Faisal R Ali

• BA MA Cantab, BM BCh Oxon MRCP MRCS MRCP(Dermatology) FRCP PhD Cantab
• University of Central Lancashire

Topical medicaments are the mainstay of the dermatologists' therapeutic arsenal. Laser-assisted drug delivery enhances the ability of topically applied medicaments to penetrate the skin. We discuss the mechanisms of laser-assisted drug delivery and animal models that have informed clinical practice. We review clinical studies that have employed las...

Nicotinamide (niacinamide) is the water-soluble, amide form of vitamin B3. We review the evidence underlying the use of nicotinamide for various dermatological indications, including nonmelanoma cancer prophylaxis, blistering disorders, acne vulgaris and cosmetic indications, and speculate upon its future role in dermatological practice.

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Disorders of facial hyperpigmentation including melasma, postinflammatory hyperpigmentation and solar lentigines are common cutaneous conditions which can have a huge impact on patients' quality of life and often prove difficult to treat. The nascent market of cosmeceutical options provides a potentially safer and efficacious alternative for treati...

Background: 5-fluorouracil (5-FU) is widely used for treatment of malignant and premalignant skin cancers; however, its use in other common cutaneous conditions has been less widely reported. Objective: We investigated the off-label uses of 5-FU beyond malignant and premalignant skin disease. Methods: We conducted a literature review searching mu...

Basal cell carcinomas (BCCs) are the most common type of cancer diagnosed in the world, predominantly affecting the head and neck region. However, metastatic BCCs (mBCC) are exceptionally rare, with an estimated prevalence between 0.0028%-0.55%. We present a case of a young patient that demonstrates the highly aggressive nature of morphoeic BCC and...

Metastatic basal cell carcinomas (mBCCs) are exceedingly rare, with an estimated variable prevalence rate between 0.003 and 0.55% among all basal cell carcinomas. Although there are hundreds of reported cases of mBCCs, a dearth of evidence exists of mBCCs in patients with Gorlin syndrome—an autosomal dominant genetic disorder. The purpose of this a...

Acne remains one of the most common inflammatory dermatoses seen worldwide. There are significant challenges when managing acne relating to a variety of factors, including (1) lack of consensus on the use of the numerous available grading systems and outcome measures, (2) appreciation of the numerous areas that relate to severity, (3) the chronic n...

During consultations, patients can be overwhelmed with new diagnoses, complex treatment plans, particularly when bad news is broken (such as a new skin cancer diagnosis). Patients may be unable to recall nuanced medical information, particularly if elderly, attending on their own, with lower literacy, with impaired sensory abilities and where Engli...

Context: Topical sirolimus is increasingly utilised off-license to manage various dermatological conditions whilst avoiding typical adverse effects associated with systemic sirolimus. However, widespread use is limited by a highly heterogeneous evidence base of mixed quality. Objective: to evaluate the current evidence base for the indications, ef...

Whilst isotretinoin is an effective treatment for severe acne vulgaris, isotretinoin induced cheilitis is one of the most troubling side effects of the treatment. In their excellent review, which briefly covers the treatments for isotretinoin induced cheilitis, Narayaran et al have overlooked the utility of Omega-3 Fatty Acids (O3FA). O3FA, a clust...

Melanoma incidence is increasing. We ascertained perceptions regarding sunscreen and factors influencing choice in patients with melanoma. A survey was distributed to all the supporters of a melanoma patient support group. 571 responses were received across six weeks. Most (79.2%; n=452) indicated they knew how much sunscreen to apply; the most pop...

Whilst the advent of fourth-generation retinoids such a trifarotene marks a advancement in acne therapy and applications are still being elucidated, clinicians should not dismiss the importance of simple, non-pharmacological measures such as regular skin cleansing and the use of moisturisers, reaffirming their crucial place in the holistic manageme...

The recent review on lentigo maligna succinctly outlines treatment options for patients with lentigo maligna. Our own retrospective real-world data regarding patient preferences and treatment outcomes may be instructive for dermatologists treating patients with lentigo maligna.

We would encourage dermatologists to specifically ask patients about restrictive diets (e.g. veganism) and vaping, amongst other lifestyle factors, when counselling patients regarding outcomes following skin surgery.

Introduction & Objectives: Post-surgical skin healing is a dynamic process involving several stages of progression: hemostasis, inflammation, cell proliferation, epithelialisation, and tissue remodelling—various genetic and modifiable factors, including nutrition, control skin wound healing. However, the impact of veganism on post-surgical wound...

Introduction & Objectives: Healthcare facilities in the United States produce more than four billion tons of waste annually, with approximately 70% of that total attributed to operating rooms, labour and delivery suites. There has been increased focus on dermatology departments to reduce waste. We propose three previously unreported practical met...

Introduction & Objectives: Sleep is defined as a temporary suspension of awareness with decreased sensitivity to external stimuli and is regulated by the circadian rhythm. Sleep is vital in calibrating skin physiology, and various hormones and pro-inflammatory cytokines exhibit circadian rhythmicity. This review explores the complex bi-directiona...

Long-term exposure to air pollution is responsible for increased mortality and morbidity from respiratory and cardiovascular disease.¹ However, there is limited research on the impact of air pollution on skin disease. Grether-Beck et al. investigated air pollution’s impact on skin pigmentation, exposing skin tissue to diesel exhaust particles (DEPs...

Sleep is an under evaluated symptom when assessing patients with cutaneous disease. Consequently, the relationship between sleep deprivation and disease burden is often not considered. The focus of our review article is to explore the bi-directional relationship between sleep and cutaneous disease investigating the disruption in circadian rhythmici...

Dear Editor, Diagnostic biopsies are frequently undertaken in dermatology, including prior to Mohs micrographic surgery (MMS). The retrospective study of Araneda and colleagues¹ in Clinical and Experimental Dermatology (CDE) that seems to show no difference in the number of stages of MMS whether a punch or shave biopsy has been undertaken for inves...

https://doi.org/10.1093/ced/llad159 Dear Editor, There are intermittent shortages of local anaesthetics in many countries across the world. Dermatological surgeons are often forced to rely on dental cartridges of anaesthetic solution. In clinics where on-site sterilization of reusable equipment is not possible, disposable metal and plastic dental s...

Postsurgical skin healing is a dynamic process involving several stages of progression: haemostasis, inflammation, cell proliferation, epithelialization and tissue remodelling. Skin wound healing is controlled by a variety of genetic and modifiable factors, including nutrition. However, the impact of veganism on postsurgical wound healing remained...

Metformin is an established staple drug in the management of Type 2 diabetes mellitus. In this systematic review, we sought to establish the clinical utility of metformin in a range of dermatological conditions. The pathophysiology of acne vulgaris and polycystic ovarian syndrome (PCOS) is well suited to the pharmacological profile of metformin, an...

https://doi.org/10.1093/ced/llac036 Linked Article: Charalambides et al. Clin Exp Dermatol 2022; 47:1781–93. Dear Editor, The anticipated pain of any surgical procedure and the injection of local anaesthetic is often one of the foremost concerns of patients prior to dermatological surgery. We therefore welcome and read with great interest the recen...

Zinc has numerous pharmacological uses in dermatology. Its antioxidant and immunomodulatory properties are thought to correlate with its efficacy in acne vulgaris and leishmaniasis, amongst other cutaneous conditions. We conducted a review of the literature on the use of zinc in dermatology; in particular, we investigated its role in acne vulgaris,...

Dear Editor, Mohs micrographic surgery (MMS) is the gold standard treatment for high‐risk basal cell carcinomas (BCCs). Tumour debulking prior to the Mohs layer optimizes relaxation of the tissue, acts as a positive control and aids identification of high‐risk histological features.¹,² A previous study found that 25·3% (n = 99) of preoperatively bi...

Ultrasound has long been a diagnostic staple throughout medicine, with extensive use in orthopaedics and obstetrics. In this review, we find there are a range of versatile uses for diagnostic ultrasound in dermatology, with particular clinical relevance in the imaging of skin tumours. Our review outlines that diagnostic ultrasound can play an impor...

ABSTRACT: Objective. Rosacea is a common inflammatory cutaneous condition with a complex yet unknown etiopathogenesis. Diet and certain food items are known to trigger or worsen rosacea symptoms, but conflicting and often inconsistent advice is given to patients regarding this link. We provide an up-to-date literature review on the relationship bet...

Timolol, a non-selective β-adrenergic receptor blocker, is well-tolerated and is becoming increasingly popular in dermatology especially after its use in the management of infantile hemangiomas. Its effects are mainly due to vasoconstriction, inhibition of angiogenesis and keratinocyte migration promotion for re-epithelialization and wound healing....

Conflict of interest: the authors declare that they have no conflicts of interest. Linked articles: Brady M. Clin Exp Dermatol 2021; doi: 10.1111/ced.14875. Searle T et al. Clin Exp Dermatol 2020; 45: 841–7. Dear Editor, We thank Dr Brady for his response¹ to our article on surgical plume in dermatology,² and note his interest in investigating the...

Conflict of interest: the authors declare that they have no conflicts of interest. Linked article: Spring LK et al. JAMA Dermatol 2017; 153: 802–9. Isotretinoin is the most effective treatment in severe, refractory acne vulgaris.¹ Historically, dermatological procedures have been avoided for 6–12 months following isotretinoin, owing to concerns sur...

We read with interest the article by Dr Naik which reviews novel targets and therapies for keloids (1). Dr Naik discussed the use of botulinum toxin A, intralesional verapamil and the potential use of novel miRNA modulation.We believe that the author might have overlooked the use of 5‐fluorouracil (5‐FU) and the use of laser assisted drug delivery...

The impact of the COVID‐19 pandemic upon melanoma care remains as yet poorly understood. We undertook a UK‐wide national survey, in conjunction with a patient support group (Melanoma UK), to explore patient perceptions of the impact of the pandemic upon treatment and outpatient care of their melanoma. Our findings suggest that following the onset o...

Recent articles in this journal have focussed on qualitative clinician descriptions of alterations in service provision and patient perception of changes during the COVID‐19 pandemic, but few explore whether these changes have impacted patient outcomes. Each patient being considered for Mohs Micrographic Surgery (MMS) has a preoperative consultatio...

Systemic photoprotection aims to negate the negative effects of ultraviolet radiation‐induced DNA damage. Systemic supplements might be used as a monotherapy or in combination with topical sunscreens. Using the keywords ‘carotenoids,’ ‘flavonoids,’ ‘systemic photoprotection,’ ‘polyphenols’ and ‘polypodium leucotomos extract,” we searched the databa...

Background and aims: Perioral dermatitis is a common cutaneous condition characterized by acneiform facial eruptions often with an eczematous appearance. A granulomatous subtype exists in addition to the classic variant. While topical corticosteroids have been largely implicated in this condition, its etiology is not completely understood. Method...

Rosacea is a common cutaneous condition affecting predominantly the face. It is historically characterised into four subtypes: erythematotelangiectatic, papulopustular, phymatous and ocular rosacea. This article describes the pathophysiology, clinical features and current treatment options for rosacea, and discusses updated diagnostic criteria. Gen...

Firstly, the use of saline as local anesthetic (LA) can be particularly helpful if urgent biopsies are needed, in patients who have suspected LA allergy or for whom LA is less desirable, for example in pregnant women. The use of saline has also been found to cause less pain than lidocaine anaesthetic which is relevant for paediatric or anxious pati...

We thank Jaulim and Yoo for their response¹ to our article² and for hypothesising the possible effect of ‘screen light’ on melasma and pigmentation. The COVID‐19 pandemic has led to the enforcement of working from home. This in turn has led to increasing screen time with all its associated consequences on the skin and appearance, including screen r...

Background Sixty years ago, Ross discussed the treatment of acne vulgaris with oral dapsone and was fundamental in demonstrating the importance of this medication in dermatology. Following this, topical formulations have been used for the treatment of acne vulgaris which has not responded to traditional therapies. We explore the impact that the dis...

Laser-assisted drug delivery augments the distribution and penetration of topically applied treatments, leading to enhanced delivery and bioavailability. We discuss the therapeutic application of laser-assisted drug delivery in clinical practice in cases of non-melanoma skin cancer, vitiligo, melasma, scarring, and alopecia (female pattern hair los...

Vitiligo is an autoimmune skin condition characterized by depigmented macules and patches, and has a huge psychosocial impact on patients. Treatment of vitiligo aims to prevent the spread of disease and facilitate repigmentation of affected lesions. The mainstay of treatment for unstable vitiligo has been topical agents (corticosteroids, calcineuri...

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We read with interest the case report of a patient with solar urticaria exacerbated by visible light (VL) published by Wright and colleagues. Dermatologists often highlight the importance of the use of sunblock with sun protection factor against ultraviolet A and B rays, yet many sunblocks fail to protect against VL. There is enough evidence at pre...

Hydroquinone has pharmacological uses in disorders of pigmentation because of its ability to competitively inhibit the enzyme tyrosinase. Our contemporary review presents the strongest evidence supporting the use of hydroquinone with the most effective and tolerable formulations combining hydroquinone, retinoid and corticosteroid (modified Kligman...

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Intralesional methotrexate (IL-MTX) is a long-established treatment, which is arguablyunderutilized by dermatologists. We describe the underlying evidence base and practical considerations for its broad range of cutaneous indications,including in cutaneous oncology (keratoacanthomas, squamous cell carcinomas, lymphomas), inflammatory dermatology (n...

We thank the authors for their commentary on our article Rosacea and the Cardiovascular System.1 The authors discuss the risk of “excessive health examination”. Whilst we do not advocate over investigation or over treatment of any patient, the association between cardiovascular disease and rosacea is evident2,3 and any dermatologist or clinician tr...

Hyaluronidase is mostly widely recognized for its off-label use in correction of complications of hyaluronic acid fillers. However, its utility in other aspects of dermatology is less widely acknowledged. We describe the varied uses of hyaluronidase in dermatology and the underlying evidence base for its dermatological indications. This includes it...

Hyaluronidase is mostly widely recognized for its off-label use in correction of complications of hyaluronic acid fillers. However, its utility in other aspects of dermatology is less widely acknowledged. We describe the varied uses of hyaluronidase in dermatology and the underlying evidence base for its dermatological indications. This includes it...

Spironolactone is a synthetic aldosterone receptor antagonist, with a role off‐label in various dermatological conditions. Its antiandrogenic properties make it suitable for diseases in which excess androgen production results in unwanted and psychologically distressing manifestations in susceptible females. Treatment with spironolactone aims to at...

Background The pathophysiology of keloid scars is still not fully understood and a universally reliable effective treatment has not been identified. Pharmacogenetics explores how drug response to a particular therapy can relate to genetic variations. Purpose To investigate how pharmacogenetics could be applied to keloid scars and the relevance of...

Rosacea is a common skin condition characterised by erythema, papules and pustules. Increasing evidence suggests that the gut–skin axis is implicated in the pathogenesis of rosacea. Sufficient evidence exists to support the notion that the gut microbiome plays a role in the inflammatory cutaneous response and there appear to be associations with sm...

Dermatologists performing surgical procedures face occupational and health hazards when exposed to surgical plume released during electrosurgical and ablative laser procedures. These hazardous fumes have toxic, infectious and carcinogenic effects. Understanding this risk is of particular importance during the COVID‐19 pandemic as the understanding...

Understanding patient experiences of healthcare systems during the pandemic is important to help strategize for future similar events. We operated a reduced Mohs micrographic surgery (MMS) service during the pandemic through rationalising patients by tumour type, age, co‐morbidities and patient choice. We sought to establish patient expectations an...

Azelaic acid has numerous pharmacological uses in dermatology. Its anti-inflammatory and anti-oxidant properties are thought to correlate with its efficacy in papulopustular rosacea and acne vulgaris, amongst other cutaneous conditions. We conducted a review of the literature on the use of azelaic acid in dermatology using key terms “acne,” “azelai...

Rosacea and the cardiometabolic syndrome are both associated with chronic inflammation and a pro‐inflammatory phenotype. Emerging clinical evidence supports the relationship between rosacea and cardiometabolic syndrome hypertension and obesity. This article reviews our current findings and understanding in the skin and cardiovascular relationship i...

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In the United Kingdom, Google is often the search engine used to explore information relating to many aspects of people’s lives, including dermatological advice and information. The frequency of searching for particular terms could indicate the relative importance that the public assigns to various conditions and is dynamic, fluctuating in differen...

Coronavirus Disease 2019 (COVID‐19) pandemic has overwhelmed and disrupted healthcare systems including dermatology services. National directives were issued to reduce patient footfall within hospitals in anticipation of a deluge of COVID‐19 admissions. We conducted a survey focusing on the impact of the pandemic upon Mohs micrographic surgery (MMS...

We read with interest the article by Ma et al. highlighting the challenges UK dermatologists face in the diagnosis and management of hyperpigmentary disorders. ¹ Lack of confidence was cited alongside gaps in the training on pigmentary disorders. We note their survey was conducted in 2018 and had a 4% response rate (74 self‐selecting respondents ou...

COVID19 has forced a sea change in the practice of dermatology across the world in 2020. Some changes enforced upon us will be long standing after the horrific pandemic and current deployment of many dermatologists to internal medicine. Whilst attention is currently focussed upon managing the pandemic and its immediate impact of COVID19 upon dermat...

We read with interest the short paper describing, and commend the authors on sharing their experience the continued use of phototherapy in COVID‐19 affected Italy. Phototherapy is undoubtedly a long‐established, relatively safe means of reducing the burden of inflammatory skin disease avoiding large doses of immunosuppression. Home phototherapy dev...

We commend Deepak and colleagues in highlighting the virtues of instant messaging tools such as WhatsApp during the COVID‐19 crisis1. Whilst WhatsApp's advantages include being highly intuitive, widely used and accessible, there are concerns among clinicians about its use, as well as that of other commercially available communications apps. These i...

COVID‐19 presents many pressing challenges to the global dermatological community and our patients with ongoing skin needs, which must be considered by every dermatology provider. Many of these are logistical and administrative, distinct from physical manifestations, and could be summarized by the acronym COVID (Consultations, Operations, Videoconf...

Tranexamic acid (TA) is an antifibrinolytic agent, increasingly recognized as being of utility for a wide variety of skin diseases. We review the evidence supporting the use of TA for a range of dermatological indications, including (among others) melasma, postinflammatory hyperpigmentation, urticaria, angio‐oedema and haemostasis, in addition to p...

Whilst the use of isotretinoin has revolutionized the treatment of acne vulgaris, isotretinoin is increasingly recognized as a useful therapeutic option for many other cutaneous conditions. We review the evidence underlying the use of isotretinoin for a variety of dermatological indications including hidradenitis suppurativa, sebaceous gland pathol...

For squamous cell carcinoma (SCC) treated using Mohs micrographic surgery (MMS), interpretation of haematoxylin and eosin-stained frozen sections can be challenging. In these situations, ancillary use of immunostaining is a useful tool for the Mohs surgeon. However, use of immunostaining in MMS laboratories is limited, mainly because current manual...

Keloid scars are common and have a predilection for young, ethnic skin often with a family history. Keloids can be painful and pruritic and cause significant emotional distress when particularly visible or prominent. In this article, we review the evidence underlying the use of laser- and energy-based devices for treatment of keloid scars, either a...

Molluscum contagiosum (MC) is an infectious dermatosis that commonly presents in children and immunocompromised individuals. Although lesions usually resolve spontaneously after several months, they can be symptomatic and cause psychosocial distress. We review the evidence underlying treatment methods available for MC lesions, including potassium h...

Intravenous immunoglobulin (IVIg) is a solution of human IgG, salt, sugars and solvents, which is used to treat a multitude of diseases. Although IVIg has been known to treat many diseases safely and successfully, there are relatively few supporting randomized controlled trials. In this article, we review the biological mechanisms of IVIg in dermat...

Intravenous immunoglobulin (IVIg) is a solution of human IgG, salt, sugars and solvents used to treat a multitude of diseases. Although IVIg has been known to treat many diseases safely and successfully, there are relatively few supporting randomized controlled trials. In part two of this review, we assess the clinical indications of IVIg in dermat...

Acne scars are present in 95% of patients with acne, and can cause profound psychosocial morbidity. Fillers are commonly used for facial soft tissue augmentation, and there is increasing interest in their use for the treatment of acne scars, particularly for the atrophic subtype. We review the evidence for the use of temporary, semi-permanent and p...

As staples of the histopathology laboratory, hematoxylin and eosin have become the inimitable scaffold on which many of our dermatological diagnoses are made.