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Throughout the battle against SARS-CoV-2 (COVID-19), various medications have been repurposed in hopes of finding a successful treatment modality to combat the global pandemic. One medication that has recently begun to show promising advancement in clinical trials is the well-known anti-parasitic medication, ivermectin. In this review, we delve into ivermectin and its use as a therapeutic agent against COVID-19. The foundation of how ivermectin treats COVID-19 lies in its ability to inhibit the viral replication process. After assessing the mechanism, pharmacokinetic properties, and current uses of ivermectin, we hypothesized that administering ivermectin intranasally would best capitalize on the inhibitory qualities while avoiding dangerous dosages that would be achieved with oral treatment. Therefore, we propose early use of ivermectin to limit viral replication and severity, as well as prophylactic administration of ivermectin to protect those in high-exposure environments.

Human papillomavirus (HPV) remains to be one of the most common viruses that afflicts the skin and mucosa. Direct contact with cutaneous lesions facilitates a majority of viral transmission. However, the development of laser therapy as treatment for HPV brought to attention the concern of infectious laser plume and the risk it poses to those inhaling it. We conducted a literature review using English articles in PubMed to validate this risk and propose the best safety practices dermatologists can apply when using laser therapy as treatment for HPV. Our investigation identified smoke evacuators as primary modes of mitigation, and we suggest further studies will aid in the refinement of best practice recommendations.

Every year, about 235,000 people over the age of 15 suffer from falls in the bathroom and visit the emergency room, with 37.3% being related to bathing or showering. While various approaches exist to minimize these risks, the core etiology of slipping is often overlooked by consumers, producers, and physicians. The foremost contributor to the cause of slipping in the shower or bath is the use of soaps and bathing products. These products can accumulate on the floor of the shower or tub and consequently alter its surface properties, such as decreasing friction or hindering the body’s natural ability to sense position. Two of the major contributors to this increased slipperiness found in many bath products are oils and surfactants. This brings to light the question of using less dangerous substances in the products, as well as educating the consumer about the inclusion of properties that predispose to slipping. Overall, the consumers’ safety needs to be considered when products are created and marketed. With such a high incidence of slipping occurrences related to bathing or showering, there is a need for more research in this specific area. The high-risk environment due to soaps, coupled with the lack of research regarding this topic, warrants further evaluation from the product producers. It is imperative that further research is required on the specific chemical properties and their effect on surfaces and how they contribute to consumers’ safety.

Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer, accounting for 20% of all skin cancers. The risk of the disease continues to rise annually with an estimated 50-200% increase in incidence within the last three decades. Although cSCC is one of the most common skin cancers, reported having 1 million cases per year in the United States, there is inconsistency with its reported metastatic rate. Research exploring cSCC metastasis found an overall rate of 1.2-5% but this range varies, and some dermatologists are finding cSCC's ability to spread more worrisome. This allows for clinical variation in the appropriate treatments and follow-up guidelines when diagnosing a patient with cSCC. Poor prognosis in patients with a high metastatic potential makes cSCC clinically problematic. Clinician emphasis should be put on risk factors, anatomical site, tumor presentation, and histological features when evaluating cSCC's metastatic potential. In this review, specific skin conditions that predispose to cSCC and discrepancies in its reported metastatic potential will be discussed.

Dimethyl sulfoxide (DMSO) is a highly reactive by-product of paper production in the form of an odorless, colorless liquid that has been studied since the 1860s. Initially it was utilized as a solvent, but more recently it is being investigated for therapeutic applications. Owing to its versatility, the use of DMSO has been proposed in many different medical fields for a variety of applications, with possibly the widest use being in the field of dermatology. The clinical interest in the use of DMSO for dermatology conditions stems from this solution's efficacy as a vehicle to deliver pharmacological agents across the stratum corneum and its ability to penetrate biological membranes. Currently there is only one FDA approval for the use of DMSO, and it is not in the dermatologic field but rather for interstitial cystitis. Outside of the FDA scope of usage, DMSO is used frequently to treat osteoarthritis in humans and animals, as well as other chronic pain conditions. This suggests the possible utility of DMSO being applicable to other inflammatory conditions such as pruritus. Further research is necessary to explore the promising utilization opportunities of DMSO in dermatology.

Pruritus is one of the most common dermatologic complaints and, as the most common dermatologic symptom, is a major contributor to frequent dermatology visits. Chronic pruritus mirrors another major medical condition faced by millions of Americans each year - chronic pain. In older literature, pain and pruritus were thought to have been conveyed by the same C fiber, and the proportion contributing to pruritus was just a small subset of this general fiber. Overall, pain and pruritus share many integral similarities. Although these sensations both initiate the body's awareness to injury, pain and itch may have evolved for sensing different damages such as a burrowing parasite or a noxious stimulus, respectively. This seems to have been validated through analyses of their pathophysiology, acute and chronic conditions, and treatment modalities. However, their symptoms and intrinsic mechanisms vary considerably. It is important to view pruritus in more of an overall, whole body experience, rather than just the sensory aspect. Future studies should investigate the psychological treatment of chronic pruritus, considering the immense similarities with its chronic pain counterpart.

Acne vulgaris is a disease of the pilosebaceous unit that may manifest as either noninflammatory or inflammatory skin lesions. The microcomedone theory suggests that the first step in the pathogenesis of acne vulgaris is the noninflammatory comedone. The comedone is a collection of keratin and sebum that is trapped within the pilosebaceous unit due to hyperproliferation of keratinocytes in the follicular lining. The biofilm produced byP. acnesbacteria promotes the formation of a comedone by acting as a biological glue that prevents expulsion of the hyperkeratotic plug. In addition to its adhesive properties, the biofilm has virulence factors contributing to the pathogenicity ofP. acnesin acne vulgaris. With further investigation and a better understanding of theP. acnesbiofilm, new therapeutic options for acne vulgaris can be made available. By targeting theP. acnesbiofilm, treatment can be made more effective and precise, without the concern of side effects seen in currently available acne medications.

Seborrheic Keratosis (SK) is a common, benign epidermal tumor as observed by dermatologists. Removal is rarely indicated, and usually requested by patients for cosmetic preference. The most common method of removal is cryotherapy, but other topical treatments exist. Topical Hydrogen Peroxide has been recognized as an effective topical treatment. Safety concerns and maximum efficiency of peroxides have been a topic of study in a variety of dermatological conditions. This article aims to review the chemical composition of hydrogen peroxide (H202) in treating SK, methods to increase its effectiveness as a topical dermatological product, and explore the promising new FDA approved treatment.

In 2016, a new drug, crisaborole, was developed and approved, for the first time in 15 years, as an effective treatment for Atopic Dermatitis (AD). Crisaborole is a topical phosphodiesterase 4 (PDE4) inhibitor, which alleviates AD symptoms, such as pruritis, inflammation, and flares. Similar to other topical treatments like corticosteroids and calcineurin inhibitors, crisaborole has been found to cause pain during application. The pain felt during a topical application can be attributed to many possible causes, such as increased sensitivity to pain-provoking and itch-provoking stimuli, prior inflammation, prior damage, and hypersensitized skin of the patient to which the topical cream is applied. Crisaborole has been reported to be effective, yet the application site pain is a major road bump in the effective treatment of some patients. Some possible ways to circumvent this pain are letting the epidermis soothe and heal before starting crisaborole, starting this treatment modality before the skin has a chance to become irritated and inflamed, and numbing the area with an ice pack prior to topical crisaborole application. Overall, crisaborole has been an effective treatment modality, but further research is necessary to allow for safe use of this life-changing AD topical medication.

Objective: To review the efficacy and costs of various contact immunotherapies, contact allergens, intralesional immunotherapies, and intralesional cytotoxic agents for the treatment of recalcitrant warts. Background: Cutaneous warts are common viral skin lesions caused by human papillomavirus that can be challenging to treat and frustrating for physicians and patients. Although several treatment options exist, there is no single treatment that can ensure a complete response with lack of lesion recurrence. Immunotherapies for recalcitrant warts present as a cost-effective, efficient therapy option for patients. Intralesional approaches have the added benefit of affecting warts at locations distant to the target location by inducing a systemic T-cell mediated response in the body. Results: Various contact immunotherapies, contact allergens, intralesional immunotherapies, and intralesional cytotoxic agents have shown to be effective in treating warts. The costs of each treatment varies drastically from around $10 US to over $1000 US to achieve a complete response. Several antigens were found to be both efficacious and cost effective. Conclusion: Although efficacy of several antigens has been confirmed by randomized studies, more randomized comparative studies will need to be performed in order to determine the best antigen and correct standardized doses for the treatment of warts in individual patients. It is important to note that individual response to antigen type and dose may vary among patients. Therefore, further studies may play an important role in the use of immunotherapies in a clinical setting.

In recent years, it has become increasingly clear that genital ulcers from herpes simplex virus (HSV) are associated with HIV acquisition. In light of this evolving synergy in transmission and the availability of effective antiviral therapy, proper diagnosis and management of HSV becomes increasingly important. Unfortunately, conventional HSV management is founded on several popular misconceptions. Herein, we hope to dispel these common misconceptions and expand the current model of herpetic reactivation. By doing so, we aimed to unveil potential pitfalls in current herpetic management.

Herpes simplex virus is a widespread disease affecting about one-third of the world's population. Many individuals suffer from its painful and debilitating manifestations, which greatly impact daily living and can lower one's self-esteem and confidence. It is therefore vital to understand this disease process including its acquisition, replication, transmission, clinical manifestations, diagnosis, and treatment in order to better manage patients. While herpes can have many negative consequences, it also appears to offer some benefit to humans through a symbiotic relationship. In this review of herpes, there are three important points that need to be emphasized. First, herpes can be found in all organs throughout the human body and not just the dorsal root ganglion. Secondly, herpes has been proven to be recurrent by laboratory testing. Thirdly, hospitals should institute respiratory (not merely skin) precautions for herpes zoster due to potential airborne transmission.

Contact dermatitis is not a homogenous entity, but rather a number of subtypes contributing to different clinical presentations. For better understanding, instructional sheets provide information that assists in patient care. Informational sheets on contact dermatitis, patch testing, hand dermatitis, stasis dermatitis, and poison ivy are reviewed for open forum. Although often considered archaic therapy, restriction in use of soaps/cleansers appears to aid in clinical improvement of contact irritant dermatitis. Patient education on patch testing is greatly aided by presenting visual material prior to formal discussion. An internet site for more information regarding culprit environmental allergens is presented. Some simple methods for patients to achieve clinical improvement with eczema, hand dermatitis, and poison ivy are presented. Simplicity, clarity, as well as practical, usable informa- tion are important with patient presentation of the subject of eczema. The material has to be presented in an easy-to- follow, coherent manner for patients. Semantics and scien- tific detail are not necessarily included. Thus on instructional sheets

Urticaria is a common dermatosis characterized by spontaneous recurrent bouts of hives. A common belief is that the tedious search for an underlying cause of spontaneous urticaria is fruitless, and even when successful an appropri- ately dealt with, is not necessarily followed by complete resolution of symptoms. In contrast, urticaria has a great impact on patients' quality of life. These patients suffer considerable loss of energy, sleep disturbance, and emotional upset. Urti- caria remains a big problem in term of etiology, pathogenetic mechanism, and pharmacologic treatment. Whereas text- books and reviews on the topic of urticaria devote limited space to investigations and optional trial therapies for the entity, this article is devoted to the subject. A three-step template for the treatment of urticaria is offered which may prove help- ful for you and your patients.

Hair serves as a social sign of gender, age, status, values, and group membership. Hair is a major part of one's self-identity, and central to one's feeling of personal attractiveness. Treating a patient with hair loss and/or hair issues is not easy because of psychosocial overtones and patients' distress and body image concerns. In this paper, several common hair diseases will be discussed in consort with sample patient instructional sheets. They include trichorrhexis nodosa, te- logen effluvium, pattern alopecia, alopecia areata, excess facial hair in females, and male pattern baldness. This paper therefore presents a template from which individual physicians can assess whether any portion of the material is worth be- ing incorporated into their individual practices. Scalp hair has been endowed with greater social and psy- chological significance than biological importance. Medi- cally, it merely provides some shielding from ultraviolet rays and some cushioning of the cranium from head gear. Histori- cally and culturally, hair serves as a social sign of gender, age, status, values, and group membership. As stated previ- ously, "from monks to skinheads, prisoners of war to warri- ors, bigwig European aristocrats to mop top Beatles, and hippies to head-shaven celebrity athletes, hair makes a statement whether chosen or imposed (1)". Hair is a major part of one's self-identity, and central to one's feeling of personal attractiveness. Physical appearance symbolizes one's perceptions, thoughts, feelings, and behav- iors. People use this physical attribute to express one's indi- viduality. Hair styling is a major part of one's daily grooming ritual. Quoting a psychologist, "Preparing one's hair is prepa- ration to face one's social world. The expression 'bad hair day' is testimony to the psychological importance of hair. Hair loss can turn every day into a bad hair day (1)".

Patient informational/instructional sheets can be used not only to assist in providing patients with baseline ma- terial regarding their condition, but also aid in physicians communicating a treatment protocol. Educational material re- garding acne, adult acne, perioral dermatitis, and isotretinoin is included for perusal and discussion. Within this frame- work, one learns the unifying concept of the Propionibacterium acnes biofilm, methods to maximize production of ben- zoyl peroxide radicals (the active biological form of this compound), unplugging ability of oral antibiotics, and low-dose isotretinoin therapeutics. Caring for patients involves a number of critically impor- tant elements including being sympathetic, understanding, supportive, and educating them about their condition and their treatment regime. Regarding that latter point, there are diverse methods that can be utilized to convey to patients information concerning their individual skin condition and therapy. One method would be patient informational sheets to assist in providing patients with baseline material regard- ing their condition and treatment. Of course, they should be written in language which most patients will find easy to comprehend, and offered after greeting the patient and per- forming a history and physical examination. In the case of acne and related conditions, it is also helpful to introduce the topic by using diagrams explaining that bacteria within the hair follicle unit produce toxins that cause inflammation, and that treatments will be directed at these bacteria, or their food source, the sebaceous gland. Without further ado, figures 1 through 5 are the initial instructional sheets used in Sylvania, Ohio for the following conditions: acne, adult acne, perioral dermatitis, and isotreti- noin. Please note there is an additional sheet for females who opt for accutane, due to all the additional steps required to obtain this drug for this sex. Of note, these informational sheets selected for discussion are for patients who either have no insurance or insurance which provide limited drug coverage. Certainly, with patients with standard insurances, trade name products become more economically feasible and informational sheets would be easily modified to reflect one's preferred therapies with this expanded therapeutic ar- mamentarium. Physician-written instructional sheets parallel the clinical teachings and beliefs of the individual disease state. Thus, the remainder of this paper will discuss the mate- rial contained within these information sheets, and offering justification of the beliefs expressed within them.

Background: Seborrheic dermatitis affects approximately 2 to 5% of the populace. Interestingly, the term 'seb- orrheic dermatitis' is somewhat a misnomer as there is no direct quantitative relationship between the degree of sebaceous activity and susceptibility to seborrheic dermatitis. Method: A pilot study was performed to initiate assessment of patient satisfaction with oral minocycline and topical keto- conazole for seborrheic dermatitis, and in so doing, set a stage for discussion for a novel assessment on the pathophysiol- ogy of this condition. Results: Clinical improvement of seborrheic dermatitis occurred with oral minocycline and topical ketoconazole. In terms of all parameters studied, the condition improved with therapy and all patients desired to continue with the treatment regimen. Conclusions: One could speculate that the clinical benefit of seborrheic dermatitis with antibiotics is likely via its effect on the microbiology within the sebaceous unit as well as on the alterations which thereby occur to the composition of the sebaceous secretions as they pass through the pilosebaceous unit. After being secreted, human sebum can be altered by various factors including secretion of hyaluronidase, proteases, and lipases by P. acnes. A closer examination of the al- teration in sebum content both in the seborrheic condition and in treatment therapies warrants further investigation.

Background. Seborrheic keratoses are the most common benign tumors in adults. Despite their negative cosmetic appearance, no topical treatment is commonly recommended for these lesions. Objective. Our objective was to assess whether clinical benefit could be achieved by using a keratolytic topical agent and superficial scraping for this condition. Methods. A topical 50% urea-containing product under occlusion was applied daily to large and/or thick hyperkeratotic seborrheic keratoses on the truck and extremities. The patients were instructed to digitally scrape the surface of the lesions in an attempt to reduce the thickness of the lesions. Results. In a pilot nonrandomized open-label survey, patients expressed satisfaction with using this topical therapeutic technique. Conclusions. Hyperkeratotic seborrheic keratoses can be satisfactorily managed with topical agents and scraping with reasonable patient satisfaction. Further studies with various keratolytic agents using other delivery systems are warranted.

Control of various infestations requires an accurate understanding of transmission. After thousands of years of lice infestation, scientific documentation of indirect contact transmission has been substantiated. Lice can be transferred in the egg, instar, and adult stages. Lice have now been shown in the laboratory to be readily dislodged by air movements such as blow-drying one's hair, combing, and toweling. Moreover, passive transfer to adjoining fabric is also frequently observed. Louse transmission by fomites occurs more frequently than has been commonly believed. Close proximity suffices to increase the likeliness of a new infestation. Thus louse control measures should take account of fomite transmission and include screening of all individuals within an infested person's immediate circle of contact, laundering of everything within the infested individuals' bed or quarantining of such material for 10 days, thorough vacuuming of floors, carpets, upholstery, with a standard vacuum cleaner.

Background Concerns have arisen over the development of antibiotic-resistant organisms due to the prolonged use of oral and topical antibiotics in acne vulgaris. We have previously demonstrated that benzoyl peroxide used in consort with a chemical with an accessible tertiary amine, such as an allylamine, increases radical activity and biological effect. Objectives The purpose of this pilot study was to assess the efficacy of two nonantibiotic topical remedies for mild to moderate acne, with one of the agents being a combination of benzoyl peroxide with butenifine, an allylamine. Methods In an open-label, patient-satisfaction, 8-week comparative study, 23 patients demonstrating mild to moderate facial acne were given randomly either benzoyl peroxide in Proactiv Solution or the combination of benzoyl peroxide with an allylamine. Results The allylamine–benzoyl peroxide combination therapy outperformed Proactiv Solution during each 2-week stage of evaluation in terms of reduction of comedones, inflammatory lesions, and degree of oiliness. There was a marked preference for the allylamine–benzoyl peroxide combination in terms of patient satisfaction. Conclusions Benzoyl peroxide used in consort with antimicrobial agents that contain an accessible tertiary amine, such as erythromycin, has previously been shown to increase radical activity and biological effect. Trials of short duration with small numbers of patients do not adequately inform practitioners about whether the combination of allylamines with benzoyl peroxide is a viable alternative to topical antibiotic therapy for acne. Nevertheless, the higher satisfaction with the allylamine–benzoyl peroxide combination certainly warrants further investigation.

Background: Pediculus humanus capitis (head lice) belongs to the order Anoplura, which are blood-feeding ectoparasites that live on human hair. Within these insects reside symbiotic bacteria that enable the insect to flourish on dietary sources of limited nutritional value. These symbiotic bacteria are essential to the survival of the insect. Objective: To assess the feasibility of treating head lice by altering their symbiotic bacteria. Methods: In addition to a literature review of the expanded role of symbiotic bacteria in other organisms, the anatomic localization of their presence in human head lice and molecular characterization of the head louse symbiont were analyzed. Results: Anatomically, the bacterial symbiotes are localized to the midgut mycetome in males and the ovaries in females. The 16S ribosomal ribonucleic acid phylogenetic analysis was presented. Features of this bacterial symbiote may make this symbiont accessible as a target for pediculocidal and ovicidal therapy by altering its habitat and existence. Conclusions: An understanding of the nature of bacterial symbiotes of head lice might lead to alternative strategies for eradication or inhibition of these necessary bacteria, thereby controlling head lice with less toxic agents than conventional insecticides, to which the organism continues to increase its resistance.

The human papillomavirus is a DNA virus that is involved in the pathogenesis of several benign and malignant lesions. Although numerous types of HPV exist, vaccines currently target HPV’s 6, 11, 16, and 18, which are the most commonly implicated in verrucae and oral-genital neoplasms. Although the HPV vaccine has been recommended as part of the vaccination schedule in adolescents for several years, widespread inoculation has not yet become common practice. It is imperative that vaccination be more broadly instituted to decrease the incidence of HPV related lesions in both males and females

Summary Background Dermatophyte infections can be polymicrobial. Topical antifungal therapies offer limited coverage of yeasts and Gram-positive and Gram-negative bacteria. Moreover, the increased usage of these topical antimicrobial agents has resulted in the development of resistant cases. Benzoyl peroxide (BP), used in concert with antimicrobial agents containing an accessible tertiary amine, has previously been shown to increase radical activity and biological effect. Objectives To determine the applicability of using the tertiary amine terbinafine in concert with BP in dermatophyte and mixed skin infections by means of in vitro testing. Methods In this preliminary in vitro study, the effect of BP, alone and in combination with terbinafine, was tested against Candida albicans, Pseudomonas aeruginosa and Staphylococcus aureus isolates following a checkerboard modification of the National Committee for Clinical Laboratory Standards M27-A2 and M7-A6. The individual minimum inhibitory concentrations of terbinafine, BP, and the combination, were determined against each isolate. Results The combination of BP with terbinafine led to additive activities against the majority of Candida albicans isolates tested and additionally expanded the bacterial coverage of terbinafine. Conclusions The combination of antifungal agents bearing a tertiary amine with BP may have benefit in polymicrobial infections, given its wider antimicrobial coverage. Further appreciation of this mechanism of catalysis of BP radical formation by certain antimicrobials and other tertiary amine-containing compounds may lead to the discovery of improved treatments for several dermatological conditions.

Head lice, like many insects, produce a protective coating for their newly laid eggs that is essential to the survival of the species. Knowledge of the composition of the sheath, which is the glue by which the egg is attached to human hair, and the nit laying process could lead to production of agents that could be used to attack louse infestations by interfering with the normally protected environment of nymph development within the egg. The physical removal of nits has become an important part of treatment of head louse infestations given the "no-nit" policy in schools. Biochemical analysis has revealed that the nit sheath of the head louse is composed of 4 bands of protein, possibly cross-linked to aliphatic components with a tertiary structure of beta sheeting. Nature has protected the louse by making the nit sheath similar in composition to the hair; thereby, agents designed to unravel the nit sheath may also damage human hair. Possible targets to destroy the nit sheath include proteases, denaturants, beta sheet breaker proteins, and small protein inhibitors of sheath formation. Better understanding of insect glues may allow us to develop compounds so that the liquid secretions of the collateral glands of the female louse, which becomes the nit sheath, do not solidify by oxidation when placed with the louse egg onto human hair. Knowledge of insect behavior, such as oviposition, may also suggest methods for repelling female lice from laying eggs onto hair. Alternatively, agents that coat the nits and restrict the oxygen transfer to the developing larvae may prove beneficial.

Parasitic diseases caused by helminths, or worms, account for billions of human infections worldwide. Although most human pathogens caused by these organisms are infrequent in the United States, skin manifestations of parasitic diseases are being seen much more frequently in dermatologists' offices due to the increase in immigration and travel. Helminths are notable for their complicated lifecycles often including consecutive developmental phases, in separate hosts or in a free-living state. These parasitic organisms are usually macroscopic, multicellular organisms, and do not breed within their mammalian hosts. Notably, many helminthic diseases present with dermatologic signs and symptoms including skin nodules, cysts, migratory skin lesions, and pruritus. In this section, we discuss cutaneous myiasis as well as the four most common nematode dermatologic conditions seen in the United States.

Airborne contact dermatitis (ABCD) is an inflammatory reaction involving the skin upon exposure to allergenic agents or irritants suspended in air. In allergic ABCD, the hypersensitivity is classified as a type IV reaction. Substances responsible for such reactions can be of plant or non-plant origin. Commonly reported plants include those of the Compositae family, which includes ragweed, goldenrod, and sunflowers. Establishing an accurate diagnosis is critical for preventing exposure and improving symptoms in patients. Obtaining a detailed history and performing a physical examination to determine the sites of involvement, as well as patch testing to establish the causative allergen, are the main methods of arriving at the correct diagnosis. Treatment often involves avoidance of the allergens or irritants when possible and may also include the application of topical barrier creams or systemic therapy in more severe cases. This article reviews the topic of ABCD and highlights its most common etiologies in the USA.

Objective: To assess the chemical composition of cerumen by flash pyrolysis-gas chromatography/mass spectrometry. Study Design: Collected earwax specimens were fractionated into residue and supernatant by means of deoxycholate. This natural bile acid produces significantly better disintegration of earwax in vitro than do presently available ceruminolytic preparations, and also has demonstrated excellent clinical results in vivo to date. Patients: The sample for analysis was obtained from a patient with clinical earwax impaction. Results: The supernatant is composed of simple aromatic hydrocarbons, C5-C17 straight-chain hydrocarbons, a complex mixture of compounds tentatively identified as diterpenoids, and steroids, in particular cholesterol. The residue, on the other hand, produced simple aromatic compounds (including benzenes, phenols, and benzonitriles), C5-C25 straight-chain hydrocarbons, greater relative quantities of nitrogen compounds and phenol, and lesser importance of the (tentatively identified) diterpenoids. Conclusions: Through the use of the detergent deoxycholate, squalene and a tentatively identified diterpenoid were revealed to be present in a free, unbound state, whereas some steroids and hydrocarbons appeared to be bound to a macromolecular structure by nitrogen linkages or other bonds. Additionally, this study reintroduces detergents as a viable method of earwax removal, specifically the bile acids.

Background: The incidence of head lice infestations in North America is escalating with an estimated 12 million cases of head lice per year despite the existence of insecticidal therapies. Objective: To evaluate certain characteristics of the human head louse, including their chitinous structure, nymphal developmental stages, legs with claw adaptations, antennae with sensory perceptions, and spiracles by which oxygen exchange occurs, for assessment of possible means to control the spread and growth of this insect. Methods: Scanning electron-microscopic examination of head lice was performed. Results: Newer treatments of head lice must acknowledge defense mechanisms that are based on anatomic structure and physiologic characteristics, details of louse transmission, and the insects' ability to ‘resurrect’ after sham death. Conclusions: An understanding of lice entomology is essential in the pursuit of novel means to control the lice epidemic.

Objective: To assess the protein and simple sugar content of earwax in pursuit of better ceruminolytic agents. Study Design: Collected earwax specimens were tested in several media for dissolution before being analyzed for amino acid and carbohydrate content. Patients: The samples were obtained from eight random patients requiring ear plug removal. Results: The amino acid composition differs considerably from hair and stratum corneum of glabrous skin. Sugar analysis revealed high levels of galactosamine and galactose. Conclusions: This analysis of proteins and carbohydrates further characterizes earwax. Future ceruminolytic agents must dissolve lipid, keratin, and a monolayer of lipid covalently bound to the epidermal cells, which encourages cellular aggregation.

Sweating is a normal and important mechanism of thermoregulation which is essential for survival. When sweating becomes excessive, the resulting condition is called hyperhidrosis. While hyperhidrosis is not a fatal condition, it can greatly affect one's quality of life due to its psychological and social impact. To understand this condition, it is necessary to explore the biology of sweat glands including the eccrine, apocrine, and apoeccrine sweat glands. It is also vital to understand the physiological significance of sweat to maintain the human body temperature in order for it to function properly. Hyperhidrosis can be divided into a primary and secondary condition and it is also associated with a wide variety of other conditions. Many treatments exist to alleviate this disorder including aluminum compounds, aldehydes, anticholinergic agents like glycopyrrolate, benztropine and oxybutynin, botulinum toxin A, antiperspirants, sympathectomy, iontophoresis, and sweat gland suction. Ultimately, knowledge of this disorder and its methods of treatment and management are imperative to optimize treatment for patients suffering from hyperhidrosis. Hyperhidrosis is defined as sweating greater than is necessary for the maintenance of normal body thermoregulation. While hyperhidrosis is not a fatal condition, it can greatly affect one's quality of life due to its psychological and social impact. Hyperhidrosis can also render the skin susceptible to infection because of the continuous dampness of the skin. It is thus important to understand this condition and its complications in order to better manage and treat patients. In order to understand the disorder of hyperhidrosis, it is first necessary to explore the biology of sweat glands. There are three major types of sweat glands: eccrine, apocrine, and apoeccrine. Eccrine sweat glands are the most numerous of all glands and can be found throughout the body surface except for the lips and the glans penis. Eccrine sweat glands consist of a ductal portion and a secretory portion. The major function of the ductal portion is to reabsorb ions from the primary sweat to create an isotonic sodium chloride solution. The major function of the secretory portion is as its name suggests: secretion. Eccrine sweat is composed primarily of water in addition to other ions such as sodium, chloride, potassium, and calcium. Eccrine sweat glands are innervated by postganglionic sympathetic fibers and the major neurotransmitter is acetylcholine. Many different types of muscarinic acetylcholine receptors can be found on eccrine sweat glands and thus these receptors can be blocked by antimuscarinic agents. Apoeccrine glands can be found on the hairy areas of the body like the axilla, mammary, perineal, and genital regions. Apoeccrine sweat is oily, lacks an odor, and is rich in proteins, lipids, and steroids. Apoeccrine glands receive sympathetic innervation and the major neurotransmitters are epinephrine and norepinephrine. These glands are mixed glands found in the hairy regions of

Intertrigo is a superficial inflammatory dermatitis involving juxtaposed skin surfaces subjected to friction, heat, moisture, and maceration. In response to encouraging reports of topical sucralfate's effect on epithelialization of wounds as well as its bacteriostatic property, a clinical trial evaluating its possible role as a topical agent for intertrigo was initi- ated. For expected beneficial effects, zinc oxide and ketoconazole were added with sucralfate to the vehicle. The study was an open-label comparison designed to examine patient satisfaction with topical sucralfate vs the patients' prior thera- pies for their condition. At the conclusion of our pilot study, patients completed a survey questionnaire so that we could assess the value of this product in clinical usage. By all parameters queried, patient satisfaction was very high with this product for their condition. It is conjectured that such a formulation might be useful also for diaper rashes, diaper wipes, blisters, and open skin sores.

Objective To characterize the immune response to Propionibacterium acnes in acne patients. Design Comparison of serologic responses in acne and normal patients using counterimmunoelectrophoresis for antibody and an enzyme-linked immunosorbent assay (ELISA) to detect immunoglobulin G (IgG) antibody. Setting The serum of acne and nonacne patients from the Dermatology Clinic at the Medical College of Ohio was utilized for analysis. Results Using counterimmunoelectrophoresis, antibody was detected in 13 of 20 acne patients. The antigen was detectable as an anion in the barbital buffer at pH 8.2, strongly suggesting a carbohydrate component. By ELISA, the antibody proved to be IgG, and the bacteria and its water-soluble fractions were capable of fixing complement. Conclusions The primary instigator of inflammation in acne vulgaris is an immunologic reaction to extracellular products of P. acnes. The immunologic response involves both humoral and cell-mediated pathways. The antibodies to P. acnes have not been characterized fully, although they are largely of the IgG class. We have further characterized the dominant antigen to have a carbohydrate component.

Pruritic scalp has not traditionally been specifically categorized as a separate dermatologic condition; but rather it has been included within the broad category of seborrheic dermatitis. This has severely limited testing and understand- ing of this entity. The objective of this study was to assess patient satisfaction with various topical and oral therapies for pruritic scalp. For this purpose, an open-label, five-week study, 12 patients with pruritic scalp were given five different therapies, each to be used for one week. The participants then completed a survey to assess their opinion on the different therapies. No one treatment was universally preferred. Lanacaine solution and steroid solution achieved slightly higher marks. In a few cases, oral antihistamines proved curative. In short, pruritic scalp is a distinct condition in which one experiences episodic itching of the head without any visible or pathological sign of psoriasis, head lice, or any other scalp disorder. The divergent responses in this study underlines that there are probably different factors and trigger points which elicit the condition. More studies on this entity are warranted.

The Propionibacterium acnes biofilm has previously been shown to exist via genomic studies and to make a biological glue which allows for adherence to follicular walls. This gylcocalyx polymer secreted by P acnes also finds its way into sebum composition where it causes the adhesiveness of keratinocytes leading to comedones. An appreciation of P acnes biofilms and secretions has implications in immunogenicity of the organism, clinical course of acne, and therapy for comedonal and inflammatory acne.

Physician: “No one has the foggiest notion why God gave us moles on our skin ... and that’s the honest truth.” Melanocytes are derived from melanoblasts that arise from the neural crest. Melanocyte numbers vary little between human populations, although they differ in size, number, and the structure of melanosomes. 1 In the human epidermis, they have a close association with keratinocytes via dendrites. Although well known for their role in skin pigmentation, this is probably not the only function of these cells. Indeed, melanocytes have numerous enzymes with capabilities in antimicrobial defense, as well as genetic, biochemical, and functional links to the immune system. 2 Melanin, endogenously produced by melanocytes, is able to interact with enzymes and modulate their behavior, is a powerful cation chelator, and can bind and neutralize oxidants, microbicidal peptides, and antimicrobial drugs. 3–6 A better appreciation of the biological effects of melanocytes may assist in all aspects of the evaluation, understanding, and treatment of diseases associated with this cell line, such as vitiligo and melanoma. There are definite flaws in the media dogma that melanin’s main role is in protection against ultraviolet light. To begin with, it fails to explain the increase in the prevalence of melanin and melanocytes in skin not normally exposed to the sun, such as the genitalia, 1 and other body tissues, such as the epithelium of the inner ear, uveal tract of the eye, brain tissue, and the peritoneum. 7 Moreover, many nocturnal animals, such as bats, are highly melanized on their exterior surface. In addition, African albinos, despite the absence of melanin’s sun protection, do not have an increased incidence of melanoma. 2

The Food and Drug Administration (FDA) has been more proactive in regulating sunscreen products. In 2011, the FDA publicized a set of new requirements for marketing over-the-counter sunscreens in the United States. The primary goal of the new FDA requirements was to provide consumers with a clear understanding of the level of protection actually provided by a sunscreen. Furthermore, information about protection against ultraviolet A radiation, associated with early aging and skin cancer, was to be clarified. With the new regulations, sunscreen products that provide protection against ultraviolet A and ultraviolet B would be allowed to be marketed as broad-spectrum sunscreen [1].

In recent years, it has become increasingly clear that genital ulcers from herpes simplex virus (HSV) are associated with HIV acquisition. In light of this evolving synergy in transmission and the availability of effective antiviral therapy, proper diagnosis and management of HSV becomes increasingly important. Unfortunately, conventional HSV management is founded on several popular misconceptions. Herein, we hope to dispel these common misconceptions and expand the current model of herpetic reactivation. By doing so, we aimed to unveil potential pitfalls in current herpetic management.

Skin disorders of the foot are common in patients who exercise. Knowing the causes, diagnostic indications, and treatment of seven common skin conditions-friction blisters, calluses, corns, talon noir, tennis toe, plantar warts, and tinea pedis-can help physicians manage these disorders in active patients.