Skin Health Institute

Artificial intelligence programs were not used in the provision of this article. The authors declare no conflicts of interest. Research data are not shared. Table S1: MOAHFLA (% male patients; % occupational dermatitis; % with atopic dermatitis; % hand dermatitis; % leg dermatitis; % face dermatitis; % age > 40 years) characteristics for individuals with alkyl glucoside (AG) allergic contact dermatitis (ACD) compared to those tested to AG without a relevant reaction from a retrospective study from 1st January 2016 to 31st December 2024. Analysis was made with χ2 test with Yate's continuity correction unless otherwise specified. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Introduction Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by eczematous lesions, intense itch, and skin pain. The chronic nature of the disease requires safe and effective long term treatment options. Upadacitinib (UPA) is a Janus kinase inhibitor approved for the treatment of moderate-to-severe AD in adults and adolescents. Materials and Methods Patients in the randomized, double-blind, multicenter, placebo-controlled, phase 3 Measure Up 1 (NCT03569293), Measure Up 2 (NCT03607422), and AD Up (NCT03568318) trials were pooled for analysis. Adolescents and adults (aged 12–75 years) with moderate-to-severe AD were randomized 1:1:1 to receive once-daily oral monotherapy with UPA 15 mg, UPA 30 mg, or placebo (Measure Up 1, Measure Up 2) or in conjunction with topical corticosteroids (AD Up). The first 16 weeks of each study were placebo-controlled, double-blinded with a blinded extension period of up to 524 weeks. Patients who were initially randomized to UPA maintained their original treatment. Patients initially randomized to placebo were rerandomized (1:1) to blinded UPA 15 mg or UPA 30 mg. Treatment-emergent adverse events (TEAEs) and adverse events of special interest (AESI) were assessed by exposure-adjusted rates per 100 patient-years (PY) for the entire treatment period. Results A total of 2683 patients were treated with either 15 mg (N = 1337) or 30 mg (N=1346) of UPA with a total of 9623.7 PYs of exposure. Overall rates for TEAEs were higher with UPA 30 mg than UPA 15 mg. Serious AE, and AE leading to discontinuation were generally similar between UPA 15 mg and 30 mg. Rates of TEAEs leading to death remained low in both groups (both UPA 15 mg and 30 mg, 0.1 events per 100PY [E/100PY]). Rates of AESIs were: serious infections (UPA 15 mg, 2.2E/100PY; UPA 30 mg, 2.7 E/100 PY), herpes zoster (UPA 15 mg, 3.2 E/100PY; UPA 30 mg, 5.1 E/100PY), nonmelanoma skin cancer (NMSC; UPA 15 mg, 0.4 patients per 100 patient-years [n/100PY]; UPA 30 mg 0.5 n/100PY), malignancy excluding NMSC (UPA 15 mg, 0.3 n/100PY; UPA 30 mg, 0.4 n/100PY), adjudicated major adverse cardiovascular events (UPA 15 mg, 0.2 n/100PY; UPA 30 mg, < 0.1 n/100PY), and adjudicated venous thromboembolic events (UPA 15 mg, 0.1 n/100PY; UPA 30 mg, 0.2 n/100PY). Incidence rates for MACE, VTE and malignancy were similar or below background rates observed in real-world AD populations. Conclusions This integrated analysis of three phase 3 trials with over 9600 patient-years of exposure demonstrates consistently low rates of adverse events of special interest throughout 7 years of upadacitinib treatment. Rates were generally similar between doses and did not exceed background incidence rates in real-world atopic dermatitis populations, supporting the established benefit-risk profile of upadacitinib for moderate-to-severe atopic dermatitis.

Phototherapy with narrowband ultraviolet B (UVB) is an effective treatment for vitiligo. However, it requires frequent in-office visits. Self-administered home-based UVB (HBUVB) therapy with a handheld or panel device is an alternative that has received limited research attention. The purpose of this systematic review and meta-analysis is to evaluate the effectiveness and safety of HBUVB in the treatment of vitiligo compared to in-office UVB (IOUVB). Searches were conducted on Medline, Cochrane and Embase from inception until 4th of August, 2024. Studies with primary data of patients being treated with a hand-held UVB device were included in this study. Efficacy as measured in number of patients achieving > 50% or > 75% repigmentation was the primary study outcome. Secondary outcomes analyzed were cost, adverse events and adherence. Eighteen studies were included with a total of 1341 vitiligo patients. Of these, four studies (148 HBUVB and 143 IOUVB) could be used for the meta-analysis. HBUVB was not inferior to IOUVB at achieving > 50% (OR 1.04, 95% CI 0.58-1.87) and > 75% repigmentation (OR 1.26, 95% CI 0.65-2.42). Home-based UVB was not associated with an increase in risk for either erythema or burning sensations when compared to IOUVB. There was a 14% lower rate of discontinuation amongst patients using HBUVB. Home-based UVB therapy is not inferior to in-office UVB therapy in efficacy or rate of adverse events and demonstrates favourable treatment adherence. This meta-analysis provides evidence supporting HBUVB as a safe and effective alternative to IOUVB in patients with vitiligo. PROSPERO registration number: (CRD42023478123).

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease estimated to affect approximately 30% of children and 10%-15% of adults in Australia. Of those with this condition, one in five is estimated to have moderate-to-severe disease. Treatment guidelines for patients with moderate-to-severe AD recommend adding or switching to a targeted systemic medication if the disease is not well controlled with topical treatment. Without access to these medications, healthcare providers are limited in their ability to effectively treat moderate-to-severe AD. Availability of these guideline-recommended targeted systemic agents varies across the globe because of differences in both approval and reimbursement decisions. Patients in Australia should have funded or subsidised access to these highly effective, well-tolerated medications for moderate-to-severe AD. To highlight the importance of this, and to better understand potential barriers to such access in Australia, we conducted a narrative review of health technology assessment processes and the availability of funded/subsidised targeted systemic therapies for moderate-to-severe AD in patients aged ≥ 12 years in Australia and in countries with comparable healthcare systems, such as the United Kingdom, Canada, New Zealand and France. To provide context for this, we summarised current international guideline-recommended treatment for moderate-to-severe AD and considered healthcare resource utilisation in moderate-to-severe AD, both in Australia and internationally. In Australia, patients only have access to a limited selection of medicines launched globally. This suggests that national healthcare systems should consider updating health technology assessment procedures to better align with the current targeted high-cost therapeutics environment.

ABSTRACTBackgroundGlucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) have gained rapid popularity for both medical and consumer‐directed weight loss. This growth has been accompanied by increased public discussion regarding facial aesthetic changes, commonly referred to as “Ozempic face,” characterized by volume depletion and cutaneous laxity.ObjectiveTo quantify temporal patterns of public search interest in a widely known GLP‐1 RA and evaluate corresponding awareness of its cosmetic facial sequelae using infodemiologic methods.MethodsGoogle Trends data for “Ozempic” and related frequently co‐searched queries were analyzed from November 2021 to December 2024. Trends in relative search volume (RSV) were examined, with particular focus on terms associated with facial aesthetics, including “Ozempic face” and “plastic surgeons Ozempic face.”ResultsRSV for “Ozempic” showed a steady upward trajectory over the study period. Queries related to facial aesthetic consequences exhibited substantial proportional increases. Notably, “Ozempic face” demonstrated a 4600% rise in RSV, and searches for “plastic surgeons Ozempic face” similarly grew markedly.ConclusionsPublic interest in GLP‐1 RAs is strongly associated with rising awareness and concern about their facial aesthetic effects. These trends suggest that aesthetic practitioners should expect more patient inquiries regarding GLP‐1–related facial changes and should proactively integrate counseling and corrective treatment options into clinical practice.

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

The authors have nothing to report.

ABSTRACTOver 5000 patients are newly diagnosed with Alopecia areata (AA) in Australia each year. AA severity varies from a single small patch to complete loss of scalp hair, body hair including eyelashes and eyebrows. Approximately 40% of affected individuals experience only a single patch and achieve spontaneous, complete and durable remission within 6 months (acute AA). A further 27% develop additional patches but still attain complete remission within 12 months (chronic AA). Chronic persistent AA (CPAA) is defined by an episode duration of > 12 months and occurs in approximately 33% of patients. Without systemic treatment, 55% of individuals with CPAA will have persistent multifocal relapsing and remitting disease, 30% will progress to alopecia totalis (AT) and 15% will ultimately develop alopecia universalis (AU). The physical disfigurement, unpredictable course, social isolation and rejection contribute to the psychological distress attributable to AA. A wide range of topical, intralesional and systemic agents used to treat AA were evaluated in the 2018 Australian expert consensus statement. In 2020, the international Alopecia Areata Consensus of Experts (ACE) publication stated that if reimbursed, Janus Kinase inhibitors (JAKi's) would be an ideal systemic treatment for adults with AA. TGA approval of baricitinib in 2023 and ritlecitinib in 2024 for severe AA is the first step on the pathway for these systemic medications to be reimbursed on the Australian Government Pharmaceutical Benefits Scheme (PBS). Reimbursement would significantly transform the Australian therapeutic landscape for AA. The purpose of this 2025 Update on the Australian Expert Consensus Statement on the treatment of chronic, moderate to severe AA is to augment the 2018 treatment algorithm to include these TGA‐approved medications and to address indications for initiation, continuation and dose titration of systemic JAKi treatment, appropriate choice of agent, satisfactory outcome measures and to provide guidance on when to discontinue successful or unsuccessful treatment.

Deucravacitinib was significantly more effective than placebo in the 52-week, phase III POETYK PSO-1 and PSO-2 trials. This study further evaluated deucravacitinib efficacy compared with placebo in these trials based on Psoriasis Area and Severity Index (PASI) outcomes. Patients with moderate to severe plaque psoriasis received placebo or deucravacitinib 6 mg once daily. At week 16, patients crossed over from placebo to deucravacitinib. Patients treated with deucravacitinib had greater reductions from baseline in PASI within 1 week, with higher improvements observed compared with placebo at week 16. Patients who crossed over to deucravacitinib at week 16 achieved similar improvements at week 52 as patients treated continuously with deucravacitinib from day 1. Significantly higher proportions of patients treated with deucravacitinib achieved treat-to-target PASI thresholds (≤ 1, ≤ 2, ≤ 3, ≤ 4, ≤ 5), and significantly greater improvements were observed in each PASI component (body region: head, trunk, upper/lower extremities; plaque characteristics: erythema, induration, desquamation) compared with placebo at week 16.

Fragrance allergens are a major cause of allergic contact dermatitis (ACD) in patients with head and neck dermatitis [1], and can often be missed in an ingredient list as they may masquerade under a botanical name or are not specified [2]. We present a case of coumarin ACD caused by Melilotus officinalis (sweet clover) extract in a tinted moisturiser. A 31-year-old female with mild lifelong flexural atopic dermatitis developed facial dermatitis. This improved after using topical corticosteroid and tacrolimus ointments, switching to fragrance-free skin care products, and using mineral sunscreen. She suffered an acute major flare of severely itchy, erythematous, flaky facial dermatitis 3 days after applying full face makeup for a job interview. She continued wearing the same makeup. Systemic prednisolone and mycophenolate mofetil helped but were discontinued because of side effects. A trial of narrowband UVB phototherapy further flared her condition. Examination showed well demarcated facial lichenified erythematous plaques with no papules or pustules. There was significant post-inflammatory hyperpigmentation (Figure 1). Skin prick test was negative to pollens and house dust mite. IgE level was normal and ANA, ENA, dsDNA were negative. Patch testing was performed at our tertiary dermatology centre in Melbourne. Haptens were obtained from Chemotechnique Diagnostics (Vellinge, Sweden) and applied with Allergeaze patch test chambers (SmartPractice, Phoenix, Arizona, United States). The patient underwent testing with the Australian Baseline Series, as well as with cosmetics, fragrance, and sunscreen series. Additionally, 22 personal items were tested, and the patient underwent photo-patch testing with our sunscreen series. Results from patch testing are shown in Table 1. Photographs of the patient's skin reactions following the patch tests are not available. Benzophenone 3 (oxybenzone) 10.0% pet Benzophenone 3 10.0% pet with 5 J UVA Neg Neg Neg + Contained in her Blistex SPF30 lip balm which she had used previously Coumarin 5.0% pet Cinnamal 1.0% pet + ?+ + + Our patient was diagnosed with ACD to coumarin, which we believe to be present in the M. officinalis extract found in her tinted moisturiser. She also reacted to fragrance mix 2, which includes coumarin, and finally had photoallergy to benzophenone 3, contained in her lip balm used previously. Despite contacting the manufacturer, we were unable to obtain individual ingredients of the tinted moisturiser in a testable form for independent patch testing. After avoiding this moisturiser, she had no further flares of facial dermatitis and did not require ongoing systemic immunosuppression (Figure 2—after treatment). Coumarin (CAS number: 91-64-5) occurs naturally in fruits such as kiwi fruit and pineapple and is used in cosmetics as a fragrance [1]. It has been reported that 1.2%–6.8% of patients with fragrance contact allergy are allergic to coumarin [3]. In one study by Nardelli et al., 6% of patch tested patients reacted to fragrance mix II, which contains coumarin, and within the reactive population, 4.4% reacted to coumarin as an individual constituent [4]. Local lymph node assays have shown that the more impurities in coumarin, the higher the chance of skin sensitisation [3, 5]. In the European Union, coumarin is one of the 26 fragrances required to be listed in leave-on products at 10 ppm concentration and 100 ppm in rinse-off products [2, 6]. M. officinalis (sweet clover) extract is marketed as an astringent and soothing agent in cosmetics, and is also described as having oestrogen-like activity, inhibiting activities of elastase and lipase and promoting fibroblast production [7]. However, it is not widely recognised that M. officinalis extract contains coumarin as a plant secondary metabolite in mean concentrations of 0.3% but does not contain furocoumarins that may cause photosensitisation [8]. The reaction to coumarin (benzopyrone) and photoallergic reaction to benzophenone-3 (diaryl ketone) show no evidence of cross-sensitisation due to their significant structural difference. In-depth chemical analyses of plant extracts used in cosmetics are not always available, making it difficult for consumers to avoid low concentrations of coumarin or other potential allergens. In the United States, where Bare Minerals is based, products containing M. officinalis extract are featured as fragrance-free on the SkinSafe website [9]. In the Environmental Working Group (EWG) Skin Deep website, there is no overlap between the list of coumarin-containing products (3874) and that of M. officinalis products, with 23 cosmetic products listed as fragrance-free [10]. Therefore, there needs to be an awareness that some products labelled as ‘fragrance-free’ may contain plant extracts which could trigger ACD in fragrance-sensitive individuals [2]. Kay Lin Ng: writing – original draft, conceptualization, methodology. Mei-Mui Tam: conceptualization, methodology, writing – review and editing. Rosemary Nixon: writing – review and editing. The patient has given their full consent for their information to be supplied. The authors declare no conflicts of interest.