Immunohistochemical and Histopathological Characterization of Spina Bifida Defect Tissues Removed After Prenatal and Postnatal Surgical Repair.

Background: Myelomeningocele or spina bifida is an open neural tube defect that is characterized by protrusion of the meninges and the spinal cord through a deformity in the vertebral arch and spinous process. Myelomeningocele of post-natal tissue is well described; however, pre-natal tissue of this defect has no known previous histologic characterization. We compared the histology of different forms of pre-natal myelomeningocele and post-natal myelomeningocele tissue obtained via prenatal intrauterine and postnatal surgical repairs. Methods: Pre-and post-natal tissues from spina bifida repair surgeries were obtained from lipomyelomeningocele, myeloschisis, and myelomeningocele spina bifida defects. Tissue samples were processed for H&E and immunohistochemical staining (KRT14 and p63) to assess epidermal and dermal development. Results: Prenatal skin near the defect site develops with normal epidermal, dermal, and adnexal structures. Within the grossly cystic specimens, histology shows highly dense fibrous connective tissue with complete absence of a normal epidermal development with a lack of p63 and KRT14 expression. Conclusion: Tissues harvested from prenatal and postnatal spina bifida repair surgeries appear as normal skin near the defect site. However, cystic tissues consist of highly dense fibrous connective tissue with complete absence of normal epidermal development.

Psychology of aesthetics: Beauty, social media, and body dysmorphic disorder.

The perception of beauty is fluid within society and can morph based on cultural practices and societal interaction, such as social media exposure. The exposure to digital conference platforms has increased significantly, leading users to check their appearance constantly and find flaws in their perceived virtual appearance. Studies have shown that frequent social media use may lead to unrealistic body image ideals, a significant concern with appearance, and anxiety. Also, social media exposure can worsen body image dissatisfaction, social networking site addiction, and comorbidities of body dysmorphic disorder (BDD) such as depression and eating disorders. Additionally, excessive social media use can increase preoccupation with imagined image defects among BDD patients leading them to pursue minimally invasive cosmetic and plastic surgery procedures. This contribution aims to provide an overview of the evidence surrounding the perception of beauty, cultural aspects of aesthetics, and social media's consequences, especially on BDD's clinical specifics.

Shifting the Standard of Beauty: Beginning of the Body Inclusive Model.

BACKGROUND: While the American standard of beauty idolizes unattainable thinness, social media exposure has been instrumental in crafting a more inclusive perception of beauty. METHODS: Using several websites with public data on models, we gathered body measurements and characteristics of both plus-size and the overall top 10 paid mainstream models. We then collected social media data for these models using the social media analytics tool called Social Blade. We compared social media data between plus-size and mainstream models. RESULTS: While plus-size models have increased BMI, the waist/hip ratio was 0.74 on average, compared to 0.71 in mainstream models. The average social media following among the top 10 plus-size models was 3.8 million compared to 38 million amongst the top 10 mainstream models (p = 0.039). There was no significant difference between the average likes per post, average comments per post, and total posts between the top mainstream models and top plus-size models (p-values 0.11, 0.12, and 0.15, respectively). CONCLUSION: With the changing societal body image in America, plus-size models have gained in popularity and positively impacted a body-inclusive model of beauty. However, the mainstream model still prevails as the social media powerhouse of influence.

Social Media as a Medium for Dermatologic Education.

Purpose of Review: We explore the utility of social media platforms as educational tools in dermatology, providing a summary of how these sites are used by the public and dermatologists alike, and demonstrating ways these findings may be applied for educational purposes. Recent Findings: Over half of the world's population utilizes social media platforms. More recently, these platforms have increasingly been used for educational purposes. In the field of dermatology, a large portion of the educational content is coming from users with no formal medical or dermatologic training. Summary: Each of the top five social media platforms in the world (Twitter, Instagram, TikTok, YouTube, and Facebook) has unique qualities which people may utilize to educate fellow users. As more of the population seeks online health information and education, it is important that dermatologists, while taking ethical considerations into account, become more comfortable facilitating educational content on social media.

Type III cutaneous atypical meningioma of the scalp.

Meningiomas occur rarely in extracranial sites, including the skin, where they may pose a diagnostic challenge because of their histopathologic overlap with several other spindle-cell tumors. Cutaneous meningiomas are divided into type I (congenital), type II (ectopic), and type III (via direct extension) lesions. We present a rare case of atypical meningioma of the skin in a 71-year-old woman who presented with a painful and enlarging lesion on the left central frontal scalp. Biopsy showed bone and soft tissue with involvement of a spindle cell neoplasm, consisting of whorled nests with atypical features, including variably increased mitotic index, areas of hypercellularity, and sheeted architecture. The overall findings were consistent with an atypical meningioma (World Health Organization grade 2). Atypical meningiomas constitute only 5% to 15% of all meningiomas. Magnetic resonance imaging of the skull later demonstrated a left frontal tumor consistent with an atypical meningioma that had eroded through the skull. Dermatopathologists should consider cutaneous meningioma as a differential diagnosis of spindle-cell neoplasms of the skin and subcutaneous tissue in head and neck.

Emerging topical therapies to treat pigmentary disorders: an evidence-based approach.

BACKGROUND: Hyperpigmentation disorders are commonly encountered in dermatology clinics. The use of prescription-grade and over-the-counter topical lightening agents has increased in popularity, leading to a substantial growth of research over the past decade. OBJECTIVE: We seek to review clinical studies evaluating the use of different Rx-grade and OTC ingredients in treating hyperpigmentation. METHODS AND MATERIALS: A comprehensive search on PubMed was conducted to identify patient-based evidence on the most common ingredients used as topical lightening agents: arbutin, ascorbic acid, cysteamine, hydroquinone, kojic acid, niacinamide, retinoids, and triple-combination therapy. The topicals were classified as either prescription-grade or over-the-counter. RESULTS: Varying levels of evidence support the use of topicals in treating hyperpigmentation. There were more clinical trials examining Rx-grade products than OTC products. Mild but tolerated side effects are noted in many of these agents. CONCLUSION: Careful monitoring and adjustment of doses will be needed to maximize skin lightening benefits and minimize side effects.

Indoor tanning: Evidence surrounding advertised health claims.

Indoor tanning continues to remain common, despite evidence of an increased risk of skin cancer from artificial ultraviolet (UV) radiation. In the hopes of gaining customers, the tanning bed industry has marketed health benefits of indoor tanning such as increased vitamin D production, development of a base tan, enhanced mood, and treatment of certain dermatologic conditions. To better educate their patients, providers need a comprehensive reference reviewing the evidence that support or oppose these claims. In this work, we conducted an evidence-based review of the literature to identify and grade studies that investigate health claims related to UV exposure. Results indicate that there is little evidence to support each of these proposed health benefits. Tanning beds emit primarily UVA radiation, which is relatively ineffective at activating vitamin D or mood enhancing pathways, and the effects are minimal in regard to tanning beds generating a protective base tan or treating dermatologic conditions compared with the increased risk of skin cancer. Health care providers must continue to warn and educate patients about the misleading information propagated by the tanning bed industry as well as about the dangers of artificial UV radiation.

Social Media and Clinical Research in Dermatology.

PURPOSE OF REVIEW: The immense growth of social media has afforded new opportunities in dermatology clinical research. This review serves to outline how social media has impacted clinical research and to explore future avenues for which social media can make a significant impact in dermatology clinical research. RECENT FINDINGS: Recent clinical trials augmented by social media have demonstrated increased participant enrollment, shortened recruitment timelines, and decreased recruitment cost. The incorporation of social media into clinical research has also afforded greater access to teledermatology and the initiation of virtual clinical trials. SUMMARY: Clinical research serves as a primary source of evidence for refining healthcare practices by expanding the understanding of patient demographics, methods for improving patient care, and new therapeutic discoveries. Since its initiation, social media has played an integral and ever-expanding role in clinical research.

Social Media and Ethical Challenges for the Dermatologist.

Purpose of Review: The purpose of review is to provide guidance on the use of social media within the context of dermatology and discuss its ethical, professional, and legal implications in education, mentorship, networking, business, and clinical settings. Recent Findings: Despite its fundamental value as a means of communication and knowledge sharing, social media carries legal, ethical, and professional challenges. Healthcare providers have run into issues such as misinformation, conflicts of interest, and overstepping patient-physician boundaries when using social media. An interesting finding is that dermatologists commonly engage with an online audience through social media marketing or being an influencer to improve business and extend their reach to clients; however, this warrants formal training and the need to monitor their own online presence to prevent legal consequences. Summary: Social media has become integral in everyday life; billions of people now receive information and stay connected with each other through social platforms. Within medicine, social media has enhanced various aspects of healthcare, such as professional networking, patient care, and patient education. In dermatology, social media allows dermatologists to promote their businesses and services through patient testimonials, posting advice on blogs, and networking with a large audience of potential patients. However, having a social media presence must be exercised with care, purpose, and transparency to maximize benefits and minimize harmful consequences. This is especially important when inappropriate social media posts by physicians can be scrutinized for breaching patient confidentiality, violating privacy, financial conflicts of interest, and possibly disseminating incorrect information.

Commonly Used Over the Counter Therapies for Hair Growth in Skin of Color: An Evidenced-Based Review.

BACKGROUND: Given the immense psychosocial effects of hair loss as well as patient preference for treatment type, it is common for patients to turn to alternative medicine to improve their conditions. However, the commonly used alternative treatments can vary greatly between patients and particularly among skin of color populations. OBJECTIVE: In this work, we performed a scoping review of the evidence behind alternative topical treatments for hair loss used by skin of color patients. Methods & Materials: We conducted a comprehensive search using PubMed to identify relevant studies. RESULTS: Results show a diverse variety of hair growth products used; however, only a few are supported by randomized controlled trials, case reports, pilot studies, and animal studies with some important limitations. CONCLUSION: This information will be exceedingly useful for physicians so they may relay accurate evidence on these haircare practices to their skin of color patients. J Drugs Dermatol. 2021;20(7):726-731. doi:10.36849/JDD.5689.

Scoping Review of Therapeutic Strategies for Keloids and Hypertrophic Scars.

BACKGROUND: Keloids are an abnormal proliferation of scars that can involve large areas of tissue beyond the original injury site. Hypertrophic scars are similar clinically, but do not exceed the original scar limits. These scarring abnormalities can cause noxious symptoms such as pain, tenderness, itching, and ulcerations. The aim of this review is to discuss current therapies for both types of abnormal scarring, and to determine if guidelines can be provided for excisional treatment with adjuvant therapies versus non-excisional methods. METHODS: A systematic literature search was performed through the Web of Science database. The search revolved around keywords such as "keloid," "hypertrophic scars," and "treatment." Articles were reviewed and screened for inclusion and exclusion criteria. The review focuses on an analysis and summarization of randomized control trials regarding keloid or hypertrophic scar treatments. RESULTS: The original searches produced 1161 and 1275 articles for keloid and hypertrophic scars, respectively. In total, 316 duplicates were found. After accounting for 2014-2019 publication time, 655 keloid and 893 hypertrophic scar articles were reviewed. This resulted in 15 articles that pertained to treatment and randomized control trials. CONCLUSIONS: Keloids and hypertrophic scars present a clinical challenge. Based on qualitative review of recurrence, neither excision plus adjuvant therapy or nonsurgical treatments can be recommended preferentially at this time. More research is needed to determine if recurrence rate bias exists between the treatment regimens, as excisional treatment plus adjuvant therapy is reserved for refractory scars.