An analysis of keloid patient questions on Reddit.

Reddit is one of the world's leading social media platforms, fostering active community discussions on a variety of topics including keloids. The prevalence and reach of conversations on Reddit underscore the need to investigate and understand patient perspectives and gaps in knowledge. Herein, we present an in-depth analysis of questions and concerns of Reddit users on keloids, offering valuable insights into patient experiences, knowledge gaps and treatment preferences. The study presents a distinct approach by harnessing the power of social media data to understand patient perspectives, which may not be readily apparent in clinical settings. All posts on the 'Hot' page of the subreddit r/Keloids were analyzed. Questions were categorized and subcategorized to reveal common themes. A total of 644 questions from 513 posts between 26 March 2017 and 28 August 2023 were identified and analyzed. Reddit users most frequently asked questions regarding keloid management (57.5%). Other common categories included uncertainty regarding diagnosis or symptoms (15.1%), living with keloids (7.5%) and causes or triggers (6.2%). This analysis highlights critical areas of patient knowledge gaps and potential misconceptions regarding keloids. For dermatologists, understanding these patient questions is crucial. Such insights allow for patient-centric education and treatments, ensuring more effective and comprehensive care.

Photobiomodulation CME part I: Overview and mechanism of action.

Photobiomodulation (PBM), previously known as low-level laser light therapy, represents a noninvasive 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 nondermatologic 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 (eg, 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 (eg, 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.

An Analysis of Dermatology-Related Red-Light Therapy Patient Questions on Reddit.

BACKGROUND: Reddit is one of the world's most popular social media platforms and is increasingly used as a health information resource for patients on topics such as red-light (RL) therapy. OBJECTIVE: In this article, the authors present an analysis of prevalent patient questions and concerns regarding RL therapy. METHODS: All posts on the "Hot" page of the r/redlighttherapy subreddit were analyzed and categorized. RESULTS: A total of 930 questions from 664 posts were analyzed. The most commonly asked question category was related to product recommendations or feedback (29.7%), followed by usage instructions (15.3%), safety and side effects (12.6%), and indications and efficacy (12.3%). CONCLUSION: Understanding patient concerns and questions about RL, as expressed on online platforms like Reddit, can help clinicians improve patient satisfaction, education, and clinical outcomes. The study offers an innovative approach by using social media to uncover valuable patient insights that might not be easily observable within clinical settings.

Inverse Eruptive Syringoma in a Skin of Color Patient.

Syringomas are benign neoplasms derived from eccrine sweat glands. Eruptive syringomas are a subtype of syringomas and are typically located on the chest, neck, and abdomen during puberty or childhood. Herein, we present a 20-year-old African American female with an atypical case of eruptive syringomas, characterized by an unusual distribution on her chest, abdomen, and anterior and posterior bilateral extremities. This case underscores the importance of recognizing diverse presentations of skin conditions in patients with skin of color and adds to the limited reports of eruptive syringoma in these populations. We present and emphasize this atypical manifestation of eruptive syringomas in an individual with darker skin to promote awareness and improve diagnosis and patient outcomes.J Drugs Dermatol. 2024;23(7):564-566. doi:10.36849/JDD.8103.

The Importance of Photoaging Prevention in All Skin Types: An Update on Current Advancements.

Light from across the electromagnetic spectrum, including ultraviolet, visible, and infrared light, can cause detrimental cutaneous effects including photocarcinogenesis and photoaging. Traditional and broad-spectrum sunscreens offer protection against ultraviolet radiation. However, visible and infrared light may not always be covered by traditional sunscreens. These forms of solar radiation have been shown to cause photodamage and may have particular importance in the effects induced in skin of color. This article aims to review the mechanisms of photoaging from various light forms, the implications of these damaging effects on skin of color, and innovative approaches that can advance the way patients practice photoprotection. We will expand upon the latest innovations in photoprotection that hold the potential to increase patient adherence and improve skin health across all skin types. J Drugs Dermatol. 2024;23(1):1306-1310.   doi:10.36849/JDD.7255.

Updates on the Molecular Basis of Photoaging in All Skin Types.

Photoaging is a complex, ongoing process that clinically manifests as cutaneous rhytides, atrophy, laxity, dyspigmentation, telangiectasias, roughness, and mottled appearance of the skin. There is an abundance of research establishing the mechanism of ultraviolet (UV) - induced photodamage as it is a significant source of photoaging and skin cancers. While UV damage is known to induce photoaging, it is important to understand how other forms of light radiation also contribute to this process. UV only constitutes 5 to 10% of solar radiation that reaches the earth's surface. The remaining nearly 90% is evenly split between infrared and visible light radiation. Early research shows that varied skin types may elicit different photobiologic responses to light. This article presents the mechanisms and biomarkers of photodamage induced by light from across the spectrum, including UV, visible light, and infrared to better prevent and reverse the damage of photoaging in all skin types.J Drugs Dermatol. 2024;23(7):504-509.  doi:10.36849/JDD.7438.

Sunscreen Practices and Preferences of Skin of Color Patients.

Sunscreen is an essential way to protect against photodamage from ultraviolet (UV) radiation. Despite the recognized benefits of sunscreen in preventing skin damage from UV light, its use varies across different patient groups. This cross-sectional, questionnaire-based study aims to uncover the sunscreen usage patterns, preferences, and barriers among non-Hispanic White (NHW) and skin of color (SOC) individuals. Our findings demonstrate that NHW individuals are more likely to wear sunscreen daily (31% NHW vs 25% SOC) and reapply sunscreen at least once a day (76% NHW vs 45% SOC) compared with SOC individuals. SOC individuals demonstrate a willingness to use sunscreen, but they face barriers such as cost (2% NHW vs 16% SOC), lack of knowledge in finding suitable products (22% NHW vs 41% SOC), and concerns about white cast (7% NHW vs 25% SOC). SOC individuals are less likely to know the difference between mineral and chemical sunscreen (49% NHW vs 29% SOC), less likely to learn about sunscreen from dermatologists (36% NHW vs 22% SOC), and more likely to prefer sunscreen from brands owned by people of color (13% NHW vs 47% SOC).  In addition to analyzing the broader categories of NHW and SOC, subgroup analysis was conducted on specific subgroups, including Black, Asian, and Hispanic groups. Herein, we highlight differences in motivations, sunscreen preferences, sources of information, and knowledge levels about sun protection between NHW and SOC individuals. By uncovering the unique needs and challenges faced by SOC individuals, we aim to improve culturally competent patient education and promote effective sun protection practices across diverse populations. J Drugs Dermatol. 2024;23(6):456-462.     doi:10.36849/JDD.8268.

Investigating the Relationship Between Acne and Vasodilatory Medications in a Hospital-Wide Adult Population.

Acne vulgaris is a common chronic dermatological condition characterized by obstruction and inflammation of pilosebaceous units. Recent research on a different dermatologic condition has demonstrated that the use of vasodilatory medications is associated with a decreased relative risk of rosacea. This finding is significant due to the overlapping inflammatory pathways involved in rosacea and acne. Herein, a retrospective cohort study was designed to determine the correlation between vasodilator usage and the risk of developing acne within 5 years, contrasting it with thiazide diuretics, chosen as a control due to its non-vasodilatory antihypertensive mechanism and availability of data. Angiotensin-converting enzyme (ACE) inhibitors (RR, 0.775; 95% CI, 0.727-0.826; P<0.05), angiotensin receptor blockers (ARBs) (RR, 0.739; 95% CI, 0.685-0.797; P<0.05), beta-blockers (BB) (RR, 0.829; 95% CI, 0.777-0.885; P<0.05), and calcium channel blockers (CCB) usage (RR, 0.821, 95% CI, 0.773-0.873; P<0.05) were associated with a significantly lower risk of developing acne within 5 years of initiating therapy compared to thiazide diuretics. It is unclear if thiazide diuretics are more likely to cause acne within the adult population or if vasodilators are protective against the development of acne. Finding mechanisms and therapeutics that lower the risk of developing acne is of significant public health interest, and this study provides a step toward this endeavor. Further research is required to uncover the underlying mechanisms for this reduction in the development of acne.  J Drugs Dermatol. 2024;23(6):446-449.     doi:10.36849/JDD.8362.

Racial and ethnic underrepresentation in dermatology clinical trials.

BACKGROUND: Including participants of diverse racial and ethnic populations in clinical trials is important to reduce disparities and promote health care equity. OBJECTIVE: To evaluate racial and ethnic representation in dermatology clinical trials. METHODS: Participant data from dermatology trials completed in the United States from 2017 to 2021 from ClinicalTrials.gov were compared to census data to determine if minority groups were represented at rates that reflect population demographics. Participation was compared with prevalence rates for the most underrepresented racial group. RESULTS: Of 246 trials that met inclusion criteria, 87.4% (215) reported racial data. Compared to census data, Black/African American, American Indian/Alaskan Native, and 2 or more races were underrepresented. Hispanic or Latinos were an underrepresented ethnic group. LIMITATIONS: The search was limited to ClinicalTrials.gov registered studies that fell within search parameters. Race reporting methods were not specified. Detailed analysis was only performed for the most underrepresented racial group. CONCLUSION: Certain minority groups were underrepresented in dermatology trials. Black/African Americans were most underrepresented and underrepresented even when accounting for prevalence rates. Trial representation that accurately reflects population demographics and subgroup prevalence rates can help reduce health inequity, improve clinical understanding, and enhance treatment access for the growing diverse population.

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.

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.

The Association Between Herpes Simplex Virus and Alzheimer's Disease: A Systematic Review.

Alzheimer's disease (AD) is a significant public health concern, affecting more than 6 million Americans; and currently, there are no cure or effective treatment options. The underlying etiology and pathogenesis are not fully understood, presenting a barrier to therapy. A substantial amount of data exists associating infection with Herpes simplex virus 1 (HSV-1) and AD. This review of published studies highlights the epidemiological associations between HSV-1 and AD. A systematic search of PubMed, Embase, and Web of Science was conducted on January 6, 2022, using PRISMA guidelines. Articles that presented epidemiological data correlating HSV-1 with AD were included. Bibliographies were screened for additional relevant articles as well. After review, 21 studies were included: 2 review articles and 19 population-based studies including case control, cohort, and cross-sectional studies.  The quantitative data derived from the studies in this report substantiate a relationship between infection with HSV-1 and AD. Based on these results, it may be of reasonable benefit to more consistently treat latent or active HSV-1 infection with anti-viral medications to potentially reduce the risk of AD. Furthermore, a prospective randomized controlled clinical trial could elucidate the benefit of anti-viral therapy to prevent or limit AD.J Drugs Dermatol. 2023;22(10):1046-1052     doi:10.36849/JDD.6785.

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.

The Role of Hormone Therapy in Female Aesthetic Rejuvenation.

Hormones are intricately involved in age-related aesthetic changes. Declining levels of several hormones in the postmenopausal period are associated with unwanted changes in appearance, including weight gain, fat redistribution, aged skin, and hair thinning. Hormone therapies may prevent or reverse these changes. In this article, we explore the role of estrogen, progesterone, testosterone, dehydroepiandrosterone, and melatonin in female aesthetics. Based on our current understanding of the literature, dermatologists may safely and efficaciously incorporate several hormone formulations in their repertoire of treatments for female aesthetic rejuvenation. J Drugs Dermatol. 2022;21(9):954-960. doi:10.36849/JDD.6232.

Combination Facial Aesthetic Treatment in Millennials.

BACKGROUND: There is growing demand for minimally invasive cosmetic procedures in the millennial population, with botulinum toxin and dermal fillers among the most popular products. OBJECTIVE: To evaluate patient satisfaction and psychosocial impact of multimodal aesthetic treatment in a millennial cohort. METHODS AND MATERIALS: In this single-center, prospective, rater-blinded, pilot study, 20 millennial participants received a samevisit combination facial aesthetic treatment using botulinum toxin and dermal fillers, with an optional botulinum toxin touch-up at 2 weeks. Assessments were conducted at baseline and 2 months post-treatment. The primary endpoint was change in satisfaction with overall facial appearance post-treatment. Secondary endpoints included changes in satisfaction with various facial areas, social and psychosocial functioning, self-perceived age, and blinded clinician assessment. RESULTS: Participants reported significantly greater satisfaction with overall facial appearance 2 months post-treatment when compared to pre-treatment (P<0.001). Participants self-reported numerous improvements in appearance, including greater satisfaction with various properties of the lips, cheeks, and overall facial lines, self-perceived age, and social and psychological functioning. CONCLUSION: Combination botulinum toxin and dermal filler treatment is a safe and effective means of improving millennial satisfaction with overall facial appearance and various facial areas, decreasing self-perceived age, and improving aspects of psychosocial functioning. J Drugs Dermatol. 2022;21(1)37-42. doi:10.36849/JDD.6425.

Analysis of Reddit Reveals Dupilumab Questions Among Atopic Dermatitis Patients.

BACKGROUND: Atopic dermatitis patients are turning to social media to seek guidance and source medical information. Reddit, the seventh most visited website in the US, contains the popular "eczeMABs" subreddit, a forum dedicated to discussing monoclonal antibody therapy for atopic dermatitis. OBJECTIVE: To uncover atopic dermatitis patients' dupilumab-related information needs. METHODS: The authors analyzed all questions posted on the "eczeMABs" subreddit. Each question was then separated into categories and subcategories for analysis. RESULTS: 262 questions from 189 posts were analyzed. The greatest proportion of questions was related to side effects (36.3%), with patients most frequently inquiring about flares (25/95), ocular effects (17/95), and dry skin (10/95). Usage instructions (13.4%) and general experience (8.0%) were common question categories as well. LIMITATIONS: The questions of the "eczeMABs" subreddit subscribers may not reflect the questions of all atopic dermatitis patients. CONCLUSION: Reddit provides valuable insight into atopic dermatitis patient gaps in knowledge regarding dupilumab therapy. Physicians can use this knowledge to better address the information needs of patients, potentially leading to better outcomes and more informed, empowered patients. J Drugs Dermatol. 2022;21(3):292-294. doi:10.36849/JDD.5942.

SUPPLEMENT ARTICLE: Scientific and Clinical Insights into the Facial Application of Mineralizing Volcanic Water.

BACKGROUND: The term "exposome" describes the totality of exposures an individual is subjected to from conception to death. Both internal and external exposome factors affect skin health. External exposures that contribute to facial skin aging include solar radiation, air pollution, tobacco smoke, and unbalanced nutrition. The review explores scientific and clinical insights into the exposome impact on facial skin aging and topical mineralizing volcanic water use potential benefits. METHODS: An expert panel of seven dermatologists and two clinical researchers specializing in aesthetic and dermatological indications reviewed and discussed the literature on the exposome and mineralizing volcanic water's role in relation to the exposome. Two virtual advisory boards were conducted between February and May 2021. Following the meetings, an additional systematic literature review explored publications relevant to the exposome, topical essential minerals, and skin health. The results of the two advisory boards, coupled with expert opinion and the outcome of the updated systematic literature review, informed the statements on which the advisors reached a consensus. CONCLUSIONS: A combination of in vivo, in vitro, and clinical data on topical mineralizing volcanic water application indicates that the serum supports the skin's antioxidant defenses and reduces skin inflammation. Additionally, the serum may have benefits as an adjunct for facial dermatoses and post-procedural skincare. J Drugs Dermatol. 2022;21:4(Suppl 1):s3-10.

Skin of Color Skin Care Needs: Results of a Multi-Center-Based Survey.

Targeted marketing and media may serve as potential sources of health information for consumers, influencing knowledge, practices, perception, and utilization of health care services. In addition to this vulnerable consumerism, there are barriers to healthy consumerism including exposure to different sources or lack thereof, lack of knowledge, inadequate transportation, or proximity to stores, cost, and marketing of products that are not suitable for all skin types. We conducted a multi-center “Skin of Color Skin Care Needs” survey to characterize the skin care practices, concerns, and habits of both persons of color and non-Hispanic whites to evaluate barriers and influences on product choice and behaviors in these populations. One hundred and twenty-one respondents (74%) self-identified as a nonwhite racial group, while 31 respondents (19%) self-identified as non-Hispanic white. The top skincare concerns in the skin of color population were acne and blemishes (40%), dry skin (32%), and pigmentation/dark spots (26%). In the non-Hispanic white population, the top concerns were fine lines and wrinkles (42%), followed by acne and blemishes (39%), and dry skin (26%). When questioned about barriers respondents faced in discovering and using dermatologic products, SOC respondents were more likely to cite lack of available products for their skin type (11%), as compared to white respondents (0%). Skin of color respondents identified internet (42%) and social media (29%) as major sources of information regarding dermatologic products as compared to white respondents (26% and 13%, respectively). Health care disparities can be heightened by targeted marketing and the media, which have a major impact on patient health literacy and consumer choices. Dermatologists should be aware of this impact in order to address the knowledge gaps, minimize bias, and increase inclusivity for all skin types. J Drugs Dermatol. 2022;21(7):709-711. doi:10.36849/JDD.6557.

2020 IDEOM Annual Meeting: Actinic Keratosis Stakeholders Survey Identifies Gaps in Research and Care.

This is a report of the survey results from the International Dermatology Outcome Measures (IDEOM) actinic keratosis (AK) workgroup. The purpose of the survey was to compile a list of gaps within AK care and management that require refinement. The results were discussed at the IDEOM annual meeting held virtually on October 23–24, 2020. This built a framework with which the AK workgroup, which consisted of physicians, patients, and pharmaceutical scientists, discussed at length in their breakout session at the meeting. The electronic survey was distributed to patients, pharmaceutical scientists, and leading physician experts in the field via email on September 22, 2020, with a deadline of October 2, 2020. The survey consisted of three open-ended prompts concerning key gaps and/or unmet needs in (1) the care of AKs, (2) outcome measurement of AKs in clinical trials and, (3) the measurement of AKs in clinical practice. The results were qualitative, with a response rate of 47%. Responses included reform of outcome measures for clinical trials, a methodology for evaluating the efficacy of preventative measures, and a comparison of treatments to establish a treatment protocol, among other efforts. This paper will also provide a brief overview of the current state of the AK outcome measures, emphasizing the heterogeneity of the measures and detailing the AK workgroup's future efforts to create a reliable and applicable core outcome measure set. J Drugs Dermatol. 2022;21(2):128-134. doi:10.36849/JDD.6360.