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.
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.
Copyright (c) 2025 Journal of Integrative Dermatology
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.
Increased Popularity of Goat Milk Soap: Analyzing Five Years of Google Trends
In recent years, patients have sought out alternative, non-pharmacologic therapies to manage their atopic dermatitis. Accordingly, goat milk soap (GMS) is a product that has gained increasing popularity as its sales have been driven by online consumer endorsements promising significant improvement in the overall health, hydration, and appearance of the skin. As patients continue to utilize the internet for health recommendations, Google remains a primary source of information. Using a Google Trends analysis, our study aimed to analyze the popularity of GMS on Google. Authors queried all searches in the United States from January 2018 through December 2023 using the terms “goat soap” and “eczema soap” as well as the topic “Goat Milk Soap”. Within the aforementioned timeframe, the interest in the term “goat soap” was greater than all other categories, including the term “eczema soap”. All searches demonstrated a positive trend, with searches for “goat soap” and “goat milk soap” having positive trends of +0.44 and +0.61 respectively. These results highlight the growing interest in GMS over the last five years, despite a lack of clinical evidence supporting the claimed benefits. Few studies discuss the potential benefits of using goat milk-containing products, highlighting their anti-inflammatory, anti-bacterial, and moisturizing properties as well as their potential use for atopic dermatitis. Therefore, there is a need for further research in this area so that providers within the dermatology community are able to offer well- informed recommendations to atopic dermatitis patients.
Copyright (c) 2026 Journal of Integrative Dermatology
Review of Omega-3 Fatty Acid Dietary Supplementation in Cutaneous Inflammatory Disorders
# Relevance Dietary supplements are commonly used by patients to enhance skin health and for the treatment of cutaneous disorders. Currently, the Food and Drug Administration (FDA) is not authorized to approve the efficacy or safety of dietary supplements prior to public marketing. Therefore, evidence-based medicine is needed for dermatologists to better counsel patients regarding the efficacy and safety of dietary supplements for chronic conditions, such as acne vulgaris, psoriasis, atopic dermatitis, and rosacea. # Objective To provide an up to date review of the effects of oral supplementation of Omega-3 Fatty Acids (O3FA) such as docosahexanoic acid (DHA) and eicosapentaneoic acid (EPA) on cutaneous inflammatory conditions in the literature. This systematic review examines O3FA’s impact on acne vulgaris, psoriasis, atopic dermatitis, and rosacea; ultimately, to determine the efficacy and safety of supplementation. # Methods A comprehensive electronic search with EPA and DHA for acne vulgaris, psoriasis, atopic dermatitis, and rosacea in PubMed/MEDLINE, Cochrane Central, Embase, and Google Scholar yielded 99 articles. Duplicate, non-English articles, animal studies, and irrelevant articles were excluded. These parameters resulted in 79 articles excluded as they did not meet study qualifications. Initially there were 20 articles included but during the writing process, three additional articles were published, bringing the final total to 23 articles in this review. # Results Dietary supplementation of O3FAs resulted in varying significance in the improvement of acne vulgaris due to limited studies, small sample sizes, and lack of control groups. While the majority of articles included for psoriasis demonstrated improvement in clinical symptoms, most of the studies for atopic dermatitis did not indicate significant enhancement. Lastly, one placebo controlled study showed O3FA supplementation effectively treated dry eye symptoms associated with ocular rosacea. # Conclusion There are limited studies investigating the efficacy of O3FA oral supplementation in the treatment of acne vulgaris, psoriasis, atopic dermatitis, and rosacea. In all, some evidence supports the beneficial impact of O3FA supplementation for the treatment of psoriasis and atopic dermatitis, while there are minimal results for acne vulgaris and ocular rosacea. Of the small studies included in this review, there are multiple limiting variables which indicate a need for further evaluation.
# Background The making of homemade versions of sunscreens is becoming a popular movement across social media platforms, as proponents claim these alternatives are safer and effective. There is a scarcity of information on the make-up of common homemade recipes and the ways in which they compare to FDA-approved sunscreens. # Objective This review discusses the main components and implications of social media-derived homemade sunscreen alternatives. # Methods We conducted a review of the common ingredients used in homemade sunscreen recipes. # Results Common homemade sunscreen recipes are composed of a base of sun protective filter, a water protective agent, an emollient oil, and an essential oil. The self-made versions are thought to be effective alternatives without the addition of harmful ingredients. Though many of these recipes contain more natural ingredients, they do not undergo the same scientific testing protocols to offer information on sun protective factor and safety. # Discussion Understanding the limitations of homemade skincare alternatives may help clinicians counsel their patients on the potential risks associated with its use and reveal potential health concerns related to the spread of misinformation across popular media platforms. # Capsule Summary This article offers additional insight into the formulary properties of homemade sunscreen recipes and the differentiating features from standard sunscreens. The presented information prompts experts in the field to further investigate the efficacy of homemade sunscreen alternatives and to consider the impact of scientifically unproven trends in dermatology.
Homemade sunscreen, Efficacy, Formulation, Sunscreen alternatives, Social media trends
Stasis Dermatitis: A Review of Differential Diagnosis, Pathogenesis, and Current Treatment Options
Stasis dermatitis (SD) is a cutaneous manifestation of chronic venous insufficiency (CVI), secondary to venous hypertension. It is characterized by troublesome symptoms such as erythema, edema of the lower extremities, pain, trophic changes of the skin, and pruritus, and has a significant impact on patient quality of life. Understanding the pathogenesis of SD and targeting the underlying causes of the disease are vital in ensuring appropriate treatment and management. If left untreated or inadequately managed, venous hypertension and its subsequent inflammatory processes result in further damage to the vessels and endothelium, leading to a cycle of worsening symptoms and complications which may require further treatment. SD is usually managed conservatively; however, more severe cases may require invasive interventions. Direct evidence regarding the treatment of SD is lacking and treatment options are often borrowed from therapy options used to treat CVI and other types of dermatitis. It is important to acknowledge that SD is a chronic disease. Although treatment alleviates symptoms and assists in preventing the progression of the disease, there is no cure. This review discusses the diagnosis, treatment and management of SD and its associated complications and how these treatment options relate to its pathogenesis.
Manipulating the Microbiome: What is Known, What is Unknown?
We are outnumbered: there are more microbes in and on our bodies than our own host cells. The microbiome is a complex system that varies between individuals and, like, fingerprints, is unique. Colonization of newborns may occur even before birth via hematogenous spread of microbes from the mother’s oral cavity and gastrointestinal tract into the intrauterine cavity. Thereafter and throughout life, gut and skin integrity play an important role in the health of the microbiome. There are multiple pathways to skin and gut dysbiosis, but the possibility of effective therapies remains promising. Abbreviations: • AD = atopic dermatitis • CoNS = coagulase-negative staphylococci • SCORAD = scoring atopic dermatitis • SA = *staphylococcus aureus*
Complementary and Alternative Treatments for Hidradenitis Suppurativa: A Systematic Review
Hidradenitis Suppurativa (HS) is a chronic inflammatory disease characterized by recurrent painful and deep dermal abscesses, sinus tracts, and dermal contractures. HS significantly reduces quality of life and leads to long-term sequelae impacting physical and mental well-being. Despite conventional therapies such as antibiotics and immunomodulators, management remains challenging and marked by recurrences, undesirable side effects, and financial burden. Faced with such choices, many patients seek complementary and alternative medicine modalities (CAMs). Literature on CAMs for HS is sparse and deficient in evidence-based clinical data. Several reviews cover non-pharmacological approaches to HS, however we aim to include CAMs such as Ayurveda and Traditional Chinese Medicine (TCM). A literature search was conducted utilizing PRISMA guidelines in 8 databases on complementary and alternative therapies in HS over the last decade. No randomized controlled trials were found. However, a combination of 42 systematic reviews, retrospective and prospective studies, case series and reports were included in this review article. Results on CAMs for HS yielded a higher frequency of literature and evidence supporting lifestyle changes such as smoking cessation, weight loss and dietary modifications. Other treatments that have shown some positive clinical effects include zinc, vitamin D, curcumin, TCM, Ayurveda, wound care dressings for HS lesions, and mental health management. There is currently not enough evidence to recommend the use of these CAMs for HS, but the current data is promising for future investigations and large-scale clinical trials.
Proceedings of the 4th Annual Integrative Dermatology Symposium, Sacramento, CA
The 4th Integrative Dermatology Symposium was held in Sacramento, California, over three days, on October 22 to October 24, 2021. The goal of the 4th annual Integrative Dermatology Symposium was to promote a dialogue between practitioners from various disciplines such as dermatologists, naturopathic doctors, and various other alternative medical practitioners to advance the field of integrative dermatology. Speakers provided evidence-based ways to supplement standard practices with an integrative approach to enhance patient care and patient satisfaction. Integrative dermatology is a burgeoning field that can benefit patients who have failed standard treatments or those who desire to complement conventional therapy. The following are the proceedings from the conference.
Integrative Therapies for Warts and Molluscum Contagiosum
Warts and molluscum contagiosum (MC) are common viral skin infections that affect individuals of all age ranges, especially those who are immunocompromised and those in close contact with others. Conventional therapies for warts and MC include cryotherapy, curettage, imiquimod, and salicylic acid. However, evidence-based treatment guidelines for warts and MC are lacking. Considering that conventional therapies may be ineffective in some cases and limited by pain, especially in the pediatric population, clinicians and patients often seek complementary and alternative therapies. This review summarizes the clinical evidence surrounding the following integrative therapies for warts and MC: cantharidin; essential oils such as those from *Backhousia citriodora*, *Melaleuca alternifolia*, and *Santalum album*; propolis; *Echinacea*; heat therapy; garlic; and oral zinc. Anti-inflammatory, anti-proliferative, and/or immune-modulating effects of these modalities assist in clearing warts and MC. For children who tend to be more vulnerable to suggestion, hypnosis can be attempted as an alternative wart therapy.
A comprehensive review of topical bakuchiol for the treatment of photoaging
# Relevance Photoaging refers to premature aging of the skin due to chronic ultraviolet radiation. Retinoids and retinol are the mainstay treatment for photoaging but come with the potential for cutaneous side effects and concerns of teratogenicity/embryotoxicity. Hence, there is an increasing demand for retinoid-like products without significant adverse effects. Bakuchiol, a phytochemical compound derived from *Psoralea corylifolia*, a medicinal plant widely used in Ayurveda and Traditional Chinese Medicine (TCM), has recently gained traction as a promising natural alternative to topical retinol. # Objective To review the anti-aging properties, efficacy, tolerability, and safety of topical bakuchiol compared to topical retinol for the treatment of photoaging. # Methods A comprehensive search of peer-reviewed articles was conducted through PubMed and EMBASE using the key terms "bakuchiol" AND " photoaging." Six abstracts and titles were screened, four articles underwent full-text review and the reference section of each article was scanned to find additional articles. The search process yielded seven articles from 2014 to 2021, which were included for analysis. # Results Comparative gene expression profiling revealed that topical bakuchiol can operate as a functional analog of topical retinol *in vitro*, with considerable advantages in safety, photostability, and ease of formulation. Across all studies reviewed, bakuchiol was effective in improving photoaging with minimal side effects on normal and sensitive skin. Bakuchiol demonstrated comparable efficacy and better tolerability than retinol when tested side-by-side. Additionally, there may be an enhanced photoprotective effect when formulated with other antioxidants. # Conclusion Topical bakuchiol can act as a functional analog of retinol and has additional antioxidant properties that are enhanced when formulated with other antioxidants. It demonstrates clinically significant similarity to topical retinol in efficacy and superiority in tolerability and safety. Topical bakuchiol may be considered as a key ingredient in skincare formulations for individuals who have sensitive skin who may not tolerate topical retinoids and those who are seeking natural antioxidant products. While concrete clinical evidence is insufficient to make definitive claims on pregnancy safety, bakuchiol can be considered a safer option for those who are pregnant, nursing and trying to conceive based on mechanism of action.
A Clinician’s Guide to Counseling about Prescription Medication Risks in Atopic Dermatitis
Atopic dermatitis (AD) is a chronic inflammatory skin condition that can cause intense itching and recurrent eczematous lesions. It affects one in five children worldwide and often persists into adulthood, requiring management of both acute flares as well as more proactive strategies. With the emergence of new and more powerful therapeutics in the last decade, the safety and efficacy of these treatments have been under increased scrutiny. Accordingly, the complexity for selection of an appropriate medication has greatly increased. This review aims to clearly outline the risks of medications so that clinicians can communicate them to their patients more effectively. This review will focus on the most commonly used therapies and selected therapies in late-stage development including topical corticosteroids, topical calcineurin inhibitors, Janus kinase inhibitors, and biologics.
Chronic Actinic Dermatitis treatment with Dupilumab: A Case Report and Review of the Literature
Chronic Actinic Dermatitis (CAD), also known as photosensitivity dermatitis, is broadly defined as dermatitis with or without a pseudolymphomatous eruption in sun-exposed regions and can be very refractory to treatment. We describe a patient who failed numerous conventional therapies and finally responded to treatment with dupilumab, a biologic that targets IL-4 and IL-13.
Dermatological Side Effects of SARS-CoV-2 Vaccinations
The coronavirus disease 2019 (COVID-19) pandemic has had a tremendous effect on the world, causing significant morbidity and mortality amongst millions. The disease is caused by a novel respiratory virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The highly contagious transmission of SARS-CoV-2 has led to many health agencies across the globe authorizing emergency use of newly created vaccines to limit disease occurrence and severity. Due to the rapid authorization, side effects of the vaccine are continuously being investigated and explored. In this review, we provide the current data reported regarding the dermatological side effects following vaccination against COVID-19. To date, the most commonly reported cutaneous side effect is a delayed, local reaction, while the least common was one reported case of Stevens-Johnson Syndrome. Other conditions reported include but are not limited to, new-onset or exacerbations of conditions such as psoriasis, vitiligo, lichen planus, and bullous diseases. Almost all the conditions were resolved with supportive care, or a short course of steroids with recommendations to continue vaccination.
Integrative Approaches to Skin Cancer Chemoprevention and Sun Protection: Beyond Sunscreen
Over time, ultraviolet radiation from the sun can inflict substantial damage to human skin. While traditional sun protective agents, including sunscreens and sunblocks, are generally considered safe and effective, limitations exist regarding their absolute benefit. With a growing concern for skin health related to sun damage, the use of complementary and alternative sun protection methods has become increasingly popular. Many studies have been conducted and evidence suggestive of a photoprotective benefit from a variety of alternative agents is accumulating. The aim of this paper is to review the available literature regarding the photoprotective and chemopreventive properties of a variety of these agents. To find relevant articles and studies, a literature review was conducted across six databases including PubMed, EMBASE, Cochrane Library, PubMed Central, UpToDate, and Google Scholar, utilizing PRISMA guidelines. Randomized controlled trials, systematic reviews, as well as retrospective and prospective cohort studies were included in this review. While evidence supports the photoprotective properties of many of these agents (e.g., polypodium leucotomos, genistein, niacinamide, silymarin, and others), few long-term studies of these agents have been conducted resulting in a paucity of data regarding their chemopreventive effect in humans. Given the lack of available evidence, no consensus recommendations currently exist. However, with the photoprotective potential that many of these agents display, future trials may provide sufficient evidence to support their use in skin chemoprevention.
Complementary and Alternative Therapies for Alopecia Areata
Alopecia areata (AA) is a chronic autoimmune disease of the hair follicle, resulting in nonscarring hair loss. While initial therapy for AA often consists of topical and intralesional corticosteroids, some patients may also turn to complementary and alternative medicine (CAM) for additional treatment. This narrative review aims to summarize recent complementary and alternative therapies for AA.
Hypochlorous Acid: Applications in Dermatology
# Relevance Hypochlorous acid (HClO) is a weak acid and powerful oxidant traditionally used as an active ingredient in various sanitizers and disinfectants. HClO is produced endogenously from activated leukocytes, and it was first exogenously synthesized in 1834, later to be used medicinally as a wound disinfectant during World War I and II. # Objective In this review, we aim to review the literature assessing the efficacy and safety of dermatologic uses of topical hypochlorous acid. # Methods A PubMed search for articles with the following keywords was performed: “hypochlorous acid” AND “dermatology” OR “dermis” OR “dermal.” Forty-one reports were included in the efficacy and safety analysis. # Results Hypochlorous acid exhibits antimicrobial properties and has been demonstrated to promote re-epithelialization in wound healing with low cytotoxicity to keratinocytes and fibroblasts. Recent work has highlighted its anti-inflammatory properties via modulation of the NF-kβ signaling pathway and downregulation of inflammatory cytokines; reports have discussed its application for the management of various inflammatory skin conditions including atopic dermatitis and psoriasis. # Conclusion Dermatologic application of hypochlorous acid includes infection prevention, wound care and scar management, inflammatory modulation, treatment in atopic dermatitis and pruritus. Emerging research has discussed potential applications in acne vulgaris, seborrheic dermatitis, and tumor suppression.
Integrative approaches to hyperpigmentation therapy
Hyperpigmentation involves darkening of skin due to increased production of melanin and encompasses a wide range of dermatologic conditions, including melasma, post-inflammatory hyperpigmentation, maturational hyperpigmentation, and periorbital melanosis. The etiologies of hyperpigmentation may be inherited, acquired, or congenital. There are multiple approaches for treating hyperpigmentation, including conventional therapeutics and complementary and alternative medicines (CAMs). There is a growing body of literature investigating the uses of these alternative therapies in patients with hyperpigmentation, which can be broadly organized into three major groups: 1) minimally invasive treatments, 2) plant-based therapies, and 3) natural antioxidants. CAMs offer relatively low-risk and readily available treatment options for patients seeking to manage hyperpigmentation. The use of these alternative therapies has gained substantial traction in recent years. These therapies may be especially beneficial for patients who have not achieved favorable clinical outcomes using conventional treatments alone. A greater understanding of the various integrative approaches available for treating hyperpigmentation can allow providers to make the most informed recommendations and help ensure the best health outcomes for patients.
Lifestyle Modifications for Hidradenitis Suppurativa Beyond Diet: A Narrative Review
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder marked by deep-seated, inflamed nodules. In order to improve the quality of life in patients impacted by this chronic and debilitating disease, it is important to increase one’s understanding about HS and its treatment beyond the traditional therapies. The purpose of this review is to gather data pertaining to lifestyle factors and their association with HS to provide recommendations that optimize traditional treatments for HS patients. A literature search was conducted on PubMed, Google Scholar, EMBASE, Clinicaltrials.gov, and Cochrane Library databases. There was a total of 50 studies included in the review, including 2 meta-analyses, 2 prospective, 2 cross-sectional, 6 case-control, 8 case reports, and 12 retrospective studies. Lifestyle factors associated with HS included psychological stress, mechanical stress, sleep quality, substance use, and smoking. HS patients have increased odds of having anxiety, poor sleep, and substance-related disorders. Minimizing mechanical stress and advocating for smoking cessation may help with HS flares. This review features other lifestyle factors beyond weight and diet that are infrequently discussed as exacerbating or affecting HS disease. Clinicians are encouraged to screen for psychological comorbidities, substance-related disorders, and sleep disorders to provide patients with an integrated multidisciplinary care model for HS to optimally manage symptoms and comorbidities.