A Novel Systems-Wide Approach in Addressing Acne with a Multi-Targeting Nutraceutical.

Acne vulgaris (AV) is one of the top concerns dermatologists encounter from women. Until now, therapies addressing AV have largely centered around, and have been successful at, targeting the pathophysiological mechanisms that occur at the pilosebaceous unit: sebum hypersecretion, follicular keratinization, over-proliferation of Cutibacterium acnes, and a localized immune response. In addition to these, there is good evidence to suggest that other systemic drivers of a generalized inflammatory response may contribute to the development or exacerbation of acne and that addressing these underlying factors may open more opportunities for developing effective treatments. These include psycho-emotional stress, diet and metabolism, hormonal fluctuations, skin and gut microbiome, oxidative stress, and immune response. While there is accumulating evidence that vitamins, minerals, and botanicals may mitigate some of the pro-inflammatory effects from the activation of these underlying systems, their use and recommendations are limited by a lack of quality efficacy and safety evidence. Here, we present the current evidence for the use of individual supplements in addressing the 6 systemic underlying drivers of AV. We also present a clinical study on the safety and efficacy of a nutraceutical combining many of these ingredients in the management of AV in men and women.  J Drugs Dermatol. 2024;23(3):160-167     doi:10.36849/JDD.8138.

Treatment for central centrifugal cicatricial alopecia-Delphi consensus recommendations.

BACKGROUND: There is no established standard of care for treating central centrifugal cicatricial alopecia (CCCA), and treatment approaches vary widely. OBJECTIVE: To develop consensus statements regarding the use of various pharmacological therapies in treating adults with CCCA. METHODS: We invited 27 dermatologists with expertise in hair and scalp disorders to participate in a 3-round modified Delphi study between January and March 2023. Statements met strong consensus if 75% of respondents agreed or disagreed. Statements met moderate consensus if 55% or more but less than 75% agreed or disagreed. RESULTS: In round 1, 5 of 33 (15.2%) statements met strong consensus, followed by 9 of 28 (32.1%) in round 2. After the final round 3 meeting, strong consensus was reached for 20 of 70 (28.6%) overall statements. Two statements achieved moderate consensus. LIMITATIONS: This study included only English-speaking, US-based dermatologists and did not consider nonpharmacological therapies. CONCLUSION: Despite varying opinions among dermatologists, consensus was reached for several statements to help clinicians manage CCCA. We also highlight areas that lack expert consensus with the goal of advancing research and therapeutic options for CCCA.

Promoting a Healthy Skin Barrier Using Skin Care in People With Mature Skin Xerosis.

INTRODUCTION: Most people are living into their sixties and beyond. Fundamental changes in chronologically aged skin have significant and widespread dermatological implications. This review discusses aging-associated alterations in epidermal function leading to xerosis and related pruritus and the benefits of maintaining or restoring a healthy skin barrier using skincare, specifically ceramide-containing skincare.   Methods: A panel of 7 dermatologists convened for a meeting to review aspects of xerosis in mature skin, skin barrier changes, and nuances in the treatment and maintenance of mature skin using gentle cleansers and moisturizers. From the selected literature, 13 statements were drafted. During the meeting, the draft statements underwent the panel's evaluation at a workshop, followed by a plenary discussion adopting 5 statements using evidence from the literature coupled with the panel's opinions and experiences. RESULTS: The exact etiology of xerosis is not entirely understood and likely depends on several genetic and environmental mechanisms. Aging-associated changes in epidermal function include a marked reduction in total lipids in the stratum corneum relative to young skin due to reduced epidermal lipid synthesis. In aging skin, xerosis is significantly associated with pruritus. Studies have shown that lipid-containing skin care, such as a gentle ceramide-containing cleanser and moisturizer, promotes a healthy barrier reducing xerosis and pruritus in individuals with mature skin.  Conclusions: The development of xerosis in mature skin involves several genetic and environmental mechanisms. Skincare, including gentle cleansers and moisturizers, has reduced xerosis and pruritus in mature skin individuals.     J Drugs Dermatol. 2024;23(1):1253-1259.     doi:10.36849/JDD.7560.

Skin tone representation in dermatologic direct-to-consumer advertisements: a cross-sectional analysis and call to action.

Background: Direct-to-consumer advertisements (DTCAs) in medical marketing serve as a prominent modality to deliver information to an increasingly diverse audience of consumers and increase prescription sales. In dermatology, advertisements have the potential to shape the public's opinions, aid in the understanding of skin conditions, and raise awareness of available treatments. Objective: To investigate and characterize the representation of skin tones in DTCAs. Methods: Nielsen ratings were utilized to identify the networks most watched by Black viewers in 2022. Programming on NBCUniversal, ABC, CBS, and FOX that aired in the District of Columbia, suburban Maryland, and Northern Virginia from June 2022 to July 2022 was reviewed for DTCAs. DTCAs were then analyzed to determine the skin tones of models and skin conditions depicted on models with darkly pigmented skin. Results: Of the 106 DTCAs related to dermatologic conditions, there were 13 unique advertisements featuring 32 unique models. Four advertisements depicted the skin condition on darkly pigmented skin tones. Using the Monk Skin Tone (MST) scale to assess the 32 unique individuals, only 25% (n = 8) were rated at an MST 7 or above, and 6.25% (n = 2) were rated at an MST 10. Limitations: This study has the limitation of only sampling DTCAs from Washington, District of Columbia which does not fully represent all dermatology-related DTCAs in the United States. Conclusion: Results of this content analysis demonstrate that the number of persons of color within dermatologic DTCAs is 23%, whereas there are 13.6% Black individuals in the 2021 US census. This suggests that DTCAs are becoming more diverse since 2018. However, findings also show that the vast majority of DTCAs do not include models with darkly pigmented skin, and there remains a lack of advertisements depicting skin disease among people of color. Given the role of DTCAs in informing and aiding patients' requests for prescription drugs, representation of all skin tones is essential for this communication to be effective, especially in the field of dermatology.

Cosmetic Enhancement Updates and Pitfalls in Patients of Color.

Skin of color in dermatology encompasses individuals of various ethnic backgrounds including Black or those of African descent, Hispanic or Latino, Asian, Native American, Pacific Islander, and those of mixed ethnicities. Because these populations continue to expand, more patients of color (POC) are seeking out cosmetic enhancements and treatments. Aside from cosmeceuticals, nonsurgical cosmetic rejuvenation options, such laser and light-based treatments, neurotoxins, soft tissue augmentation, and more recently body contouring and skin tightening, are becoming increasingly popular worldwide. This article examines risks of cosmetic enhancement procedures in POC and best practices to prevent adverse events.

Aesthetic considerations when treating patients of African descent: Thriving in diversity international roundtable series.

BACKGROUND: Black patients of African descent are an ethnically diverse demographic and have unique anatomical features, aging processes, and responses to aesthetic procedures that must be considered when planning treatment. AIMS: To discuss similarities and differences in the anatomy and treatment preferences of Black patients of African descent and explore how these differences may influence aesthetic practices. PATIENTS/METHODS: In support of clinicians who wish to serve a diverse patient population, a 6-part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022. RESULTS: The results of the third roundtable in the series, the African Patient, are described here. The expertise and perspectives of African physicians, US physicians who treat African American patients, and physicians practicing within Latin America and Europe who treat patients of color (POC) of African descent are included, as well as information gleaned from injection demonstrations. CONCLUSIONS: Black African patients seek aesthetic treatment for a variety of conditions. Patients with darker skin can benefit from treatment with fillers, neurotoxins, and energy-based devices, but the application of these approaches should take into account the unique characteristics of each individual patient and the cultural and biological influences that impact treatment outcomes.

Efficacy and Safety of DaxibotulinumtoxinA for Injection in the Treatment of Glabellar Lines by Age and Race: Subgroup Analysis of the SAKURA Clinical Trials.

BACKGROUND: DaxibotulinumtoxinA for Injection (DAXI) is a novel botulinum toxin type A formulation approved for the treatment of glabellar lines. The efficacy, safety, and extended duration of response of DAXI 40 U for glabellar lines were demonstrated in 2 Phase 3, randomized, double-blind studies (SAKURA 1 and 2) and a Phase 3 open-label trial (SAKURA 3). OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of the first DAXI 40 U treatment received in SAKURA 1, 2, or 3 across age and race subgroups. METHODS: Adults with moderate-to-severe glabellar lines (Investigator Global Assessment-Frown Wrinkle Severity [IGA-FWS] and Patient FWS [PFWS] scales) were evaluated for glabellar line severity for ≤36 weeks after the first DAXI treatment. Efficacy and safety were analyzed by age (18-45, >45-55, and >55 years) and race (Asian, Black and African American, and White). RESULTS: Overall, 2785 patients were included in the efficacy analysis. The proportion of patients achieving none or mild glabellar line severity at maximum frown (IGA-FWS) after DAXI treatment was high in all age and race subgroups (>96% at Week 4). Glabellar line severity of none or mild by composite IGA-FWS and PFWS rating was maintained for a median of 24.0 weeks in all age subgroups, and for 27.0, 25.3, and 24.0 weeks in the Asian, Black and African American, and White subgroups, respectively. Treatment-emergent adverse events were similar across all subgroups. CONCLUSIONS: Consistent with the overall study population, DAXI 40 U demonstrated a high response rate and duration of effect of ≥24 weeks across all age and race subgroups.

An update on cosmetic procedures in people of color. Part 2: Neuromodulators, soft tissue augmentation, chemexfoliating agents, and laser hair reduction.

Recent years have brought forth the undeniable practice gap in dermatology concerning knowledge and experience of cosmetic procedures in people of color (POC). A paucity in the literature regarding evidence-based recommendations for the management of POC undergoing cosmetic procedures and the rise of cosmetic procedures in dermatology serves as a call to action to provide education regarding differences in skin of color that may impact the cosmetic outcomes. To mitigate the current practice gap on the safety, use, and benefits of cosmetic procedures in POC, part 2 will discuss the authors' recommendations and clinical pearls, as well as evidence-based management for neuromodulators, soft tissue augmentation, chemexfoliating agents, and laser hair reduction in POC undergoing cosmetic procedures.

An update on cosmetic procedures in people of color. Part 1: Scientific background, assessment, preprocedure preparation.

Increased life expectancy, focus on appearance, and readily available and accessible cosmetic procedures have served to drive an increase in the number of nonsurgical cosmetic procedures performed in the last 20 years. Demographic shifts in the United States, with increases in diverse populations that seek nonsurgical cosmetic procedures, have resulted in the need for a better understanding of cultural preferences as well as structural and biological differences in the skin of people of color (POC). Although many advances in the form of cosmeceuticals, cosmetics, and photoprotection have been made to address the aesthetic needs of and minimize complications in POC, nonsurgical cosmetic procedures are required to address common aesthetic concerns. Gaps remain in the education of dermatologists regarding the appropriate selection and execution of nonsurgical cosmetic procedures in POC. This educational initiative will facilitate a favorable outcome and optimal cosmetic results for POC.

Telemedicine Alopecia Assessment: Highlighting Patients With Skin of Color.

Alopecia has been one of the more common concerns reported at teledermatology (TD) visits during the COVID-19 pandemic. In light of the growing use of TD, a team of experts were consulted to develop workflows for virtual hair and scalp examinations, with particular consideration for skin of color patients.

Evaluating the Effect of Incobotulinumtoxin A for Glabellar, Forehead, and Crow's Feet Lines Using A High Dilution.

BACKGROUND: As aesthetic preferences have evolved and patients wish their muscles to be relaxed, but not frozen, a higher dilution of incobotulinumtoxinA (INCO) has allowed for increased spread using fewer units, yet no studies to date have investigated the efficacy, longevity, and safety of hyperdiluted INCO. OBJECTIVE: We evaluated the effect of incobotulinumtoxinA (INCO) in glabellar, forehead, and lateral periorbital lines using a high dilution. METHODS: Subjects with moderate-to-severe upper facial lines at rest according to the Merz Aesthetics Scales™ (Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany) received 15U of INCO to the glabellar (n=4 injection sites), 10U to the rest of the forehead (n=10 injection sites), and 5U to the lateral periorbital lines (n=3 injection sites/eye). Primary outcomes were physician- and subject-rated improvement at one month using the Global Aesthetic Improvement Scale (GAIS) and changes in line severity using the Merz Aesthetics Scales™. RESULTS: The study included 15 women aged 35 to 65 years. At one month, physician GAIS scores indicated 91.2% of subjects were very much improved and 8.8% were much improved; 91.5%, 78.0%, and 57.6% of participants remained at least improved at four, five, and six months, respectively. Subject GAIS scores at one month were in agreement with physician scores. At one month, an improvement of at least one point in Merz Aesthetics Scales™ scores in glabellar, forehead, and lateral periorbital lines was reported in 88.9%, 98.3%, and 94.8% of participants, respectively. Subject satisfaction was high throughout the study. No treatment-related adverse events were observed. CONCLUSION: Hyperdilute INCO was effective at improving overall appearance and reducing line severity in individuals with moderate-to-severe upper facial lines. Patient satisfaction was maintained up to six months and treatment was well tolerated.

Global Perspectives of the Patient of Color

Many cultures associate beauty with an even complexion. It has been shown in many reported references, the major cosmetic concern in patients of color is discoloration. This issue addresses discoloration of individuals of color and the use of a multitude of preparations that can blend the complexion. Authors in Asia, Sweden, France, and Brazil discuss the use of injectable deoxycholic acid in nonsubmental regions and hyaluronic acid for skin boosting, an off-label usage or procedures in the United States. Skin boosting improves hydration and the smoothness of the skin. Additionally, international methods of treating cosmetic patients with multiple modalities are discussed.

Practical Applications for Medical and Aesthetic Treatment of Skin of Color With a New 650-Microsecond Laser

The following roundtable is edited from discussion between the authors concerning treatment with the 650-microsecond 1064nm Nd:YAG laser. These dermatologist experts share their expertise, experience, and treatment pearls regarding the device for medical and aesthetic use, and in treatment of skin of color (SOC).

Laser Treatment of Skin of Color for Medical and Aesthetic Uses With a New 650-Microsecond Nd:YAG 1064nm Laser

Individuals with skin of color are a rapidly growing portion of the cosmetic procedures market. There are unique challenges to treating skin conditions in skin of color patients. This article and roundtable discussion focus on the use of energy-based modalities, particularly a 650-microsecond 1064nm laser that delivers energy in a collimated beam. Alone or in combination with other therapies, the 650-microsecond 1064nm laser has been used successfully to treat melasma, acne, postinflammatory hyperpigmentation, pseudofolliculitis barbae, hair removal, acne keloidalis nuchae, and aging skin in skin of color. J Drugs Dermatol. 2019;18(4 Suppl 1):s135-137.