced dark-field microscopic (EDFM) image. HSI-EDFM can be used to confirm the identity of the materials of interest in a sample and generate an image "mapping" their presence and location in a sample. Hyperspectral mapping is particularly important for biological samples, where ENM morphology is visually indistinct from surrounding tissue structures. While use of HSI (without mapping) is increasing, no studies to date have compared results from hyperspectral mapping with conventional methods. Thus, the objective of this study was to utilize EDFM-HSI to locate, identify, and map metal oxide ENMs in ex vivo histological porcine skin tissues, a toxicological model of cutaneous exposure, and compare findings with those of Raman spectroscopy (RS), energy-dispersive X-ray spectroscopy (EDS), and scanning electron microscopy (SEM). Results demonstrate that EDFM-HSI mapping is capable of locating and identifying ENMs in tissue, as confirmed by conventional methods. This study serves as initial confirmation of EDFM-HSI mapping as a novel and higher throughput technique for ENM identification in biological samples, and serves as the basis for further protocol development utilizing EDFM-HSI for semiquantitation of ENMs.

Efficacy of a Skin Condition-Adapted Solution for Xerosis and Itch Relief Associated With Aging.

In recent decades, the stratum corneum (SC), has been recognized for its multifunctional role in maintaining the homeostasis of the human epidermal barrier. A better understanding of the SC's ability to act as its own biosensor in detecting dysfunction and integrating restorative actions can help identify the origin of certain skin conditions. A more holistic understanding of the morphological changes of the SC during the natural aging process and how it deviates in disease states can help bring about new treatment strategies. Some important recent clinical studies point to new treatments and add to the existing body of research on corneobiology. These studies offer some explanation of and validation for the various ingredients incorporated into moisturizers and barrier repair devices aimed at treating pruritus and xerosis associated with the aging skin. J Drugs Dermatol. 2016;15(suppl 11):s91-94.