Henry W. Lim

Background: The 2015 core domain set (CDS) for vitiligo defines outcomes for clinical trials, comprising three essential and four recommended outcome domains/domain items. Periodic reassessment is required to ensure its continued relevance. Objectives: To evaluate the content validity (relevance, comprehensiveness and comprehensibility) of the 2015 vitiligo CDS to inform a consensus-based update as part of a core outcome set, including core outcomes and core measurement instruments. Methods: A roundtable discussion and three surveys reassessed the 2015 vitiligo CDS regarding relevance (≥ 70% agreement for ‘essential’), comprehensiveness (identification of missing domain items) and comprehensibility (clarity of terminology and descriptions). Results: Fifty-three patients with vitiligo (group 1) and 37 experts (36 dermatologists and 1 researcher; group 2) participated. Two previously essential domains (‘Repigmentation’ and ‘Side effects/harms’) were re-endorsed as essential by both groups. ‘Maintenance of gained repigmentation’ was rated essential by patients only. Among previously recommended domains, ‘Quality of life’ was considered essential by both groups, whereas ‘Cosmetic acceptability of repigmentation’ and ‘Cessation of spreading of vitiligo’ were rated essential by patients only. ‘Tolerability/burden of treatment’ was not considered essential by either group. Frequently suggested missing items (outcomes and contextual factors) included psychological impact, treatment session duration, overall treatment duration, treatment costs, patient education and evaluation of associated auto­immune diseases. Proposed updates included refining domain terminology (e.g. vitiligo-specific/health-related quality of life; replacing ‘harms’ with ‘adverse events’) and addressing feasibility-related timeframes. Conclusions: While the 2015 vitiligo CDS retains content validity for several domains, meaningful updates are warranted. These findings will inform the development of a revised and updated CDS.

Skin‐related neglected tropical diseases (skin NTDs) remain visible markers of health‐system inequity. The World Health Organization (WHO) road map for neglected tropical diseases 2021–2030, its 2022 strategic framework for skin NTDs, and the WHO Global Report on Neglected Tropical Diseases 2025 already establish integration, primary‐care mainstreaming, and improved access to diagnostics and medicines as global priorities. Drawing on Workshop 1 of the 4th International League of Dermatological Societies (ILDS) World Skin Summit, this viewpoint positions the Cape Town Action Plan not as a competing policy framework, but as an implementation compact for translating existing commitments into locally owned service readiness, accountable delivery, and measurable follow‐through.

Background: Patients with immune‐mediated inflammatory diseases (IMIDs) of the skin face challenges beyond visible signs. Despite their significant psychosocial burden, the global impact of skin IMIDs on work productivity has not been systematically reviewed. Objective: To evaluate the global burden of skin IMIDs on work productivity. Methods: We conducted a systematic review and meta‐analysis. Eight electronic databases (PubMed, Web of Science Core Collection, Embase, SciELO, KCI Korean Journal Database, Global Index Medicus, Informit and Google Scholar) were searched from inception to June 2024. We included quantitative studies reporting work‐related outcomes in adults (≥18 years) with alopecia areata, atopic dermatitis, hidradenitis suppurativa, psoriasis or vitiligo. For the meta‐analysis, studies had to report Work Productivity and Activity Impairment (WPAI), Work Limitations Questionnaire (WLQ) or sick leave duration. Two reviewers independently screened and extracted data. Risk of bias was assessed using validated tools. Data were pooled using frequentist and Bayesian approaches to ensure estimations robustness across heterogeneous designs and sample sizes. Results: Across 100 studies with a cumulative sample of 306,619 participants worldwide, skin IMIDs were consistently associated with impaired work functioning. Notably, the mean WPAI overall work impairment was 28.96 (95% CI 25.61; 32.31), and participants averaged 16.74 days of sick leave per year (95% CI 7.39; 26.1). Findings suggest that occupational impairment was influenced by psychosocial factors, thereby highlighting broader societal and economic consequences. Conclusion: Skin IMIDs substantially reduce work functioning and productivity worldwide, representing an underrecognized burden on individuals, employers and health systems. Better multidisciplinary strategies are needed to prevent occupational disadvantage and mitigate the economic and social impact of these chronic conditions.

Background/Purpose: Visible light (VL), and particularly high‐energy visible light (HEVL), reaching Earth's surface has emerged as a relevant contributor to skin damage. VL has been implicated in oxidative stress, inflammation, pigmentation disorders, and photoaging, especially in individuals with darker skin phototypes. As conventional sunscreens offer limited protection in the visible spectrum, increasing attention has been directed toward complementary photoprotective strategies, including the use of natural compounds with antioxidant and anti‐inflammatory properties. This systematic review aims to evaluate and synthesize the available preclinical and clinical evidence on the photoprotective effects of natural compounds against VL‐induced skin damage, emphasizing their mechanisms of action, efficacy, and safety. Methods: A comprehensive literature search was performed to identify studies reporting validated objective outcomes, including colorimetric parameters, diffuse reflectance spectroscopy, or clinical grading scales. Eligible studies were included, qualitatively synthesized, and risk of bias was evaluated. Results: Preclinical studies demonstrated that natural compounds mitigated VL‐induced oxidative stress, inflammation, and pigmentation‐related pathways. Clinical studies showed that formulations containing natural compounds improved VL‐induced erythema and pigmentation outcomes. However, considerable heterogeneity was observed in irradiation protocols, outcome measures, and study designs, precluding quantitative meta‐analysis. Conclusion: Overall, available evidence supports a protective role for selected natural compounds against VL‐induced skin damage, particularly through antioxidant and anti‐inflammatory mechanisms, with the strongest clinical evidence focusing on natural sources of polyphenols. Nevertheless, this review highlights the need for standardized phototesting protocols and well‐designed clinical trials. Future research should focus on comparative efficacy, long‐term safety, and integration of natural compounds into combined photoprotection strategies tailored to different skin phototypes.

Background: Post‐inflammatory hyperpigmentation (PIH) is among the most burdensome sequelae of inflammatory dermatoses in skin of color (SOC), and reduction of visible pigmentation represents the primary clinical outcome of interest. Tinted sunscreens containing iron oxides and/or pigmentary titanium dioxide are currently the best‐evidenced strategy for preventing visible light–driven PIH in SOC. However, cosmetic unacceptability—including white cast, poor shade match, and texture incompatibility with acne‐prone skin—significantly limits real‐world adherence. This concept paper proposes a clinical reframing: when pigment‐based visible light filters are not tolerated, pigmentation reduction may be achievable through proactive topical actives with direct anti‐pigmentation activity. Methods: This commentary synthesizes the mechanistic and clinical literature on high‐energy visible light (HEVL)–driven pigmentation in SOC, with particular focus on the opsin‐3–MITF–melanogenesis axis and topical actives with demonstrated anti‐pigmentation activity against HEVL‐induced melanogenesis. Evidence is presented to support a proposed clinical reframing and pragmatic algorithm. Results: HEVL activates opsin‐3 on melanocytes, upregulating MITF and promoting formation of stable, autophagy‐resistant melanosomes—a mechanism distinct from UVA‐driven photooxidation and particularly relevant in darker phototypes. Four prototypical actives with direct clinical or preclinical evidence against HEVL‐induced pigmentation are reviewed. Conclusion: Pigmentation reduction—rather than the mechanism by which it is achieved—should be recognized as the primary clinical endpoint in photoprotection for PIH in SOC. When pigment‐based visible light filters containing iron oxides and/or pigmentary titanium dioxide are cosmetically unacceptable, a strategy combining broad‐spectrum UVA1 photoprotection with a topical active with anti‐pigmentation activity represents a rational, evidence‐informed alternative that keeps the clinical goal firmly in focus.