Alicia Podwojniak

Oxymetazoline hydrochloride 0.05% is a lipophilic sympathomimetic nasal decongestant spray available over the counter (OTC) and commonly used for allergic and chronic rhinitis. A well-known side effect of these nasal sprays is rebound congestion termed rhinitis medicamentosa (RM), but there is little literature attesting to the relationship between RM and substance use disorder. This is a case report of severe nasal spray oxymetazoline use disorder per DSM-5 criteria discovered incidentally in a 44-year-old patient receiving care at a residential addiction treatment center for long-standing polysubstance use and bipolar disorders. The patient began using oxymetazoline in 2003 for allergic rhinitis and developed rhinitis medicamentosa that progressed to an oxymetazoline use disorder. Despite medical and clinical interventions, cravings and urges prevented her from stopping the nasal spray. We discuss the pharmacological properties of oxymetazoline, the behavioral aspects of its intranasal administration, and the drug-induced rebound congestion that may contribute to its misuse. To our knowledge, this is the first reported case of oxymetazoline use disorder lasting 20 years.

Metabolic and bariatric surgery (MBS) is a successful surgical option for obesity. However, many patients can experience insufficient weight loss and weight regain post-operatively. Glucagon-like peptide-1 (GLP-1) receptor agonists have become available for effective weight loss treatment due to their effects of suppressing appetite, slowing gastric emptying, and promoting fat loss. This systematic review aims to evaluate the efficacy of using GLP-1 agonists to treat insufficient weight loss or regain after metabolic/bariatric surgery. Pooled analysis demonstrated that GLP-1 agonists have a moderate effect on weight loss after failed weight loss or weight regain following MBS, with a Cohen’s d-score of 0.470 (p ≤ 0.001). GLP-1 agonists show promise and deserve additional research as part of the standard of care following MBS with insufficient weight loss.

To investigate the benefits of topical 8% capsaicin patches for the decrease of postsurgical neuropathic pain level and area. A systematic review with pooled analysis was conducted utilizing the PRISMA 2020 guidelines. Five commonly used databases were employed utilizing a search string made from MeSH terms and boolean operators. Retrieved articles were then subjected to title and abstract appraisal, followed by full-text appraisal by two independent reviewers and an adjudicator to break ties. A total of 127 articles were retrieved from five commonly used databases. Of the 127 articles, 20 were subjected to full-text appraisal, with 12 remaining for inclusion. Due to a heterogeneity greater than the 50% threshold provided by Cochrane, a random-effects pooled-analysis was conducted in lieu of meta-analysis. The random-effects pooled-analysis denotes an overall Cohen's d of 1.09 (95% CI: 0.58-1.56; p < 0.001). All studies that investigated neuropathic pain area denote a decrease in pain size, with some denoting a continued reduction with subsequent application. Further larger randomized-controlled trials are required to strengthen the position of topical capsaicin patches in the physician's armamentarium. www.crd.york.ac.uk/prospero identifier is CRD42024542508.

Background: Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusions (CSIIs) are the current standard treatment devices for type 1 diabetes (T1D) management. With a high prevalence of T1D beginning in pediatrics and carrying into adulthood, insufficient glycemic control leads to poor patient outcomes. Dermatologic complications such as contact dermatitis, lipodystrophies, and inflammatory lesions are among those associated with CGM and CSII, which reduce glycemic control and patient compliance. Objective: This systematic review aims to explore the current literature surrounding dermatologic complications of CGM and CSII as well as the impact on patient outcomes. Methods: A systematic review of the literature was carried out using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines using 5 online databases. Included articles were those containing primary data relevant to human participants and adverse reactions to CGM and CSII devices in pediatric populations, of which greater than 50% of the sample size were aged 0‐21 years. Qualitative analysis was chosen due to the heterogeneity of outcomes. Results: Following the application of exclusion criteria, 25 studies were analyzed and discussed. An additional 5 studies were identified after the initial search and inclusion. The most common complication covered is contact dermatitis, with 13 identified studies. Further, 7 studies concerned lipodystrophies, 5 covered nonspecific cutaneous changes, 3 covered unique cutaneous findings such as granulomatous reactions and panniculitis, and 2 discussed user acceptability. Conclusions: The dermatologic complications of CGM and CSII pose a potential risk to long-term glycemic control in T1D, especially in young patients where skin lesions can lead to discontinuation. Increased manufacturer transparency is critical and further studies are needed to expand upon the current preventative measures such as device site rotation and steroid creams, which lack consistent effectiveness.

Background: Acne vulgaris is a pervasive skin disease characterized by inflammation of sebaceous units surrounding hair follicles. It results from the complex interplay between skin physiology and the intricate cutaneous microbiome. Current acne treatments, while effective, have major limitations, prompting a shift towards microbiome‐based therapeutic approaches.Objectives: This study aims to determine the relationship between acne and the cutaneous microbiome, assess the effects of current treatments on the cutaneous microbiome, and explore the implications for developing new therapies.Methods: A systematic review was performed using PubMed and SCOPUS databases within the last 10 years. Methodological quality was assessed independently by two authors. The search retrieved 1830 records, of which 26 articles met the inclusion criteria. Meta‐analysis of alpha diversity change was assessed using fixed and randomized effect models per therapeutic group.Results: Eight studies pertain to the role of the cutaneous microbiome in acne, identifying C. acnes, S. aureus and S. epidermidis as key contributors through overproliferation, commensalism, or dysbiosis. Eleven studies discuss current acne treatments, including doxycycline (1), topical benzoyl peroxide (BPO) (4), isotretinoin (2), sulfacetamide‐sulfur (SSA) (2) and aminolevulinic acid‐photodynamic therapy (ALA‐PDT) (2), identified as modulating the cutaneous microbiome as a mechanism of efficacy in acne treatment. Seven studies discuss new treatments with topical probiotics, plant derivatives, and protein derivatives, which contribute to acne clearance via modulation of dysbiosis, inflammatory markers and diversity indexes. A meta‐analysis of the effects of existing therapeutics on the cutaneous microbiome identified benzoyl peroxide as the only treatment to facilitate significant change in diversity.Conclusions: Despite the heterogeneity of study types and microbiome classifications limiting the analysis, this review underscores the complexity of microbial involvement in acne pathogenesis. It delineates the effects of acne therapeutics on microbial diversity, abundance, and composition, emphasizing the necessity for personalized approaches in acne management based on microbiome modulation.

Systemic sclerosis (SSc), a rheumatologic autoimmune disease, can present diversely, especially in patients with skin of colour (SOC). Differences in clinical manifestations among SOC individuals compared to predominantly White populations require a comprehensive examination to optimize diagnosis and treatment. This systematic review aims to explore the differences in SSc manifestations among individuals with SOC, identifying variations in disease severity, clinical features and psychosocial impacts. A systematic review of the literature was conducted following PRISMA guidelines. Databases searched included PubMed, SCOPUS, Cochrane and Web of Science, focusing on studies published within the last 10 years. Nine studies were selected and qualitatively analysed due to the heterogeneity of study types. Key findings highlight significant variations in disease severity and cutaneous clinical features among SOC cohorts compared to predominantly White populations. Raynaud's phenomenon was prevalent across all ethnicities; however, SOC groups exhibited fewer hallmark features of scleroderma, such as telangiectasias, calcinosis and digital swelling, which complicates diagnosis. SOC individuals showed a higher propensity for severe pulmonary complications and increased mortality rates. Atypical cutaneous presentations in SOC were associated with disease progression. Psychosocial impacts were more pronounced in SOC individuals, with greater awareness and dissatisfaction over cutaneous symptoms. Recognizing the atypical presentations of SSc in SOC is critical for early diagnosis and optimizing patient outcomes. The study underscores the need for further research to determine if observed differences are due to variations in prevalence, genetic factors or insufficient training in recognizing cutaneous manifestations in SOC. Enhanced awareness and targeted training for healthcare providers are essential to address these diagnostic challenges and improve care for SOC patients with SSc.

BACKGROUND Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusions (CSII) are the current standard treatment devices for type 1 diabetes (T1D) management. With a high prevalence of T1D beginning in pediatrics and carrying into adulthood, insufficient glycemic control leads to poor patient outcomes. Dermatologic complications such as contact dermatitis, lipodystrophies, and inflammatory lesions are among those associated with CGM and CSII, which reduce glycemic control and patient compliance. OBJECTIVE This systematic review aims to explore the current literature surrounding dermatologic complications of CGM, CSII, and the impact on patient outcomes. METHODS A systematic review of the literature was carried out using PRISMA 2020 guidelines utilizing five online databases. Included articles were those containing primary data relevant to human subjects and adverse CGM and CSII devices in pediatric populations of which greater than 50% of the sample size were ages 0-21. Qualitative analysis was chosen due to the heterogeneity of outcomes. RESULTS Following the application of exclusion criteria, 25 studies were analyzed and discussed. The most common complication covered is contact dermatitis with 12 identified studies. 6 studies concern lipodystrophies, 4 cover nonspecific cutaneous changes, and the remaining 3 cover unique cutaneous findings such as granulomatous reactions and panniculitis. CONCLUSIONS The dermatologic complications of CGM and CSII pose a potential risk to long-term glycemic control in T1D, especially in young patients where skin lesions can lead to discontinuation. Increased manufacturer transparency is critical and further studies are needed to expand upon the current preventative measures such as device site rotation and steroid creams, which lack consistent effectiveness.

The evolution of personalized medicine in dermatology signifies a transformative shift towards individualized treatments, driven by the integration of biomarkers. These molecular indicators serve beyond diagnostics, offering insights into disease staging, prognosis, and therapeutic monitoring. Specific criteria guide biomarker selection, ensuring attributes like specificity, sensitivity, cost feasibility, stability, rapid detection, and reproducibility. This literature review, based on data from PubMed, SCOPUS, and Web of Science, explores biomarkers in Hidradenitis Suppurativa (HS), Psoriasis, Atopic Dermatitis (AD), Alopecia Areata (AA), Vitiligo, and Chronic Spontaneous Urticaria (CSU). In HS, TNF-α, IL-1β, and MMPs serve as biomarkers, influencing targeted therapies like adalimumab and anakinra. Psoriasis involves biomarkers such as TNF-α, IL-23, and HLA genes, shaping treatments like IL23 and IL17 inhibitors. AD biomarkers include ECP, IL-4, IL-13, guiding therapies like dupilumab and tralokinumab. For AA, lipocalin-2, cytokines, and genetic polymorphisms inform JAK inhibitors’ use. Vitiligo biomarkers range from cytokines to genetic markers like TYR, TYRP1, guiding treatments like JAK inhibitors. CSU biomarkers encompass IgE, cytokines, and autologous serum tests, influencing therapies like omalizumab and cyclosporine. Comparing conditions, common proinflammatory markers reveal limited specificity. While some biomarkers aid diagnosis and standard treatments, others hold more scientific than clinical value. Precision medicine, driven by biomarkers, has shown success in skin malignancies. Future directions involve AI-powered algorithms, nanotechnology, and multi-omics integration for personalized dermatological care.

CO2 and Er:YAG are the two most common types of ablative lasers in use today. Ablative lasers are known for their superior efficacy in penetrating deeper through the skin layers when compared to non-ablative lasers. This review compares the outcomes and adverse events associated with CO2 and Er: YAG lasers, in conjunction with other therapeutic modalities, in the treatment of common skin conditions. A PRISMA-compliant systematic review of PubMed and Embase databases was conducted from January 2012 to December 2022. Study types that were eligible for this review included clinical trials, randomized controlled trials, case reports, case series, cohort studies, and meta-analyses. The study protocol was registered (PROSPERO 2022: CRD42022348569). The search strategy produced 27 studies comprising 946 patients who were treated for acne scars, postacne hyperpigmentation, solar lentigines, facial rejuvenation, refractory vitiligo, and epidermal verrucous nevi. Erythema, pain, and hyperpigmentation were the most commonly reported adverse effects. A higher rate of adverse events was observed in CO2 laser therapies (n=610, 64.5%) when compared to Er: YAG and other laser cohorts (n=40, 4.2%). Both CO2 and Er: YAG lasers demonstrate similar efficacy in the treatment of benign cutaneous conditions. Further research is needed for parallel comparison of CO2 and Er: YAG lasers.

Although White individuals have higher incidence of melanoma, clinical outcomes are worse among patients with skin of color. This disparity arises from delayed diagnoses and treatment that are largely due to clinical and sociodemographic factors. Investigating this discrepancy is crucial to decrease melanoma-related mortality rates in minority communities. A survey was used to investigate the presence of racial disparities in perceived sun exposure risks and behaviors. A survey consisting of 16 questions was deployed via social media to assess skin health knowledge. Over 350 responses were recorded, and the extracted data were analyzed using statistical software. Of the respondents, White patients were significantly more likely to have higher perceived risk of developing skin cancer, highest levels of sunscreen usage, and higher reported frequency of skin checks performed by primary care providers (PCPs). There was no difference between racial groups in the amount of education provided by PCPs related to sun exposure risks. The survey findings suggest inadequate dermatologic health literacy as a result of other factors such as public health and sunscreen product marketing rather than as a consequence of inadequate dermatologic education provided in healthcare settings. Factors such as racial stereotypes in communities, implicit biases in marketing companies, and public health campaigns should be considered. Further studies should be conducted to determine these biases and improve education in communities of color.