Exosomes are small extracellular vesicles (30-150 nm in size) that play a critical role in cellular communication, transporting proteins, lipids, and nucleic acids between cells. This literature review focuses on evaluating the potential benefits and limitations of exosomes in enhancing skin health and aesthetics through indications such as skin rejuvenation, hair restoration, and pigmentation disorders.

Nasal defects after skin cancer excision can often be healed by second intention in certain circumstances.

Acne vulgaris is one of the most common skin diseases worldwide and affects a large population of patients. Post-acne scarring can pose a significant psychosocial burden on patients of all ages; therefore, treatment approaches must be both rapid-acting and effective. Microneedling is a minimally invasive technology that involves the creation of controlled tissue microinjury and subsequent induction of collagen production and tissue remodeling. Platelet-rich plasma (PRP) is an autologous preparation of plasma containing supraphysiologic concentrations of platelets, growth factors, and cytokines. The combination of microneedling and PRP therapy has been postulated to offer synergistic effects in the treatment of acne scarring. The purpose of this review is to critically analyze recent clinical trials that compare the efficacy of microneedling monotherapy to the combination of PRP and microneedling for the treatment of atrophic acne scarring. J Drugs Dermatol. 2025;24(1):41-46. doi:10.36849/JDD.8585R1.

The prevalence of burnout among United States (US) dermatologists has surged, reaching 49% in 2023, with a growing volume of bureaucratic tasks (eg, charting, paperwork) the leading factor behind professional fatigue. We seek to explore the competitive landscape and efficacy of AI-powered patient documentation to alleviate burnout among dermatologists by optimizing documentation practices while maintaining accuracy.

Obesity is a metabolic disease that is marked by excessive fat accumulation and is objectively defined as a body mass index (BMI) ≥30 kg/m2. Obesity is associated with several other comorbidities, including psoriasis, which is a chronic autoimmune skin disease. Adipocytes produce pro-inflammatory signaling molecules, namely adipokines and classic cytokines, that drive increased inflammation axnd may contribute to the pro-inflammatory pathways driving psoriasis disease pathogenesis. Optimizing dermatologic management of obese patients with psoriasis may be challenging due to the effect of comorbid obesity on the pharmacokinetics of systemic therapies. Biologic therapy is a mainstay of psoriasis treatment in these patients. The IL-17 and IL-23 inhibitor classes, including those targeting the IL-17 receptor (brodalumab), IL-17 cytokine antagonists (secukinumab, ixekizumab, bimekizumab), and IL-23 cytokine antagonists (guselkumab, risankizumab, tildrakizumab). In general, the most efficacious biologics that work well for generalized plaque psoriasis also tend to work well for most obese psoriasis patients. For example, brodalumab, an IL-17 receptor inhibitor, demonstrated comparable efficacy across BMI categories in both clinical trial and real-world practice data. In addition to psoriasis-specific therapy, interventions targeted at weight loss may help treat obesity and decrease psoriasis disease severity. These interventions include glucagon-like peptide-1 receptor agonist therapy, caloric restriction, and different forms of bariatric surgery. Clinical trials and real-world data evaluating the efficacy of different biologic treatments and weight-loss interventions in the treatment of obese psoriasis patients should be used to support clinical decision-making for treatment options. J Drugs Dermatol. 2025;24:1(Suppl 1):s4-14.

Botulinum toxin is a well-established treatment for dynamic glabellar lines. Glabellar contraction patterns were described previously in the general Brazilian population and also among Koreans, Chinese, and Indian individuals. So far, no study has addressed glabellar contraction "patterns" in Black subjects.

Delayed reactions to hyaluronic acid (HA) fillers have been reported following various immunologic and infectious triggers.

The Restylane® portfolio of hyaluronic acid (HA) fillers comprises a broad range of products, each with a unique combination of gel strength/firmness and flexibility. Restylane® Shaype™ (HASHA) is a new HA injectable produced with NASHA-HD™ technology and the most recent addition to the Restylane portfolio. NASHA-HD is an evolution of the NASHA™ platform that adds more HA and uses a more efficient cross-linking even though the degree of modification is kept low. HASHA has an HA-concentration of 25 mg/mL and a G prime (G') of 916 Pa (0.1 Hz). Experts recommend using HASHA for treatment in the chin area because its high G' allows a higher degree of correction/projection with lower injection volumes, especially in those patients with pronounced chin retrusion, together with a long duration of effect and good overall safety. Depending on the patient's needs and the aim of treatment, different approaches and injection techniques should be applied. This paper reflects the recommendations of an interdisciplinary expert panel for the use of HASHA for the correction of the chin area, including patient selection, product volume, product placement, injection technique, and post-treatment care. Recommendations were discussed and agreed as a consensus, according to cross-sectional expertise and clinical experience.   J Drugs Dermatol. 2025;24(1):70-78. doi:10.36849/JDD.8593.

The use of neuromodulators for cosmetic purposes has a remarkable safety record; nevertheless, unwanted effects can and do sometimes occur when neurotoxins are used for facial rejuvenation, such as neutralizing antibodies and eyelid ptosis. The primary objective of the following roundtable discussion was to review the most commonly reported complications from neurotoxins and summarize considerations for reducing the risk of complications. A roundtable discussion was held by 5 notable experts in their field during a special addition of the Thriving in Diversity webinar series on Thursday, February 15, 2024. Three presenters were provided with an opportunity to share their knowledge. Common complications associated with the use of neuromodulators include lack of response due to neutralizing antibody formation and eyelid ptosis. Common complications, such as neutralizing antibodies, can often be prevented by avoiding known risk factors. The use of topical alpha adrenergic agonists can often improve the appearance of eyelid ptosis. The cosmetic use of neuromodulators remains extremely safe, and serious adverse events rarely occur. J Drugs Dermatol. 2025;24(1):7-11. doi:10.36849/JDD.8355.

Acne treatment can take weeks to deliver noticeable improvements, which may diminish patients' perception of treatment effectiveness and undermine treatment adherence. Combination topical treatments that target multiple acne pathophysiological pathways are more efficacious than topical monotherapies, and simplifying combination treatment by delivering multiple active ingredients as fixed combinations may improve adherence.

There is continuous demand for safe, effective cosmetic ingredients to treat the signs of aging skin, including fine lines, wrinkles, brown spots, discoloration, laxity, and sagging. While there are a plethora of cosmeceutical peptides, few combine anti-aging and anti-inflammatory benefits with small size.

Acne vulgaris affects approximately 80% of young adults and adolescents in the world. Acne presents as comedones, pustules, papules, and nodules on the face, chest, shoulders, or back. It can lead to a significant decrease in quality of life with a high risk of associated depression and anxiety. Hyperstimulation of sebaceous glands by androgens play a pivotal role in acne pathogenesis. Clascoterone 1% cream is a first-in-class topical androgen receptor inhibitor approved for treatment of acne in patients 12 years and older. In the following real-world cases, expert dermatologists demonstrate use of clascoterone cream as monotherapy or in combination with other agents to treat acne in a variety of patients. Experts found that twice-daily use led to best overall results with patients. Real-world cases serve as invaluable guides for patients and dermatologists to help form personalized, targeted acne regimens. J Drugs Dermatol. 2025;24:1(Suppl 2):s3-10.

Acne is prevalent in approximately 80% of individuals aged 11 to 30 years, with scarring occurring in about 40% of cases. Early and sustained treatment is crucial for preventing acne scarring, regardless of severity.

Injectable biostimulator treatments stimulate endogenous collagen in aging skin, but whether they act through similar pathways is unknown. This study evaluates two biostimulatory agents' effects on genes, expressed proteins, and respective pathways as potential aging biomarkers and treatment outcomes.

Melasma, a symmetric pigmentary disorder, is more prevalent in women and individuals with darker skin tones. Despite its global prevalence, there is a notable gap in the understanding of gender, racial, and Fitzpatrick skin type (FST) representation in melasma clinical trials. We conducted a comprehensive search of the United States (US) National Library of Medicine clinical trials database (ClinicalTrials.gov) on March 2nd, 2024, to identify melasma clinical trials. The aim of this study was to assess the demographic representation of participants enrolled in melasma clinical trials. Out of 56 trials identified, 19 met the inclusion criteria, comprising 614 patients. Our analysis revealed a predominant representation of female patients (96.58%) and a diverse representation of racial and ethnic groups, with a majority of Hispanic or Latino patients (43.10%), followed by Asian (23.71%), White (15.52%), and Black or African American patients (14.66%). Fitzpatrick skin types III and IV were most common among trial participants, totaling over 75% of trial participants. The identified gender, racial, and FST representation suggest a deliberate effort towards more inclusive research practices in dermatology. This trend towards inclusivity sets a valuable precedent for improving representation in research for other dermatological conditions that disproportionately impact skin of color patients. J Drugs Dermatol. 2025;24(1):19-22. doi:10.36849/JDD.8379.

Currently, available technologies and procedures enable aesthetic dermatologists to provide their patients with beneficial treatment outcomes for a wide variety of skin conditions. These treatments range from laser resurfacing and radiofrequency procedures to chemical peels and microneedling. The concept of integrated skincare is based on the application of adjunct therapies before, during, or after cosmetic medical procedures to promote healing, minimize discomfort, shorten down-time, and enhance overall aesthetic outcomes. Numerous peer-reviewed studies have demonstrated the benefit of combining a variety of adjunct treatments with cosmetic procedures. The concurrent application of integrated skincare can improve these skin-related issues and provide patients with greater global outcomes. The primary objective of the following consensus roundtable was to discuss best practices for aesthetic providers with or without dermatological training when treating patients with aging skin complaints and review considerations for evaluating patients interested in cosmetic procedures with concomitant skin issues, such as skin dyschromias, lines, and wrinkles. A roundtable discussion was held by several notable experts in their field during a special addition to the Thriving in Diversity webinar series on Saturday, July 8, 2023. The discussion included four leading dermatologists, one oculoplastic surgeon, and one facial plastic surgeon who provided their clinical experience and consensus recommendations for applying integrated skincare in the aesthetic medical practice. J Drugs Dermatol. 2025;24(1):47-53. doi:10.36849/JDD.7999.

Many dermatologic medications have the potential to induce ocular complications. Traditional medications, including corticosteroids, retinoids, antibiotics, antihistamines, and immunosuppressants, have been associated with eye dryness, irritation, allergy, infection, atrophy, pigmentary changes, increased intraocular pressure, and impaired vision. Novel therapeutic agents such as biologics raise new concerns for ocular surface disease and conjunctivitis. Dermatologists should recognize these oculocutaneous side effects for appropriate decision-making, coordinating interdisciplinary care, and optimizing patient outcomes. J Drugs Dermatol. 2024;23(12):1108-1113. doi:10.36849/JDD.8236.

There are numerous over-the-counter products for treating acne, although many formulations have tolerability issues and lack the cosmetic elegance desired by adult patients.

Acne scarring can have a detrimental impact on quality of life, making early and effective treatment essential. Lasers and energy-based treatment are the preferred treatment modality, yet a clear consensus on the ideal laser selection is lacking in the literature.