Prediction markets increasingly allow participants to take financial positions on biomedical outcomes, including clinical trial results and US Food and Drug Administration decisions. Dermatologists may possess specialized expertise that helps them interpret emerging therapeutic data, but physician participation raises concerns about conflicts of interest, material nonpublic information, patient trust, and professional responsibility. These concerns are particularly relevant for physicians involved in clinical trials, regulatory activities, peer review, or industry consulting. We discuss the ethical implications of physician participation in prediction markets and propose principles to distinguish acceptable use of publicly available information from inappropriate trading based on privileged professional knowledge.
Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for type 2 diabetes mellitus and obesity, with expanding therapeutic applications. Although gastrointestinal adverse events are the most recognized toxicities, Cutaneous adverse events constitute a large burden of total adverse reactions. Objective To review the prevalence, clinical features, mechanisms, and management of non-immunologic Injection Site and Dermatologic Reactions associated with GLP-1RAs. Methods A review of clinical trials, pharmacovigilance studies, and case reports and series was performed. In addition, adverse event reports for tirzepatide, semaglutide, liraglutide, exenatide, dulaglutide, and lixisenatide were extracted from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). Injection-site events were combined with skin-related adverse events to generate an adjusted "Skin and Injection-Site Reactions" category for comparison across agents. Results Among 442,567 FAERS reports, 137,412 (31.0%) involved skin and injection-site reactions, representing the third most frequently reported adverse event category. Exenatide demonstrated the highest proportion of skin and injection-site reports (53.1%), followed by dulaglutide (33.5%), tirzepatide (32.6%), liraglutide (17.1%), semaglutide (12.2%), and lixisenatide (6.9%). Common reactions included pain, bleeding, erythema, bruising, mass, pruritus, and swelling. Additional adverse events included dysesthesias, nodules, granulomatous reactions, bruising, and hyperhidrosis. Most reactions were mild to moderate and generally managed symptomatically without requiring treatment discontinuation. Conclusions Non-immunologic cutaneous adverse events comprise a substantial proportion of reported GLP-1RA-associated adverse events with differing rates among individual agents. Recognition of these reactions and appropriate supportive management may improve patient outcomes. Prospective studies are needed to better define their adverse event risk rates, mechanisms, and optimal management strategies.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of obesity, type 2 diabetes mellitus, and cardiometabolic disease through effects on weight reduction, glycemic control, and systemic inflammation. Their varied immunometabolic actions have generated increasing interest in dermatology, where chronic inflammatory skin diseases frequently coexist with obesity, insulin resistance, metabolic syndrome, and cardiovascular disease. Emerging evidence from clinical trials, observational studies, and real-world analyses suggests that GLP-1RAs may improve outcomes in psoriasis and hidradenitis suppurativa while simultaneously reducing the burden of associated metabolic and cardiovascular comorbidities. In psoriasis, combination therapy with tirzepatide has demonstrated enhanced skin clearance, substantial weight loss, and reduced risk of psoriatic arthritis. In hidradenitis suppurativa, GLP-1RAs have been associated with improvements in cardiometabolic outcomes and reductions in systemic complications. Collectively, these findings support an evolving paradigm in which the greatest therapeutic utility of GLP-1RAs in dermatology may lie not in direct modulation of cutaneous inflammation but in addressing the metabolic dysfunction and chronic systemic inflammation that drive disease severity and multimorbidity. We review the current clinical evidence and propose a conceptual framework positioning GLP-1RAs as immune-metabolic therapies that target the systemic comorbidities of inflammatory skin disease, which may provide future opportunities for cutaneous disease modification and integrated dermatologic care.
The introduction of dermatology's specialty-specific Standardized Letter of Evaluation (SLOE) for the 2026-2027 residency cycle aims to improve fairness, comparability, and reduce bias in applicant assessment. Although standardization may reduce differences in writing style and interpretation, it does not eliminate subjectivity and may redistribute how and where bias affects the process. Rating inflation, ceiling effects, and interrater variability have been reported in dermatology and other specialties, while evidence that standardized ratings predict residency performance remains limited; furthermore, standardizing evaluation does not standardize opportunity: ratings of research, professionalism, and communication may reflect differences in mentorship, resources, clinical exposure, and evaluator relationships. Programs should, therefore, avoid interpreting small numerical differences as precise measures of ability and instead consider SLOEs within a holistic review. Ethical implementation will require ongoing assessment of rating inflation, interrater variability, demographic disparities, and predictive validity. Ultimately, the SLOE's value will depend on whether it improves comparability and transparency without creating false precision or masking unequal opportunities.
Isotretinoin is an effective acne therapy but highly regulated due to its potential teratogenicity and serious side effects. Isotretinoin distribution is currently monitored through the Food and Drug Administration- (FDA)-mandated iPLEDGE Risk Evaluation and Mitigation Strategy System (REMS). Safe prescribing depends not only on FDA and physician oversight, but also on patients taking the medication as prescribed and adhering to established safeguards, such as frequent pregnancy tests and routine monitoring. Concerns regarding nonadherence or potential medication diversion in the setting of apparent treatment failures raise ethical tensions, particularly if the provider cannot definitively assess how the medication is being used. We outline the ethical obligations of providers when there is credible suspicion for isotretinoin nonadherence or diversion.
Yellow nail syndrome (YNS) is a rare disorder defined by the triad of yellow nail discoloration, lymphedema, and respiratory tract disease. Only two of the three signs should be present to diagnose YNS; however, this can be challenging as patients often do not exhibit all three signs concurrently. The association between YNS and malignancy has led to the hypothesis that YNS may be paraneoplastic. Treatment may include oral vitamin E for nail discoloration, serial thoracenteses for pleural effusions, and compression garments along with bandaging for lymphedema.
As parental leave becomes increasingly common in dermatology residency programs, ethical questions arise regarding redistribution of clinical responsibilities. We examine whether requiring co-residents to cover additional on-call duties during colleagues' parental leave is ethically justified using the principles of autonomy, justice, beneficence, nonmaleficence, and honesty. While residents have an autonomous right to parental leave, programs should recognize the impact on co-residents. Temporary redistribution of duties may be necessary to maintain patient care, but justice requires that added workloads be distributed fairly and mitigated to avoid burnout, compromised education, and threats to patient safety. Residency programs should implement transparent parental leave policies, engage residents in policy development, and adopt equitable scheduling strategies rather than relying solely on peer coverage. Ethical parental leave policies should balance support for residents taking leave with fairness to their colleagues while maintaining resident well-being, educational quality, and patient care.
Dermatologist-inventors have ethical responsibilities extending beyond demonstrating that an innovation is helpful, accurate, and safe. Diagnostic technologies can be a positive influence on access to care, healthcare equity, and patient trust, particularly when these technologies are intended for rural and resource-limited communities. Ethical development of novel dermatologic diagnostic technologies requires consideration of beneficence, justice, transparency, accessibility, and responsible commercialization. Physician-inventors should evaluate whether a technology addresses a meaningful clinical need, performs adequately across diverse patient populations, and can be integrated into real-world clinical settings. Accessibility should also be considered during the design process rather than after development. Eliminating unnecessary cold-chain requirements may improve the feasibility of distributing diagnostic technologies to rural and low-resource settings where refrigeration and temperature-controlled transportation might be limited. These design strategies should be supported by appropriate analytical and clinical validation to ensure that accessibility does not compromise diagnostic performance. Such validations could lead to perpetuating inequities in underserved communities, where low cost technologies are most likely to have the biggest impact.
Genital herpes is a common, recurrent, chronic sexually transmitted infection that is frequently encountered in dermatologic practice, and in which the psychosocial burden often exceeds the physical manifestations, as many affected individuals are asymptomatic or experience only mild symptoms. Shame, fear of rejection, anger, depression, and anxiety surrounding disclosure can diminish quality of life more than the physical manifestations of the herpes infection. These concerns are compounded by practical threats to confidentiality, especially for adolescents whose explanation-of-benefits statements are insured under a parent's plan. Using two cases, we examine the ethical tensions that a diagnosis of genital herpes can create for the dermatologist. In the first, a patient requests omission of the diagnosis from her record; in the second, the same patient declines to notify an identifiable partner. In genital herpes, ethical management requires balancing confidentiality against truthful documentation and the interests of identifiable partners, while attending to stigma, relational autonomy, truthfulness, beneficence, informed consent, and psychologic morbidity alongside antiviral therapy.
Carcinoid syndrome refers to the signs and symptoms a patient experiences secondary to a carcinoid tumor or another well-differentiated neuroendocrine tumor, which secretes serotonin and other peptides that enter the bloodstream; only 10% of patients with carcinoid tumors experience carcinoid syndrome. Common findings include facial flushing, tachycardia, and shortness of breath. Carcinoid tumors usually originate in the gastrointestinal tract. They are slow growing but can metastasize to the liver, lymph nodes, and elsewhere. Primary or metastatic cutaneous carcinoid tumors present as pink, fast-growing dermal or subcutaneous nodules. The diagnostic workup includes a thorough history and physical examination of the entire body, including a urinary 24-hour 5-hydroxyindoleacetic acid and serum chromogranin A tests. Management of carcinoid syndrome initially includes the use of somatostatin analogs, diet, medication regulation, and clinical monitoring. More aggressive treatment, such as peptide receptor radionuclide therapy or everolimus, a mechanistic target of rapamycin (mTOR), may be required.
Necrobiotic Xanthogranuloma (NXG) is a rare non-Langerhans histiocytosis often associated with paraproteinemia or hematologic disease. NXG is usually characterized by yellow-orange, reddish-brown, or violaceous papules and nodules which may progress to form infiltrative plaques, with lesions often occurring in a periorbital distribution. Histopathologic study typically demonstrates bands of inflammatory granulomatous tissue separated by zones of necrobiosis, with the dermis and subcutaneous tissue most commonly affected. Historically, the diagnosis has been made based on consistent clinical and histologic findings, although diagnostic criteria have recently been proposed. Research on NXG is limited due to the condition’s rarity, making comparisons between therapeutic agents difficult. Numerous systemic and localized treatments have been documented with varying responses. Necrobiotic Xanthogranuloma (NXG) is a rare form of non-Langerhans histiocytosis first described by Steven Kossard and Richard Winkelmann (1924 -2012) in August 1980.1 NXG is characterized by yellow-orange, reddish-brown, or violaceous papules and nodules, which progress to form infiltrative plaques.2 While most commonly found on the periorbital skin, lesions may occur across multiple sites, including the trunk, extremities, and extracutaneous tissues.2 The histopathology is characterized by zones of necrobiosis separating bands of granulomatous infiltrate extending from the dermis to the subcutaneous tissue, with the epidermis often unaffected.1 Touton-type giant cells, foreign-body giant cells, and foam cells are also frequently appreciated, and cholesterol clefts may be present.3 Systemic paraproteinemia is associated with over 80% of patients with NXG and may precede or follow the initial presentation of cutaneous lesions for several years.4–8 Evaluation for potential underlying disease and effective treatment is necessary. As NXG is a rare condition, research is limited to case reports and retrospective studies, limiting assessment for efficacy of therapeutic agents. Numerous systemic and localized therapies have been used with varying response.2,9,10 We review the epidemiology, pathogenesis, clinical presentation, histopathology, diagnosis, and treatment of necrobiotic xanthogranuloma.
Glucagon-like peptide-1 receptor agonists and related incretin therapies have moved rapidly from second-line diabetes agents to widely prescribed cardiometabolic medications, and dermatologists increasingly encounter patients who are already taking them. Obesity is common among dermatology patients and is particularly prevalent in psoriasis and hidradenitis suppurativa, yet most eligible patients are not receiving glucagon-like peptide-1 receptor agonist therapy, and nearly all prescriptions originate outside dermatology. This positions dermatologists at the intersection of two distinct clinical questions: how to manage the cutaneous consequences of therapy in patients already receiving these agents, and when to raise the possibility of treatment in patients who may benefit. This narrative review examines patient selection, including the metabolic and inflammatory phenotypes most likely to see dermatologic benefit, and the practical demands of therapy that influence whether treatment succeeds. It reviews the dermatology-relevant adverse effects that patients most often notice, including facial volume loss, hair shedding, and gastrointestinal intolerance, along with a monitoring approach suited to the dermatology visit. Throughout, it argues that shared decision-making offers a useful framework for an area where the evidence is still evolving and where treatment can reshape how patients look and feel.
"Tanmaxxing" is an emerging online trend that promotes intentional ultraviolet (UV) exposure with minimal sun protection to achieve a darker tan. This beauty trend encourages participants to become as tan or dark as possible. While traditional tanning culture is well-documented, newer platforms such as Instagram® and TikTok® enable promotional materials to reach larger, younger audiences. They have recently not only begun promoting avoidance of sunscreens but also endorse the use of tanning oils. Engagement-based algorithms boost provocative videos of creators promoting sun-seeking behaviors, such as indoor tanning. These videos typically minimize or omit the risks, while the creators financially benefit from the participation of impressionable audiences. We outline the ethical implications of leveraging social media algorithms to promote tanmaxxing, exploring autonomy and adolescent vulnerability, and propose solutions to better protect adolescents and young adults from the normalization of preventable harm.
Smoking has been associated with increased disease severity, poorer treatment response, and adverse outcomes in several dermatologic conditions, including hidradenitis suppurativa (HS), psoriasis, cutaneous lupus erythematosus, and chronic wounds. Although smoking cessation counseling is traditionally viewed as the responsibility of primary care clinicians, dermatologists frequently encounter patients whose skin disease may be influenced by tobacco use. This raises an important ethical question: when does counseling regarding lifestyle behaviors fall within the scope of dermatologic practice? Herein, we discuss the ethical justification for dermatologists to engage in smoking cessation counseling through the principles of beneficence, autonomy, and justice. Beneficence supports counseling when tobacco use is relevant to disease severity, treatment response, procedural outcomes, or prevention. At the same time, counseling must respect patient autonomy and avoid approaches that may contribute to emotional distress, perceived judgment, or damage to the therapeutic alliance. Justice further requires recognition of the social and structural barriers that can make smoking cessation difficult for many patients. More broadly, smoking serves as a model for addressing other modifiable health behaviors that may affect skin health, including obesity, alcohol use, and vaccination status. Dermatologists are not obligated to comprehensively manage all lifestyle factors; however, they have an ethical/professional responsibility to discuss behaviors that have meaningful implications for patient outcomes.
Authors of fiction are unique. They develop the characters of their novels for their readers, with the main character of a book being the protagonist. Other important characters include the antagonist and the deuteragonist. This paper focuses on fiction novels in which one of the key characters is a dermatologist. Biographic sketches that describe some of the features of the authors who write these novels are provided. The authors include nine non-medical writers: Sue Civil-Brown, Tom Jordon, Janice Kaplan, Lynn Schnurnberger, Carolyn See, Terry Southern, Camy Tang, Bruce Wagner, and Sheila Gewirtzman. They also include a non-dermatologist physician (Sara Cohen who is a physiatrist and writes under the pseudonym Freida McFadden), and dermatologists Terry Cronin and Garry Gewirtzman (who writes with his wife Sheila, who is an accountant). A total of 10 dermatologists are included in the 18 books in which a dermatologist is a main character; one author wrote three books that had the same dermatologist as a protagonist, and a husband and wife team of writers wrote a series of seven novels in which a dermatologist was featured. The fictional dermatologists were either the protagonist (seven dermatologists in 15 novels), the antagonist (two dermatologists), or the deuteragonist (one dermatologist). The 18 novels were written by 12 authors. Nine of the authors had not attended medical school; however, three of the authors were physicians. Seven books were written by a husband and wife team (a dermatologist and his accountant wife). One book was written by two women who were not physicians. The dermatologist is a man as in six of the dermatologists or a women as in four of the dermatologists. All four of the women dermatologists were characters in novels written by women (five authors). The six men were included in books by either a man (four authors) or a woman (one author) or coauthors (including both a man and a woman). Some writers publish their novels under a pseudonym, with the authors having various personal reasons for using a pen name. Six of the 12 (50%) of the authors who wrote a novel with a dermatologist as the main character either used a pseudonym in that novel, or a different book, or both. Many of the non-physician authors (five of nine, 56%) used a pen name; these included four women and two men. Only the woman physician author used a pseudonym. One of the men used a shortened version of his first name and did not include the suffix after his last name; both of the men did not include their middle name or the first letter of their middle name. The dermatologist-as either a protagonist, an antagonist, or a deuteroantagonist-provides the reader with an intriguing character in a novel.
This review provides an overview of current evidence on the presence, distribution, and physiological role of glucagon-like peptide-1 (GLP-1) receptors in skin tissue. Although GLP-1 receptor agonists are primarily used to treat type 2 diabetes mellitus and obesity, increasing evidence suggests that they may also have direct effects on the skin. This review examines the available research on GLP-1 receptor expression in major skin cell types, including keratinocytes, dermal fibroblasts, and the cutaneous microvascular endothelium. The strength of the evidence is evaluated according to the species studied, the experimental model used, and the method of receptor detection, including gene expression, protein identification, and functional activity. Differences in findings across animal models, cultured cells, and human tissue are also considered. In addition, this review distinguishes between skin effects that are likely mediated by direct activation of GLP-1 receptors within cutaneous tissue and those that occur indirectly through systemic metabolic improvement or modulation of immune and inflammatory pathways.
Sexual health is central to quality of life; yet, its relationship to dermatologic disease remains insufficiently studied. Skin conditions can directly contribute to sexual dysfunction through pruritus, scarring, pain, and body image distress, and genital involvement is common but often overlooked. We present two cases to examine the ethical implications for dermatologic practice. In the first, a patient with vulvar lichen sclerosus reports avoiding intimacy, but the dermatologist does not explore the concern further. In the second, a patient with well-controlled plaque psoriasis never discusses the effects of genital involvement, because the dermatologist does not initiate the conversation. These cases show how silence may perpetuate unrecognized suffering and restrict meaningful patient autonomy. Ethical dermatologic care for sexual manifestations of skin disease requires sensitivity; permission-based, trauma-informed inquiry that prioritizes the patient's control, safety, and agency by asking consent before discussing sensitive topics; equitable screening; treatment of modifiable cutaneous contributors; and appropriate referral when concerns extend beyond dermatologic management.
BACKGROUND:Throughout history, the perception of female beauty has been shaped by cultural and historical values as well as evolutionary patterns. Understanding these paradigms is essential to grasping these concepts and their evolution, and to applying them to contemporary treatments. This comprehensive review aims to synthesize historical, evolutionary, and anthropometric data regarding female beauty, tracing its evolution to modern clinical applications in aesthetic medicine. METHODS:We analyze the various standards of beauty from antiquity-spanning ancient Egypt, ancient Greece, and Rome-up to the present day. RESULTS:From a biological perspective, evidence shows that certain characteristics-such as facial symmetry, sexual dimorphism, skin characteristics, youthful appearance, and signs of health-are consistently perceived as attractive and as indicators of beauty. CONCLUSIONS:Throughout the history of civilization, beauty has demonstrated an interplay between evolutionary biology, culture, psychology, history, and technology. Standards of beauty remain highly variable and continue to evolve. Social media and "influencers" are among the key factors shaping beauty standards today. A balanced, evidence-based, and safety-conscious approach to understanding beauty and treatments is essential in the field of aesthetics.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have rapidly expanded beyond the treatment of type 2 diabetes mellitus (T2DM) and obesity, with increasing relevance to dermatologic practice as more patients present while receiving these therapies. This medication class now includes oral formulations including oral semaglutide and the first non-peptide oral GLP-1RA, orforglipron as well as next-generation triple agonists such as retatrutide, which demonstrated up to 24.2% body weight reduction in phase 2 trials and a favorable body composition profile, with preferential fat over lean mass loss. Although GLP-1 RAs provide substantial metabolic and weight reduction benefits, their growing use has introduced a broad spectrum of systemic and cutaneous adverse effects that dermatologists must recognize and monitor. This review summarizes the current evidence regarding the safety profile of GLP-1RAs with emphasis on dermatologic implications and interdisciplinary monitoring considerations. Common adverse effects include gastrointestinal (GI) intolerance, nutritional deficiencies, gallbladder disease, pancreatitis, and loss of lean body mass. Other rarer potential side effects include anemia, neuropsychiatric, and sexual health effects. Emerging data also suggest associations with ophthalmologic complications, skeletal fragility in older adults, and alterations in body composition that may influence cosmetic and procedural outcomes. Dermatologic adverse events include alopecia, eczematous and hypersensitivity eruptions, bullous and pustular dermatoses, acneiform eruptions, hyperhidrosis, and significant facial volume loss ("Ozempic face"). Current evidence regarding GLP-1RA use in pregnancy remains limited and evolving, with recommendations generally advising discontinuation prior to conception. Given the increasing overlap between metabolic disease management and dermatologic care, dermatologists should understand contraindications, screening strategies, nutritional monitoring, and counseling considerations associated with GLP-1RA therapy. A multidisciplinary approach involving primary care physicians, endocrinologists, ophthalmologists, dietitians, and dermatologists is essential to optimize patient safety while maintaining the substantial therapeutic benefits of these medications.
Dermatology residency applications have become increasingly competitive, with more applicants applying each year against a relatively fixed number of residency positions. The implementation of tiered preference signaling, although ideal for applicants to express genuine interest in programs, has effectively reduced the number of applications per candidate and increased the value of each interview opportunity. With limited interviews distributed across select dates, scheduling conflicts inevitably arise each cycle, prompting applicants to coordinate with one another to swap interview dates. Of concern, there have been reports of medical student dermatology residency applicants seeking monetary compensation in exchange for their desired slot. We outline these ethical considerations and propose strategies to reduce incentives for monetized interview swaps.
