Background Guidelines differ on routine cardiovascular screening with electrocardiography (ECG), echocardiography (ECHO), or cardiology consultation before oral beta-blocker therapy for infantile hemangioma (IH). Objectives To assess the utility of routine cardiovascular screening before oral beta-blocker therapy for IH in real-world practice. Methods We searched PubMed, Web of Science, and the Cochrane Library (on 11 December 2025) for studies reporting ECG, ECHO, or cardiology consultation before oral beta-blockers in IH. Pooled proportions were estimated using random-effects models; remaining findings were described qualitatively. Results We included 11 studies (n = 2,225). Of 10 studies systematically performing ECG (n = 1,970), only two infants from one study were ineligible for therapy. No patient was ineligible after ECHO (n = 1,250; seven studies) or cardiology consultation (n = 550; five studies). One patient discontinued therapy for a cardiac adverse event despite a normal pretreatment ECG. The pooled proportion of abnormal findings was 8.2% for ECG (95% CI 2.4%–24.7%) and 31.5% for ECHO (95% CI 17.3%–50.2%), both with high heterogeneity (I2 = 96.9% and 97.6%, respectively). Conclusions Routine cardiac screening rarely precludes beta-blocker therapy, although abnormal results are common. As all included studies evaluated propranolol, these findings may not extend to other beta-blockers.
Afro-textured hair possesses distinct structural and biologic characteristics that influence hair fragility, grooming practices, and susceptibility to certain scalp disorders. Emerging evidence demonstrates that individuals of African descent also experience disproportionate burdens of hair-related disease, chemical exposures from hair products, barriers to culturally competent care, and inequities in research representation. However, no unifying framework currently exists to conceptualize these interconnected inequities within dermatology. This review introduces the term “hair health disparities” to describe inequities in hair and scalp health arising from the intersection of biologic, environmental, structural, and healthcare-related factors affecting individuals of African descent. Existing literature was synthesized across seven domains: chemical exposures from hair products, hair and scalp dermatoses, clinical education and representation, research and clinical trial participation, access to dermatologic care, physical and mental health, and workplace and school environments. Individuals of African descent experience disproportionate exposure to endocrine-disrupting chemicals in hair products, increased prevalence of traction alopecia and central centrifugal cicatricial alopecia, underrepresentation in educational resources and clinical trials, and barriers to timely dermatologic care. Recognition of hair health disparities as a multidimensional framework may help guide culturally informed education, inclusive research efforts, patient counseling, and interventions aimed at advancing equitable hair and scalp care.
Background Folliculitis decalvans (FD) is a rare neutrophilic cicatricial alopecia characterized by recurrent follicular inflammation and progressive irreversible hair loss. Conventional systemic therapies provide incomplete disease control, leading to off-label use of biologics and small molecules in refractory FD. Methods A systematic review of PubMed/MEDLINE and Embase was conducted following PRISMA guidelines. English-language human studies reporting biologic and small-molecule therapies and clinical outcomes in FD were included. Results Across 22 studies involving 70 patients, TNF-α inhibitors represented the most frequently reported therapeutic class, with adalimumab being the most commonly used agent, followed by PDE4 inhibitors, JAK inhibitors, and IL-17 inhibitors. TNF-α inhibitors were associated with clinical improvement or remission, while apremilast demonstrated heterogeneous outcomes. JAK inhibitors showed clinical improvement or remission, although relapses occurred after treatment discontinuation. Secukinumab resulted in improvement in one patient and remission in the other, whereas ixekizumab was associated with worsening. Adverse events were limited. Discussion Biologics and small molecules may represent promising therapeutic options for refractory FD, particularly TNF-α and JAK inhibitors. However, the available evidence remains constrained by the predominance of case reports and case series, heterogeneous therapeutic approaches and outcome reporting, and the absence of standardized outcome assessment and long-term follow-up.
Vascular occlusion is a well-documented complication of cosmetic hyaluronic acid fillers but remains underrecognized following intra-articular hyaluronic acid injection for the treatment of osteoarthritis. We reviewed published reports of cutaneous vascular complications following intra-articular hyaluronic acid injections to characterize clinical presentation, timing, histopathologic findings, proposed mechanisms, and management strategies. Thirteen cases were identified. Patients most commonly developed painful livedoid or retiform purpura near the injected joint, with clinical or histologic evidence of necrosis in ten cases. Symptom onset ranged from immediately during injection to 25 days after the procedure, suggesting a broader temporal pattern than is typical of cosmetic filler-associated vascular occlusion. Histologic examination demonstrated intravascular basophilic material consistent with hyaluronic acid in nine of ten cases, often associated with thrombus formation, supporting an embolic mechanism. Management strategies varied, including conservative care, antithrombotic therapy, and hyaluronidase. In the three cases treated with hyaluronidase, delayed administration was associated with symptomatic improvement, although evidence remains limited. Greater recognition of painful livedoid or retiform cutaneous changes following intra-articular hyaluronic acid injection may facilitate earlier diagnosis and management and support greater consideration of this rare but potentially serious complication in patient counseling, post-procedure monitoring, and safety discussions.
Introduction Tinea versicolor, a yeast infection caused by the Malassezia species, presents as hypo or hyperpigmented patches. Despite treatment, lesions may take several months to return to normal pigmentation. Moreover, the recurrent nature of the disease along with patient exhaustion of conventional treatments have led to an increasing interest in alternative treatments. Methods A review was conducted to critically evaluate the evidence behind topical herbal remedies for tinea versicolor. Databases including ClinicalTrials.gov, PubMed, and Google Scholar were searched with keywords related to topical herbal remedies and tinea versicolor from 2000 to 2025. Results A total of 14 studies assessing novel topical formulations on human subjects were selected for further review. Studies with a lack of measurable clinical outcomes (lesion reduction, mycological cure, standardized symptom scoring, etc.) were excluded. These studies compared various herbal remedies, including Terminalia chebula, Phyllanthus emblica, Psoralea corylifolia, etc., to conventional anti-fungal treatments. Our results highlight that herbal remedies led to comparable improvements in mycological cure rates, itching, scaling, and erythema. Conclusions Given the growing demand for integrative dermatologic therapies, our study shows promise for topical herbal remedies in the management of tinea versicolor.
Background Low-dose naltrexone (LDN) is a long-acting opioid receptor antagonist that exerts immunomodulatory effects through intermittent receptor blockade, upregulation of opioid growth factor, and reduction of pro-inflammatory cytokines. Its dermatologic use has expanded, with reported benefit in inflammatory conditions such as Hailey-Hailey disease (HHD), Darier disease, lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), dermatomyositis, and psoriasis. This systematic review evaluates LDN for treatment of pruritus in dermatologic disease. Methods Following PRISMA guidelines, PubMed, Embase, Web of Science, and ClinicalTrials.gov were searched for English-language studies assessing off-label LDN for pruritus. Two independent reviewers screened studies and extracted data on dosing, pruritus outcomes, and adverse effects. Results Of 574 articles identified between 2005 and 2025, 20 studies met inclusion criteria, comprising 205 patients (mean age 48.2 years). LDN was used across eight dermatologic conditions, most commonly HHD, LPP, FFA, and psoriasis. The most frequent dose was 6 mg, with some patients titrated from 3 to 4.5 mg. Conclusions HHD demonstrated the strongest response, with complete pruritus resolution in 45.5% and partial improvement in 38.6%. FFA and LPP showed moderate benefit, while other conditions had variable responses. Adverse effects were mild. Larger, prospective studies are needed to clarify durability of response, dosing strategies, and long-term safety.
Background Solid organ transplant recipients (SOTRs) face elevated risk of cutaneous squamous cell carcinoma (cSCC) due to chronic immunosuppression. HPV, an oncogenic virus linked to cSCC in SOTRs, may contribute to this risk, suggesting vaccination may help reduce disease burden. However, evidence on HPV vaccination uptake, immunogenicity, and efficacy in SOTRs remains incompletely synthesized. Methods MEDLINE, Embase, and Web of Science were searched from January 1, 2006 through March 26, 2025. Two reviewers independently screened articles, extracted data, and assessed quality using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) and JBI (Joanna Briggs Institute) tools. This review was pre-registered with PROSPERO (CRD420261366808) and OSF (10.17605/OSF.IO/3KVUX). Results Of 652 screened studies, 16 met the inclusion criteria. HPV vaccination rates were consistently low in SOTR cohorts, particularly in adults. Seroconversion rates ranged from 52 to 90%, below immunocompetent benchmarks; greater immunosuppression predicted attenuated response. Preliminary efficacy data suggest reductions in HPV-associated lesion burden with vaccination, but are derived from small, heterogeneous studies insufficient to establish causality. Conclusions HPV vaccination is underutilized in SOTRs and elicits attenuated immunogenicity. Efficacy data are promising but limited. Prospective controlled trials are needed to establish efficacy against HPV-associated disease in this population.
Squamoid eccrine ductal carcinoma (SEDC) is an uncommon adnexal neoplasm that most often affects elderly patients and arises on sun-exposed skin. It poses a diagnostic challenge as it clinically and histologically resembles squamous cell carcinoma (SCC) and other adnexal tumors, frequently resulting in misdiagnosis. Accurate identification relies on deep incisional or excisional biopsies that capture the ductal component, supported by immunohistochemical markers, though these are not entirely specific. SEDC exhibits infiltrative growth and frequent; perineural invasion, contributing to high recurrence rates after wide local excision (WLE). Case reports increasingly support Mohs micrographic surgery (MMS) as the preferred surgical management technique due to its low rate of recurrence and complete margin control.
Scalp rosacea is an uncommon and likely underdiagnosed manifestation of extrafacial rosacea. Since its first description in 1975, scattered reports and small series have identified characteristic features, including erythema, telangiectasias, papules, pustules, and perifollicular scaling in hairless or androgenetic areas of the scalp. Trichoscopy has recently expanded diagnostic accuracy, revealing vascular polygons, arborizing vessels, follicular plugs, and peripilar scaling. Histopathology often demonstrates perifollicular and perivascular lymphocytic infiltration, sometimes associated with Demodex folliculorum. Differential diagnoses include psoriasis, seborrheic dermatitis, lichen planopilaris, dermatomyositis, and contact dermatitis. Therapeutic approaches mirror those used in facial rosacea, including oral tetracyclines, low-dose isotretinoin, adjuvant probiotics, and topical ivermectin and metronidazole. Recent studies highlight the relevance of follicular scaling and scalp involvement as potential markers of disease severity and Demodex proliferation. Despite increasing recognition, standardized diagnostic and therapeutic guidelines are lacking. Scalp rosacea deserves broader awareness to improve recognition and management, and further prospective studies are needed to clarify its pathogenesis and optimize therapeutic strategies.
The concept of the exposome, encompassing the cumulative environmental exposures encountered throughout life, on cutaneous aging, pigmentary disorders, and inflammatory dermatoses has been increasingly recognized, but its influence on hair and scalp biology remains less understood. Hair follicles represent highly dynamic mini-organs that continuously interact with external environmental factors, rendering them particularly susceptible to exposomic insults. Airborne particulate matter, polycyclic aromatic hydrocarbons, heavy metals, tobacco smoke, ultraviolet radiation, water contaminants, occupational chemicals, microbiome dysbiosis, and lifestyle-related exposures have been implicated in follicular dysfunction through mechanisms involving oxidative stress, immune dysregulation, endocrine disruption, microinflammation, epigenetic modification, and stem cell exhaustion.Emerging experimental and epidemiologic evidence suggests that environmental pollutants may contribute to the pathogenesis and progression of several trichological disorders, including androgenetic alopecia, telogen effluvium, alopecia areata, cicatricial alopecias, seborrheic dermatitis, sensitive scalp syndrome, and premature hair graying. Pollutant-induced activation of the aryl hydrocarbon receptor, generation of reactive oxygen species, disruption of scalp barrier integrity, and alteration of the follicular microbiome constitute vital mechanistic pathways anchoring environmental exposures to hair disease.
Chemotherapy-induced alopecia (CIA) is a visible and psychosocially consequential toxicity of systemic cancer therapy. Scalp cooling is the primary preventive intervention, yet the evidence base informing its use has largely been generated from predominantly White cohorts, with limited race- and ethnicity-stratified efficacy data. This literature review summarizes current evidence on scalp cooling outcomes in patients with skin of color and diverse hair phenotypes, emphasizing efficacy gaps, biologic and technical determinants, access barriers, and survivorship implications. Available studies suggest that scalp cooling success may be influenced by chemotherapy regimen, cap-to-scalp contact, hair morphology, pharmacogenetic susceptibility, device design, counseling, cost, and geographic access. Early prospective data in Black women and registry data identifying Asian race and non–West-European hair type as predictors of reduced success raise concern that current devices and protocols may not perform equally across populations. Persistent chemotherapy-induced alopecia and alopecia-related distress also vary across racial and ethnic groups. Future scalp cooling research should prioritize diverse enrollment, objective hair phenotyping, scalp temperature mapping, patient-reported outcomes, adaptive device design, and equitable implementation strategies. Capsule Summary Scalp cooling reduces chemotherapy-related hair loss, but evidence remains limited for patients with skin of color and diverse hair phenotypes.Dermatologists should consider hair phenotype, cap fit, access barriers, and patient-reported distress when counseling patients about scalp cooling. Methods A non-systematic literature search was performed using PubMed, Google Scholar, and reference lists of relevant articles. Search terms included “chemotherapy-induced alopecia,” “persistent chemotherapy-induced alopecia,” “scalp cooling,” “skin of color,” “hair morphology,” “hair phenotype,” “Black women,” “Asian patients,” “racial disparities,” “ethnic disparities,” and “supportive oncology.” Priority was given to prospective trials, registry studies, retrospective cohort studies, qualitative studies, reviews, and consensus statements evaluating scalp cooling efficacy, persistent chemotherapy-induced alopecia, hair morphology, biologic susceptibility, device design, access barriers, and psychosocial outcomes across diverse populations.
[cannot exceed 200 words and can be structured or unstructured]There are currently no established guidelines for the treatment of acquired dermal macular hyperpigmentation (ADMH). ADMH is an umbrella term used to describe several pigmentary conditions with overlapping features including erythema dyschromicum perstans (formerly known as ashy dermatosis), lichen planus pigmentosus, and Riehl’s melanosis. Due to clinical and histological overlap and a lack of consistently distinguishing features, there has recently been a shift to group these conditions together under a singular term.ADMH is difficult to treat, and the diffuse, noticeable hyperpigmentation negatively impacts patients’ quality of life. To address this gap, we consulted pigmentary experts and conducted a literature review to identify articles on the treatment of ADMH. Most data available is limited to smaller uncontrolled observational studies and case reports/series given the uncommon nature of the disease, highlighting the need for novel therapeutics, larger scale controlled clinical trials, and global expert treatment guidelines. However, by synthesizing the available literature and expert opinions, we developed a provisional estimate of current treatment efficacy that we hope will provide guidance when treating ADMH.
Background Survey-based studies have reported frequent physical discomfort among dermatologic surgeons, particularly in the neck, back, and shoulders. However, there remain limited data identifying which operative variables influence ergonomic sustainability in outpatient dermatologic surgery. Moreover, standardized ergonomic guidelines in dermatologic surgery remain poorly defined. Objective This review aims to synthesize operative variables influencing neutral posture. It highlights the importance of applying objective ergonomic data and evidence-based interventions to outpatient dermatologic surgery. Methods A narrative review was conducted using PubMed, Web of Science, Embase, and OVID Medline databases. Search terms included “ergonomics,” “dermatologic surgery,” “office-based surgery,” and “neutral posture.” Results Key physical variables influencing ergonomic risk included working height, visualization, patient and surgeon positioning, and time in static postures. Cognitive workload further contributed to sustained static postures. Ergonomic interventions addressing both physical and cognitive variables have been established. Limitations Despite the prevalence of musculoskeletal symptoms among dermatologic surgeons, much of the existing ergonomic literature has been conducted in operating room environments or within surgical specialties outside of dermatology. Conclusion There remains a lack of specialty-specific objective data in the field of ergonomics for dermatology. Future research should focus on objective, longitudinal assessment of postural exposure during dermatologic surgery.
Background Whey protein (WP) is one of the most commonly used dietary supplements worldwide, yet, possible impact on hair remains unclear. Direct effects of WP on hair have not been well defined, and the available evidence is inconsistent and indirect. Objective To explore and synthesize the current evidence regarding WP use, focusing on its effect on hair, to highlight areas where evidence is lacking, and to outline the mechanisms that may connect WP use to hair. Methods A comprehensive review of the literature was conducted using PubMed and EMBASE. Two independent reviewers screened the abstracts of experimental, clinical, and observational studies addressing WP use; relevant articles were extracted and discussed. Results Limited human trials and mechanistic studies suggest that WP possible effects are mediated through amino acid composition, insulin-like growth factor 1 modulation, and hormonal changes; however, clinical trials are lacking. Conclusion Understanding the relationship between WP and hair is essential, given the global prevalence of protein supplement use. More focused clinical research is needed to determine whether WP plays a role in hair growth or loss, and to guide evidence-based counseling for patients who regularly use or want to use WP.
Bacterial skin neglected tropical diseases (NTDs) are associated with high morbidity and mortality, and with permanent sequelae, including disfigurement or functional impairment. Early intervention may improve patient outcomes, and dermatologists have an important role in expedited diagnosis and treatment. Recent studies have aimed to optimize antibiotic regimens for greater accessibility and efficacy. Immunization remains limited, and many bacterial skin NTDs have no approved vaccines. Development of vaccine targets and sustained mass eradication efforts are necessary to reduce global burden. In this clinical review, we synthesize management guidelines, outcomes, and updates in preventive efforts for bacterial skin NTDs, including leprosy, Buruli ulcer, treponematoses (yaws, bejel, pinta), noma, Bartonella infections, rickettsial infections, and Group A Streptococcus.
Acne vulgaris is a common dermatologic condition that may be exacerbated in athletes due to unique environmental, mechanical, and hormonal factors. Friction, occlusion, sweat, and supplement use can contribute to acne development and modify clinical presentation, often overlapping with acne mechanica and other follicular disorders. A literature review was conducted using PubMed to identify studies related to acne in athletic populations, including factors influencing pathophysiology and management. Relevant clinical studies, reviews, and case reports were included, with emphasis on data applicable to athletes. Management of acne in athletes requires consideration of sport-specific exposures, treatment tolerability, and regulatory factors. Topical therapies remain first-line, while systemic treatments such as antibiotics, isotretinoin, and hormonal therapies may be used in appropriate cases. Special considerations include minimizing irritation in the setting of sweat and friction, addressing supplement-associated acne, and awareness of antidoping regulations for certain medications. Effective acne management in athletes requires an individualized approach that accounts for sport-specific exposures, treatment tolerability, and athlete-specific safety considerations.
