Over the past decade, nonprescription skincare has gained significant attention. However, evidence supporting many skincare trends often lacks the rigorous testing seen in randomized controlled trials (RCTs) for prescribed medications. Vehicle arms in RCTs, which test nonmedicated treatments, provide insights that support the advocacy of basic skincare practices. This narrative literature review explores the lessons drawn from vehicle arms of RCTs in the management of conditions like acne vulgaris, actinic keratoses, melasma, postinflammatory hyperpigmentation and rosacea. A literature search was performed on MEDLINE and Embase to identify RCTs involving vehicle arms for the dermatological conditions. Data on outcomes, study design and sample size were extracted and analysed. Basic skincare practices such as cleansing, moisturizing and sun protection have consistently demonstrated meaningful improvements in dermatological outcomes, even without active treatments. Vehicle arms often achieve a substantial proportion of the efficacy seen in active treatments, frequently exceeding half of the efficacy seen in active treatments, emphasizing the potential of simple skincare regimens. For acne vulgaris, two identical international phase III RCTs (involving 2817 participants) demonstrated up to 25.7% improvement in facial acne severity and 51.2% reduction in inflammatory lesions with vehicle treatment. In actinic keratoses, an RCT (n = 468) showed up to 24% reduction in lesion count and 17% complete clearance in the vehicle arm. In melasma, an RCT (n = 48) demonstrated up to 66.6% improvement in severity with vehicle treatment. In postacne vulgaris postinflammatory hyperpigmentation, a phase IV trial (n = 123) showed up to 44.9% improvement in overall disease severity with vehicle treatment. For rosacea, a multicentre RCT (n = 120) showed up to 27% reduction in erythema in the vehicle arm. Basic skincare is an essential component of dermatological treatment. Evidence from placebo-controlled trials reinforces the value of skincare routines, which should be incorporated into treatment plans alongside active therapies to enhance efficacy and optimize patient outcomes.

Papulopustular rosacea is a chronic inflammatory condition of the pilosebaceous unit, with an unclear exact cause, but it is thought to involve an exaggerated immune response, persistent inflammation, and possibly an increased presence of Demodex mites on the skin. This is a case report of a 22-year-old woman with papulopustular rosacea treated with a 1,726-nm sebum-selective laser over three sessions. Progressive clinical improvement was observed, with a reduction of inflammatory lesions from 234 at baseline to complete clearance, along with improvement in erythema, flushing, and patient-reported symptoms. Demodex density decreased from 58 mites/cm2 to 12 mites/cm2. Treatment was well tolerated, with no adverse events and high patient satisfaction. These findings suggest that sebum-selective laser therapy may offer a non-pharmacologic treatment option for papulopustular rosacea, potentially by modulating sebaceous gland activity. Further studies are needed to confirm efficacy and clarify mechanisms.

Severe acne, left untreated, lead to permanent scarring and facial deformities, causing significant physical and psychological distress. Traditional ablative lasers, while effective for treating facial atrophic acne scars, are often limited by long recovery times and complications such as erythema, hyperpigmentation, and scarring. This study aims to compare the efficacy of fractional carbon dioxide (CO2) laser treatment with and without subcision for improving facial acne scars, seeking a more effective treatment with minimal recovery time. A total of 30 patients (18-40 years) with facial atrophic scars, attending the Dermatology OPD of a tertiary hospital, allocated into Group A (Fractional CO2 with subcision) and Group B (Fractional CO2 without subcision). The study used Goodman and Baron's quantitative and qualitative acne scar grading system for objective assessment and patients provided feedback using a 5-point Likert scale to gauge satisfaction. The scar improvement was better in Group A compared to Group B (p-value = .007), which was statistically significant. Patients receiving Fractional Carbon Dioxide Laser with subcision were more satisfied with the treatment outcome compared to those receiving Fractional Carbon Dioxide Laser alone. Keywords: Facial acne scars, Fractional carbon dioxide laser, Subcision.

Topical corticosteroid withdrawal (TCSW) can occur after prolonged topical corticosteroid (TCS) use. Despite the effectiveness of TCS in treating dermatological conditions, the phenomenon of steroid phobia has been gaining attention on social media platforms. This has contributed to increased anxiety among patients and potentially influenced their treatment adherence. This review aims to update the findings of two studies by investigating the latest research on TCSW. A systematic search was conducted in Ovid MEDLINE, PubMed, and the Cochrane Library from October 2020 to June 2024. Seven studies were included in the analysis, including five case reports, one case series, and one qualitative cross-sectional survey, reflecting the limited and descriptive nature of the currently available evidence on TCSW. TCSW appears to predominantly occur in adult women (90%) using TCS for atopic dermatitis (99.5%), mostly on the face (90%). Common symptoms include burning (89.8%), itching (85.6%), and skin hypersensitivity (82.3%), with erythema (89.6%) and desquamation (88.7%). TCSW appears to occur more commonly in women using high-potency TCS on the face long-term. Inconsistent diagnostic criteria, variable definitions, and the primarily descriptive nature of the currently available evidence complicate accurate diagnosis and treatment of TCSW. Increased awareness, education, and research on standardized criteria and management strategies are essential.

Rosacea is a chronic inflammatory skin disorder primarily characterized by persistent facial erythema, episodic flushing, papules and pustules, as well as phymatous changes. Despite extensive research, the pathogenesis of rosacea has not yet been fully elucidated. Current evidence suggests that rosacea develops on the basis of genetic susceptibility and results from the complex interplay of multiple endogenous and environmental factors, including immune dysregulation, impairment of skin barrier function, microbial imbalance, metabolic disturbances, and neurovascular dysfunction. Due to its chronic, refractory, and recurrent nature, rosacea imposes a substantial physical and psychological burden on affected individuals and markedly compromises quality of life. In recent years, accumulating studies have demonstrated that patients with rosacea frequently present with metabolic comorbidities related to lipid metabolism disorders, such as dyslipidemia, diabetes mellitus, and obesity. Notably, these metabolic abnormalities are reflected not only in circulating lipid profiles but also in alterations in the composition and proportion of facial sebum lipids. This review summarizes current evidence regarding abnormalities in serum lipid profiles and cutaneous lipid metabolism in patients with rosacea, and discusses the potential mechanisms by which dysregulated lipid metabolism may contribute to the initiation and progression of rosacea.