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Juan Francisco Mir-Bonafé,1 Jaime Piquero-Casals,2 Ludmila Prudkin,3 Jesus Delgado,3 Julia Santamaria Martínez,3 Vicente Garcia-Patos Briones4 1Department of Dermatology, Hospital Son Llàtzer, Palma de Mallorca, Spain; 2Department of Aesthetic Dermatology and Laser, Dermik, Clínica Dermatológica Multidisciplinar, Barcelona, Spain; 3Innovation and Development, ISDIN, Barcelona, Spain; 4Department of Dermatology, Hospital Vall d’Hebron, Barcelona, SpainCorrespondence: Jaime Piquero-Casals, Department of Aesthetic Dermatology and Laser, Dermik, Clínica Dermatológica Multidisciplinar, Barcelona, Spain, Tel +34 935464710, Email j.piquero@dermik.esBackground: Noninfectious inflammatory dermatoses of the scalp are common, and their symptomsin particular, those affecting appearance, can have a psychological effect that may be disproportionate to their clinical severity. Effective, cosmetically acceptable treatments are important to manage these conditions. Topical corticosteroids form the cornerstone of acute treatment for many of these conditions. We surveyed practicing dermatologists and dermatology residents to determine the current clinical practice in prescribing topical corticosteroids for these disorders in their various preparation formats.Methods: A Delphi method was used, consisting of 2 questionnaire rounds. The first round contained 34 questions and was completed by 612 dermatologists and dermatology residents via email. The first round of responses was analyzed, and points that had > 70% agreement were used to form a second questionnaire of 21 statements. This second round was completed by 346 participants, and their responses were used to generate a final report. Participants were practicing in both public and private practices.Results: Clobetasol propionate 0.05% topical solution was considered to be the most appropriate treatment for noninfectious inflammatory scalp dermatoses in general, with 75.1% agreement in the second round of questionnaire. The main advantages of clobetasol propionate over other topical corticosteroids were reported as potency, effectiveness, and broad action spectrum (94.8% agreement). The preferred pharmaceutical format was the solution of clobetasol propionate.Conclusion: Clobetasol propionate was the preferred topical treatment for the management of scalp dermatoses, usually as first-line treatment; solution was the preferred preparation.Keywords: seborrheic dermatitis, psoriasis, shampoo, topical, solution, clobetasol, scalp, therapy

Jaime Piquero-Casals,1 Corinne Granger,2 Vanesa Piquero-Casals,1 Aurora Garre,2 Juan Francisco Mir-Bonafé1 1Department of Aesthetic Dermatology and Laser, Dermik, Clínica Dermatológica Multidisciplinar, Barcelona, Spain; 2Innovation and Development, ISDIN Pharmaceutical Laboratories, Barcelona, SpainCorrespondence: Jaime Piquero-Casals Carrer Escoles Pias 7. CP, Barcelona 08017, SpainEmail jaime.piquero@e-campus.uab.catBackground: Melasma is a difficult-to-treat, recurrent pigmentary disease. Combined therapy gives better, longer-lasting results.Objective: To determine the clinical effects of a treatment protocol of trichloroacetic acid, phytic acid and ascorbic acid peel combined with oral antioxidant supplement and topical treatment for refractory melasma.Patients and Methods: We present four cases of patients with melasma, who, despite multiple treatments including hydroquinone, showed no improvement. We initiated a 16-week protocol involving 3 in-clinic peels (4 weeks apart) and a daily home treatment. The peels contained 30% trichloroacetic acid, 2% phytic acid, 8% L-ascorbic acid, Camellia sinensis leaf extract and Vitis vinifera seed extract. The home treatment was a depigmenting serum (4-butyl resorcinol, hydroxy-phenoxy propionic acid and niacinamide), a specific SPF50+ sunscreen, and an oral supplement (Polypodium leucotomos; green tea extract; Vitis vinifera; vitamins C, E, and D; and carotenoids), all in the morning, and, at night, a compounded gel-cream (4% hydroquinone, 0.025% tretinoin and 1% hydrocortisone). After 16 weeks, the gel-cream was stopped; the rest of the regimen (topical and oral) was continued for 12 further weeks. Melasma was assessed using the melasma severity scale (MSS) before starting the protocol, and at 4 and 12 weeks after the last peel. Photographs were taken before treatment and at the last evaluation. Patients indicated their satisfaction on a 5-point scale.Results: All patients had good tolerance to the procedures. Three showed an excellent (> 75%) improvement and one showed a good (50– 75%) improvement. All four were very satisfied. At follow-up (12 weeks after last peel), no patients had recurrence.Conclusion: This protocol of trichloroacetic acid, phytic acid and ascorbic acid peel combined with an oral supplement and topical daily treatment is a viable treatment option for refractory melasma.Keywords: trichloroacetic acid, phytic acid, ascorbic acid, peel, peelings, oral supplement, Polypodium leucotomos, topical treatment, melasma

Competing Interests: The authors declare no conflicts of interest.

Competing Interests: The authors declare no conflicts of interest.

Background: Acne pathophysiology includes a complex interaction among inflammatory mediators, hyperseborrhea, alteration of keratinization and follicular colonization by Propionibacterium acnes., Aims: To describe the impact of the exposome on acne and how photoprotection can improve outcomes., Methods: A narrative review of the literature was carried out; searches with Google Scholar and Pubmed from January 1992 to November 2022 were performed. The keywords used were "acne," "sunscreens," "photoprotection," "cosmetics," "cosmeceuticals," "pathogenesis," "etiology," "exposome," "sunlight," "stress," "lack of sleep," "diet," "postinflammatory hyperpigmentation," "pollution," "exposome," "ultraviolet radiation," and "visible light.", Results: Environmental factors such as solar radiation, air pollution, tobacco consumption, psychological stress, diverse microorganisms, nutrition, among others, can trigger or worsen acne. Solar radiation can temporarily improve lesions. However, it can induce proinflammatory and profibrotic responses, and produce post-inflammatory hyperpigmentation and/or post-inflammatory erythema. While photoprotection is widely recommended to acne patients, only four relevant studies were found. Sunscreens can significantly improve symptomatology or enhance treatment and can prevent post-inflammatory hyperpigmentation. Furthermore, they can provide camouflage and improve quality of life. Based on acne pathogenesis, optimal sunscreens should have emollient, antioxidant and sebum controlling properties., Conclusions: The exposome and solar radiation can trigger or worsen acne. UV light can induce post-inflammatory hyperpigmentation/erythema, and can initiate flares. The use of specifically formulated sunscreens could enhance adherence to topical or systemic therapy, camouflage lesions (tinted sunscreens), decrease inflammation, and reduce the incidence of post-inflammatory hyperpigmentation/erythema., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Competing Interests: The authors declare no conflicts of interest.

Competing Interests: The authors declare no conflicts of interest.

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Competing Interests: Competing interests:: None.

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Competing Interests: Competing interests: None

Competing Interests: The authors declare no conflicts of interest.

Competing Interests: The authors declare no conflicts of interest.

Competing Interests: The authors declare no conflicts of interest.

Competing Interests: The authors declare no conflicts of interest.

A 32-year-old man visited our clinic for evaluation of a mildly pruritic lesion on the glans. He complained of a recurrent red patch, which had been slowly enlarging over the previous three months. Clinical examination revealed a slightly raised plaque with a reticulated lacy net pattern and white threads on the glans. There was no evidence of skin, nail or other mucosal involvement on physical examination. Laboratory tests, including hepatitis and syphilis serologies, were normal or negative. Penile dermoscopy revealed white reticular and circular lines [Wickham striae] on a red background. Penile dermoscopy should be included as a part of the clinical inspection of genital diseases to support diagnosis, as well as to ideally avoid unnecessary invasive investigation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: The authors have no conflicts of interest to disclose.

Competing Interests: Competing interests: The authors have no conflicts of interest to disclose.

Competing Interests: Competing interests: The authors have no conflicts of interest to disclose.

Induction of psoriasis following administration of beta blocker containing eye drops has rarely been documented. We report eight cases of psoriasis triggered by timolol eye drops. Since the clinical and histopathological features of this drug reaction are indistinguishable from those of idiopathic psoriasis, a thorough drug history should be taken in all patients, especially elderly ones, with recent onset of psoriasis., (© 2019 The Australasian College of Dermatologists.)

Facial seborrheic dermatitis (FSD) is a chronic and relapsing inflammatory skin disorder occurring in areas of the face rich in sebaceous glands. It clinically manifests as erythematous scaly macules or plaques, often associated with pruritus. Although the pathogenesis of seborrheic dermatitis is not yet fully understood, Malassezia yeast, hormones, sebum levels, and immune response are known to play important roles. Additional factors including drugs, cold temperatures, and stress may exacerbate the condition. Currently, the available treatments do not cure the disease but relieve symptoms. Various pharmacological treatments are available, including antifungal agents, keratolytics, topical low-potency steroids, and calcineurin inhibitors. All of them provide several benefits, but they also have potential side effects. Seborrheic dermatitis tends to have a chronic, recurrent course. To avoid the long-term use of drugs, topical non-pharmacological products such as cosmetics or medical devices may improve clinical outcomes. Products with antimicrobial and anti-inflammatory ingredients such as zinc, piroctone olamine, dihydroavenanthramide, biosaccharide gum-2, and stearyl glycyrrhetinate may speed FSD recovery and avoid flare-ups. Finally, the use of specific cleansers, moisturizers, and sunscreens formulated as light creams or gel/creams should be strongly recommended to all FSD patients. We provide a brief review of the most used non-pharmacological cleansers, topical gel/creams, and specific sunscreens in the management of FSD.