The Journal of Integrative Dermatology publishes information concerning the skin and external and internal factors that modulate its function, health, and disease. The Journal of Integrative Dermatology is an international, peer-reviewed, open-access journal committed to the highest standards of rigor and relevance spanning multidisciplinary fields represented in integrative dermatology, including but not limited to conventional treatments and pharmaceuticals, naturopathic medicine, ayurveda, energy medicine, lifestyle medicine, nutrition, microbiome, gut health, functional medicine, and traditional Chinese medicine. The Journal of Integrative Dermatology is the first of its kind, expanding the rigorous evidence around interdisciplinary modalities in cutaneous science.
Hormetic Stimulation and its Potential Health benefits for Skin
Numerous treatment strategies have been proposed to slow the aging process or mitigate its detrimental effects. Hormesis, or hormetic stimulation, refers to the process by which mild and controlled stressors induce adaptive and beneficial cellular responses. These stressors, ranging from plant-derived compounds to nanomaterials, can be natural, chemical, or mechanical in origin. Recent technological advances have led to the development of more targeted compounds that harness the potential of hormesis for therapeutic and cosmetic applications. In this review, we conducted a comprehensive literature search using Google Scholar, PubMed, and ScienceDirect to examine original studies on hormetic stimulation in skin cells. We highlight the roles of heat shock proteins (HSPs), nuclear factor erythroid 2-related factor 2 (Nrf2), and heme oxygenase-1 (HO-1) in mediating these effects. Evidence indicates that mild heat stress enhances antioxidant capacity and proteasome activity, curcumin induces Nrf2/HO-1 activation and promotes wound healing, and low-dose nanomaterials stimulate cell viability and regeneration. We also discuss the emerging application of nanomaterials in cosmetic formulations and their hormetic impact on skin health. Although the underlying mechanisms are increasingly well understood, further research is needed to clarify the clinical implications and optimize the use of hormetic agents in dermatology and anti-aging interventions.
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Dietary and Microbiome-Directed Adjuncts in Atopic Dermatitis: Prebiotics, Probiotics, Synbiotics, and Parabiotics
# Background Microbiome-directed therapies are increasingly used by patients with atopic dermatitis (AD), yet clinical guidance remains fragmented and often extrapolated from low-quality evidence. This review synthesizes current data on dietary strategies, prebiotics, probiotics, synbiotics, and parabiotics for the treatment of AD. # Methods We performed a comprehensive literature search of PubMed/MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov from inception to October 2025 evaluating randomized controlled trials, mechanistic studies, and systematic reviews reporting clinical outcomes in patients with AD. Interventions were assessed for efficacy, durability, safety, age-specific effects, and strain- or formulation-specific patterns. Particular attention was given to trials using standardized severity indices and those incorporating microbiome or metabolomic profiling. # Results Evidence supporting diet-based interventions is limited: whole-food, fiber-diverse dietary patterns may confer microbiome-mediated benefits, whereas elimination diets should be restricted to confirmed IgE-mediated food allergy. Prebiotics show modest, inconsistent improvements in pediatric AD but limited effect in adults. Probiotic and synbiotic trials demonstrate strain-dependent and age-dependent outcomes, with best responses in older children and adults using high-quality, well-characterized strains. Postbiotics, though less studied, show short-term symptomatic improvements with favorable safety profiles but no sustained benefit after discontinuation. Across modalities, heterogeneity in strain selection, dosing, formulation, and outcome measures limits comparability. Mechanistic data increasingly support roles for SCFA signaling, immune modulation, and barrier effects, but results remain preliminary. # Conclusions Microbiome-directed adjuncts may provide modest, strain-specific, and age-specific benefits in treating established AD, but should not replace standard anti-inflammatory therapy. Given rapid commercial expansion and growing patient use, dermatologists need clear, evidence-based counseling frameworks. Future trials require standardized strain characterization, high-resolution microbial profiling, and rigorous clinical endpoints to identify truly effective therapeutics.
Open Label Pilot Study on the Combination of an Oral Pre- and Pro-biotic, a Biotech Botanical Moisturizer and Unscented Soap in Moderate Atopic Dermatitis
# Relevance Atopic dermatitis (AD) is an inflammatory skin condition with a multifac-torial pathophysiology. Standard treatment emphasizes topical corticosteroids (TCs), but there is growing interest in alternatives to TCs. # Objective To evaluate the efficacy of a novel pre- and pro-biotic supplement, a biotech botanical moisturizer, and an unscented soap on AD severity, pruritic, and skin biophysical properties. # Methods The efficacy of the pre- and pro-biotic supplement were evaluated. An open label trial was conducted involving 34 subjects with moderate AD. At baseline and day 56, the SCORAD, pruritus, and skin biophysical measures were assessed. # Results Between D0 and D56, mean total SCORAD decreased by 93% (p<0.0001), mean oSCORAD decreased by 94% (p<0.0001), and mean p-NRS decreased by 92% (p<0.0001). By D56, TEWL decreased by 39% (p=0.0001), hydration increased by 115% (p<0.0001), and desquamation index decreased by 18% (p<0.005). # Conclusions The pre- and pro-biotic supplement, botanical moist-urizer, and unscented soap demonstrated improvement in skin barrier integrity and AD severity in 8 weeks, suggesting potential clinical efficacy for AD management.
Effect of tralokinumab treatment in patients with moderate-to-severe atopic dermatitis and allergy-related conditions
Atopic dermatitis (AD) is a chronic inflammatory skin disease often associated with allergy-related comorbidities such as asthma, hay fever, food allergies, and eye allergies. This study evaluated the effects of tralokinumab treatment in patients with moderate-to-severe AD and coexisting allergy-related conditions. Data from four phase 3 clinical trials involving adults and adolescents with moderate-to-severe AD were analyzed over a 16-week period, comparing tralokinumab with placebo. Patients were grouped according to self-reported history of asthma, hay fever, food allergies, and eye allergies. Results showed that patients receiving tralokinumab demonstrated significant improvements in AD severity regardless of allergy history, including clearer skin and reduced disease severity. Reported side effects were generally mild to moderate and comparable to placebo. Overall, tralokinumab reduced AD severity in patients with moderate-to-severe AD, supporting its use as a treatment option for individuals with co-occurring allergy-related conditions.
From Phytochemicals to Nanocosmeceuticals: Green Nanocarriers for Anti-Inflammatory and Antioxidant Skin Therapy
Chronic inflammatory and oxidative stress–driven skin disorders, including acne vulgaris, atopic dermatitis, psoriasis, photoaging, and impaired wound healing, share convergent pathogenic mechanisms characterized by redox imbalance, cytokine dysregulation, and impaired barrier function. Although plant-derived phytochemicals such as flavonoids, terpenoids, phenolic acids, and alkaloids exhibit broad antioxidant, anti-inflammatory, and reparative activities across these conditions, their dermatologic translation is constrained by chemical instability, low bioavailability, and limited cutaneous penetration. Advances in green nanotechnology offer a strategy to overcome these limitations by integrating botanical pharmacology with nanoscale delivery through environmentally benign synthesis. Phytochemical-mediated nanoparticle fabrication enables plant metabolites to serve as both reducing and capping agents, yielding nanocarriers with enhanced physicochemical stability, biocompatibility, and intrinsic biologic activity. These green nanocarriers improve penetration of the epidermis and follicles, increase local retention, and enable environmentally responsive release within inflamed or oxidative skin microenvironments. Across diverse phytochemical classes, modulation of key cutaneous signaling pathways, including Nrf2–Keap1, NF-κB, MAPK, the aryl hydrocarbon receptor, and PI3K–Akt–mTOR, underlies observed effects on oxidative stress regulation, cytokine suppression, cellular proliferation, extracellular matrix remodeling, and barrier restoration. Phytochemical-rich surface coronas further contribute to antioxidant buffering, controlled release, and microenvironment-specific interactions, enhancing therapeutic precision while limiting off-target exposure. Considerations related to safety, toxicology, reproducibility, regulatory oversight, and sustainability remain central to clinical translation, particularly given the inherent variability of plant-based synthesis. Collectively, this review positions green nanocosmeceuticals as a sustainable and biologically sophisticated paradigm for next-generation dermatologic therapeutics.
Five Mountains, One Summit: A Framework for Product Success
Clinician-founders function at the interface of patient care and product development. However, they often face challenges that extend beyond a single clear solution. Successful product development often emerges across many parallel domains. To address this, we propose the Five Mountains Framework, a model in which each “mountain” represents a distinct lever to manipulate during product development and deployment. Formulation, the experience lever, refers to the texture, scent, packaging, and regimen simplicity, determining whether a product is used or abandoned. Evidence, the credibility lever, reflects the clinical data supporting the utility of the product. Narrative, the meaning lever, shapes the consumer perception of the product before it is even used. Accessibility, the reach lever, converts interest into action by making the product easy to find and affordable. Education, the understanding lever, guides consumers toward confident, effective use of the product. Together, these five domains constitute the Five Mountains Framework, which represents the landscape that clinician-founders need to navigate to produce a successful product.
From Vectors to Vulnerability: Climate Change’s Role in Dermatology
Climate change is a major crisis in the medical, political, and environmental realms, significantly impacting local and global health. Dermatology is not immune to the effects of climate change, yet this is underrecognized as a key issue in our specialty. This review synthesizes the current literature on the complex relationship between climate change and dermatologic conditions, specifically focusing on four key areas: UV exposure, infectious dermatoses, impact on vulnerable populations, and medical waste. Rapidly rising temperatures and ozone layer depletion directly correlate with increased UV exposure, thereby increasing the risk of skin cancer and photosensitive dermatoses. Climate change ultimately alters both vector and microbial survival, thus expanding the geographic ranges of pathogens and, through extreme weather and human migration, fostering the emergence of both known and novel infectious dermatoses. Vulnerable populations are disproportionately bearing the brunt of these dermatologic consequences due to various structural inequities. Finally, dermatologic practices generate waste that contributes to climate change, and while the use of artificial intelligence (AI) in dermatology has exciting and innovative applications, developers and users should be mindful of the environmental impact and prioritize sustainable strategies when possible.
Introduction of Oral Probiotics for Symptom Reduction in Pediatric Atopic Dermatitis: A Prospective Pilot Study
# Relevance Atopic dermatitis is a chronic inflammatory skin condition that significantly affects quality of life in children and families. Increasing interest in integrative approaches has led to investigation of probiotic supplementation as a potential adjunctive therapy. # Objective To evaluate the clinical impact of daily oral probiotic supplementation in children with sub-optimally controlled atopic dermatitis in a pediatric primary care setting. # Methods This prospective single-arm pilot study enrolled children aged 0–15 years with clinician-diagnosed atopic dermatitis and persistent symptoms. Participants initiated daily oral probiotic supplementation for 12 weeks. Symptom severity was assessed using the Patient-Oriented Eczema Measure (POEM) at baseline and at 4-, 8-, and 12-week follow-up. The primary outcome was change in POEM score from baseline to week 12. Descriptive statistics were used to evaluate symptom change and adherence. # Results Seventeen participants completed the 12-week intervention. Mean baseline POEM score decreased from 10.41 to 3.7 at week 12 (mean change −6.74), corresponding to a mean percent improvement of 64%. Fourteen participants (82%) demonstrated reduction in POEM score. Adherence (≥5 days per week) was observed in 76% of participants. One participant reported mild gastrointestinal discomfort; no serious adverse events occurred. # Conclusion Daily oral probiotic supplementation was associated with meaningful reductions in patient-reported atopic dermatitis symptoms in this pilot cohort. These findings support further controlled studies evaluating probiotics as an adjunctive strategy in pediatric atopic dermatitis management.
Hidradenitis Suppurativa Subtypes: Exploring Proposed Phenotypes and Their Clinical Relevance
Hidradenitis suppurativa (HS) is a multi-factorial disease with a wide range of presentations. Several classification systems have attempted to define unique phenotypes, aiming to guide clinical management and elucidate underlying mechanisms. However, overlapping features limit their practical utility. We reviewed existing literature and consolidated key features into four clinical domains: weight, smoking, atypical site involvement, and inflammatory load. By considering these factors, clinicians can adopt a more individualized, integrative approach to HS management. We recommend clinicians discuss weight management and smoking cessation with all HS patients. For pharmacological management, atypical site involvement, a moderate to severe assessment with HS-IGA (Hidradenitis Suppurativa Investigator Global Assessment), and a high HiSQoL (Hidradenitis Suppurativa Quality of Life) score may warrant early systemic therapy to control disease progression and reduce long-term complications.
Beyond Hot Flashes: Understanding and Treating Menopause-Associated Skin Changes
Menopause represents a pivotal physiological transition with profound dermatologic implications. Declining estrogen and shifts in other sex hormones trigger a spectrum of cutaneous and hair changes, including dryness, pruritus, impaired barrier function, acne, rosacea, hair thinning, increased facial hair, and accelerated skin aging. These manifestations extend beyond cosmetic concerns, contributing to discomfort, reduced quality of life, and increased vulnerability to inflammatory and infectious dermatoses. This review examines the underlying mechanisms of menopause-associated skin and hair changes and highlights current and emerging therapeutic strategies to inform clinical management. Estrogen plays a central role in dermal and follicular homeostasis through collagen, elastin, water retention, and ceramide regulation. As such, estrogen deficiency contributes to collagen loss, impaired barrier integrity, reduced elasticity, and increased transepidermal water loss—exacerbating xerosis and skin sensitivity. Hormonal shifts, including relative androgen excess, further contribute to acne, sebaceous gland activity, and unwanted hair growth. Moreover, barrier dysfunction and immune dysregulation may worsen existing dermatologic conditions, underscoring the complexity of menopause-related skin changes. Emerging therapeutic options are evolving beyond systemic and topical hormone replacement therapy, as their use is limited by systemic risks. Alternative and adjunctive approaches, including selective estrogen receptor modulators, topical retinoids, antioxidants, phytoestrogens, and regenerative options such as exosomes, offer promising, targeted options for postmenopausal skin management. Given the high prevalence of dermatologic and hair concerns during menopause and the postmenopausal period, heightened awareness, evidence-based treatment strategies, and continued research are essential. Understanding the multifactorial pathophysiology of menopause-associated skin changes enables more comprehensive, empathetic, and patient-centered care. Lastly, by integrating hormonal, non-hormonal, and supportive therapies, clinicians can better address the unique dermatologic challenges of menopause, ultimately improving outcomes and quality
Cyano-Phycocyanin: A Potential Photoprotective Nutraceutical to Reduce Ultraviolet Radiation-Induced Damage and Skin Cancer Risk
# Purpose Antioxidant supplementation has been clinically proven to prevent tissue damage and boost repair mechanisms by mitigating oxidative stress. This article aims to achieve an in-depth understanding of Cyano-Phycocyanin's (C-PC)’s mechanism of action and overall benefits after exposure to ultraviolet radiation (UVR) from the sun. C-PC, a phycobiliprotein extracted from nutrient-dense, safe-to-consume blue-green algae known as Spirulina or Arthrospira platensis (AP), is considered a “superfood” due to its exceptional nutritional profile and bioactive properties. C-PC’s potent antioxidant and anti-inflammatory benefits are well-known to promote tissue repair and overall health. UVR accounts for approximately 80-90% of skin environmental aging and is the leading cause of skin cancer (non-melanoma and melanoma). Thus, our hypothesis suggests that C-PC supplementation as an adjunct photoprotective therapy may help prevent or diminish intrinsic and/or environmental aging linked to UVR and the tumorigenicity of UVR. # Method A PubMed, Clinical Key, and Cochrane Library literature search was conducted using the following search terms: cyano-phycocyanin, spirulina, antioxidant, free-radical damage, ultraviolet radiation, oxidative stress, and skin cancer. Twenty pertinent articles were retrieved as the basis for this clinical review. # Results Robust in vitro and animal models evidence-based research showed a positive correlation between C-PC supplementation, and cellular protection suggesting a potential role in skin cancer protection. # Conclusion C-PC in vivo and in vitro research indicates promising results in repairing and reversing cellular damage. However, while preclinical data is compelling, human clinical evidence is still pending to determine the level of benefit linked to oral supplementation with C-PC.
Reframing Dermatologic Disease Through Trauma, Attachment, and Autonomic Science: An Integrated Biopsychosocial Framework for Clinical Practice
Chronic skin disease is commonly explained through immune dysregulation, barrier impairment, and genetic risk, yet growing evidence indicates that stress physiology, early adversity, and relational experience also shape dermatologic vulnerability and symptom expression. Research from neuroscience, psychoneuroimmunology, trauma studies, and attachment science demonstrates that autonomic regulation and early relational environments influence inflammatory responses, sensory processing, and the chronicity of multiple skin conditions. Because the skin and nervous system share an ectodermal origin, they maintain continuous bidirectional communication across the lifespan. Nervous system signals regulate cutaneous inflammation, barrier repair, pruritus, and nociception, while the skin functions as a neuroimmunoendocrine organ capable of producing and responding to stress mediators. These pathways contribute to “skin memory,” reflected in autonomic tone, inflammatory thresholds, and stress-reactive sensory profiles. Consequently, cutaneous responses represent systemic nervous system patterns rather than isolated local events. This Perspective introduces the Somatic Skincare™ Method as a clinical framework integrating autonomic regulation, relational safety, and affective touch with conventional dermatologic care. Trauma-informed, nervous system–aware approaches may reduce shame, enhance coping strategies, and improve symptoms not fully addressed by medical therapy alone. This synthesis reframes dermatologic disease as a biologically and relationally embedded process and proposes an expanded model for assessment, patient education, and therapeutic intervention within integrative dermatology.
Calming the Itch: Evidence-Based Non-pharmacologic Interventions for Chronic Pruritus
Chronic pruritus, defined as itch lasting more than six weeks, affects up to 22% of individuals during their lifetime and carries a substantial burden, including impaired sleep, reduced quality of life, and increased risk of depression. Conventional pharmacologic therapies often provide only partial or temporary relief, particularly when itch arises from neuropathic or psychogenic causes, highlighting the need for complementary strategies. This review examines evidence for non-pharmacologic interventions, which can be grouped into neuromodulation, mind-body approaches, and barrier or environmental strategies. Neuromodulatory options such as phototherapy, transcutaneous electrical nerve stimulation (TENS), cryotherapy, heat therapy, and acupuncture act on neural pathways. Of these, narrowband ultraviolet B (NB-UVB) phototherapy has the strongest evidence, consistently improving itch and reducing corticosteroid use. Mind-body interventions, including cognitive behavioral therapy (CBT), meditation, relaxation training, music therapy, and massage, target the perception of itch and the itch-scratch cycle, with benefits most evident in atopic dermatitis (AD). Barrier-focused therapies such as antimicrobial textiles and wet-wrap treatment enhance hydration, restore skin integrity, and may provide rapid relief, particularly in pediatric AD. Despite encouraging findings, most trials are small, short-term, and heterogeneous. These therapies should be considered supportive adjuncts to standard care, with larger controlled studies needed to establish long-term efficacy.
One Oral Dermatologic Supplement with Two Indications? A Review of Active Ingredients in Popular Hair Supplements and Their Efficacy in Treating Hair Loss and Acne
The use of oral supplements in the treatment of dermatologic conditions has been increasing. These supplements often contain a combination of vitamins, minerals, and botanicals. They are advertised to treat various conditions, including hair and skin disorders. Given the overlap in ingredients, this review explores whether a single oral supplement could effectively address multiple dermatologic conditions, even if not specifically advertised. A Google search was performed for “hair growth supplements.” The top results were reviewed with documentation of active ingredients, and then a literature search was performed for each ingredient’s role in hair and acne management. Results showed that vitamins A, C, D, and E, as well as biotin, zinc, and selenium, demonstrated mixed efficacy in treating hair loss and acne, while iodine supported hair growth but was associated with worsening acne. By synthesizing the current data, clinicians can help consumers make more informed decisions and gain a clearer understanding of the supplements they use.
An Overview of Hyperhidrosis Treatment Options with an Emphasis on Iontophoresis as a Non-invasive, Effective, and Safe Treatment Modality
# Relevance Hyperhidrosis, a condition characterized by excessive sweating beyond physiological needs, most commonly affects adolescents and young adults aged 18-39, though it can also present in pediatric populations. Approximately 15.3 million people in the United States, about 4.8% of the population, are affected. Despite its prevalence, evidence remains limited for many treatment modalities, particularly iontophoresis. # Objectives The purpose of this manuscript is to review the general treatment options for hyperhidrosis, with a specific focus on iontophoresis as an integrative approach. # Methods A comprehensive literature search was conducted using PubMed, Google Scholar, and the University of Wisconsin Libraries. Search terms included various combinations of keywords such as “hyperhidrosis”, “primary and secondary hyperhidrosis”, “treatment management”, “quality of life”, “prevalence”, “antiperspirants”, “iontophoresis” (including its mechanisms and guidelines), “botulinum toxin”, “anticholinergics”, “MiraDry”, “surgical management”, “psychological impact”, and “supplement.” Studies were selected based on their relevance to the pathophysiology and therapeutic applications of hyperhidrosis, with no restrictions on publication date or language. # Results Treatment options for hyperhidrosis include topical antiperspirants, topical anticholinergics, oral anticholinergics, botulinum toxin injections, surgical sympathectomy, microwave-based treatment, iontophoresis, multidisciplinary care and supplements. Iontophoresis is considered a first-line, non-invasive treatment for palmar and plantar hyperhidrosis. It may also be used for axillary hyperhidrosis when compatible machines with specialized attachments are available. The procedure involves immersing the affected areas, typically the hands or feet, most commonly in tap water or medicated solutions such as aluminum salts, glycopyrrolate, glycopyrronium bromide, or poldine methosulfate while a mild electrical current is applied. Clinical studies have shown that iontophoresis can significantly improve quality of life, with symptom relief lasting up to three months following treatment. In pediatric patients, approximately 50% of those with primary palmar hyperhidrosis report noticeable symptom improvement. Treatment protocols vary depending on the manufacturer, but commonly recommend 10-30-minute sessions, administered 3-5 times per week. One retrospective review found that clinical benefit was typically observed after an average of 15 treatment sessions, though studies noted improvements between 6-15 sessions. # Conclusions Hyperhidrosis can significantly impact quality of life, but a range of treatments can offer relief. Iontophoresis stands out as a safe, effective, and drug-free option for many patients, particularly those with focal symptoms. Further research is needed to standardize treatment protocols and better understand long-term outcomes.
Open-Label Study Demonstrating Improvement in Atopic Dermatitis and Pruritus Resulting from the Use of an Oral Antioxidant-Enhanced L-Histidine Supplement with a Plant-Biotech Moisturizer and Unscented Soap
# Relevance Atopic dermatitis (AD) is an inflammatory skin condition with a multifactorial pathophysiology. Standard treatment emphasizes topical corticosteroids (TCs), but there is growing interest in alternatives to TCs. # Objective To evaluate the efficacy of a novel antioxidant-enhanced L-histidine supplement, a plant-biotech moisturizer, and an unscented soap on AD severity, pruritus, and skin biophysical properties. # Methods An open-label trial was conducted including 35 subjects with moderate AD. At baseline and day 56, the SCORAD, pruritus, mood changes, and skin biophysical measures were assessed. # Results Between D0 and D56, mean total SCORAD decreased by 93% (p<0.0001), mean oSCORAD decreased by 92.1% (p<0.0001), and mean p-NRS decreased by 97% (p<0.0001). By D56, TEWL decreased by 29% (p=0.002), hydration increased by 117% (p<0.0001), and desquamation index decreased by 83% (p<0.0001). In addition, when mood was assessed at D56 relative to baseline, there were significant reductions in overall negative affect (p<0.05). # Conclusion The oral supplement, plant-biotech moisturizer, and unscented soap demonstrated improvement in skin barrier integrity and AD severity in 8 weeks, suggesting potential clinical efficacy of plant-biotech for AD management.
From the Kitchen to Your Skin: A Review of Nontraditional Moisturizers
In recent years, consumers have become more aware of the ingredients used in their daily personal care products. Added colorants, fragrances, and preservatives have raised concerns about safety. Due to this, there has been increased interest online to identify integrative moisturizers for use in consumers’ routines. This review investigates nontraditional moisturizers studied in the literature and reports on their proposed mechanism of action, clinical efficacy, and potential side effects. Studies were identified through searches on PubMed, Google, and Google Scholar using a broad range of search terms. Findings show many of these agents can decrease transepidermal water loss, support skin barrier function, and deliver essential nutrients to skin. Future studies are needed to investigate these products for specific use as skin moisturizers in a wide range of skin types to evaluate their application in clinical practice. By synthesizing the current data, consumers can make well-informed decisions, and these products can help diversify skincare ingredients, offering more easily accessible and cost-effective options.
Insulin resistance in Mexican women with acne vulgaris
# Relevance Acne vulgaris is the most common dermatological condition defined as a chronic inflammatory disease of the pilosebaceous unit. Insulin could be part of the pathophysiology of acne through various mechanisms. # Objective To determine the prevalence of insulin resistance in female patients with acne vulgaris. # Methods We designed a descriptive observational study, in which we included a sample of 319 women with acne vulgaris. The diagnosis was established clinically by a dermatologist. Clinical data and biochemical parameters of serum insulin, fasting glucose, HOMA-IR and lipid profile were evaluated. # Results 319 women diagnosed with acne vulgaris were included, with a mean age of 30.45 years ± 0.37 (18-69). 82.8% (264) of them were over 25 years old, classified as adult female acne. Laboratory results were: mean serum insulin 16.83±0.43 (2.61-54.30), mean glucose 90.74±0.83 (69-304), HOMA-IR 3.82±0.11 (0.53-14.08), and mean total cholesterol 173.92±1.88 (100-303). Of the 319 patients, 317 of them (99.37%) had a HOMA-IR >1.22. # Conclusion Insulin resistance is underdiagnosed. It is essential that dermatologists diagnose and treat it promptly to improve the response to treatment and avoid the development of metabolic and cardiovascular complications.
Indigo Naturalis in Dermatology: Current Evidence and Clinical Applications
Indigo naturalis (IN) is a dried, dark blue powder derived from the leaves and stems of plants such as _Baphicacanthus cusia Bremek_., _Polygonum tinctorium Aiton_, and _Isatis indigotica Fort_. Aside from its prominent use in textiles due to its rich blue color, IN was used to treat a variety of medical conditions such as hemoptysis, epistaxis, chest pain, sore throats, oral ulcers, and infantile convulsion. Modern research has isolated many active compounds from IN, which have been found to exhibit a wide range of biologic activities, including antiviral, antibacterial, anti-inflammatory, antiangiogenic, antioxidant, and immune modulating effects. These pharmacologic properties have sparked growing interest in evaluating the efficacy and safety of IN-based therapies for a variety of dermatologic conditions. While the current literature on the dermatologic applications of IN is still developing, its pharmacologically active compounds and early clinical findings point to significant potential for future investigation. This review examines some of that literature from a clinical perspective.
Healing from the Desert: Southwestern U.S. Indigenous Botanicals for Inflammatory Skin Conditions
# Relevance For millennia, Indigenous communities of the American Southwest have used native plants to treat skin inflammation, wounds, and infections. Despite this rich ethnobotanical knowledge, many of these therapies remain underrepresented in dermatologic literature and practice. # Objective This review bridges traditional Indigenous use and modern scientific validation of four Southwestern botanicals, Larrea tridentata (chaparral), Yucca spp., Juniperus monosperma (desert cedar), and Aloe vera, with established or emerging applications in inflammatory skin conditions. # Methods A structured literature search was conducted across biomedical and ethnobotanical databases (PubMed, Scopus, ScienceDirect, Google Scholar, AnthroSource). Inclusion criteria prioritized topical use, Indigenous documentation, Southwestern U.S. origin, and relevance to dermatology. Extracted data were organized into four categories: traditional use, phytochemistry, mechanisms of action, and safety. # Results All four botanicals demonstrated convergent support between traditional applications and biomedical findings. Larrea tridentata exhibits potent antioxidant and anti-inflammatory activity via nordihydroguaiaretic acid, though systemic toxicity limits internal use. Yucca spp. deliver saponins and flavonoids that suppress NF-κB and MAPK pathways, reduce cytokines, and combat microbial infections. Juniperus monosperma, rich in thujone, α-pinene, and bornyl acetate, demonstrates antimicrobial and anti-inflammatory activity, with caution warranted due to potential neurotoxicity in high concentrations. Of the four botanicals studied, Aloe vera shows the most robust clinical evidence for wound healing, eczema, and psoriasis, with key compounds like acemannan and aloin supporting epithelial regeneration and cytokine modulation. # Conclusion Southwestern Indigenous botanical therapies for skin inflammation are increasingly supported by molecular and clinical evidence. Integrating these therapies into modern dermatology requires both scientific rigor and cultural respect. Future research should emphasize culturally contextualized formulations, safety assessments, and collaborative efforts with Indigenous communities to ethically preserve and apply ancestral knowledge.
The Impact of Social Media Influencers on Skincare Behaviors Among Skin of Color Populations: A Narrative Review (2015-2025)
Social media influencers have become key sources of skincare advice for skin-of-color (SOC) communities in the U.S., often bridging gaps in representation and cultural relevance within dermatology. These digital platforms offer accessibility and relatability that many SOC individuals feel is lacking in traditional care. However, influencer content remains largely unregulated, raising concerns about misinformation, cultural insensitivity, and disparities in digital health literacy. This scoping review explores how influencer-driven skincare content affects dermatologic engagement among SOC audiences. We analyzed 36 peer-reviewed studies published between 2015 and 2025, identified through PubMed and Google Scholar using SOC- and dermatology-focused search terms. Only U.S.-based research targeting SOC populations was included. Inductive thematic analysis revealed key trends, and thematic saturation was reached by the 30th study. Findings show that 42–59% of SOC individuals rely on influencers for skincare guidance, often due to cost, accessibility, and the lack of culturally competent care. Yet, misinformation was common: over 50% of influencer content on hyperpigmentation promoted unsafe hydroquinone use, and 12% included harmful DIY remedies. Spanish-language content showed significantly higher error rates, and 62% of hijabi influencers recommended non-halal products. While dermatologist-created content was more accurate, it lacked reach and engagement. Influencers serve an important role by making skincare more inclusive, but the risks of misinformation and cultural mismatch are substantial. To improve outcomes, stronger collaborations between influencers and dermatologists, increased accountability from platforms, and culturally tailored communication strategies are essential to meet the needs of SOC communities.
Practical Pain-Free Dermatology: A Review of Evidence-Based Approaches to Minimizing Procedural Discomfort
# Background Procedural pain remains a major barrier in dermatologic care, often influencing whether patients pursue treatment and impacting overall satisfaction and even procedural success. While some have embraced a range of evidence-based pain management strategies, overall dermatology has many unmet needs in consistent implementation and research. # Objective This narrative review aims to summarize and evaluate current evidence-based pharmacologic and non-pharmacologic strategies used to minimize procedural pain in dermatology and highlight the need for broader adoption, in both pediatric and adult care. # Methods A comprehensive literature review was conducted using PubMed to identify studies published from May 2015 to the present, focusing on clinically relevant pain management strategies in dermatologic procedures. In addition to database searches, reference lists of key articles were reviewed to identify further relevant studies. Included sources were selected based on their clinical applicability and contribution to the understanding of procedural pain management. Results were categorized into pharmacologic methods (e.g., anesthetics) and nonpharmacologic approaches (e.g., distraction, sensory modulation). # Results Liposomal formulations of lidocaine demonstrate improved onset and absorption compared to traditional agents. Nonpharmacologic techniques—including virtual reality, noise-canceling headphones, vibration, cooling sprays, music, and aromatherapy—were also effective, particularly in pediatric patients. However, there is a lack of standardized implementation in adult dermatology. Studies support the potential for combining pharmacologic and non-pharmacologic approaches for enhanced results. # Conclusion Effective pain control improves comfort, satisfaction, and possibly even treatment success in procedures. While pediatric dermatology is often guided by more structured protocols, care in adult dermatology may be less uniform across practices. Future research should prioritize developing patient-centered, standardized pain management strategies, with continued emphasis on pediatrics and expanded exploration in adult care where evidence is lacking.
Milk and Skin: A Narrative, Integrative Review of Dairy and Dairy Substitutes Through the Lens of Cutaneous Inflammation
Nutrition influences pathophysiology in acne and many cutaneous inflammatory disorders. Milk and milk products may worsen inflammation via multiple mechanisms. Recent syntheses on diet and acne, alongside reviews of vegan/plant‑forward approaches, justify addressing these questions in dermatology practice. An integrative, patient-centered approach, utilizing short-term trials, objective tracking, and balanced communication is proposed given the heterogeneity of studies and many remaining questions.
From Root to Regulation: The Pharmacognostic Journey of Botanical Drugs in Dermatology
Botanical remedies have long served as foundational therapies in dermatology, with traditions spanning ancient Egyptian, Ayurvedic, and Chinese medical systems. Recent decades have seen a resurgence of interest in plant-based treatments, driven by both consumer demand and scientific advances. This narrative review examines the pharmacognostic and regulatory trajectory of botanical drugs in dermatology, focusing on case studies of FDA-approved agents including capsaicin (Qutenza®), sinecatechins (Veregen®), and birch bark extract (Filsuvez®). We trace their development from ethnobotanical use to modern clinical trials, highlighting key milestones in safety, efficacy, and standardization. The review also explores near-regulatory candidates, such as Lindioil and bakuchiol, which show promise in treating inflammatory dermatoses. Special attention is given to the U.S. FDA’s Botanical Drug Pathway, which outlines distinct challenges related to raw material variability, chemical complexity, and regulatory compliance. Finally, we discuss emerging tools – such as artificial intelligence, synthetic biology, and plant cell culture – that are reshaping the landscape of botanical dermatology. Together, these insights offer a framework for responsibly integrating evidence-based botanicals into future dermatologic care.
Canine–Pediatric Parallels in Atopic Dermatitis: What Can We Learn from Each Other?
# Relevance and Objective Atopic dermatitis (AD) is a common, chronic inflammatory skin condition that typically manifests in early childhood and has a negative impact on quality of life. AD also occurs in canines, offering a unique comparative model that may inform pediatric care and vice versa. This narrative review explores shared and divergent approaches to managing human pediatric AD (hAD) and canine AD (cAD), highlighting therapeutic parallels and insights for enhancing the management of AD. # Methods A literature search of PubMed and Cochrane databases from 2015 to the present was conducted using the terms ‘(canine or canines), (atopic dermatitis), and (treatment or therapy)’ and ‘(child or children or pediatric), (atopic dermatitis), and (treatment or therapy)’, with relevant articles screened and included in this review. # Results Topical therapies are foundational in both populations, yet tolerability and adherence remain key challenges—children often reject stinging or greasy preparations, while canine treatment is limited by licking, fur interference, and caregiver fatigue. Systemic therapies, especially steroids, are used sparingly in children due to potential systemic adverse effects, whereas they are used more liberally in veterinary care. Newer targeted therapies have transformed treatment paradigms. Canine-specific therapies such as allergen-specific immunotherapy (AIT) and elimination diets demonstrate consistent benefits, whereas their roles in pediatric AD remain less defined. # Conclusion Ultimately, comparative analysis of pediatric and canine AD underscores a shared need for individualized, compassionate, and practical care strategies—reinforcing the value of translational insights in advancing treatment for young patients with AD.
Rapid Improvement of Pediatric Atopic Dermatitis with a Standardized Isosorbide Diester Moisturizer Used Alongside NB-UVB Phototherapy: A Case Report
Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by impaired epidermal barrier function, dryness, and itching. It often requires long-term management with moisturizers and anti-inflammatory agents to reduce symptoms and restore barrier function. We describe a 9-year-old boy with moderate refractory AD who showed rapid improvement within four weeks of starting a standardized isosorbide diester moisturizer during ongoing narrowband UVB phototherapy.
Plant-Biotech Moisturizer and Cold-Processed Soap Improve Atopic Dermatitis, Pruritus, and Biophysical Measures
# Relevance Atopic dermatitis (AD) is a chronic inflammatory condition with a relapsing course. While topical steroids are commonly used in the management of AD, there is growing interest in the use of non-prescription or naturally derived products such as moisturizers and cleansers (e.g. unadulterated soap). Topical use of plant-biotech derived actives has shown anti-inflammatory and antioxidant effects, the potential to reduce pruritus, and the ability to restore the skin barrier. # Objective This study evaluated the effects of an over-the-counter plant-biotech moisturizer combined with a gentle soap on the skin of individuals with mild to moderate AD. # Methods An open-label trial was conducted involving 34 subjects over the age of 18 with mild to moderate AD. At baseline and day 56, SCORAD (SCORing Atopic Dermatitis), pruritus, mood changes, and skin biophysical measures were assessed. # Results By day 56 the mean total SCORAD decreased by 99% (p < 0.0001), the objective SCORAD decreased by 94% (p<0.0001), and the pruritus numeric rating scale (NRS) improved by 93% (p < 0.0001) in comparison to baseline. All skin parameters improved as well. # Conclusions A plant-biotech derived moisturizer and soap improved mild to moderate AD over the course of 8 weeks.
A Scoping Review of the Scientific Literature on Dietary Modifications in Lichen Sclerosus Amidst Anecdotal Claims
Lichen sclerosus (LS) is a chronic, inflammatory skin condition characterized by thinning and scarring of the genital and perianal areas. Although the incidence of LS is rising, its etiology remains poorly understood. However, autoimmune dysfunction and hormonal imbalances have been suggested to play a role in its progression. While high-potency steroids have replaced testosterone as the primary treatment, there remains a significant gap in maintenance therapy protocols. Popular media and support groups often suggest dietary modifications as potential strategies for managing LS, though scientific evidence remains sparse. This scoping review follows PRISMA-ScR guidelines to evaluate the existing literature on the role of dietary factors in LS incidence and progression. Studies were selected based on their focus on nutritional interventions, excluding those solely involving non-oral supplements or prescription medications. Our search identified 51 potential articles, of which 9 met the inclusion criteria after screening and review. The review highlights mixed evidence regarding dietary influences on LS. Meat-based diets, particularly pork consumption, may exacerbate symptoms, while plant-based diets rich in carotenoids and supplements like avocado and soybean extracts show potential benefits. However, the studies varied in methodological rigor, with many being case reports or small cohort studies, limiting their generalizability. The findings underscore a significant gap between anecdotal recommendations and evidence-based practice. Robust, large-scale randomized controlled trials are needed to clarify the impact of dietary modifications on LS. This review calls for more comprehensive research to develop scientifically validated dietary guidelines for LS management, addressing the widespread reliance on anecdotal evidence in patient communities.
Microbiome Testing in Medicine: Promise, Pitfalls, and Its Role in Guiding Therapeutic Decisions
Advances in genome sequencing have provided a clearer view of the gut microbiome and its links to many disorders. These new insights have sparked growing interest in microbiome testing as a method of guiding treatment decisions. This review highlights key testing approaches, including 16S rRNA sequencing, shotgun metagenomics, metatranscriptomics, metabolomics, and culturomics, and considers their relevance for clinical care, with a focus on dermatology. While testing is readily available and established for conditions like _Clostridioides difficile_ infection, broader use is limited by inconsistent methods, patient variability, and a lack of clinical standards. Therapies such as probiotics, antibiotics, and fecal microbiota transplantation are being explored, though evidence supporting their efficacy remains inconsistent. In dermatology, microbiome studies are underway in atopic dermatitis, psoriasis, acne, and hidradenitis suppurativa, but recommendations for evidence-based interventions are limited. Importantly, even the methods to evaluate the impact of these therapies at the level of the microbiome are still being developed. Until clear guidelines and validated biomarkers are established, microbiome test results should be interpreted with caution. For microbiome testing to provide value about actions that can be taken in patient care, future work must focus on validating biomarkers, defining actionable thresholds, and linking microbial signatures to outcomes of treatments.
Therapeutic Frameworks for Topical Steroid Withdrawal Syndrome: Western and Traditional Chinese Medicine Approaches to Four Cases
Topical steroid withdrawal syndrome (TSW) is a term used to describe a constellation of adverse effects observed in some patients after discontinuation of topical corticosteroid use. TSW remains a poorly understood and debated condition, lacking standardized diagnostic criteria and formal treatment recommendations. Cases of TSW treatment in the existing literature demonstrate some evidence for treatment modalities employed by both Western and Traditional Chinese Medicine (TCM), although study quality is low overall. No studies have compared the Western and TCM approaches in the context of TSW. This article presents four distinct presentations of TSW, accompanied by initial treatment plans suggested by a board-certified dermatologist and a licensed TCM practitioner to illustrate the differing considerations taken in treatment of these patients, as well as highlight similarities and differences from the two approaches. Both Western and TCM approaches operate with a framework of personalized treatment that evolves with response to initial therapies. However, TCM places greater emphasis on systemic symptoms as drivers of disease and windows into pathogenesis. As such, TCM treatments feature greater personalization based upon discerning the root cause determined by observing patterns of disease and/or TCM-defined organ/meridian disorders. In this way, herbs are chosen to target the root cause, rather than just symptomology. While TCM treatment begins with highly individualized treatment formulas, Western treatment starts with a basic regimen for patients to which adjunctive therapies are added. In the absence of treatment guidelines, observing how different practitioners approach TSW offers insight into the spectrum of treatment options and how they might complement one another.