Authors of a study published in the International Journal of Dermatology reviewed the efficacy and safety of saw palmetto extract (SPE), reported to inhibit 5-alpha reductase, as an over-the-counter alternative for androgenetic alopecia. Although the reduction in DHT is far more tempered with SPE compared to finasteride (32% vs. 70%), the authors noted, SPE can potentially improve hair density and quality, as well as improve urinary retention and sexual dysfunction associated with benign prostatic hyperplasia.
[Oral vs. topical finasteride: Sexual, neuropsychiatric AEs. Read more.]
The recommended daily dose of SPE ranged from 54 mg to 3600 mg, with 5.1% not describing any dosage information. Although nearly 90% reported some form of safety information, the type or quality of information varied widely between products.
[Are nutritional supplements aimed at skin care helpful, harmful, or placebo for patients? Read more.]
Studies have indicated that SPE is well tolerated, with the majority of side effects being minor and temporary. Prospective clinical trials evaluating SPE have not evaluated optimal dosage or sequelae of long-term use.
DermWorld Insights and Inquiries: Diagnosing the primary cutaneous SMARCA4 deficient cutaneous tumor — You don’t know what you got ‘til it’s gone
Understandably, dermatologists are often surprised to receive a histopathologic diagnosis of Merkel cell carcinoma, given the relatively nondescript clinical features that suggest a basal cell carcinoma or inflamed cyst. The purpose of this commentary is to introduce dermatologists to another tumor that will likely not be diagnosed clinically — the primary cutaneous SMARCA4-deficient cutaneous tumor (PCSDCT) that is in the family of SMARCA4-deficient undifferentiated malignant neoplasms (SD-UMN), which are highly aggressive cancers. The undifferentiated appearance yields a broad histologic differential diagnosis, including a poorly differentiated squamous cell carcinoma, melanoma, Merkel cell carcinoma, and others, thereby requiring a large panel of immunohistochemical stains. Keep reading!
Location of body itch and stress in patients with chronic pruritus
Authors of a Brief Report in JAAD investigated the correlation between chronic pruritus (CP) at different body locations and patient stress levels. They surveyed 103 adults with CP (100% response rate) to assess itch location and severity.
The cohort had an average CP duration of six years, with most patients experiencing two to four itch episodes daily. The mean visual analog scale itch, Dermatologic Quality of Life Index, and Perceived Stress Scale (PSS) scores were 5.6, 8.0, and 16.4, respectively. Significant differences in mean PSS scores were found between patients with and without scalp itch, indicating these locations are associated with increased stress. The researchers found significant associations for groin and thigh itch, suggesting these areas are predictive of higher PSS scores. Other locations did not show significant associations between itch and stress levels.
Experts explore the underlying mechanisms of the link between the brain and the skin. Read more.
Are hormonal intrauterine devices linked to melasma?
Authors of a Brief Report in JAAD explored the risk of melasma among patients using combined oral contraceptives (COCs), progestin-only oral contraceptives (POCs), and hormonal intrauterine devices (hIUDs).
[Androgenic skin conditions and hormonal IUDs. Read more.]
Over one year, no difference in melasma risk was detected for POCs and hIUDs, whereas significantly increased melasma risk was observed for COCs. At three and five years, both COCs were associated with significantly increased melasma risk, whereas no difference was observed for hIUDs. Their findings suggested that hIUDs may be a safer option for those at higher risk for chronic dyspigmentation. Melasma risk may correlate with systemic hormone exposure, with the highest risks seen in COCs, followed by POCs, while hIUDs, which release hormones locally at lower daily doses, have the lowest risk, the researchers’ data suggest.
Are herbal remedies effective for melasma? Read more.
Medicare finalizes slight payment increase for 2026
Dermatologists will see a slight payment increase for the first time in five years, according to the final 2026 Medicare Physician Fee Schedule (PFS) published on Oct. 31. While this is a step forward, other finalized policies may reduce physician payment in future years. Securing comprehensive Medicare payment reform with an annual, inflation-based update remains the Academy’s top advocacy priority. Read more.
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