Over the past century, advances in scientific understanding and therapeutic development have fundamentally reshaped dermatology. Diseases once managed with empiric, toxic, or largely ineffective treatments can now be approached with therapies that target specific pathways, achieve sustained disease control, and, in some cases, alter prognosis. Herein, we reviewed landmark therapeutic advances across infectious, inflammatory, autoimmune, vascular, and oncologic dermatology, focusing on interventions that changed the standard of care or substantially improved patient outcomes. Transformative advances include penicillin for syphilis, isotretinoin for severe acne, biologics for psoriasis, corticosteroids and rituximab for pemphigus vulgaris, targeted biologic and Janus kinase inhibitors for inflammatory and autoimmune diseases, beta-blockers for infantile hemangiomas, immunotherapy and targeted therapy for cutaneous malignancies, and Hedgehog pathway inhibitors for advanced basal cell carcinoma. Collectively, these breakthroughs expanded what treatment could achieve, from curing previously chronic infection and controlling severe inflammatory disease to restoring hair or pigmentation and prolonging survival in advanced malignancy. Progress arose through both sustained research into disease biology and unexpected clinical observations that opened new therapeutic possibilities. These landmark therapeutic breakthroughs trace dermatology's evolution from empiric treatment toward increasingly precise, mechanism-based care. This history illustrates how scientific discovery and clinical observation can redefine the management and prognosis of dermatologic disease.

Women now comprise the majority of dermatology residents, and residency training coincides with a childbearing timeline that residents do not control. Federal legal and national accreditation frameworks establish meaningful minimum standards for lactation accommodations. Yet compliance with these standards does not guarantee that accommodations function in practice. The central ethical failure is not scheduling conflicts that inevitably arise and interfere with the usage of such accommodations, but the absence of a functional process through which a resident can flag that an accommodation is not working under real clinical conditions. Closing this gap between policy and practice requires shared responsibility: residents communicating needs proactively, and programs providing confidential, non-evaluative structures for residents to voice their needs. When responsibility is shared rather than individually absorbed, dermatology residency programs honor the ethical principles of autonomy, beneficence, non-maleficence, and justice.

Obesity is increasingly recognized as a systemic determinant of dermatologic disease rather than merely a comorbidity accompanying skin disorders. Excess adiposity promotes insulin resistance, adipose-tissue dysfunction, chronic low-grade inflammation, altered immune responses, vascular abnormalities, mechanical stress, and impaired tissue repair, thereby influencing the development and severity of inflammatory and metabolic dermatoses. Psoriasis, hidradenitis suppurativa (HS), psoriatic arthritis (PsA), acanthosis nigricans, intertriginous disease, and impaired wound healing exemplify conditions in which metabolic and cutaneous pathways are closely interconnected. This relationship provides the biological basis for the concept of a metabolic-dermatologic axis, in which adipose tissue, systemic metabolism, immune activation, and cutaneous inflammation interact bidirectionally.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are among the most widely prescribed medications in the United States, with expanding indications beyond type-2 diabetes mellitus to include obesity, cardiovascular risk reduction, and metabolic dysfunction-associated steatohepatitis. As their utilization increases, the dermatologic effects of these agents become increasingly relevant to clinical practice. This narrative review examines the cutaneous effects of GLP-1RAs across six domains: facial volume loss and accelerated skin aging, changes in hair density, wound healing, striae distensae and body skin laxity, cutaneous adverse events, and emerging therapeutic benefits in inflammatory skin disease. Herein, we review proposed mechanisms and evidence-based management strategies for each domain, including biostimulatory fillers, energy-based devices, nutritional optimization, and pharmacologic interventions. Prospective, large-scale clinical studies are needed to clarify mechanisms of GLP-1RA modulation in skin and to guide management of these AEs as next-generation agents enter clinical practice.

The widespread adoption of glucagon-like peptide-1 (GLP-1) receptor agonists has introduced a growing clinical challenge for dermatologists and cosmetic practitioners: managing the facial changes associated with rapid weight loss. The term "Ozempic face" has entered popular vocabulary to describe the appearance of accelerated facial aging in patients on these medications, characterized by volume deflation, skin laxity, and loss of structural support. This review examines the anatomical and histological basis of these changes, with attention to the roles of dermal white adipose tissue (dWAT), skeletal remodeling, and sarcopenia. We discuss the clinical presentation of weight-loss-associated facial change and outline a practical framework for patient assessment and counseling. The timing and sequencing of interventions across the weight loss journey are addressed, with emphasis on a health-first approach that prioritizes tissue preservation. As GLP-1 receptor agonists expand into new therapeutic indications, including inflammatory skin diseases, dermatology clinicians are uniquely positioned to counsel and manage patients experiencing these changes.

Pseudofolliculitis barbae (PFB) is a chronic inflammatory disorder triggered by shaving and disproportionately affects individuals of African descent. For service members, medically appropriate management may conflict with military grooming standards requiring a clean-shaven appearance. Recent policy changes have placed greater restrictions on shaving waivers and may create career consequences for service members who continue to require accommodations despite treatment. These policies raise ethical concerns involving justice, beneficence, nonmaleficence, and autonomy. Military safety requirements related to protective equipment must be balanced against the clinical needs of patients with PFB. Laser hair removal may provide meaningful benefit but can recur, permanently alter facial hair growth, and carry additional risks depending on skin type, device selection, and treatment setting. Dermatologists should provide accurate medical assessments, support medically necessary accommodations, and use shared decision-making so that treatment remains guided by clinical need and patient preference rather than institutional pressure.

Pseudofolliculitis barbae is a chronic inflammatory disorder triggered by shaving and disproportionately affects individuals of African descent. For service members, medically appropriate management may conflict with military grooming standards requiring a clean-shaven appearance. Recent policy changes have tightened restrictions on shaving waivers and may create career consequences for service members who still require accommodations despite treatment. These policies raise ethical concerns involving justice, beneficence, nonmaleficence, and autonomy. Military safety requirements related to protective equipment must be balanced against the clinical needs of patients with pseudofolliculitis barbae. Laser hair removal may provide meaningful benefit but can recur, permanently alter facial hair growth, and carry additional risks depending on skin type, device selection, and treatment setting. Dermatologists should provide accurate medical assessments, support medically necessary accommodations, and use shared decision-making so that treatment remains guided by clinical need and patient preference rather than institutional pressure.

New dermatologic therapies derived from long-used natural substances can enter the market at prices far above previously available compounded or imported formulations, once they receive US Food and Drug Administration approval. Patent protection is often blamed for this shift, but the mechanism at work, in most cases, is Food and Drug Administration-granted market exclusivity, a distinct incentive that can apply even to substances too old to be patented. Herein, we examine how this incentive structure has affected access to cantharidin, a naturally derived agent long used to treat verrucae and molluscum contagiosum, after its formal Food and Drug Administration approval. We outline the ethical tensions this type of scenario raises for physicians trying to balance beneficence, nonmaleficence, autonomy, and justice. Rather than a blanket exception for compounding, targeted evidence-based reforms are proposed that could preserve incentives for genuine innovation while protecting patient access and distributive justice.

Emotional support animals (ESAs) may provide companionship and psychological support to individuals with mental health conditions, and dermatologists may encounter patients requesting ESA documentation or seeking to bring an animal into the clinical setting. These situations raise distinct ethical, legal, and practical considerations. Unlike service animals trained to perform disability-related tasks, ESAs do not have the same federal public-access protections. This paper provides a framework to help dermatologists distinguish service animals from ESAs, evaluate requests for ESA documentation, determine when additional evaluation is needed, and manage animal-access questions in clinical settings. A proportionate approach can support patients with disability-related needs while maintaining appropriate professional boundaries and consistent clinical practice.

Psoriasis is a chronic, systemic inflammatory skin disease associated with musculoskeletal, cardiovascular, metabolic, psychiatric, and gastrointestinal comorbidities. Glucagon-like peptide-1 (GLP-1) receptor agonists and dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists have emerged as potential therapeutic adjuncts for psoriasis because, beyond their metabolic effects, these agents exhibit anti-inflammatory properties and may reduce cytokine expression and inflammatory biomarkers. This review summarizes current evidence from randomized trials and nonrandomized studies on GLP-1 receptor agonists and dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists in patients with psoriasis and discusses their potential role in disease management. Observational studies of liraglutide, semaglutide, exenatide, dulaglutide, and tirzepatide generally showed improvements in psoriasis severity, body weight, metabolic parameters, inflammatory biomarkers, and quality of life, although most studies were limited by small sample sizes and uncontrolled designs. Randomized trials likewise suggest dermatologic benefit, particularly in patients with obesity, type 2 diabetes mellitus, or both. Most notably, the phase 3b TOGETHER trial demonstrated greater skin clearance and weight reduction with ixekizumab plus tirzepatide than with ixekizumab alone in patients with moderate-to-severe psoriasis and overweight or obesity. Complementary findings from the TOGETHER-Psoriatic Arthritis trial showed improvement in psoriatic arthritis disease activity as early as week four, before clinically meaningful weight loss, supporting the potential weight-independent anti-inflammatory effects of these agents. Future studies should include patients without obesity or diabetes to clarify the relative contributions of weight loss and direct anti-inflammatory effects to clinical response and determine whether the dermatologic benefits of GLP-1-based therapies extend to patients without underlying metabolic dysfunction.

Dermatology has long been one of the most visual of the medical specialties, built on observation, illustration, and pattern recognition. While the scientific achievements of its pioneers are well documented, the portraits, engravings, silhouettes, sculptures, medals, and early photographs that preserved their likenesses have received comparatively little attention. These images form a historical archive in their own right, reflecting not only the physicians themselves but the artistic conventions, technical means, and professional culture of their era. This review traces the history of dermatology through a selected series of such portraits, chosen to illustrate major transitions in the field: morphologic classification, clinicopathologic correlation, dermatopathology, medical mycology, immunology, dermatologic surgery, phototherapy, pigment biology, and targeted molecular therapy. Each portrait is discussed within its historical and, where informative, its artistic context, from Renaissance engravings and eighteenth-century silhouettes to nineteenth-century academic paintings and modern photography. The individuals included were selected for their documented, enduring contributions to the specialty and for the availability of authentic visual material; the selection is illustrative rather than exhaustive, and its predominantly European and North American emphasis is acknowledged as a limitation rather than a claim of completeness. Beyond cataloging individual achievement, we argue that these images preserve a collective visual memory of the specialty and illustrate how portraiture has contributed to dermatology's professional identity.

Albrecht Dürer's illness has often been interpreted through a splenic and malarial framework, largely due to the famous self-portrait in which he points to a painful area on his left side and refers to a "yellow spot," iet, this interpretation may be too organ-centered. The image may not simply localize pain; it may depict a true cutaneous lesion. Once the malaria hypothesis is weakened, the combination of a recurrent fever, the constitutional decline, and a painful, marked lesion becomes newly legible within the modern spectrum of late-onset autoinflammatory disease, especially the VEXAS syndrome and related neutrophilic dermatoses. These disorders frequently affect older men, commonly present with fever and skin lesions, and may include tender, infiltrated plaques or Sweet syndrome-like eruptions on the trunk. This contribution argues that Dürer's "yellow spot" is better interpreted as a painful inflammatory skin lesion-possibly a localized neutrophilic plaque, a pseudopustular lesion, or a confluent Sweet-like eruption-rather than as a projection of splenic pain.

Although basal cell carcinoma, squamous cell carcinoma, and melanoma represent the most frequent malignant tumors of the eyelids, a diverse group of rarer adnexal and neuroendocrine neoplasms also demonstrates a strong predilection for this anatomic site. These tumors, including sebaceous carcinoma, Merkel cell carcinoma, primary cutaneous mucinous carcinoma, endocrine mucin-producing eccrine gland carcinoma, primary apocrine adenocarcinoma, and primary signet ring (histiocytoid) carcinoma, are characterized by unique epidemiologic patterns, biologic behavior, and histopathologic features. The specialized microanatomy of the eyelid-with a dense concentration of meibomian (sebaceous), apocrine (Moll), and eccrine glands-combined with thin tissue planes, rich lymphovascular networks, and chronic ultraviolet exposure, contributes to their development, patterns of local invasion, and potential for metastasis. Accurate diagnosis often requires careful clinicopathologic correlation, incorporating immunohistochemical and molecular studies to distinguish primary lesions from eyelid metastases and identify syndromic associations. This review provides a comprehensive synthesis of the epidemiology, pathogenesis, clinical presentation, detailed histopathology, genetic alterations, differential diagnosis, management, and prognosis of these rare malignant eyelid tumors, with emphasis on early recognition and multidisciplinary care.