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Bacteriophages, also known as phages, are viruses that selectively target and infect bacteria. In addition to bacterial dysbiosis, dermatologic conditions such as acne, psoriasis, and atopic dermatitis are characterized by a relative reduction in the abundance of phages and the overgrowth of the corresponding bacteria. Phages often exhibit high specificity for their targeted bacteria, making phage-replacement therapy a promising therapeutic strategy for the control of pathogenic bacteria in dermatologic disease. Novel therapeutic strategies regulating pathogenic bacteria are especially necessary in light of growing antibiotic resistance. In this review, we aimed to review the medical literature assessing phage dysbiosis and therapeutic trials in dermatology. Ultimately, studies have depicted promising results for the treatment of acne, psoriasis, and atopic dermatitis but are limited by low sample sizes and the omission of control groups in some trials. Additional work is necessary to validate the efficacy depicted in proof-of-concept trials and to further determine optimal treatment vehicles, administration mechanisms, and dosing schedules. This review provides the necessary framework for the assessment of phage efficacy in future trials.

Teledermatology is an expanding field within dermatology that has grown and become more clinically accepted by both patients and doctors. With approximately 260 million mobile phone users in the US and 4-6 billion worldwide with access to mobile phones, teledermatology serves as a potentially useful tool for diagnosis and management (Samkange-Zeeb and Blettner in Emerg Health Threats J, https://doi.org/10.3134/ehtj.09.005 , 2009). In this review, we provide a detailed overview of mobile phone technology and the accumulating evidence for its incorporation into dermatology. Key questions addressed include accuracy and concordance between mobile teledermatology and face-to-face dermatology for the diagnosis of skin conditions. Similarly, accuracy and concordance were compared for the management of skin conditions. To track the development of mobile phone technology, we also assessed how data were captured, stored, and displayed in teledermatology studies.

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).

We present perspectives from four fourth year medical students who matched into dermatology that highlight the factors they believed helped them most. The purpose is to offer advice to medical students interested in dermatology. We divide the paper into four areas of discussion: academics, extracurricular activities, research, and mentorship. All four factors are crucial for a strong dermatology application. We believe the paper provides valuable suggestions and guidance to students considering a career in dermatology.

Mildred Min,1,2 Caitlin Egli,1,3 Rebecca Alonzo Bartolome,4 Raja K Sivamani1,2,5,6 1Integrative Skin Science and Research Sacramento, Sacramento, CA, USA; 2College of Medicine, California Northstate University, Elk Grove, CA, USA; 3College of Medicine, University of St. George’s, University Centre, West Indies, Grenada; 4Nalón Innova, Asturias, Spain; 5Department of Dermatology, University of California-Davis, Sacramento, CA, USA; 6Pacific Skin Institute, Sacramento, CA, USACorrespondence: Raja K Sivamani, Integrative Skin Science and Research Sacramento, 1451 River Park Dr. Suite 222, Sacramento, CA, 95815, USA, Tel +1 916-750-2463, Email raja.sivamani.md@gmail.comPurpose: The topical application of antioxidants has been shown to augment the skin’s innate antioxidant system and enhance photoprotection. A challenge of topical antioxidant formulation is stability and penetrability. The use of a targeted drug delivery system may improve the bioavailability and delivery of antioxidants. In this ex vivo study, we assessed the effects of the topical application of a liposome-encapsulated antioxidant complex versus a free antioxidant complex alone on skin photoaging parameters and penetrability in human skin explants.Patients and Methods: Human organotypic skin explant cultures (hOSEC) were irradiated to mimic photoaging. The encapsulated antioxidant complex and free antioxidant complex were applied topically onto the irradiated hOSEC daily for 7 days. The two control groups were healthy untreated hOSEC and irradiated hOSEC. Photoprotective efficacy was measured with pro-inflammatory cytokine (IL-6 and IL-8) and matrix metalloproteinase 9 (MMP-9) secretion. Cell viability and metabolic activity were measured via resazurin assay. Tissue damage was evaluated via lactate dehydrogenase (LDH) cytotoxicity assay. Skin penetration of the encapsulated antioxidant complex was assessed via fluorescent dye and confocal microscopy.Results: Compared to healthy skin, irradiated skin experienced increases in IL-6, IL-8 (p < 0.05), and MMP-9 (p < 0.05) secretion. After treatment with the encapsulated antioxidant complex, there was a 39.3% reduction in IL-6 secretion, 49.8% reduction in IL-8 (p < 0.05), and 38.5% reduction in MMP-9 (p < 0.05). After treatment with the free antioxidant complex, there were no significant differences in IL-6, IL-8, or MMP-9 secretion. Neither treatment group experienced significant LDH leakage or reductions in metabolic activity. Liposomes passed through the stratum corneum and into the epidermis.Conclusion: The topical application of a liposome-encapsulated antioxidant complex containing ectoin, astaxanthin-rich microalgae Haematococcus pluvialis extract, and THDA improves penetrability and restored IL-6, IL-8, and MMP-9 levels in irradiated human skin explants, which was not seen in the comparator free antioxidant complex group.Keywords: skin explants, ectoin, astaxanthin, THDA, tetrahexyldecyl ascorbate

Chaitra Subramanyam,1,2 Hemali B Gunt,3 Raja K Sivamani1,4– 6 1Integrative Skin Science and Research, Sacramento, CA, USA; 2Western University of Health Sciences, Lebanon, OR, USA; 3Burt’s Bees, Durham, NC, USA; 4Pacific Skin Institute, Sacramento, CA, USA; 5Department of Dermatology, University of California-Davis, Sacramento, CA, USA; 6College of Medicine, California Northstate University, Elk Grove, CA, USACorrespondence: Raja K Sivamani, Email raja.sivamani.md@gmail.comIntroduction: The vermillion lip has unique physical properties and environmental exposures make them prone to dryness and chapping. While lips contribute to facial beauty, perioral aging is highly individual and dependent on ethnicity. Specifically with regard to South Asian population, there is no other literature identified on the biophysical characteristics of the vermillion lip.Methods: In this work, characteristics of the vermillion skin in South Asians were examined through various clinical and biophysical characteristics of the lips such as dryness and roughness, fine lip lines, lip texture, hydration, and barrier function. Healthy South Asian females, from age 20– 45 were recruited for this study and transepidermal water loss (TEWL), hydration, visual lip tolerance, and visual dryness were measured and graded by the dermatologist-investigator.Results: Lip texture and fine lines significantly increased from the 20s to the 40s. Overall lip health significantly decreased with age. TEWL and dryness increased with age while hydration decreased with age, although not significantly so.Discussion: This first-of-its kind study on South Asian females establishes that with age there is a decrease in overall lip health and an increase in signs of aging of the lips (fine lines, texture) from the 20s to 40s.Keywords: aging, fine lines, lip, South Asian, texture

Mimi Nguyen,1 Simran S Sandhu,1 Raja K Sivamani1–41Department of Dermatology, University of California – Davis, Sacramento, CA, USA; 2Department of Biological Sciences, California State University Sacramento, Sacramento, CA, USA; 3College of Medicine, California Northstate University, Elk Grove, CA, USA; 4Department of Dermatology, Pacific Skin Institute, Sacramento, CA, USAAbstract: Actinic keratosis (AK) is an early in situ squamous cell carcinoma that results from UV light exposure and has the potential to evolve into invasive tumor. Therefore, it is crucial that AKs are monitored and treated appropriately. Photodynamic therapy (PDT) is a treatment option that is minimally invasive and leaves patients with cosmetically superior results. However, disadvantages of PDT include pain and lengthy clinic visits. Accordingly, there has been much interest in the use of daylight photodynamic therapy (daylight-PDT) as a more convenient and less painful alternative to conventional photodynamic therapy (c-PDT). Current evidence shows that daylight-PDT is noninferior to c-PDT in the short and long term. Patients reported decreased pain with daylight-PDT and were more satisfied with the procedure (P