In this podcast, Hilary Baldwin, MD, FAAD, and Jeffrey Fromowitz, MD, FAAD, discuss the burden of rosacea, management tips, available treatments, antibiotic stewardship, and more.

Managing Papulopustular Rosacea

Learn more about what treatments are on the rise for plaque psoriasis, the latest management advice and what trends are shaping the future of the disease. 

The changing treatment landscape of plaque psoriasis

American College of Allergy, Asthma, and Immunology (ACAAI)

New Frontiers in Cosmetic Medicine and Medical Dermatology

American Society for Dermatologic Surgery (ASDS)

Poll

POLL: What conference are you looking forward to the most?

Coverage from the Maui Derm NP & PA conference this weekend;

Articles

A glimpse at what to expect from Dermatology Times this week.

What’s New on Dermatology Times: September 27-October 1

Morgan Petronelli is an associate editor for 

and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

She enjoys working out, listening to music, and playing with her dog Scout. You can reach her at 

POLL: How do you treat your SOC patients with acne?

Nuances for Treating Acne in SOC Patients

At the Skin of Color Update 2021, Andrew Alexis, MD, MPH, presented on the subtle distinctions in treating skin of color patients with acne.

DermTech’s Pigmented Lesion Assay data was published in SKIN: The Journal of Cutaneous Medicine showing the results of its melanoma detection.

FDA Approves Halobetasol Propionate Foam for Plaque Psoriasis in Adolescents

The FDA has approved halobetasol propionate foam, 0.05% (Lexette; Mayne Pharma), a potent topical corticosteroid, for the treatment of plaque psoriasis in adolescent patients.

Verrica Pharmaceuticals Receives Response from the FDA

Verrica Pharmaceuticals has received a complete response letter from the FDA identifying deficiencies at a manufacturing facility for VP-102.

Dermatology Times Chief Medical Editor Weighs in On Black Box Warning for JAK Inhibitors

In this exclusive video interview, Zoe Diana Draelos, MD, Dermatology Times chief medical editor, weighs in on the recent Black Box Warning issued by the FDA to certain JAK inhibitors.

FDA Approves Ruxolitinib for Atopic Dermatitis

Incyte announced the FDA has approved its topical selective Janus kinase (JAK)1/JAK2 inhibitor ruxolitinib (Opzelura) for the treatment of mild to moderate atopic dermatitis.

FDA Accepts Priority Review for Melanoma Treatment

Bristol Myers Squibb has announced that the FDA has accepted the Biologics License Application (BLA) for relatlimab and nivolumab, a fixed-dose combination treatment for unresectable or metastatic melanoma.

Possible melanoma treatments have had multiple newsworthy events since July 2021.

What Happened at the Skin of Color Update 2021?

Catch up on all of the latest news coming out of the Skin of Color Update 2021.

The FDA has announced steps at improving the quality, safety, and efficacy of sunscreens.

Rejuvenating Laser Leads to Acne Agminate-Like Reaction

A recent case report highlights the importance of caution when using fractional laser resurfacing in patients with active or previous acne.

Pipeline of Promise for Atopic Dermatitis

A steady stream of novel therapeutic agents is now navigating the atopic dermatitis pipeline.

 features stories about Botox stigma, treating skin of color patients, laser hair removal, skin care microdosing, plus more.

Laboratory Markers Aid in Evaluating Atopic Dermatitis

Investigators added that the meaning of each laboratory marker is dependent on the drug that is being used for treatment.

The Cutaneous Connection: Episode 31- Molecular Targeting of Psoriasis Biologics

This episode highlights findings from an investigative study exploring the molecular targeting of biologics for psoriasis, the IL-17 drug class, how bimekizumab is different, plus more.

Treating Palmoplantar Psoriasis With Chemical Peel and Gentian Violet

Even with patient hesitancy, treating PPP with gentian violet and chemical peels could help patients avoid biologics.

New Frontiers Open for AD, Eczema Solutions

NEA’s Eczema Expo highlights new drugs, steroid withdrawal, alternative therapies.

Pointers With Dr Portela: Reacting to Cystic Acne with Cassandra Bankson

In this week’s Pointers with Dr Portela, the 208SkinDoc and Cassandra Bankson, a medical aesthetician and skin advocate, react to cystic acne TikToks and offer commentary.

Recognizing and Treating Rosacea in Skin of Color

Hilary Baldwin, MD, presented on how to recognize, diagnose, and treat rosacea in patients with skin of color at the Skin of Color Update 2021.

ICYMI, some of this week’s featured content includes a new podcast episode on molecular targeting of biologics, and articles on pipeline updates for melanoma, treating various skin conditions in skin of color patients, and more.

Weekly Roundup: September 20-24

 covered the Skin of Color Update 2021, which was held virtually. Below you can find a variety of conference-related articles we published, ranging from rosacea to hyperpigmentation. Click the links to read full-length stories on all of the latest news coming out of the

Andrew Alexis, MD, MPH, presented on the subtle distinctions in treating skin of color patients with acne.

ecognizing and Treating Rosacea in Skin of Color

Hilary Baldwin, MD, presented on how to recognize, diagnose, and treat rosacea in patients with skin of color.

Jill Waibel, MD, discusses her recommendations on how to treat keloids and scaring using lasers.

ovel, Non-prescription Regimen Improves Hyperpigmentation

A cosmetic topical brightener serum combined with a dual antioxidant system show promise in treating moderate to severe hyperpigmentation in skin of color patients.

Understanding Hidradenitis Suppurativa Subtypes

Ginette A. Okoye, MD, FAAD, provides several clinical pearls to help physicians find the best therapy for their individual hidradenitis suppurativa patients.

Hilary Baldwin, MD, presents on keloids in light skin patients, hypopigmentation after treatment, to stitch or not to stitch, and more.

Editor's note: Check back often as this article will continue to be updated in the coming weeks with additional coverage from the Skin of Color Update 2021.

and joined the MJH Life Sciences team in April 2021. She graduated from Kent State University in 2018 with a bachelor's degree in journalism and a minor in sociology. Linda used to work as a creative writer for 

 and was a technical writer/regulatory specialist/purchasing agent at GM Industrial before coming on to the team. She enjoys reading, traveling, and learning new perspectives. You can reach her at 

FDA took its first steps geared toward improving the quality, safety, and efficacy of sunscreens as a part of its implementation of new authorities for certain over-the-counter (OTC) drugs, according to its 

Currently, the new authorities keep the marketing conditions for these sunscreens the same, but the FDA did propose revisions and updates to the requirements related to the maximum sun protection factor (SPF) values, active ingredients, broad spectrum requirements, and product labeling, among other changes. 

Janet Woodcock, MD, acting commissioner for the FDA in Washington D.C., stated that sun safety is important for all people and Americans can reduce sun exposure risk by using sun protection such as a broad-spectrum sunscreen with SPF values of at least 15.  

“Today’s activities represent a key milestone in our implementation of transformative new authorities related to OTC drugs that will allow us to continue ensuring that sunscreens are safe and effective for frequent, life-long use and provide consumers with the protection they expect from these products,” Woodstock said. “We are committed to using our new authorities to help meaningfully advance innovative, safe and effective options for consumers and secure a robust OTC marketplace.”  

The 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act reformed the way unapproved applications for sunscreens are marketed in the U.S. by 

 for sunscreens. Requirements of this Act, alongside the final order, set the current requirements for marketing OTC sunscreen products. The deemed final order includes requirements on active ingredients from the 

1999 final monograph regulation for OTC sunscreen products

, however, the monograph did not ever take effect, along with labeling and effectiveness requirements from a 2011 

It’s important to note that the CARES act did not change the scientific standards for determining whether a sunscreen may be marketed legally without an approved application. OTC orders establish conditions under which the FDA permits certain OTC drugs to be marketed without approved new drug applications because they are generally recognized as safe and effective (GRASE), so long as they comply with all other applicable requirements, according to the release.  

The press release explained that the deemed final order perseveres the pre-CARES act status quo condition for these sunscreens, making sunscreens marketed according to nearly identical terms described in an FDA enforcement discretion policy. The FDA thus believes most sunscreens currently on the market follow the order and the order will remain in effect until the FDA issues another final order to revise it.  

The CARES Act did require the FDA to issue a proposed revised order by September 27, 2021 and the FDA has made the 

. The FDA used the order to transition the ongoing consideration of the requirements for OTC sunscreens marketing without approved applications from past rulemaking processes to this current order process. 

“The provisions in today’s proposed order are therefore substantively the same as those described in the FDA’s 2019 proposed rule on sunscreens and are aimed at bringing sunscreens that are marketed without FDA-approved applications up to date with the latest science to better ensure consumers have access to safe and effective sunscreen products,” according to the press release wrote.  

The order included a proposal to update the GRASE status for the 16 active ingredients listed in the deemed final order. Also, that dosage forms that are considered GRASE for use as sunscreens include oils, lotions, creams, gels, butters, pastes, ointments, and sticks, and GRASE status for spray sunscreens, subject to testing, and labeling requirements were proposed. 

The order’s proposals on SPF and broad spectrum were created to confirm the public have access to sunscreens with proper ultraviolet A rays (UVA) protection, as a growing number of research has linked UVA exposure to skin cancers. The label of the products was also proposed to change, to help make it easier for consumers to see important product information. 

Christopher Bunick, MD, PhD, associate professor of dermatology, Yale University and 

editorial advisory board member, commented on the FDA’s proposed changes. 

"It is encouraging to dermatologists and our patients that the FDA is taking steps toward improving sunscreen quality by addressing issues such as active ingredients, product labeling, and SPF and broad-spectrum testing procedures,” Bunick said. “This is a step in the correct direction, and I hope the FDA will continue to do more with sunscreen safety in the future, especially regarding the more recent data showing batch contaminations, chemical breakdown of certain ingredients, and blood absorption." 

There will be a 45-day public comment period in which the FDA will consider comments before then issuing a revised final order (and is considering all comments timely submitted to the 2019 proposed rule to be constructively submitted to the proposed order), according to the release. 

The CARES Act specifies the effective date for the revised final order cannot be earlier than 1 year after its issuance.  

 1. FDA takes steps aimed at improving quality, safety and efficacy of sunscreens. FDA. Published September 24, 2021. Accessed September 24, 2021. https://www.fda.gov/news-events/press-announcements/fda-takes-steps-aimed-improving-quality-safety-and-efficacy-sunscreens 

The FDA has announced steps at improving the quality, safety, and efficacy of sunscreens.  

FDA Announces Action on Sunscreens

investigated a review of peptides, studying their history, function, and its potential use in biomedicine

Peptides consist of at least 2 amino acids and can be either an oligopeptide—a short chain of amino acids—or a polypeptide—a long chain of amino acids and they a unique class of biomolecules and have filled the therapeutic niche because of their specific biochemical and therapeutic features.  

There are structural modifications to overcome these limitations and can improve the physicochemical properties, such as greater stability. There is the option of double-bridged peptides, and it reduces the peptide backbone flexibility and causes limited availability for enzymes. The conjugation to cell-penetration peptides can lead to better drug bioavailability and therapeutic efficiency, potentially leading to new treatments. 

There have been efforts made to develop short peptides or peptidomimetics to have pharmacological properties. Structural changes can happen by selectively substituting along the sequence specific residues with other residues or by substituting certain residues of the sequence with non-coded α-amino acid residues.

Cyclic peptides are already used in the treatment of diseases such as insulin, penicillin, cyclosporin, and gramicidin S and these peptides versus linear peptides have increased chemical and enzymatic stability, receptor selectively, and improved pharmacodynamic properties. 

The engineering of stable peptide moieties, which are the cyclic counterparts and non-peptide mimetics is important. Structure-activity studies have showed the importance of 3 aromatic amino acids TYR, HIS, PHE, and the C-terminal carboxylate for activity. This discovery, combined with Nuclear Magnetic Resonance techniques, the authors designed synthesized angiotensin II receptor blockers by rotation of the alkyl chain on the imidazole ring

This is important as the perspective use of angiotensin receptor blockers (ABM) as they were recently found to protect hypertensive patients from Covid-19.

The very short peptides are easier and less expensive to synthesis, higher mechanical stability, good tissue penetration, and less immunogenicity. They do have better structural optimization. Ultra-short peptides are also better for oral treatments and overcome many of the issues that long peptides run into while also providing potential for cancer cell growth inhibition.

The simplest cyclo-peptide (2,5-diktopiperazine [DKP], piperazine-2,5-diones, 2,5-dioxopiperazines, and dipeptide anhydrides) have inter alia superior rigidity, 3-dimensionality, higher cell permeability, and diverse bioactivities like anticancer, antiviral, and antioxidant. They also prevent neurodegeneration, quorum sensing, cell to cell signaling, as drug delivery systems. They were found in the central nervous system, gastrointestinal tract, and blood.

When performing solution peptide synthesis, each step requires product purification by using a gel chromatography or crystallization, whereas in solid-phase synthesis (SPPS) requires only a simple washing of the peptide and because of this, researchers can design peptide synthesizers and automate the procedure. 

This synthesis is necessary to separate the amino acids from the peptide and solution phase synthesis can be used to modify the amino acids or amide bonds. Cyclization can also be used to synthesize these peptides also. 

Though there are many peptides are synthesized by SPPS, some can be difficult to do, and these are called “difficult sequence-containing peptides.”

“During the chain elongation, intra-/inter-molecular hydrophobic interactions and/or hydrogen bondings cause aggregation of protected peptides on the resin to induce incomplete coupling and deprotection. Furthermore, after final deprotection, hydrophobic peptides hamper HPLC purifications using H2O-MeCN system,” wrote study authors.

The O-acyl isopeptide method was developed to counter these issues and it is used by synthesizing the in a form of an O-acyl isopeptide, which contains an O-acyl isopeptide bond instead of the native N-acyl peptide bond at a hydroxy group-containing amino acid residue. The peptides synthesized this way include Alzheimer’s disease-related amyloid β peptide 1-42 (Aβ42, amylin, vaccine peptide, insulin derivatives, and collagen peptide.

Molecular dynamics (MD) simulations are a useful tool for prediction and/or reproduction of experimental 3D structures of small proteins. The interactions of peptides are needed to be understood to progress on both modeling and thermodynamic aspects of their interactions and the understanding of the content of cells coming from the peptide in synthetic and protein degradation aspects. This matters in the future use of the peptide. 

MD has 2 scales, atomistic and coarse grain (CG), where is main difference is the way the atoms of a peptide are displayed. The atomistic scale shows all the atoms and CG scale shows the atoms in grouped beads. Both are used to look at the interaction of the peptide with the lipid membrane. 

The partition and insertion of single peptides in membrane of different composition have been broadly investigated using unbiased MD simulations in both scales. This has helped identify specific interactions, peptide conformation, and bilayers properties.

Other information can be found by calculating the peptide reaction path. Several methods have been used like the umbrella sampling, adaptive biasing force (ABF) method, the Wang-Landau algorithm, steer molecular dynamics, and metadynamics. Also, to take a closer look at the cooperative effects of peptides, like pore formation, has led to better therapies. 

Peptides are researched for many different uses like molecular transporters, gene delivery, vaccines, neurodegenerative therapy, treatment for autoimmune diseases, stem cell research, and anti-viral for Covid-19. For more details on these developments, please read the 

Nutraceuticals have use plant proteins which have diverse peptides to help add benefits for patients. Peptides with 2 or 3 amino acids pass easily into the blood after digestion and they have positive effects on blood pressure and lipid metabolism, along with analgesic, anti-thrombosis, anti-atherosclerotic and opioid agents.

Marine bioactive peptides have many advantages like anti-inflammatory, anticancer, and antioxidant activities and whether derived from non-edible marine organisms or seafood processing by-products, may have potential applications in the discovery of peptide-based therapeutic agents and formulation of nutraceuticals.

Peptide-based cosmeceuticals acting against both intrinsic and extrinsic aging and improving the health and appearance of skin are becoming increasingly popular, according to study authors. This heightened popularity is because of the collagen stimulation, wound healing, wrinkle smoothing, combined with the antioxidative, antimicrobial, and whitening effects. Natural peptides offer a more sustainable way to create these colismeceuticals also as they are highly biodegradability, low toxicity, manufacturing cost, and availability to scale up production.

“To sum up, short peptides can be a secret of idealized smart therapies,” wrote study authors.

The authors declare no conflict of interest.

1. Apostolopoulos V, Bojarska J, Chai T-T, et al. A global review on short peptides: frontiers and perspectives. Molecules. 2021;26(2):430. doi:10.3390/molecules26020430

A study published in Molecules explored the vast use of peptides in many therapies that could improve treatments from anti-aging to vaccines. 

Peptides and Their Many Uses

Zelira Therapeutics, a company involved in the research and development of clinically validated cannabinoid medicines, announced the launch of 

 acne treatment products through its dermatology subsidiary Ilera Derm LLC ("Zelira Dermatology").

The product line is to join the acne medication market which is valued at more than $11 billion worldwide and will consist of Wash Away gel cleanser acne treatment, Spot On acne treatment, Kick Off hydrating lotion broad spectrum SPF 30 sunscreen, After Hours moisturizing lotion acne treatment, and Clear the Way acne treatment pads, according to the press release. The ingredients in the products include hyaluronic acid, niacinamide, glycerin, thiotaine (derived from mushrooms), and peptides.

RAF FIVE is the only skin care line to feature Zylorma, a patent-pending acne fighting complex formulated with cannabidiol (CBD), salicylic acid, and additional botanical compounds developed by Zelira and Karyn Grossman, MD, a board-certified cosmetic dermatologist, New York, New York. 

Zylorma is used to fight bacteria and clogged pores associated with acne which also balances sebum production to combat and prevent acne breakouts. RAF FIVE uses pharmaceutical-grade CBD isolate derived from hemp and is tetrahydrocannabinol (THC)-free.

"I am excited to announce the launch of Zelira's Dermatology subsidiary and the RAF FIVE acne treatment line of skincare products. Dr. Grossman's reputation and experience in the cosmetic dermatology industry, combined with Zelira's peerless position in cannabinoid science, is the perfect combination,” said Oludare Odumosu, the CEO of Zelira Therapeutics and managing director, Philadelphia, Pennsylvania. “We have a unique opportunity to present a differentiated suite of proven acne treatment solutions to the US$11 billion acne treatment market where there is a high level of dissatisfaction with existing products and unmet needs. Zelira is staking a claim in the cannabinoid-based, over-the-counter skincare product market with our differentiated dermatology."

Zelira conducted an industry standard consumer use study of the RAF FIVE franchise that demonstrated improvement in all the patients during the 28-day study, according to the release, with some showing improvement as early as day 7. 

Grossman said, “I am thrilled to be a part of the new Zelira Dermatology and to have teamed up with Zelira to create Zylorma and the RAF FIVE skin care line. Zelira is already known as a leader in cannabinoid research and development for the medical cannabis market, so when they offered me the opportunity to use my medical expertise alongside their ground-breaking scientific formulations to create a truly new and unique solution for acne, I couldn't pass it up.”

She added that in her medical practice, she has seen the struggle to find effective treatments and is interested in seeing more results from the ongoing study. “I believe that science has just started to skim the surface of the skin-healing properties of cannabinoids; RAF FIVE is only the beginning."

Zelira's Dermatology subsidiary is currently developing several other topical products, anticipated to be launched in 2022 including anti-aging, sexual health/intimacy, and specific skin conditions such as psoriasis.

1. Zelira launches RAF FIVE acne treatment products through its dermatology focused subsidiary. Published September 23, 2021. Accessed September 27, 2021. https://www.prnewswire.com/news-releases/zelira-launches-raf-five-acne-treatment-products-through-its-dermatology-focused-subsidiary-301383621.html

Zelira Therapeutics has announced the launch of RAF FIVE acne treatment product.  
 

CBD Acne Skin Care Line Announced 

Galderma and Sofregen Medical, a medical device company focused on using silk protein for tissue building and regeneration, have announced they have signed a co-development and option-to-acquire agreement, according to a 

This agreement will build upon Galderma’s history of biostimulator and hyaluronic acid (HA) filler development by implementing Sofregen’s pioneering research on silk protein to co-develop a new generation of silk-based biostimulators that will enable immediate volume restoration and provide structure for new tissue generation.

“Galderma is a world leader in dermatology, with decades of experience in delivering cutting edge innovation in facial aesthetics and we are thrilled to have them as a partner. This agreement highlights Sofregen’s dedication to advancing the science of silk and will accelerate our ability to develop the next generation of biostimulator fillers with a recognized leader in this space,” said Jonathan T. Hartmann, CEO, Sofregen, Framingham, Massachusetts.

According to the agreement, both companies will perform specific activities related to the co-development of a portfolio of novel silk-based biostimulator fillers. Additionally, Galderma will have the exclusive option to acquire Sofregen’s Silk Voice and other assets associated with its aesthetic business. This grants Galderma all of the rights to the products co-developed by the companies, and ownership of Sofregen’s silk technology platform in the aesthetic and dermatological field.

"At Galderma, we’re committed to advancing dermatology through constant innovation and joining forces with other industry pioneers. Combining Galderma’s capabilities and scale with Sofregen’s novel silk platform represents a watershed moment for the aesthetics market through the development of a new category of biostimulator fillers designed to make an impact for healthcare professionals and their patients,” said Baldo Scassellati Sforzolini, global head of research & development, Galderma, Lausanne, Switzerland.

Galderma and Sofregen said they plan to launch development programs for all products imminently, according to the press release.

1. Galderma announces exclusive agreement with Sofregen to develop the next generation of biostimulator fillers using silk-based technology. Galderma. Published September 23, 2021. Accessed September 24, 2021. https://www.galderma.com/news/galderma-announces-exclusive-agreement-sofregen-develop-next-generation-biostimulator-fillers

Galderma and Sofregen Medical announced they have entered into an agreement to co-develop a novel line of silk-based biostimulators that will enable immediate volume restoration and provide structure for new tissue generation.

 Galderma, Sofregen Enter Agreement to Develop Silk-based Biostimulators

Rising COVID-19 infection rates and hospitalizations from the Delta variant continued to strain U.S. hospitals and health systems in August, according to Kaufman Hall’s latest 

Hospital margins remained below pre-pandemic levels from 2019, not including federal Coronavirus Aid, Relief, and Economic Security (CARES) Act funding. Most volume metrics also were down versus pre-pandemic levels, but up compared to lows seen in the first eight months of 2020, when COVID-19 mitigation efforts drove significant declines in overall demand.

The average length of stay increased versus 2019 and 2020, as hospitals saw a rise in high-acuity cases—including more severe COVID-19 cases—requiring longer stays. Expenses continued to climb and revenue rose for a sixth consecutive month.

The median Kaufman Hall Operating Margin Index was 3.1% in August without CARES funding, and 3.9% with the aid. The median change in operating margin was down 2.9% year-to-date versus pre-pandemic levels in the first eight months of 2019, not including CARES. With CARES, the median change in Operating Margin rose 11.2% versus January-August 2019.

Revenue and expenses also rose year-to-date versus 2019, due in part to the increase in higher acuity patients. Gross operating revenue was up 9.6% compared to 2019, while total expense per adjusted discharge was up 16.6% over the same time frame.

Key volume metrics in the latest report versus January-August 2019 include:

This article was initially published by our sister publication 

Margins in August still low along with many volume metrics.

Hospitals Hit Hard by Delta Variant 

takes a deep dive into female hair loss and 

discovers if blue LED light therapy is worth the hype. Also, 

explores why your eyelashes might be falling out and 

highlights everything you need to know before using pure shea butter. Finally, 

explains how to treated an infected piercing and 

platelet-rich fibrin (PRF) undereye injections. 

Shedding Light on Shedding: How I Navigated Female Hair Loss

Blue LED Light Therapy Devices are Trending, But Are They Worth It?

5 Reasons Why Your Eyelashes May Be Falling Out

What to Know Before Using Pure Shea Butter

A Dermatologist Breaks Down How to Treat an Infected Piercing in 7 Easy Steps

I Tried PRF Fillers for My 30th Birthday—Here’s What I Wish I’d Known First