BACKGROUND: While treatment is a definitive therapeutic component in the management of inflammatory skin conditions, adjunctive skin care comprising of appropriate cleansing, moisturization, and photoprotection are just as important. Cleansing, treatment, moisturization, and photoprotection (CTMP) constitute the four major components of holistic skincare routine for dermatological conditions. However, inadequate patient understanding of the condition, limited resources for physicians, and insufficient time for patient education during busy dermatological consultations are the main obstacles to establishing a holistic skincare routine in the real world.
OBJECTIVE: This study aimed to identify key challenges in the implementation of a holistic skincare routine, and offer practical guidance to physicians to improve adoption in the management of acne, atopic dermatitis, rosacea, and sensitive skin syndrome.
METHODS: An expert panel comprising of nine dermatologists from Australia, China, Hong Kong, Taiwan, India, Philippines, Singapore, South Korea, and Thailand convened to develop consensus statements to stimulate real-world adoption of holistic skincare routine in acne, rosacea, atopic dermatitis, and sensitive skin syndrome using the Delphi approach.
RESULTS: Consensus was defined as ≥80% of panel rating statement as ≥8 or median rating of ≥8. The final statements were collated to develop consensus recommendations to encourage adoption of holistic skincare routine.
CONCLUSIONS: Promoting patient education on the skin condition, training support staff in patient counseling, and offering physician training opportunities are the key strategies to encourage real-world adoption of CTMP as a holistic skincare routine. The consensus recommendations presented here should be considered in all dermatology patients to accomplish the ultimate goals of improved treatment outcomes and patient satisfaction.

BACKGROUND: Atopic dermatitis (AD) typically starts in infancy and early childhood. The chronic skin disorder is associated with recurrent flares, pruritus, and genetic predisposition. Daily use of moisturizers that contain lipids, such as ceramides, reduces the rate of AD flares and the need for topical steroid treatment. We aimed to provide insights on AD attenuation to tailor AD prescription therapy, skin care, and maintenance treatment to improve pediatric patients with AD and families.
METHODS: A panel of 6 pediatric dermatologists and dermatologists who treat neonates, infants, and children developed a consensus paper on AD attenuation for pediatric patients. The modified Delphi process comprised a face-to-face panel meeting and online follow-up to discuss the systematic literature search results and draw from clinical experience and opinion of the panel to adopt and agree on 5 statements.  Results: Understanding the functional properties of newborn and infant skin, discussing skincare product use with parents, and recommending tailored prescription and skincare routines can improve newborn, infant, and children’s skin health. Studies on the prophylactic application of moisturizers initiated in early infancy suggest moisturizers may delay rather than prevent AD, especially in high-risk populations and when used continuously. Increasingly there is evidence that moisturizer application reduces the severity of AD and extends the time to flares, which may help attenuate the atopic march. The protective effect of skin care for AD has been observed in studies where its daily use is ongoing; these beneficial effects may be lost in less than 1year after cessation. It is therefore important to emphasize that skin care should be routinely used when counseling patients and caregivers.  Conclusion: Healthcare providers can improve patient outcomes in atopic-prone infants and children by providing instructions regarding the daily benefits of applying skin care with gentle cleansers and moisturizers. Using gentle cleansers and moisturizers containing barrier lipids from birth onward may delay AD occurrence and mitigate severity in predisposed infants.J Drugs Dermatol. 2024;23(3): doi:10.36849/JDD.7894.

BACKGROUND: Noninvasive energy-based device (NI-EBD) aesthetic procedures has recently gained widespread usage for treating various skin conditions, enhancing skin texture and performing rejuvenation-related procedures. However, practically all NI-EBD procedures result in variable degrees of damage to the skin barrier, inducing pathological and physiological processes such as oxidative stress and inflammation, and only a small percentage of individuals possess the innate ability to restore it.
OBJECTIVE: To introduce the concept of integrated skincare and establish standardized operational procedures for perioperative integrated skincare, and furnish a theoretical basis for clinical diagnosis and treatment performed by professional medical aestheticians.
METHODS: The author leveraged domestic and international guidelines, clinical practice expertise and evidence-based research, adapting them to suit the specific circumstances in China.
RESULTS: The consensus were provided four parts, including concept and essence of integrated skincare, integrated skincare significance during the perioperative phase of NI-EBD procedures, active ingredients and functions of effective skincare products, standardized perioperative skincare procedure for NI-EBD procedures and precautions. For the standardized perioperative skincare procedure, four recommendations were listed according to different stages during NI-EBD procedures.
CONCLUSIONS: These recommendations create the \'Expert Consensus on Perioperative Integrated Skincare for Noninvasive Energy-Based Device Aesthetic Procedures in Clinical Practice in China\'.

BACKGROUND: The objective was to provide international recommendations on anti-aging dermocosmetics for clinical practice starting with essential ingredients for protection and repair before working up to advanced products for specific concerns.  Methods: Seven international experts reviewed 8 hypothetical case scenarios covering different ages, skin issues (eg, sensitivity, acne, melasma), and exposure to exposome factors for both sexes and all Fitzpatrick skin types (FST). The RAND/UCLA appropriateness method was used to obtain consensus. Seventeen key ingredients were rated on a scale from 1 (totally inappropriate) to 9 (totally appropriate). Statistical analysis, 2 meetings, and email discussions refined the recommendations.
RESULTS: High-factor broad-spectrum sunscreen (ie, protects against ultraviolet [UV] A and B rays), niacinamide, and other topical antioxidants were recommended for all scenarios. Further discussions were required for other ingredients. Tinted sunscreen/iron oxide were recommended for all FST, although compliance may be sub-optimal for darker skin phototypes (IV-VI), if not cosmetically acceptable. Combining a facial foundation with broad-spectrum sunscreen was recommended for darker phototypes to obtain visible light protection closely matching diverse color tones. Retinols were not recommended as a first-line treatment for sensitive skin, especially FST V and VI, due to the risk of irritation. After ablative laser treatment, alpha hydroxy acids should be avoided or used with caution in FST IV to VI due to the risk of post-inflammatory hyperpigmentation.
CONCLUSIONS: We describe a simple, practical tool for use in daily dermatology consultations for providing recommendations on anti-aging dermocosmetics to cover diverse and inclusive populations of patients, addressing all skin types and international needs.  J Drugs Dermatol. 2024;23(1):1337-1343.     doi:10.36849/JDD.7798.

BACKGROUND: Inflammatory skin disorders compromise skin barrier health. Early and daily skincare use aims to maintain a life-long healthy skin barrier. Racial/ethnic and age variations in skin barrier properties, cultural differences, and clinical presentation of the inflammatory skin disorder influence the choice of treatment and skin care. Ceramide-containing skin care may play a role in restoring and maintaining a healthy skin barrier.
METHODS: A panel of 6 dermatologists met to develop consensus statements based on their 8 previous publications on promoting skin barrier health throughout life using ceramide-containing skin care. The publications covered skin barrier integrity in the newborn and infant, and the role of the skin barrier in mitigating atopic dermatitis (AD); racial/ethnic variations in the skin barrier and implications for skin care; the role of the skin barrier in inflammatory skin conditions including acne, AD and psoriasis in skin of color (SOC) populations; skin barrier integrity in patients with rosacea; and xerosis in patients with diabetes mellitus. The panel synthesized the 8 publications, selected information from a literature review, and their expert opinions and experiences to create the statements. The consensus was reached through a modified Delphi method where the panel met face-to-face and followed up virtually.
RESULTS: The panel adopted 6 consensus statements highlighting the importance of skin care in restoring/maintaining a healthy skin barrier in the populations mentioned above. Skin care suited to this role is gentle, has near-physiologic pH, is pleasant to use, and contains ceramides. This type of skin care can promote a healthy skin barrier and attenuate or delay inflammatory skin conditions.
CONCLUSIONS: Adjunctive daily skin care throughout life promotes a healthy skin barrier and is beneficial in managing various inflammatory skin disorders in all populations. However, when choosing optimal treatment and skin care, physicians should consider variations in age, skin properties, presentation of the condition, and cultural differences. J Drugs Dermatol. 2023;22:2(Suppl 1):s3-14.

BACKGROUND: Treatment, cleansing, moisturizing, and photoprotection are four major components of holistic skin care for dermatological conditions. While treatment (T) is recognized as a key component in the management of dermatological conditions, there is a lack of practical guidance on the adjunctive role of cleansing, moisturizing, and photoprotection (\"CMP\"). Limited patient knowledge, confusion over product selection, and lack of guidance on how to choose and use CMP skin care products (in conjunction with pharmacological therapy) are the main barriers to establishing a holistic skin care routine for dermatological conditions.
OBJECTIVE: This study aimed to review current clinical evidence, identify gaps, and provide practical guidance on conceptualization and implementation of CMP routine in the management of sensitive skin due to underlying acne, atopic dermatitis, or rosacea, including conditions with idiopathic causes referred to as idiopathic sensitive skin syndrome.
METHODS: An expert panel comprising of 10 dermatologists from Australia, China, Hong Kong, Taiwan, India, Indonesia, Philippines, Singapore, South Korea, and Thailand convened to develop consensus statements on holistic skin care in acne, rosacea, atopic dermatitis, and idiopathic sensitive skin syndrome using the Delphi approach.
RESULTS: Consensus was defined as ≥80% of panel rating statement as ≥8 or median rating of ≥8. The final statements were collated to develop consensus recommendations on holistic skin care.
CONCLUSIONS: A dermatologist-guided holistic skin care routine is essential to improve patient confidence and reduce confusion over product selection. The consensus recommendations presented here highlight the importance of cleansing, moisturization, and photoprotection in holistic skin care and how it can be utilized as a communication tool for physicians and patients to achieve overall better patient compliance, satisfaction, and treatment outcomes.

BACKGROUND: The European Pressure Ulcer Advisory Panel, the National Pressure Injury Advisory Panel and the Pan Pacific Pressure Injury Alliance developed international Clinical Practice Guidelines of the prevention and treatment of pressure ulcers/injuries in 2009, 2014, and 2019. Despite substantial dissemination efforts, evidence about guideline dissemination and uptake in the international literature is lacking.
OBJECTIVE: The aim of this review was to capture to the greatest detail possible the number of the citations of the three published Clinical Practice Guidelines.
METHODS: The citation databases Web of Science and Scopus were searched for citations of the 2009, 2014 and 2019 Clinical Practice Guidelines including all derivative products including short versions and translations. Two separate search strategies were iteratively developed to ensure highest sensitivity.
RESULTS: The Cited Reference Search in Web of Science identified hundreds of different referencing formats with more than 2000 citing articles. The Scopus search revealed 250 different reference formats and more than 2000 citation counts. After publication there was a gradual increase of citations that peaks approximately after four years.
CONCLUSIONS: The three Clinical Practice Guidelines including all derivate versions had a substantial uptake in the scientific literature. This supports the assumption that the guideline dissemination strategies were and are successful.

OBJECTIVE: To establish a consensus on terminology used to define stomal, parastomal, and peristomal complications in Australia.
METHODS: A list of stomal, parastomal, and peristomal complications was generated through group dialogue, which was informed by clinical and academic knowledge of the researchers. An extensive literature review was undertaken to identify any additional terms and to create a database of definitions/descriptions. A library of images related to the identified conditions was generated. An online Delphi process was conducted among a representative, purposive sample of Australia expert wound, ostomy, and continence nurses and colorectal surgeons. Ten terms were presented to the panel with descriptive photographs of each complication. Up to three Delphi rounds and, if necessary, a priority voting round were conducted.
RESULTS: Seven of the 10 terms reached agreement in the first round. One term ( allergic dermatitis ) was refined ( allergic contact dermatitis ) and reached agreement in the second round. Two terms ( mucocutaneous granuloma and mucosal granuloma ) were considered by the panel to be the same condition in different anatomical locations and were combined as one term ( granuloma ). Two terms ( skin stripping and tension blisters ) were combined as one term ( medical adhesive-related skin injury ) and reached agreement in round 2.
CONCLUSIONS: A consensus in terminology used to describe stomal or parastomal/peristomal complications will enhance communication among patients and health professionals and advance opportunities for education and benchmarking of stomal, parastomal, and peristomal complications nationally.

Significance: Lymphedema is a common, distressing and debilitating condition with various etiologies. Effective diagnosis, assessment, and management rely on evidence-based clinical practice guidelines (\"guidelines\"). This study aims to describe and compare international guidelines on lymphedema diagnosis, assessment, and management. Recent Advances: The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and registered on the International Prospective Register of Systematic Reviews (PROSPERO). Systematic searches of electronic literature databases and the web were completed in December 2020 for lymphedema guidelines published in English since 2000. Quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE)-II reporting checklist. Synthesis took a narrative approach to compare guideline recommendations and associated levels of evidence. Critical Issues: This systematic review of 1,564 articles and 159 web pages yielded 14 guidelines. All guidelines were from high-income countries. Ten focused exclusively on lymphedema, and four on cancer. Most (n = 13) guidelines recommended an integrated medical, psychological assessment, and physical examination, with a limb volume measurement of >10% in the affected limb compared, confirming a lymphedema diagnosis. Recommended management involved Complex Decongestive Therapy (CDT) followed by self-management using skincare, self-lymphatic drainage massage, exercise, and compression. Future Directions: The underlying etiology of lymphedema appeared to make little difference to guideline recommendations regarding care. High-quality guidelines are available to guide lymphedema care. However, their suitability for low-resource settings is unclear.

OBJECTIVE: Radiation dermatitis (RD) is a common side effect of radiation therapy (RT). While many different treatment strategies are currently used to address RD, there is a lack of consensus and RD prophylaxis and management guidelines have remained largely unchanged over the last 10 years. This review aims to formulate unambiguous supportive care interventions by comparing RD clinical practice guidelines published between 2010 and 2021 by several organizations: Multinational Association for Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BCCA), Cancer Care Manitoba (CCMB), Oncology Nursing Society (ONS), Society and College of Radiographers (SCoR), and International Society of Nurses in Cancer Care (ISNCC).
METHODS: Areas of agreement and discordance were assessed among the MASCC, BCCA, CCMB, ONS, SCoR, and ISNCC guidelines.
RESULTS: Treatment recommendations across guidelines for acute RD and chronic RT-induced skin toxicities have been summarized. The strongest agreement among the guidelines exists for the use of topical corticosteroids, silver sulfadiazine, washing, and deodorant. All guidelines recommend the use of topical corticosteroids, and washing with water and soap is consistently supported. There is minimal consensus on an optimal dressing or barrier film for RD prophylaxis or management. MASCC weakly recommends prophylactic use of silver sulfadiazine to reduce RD, while BCCA, CCMB, and SCoR recommend its use upon signs of infection. MASCC and CCMB recommend the use of a long-pulsed dye laser to manage telangiectasia, a late effect of RT.
CONCLUSIONS: Given the extent of discordance among guideline recommendations, further research is recommended to establish optimal treatments for RD prophylaxis and management.