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.
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.
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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.
Beyond the Prescription Pad: A Guide to Over-the-Counter Itch Management
Itch is a common and often distressing symptom that significantly impacts quality of life. While identifying and treating the underlying cause is ideal, this is not always immediately possible. Fortunately, there are many effective therapies for managing itch, but they may not be accessible or suitable for every patient. In the meantime, over-the-counter (OTC) treatments and techniques remain essential for many and are often used in conjunction with prescription therapies. This review focuses on accessible OTC options to help manage itch.
Skinfluencers: Investigating the Safety and Efficacy of Consumer-to-Consumer Advice on Social Media for the Treatment of Acne Vulgaris
Within the popular social media application TikTok, users can instantly post videos up to ten minutes long on any topic they choose. Numerous TikTok users have posted their advice on treating acne vulgaris. However, since there is no surveillance of the information posted, the accuracy and safety of the recommendations shared by non-healthcare professionals are called into question. This review examines the standard acne treatment options shared by consumers on TikTok and aims to evaluate the efficacy and safety of each treatment. A search was conducted on the TikTok platform for recommendations on acne treatment. As this review focuses on consumer-to-consumer advice, all videos posted by healthcare professionals were excluded from consideration. A list of common recommendations was compiled, and a literature search was conducted to identify the implications for treating acne. Findings show common themes in advice, including dietary changes, oral supplement recommendations, and lifestyle modifications. By examining content shared on easily accessible social media platforms like TikTok, consumers and providers can stay well-informed about current trends in acne treatment, receiving up-to-date advice on the safety and efficacy of these treatments.
A Systematic Comparison of Quantity and Composition Across Animal and Plant-Based Protein Isolates
# Relevance Proteins, composed of amino acids, play a critical role in muscle synthesis, metabolism, and immune function. Protein isolates, derived from animal and plant sources, vary in their amino acid compositions and are frequently used to supplement dietary protein intake. # Methods This study aims to compare the amino acid profiles of nine protein isolates focusing on their relative deficiencies and abundances. We selected protein isolates from animal-based (whey, casein, beef, egg white) and plant-based (soy, pea, rice, pumpkin seed, hemp seed) sources for comparison. Data of the average quantities of amino acids from at least four brands per protein type were extracted. The amino acid compositions were compared relative to each other and against whey isolate. Z-scores and test statistics were used to quantify comparisons and assign ranks. # Results Egg-white, soy, and pea protein contained no relative amino acid deficiencies. Beef, rice, and hemp seed-based protein isolates were deficient in several amino acids. The leucine content was highest in whey and pea protein sources. High leucine content may inform dietary recommendations due to its association with muscle synthesis and activation of mTOR, linked to aging, insulin resistance, and inflammatory skin conditions. Arginine plays a role in nitric oxide and collagen production and was found to be more abundant in plant-based protein sources (pumpkin seed, pea, and hemp seed) compared to whey.
Triphala in Dermatology: A Systematic Review
# Relevance For millennia, Ayurvedic herbs have maintained deep cultural importance due to their wide range of applications as medicinal products. In recent decades, these herbs have gained increasing attention from the scientific community for their potential benefits on skin and hair. # Objective Because of the growing body of research supporting the dermatologic use of Ayurvedic ingredients, we aimed to summarize the available studies investigating the effect of Triphala (_Terminalia bellerica_, _T. chebula_, and _Phyllanthus emblica_) and Terminalia arjuna on skin and hair. # Methods We conducted a systematic review using PubMed with the search terms (Terminalia bellerica OR Beleric Myrobalan OR Bahera OR Bibhitaki OR Terminalia chebula OR Chebulic Myrobalan OR Black Myrobalan OR Haritaki OR Terminalia arjuna OR Phyllanthus emblica OR Emblica officinalis OR Amla OR Indian gooseberry OR Triphala) AND (skin OR hair). # Results 60 articles, which included randomized controlled trials, uncontrolled trials, animal studies, and cell culture/molecular studies, met inclusion criteria. These studies explored anti-aging properties (n=22), antioxidant activity (n=14), protection against ultraviolet radiation (n=8), anti-cancer properties (n=3), and wound healing (n=9), in addition to the treatment of conditions including hair loss (n=8), head lice (n=1), vitiligo (n=1), scalp seborrhea (n=1), psoriasis (n=1), melasma (n=2), atopic dermatitis (n=1), and tinea corporis (n=1). # Conclusion Though the studies described here demonstrate substantial evidence that Ayurvedic species promote the health of skin and hair, larger clinical trials are now needed to further explore the therapeutic potential, safety profile, and pharmacokinetics of these herbs.
The Effect of Biologics on the Cutaneous Microbiome in Atopic Dermatitis: A Review
Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by dry patches, itch, and rash that create a burden for patients. A driving factor behind AD pathogenesis and disease severity is dysbiosis. This narrative review explores the effect of different biologic therapies on shifting the microbiome composition to a less inflammatory state and its impact on AD.
Beyond Benzoyl Peroxide: The New Landscape of Over-the-counter Therapies for Acne
Acne vulgaris is a prevalent dermatological condition that primarily affects the pilosebaceous units, leading to comedones, papules, pustules, and nodules.^1^ This condition affects approximately 9.4% of the global population, making it the eighth most common disease worldwide.^2^ It predominantly affects adolescents and young adults, with a significant psychosocial impact, including diminished self-esteem and increased risk of depression.^2^ Traditionally, over-the-counter (OTC) treatments have been limited to agents like benzoyl peroxide and salicylic acid. However, recent advancements have introduced a variety of novel OTC therapies including topical probiotics and concentrated oxygen therapies which are gaining attention. Given the expanding array of OTC options and their accessibility, a comprehensive review of current therapies is essential to guide evidence-based clinical recommendations. To evaluate the efficacy and safety profiles of established and emerging OTC acne treatments, PubMed, Embase, and the Cochrane Library searches were conducted with terms included “acne vulgaris,” “over-the-counter treatments,” “topical therapies,” and specific agents. Many OTC acne therapies show antimicrobial and anti-inflammatory effects in vitro and small clinical trials. Established agents like adapalene and benzoyl peroxide had the strongest clinical evidence. Emerging options such as phage therapy and probiotics are promising but require further validation. OTC acne treatments continue to diversify, offering new options beyond legacy therapies. While some newer agents are mechanistically compelling, high-quality studies are needed to define their role in acne management.
Mindfulness-Based Techniques in the Treatment of Atopic Dermatitis: A Narrative Review
Atopic dermatitis (AD) is known to have many negative effects on mental health and quality of life, with pruritus, pain, and sleep disturbance as major contributors. Mind-body therapies which address the emotional and behavioral impacts of stress in AD are of increasing interest including Cognitive Behavioral Therapy (CBT), Habit Reversal Therapy (HRT), and Mindfulness-Based Stress Reduction (MBSR). Mindfulness-based integrative therapies for AD show improvements in disease severity, QoL, and psychological outcomes. This review highlights evidence of MBSR, ACT, IBMS, CBT, and relaxation interventions. It is critical for providers to have an understanding of how they work and when to use them.
Mindfulness-Based Stress Reduction (MBSR)
Role of dietary intervention in the management of selected skin diseases: A systematic review
# Relevance Dietary intervention in the management of skin disease is underutilized in medical practice and could be a means for patients to optimize skin health as well as overall physical and mental well-being. Summarizing existing literature can serve as a catalyst to increase research efforts focusing on dietary intervention and skin disease management which may inform the way dermatologists provide care to their patients. # Objective Dietary intervention is a commonly used option to improve physical and mental health with many evidence-based associations in improving prognoses of diabetes, high cholesterol, high blood pressure, depression, among many other conditions. The role of dietary intervention in the management of skin disease remains limited. Understanding its role may improve the options for care dermatologists may provide to their patients. # Methods A systematic search of PubMed, EMBASE, and Cochrane Central Registrar between January 1st, 1985 and December 31st, 2023 was conducted. Studies included were case reports, clinical trials, controlled studies, comparative studies, systematic reviews, and meta-analyses. Review papers were excluded. # Results Results showed that dietary intervention improves symptom severity among atopic dermatitis, acne, hidradenitis suppurativa, and psoriasis patients. # Conclusion While data shows positive associations between use of dietary intervention and decrease in symptom severity, future small and large-cohort randomized controlled trials with placebo and intervention groups are warranted.
Association between protein gap and disease severity of hidradenitis suppurativa
# Background Hidradenitis suppurativa (HS) is an inflammatory skin condition characterized by chronic follicular occlusion in intertriginous regions. Although other lab markers such as c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) have classically been used to assess degree of inflammation in HS, the correlation between protein gap, or the difference between total protein and albumin, and HS has not been previously investigated. In this study, we aim to characterize the relationship between protein gap and severity of HS. # Methods Data was obtained through retrospective chart review of patients seen in the Duke Dermatology’s HS Clinic with at least 1 follow-up appointment between 7/1/2018-7/1/2021. A one-factor ANOVA with post hoc testing and Pearson’s rho were used to compare the relationship between protein gap, Hurley Stage, and International Hidradenitis Suppurativa Severity Score System (IHS4). # Results A total of 113 patients, with mean age of 41 years, were included in this study. 62% of patients identified as Black, 82% as female, and the average BMI of participants was 34.92. At their initial visit, included patients had a median (Q1-Q3) IHS4 score of 8 (2-28) and protein gap of 3.6 g/dL (3.2-4.5). We found that protein gap has a moderate to strong positive correlation with disease severity as measured by log (IHS4) and initial protein gap. Multivariable analysis further demonstrated that protein gap is associated with higher IHS4 scores. # Conclusion Protein gap could be a useful adjunct in evaluating the severity of HS. Further research is needed to clarify the role of protein gap in longitudinal data and/or response to therapy in HS patients.
The Gut-Skin Axis: Exploring the Role of SCFAs, Obesity, and GLP-1 Receptor Agonists in Atopic Dermatitis
Atopic dermatitis (AD), a chronic inflammatory skin disorder characterized by itching, erythema, and skin barrier dysfunction, has seen a global rise in prevalence alongside increasing rates of obesity. Emerging evidence highlights the gut-skin axis—a bidirectional communication network between gut microbiota and skin—as a critical link between these conditions. Central to this axis are short-chain fatty acids (SCFAs), microbial metabolites such as butyrate, propionate, and acetate, which exert anti-inflammatory effects and enhance skin barrier integrity. Obesity, associated with gut dysbiosis and reduced SCFA levels, exacerbates AD severity by impairing immune regulation and barrier function. This review explores the mechanistic links between obesity, SCFAs, and AD, emphasizing the role of the gut-skin axis. Additionally, it considers the potential role of glucagon-like peptide-1 (GLP-1) receptor agonists, conventionally used for type 2 diabetes and obesity, in AD pathogenesis. GLP-1 receptor agonists modulate gut microbiota, enhance SCFA production, and reduce systemic inflammation, potentially improving AD outcomes. While their direct application in AD remains underexplored, these agents represent an intriguing area for future investigation. Advancing this promising frontier in dermatology will require interdisciplinary collaboration and longitudinal studies to address gaps in understanding the gut-skin axis, SCFA mechanisms, and the potential of GLP-1 receptor agonists in AD.
Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists
Hydrotherapy in Dermatology Past, Present and Future
The Hydrotherapy Center and Avène Thermal Spring Water are known for their soothing properties to treat skin concerns. In 1874, the French government declared them to be an official "public benefit.” In 1966, the Hydrotherapy Center was approved for reimbursement by the French Healthcare System and is available as a treatment for a variety of skin conditions. The obvious obstacle for scaling this treatment to benefit more patients, is the location of the Hydrotherapy Center in France which is geographically self-limiting A panel of US dermatologists convened at the hydrotherapy center, Avène France to understand the patient benefit of the 3-week treatment utilizing the water from its natural source, used in-conjunction with specific postbiotic topical products for patients with inflammatory skin conditions. A primary objective was to come to a consensus on how therapy inspired by the Avène hydrotherapy treatment could be implemented utilizing this thermal spring water and postbiotic skincare products as a standalone treatment and in conjunction with other conventional treatments.