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Background: Zinc has been used in patients with acne vulgaris for its anti-inflammatory effects; however, it is unclear if zinc supplementation is also beneficial in other inflammatory skin conditions., Objective: The objective of this article was to determine the effect of zinc supplementation on inflammatory dermatologic conditions., Data Sources: We searched the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and Ovid with no time limit up to 29 May, 2019. Trials examining supplementation with zinc in the treatment of inflammatory dermatological conditions (acne vulgaris, atopic dermatitis, diaper dermatitis, hidradenitis suppurativa, psoriasis, and rosacea) in children and adults were selected., Results: Of 229 articles, 22 met inclusion criteria. Supplementation with zinc was found to be beneficial in ten of 14 studies evaluating its effects on acne vulgaris, one of two studies on atopic dermatitis, one of one study on diaper dermatitis, and three of three studies evaluating its effects on hidradenitis suppurativa. However, the one article found on psoriasis and the one article found on rosacea showed no significant benefit of zinc treatment on disease outcome., Conclusions and Implications: Some preliminary evidence supports the use of zinc in the treatment of acne vulgaris and hidradenitis suppurativa; however, more research is needed with similar methodologies and larger sample sizes in these diseases. Further, zinc may be of some benefit in the treatment plan for atopic dermatitis and diaper dermatitis; however, additional studies should be conducted to further evaluate these potentially positive associations. To date, no evidence is available to suggest that zinc may be of benefit in rosacea and psoriasis; however, limited data are available evaluating the use of zinc in these conditions.

As we gain a greater understanding of acne pathogenesis, both new agents as well as new uses for established drugs are being considered for the treatment of acne vulgaris. Multiple clinical trials assessing new formulations or combinations of established acne treatments have been conducted, and novel uses of antimicrobials such as modified diallyl disulfide oxide and nitric oxide are being assessed in clinical trials. There are also a multitude of new therapies currently being studied that target the inflammatory cascade of acne pathogenesis, including sebosuppressive and anti-inflammatory phytochemicals, and  small molecule inhibitors targeting sebaceous glands and enzymes, among others. Laser and light therapy is also being modified for the treatment of acne through combination methods with metal nanoshells and vacuum assistance. Probiotics have gained popularity in medicine as greater knowledge of the microbiome and its effects on multiple organ systems is being elucidated. Studies describing the positive effects of certain ammonia-oxidizing bacterial strains in the regulation of the skin's inflammatory response are ongoing. Therapies for acne are constantly evolving and current gold-standard acne therapy may be supplemented with novel treatment modalities in the near future.

Acne vulgaris is a chronic inflammatory skin disease that can lead to permanent scarring. Although grading scales exist for acne scarring, there are many limitations, and there is still a need for a well validated gold standard scale for use in clinical practice or research trials. An objective measure of scar severity should be a component of global acne severity evaluations. This manuscript reviews currently available acne scar grading modalities: lesion counting; subjective self-assessment; Acne Scar Rating Scale (ASRS); evaluator-based qualitative and quantitative scarring grading systems; Echelle d'Evaluation Clinique des Cicatrices d'acne (ECCA); Global Scale for Acne Scar Severity (SCAR-S); and imaging. Despite the varying tools, most of the currently available scales do not account for scar color, depth, or change over time. A new, validated scale is needed that would allow for a more objective and accurate assessment of scar progression over time to assist with effective treatment and research.

Natural plant oils are commonly used as topical therapy worldwide. They are usually easily accessible and are relatively inexpensive options for skin care. Many natural oils possess specific compounds with antimicrobial, antioxidant, anti-inflammatory, and anti-itch properties, making them attractive alternative and complementary treatments for xerotic and inflammatory dermatoses associated with skin-barrier disruption. Unique characteristics of various oils are important when considering their use for topical skin care. Differing ratios of essential fatty acids are major determinants of the barrier repair benefits of natural oils. Oils with a higher linoleic acid to oleic acid ratio have better barrier repair potential, whereas oils with higher amounts of irritating oleic acid may be detrimental to skin-barrier function. Various extraction methods for oils exist, including cold pressing to make unrefined oils, heat and chemical distillation to make essential oils, and the addition of various chemicals to simulate a specific scent to make fragranced oils. The method of oil processing and refinement is an important component of selecting oil for skin care, and cold pressing is the preferred method of oil extraction as the heat- and chemical-free process preserves beneficial lipids and limits irritating byproducts. This review summarizes evidence on utility of natural plant-based oils in dermatology, particularly in repairing the natural skin-barrier function, with the focus on natural oils, including Olea europaea (olive oil), Helianthus annus (sunflower seed oil), Cocos nucifera (coconut oil), Simmondsia chinesis (jojoba oil), Avena sativa (oat oil), and Argania spinosa (argan oil).

Background: Probiotic, prebiotic, and synbiotic supplementation is becoming more prevalent nowadays. Clinical studies have demonstrated some of the medical benefits of probiotics, prebiotics, and synbiotics within dermatology but an evidence-based review of their effects in adults is needed., Objective: The aim of this study was to identify evidence for the use of supplementation with probiotics, prebiotics, or synbiotics for the prevention and treatment of dermatological diseases in adults., Data Sources: We conducted a search of the Ovid MEDLINE, Cochrane Central Register of Controlled trials and EMBASE electronic databases from 1 January 1946 to 11 January 2017., Study Selection: Trials examining supplementation in the treatment of dermatological diseases using oral or topical probiotics, synbiotics, and prebiotics in adults over the age of 18 years were selected., Data Extraction: Of 315 articles, 12 met the inclusion criteria., Data Synthesis: Nutritional supplementation with probiotics and prebiotics was shown to improve atopic dermatitis (AD) symptomatology, quality of life, or clinical severity in six of nine studies. One study in psoriasis was shown to improve inflammatory markers, and one study suggested that probiotics could be used as adjunctive therapy in the treatment of acne., Conclusion: Preliminary studies are optimistic for the use of some strains of probiotics for symptomatic and clinical improvement in AD, and as adjunctive treatment with antibiotics for acne. Further research is necessary to better assess how probiotics and prebiotics may be used within dermatology.

Background: Patients with psoriasis often enquire about the use of numerous botanical therapeutics. It is important for dermatologists to be aware of the current evidence regarding these agents., Methods: We conducted a systematic literature search using the PubMed, MEDLINE, and EMBASE databases for controlled and uncontrolled clinical trials that assessed the use of topical botanical therapeutics for psoriasis. The search included the following keywords: 'psoriasis' and 'plant' or 'herbal' or 'botanical'. We also reviewed citations within articles to identify additional relevant sources. We then further refined the results by route of administration and the topical botanical agents are reviewed herein., Results: A total of 27 controlled and uncontrolled clinical trials addressing the use of topical botanical agents for psoriasis were assessed in this review. We found that the most highly studied and most efficacious topical botanical therapeutics were Mahonia aquifolium, indigo naturalis, aloe vera, and, to a lesser degree, capsaicin. The most commonly reported adverse effects were local skin irritation, erythema, pruritus, burning, and pain. However, the overall evidence for these therapeutics remains limited in quantity and quality., Conclusion: The literature addresses a large number of studies in regard to botanicals for the treatment of psoriasis. While most agents appear to be safe, further research is necessary before topical botanical agents can be consistently recommended to patients.