Dermatology is a medical specialty that experiences high patient demand and long patient wait times. Dermatology clinics should look for ways to improve efficiency through the incorporation of principles from operations management. Addressing the layout and flow of a clinic can lead to operational efficiency. An ideal layout may lead to increased patient volume, satisfaction, and retention.

As it grows increasingly difficult to match into a dermatology residency program each year, there is a widening gap in research accomplishments between those who have and have not matched successfully. Applicants should be aware of the current trends in order to maximize their chances of matching. Such research inequality may subsequently lead to increases in the pressure to publish and the incidence of academic misrepresentation. Academic dermatology programs should be aware of these issues in order to help their students successfully match and exercise caution when reviewing the curricula vitae of applicants. We believe that student mentors in dermatology are in the best position to help applicants navigate these challenges until effective checkpoints can be built-in to the application system.

Matching into a dermatology residency program has become increasingly more challenging for medical students. As students continue to explore various methods to help them standout to programs, recent medical literature has continued to show evidence of the important role that visiting clerkships play. Visiting clerkships offer several benefits to both students and programs. In order to optimize visiting clerkships, the perspectives of both students and programs are each examined with recommendations provided to help maximize its benefits.

This commentary addresses the emerging market forhealth-related smartphone applications. Specific todermatology, there has been a significant increasenot only in applications that promote skin cancerawareness and education but also in those meantfor detection. With evidence showing that 365dermatology-related applications were available in2014--up from 230 in 2012--and that 1 in 5 patientsunder the age of 50 have used a smartphone tohelp diagnose a skin problem, there is clearly a largesubset of patients participating in this growing trend.Therefore, we are obligated to take a closer lookinto this phenomenon. Studies have shown thatapplications are inferior to in-person consultationswith one study showing that 3 out of 4 applicationsincorrectly classified 30% or more melanomas aslow-risk lesions. Although the FDA gained regulatoryoversight over mobile health applications in 2012and recently released their statement in 2015, theirreach only extends to cover a selected portion ofthese applications, leaving many unregulated asthey continue to be marketed toward our patients.Dermatologists should be updated on our currentsituation in order to properly counsel patients on therisks and benefits of these applications and whetherthey are acceptable for use.

This manuscript addresses the significantconsiderations concerning the development anduse of medical devices in dermatology. With therapidly growing demand and booming marketfor medical devices, especially lasers, it is crucialthat dermatologists become familiar with thenuances associated with supporting clinical studies,consumer-driven marketing strategies, and thecomplex relationships that exist between physicians,industry, and consumers. An examination of theserelationships includes an overview of the potentialbiases pertaining to advisory panels and treatingclinicians. The aim of this paper is to serve as anintroduction to the background of medical devicesand to offer dermatologists important informationon what should be considered before recommendingtreatment.

This commentary addresses the increasingly competitive nature of applying to dermatology residency programs and how both interest groups in medical schools and their dermatology departments can help to better prepare applicants. As previous literature argued that dermatology has been underemphasized in medical school curricula, we propose five fundamental options that interest groups can implement in order to offer increased exposure to our field in medical training. Furthermore, with therecent trend of many schools conferring certificates in various specialized concentrations, we also discuss interest groups pioneering certificate-grantingprograms in dermatology competency. The pros and cons of having a recognized certificate program in dermatology are presented.

The use of social media in medicine has been increasingly studied in recent years, especially concerning its role in patient outreach, education, diagnosis, and management. Dermatology is a unique field in that patients can post photographs of their skin ailments when seeking online medical advice and information. This study examines the role of public social media consultations for dermatologic conditions. A large portion of patients utilize social media for dermatologic consultations and many do not seek care from a dermatologist afterward. Future studies should trend this phenomenon, especially as the use of social media continues to expand.

Background

Key cellular players regulating human skin pigmentation include melanocytes in the epidermis that synthesize melanin, neighboring keratinocytes that receive and distribute melanin in the upper layers, and fibroblasts in the dermis that affect overlying melanocytes and keratinocytes. In addition, endocrine factors from the blood supply (endothelial cells) and inflammation-related factors play a role. Thus, new strategies for affecting pigmentation need to consider these multiple cell lines to adequately cover various causes and disease processes associated with hyperpigmentation.

Methods

Pathophysiologic mechanisms and cellular pathways involved in melanogenesis were thoroughly reviewed with particular emphasis on the cellular interplay involved in the process. A complex system of interlinking and independent pathways was defined and described demonstrating differing pathways for altered pigmentary disorders - melasma associated with endothelial cell interactions; post inflammatory hyperpigmentation associated with keratinocyte inflammatory mediators (PGE2 in particular); and photodamage involving all 4 cell types. In vitro validation studies were then undertaken to define differing cell group gene expression profiles with selected peptides and other active agents. Melanocytic production of pigment was then tested with these agents to identify key potential players capable of limiting pigmentation.

Results

Hexapeptide-12 and lactoferrin (melanocytes), Hexapeptide-11 (in keratinocytes), and phosphatidylserine (endothelial cells) were identified as major inhibitors of melanogenesis based on their gene expression profiles. This was confirmed by secondary melanin production tests performed on melanocytic lines. Additional active agents were also identified as inhibitors of melanocytic production of melanin, and together, these constituents formed the basis for a novel formulation for use in pigmentary disorders.

Conclusion

A comprehensive scientific narrative of the various facets relating to pigmentation has been presented including differing pathways affecting varied cell lines that effect pigment production. Based on this concept, actives were tested using gene expression studies as well as in vitro melanogenic model testing in different cell lines. Using this novel multi-faceted approach, we have selected and validated a series of active agents to be used in a formulation targeting the complex problem of hyperpigmentation. J Drugs Dermatol. 2022;21(11):1206-1220. doi:10.36849/JDD.7013.