Continuing research on the pathogenesis of acne has yielded a new understanding of underlying molecular and cellular pathways, suggesting new targets for therapeutic intervention, says Ichiro Kurokawa, MD, director, Department of Dermatology, Meiwa Hospital, and clinical educational professor, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan, in collaboration with Keisuke Nakase, PhD, assistant professor, Department of Microbiology, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.

The information on these advances is summarized in a recent article1 written by Kurokawa and Nakase. The authors review recent findings on the pathogenesis of acne, discuss novel treatments, and propose future therapeutic strategies. With the need for additional treatments for severe acne, Kurokawa tells 

that findings from immunological studies are of interest as they suggest the potential to use immunity induction therapy with antibodies.

“The future treatment for severe acne will involve biologic therapies targeting interleukin (IL)-1α, IL-1β, IL-6, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β,” he says. In particular, these pro-inflammatory cytokines are involved in the development of scar formation, which is the most refractory complication of severe acne. In addition, TNF-α promotes lipogenesis in human sebocytes,” says Kurokawa.

“Treatments that enable wound healing are also of interest as a therapeutic intervention to prevent permanent scarring in patients who suffer from severe acne,” he adds.

The discussion of recent findings on acne pathogenesis is divided into sections reviewing research pertaining to sebaceous gland biology, sebum, genetics, keratinization, hair cycles, immunology, bacteriology, and wound healing. Findings from these studies suggest numerous novel potential treatments.

Kurokawa explains that insulin growth factor (IGF)-1 is involved in acne pathogenesis through stimulation of lipid formation. In addition, research investigating genetic associations with acne development implicates the involvement of genes in the IGF family as well as in the melanocortin receptor and peroxisome proliferator-activated receptor (PPAR) families among others.

Kurokawa and Nakase note that while existing antimicrobial agents used for treating acne are believed to have benefits for both their effects on 

(C acnes) and anti-inflammatory activity, the search for alternatives continues due to concern over the emergence of bacterial resistance with antibiotic overuse. Vaccination strategies for eradicating 

and preventing its overgrowth show promise.

induces production of pro-inflammatory cytokines. Complete suppression of acne inflammation would likely mean combining these vaccinations with monoclonal antibody agents able to block the pro-inflammatory cytokines,” Kurokawa says.

Although there has been limited study of hair cycles in acne and a lack of research into keratin expression in the hair cycle in acne lesions, available evidence shows a shift in the hair cycle from anagen to telogen or catagen phases, according to the authors.

Kurokawa and Nakase speculate that progenitor cells in the junctional zone might differentiate towards the infundibulum and sebaceous duct cells rather than towards the lower portion of the hair follicles.

“The sebaceous gland with hypercornification in the sebaceous duct is usually atrophic without the outer root sheath below the opening of orifice of sebaceous gland,” Kurokawa says.

The authors also review novel acne therapies being used in Japan that show encouraging results for the treating both nodulocystic acne and perifolliculitis capitis abscedens et suffodiens, a related treatment-refractory disorder.

Kampo is a traditional Japanese herbal medicine using Saireito. While it is used in combination with topical benzoyl peroxide, oral antimicrobial agents, and local steroid injections, there is biological plausibility for benefit of Saireito, according to the article’s authors.

“Basic research studies are needed to determine the mechanisms by which Saireito modulates acne pathogenesis, but there is evidence that its activities include effects on endogenous corticosteroids, inflammation, reactive oxygen species, coagulation, macrophages, neutrophils, and endothelial cells,” Kurokawa says.

Other treatments used for severe acne in Japan include Jyumihaidokuto and Keigairengyoto. Jyumihaidokuto contains Bokusoku, an extract from 

that has been shown to inhibit testosterone-induced sebum synthesis. Keigairengyoto has both an antibacterial effect on 

Kurokawa, MD and Nakase, PhD report no relevant disclosures.

1. Kurokawa I, Nakase K. Recent advances in understanding and managing acne. 

Articles

Acne research delineating molecular and cellular pathogenic pathways gives insight into new therapeutic targets. According to a recent review, biologics and other therapies that modulate scar formation and wound healing will have value for treating severe acne.

Immunity Induction Therapy with Antibodies, Wound-Healing Therapies Show Potential 

The shift to telehealth visits during the height of the first wave of the COVID-19 pandemic effected noteworthy changes in the sociodemographic and clinical characteristics of patients presenting for care at a tertiary referral center, according to a recently published study.

The findings provide insights for understanding the impact of the pandemic on dermatology and, moving forward, for determining which patient populations may benefit most from access to teledermatology and how to optimize its delivery, says Avery LaChance, MD, MPH, director of Health Policy and Advocacy, Brigham and Women’s Hospital Department of Dermatology, and instructor in Dermatology, Harvard Medical School, Boston, Mass.

“It is essential that we study how the rapid expansion of telehealth throughout the pandemic impacted our patients and the practice of medicine,” says LaChance. “As a medical community, we should seek to learn as much as possible about how we can optimize telemedicine to improve patient access to dermatologic care.”

To evaluate the impact of the transition to telehealth on the practice of dermatology, LaChance and colleagues at the University of Massachusetts Department of Dermatology conducted a retrospective chart review comparing the characteristics of patients seen for in-person visits in April 2019 versus by telehealth in April 2020. The in-person cohort included 1565 patients while 767 patients were seen via telehealth during the pandemic period.

“In April, Massachusetts was recommending that all non-emergent health care be provided by telehealth. [Increased access to in-person care opened up in late May/early June.] Focusing on the month of April gave us an opportunity to investigate which patient populations were seeking out and accessing telehealth during this unique time period,” says LaChance.

She adds, “We felt that only patients who believed they would truly derive benefit from telehealth, such as those who felt their care could not wait, their condition could be adequately managed by telehealth, or who found this mode of care to be an acceptable alternative to an in-person visit, would have transitioned to virtual care during this period of time.”

Statistically significant differences identified in the two patient populations show that patients seen by telehealth were significantly younger, more likely to live out-of-state, and more diverse racially, ethnically, and linguistically. Online visits included a higher proportion of Medicaid recipients but a lower proportion of Medicare patients than the in-office cohort.

Virtual visits for inflammatory dermatoses and hair disorders accounted for higher percentages of the primary diagnoses in the teledermatology cohort. However, skin cancer and other neoplastic disorders were most common among study group patients seen in-office.

Commenting on the findings, LaChance says that the proportional increase in patients presenting for hair disorders is interesting considering a study reporting that dermatologists believe examinations for alopecia are less amenable to teledermatology.

“Hair loss is a very emotionally charged disease. Affected patients may have felt very strongly about keeping their appointment during the pandemic,” she says. “Another factor may be that certain hair loss disorders, such as telogen effluvium, which is a type of stress-induced hair loss, have increased throughout the pandemic, possibly contributing to this finding.”

LaChance says she and her colleagues “were happy to see” the uptake of telehealth by Medicaid patients. The investigators credit the broad insurance coverage of telehealth during the pandemic across multiple modalities and different types of technologies in facilitating telehealth access for patients across all backgrounds. Additionally, she notes that patients with Medicaid or in a low income bracket often face social pressures that may limit their access to in-person visits.

“The flexibility and convenience afforded by telehealth may offset the influence of a potential ‘digital divide’ and help explain the increased percentage of Medicaid patients seen by telehealth,” she says. “This is echoed by our findings in another study showing decreased no-show rates for teledermatology versus in-person visits with the most dramatic difference seen among minority patients.”

“We need to do the heavy lifting and conduct more research to understand how patients in all demographic and socioeconomic groups interface with technology and what can be done to ensure equitable access to telehealth now and moving forward,” says LaChance.

As in-person care has opened up, LaChance says that the characteristics of the patient she is seeing virtually match those of the study’s teledermatology cohort. The telehealth clinic patients are generally younger, face numerous social stressors, and have inflammatory diseases (versus concerning lesions).

“Patients and doctors together are considering multiple factors to select the mode of care that is best for each patient individually. We are improving access to care and the patient experience,” she says.

Ongoing research is focusing on defining the current digital divide in the dermatology patient population, evaluating patient satisfaction between telehealth and in-person visits for different conditions, and understanding how telehealth has improved access to care for different patient populations. Recognizing that patient populations differ depending on practice characteristics, LaChance is hopeful that others practicing in different settings and geographic locations will conduct similar research to gain a more comprehensive picture of which patient populations and disease states would benefit from continued access to teledermatology.

She and her colleagues are using their findings to advocate for legislation to ensure broad telehealth coverage in Massachusetts.

“To date, a lot of expanded coverage for telehealth is afforded by emergency legislation and executive orders at the state and federal levels,” she adds. “Legislation is needed to ensure patients continue to have broad access to telehealth coverage now and in the future.

Physicians must advocate for our patients to influence the next wave of telehealth legislation so we can maintain equitable access to this mode of care for all patients.”

1. Krueger S, Leonard N, Modest N, et al. Identifying Trends in Patient Characteristics and Visit Details During the Transition to Teledermatology: Experience at a Single Tertiary Referral Center. 

. 2020 Nov 27:S0190- 9622(20)33084-X. Epub ahead of print.

2. Franciosi EB, Tan AJ, Kassamali B, et al. Understanding the Impact of Teledermatology on No-Show Rates and Healthcare Accessibility: A Retrospective Chart Review. 

. 2020 Sep 11:S0190-9622(20)32604-9. Epub ahead of print

A retrospective study shows significant differences in the characteristics of patients seen by telehealth during the COVID-19 pandemic versus those seen during in-office visits 1 year earlier.

COVID-19-related telehealth broadens patient population 

 showing an association between finasteride use and psychological adverse events (AEs) including suicidality suggests that dermatologists should weigh benefits and risks carefully when considering finasteride for certain patients with hair loss, according to one expert.

Based on the study, the characteristics of finasteride may precipitate or potentiate psychological morbidities including suicidality specifically in patients with alopecia who are less than 45 years of age, says Roger S. Ho, MD, MS, MPH. He is director of resident education and associate professor in the Ronald O. Perelman Department of Dermatology at New York University Grossman School of Medicine, New York, N.Y. Ho was not involved with the study but wrote an accompanying editorial on the topic.

“While a definitive causal association has not yet been established, dermatologists should take into consideration this potential signal and conduct a detailed, personalized risk-benefit assessment with the patient before each prescription of finasteride for our younger alopecia population,” says Ho.

Study1 authors Nguyen et al. used disproportionality analysis (specifically, case-noncase design) to detect signals of adverse finasteride

reactions of interest reported in the World Health Organization’s global VigiBase database as of June 2019. Researchers identified 3282 adverse events (AEs) of interest, including 2926 reports of psychological AEs and 356 reports of suicidality. Nearly all cases involved male patients, and 70.9% of involved patients with age data available were 18 to 44 years old.

Researchers identified significant disproportionality signals for both psychological AEs (reporting odds ratio (ROR) 4.33; 95% confidence interval (CI) 4.17-4.49, and suicidality (ROR, 1.63; 95% CI 1.47-1.81) in finasteride users. Investigators found no signals for attempted or completed suicide.

In sensitivity analyses stratified by indication and age, patients younger than 45 years (ROR 3.47; 95% CI 2.90-4.15) and those with alopecia (ROR 2.06; 95% CI 1.81-2.34) had significant disproportionality signals for suicide compared to patients in the database using other alopecia drugs such as minoxidil. No suicidality signals appeared among older men who presumably took finasteride for benign prostatic hyperplasia.

According to Nguyen et al., the findings raise concern that younger men with alopecia may be especially at risk for suicidality compared with the general population. “Taken together,” they

wrote, “our findings suggest that the disproportional reporting of suicidality and psychological AEs in association with finasteride use could potentially be attributed to unique characteristics of the drug in young patients with alopecia.”

For example, psychological AEs could stem from the possibility that the persistent sexual dysfunction (after discontinuation of treatment) that has been associated with finasteride takes a greater toll on younger patients who had used the drug to treat a non-urological condition.

The disproportionality signals for psychological AEs and suicide among finasteride users also may stem partly from reporting bias. Sensitivity analyses showed disproportional reporting of finasteride-associated suicidality after 2012, a year that drew significant attention to a possible link between finasteride and these AEs.

Ho points out the signals for suicidality and psychological AEs identified by Nguyen et al. for finasteride only serve to stimulate further large-scale prospective pharmacoepidemiologic studies designed specifically to further evaluate these potential AEs in young patients using the drug for androgenetic alopecia. “They should not be mistaken as proof that there is a causal association between the two, as the study had some inherent biases, in particular a reporting bias due to stimulated reporting in the database,” he says.

Dr. Ho reports no relevant financial interests.

Nguyen DD, Marchese M, Cone EB, et al. Investigation of suicidality and psychological adverse events in patients treated with finasteride [published online before print, November 11, 2020]. 

. 2020 Nov 11:e203385. doi: 10.1001/jamadermatol.2020.3385.

HoRS. Ongoing concerns regarding finasteride for the treatment of male-pattern androgenetic alopecia [published online before print, November 11, 2020]. J

2020;10.1001/jamadermatol.2020.3384. doi:10.1001/ jamadermatol.2020.3384.

A recent study shows an association between finasteride use and psychological adverse events (AEs) including suicidality. Dermatologists should weigh benefits and risks carefully when considering finasteride for certain patients with hair loss, according to one expert.

Study examines finasteride risks for younger males 

The first update in more than a decade, the most recent version of the American Academy of Dermatology (AAD)-National Psoriasis Foundation (NPF) guidelines identify some substantive changes in the management and treatment of psoriasis.

The newly released guidelines cover six topics: biologics, topical therapy, systemic non-biological therapies, management of pediatric patients, use of phototherapy, and comorbidities. Abby S. Van Voorhees, MD, highlighted these updates at the ODAC 2021 Pre-Conference Sneak Peek Inflammatory Diseases Virtual Symposium held in December.

One key change is the timeline for treatment success or failure. She used a case study of a 42-year-old male patient with psoriasis and inflammatory bowel disease who experienced a worsening flare of psoriasis despite being on adalimumab for 32 weeks to illustrate the failure in treatment caused by the biologic not working.

“A primary failure of a biologic medication is when a disease doesn’t respond to the initial course of treatment within the expected timeline,” she says. A secondary failure is when the disease responds initially, but skin clearance is lost over time. Practitioners need to understand how long to give a treatment to work and how to define what’s too short or too long, according to Van Voorhees, professor and chair of dermatology at Eastern Virginia Medical School, Norfolk, Va.

Medications vary for peak efficacy. For example, she says adalimumab has a peak efficiency at week 16. While the patient in the case study did well initially, the drug lost its efficacy and experienced secondary biologic failure. Practitioners should be aware of each drug’s efficacy timelines. For tumor necrosis factor (TNF) inhibitors, peak efficacy for etanercept is week 12, for infliximab week 10, and for adalimumab week 16. For interleukin (IL)-12/23 ustekinumab, peak efficacy is week 12; for IL-23 guselkumab it is week 16; for tildrakizumab and risakizumab week 12. Lastly for IL-17, peak efficacy occurs for secukinumab, ixekizumab, and brodalumab at week 12.

Van Voorhees also discussed the new onset of psoriasis or the paradoxical worsening of psoriasis in those treated with TNF inhibitors, which is commonly seen in patients with inflammatory bowel disease (IBD). She says it can mimic psoriasis and frequently involves the palms and soles. Treatments to relieve symptoms include class 1 steroids, an alternative biologic within a class of medication, and a change of biologic agent to an alternate class.

An increased risk of some types of cancer is inherent to psoriasis. The most common malignancies among psoriasis patients are lymphohematopoietic (with a standard incidence rate of 15.1), pancreatic, oropharynx, and larynx, in addition to nonmelanoma skin cancer, especially squamous cell carcinoma. However, there is no increased risk of melanoma or non-Hodgkin lymphoma, she adds.

The new guidelines divide surgical procedures into low risk, moderate risk, and high risk. Van Voorhees says that procedures that interrupt the respiratory passages or GI or urinary tract can be considered high risk. However, procedures such as orthopedic surgery or dermatologic surgery would identify as low risk.

In a low-risk situation, patients can continue on their drugs without interruption, she says. That may not be the case if the patient requires a significant respiratory procedure, which requires discontinuation of biologics. The risk of a surgical procedure depends on the procedure under consideration, according to Van Voorhees.

Drug treatment guidelines reflect key changes as well. “The new recommendations for liver toxicity associated with methotrexate require considering performing serologic studies and the liver stiffness assessment studies,” she says.

“We have begun to understand that the liver biopsy itself carries its own morbidity and risk, therefore, the new guidelines emphasize that liver biopsies are not needed.

Methotrexate should not be given to psoriasis patients who are pregnant, nursing, have a history of alcoholism or a history of liver disease, immunodeficiency syndromes, bone marrow hypoplasia, leukopenia, thrombocytopenia, or significant anemia, or those who are sensitive to the drug.

Relative contraindications include abnormalities in renal or liver function or active infection. Risk factors for hepatotoxicity include alcohol consumption, persistent abnormal liver function tests, chronic hepatitis B or C, a family history of inheritable liver disease, diabetes, obesity, exposure to hepatotoxic chemicals or drugs, and hyperlipidemia.

Van Voorhees notes that psoriasis is connected to many comorbidities, including metabolic syndromes such as obesity, hypertension, dyslipidemia, and diabetes. The risk of sleep apnea is increased, she adds. There is also an increased risk of uveitis, depression, chronic obstructive pulmonary disease (COPD), kidney disease, cardiovascular disease, sexual dysfunction, as well as cigarette smoking and alcohol abuse. Van Voorhees emphasizes the importance of screening psoriasis patients for comorbidities so patients can receive proper treatment.

 Dr. Van Voorhees reports disclosures related to Celgene, AbbVie, Lilly, Novartis, and UCB.

1. Van Voorhees, AS. Psoriasis management guidelines: what you need to know. Presented at: 2021 ODAC Pre-Conference Sneak Peek Inflammatory Diseases Virtual Symposium; December 3, 2020.

New AAD-NPF guidelines focus on biologics, topical therapy, systemic non-biological therapies, management of pediatric patients, use of phototherapy and comorbidities. 

New AAD-NPF psoriasis guidelines mark changes

Dr. Expert is a well-respected dermatologist who practices in a jurisdiction where it is perfectly legal for non-physicians to perform cosmetic laser procedures with essentially no physician supervision. Because of these permissive legal rules, many spas in the major metropolitan area where Dr. Expert practices provide energy-based device treatments. Some spas require direct onsite physician supervision of procedures; others do not.

At one such poorly supervised spa, a state-licensed esthetician performed laser hair removal on a Black woman with a laser that, ideally, was being used to treat lighter skinned individuals. Unfortunately, the woman suffered both permanent scarring and pigmentary changes.

Dr. Expert has been asked to serve as an expert witness for the suing plaintiff. But he is uncomfortable in this role and has never served as a plaintiff’s expert. However, he has become disgusted with the lack of strict guidelines as to who can perform laser treatments and what supervision he believes should be required.

It is not that he has difficulty with non-physicians performing cosmetic laser treatments. He is a strong advocate of this practice as long as there is direct onsite physician supervision. In fact, both physician assistants (PAs) and nurse practitioners (NPs) perform these treatments in his practice. He accepts his role as plaintiff’s expert witness because he is certain the case will be straightforward. It is not!

Upon finding out that Dr. Expert will testify, the defendant esthetician's legal counsel files a motion to exclude his testimony. The defendant’s attorney is fully cognizant that his esthetician client will be held to the same standard as a dermatologist performing laser hair removal.

The motion attempting to bar Dr. Expert’s testimony is based on the premise that he is not a state-licensed esthetician and therefore should not be allowed to testify against an esthetician–even if both the physician and esthetician are ultimately held to the same standard. The defendant’s attorney assumes that it will be hard for the aggrieved plaintiff to get an esthetician to testify against another esthetician. What will the court decide?

, an anesthesiologist served as plaintiff’s expert witness in a Texas malpractice action against the defendant chiropractor. Mark Vicento, the injured plaintiff, alleged that Group, who was his chiropractor, was negligent in failing to comply with the standard of care. Vicento filed an expert opinion from an anesthesiologist.

Group then filed a motion to exclude the expert report. He contended that a physician was not qualified to testify as to the chiropractic standard of care because he was not a chiropractor.

The court disagreed based on Texas's expert witness statute which requires that the expert 1) practice health care in a field of practice that involves the same type of care of treatment as that provided by the defendant health care provider; 2) has knowledge of accepted standards of care for providers for the diagnosis, care, or treatment of the illness, injury or condition involved in the claim; and 3) is qualified on the basis of training or experience to offer an expert opinion regarding those accepted standards of health care.

Even though the anesthesiologist was not a chiropractor, he fulfilled these requirements and his expert views were accepted.

Similarly, even though he is not a licensed esthetician, Dr. Expert uses similar methods to the defendant esthetician, his specialty over- laps and intertwines with that of an esthetician, and he is qualified to perform the same functions as estheticians. His expert testimony will be accepted.

In this month's Legal Eagle article, David J. Goldberg, MD, JD, examines the legality of whether physicians can be used as an expert witness against non-physicians.

Can doctors be expert witnesses against non-physicians?

Q:What can be done for extremely dry hands from frequent washing?

Hand washing prior to touching your nose and mouth is essential during the pandemic. However, frequent washing will remove the intercellular lipids resulting in damage to the hand skin barrier and xerosis, eventually causing cracking and bleeding of the skin. A healthy skin barrier prevents infection so dermatologists must take excellent care of their hands. It may be difficult to wear a hand cream during the day, but bedtime application is necessary. The best nighttime hand creams are high in glycerin, an excellent humectant that holds water and creates an optimal environment for overnight skin healing. They should also contain an occlusive ingredient to decrease transepidermal water loss (TEWL). This ingredient could be petrolatum, dimethicone or mineral oil. Neutrogena Norwegian Formula Hand Cream is inexpensive and widely available. Apply it to the hands and around the nails to prevent fissuring and bleeding. It may be wise to wash hands with lukewarm instead of hot water to minimize intercellular lipid removal.

Q: Why am I getting chin acne under my mask?

The increase in chin acne from mask wearing is known as “maskne.” It is a form of acne mechanica induced by rubbing of the mask over the chin when speaking. Masks may be made of cloth, paper, textured hydroentangled fibers or a combination of materials. They are designed to fit tightly over the nose and mouth to prevent the expectoration and inhalation of airborne COVID-19. Tighter fitting masks allow less air to enter and escape around the edges, offering superior protection, but they also will rub with facial movement over the chin. “Maskne” occurs when the terminal and vellus hairs on the chin are rubbed preferentially because the hair sits above the skin. This rubbing results in mechanical irritation and the onset of acne mechanica, just like acne tends to occur on the back of susceptible individuals who wear back packs. The solution for “maskne” is to keep the chin clean and bacteria free. This is best accomplished by wiping the chin with rubbing alcohol each morning prior to donning the mask. Also, try to select a mask that provides protection, but is long enough to allow for some chin movement independent of the mask. Test your mask by putting it on and opening and closing your mouth. If this can be accomplished without the mask rubbing your chin, then “maskne” can be reduced to the greatest degree possible.

Q: Why are my lips always chapped under my mask and what should I do to ameliorate the problem?

Many people who wear a mask now mouth breathe to move more air through the mask. This means more air is moving through the mouth than normal resulting in drying of the lips. The best solution is to wear a lip balm, but this can mess up a good mask by making it sticky inside. Lip balm is best applied at night when the lips are at rest. This allows the lips to heal by night and dry out by day. Waxes and cocoa butter are some of the best ingredients for lip balms. An inexpensive lip balm is Palmer’s Cocoa Butter Formula Swivel Stick. The stick can be rubbed over the lips at bed- time when the mask is not worn. It is also important not to lick the lips during the day or wear a mask that constantly rubs the lips. Be sure the mask is big enough to allow easy speech. Chapped lips can be minimized by proper mask selection.

Chief Medical Editor Zoe Diana Draelos, MD, discusses the challenges COVID-19 induces on the skin including chapped lips, maskne and dry hands from excessive hand washing. 

COVID-19 Induced Skin Challenges

The year 2020 was a rollercoaster ride from start to finish. From the onset of the COVID-19 pandemic to new safety protocols and a rise in the use of personal protective equipment (PPE), this year tested the will and dedication of health care workers to the

 industry—and most importantly—their patients. 

e dermatology industry made major strides

 ground-breaking U.S. Food and Drug Administration (FDA) approvals to the latest top-line research and creation of revolution

COVID-19 may have been top-of-mind since early last year, it wasn’t the only topic on

dermatologists, dermatologic surgeons, their teams and other health care providers working in the specialty.

here’s what Dermatology Times’ readers see as

With new and emerging biologic therapies for psoriasis seemingly popping up daily, one research team is seeking a new route for treatment with the development of a probiotic specifically tailored for th

Cath O'Niell, chief scientific officer at SkinBioTherapeutics and professor of translational dermatology at the University of Manchester, discuss

 and explains how probiotics might be a new viable therapy for other inflammatory skin disease besides psoriasis.

2. Silicone pads aim to reduce mouth lines

While mouth lines can be pesky and appear prematurely due to everyday activities such as drinking out of a straw or bottle, one company is aiming to combat th

se wrinkles and fine lines by introducing a product specifically tailored for the mouth area

Multi-Area Pads from SilcSkin, are made of medical grade silicone and designed to promote cell growth and stimulate collagen and blood flow to help reduce fine lines and wrinkles in the mouth area.

Similar to the benefits of using silicone to treat scars, the product hydrates wrinkles, refines collagen structure and flattens out lines through prolonged use, according to the company.

The FDA has reported a sharp uptick in hand sanitizers containing methanol and urges the public to be vigilant of the ingredients in their hand sanitizers.

The agency initially issued a warning at the beginning of July, listing a handful of hand sanitizer manufacturers whose products had been tested by the FDA and found to contain the toxic substance.

Methanol, or wood alcohol, is a chemical found in antifreeze and fuel. When used as an active ingredient and absorbed through the skin or ingested, the substance can be toxic or life-threatening.

4. Antihistamines effective in alopecia areata study

A study published in the Journal of the American Academy of Dermatology (JAAD) evaluated the efficacy of a combination consisting of antihistamines, topical corticosteroids (TC

) and superficial cryotherapy (SC) for the treatment of alopecia areata.

 after seven months of treatment, 100% of patients 

 achieved major hair regrowth compared to 79.3% of patients who were treated 

with TCs and SC. Also, the study’s authors report no adverse effects resulting from treatment.

5. Skin symptoms observed in COVID-19 patients

The virus can reportedly affect not only the lungs, but other internal organs as well as the senses

dermatologists are observing skin reactions in patients with the disease.

These reactions include “dengue fever-like rash,” a “hives-like rash,” livedo reticularis, a “measles-like rash” and pernio located on the extremities (also known as “COVID toes”).

6. New picosecond laser treats pigmentary disorders in darker skin types

The American Society for Laser Medicine and

 Surgery shows the new 730-nm picosecond laser to have strong efficacy and safety in treating endogenous pigmentary disorders on darker skin types.

The study examines two Korean patients with III-IV Fitzpatrick skin types, as well as melasma, freckles and lentigines

 who were treated with 730‐nm Ti:Sapphire picosecond laser (Picoway, Syneron Candela Corp) with a pulse duration of 240 picoseconds.

Researchers saw significant pigmentary reduction within one treatment session, which was well

tolerated without topical anesthesia in both patients. In the 6-week follow-up, there w

 no observed post-inflammatory hyperpigmentation/repigmentation in either patient.

7. Can botulinum toxin benefit rosacea patients?

Botulinum toxin may help address erythema and flushing in patients with refractory rosacea, according to data at the 

 Virtual Meeting Experience (VMX) on June 12.

Hema Sundaram, MA, MD, FAAD, explains how botulinum toxin can be used to address erythema and flushing caused by rosacea 

other considerations providers will want to keep in mind when using this treatment in their patients.

In this Q&A, Zoe Diana Draelos, MD, explains the role of preservatives in skincare products and the general safety and efficacy of products when it comes to protecting the skin against environmental factors.

9. The promise of laser-assisted drug delivery

Hema Sundaram, MA, MD, FAAD, highlights important safety considerations to keep in mind regarding laser-assisted drug deliver

This includes using products that are suited for intradermal injections and ensuring they are sterile. She also suggests treating localized body surface areas with laser-assisted drug delivery and consider the indications of the drug that will be delivered. 

She initially presented her findings in her presentation,

10. Topical androgen receptor inhibitor approved by FDA for acne

Clascoterone cream 1% (Winlevi, Cassiopea) has been approved by the 

 for the treatment of acne vulgaris in patients 12 years and older, the company announced.

The topical, a first-in-class androgen receptor inhibitor, restricts sebum production and inflammation caused by androgen hormones.

The approval is backed by positive data from clinical studies investigating the topical, in which clascoterone cream 1% reduced the number of acne lesions and was well- tolerated. The most commonly reported local skin reaction reported was mild erythema.

11. Medical innovation expands hair loss treatment

A variety of topical and injectable therapies show potential for addressing hair loss in both men and women, says Matt Leavitt, DO.

Some of the therapies mentioned include clascoterone (cortexolone 17-alpha proprionate; Breezula, Cassiopea). This androgen receptor inhibitor is being developed as a treatment for both male and female androgenetic alopecia (AGA), topical and oral finasteride, minoxidil, ketoconazole shampoo, platelet-rich plasma (PRP), and exosomes.

12. Alembic Pharmaceuticals launches adapalene gel for acne vulgaris

Adapalene Gel USP 0.3% (Alembic Pharmaceuticals), a bioequivalent and therapeutically equivalent to Galderma’s Differin Gel 0.3% (adapalene), has launched in the United States, according to manufacturer Alembic Pharmaceuticals.

Adapalene Gel USP 0.3% is indicated for the treatment of acne in patients ages 12 years and older. The topical treatment will be available in a 45 mg gel tube, as well as a 45 mg gel pump, the company states.

The abbreviated new drug application (ANDA) for the topical retinoid was approved by the FDA in June 2020. This is the 65th product launch from 

 Alembic since its introduction of U.S. operations in October 2015.

13. First injectable for cellulite approved by FDA

The FDA has approved collagenase clostridium histolyticum-aaes (Qwo, Endo International) for the treatment of moderate-to-severe cellulite in the buttocks in adult women, making it the first FDA-approved injectable cellulite treatment.

The injectable combines two collagenases, AUX-I and AUX-II, which are purified enzymes produced naturally by the clostridium histolyticum bacterium. Together, the enzymes degrade types 1 and 3 collagen by releasing the fibrous septae, which leads to an improvement in appearance and texture of the skin, according to the company.

The company expects the injectable to be available to aesthetic healthcare providers in the United States beginning in Spring 2021.

14. Injection technique aims to optimize outcomes

 highlighted the advantages of a novel facial rejuvenation protocol that gives special attention to the line of ligaments for optimal and more efficient lifting and volumizing in clinical outcomes.

When re-volumizing the mid-face, the technique allows the clinician to reposition the facial structures while injecting only a 

amount of filler product. After repositioning the fat pads, 

 re-volumize and contour the mid-cheek and face according to treatment goals. 

The technique can be used to correct the tear troughs, nasolabial folds, nasojugal grooves, and enhancing mid-face volume, according to Gabriela Casabona, MD, director of clinical research at the Ocean Clinic

15. Allergan, Skinbetter Science announce equity and diversity initiative

Steps are being taken to increase diversity and equity within the aesthetics field by Allergan Aesthetics, an AbbVie company, and Skinbetter Science through the launch of The DREAM Initiative.

DREAM: Driving Racial Equity in Aesthetic Medicine, is focused on implementing measures to increase racial and ethnic diversity, equity, understanding, inclusion and respect within the plastic surgery and dermatology fields.

 curriculum designed to assist with identification of implicit bias in clinical and academic settings while also demonstrating how to address bias when it occurs

publish The Spectrum of Dermatologic Disease, a photo atlas textbook showing the characteristics of skin conditions across racial and ethnic skin types.

Also, the initiative will organize Forces of Beauty Summits to recognize diverse beauty standards amongst various ethnic and racial groups to help aesthetic providers, companies and the media understand the aesthetic needs of all patients.

16. FDA accepts BLA for tralokinumab for atopic dermatitis

The FDA has accepted the Biologics License Application (BLA) for tralokinumab (Leo Pharma) for treatment of moderate-to-severe atopic dermatitis (AD) in adults.

The BLA acceptance follows published positive results from three phase 3 clinical studies (ECZTRA 1, 2 and 3) that investigated efficacy and safety. Tralokinumab, a fully human monoclonal antibody, works by offsetting the interleukin-13 (IL-13) cytokine, which is believed to be one of the main contributors of inflammation in AD.

Results showed all primary and secondary endpoints were met across all three trials, including an Investigator Global Assessment (IGA) score of clear (0) or almost clear (1) at week 16 and a minimum change from the baseline of 75% or greater at week 16. The secondary endpoints include a change from the baseline in week 16 in SCORing of AD (SCORAD), Pruritis Numeric Rating Scale (NRS) of 4 and Dermatology Life Quality Index (DLQI).

The FDA will make a decision on tralokinumab in the second quarter of 2021.

17. Sunscreen controversies confuse consumers

Media reports about sunscreen use, including its potential harms, can lead consumers to wonder whether they should be using sunscreens for photoprotection and which product to choose.

Adam Friedman, MD, says dermatologists need to be knowledgeable about the controversies and be prepared to answer patients’ questions with information that will reinforce the importance of sunscreen use.

18. Long-term benefits of pembrolizumab in melanoma

Researchers have found pembrolizumab (Keytruda, Merck & Co.) demonstrates long-term survival benefits regardless of BRAF V600E/K mutation status or previous BRAF inhibitor (BRAFi) therapy with or without a MEK inhibitor (MEKi) in metastatic melanoma patients, according to a published 10-year analysis in 

The Journal of American Medical Association Oncology.

The analysis pooled data from three clinical trials (KEYNOTE-001, KEYNOTE-002 and KEYNOTE-006), evaluating a total of 1,558 patients with advanced melanoma who have been treated with pembrolizumab and BRAF tumor status (BRAF wild-type or BRAF V600E/K-mutant melanoma).

Results of the analysis demonstrated an overall response rate (ORR) of 39.8% and 34.3% for BRAF wild-type and BRAF V600E/K-mutant melanoma, respectively, as well as a 4-year progression-free survival (PFS) rate (22.9% and 19.8%) and overall survival (OS) rate (37.5% and 35.1%).

19. AbbVie launches hidradenitis suppurative education center for physicians

 to spread awareness of hidradenitis suppurativa (HS) with the launch of their new educational website tailored for physicians.

By gathering feedback from various advocacy and professional organizations, the company has created a website to provide physicians with the best resources to better identify, diagnose, manage

The website provides a variety of HS resources that physicians can use, including patient case studies, links to organizations advancing HS education, treatment and management information, links to HS support, a differential diagnosis quiz

 and an overview of causes of HS and disease progression.

Draelos, MD, shares why retinoids can be found in many anti-aging formulations and how to reduce irritation from this potent antioxidant.

For 2020, trending topics can be summed up in one word: COVID-19. But, even during a pandemic, dermatologists and the medical community at large continued to research novel therapies and seek new solutions for providing the best possible patient care. Here, Dermatology Times tracks the most compelling topics of an unprecedented year. 

Dermatology Times, January 2021 (Vol. 42, No. 1)

Immunity Induction Therapy with Antibodies, Wound-Healing Therapies Show Potential

COVID-19-related telehealth broadens patient population

Study examines finasteride risks for younger males

New AAD-NPF psoriasis guidelines mark changes

Can doctors be expert witnesses against non-physicians?

COVID-19 Induced Skin Challenges

Top 20 trending stories of 2020

Utility of PRAME staining in identifying malignant transformation of melanocytic nevi

COVID-19 study shows impact on patients with PsO, other autoimmune problems