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Chidubem AV Okeke,1 Ramona Khanna,2 Alison Ehrlich3 1Department of Dermatology, Howard University College of Medicine, Washington, DC, USA; 2Georgetown University School of Medicine, Washington, DC, USA; 3Foxhall Dermatology, Washington, DC, USACorrespondence: Chidubem AV Okeke, Department of Dermatology, Howard University College of Medicine, 520 W Street NW, Room 3035/3036, Washington, DC, USA, Email chidubem.okeke@bison.howard.eduAbstract: The recent global pandemic has resulted in increased use of quaternary ammonium compounds (QACs). Currently, QACs are active ingredients in 292 disinfectants recommended by the US EPA for use against SARS-CoV-2. Among QACs, benzalkonium chloride (BAK), cetrimonium bromide (CTAB), cetrimonium chloride (CTAC), didecyldimethylammonium chloride (DDAC), cetrimide, quaternium-15, cetylpyridinium chloride (CPC), and benzethonium chloride (BEC) were all identified as potential culprits of skin sensitivity. Given their widespread utilization, additional research is needed to better classify their dermal effects and identify other cross-reactors. In this review, we aimed to expand our knowledge about these QACs to further dissect its potential allergic and irritant dermal effects on healthcare workers during COVID-19.Keywords: patch test, systemic contact dermatitis, hypersensitivity, allergic contact dermatitis, COVID-19, healthcare

Background: Chemical hair relaxers are widely utilized by black women, yet little research exists on the allergens present in these products., Objective: This study aims to investigate allergen prevalence in the most popular chemical hair relaxers., Methods: We analysed 41 products from five major retailers, identifying allergens through ingredient lists and comparing them to the 2020 American Contact Dermatitis Group Core allergen series., Results: The most common contact allergens in chemical relaxers include propylene glycol, cetyl steryl alcohol, fragrance, D/L-a-tocopherol, tea tree oil and cocamidopropyl betaine., Conclusion: Understanding allergen exposure in products used by individuals with textured hair is needed for managing contact dermatitis in diverse populations. This analysis underscores the presence of potential allergens in hair relaxers, emphasizing the importance of dermatologists' awareness and patient scrutiny of ingredient lists., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Skin color classification can have importance in skin health, pigmentary disorders, and oncologic condition assessments. It is also critical for evaluating disease course and response to a variety of therapeutic interventions and aids in accurate classification of participants in clinical research studies. A panel of dermatologists conducted a literature review to assess the strengths and limitations of existing classification scales, as well as to compare their preferences and utilities. We identified 17 skin classification systems utilized in dermatologic settings. These systems include a range of parameters such as UV light reactivity, race, ethnicity, and degree of pigmentation. The Fitzpatrick skin type classification is most widely used and validated. However it has numerous limitations including its conflation with race, ethnicity, and skin color. There is a lack of validation data available for the remaining scales. There are significant deficiencies in current skin classification instruments. Consensus-based initiatives to drive the development of validated and reliable tools are critically needed., Competing Interests: Conflicts of interest Dr Harvey has served as a consultant for L’Oréal and SkinCeuticals and on advisory boards for AbbVie, Lilly, Bristol-Myers Squibb, and Johnson & Johnson. Dr Alexis has received grants (funds to institution) from LEO Pharma, Novartis, Almirall, Bristol-Myers Squibb, Amgen, Vyne, Galderma, Valeant (now Bausch Health), Cara Therapeutics, Arcutis, Dermavant, AbbVie, and Castle; on advisory board or as a consultant for LEO Pharma, Galderma, Pfizer, Sanofi-Regeneron, Dermavant, Beiersdorf, Ortho, L’Oréal, BMS, Bausch Health, UCB, Vyne, Arcutis, Janssen, Allergan, Almirall, AbbVie, Amgen, VisualDx, Eli Lilly, Swiss American, Cutera, Cara Therapeutics, EPI Health, Incyte, Castle, Apogee, Alphyn, and Canfield; as a speaker for Regeneron, Sanofi-Genzyme, Pfizer, and BMS; and has received royalties from Springer, Wiley-Blackwell, and Wolters Kluwer Health. Dr McKinley-Grant has served as a consultant for Janssen and Determi-Nation. Dr Taylor has served as a consultant/advisor/speaker for AbbVie, Arcutis Biotherapeutics, Inc, Armis Scientific, Avita Medical, Beiersdorf, Inc, Biorez, Inc, Bristol-Myers Squibb, Cara Therapeutics, Dior, Eli Lilly, EPI Health, Evolus, Inc, Galderma Laboratories, LP, GloGetter, Hugel America, Inc, Johnson & Johnson Consumer Products Company, L’Oréal USA, Medscape/WebMD, MJH LifeSciences, Pfizer, Piction Health, Sanofi, Scientis US, UCB, and Vichy Laboratoires; as an author at McGraw-Hill; on the Editorial Board for Practical Dermatology, Cutis, and Archives in Dermatologic Research and a peer reviewer for the British Journal of Dermatology; and as an investigator for Allergan Aesthetics, Concert Pharmaceuticals, Croma-Pharma GmbH, Eli Lilly, and Pfizer. Dr Desai has served as an investigator and/or consultant for Galderma, Pfizer, Lilly, Dermavant, AbbVie, and many other companies; he also holds multiple leadership positions in national and other organizations. Dr Jaleel has received grants from Pfizer, Skin of Color Society, Dermatology Foundation, and the NIH; as a consultant for UCB, Eli Lilly, Novartis, and ChemoCentryx. Dr Kang has served on the advisory board and/or as a consultant for Amore Pacific, CeraVe, Galderma, Eli Lilly, and Jeune. Dr Vashi has served as a consultant for Janssen Biotech, L’Oréal, and Canfield. Dr Elbuluk has served as a consultant for Avita, Scientis, Beiersdorf, Incyte, VisualDx, La Roche Posay, Beiersdorf, and Unilever; on advisory boards for Allergan, Eli Lily, Galderma, Incyte, Janssen, La Roche Posay, and L’Oréal; as speaker for Estee Lauder, La Roche Posay, Scientis, Medscape, Beiersdorf, and Dior; and as an investigator for Avita. Dr Hamzavi has served as a consultant to AbbVie, Pfizer, Incyte, UCB, Boehringer Ingelheim, Sonoma, Union therapeutics, Novartis, Janssen, Avita, Galderma, Almirall, and Vimela; as an investigator for Lenicura, Pfizer, Incyte, Avita, Loreal/Laroche Posay, Clinuvel, ITN, Chemocentyx, Ferndale Laboratories, Inc, Unigen, Inc, and Arcutis; and as a board member and Past-president of the HS Foundation and Global Vitiligo Foundation. Dr Kwatra has served as an advisory board member/consultant for AbbVie, Amgen, Arcutis Biotherapeutics, Aslan Pharmaceuticals, Cara Therapeutics, Castle Biosciences, Celldex Therapeutics, Galderma, Genzada Pharmaceuticals, Incyte Corporation, Johnson & Johnson, LEO Pharma, Novartis Pharmaceuticals Corporation, Pfizer, Regeneron Pharmaceuticals, and Sanofi; and as an investigator for Galderma, Incyte, Pfizer, and Sanofi. Dr Kholi has served as an investigator for Ferndale, Estée Lauder, La Roche Posay Dermatologique, Unigen, Johnson & Johnson, Allergan, Pfizer, Sciton, and Bayer; received support from the American Skin Association for a vitiligo project; was a consultant for Pfizer, Johnson & Johnson, Beiersdorf (previously known as Bayer), and ISDIN; and received salary support from the Dermatology Foundation through a research career development award. Dr Callender has served as an investigator and/or received grants from AbbVie/Allergan, Almirall, Aerolase, Arcutis, Avava, Beiersdorf, Eirion, Eli Lilly, Janssen, L’Oréal, Pfizer, Prollineum, skinbetter science, Symatese, and Teoxane; as a consultant or advisor for Acne Store, Aerolase, Arcutis, Avita Medical, Beiersdorf, Cutera, Dermavant, EPI Health, Jeune Aesthetics, L’Oréal, OrthoDerm, Scientis, Sente, SkinCeuticals, and UCB; as a speaker for Eli Lilly, L’Oréal, and SkinCeuticals; and has received royalties from Elsevier and UpToDate. Author Okeke, Dr Heath, Dr Lester, Dr Vasquez, Dr Rodriguez, Dr Sundaram, Author Brown, and Author Cobb have no conflicts of interest to declare., (Copyright © 2024 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest None disclosed.

Background: Direct-to-consumer advertisements (DTCAs) in medical marketing serve as a prominent modality to deliver information to an increasingly diverse audience of consumers and increase prescription sales. In dermatology, advertisements have the potential to shape the public's opinions, aid in the understanding of skin conditions, and raise awareness of available treatments., Objective: To investigate and characterize the representation of skin tones in DTCAs., Methods: Nielsen ratings were utilized to identify the networks most watched by Black viewers in 2022. Programming on NBCUniversal, ABC, CBS, and FOX that aired in the District of Columbia, suburban Maryland, and Northern Virginia from June 2022 to July 2022 was reviewed for DTCAs. DTCAs were then analyzed to determine the skin tones of models and skin conditions depicted on models with darkly pigmented skin., Results: Of the 106 DTCAs related to dermatologic conditions, there were 13 unique advertisements featuring 32 unique models. Four advertisements depicted the skin condition on darkly pigmented skin tones. Using the Monk Skin Tone (MST) scale to assess the 32 unique individuals, only 25% ( n = 8) were rated at an MST 7 or above, and 6.25% ( n = 2) were rated at an MST 10., Limitations: This study has the limitation of only sampling DTCAs from Washington, District of Columbia which does not fully represent all dermatology-related DTCAs in the United States., Conclusion: Results of this content analysis demonstrate that the number of persons of color within dermatologic DTCAs is 23%, whereas there are 13.6% Black individuals in the 2021 US census. This suggests that DTCAs are becoming more diverse since 2018. However, findings also show that the vast majority of DTCAs do not include models with darkly pigmented skin, and there remains a lack of advertisements depicting skin disease among people of color. Given the role of DTCAs in informing and aiding patients' requests for prescription drugs, representation of all skin tones is essential for this communication to be effective, especially in the field of dermatology., Competing Interests: None., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Women’s Dermatologic Society.)

Rosacea changes are a result of an immune mediated response and the angiogenic properties of the LL-37 peptide. This peptide induces an inflammatory signal that activates the NLRP3-mediated inflammasome, triggering rosacea pathogenesis. Research findings show that LL-37 peptide is inhibited by binding to a cell surface glycosaminoglycan, heparan sulfate. Heparan Sulfate Analog (HSA) is a proprietary low molecular weight analog of heparan sulfate that has been formulated into a Dermal Repair Cream (DRC), specifically to aid in such immune mediated responses. Herein, in vitro studies using human epidermal keratinocytes showed an increase in HSA decreased LL-37 toxicity and IL-8 cytokine release. A single-center, randomized double-blind trial included 16 subjects (Fitzpatrick skin types I-IV) with a clinical diagnosis of type 1 rosacea and moderate to severe facial erythema, who were undergoing Pulsed Dye Laser (PDL) treatment. The clinical improvements of their facial erythema were assessed at baseline, 2 weeks, 4 weeks, and 8 weeks. Results revealed that low molecular weight HSA significantly improves the clinical signs of rosacea during the 8 weeks of use likely resulting from inhibition of LL-37 induced IL-8 cytokine release. These findings support the use of DRC in rosacea topical treatment regimens as it demonstrates visible skin benefits and improves tolerability of PDL therapy in a shorter duration of time as compared with PDL alone.George R, Gallo RL, Cohen JL, et al. Reduction of erythema in moderate-severe rosacea by a low molecular weight Heparan Sulfate Analog (HSA). J Drugs Dermatol. 2023;22(6):546-553. doi:10.36849/JDD.7494.

Competing Interests: Conflicts of interest ASB is a consultant for Senté, Inc. ES-O, VDC, and DO have participated in Advisory Boards for Senté, Inc. SH and CAVO have no conflicts of interest to declare.

Currently, there is a lack of racial/ethnic heterogeneity in research databases, exposing a systematic issue in studies exploring inflammation-mediated diseases, such as hidradenitis suppurativa (HS). HS is a chronic inflammatory skin condition that disrupts normal structure and functioning of terminal hair follicles, resulting in the formation of recurrent abscesses, nodules, and sinus tracts within intertriginous regions. Studies have described higher serum levels of inflammation-mediated C-reactive protein (CRP) in patients with HS, a disease that predominantly affects skin of color (SOC) populations. Herein, we explore the role of CRP levels in the context of HS disease presentation, management, and psychosocial implications in SOC patients to determine existing disparities in research studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Okeke, Williams, Iwuala, Igwe, Khanna, Perry, Okoye and Byrd.)

Competing Interests: The authors have no funding or conflicts of interest to declare.