Faculty Bibliography

BACKGROUND:The value of additional photoprotection provided by use of high SPF sunscreens is controversial and limited clinical evidence exists. OBJECTIVE:To compare the sunburn protection provided by SPF100+ and SPF50+ sunscreen in conditions of actual use. METHODS:199 healthy men and women (≥18 years) participated in a natural sunlight, single exposure, split face, randomized, double blind study in Vail, Colorado. Each participant wore both sunscreens simultaneously during activities with no usage restrictions other than treatment area designation. Erythema was clinically assessed the day following exposure. Comparative efficacy was evaluated through bilateral comparison of sunburn between treatment areas and erythema score as evaluated separately for each treatment area. RESULTS:Following an average 6.1 ± 1.3 hours of sun exposure, investigator blinded evaluation identified 55.3% (110/199) of the participants as more sunburned on the SPF50+ and 5% (10/199) on the SPF100+ protected side. Post exposure, 40.7% (81/199) of the participants exhibited increased erythema scores ≥ 1 on the SPF50+ protected side as compared to 13.6% (27/199) on the SPF100+. LIMITATIONS/CONCLUSIONS:Single day exposure may not extrapolate to benefits of longer-term protection. CONCLUSION/CONCLUSIONS:SPF100+ sunscreen was significantly more effective in protecting against sunburn than SPF50+ sunscreen in actual-use conditions. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov(NCT02952235).

Leadership in dermatology develops through both established and novel pathways. As requested by the Editor of this edition of the Dermatologic Clinics, using the career of Darrell S. Rigel, MD, MS, as a framework, this article explores how mentorship, early service, clinical expertise, communication, volunteer leadership, educational platform-building, and succession shape physician leadership. The trodden path represents the established structures of mentorship, training, professional societies, and service. The untrodden path begins when a physician recognizes an unmet need and builds something useful in response.

BACKGROUND/UNASSIGNED:Athletes are at risk of developing dermatologic conditions, particularly traumatic and inflammatory dermatoses, owing to the physical and environmental stresses associated with sports participation. As sports participation continues to increase worldwide, recognition of these conditions has become increasingly important for dermatologists and sports medicine professionals. OBJECTIVE/UNASSIGNED:To review the epidemiology, clinical presentations, prevention strategies, and treatment approaches for common traumatic and inflammatory dermatoses encountered in athletes. METHODS/UNASSIGNED:A comprehensive literature search was completed using a combination of keywords: "sports," "traumatic," "inflammatory," "skin," and "dermatoses." The authors reviewed all studies and included those that addressed the topic of the review. RESULTS/UNASSIGNED:Traumatic dermatoses represented the most frequently reported conditions. Inflammatory dermatoses primarily included contact dermatitis and lichen simplex chronicus. Many conditions demonstrate sport-specific patterns related to repetitive friction, pressure, direct trauma, moisture, or exposure to athletic equipment. Preventive measures include proper equipment fit, reduction of friction and moisture, and use of protective barriers, while treatment strategies ranged from wound care and topical therapies to procedural interventions. CONCLUSION/UNASSIGNED:Sports participation is associated with a broad spectrum of traumatic and inflammatory skin disorders that may affect athlete comfort, performance, and participation.

BACKGROUND/UNASSIGNED:Inflammatory skin diseases, including psoriasis and atopic dermatitis, require long-term management strategies that balance efficacy with safety. The 2025 American Academy of Dermatology guidelines encourage the judicious application of topical corticosteroids when their use is deemed necessary and for short durations of therapy. Recent availability of newer nonsteroidal topical therapies that are effective and safe, including for prolonged durations and on sensitive skin sites, has prompted a need for evidence-based guidance for clinicians in real-world practice. Tapinarof, a first-in-class, nonsteroidal aryl hydrocarbon receptor (AhR) agonist, was approved by the US Food and Drug Administration for the treatment of plaque psoriasis in adults and atopic dermatitis in patients aged 2 years and older in 2022 and 2025, respectively; however, its optimal place in therapy remains to be established. OBJECTIVE/UNASSIGNED:To develop expert consensus statements on the role of AhR agonists in the management of inflammatory skin diseases. METHODS/UNASSIGNED:A literature search produced 31 articles meeting inclusion criteria that were independently reviewed by an 11-member expert panel that convened on January 19, 2026. A modified Delphi process was used to develop 9 consensus statements. CONSENSUS RECOMMENDATIONS/ KEY FINDINGS/UNASSIGNED:AhR agonists represent a distinct therapeutic class with a unique multimodal mechanism involving immune modulation across Th1/Th2/Th17/Th22 pathways, skin barrier normalization, and antioxidant activity; tapinarof demonstrates a favorable safety profile with no restrictions on anatomic site, body surface area, or duration of use; tapinarof may be used concomitantly with systemic therapies; tapinarof is appropriate as both initial and long-term therapy for psoriasis in adults and atopic dermatitis in patients aged 2 years and older; and nonsteroidal topical therapies are preferred for chronic inflammatory skin diseases, particularly on the face and intertriginous areas. CONCLUSION/UNASSIGNED:AhR agonist therapy offers a clinically meaningful, advanced nonsteroidal option that addresses key limitations of traditional topical therapies in inflammatory skin disease management.

BACKGROUND:Cutaneous squamous cell carcinoma (cSCC) represents a significant clinical challenge in patients with locally advanced (laCSCC) or metastatic (mCSCC) disease who are not candidates for surgery or radiation. In addition to PD-1 inhibitors, pembrolizumab and cemiplimab, cosibelimab, a PD-L1 inhibitor, has been recently approved by the US Food and Drug Administration (FDA) for laCSCC and mCSCC. Given its recent approval, practical guidance is needed to support clinician decision-making regarding cosibelimab's efficacy and safety. METHODS:A comprehensive literature review of PubMed and Google Scholar was completed for studies related to cosibelimab efficacy and safety in la and mCSCC. An expert panel of nine dermatologists with significant expertise in the treatment of cSCC gathered to review the articles and create consensus statements on the role of cosibelimab in managing laCSCC and mCSCC. A modified Delphi process was used to approve each statement, and the strength of recommendation was assigned using the Strength of Recommendation Taxonomy (SORT) criteria. RESULTS:The literature search produced over 200 articles that met the criteria, and a screening of the studies for relevance resulted in 13 articles. The panel developed six consensus statements, with five unanimously adopted with a strength of "A". CONCLUSION/CONCLUSIONS:Available data suggests that cosibelimab is an effective treatment for patients with laCSCC and mCSCC who are not candidates for surgery or radiation. Cosibelimab demonstrates a unique and favorable safety profile with no reported grade 4 or 5 immune-related adverse events after more than 2 years of follow-up.

INTRODUCTION/BACKGROUND:Sonidegib and vismodegib are Hedgehog pathway inhibitors (HHIs) approved for the treatment of locally advanced basal cell carcinoma (laBCC), as well as metastatic basal cell carcinoma (mBCC) for vismodegib. Few studies have compared real-world treatment patterns associated with HHI treatment. The objective of this study was to investigate the real-world treatment patterns and conditions of patients receiving HHIs for BCC. METHODS:In this longitudinal study, claims from the Komodo Health Claims Database (between 2016 and 2023) were used to identify patients. Baseline characteristics and comorbidities of patients were assessed. Time to treatment discontinuation (TTD), odds of discontinuation, and clinical conditions experienced during treatment were analyzed. RESULTS:Patients who received sonidegib remained on treatment longer than those on vismodegib (log-rank test; P = 0.041) and were 23% less likely (P = 0.036) and 32% less likely (P = 0.013) to discontinue treatment at 6 and 9 months, respectively. Sonidegib-treated patients were less likely to experience gastrointestinal-related conditions (33% less likely; P = 0.045), taste- and smell-related conditions (71% less likely; P = 0.048), and muscle spasms (52% less likely; P = 0.009) during treatment compared with patients who received vismodegib. CONCLUSION/CONCLUSIONS:In the real-world setting, sonidegib-treated patients remained on treatment longer than vismodegib-treated patients and were less likely to experience pharmacologically relevant clinical conditions.