Using Artificial Intelligence to Assess the Teratogenic Risk of Vitamin A Supplements.

Vitamin A in high doses has been found to be highly teratogenic, leading to severe fetal abnormalities if exposure occurs during pregnancy. Hence, prescription vitamin A acne medications like isotretinoin are highly regulated via programs such as iPledge, which intend to avert fetal exposure to isotretinoin and to educate healthcare providers, pharmacists, and patients about the significant risks associated with isotretinoin and its appropriate usage conditions. However, over-the-counter (OTC) vitamin A supplements are not subject to these requirements, and calculating the vitamin A content of these supplements can be difficult due to the lack of Food and Drug Administration (FDA) regulations and inconsistencies in labeling. If the necessary information is provided, ChatGPT, a generative artificial intelligence (AI) tool, can help the general public calculate the vitamin A content of supplements. Nonetheless, supplement manufacturers do not always provide the data necessary for these calculations.

Predictors of Skin, Hair, and Nail Supplement Use: Analysis of National Health and Nutrition Examination Survey (NHANES) Cross-Sectional Data.

OBJECTIVES: Approximately half of US adults use dietary supplements, often for dermatologic purposes. When survey respondents in a nationally representative population were asked the reasons for their use of a specific supplement, 87% chose "for healthy skin, hair, and nails." Despite widespread use, supplements have potential risks and lack regulatory safeguards. Because most supplement users choose to use them without the advice of a healthcare professional, it is important to identify factors predicting use. This study examined demographic predictors of skin, hair, and nail supplement use among 2015-2016 US National Health and Nutrition Examination Survey respondents, a nationally representative sample. METHODS: Weighted descriptive analysis using χ2 tests examined group differences among respondents who took skin, hair, and nail supplements and those who did not take supplements in the past 30 days. Multivariable logistic regression models were performed to identify predictors of skin supplement use. RESULTS: Statistically significant differences in sex, education, income, and insurance status were observed between dermatologic supplement users and nonsupplement users (P < 0.0001). Factors significantly increasing the likelihood of skin supplement use included age between 30 and 60 years (odds ratio [OR] 1.788, 95% confidence interval [CI] 1.439-2.222), age older than 60 years (OR 4.983, 95% CI 3.838-6.469), having a college degree or above (OR 2.696, 95% CI 1.952-3.724), attending some college or above (OR 1.844, 95% CI 1.364-2.494), having an annual income of >$75,000 (OR 1.285, 95% CI 1.029-1.605), and having health insurance (OR 1.559, 95% CI 1.236-1.967). Male respondents were half as likely to use supplements, compared with females (OR 0.579, 95% CI 0.488-0.687). CONCLUSIONS: Factors such as age, education, income, and sex predict supplement use. Knowledge of such trends may help practitioners counsel patients on potential supplement risks and the many unknowns related to their use. Any patient could be using skin, hair, and nail supplements over the counter, including pregnant and older adult populations, as well as generally healthy patients. This would help protect patients from the possible dangers of supplements, including laboratory test interference and teratogenicity.

Skin, hair, and nail supplements advertised on Instagram.

Teens and young adults increasingly utilize social media for health information. Dermatologic supplements, advertised on social media, may be pharmacologically active and risk adverse effects. Instagram was searched, and 100 posts from March 2021 were evaluated for ingredients, health claims, account verification status, and endorsements. Only 4% of posts were made by verified accounts, and 1% of posts contained a visible Supplement Facts label. The Food and Drug Administration does not regulate dietary supplements. Ingredients such as vitamin A found in posts can pose teratogenic risk. Other potentially dangerous ingredients included saw palmetto and biotin. To accurately counsel patients who may retrieve health information from Instagram, it is important for practitioners to be familiar with social media claims.

Do You Know How to Assess Risks Posed by Over-the-Counter Vitamin A Supplements?

Dietary supplements are regulated as foods by the US Food and Drug Administration (FDA) and, despite their potentially harmful effects, are not subject to labeling rules that apply to prescription medications. This commentary responds to a case about vitamin A supplement safety. The commentary compares regulation of vitamin A-derivative prescription medications, such as isotretinoin, to regulation of high-dose vitamin A supplements, illuminating both products' potential for causing birth defects. Label analysis is key to educating patients about risks of vitamin A-containing supplements. The commentary also suggests the need for more FDA oversight of the dietary supplement industry.

Demographics of Dietary Supplement Use for Skin: An Analysis of NHANES Cross-Sectional Data.

Dietary supplement use is common, with reported use by over half of US adults. This cross-sectional study utilized 2015–2016 National Health and Nutrition Examination Survey data. A total of 9971 respondents were surveyed, of which 3704 reported taking dietary supplements for "healthy skin, hair, and nails." Of those reporting skin supplement use, the majority had health insurance and some college education or above. Many respondents were 19 or younger, were of non-Hispanic White race, had a household income of more than $100,000 per year, and some were pregnant. More than two-thirds of the respondents decided to take the supplements on their own rather than at the advice of a healthcare professional, which is quite alarming. This study helps identify demographic groups more likely to consume skin, hair, and nail supplements. Overall, physicians should educate their patients on dietary supplements to avoid drug-supplement interactions and address the factors that influence the use of over-the-counter skin supplements. J Drugs Dermatol. 2022;21(4):434-436.doi:10.36849/JDD.5744.

Acne Supplements Sold Online.

INTRODUCTION: As no centralized database of acne supplements is available, we aimed to provide an overview of these products, with a focus on safety. OBJECTIVES: The objectives of this study were to document the number, formulation, contents, and marketing strategies utilized by acne supplements sold online. METHODS: An online search was conducted between March and May 2020. Products were included in the study if they used the terms: "whitehead", "blackhead", or "acne". Data were extracted from the website, box, and Supplement Facts label. RESULTS: 49 products were identified, which contained 146 unique ingredients. These included vitamins, minerals, food extracts, botanical extracts, amino acids, animal products, and distinct microbial strains. Few (4.1%) products were tested by third parties. CONCLUSIONS: This survey of acne supplements available online raised concerns regarding lack of warning labels, teratogenicity, exceedingly large levels of vitamins and minerals, and lack of third-party testing. Given the limited regulation and oversight of dietary supplements, it is imperative that physicians educate patients on the potential risks of these products.

Stress and Skin: An Overview of Mind Body Therapies as a Treatment Strategy in Dermatology.

Stress has multiple and wide-ranging physiologic and clinical impacts on skin disease. This has led to an interest in mind body therapies as potential adjunct treatments for skin disease. The stress response results in the activation of the endocrine, neurologic, and immune systems, with a resulting cascade of impacts, that are both systemic and cutaneous. The 2 main arms of the stress response are the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. The resultant release of cortisol, catecholamines, and neuropeptides has multiple effects. Clinically, these have been shown to increase skin inflammation, increase itching, impair skin barrier function, impair wound healing, and suppress immunity. Mind body therapies are those that focus on the interaction between the mind and the body, with the goal to influence physical function and impact health. These have been shown to ameliorate some of the harmful physiologic changes attributed to stress or to reduce harmful behaviors. In some cases, such as with biofeedback, they may also result in beneficial physiologic changes. Treatments such as meditation, biofeedback, hypnosis, guided imagery, and others have been evaluated in the treatment of skin disease and have shown some benefits. Although randomized controlled trials are limited, these interventions have shown beneficial effects on itching, psychosocial outcomes, and even skin severity. These interventions have been evaluated in diseases such as atopic dermatitis, psoriasis, trichotillomania, and others. Given the potential benefits, improvements in psychosocial outcomes, and a low risk profile, referral to qualified practitioners or multidisciplinary clinics should be considered for some patients.

Risk of Birth Defects From Vitamin A "Acne Supplements" Sold Online.

BACKGROUND: Dietary supplements are popular among US consumers and claim to address a variety of conditions, including acne. Acne supplements containing vitamin A are of particular interest, due to the potentially teratogenic effects of vitamin A doses over 10,000 IU. OBJECTIVE: This study examined dosage, pregnancy risks, and labeling of vitamin A-containing acne supplements available online. METHODS: An Internet search of acne supplements sold online was conducted between March and May 2020. Supplement labels and websites were analyzed for vitamin A content and pregnancy warnings, and then divided into categories based on dosage and teratogenic risk. RESULTS: A total of 49 acne supplements was found, and of these 26 (53%) contain vitamin A. Three supplements are likely teratogenic, 4 contain vitamin A doses exceeding the daily level of intake that meets the nutritional needs of most people, and 15 have an unknown teratogenic risk. Among the 6 supplements with over 10,000 IU vitamin A, 2 have no pregnancy warning at all, including the supplement with the highest vitamin A dose found in this study. CONCLUSIONS: Dietary supplements are not subject to the same stringent regulations as drugs, and as such, consumers may be unaware of pregnancy risks. Furthermore, FDA requirements on labeling of vitamin A supplements may lead to consumer confusion regarding dosage. As such, we encourage stricter labeling requirements for vitamin A-containing supplements, including pregnancy warnings for high-dose supplements and clearer dosage labeling.

Risks of Skin, Hair, and Nail Supplements.

Skin, hair, and nail supplements, sometimes referred to as "beauty supplements" or "ingestible skin care," are a large and growing industry. These products may contain vitamins and minerals, sometimes in very high doses. They may also contain herbs, hormones, microbes, or animal derivatives such as fish oils and collagen powders. Dietary supplements are regulated as foods, not as drugs, by the US Food and Drug Administration (FDA). Therefore, manufacturers do not need to provide any proof of safety, efficacy, or quality prior to sale. This is of serious concern, as many adverse effects due to supplement components have been reported. The potential risks cover multiple categories. These include acute toxicities, such as choking, as well as chronic toxicities, such as increased risk of diabetes. Teratogenicity and interactions with drugs and laboratory testing have been documented in research studies. Other risks include potentially increased risk of cancer with long-term use, allergic reactions, and others. It is vital that physicians educate their patients on these risks. As no post-marketing surveillance programs are required for supplements, our understanding of supplement risks is incomplete. Physicians should be wary of these risks and encourage further research and regulation.

Acne related to dietary supplements.

Multiple prescription medications may cause or aggravate acne. A number of dietary supplements have also been linked to acne, including those containing vitamins B6/B12, iodine, and whey, as well as "muscle building supplements" that may be contaminated with anabolic-androgenic steroids (AAS). Acne linked to dietary supplements generally resolves following supplement discontinuation. Lesions associated with high-dose vitamin B6 and B12 supplements have been described as monomorphic and although pathogenesis is unknown, a number of hypotheses have been proposed. Iodine-related acne may be related to the use of kelp supplements and has been reported as monomorphic, inflammatory pustules on the face and upper trunk. Whey protein supplements, derived from milk and used for bodybuilding, are associated with papulonodular acne involving the trunk and sometimes the face. Finally, AAS-induced acne has been described as acne fulminans, acne conglobata, and acne papulopustulosa. With studies indicating that about half of US adults report using dietary supplements, it is important that dermatologists directly ask acne patients about their supplement use and educate them on the potential risks of even seemingly innocuous dietary supplements.

Safety Concerns of Skin, Hair and Nail Supplements in Retail Stores.

BACKGROUND: Dietary supplements promoted for "skin, hair, and nail" health are becoming increasingly popular, although there is a lack of regulatory oversight. As no centralized database or repository for these supplements is available, the aim of this study was to provide an overview of supplements in a sample of retail stores, with a focus on safety concerns. METHODS: Dermatology supplements were defined as those that featured the words "skin", "hair", "nails", "beauty", or "glow" in the product name or tagline. Seven stores including drug, grocery, department, and cosmetics stores were surveyed within a three-mile radius. Data were extracted from the Supplement Facts label of each product. RESULTS: A total of 176 separate supplements were identified, containing a total of 255 distinct ingredients. These included vitamins, minerals, food extracts, botanicals, animal products (collagen, fish oils), amino acids, a hormone, and distinct microbial strains. CONCLUSION: This survey of "dermatology" supplements available in local retailers raised several safety concerns, including potential interactions, teratogenicity risks, a lack of independent third-party testing, lack of warning labels, and nutrient "overdosing". Given limited regulation of dietary supplements, it is imperative that physicians educate patients on the potential risks. These include risks related to supplement ingredients and dosages, as well as risks related to the lack of regulatory oversight. Patients must also be educated about the multiple gaps in our knowledge of dietary supplements, especially in terms of efficacy and long-term safety.

Skin, Hair and Nail Supplements: An Evidence-Based Approach

Dermatology supplements, often marketed as "skin, hair, and nail" supplements, are becoming increasingly popular. However, many consumers lack an understanding of the science of dietary supplements or the specifics of the supplement industry. While certain supplements at the right dose in the right population may prove beneficial, the evidence is sparse for many supplements. In addition, the use of some supplements has resulted in serious adverse effects. From a regulatory standpoint, the US FDA recognizes dietary supplements as foods. This distinction has multiple ramifications, including the fact that manufacturers do not need to prove efficacy, safety, or quality prior to sale. Therefore, physicians and consumers must evaluate each supplement ingredient and formulation individually. This article outlines an evidence-based approach to assess dermatology supplements. As a starting point, all supplements should be evaluated for PPIES: purity, potency, interactions, efficacy, and safety.

Diet and eczema: a review of dietary supplements for the treatment of atopic dermatitis.

In the context of increasing popularity of "natural" alternatives to conventional medicine, several dietary supplements have gained the attention of researchers and consumers alike in the treatment of atopic dermatitis (AD). Readily available without a prescription and frequently perceived to have fewer side effects than traditional medications, these "natural" remedies may be featured in discussions with patients, and clinicians should therefore be familiar with their efficacy and safety. Based on trials to date, no dietary supplements can be recommended for routine use in the treatment of AD. However, some promising results have been noted from the use of probiotics and prebiotics taken in combination. Given significant differences in study design to date, however, further studies would be needed to clarify dose and strains of probiotics. Studies of vitamin D have been limited and have produced conflicting results, although further trials in selected subsets of patients may be indicated. Very limited data is available on fish oil supplements, while future studies on Chinese herbal medicine would require evaluation of comparable herbs and formulations. Finally, multiple trials of evening primrose oil and borage seed oil have shown improvement similar to placebo, and neither is currently recommended in eczema therapy.

Complementary and alternative medicine in dermatology: an overview of selected modalities for the practicing dermatologist.

According to survey data, 35-69% of patients with skin disease have used complementary and alternative medicine (CAM) in their lifetime. A literature search on this subject reveals a number of studies on the efficacy of CAM treatment for dermatologic conditions, as well as a number of articles showing the growing prevalence of CAM use amongst patients suffering from these conditions. Given the consensus amongst these articles that dermatologists require increased education on CAM, this paper presents an overview of some of the most widely used systems of alternative medicine to serve as a tool for practicing dermatologists. Specifically, the history and theory behind psychocutaneous therapies, traditional Chinese medicine (including acupuncture), homeopathy, and Ayurvedic medicine will be described, along with current evidence for their efficacy and reports of their adverse effects. The authors conclude that more evidence and better studies are needed for each of the major CAM modalities before they may be considered as independent therapeutic options. Moreover, given the shortage of evidence supporting the efficacy and safety of CAM, dermatologists should obtain a thorough history of CAM use from their patients. In general, ingestible substances including most homeopathic, Ayurvedic, and traditional Chinese medicine herbal formulations that are not US FDA regulated should be viewed with caution as they may cause severe adverse effects such as arsenicosis and hepatotoxicity. On the other hand, less invasive techniques such as acupuncture and psychocutaneous therapies may be more acceptable given their low-risk profile. Ultimately, until the availability of more sound data, these treatments should primarily be used in combination with conventional treatment and rarely independently.

Irritant contact dermatitis from plants.

Irritant contact dermatitis (ICD) from plants is a very common phenomenon as potentially irritant plants and plant products are commonly found in the everyday environment, including the home, garden, workplace, and recreational setting. It is therefore essential to have a basic understanding of the various plant-derived physical and chemical irritants. ICD from plants is commonly divided into mechanical irritant contact dermatitis (MICD) and chemical irritant contact dermatitis (CICD). The common mechanical plant irritants include thorns, spines, glochids, trichomes, and sharp-edged leaves. Many chemical irritants have yet to be elucidated, but known culprits include calcium oxalate, protoanemonin, isothiocyanates, bromelain, diterpene esters, alkaloids, and other chemical irritants such as naphthoquinone and acids. This review details the major plant contributors to MICD and CICD, along with their respective irritants. The clinical presentations seen in ICD (versus other plant dermatoses) will also be described, along with diagnostic considerations and exposure data. We also review mechanisms for the development of ICD and current treatments for ICD from plants.

Common misconceptions in contact dermatitis counseling.

Both physicians and patients hold many misconceptions when it comes to allergen avoidance. Ten commonly held misconceptions are exposed, allowing more accurate approach to the individual with cutaneous allergies.