Background Emoticons and emojis have become staple additions to modern-day communication. These graphical icons are now embedded in daily society through the various forms of popular social media and through users’ personal electronic conversations. With ever-increasing use and inclusivity, exploration of the possible health care and dermatology applications of these tools is imperative. Objective The goal of this narrative review was to provide and evaluate an up-to-date literature survey examining the utility of emoticons and emojis in medicine. Special attention was paid to their existing and potential uses in the field of dermatology, especially during the COVID-19 pandemic. Methods A PubMed search of peer-reviewed publications was performed in mid-2021 to collect articles with emoticon or emoji keywords in combination with other health care–relevant or dermatology-relevant keywords. Screening of publications and described studies was performed by the authors with education and research experience in health care, dermatology, social media, and electronic communication trends. Selected articles were grouped based on common subjects for qualitative analysis and presentation for in-depth discussion. Results From this extensive search, researchers were able to identify a wide variety of publications detailing the use of emoticons and emojis in general health care, pediatric health care, public health, and dermatology. Key subject areas that emerged from the investigation included the ability of emoticons and emojis to improve communication within pediatric health care, enhance mood and psychological assessment or mental health screening in adults, develop interventions to improve patient medication adherence, complement novel means of public health and COVID-19 surveillance, and bolster dermatology-specific applications. Conclusions This review illuminated the repurposing of emojis and emoticons for a myriad of advantageous functions in health care and public health, with applications studied in many populations and situations. Dermatology-specific uses were relatively sparse in the literature, highlighting potential opportunities for growth in future studies and practices. The importance of diversity and inclusivity has extended to emojis, with the recent introduction of skin color customization and new emojis better representing the comprehensive spectrum of users’ experiences. A continuously evolving and technology-driven population creates a unique niche for emoticons and emojis to ease worldwide communication and understanding, transcending the barriers of age, language, and background. We encourage future studies and innovations to better understand and expand their utility.

To the Editor, Gua-sha, Jade Rollers, and facial massages are alternative treatments that improve blood flow and lymphatic drainage resulting in clearer skin. Gua-sha and Jade Rollers originated from ancient China, becoming part of the Western beauty routines during the 1970s. Today, they are popular due to recent social media trends. 1 Guasha treatment uses a polished jade stone to scrape skin gently. Jade Rollers resemble a small paint roller made of jade stone used to massage skin. Both methods require an upward and outward motion to reduce inflammation, improve skin complexion, and decrease wrinkles. We aim to compare these techniques and the content of top 10 websites of the respective technique as determined by the Google search algorithm.Google search was performed using "Gua-sha," "Jade Roller," and "Facial Massage." Top 10 website results were reviewed for content, including proposed benefits, proposed risks, mentioned studies, references cited, and quoted experts. Websites for advertising and selling products were excluded.The most common websites (Table 1) were beauty websites (11 websites), followed by health websites (10 websites) and news websites (9 websites). Common benefits proposed included reduced inflammation, decreased wrinkles, reduced puffiness, improved blood circulation, improved lymphatic drainage, muscle tension relief, and migraine relief (Table 1). Common proposed risks included bruising, risk of infection, and skin irritation (Table 1). Five websites cited

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Importance: Treating AD with dupilumab, a monoclonal antibody that inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13), may be associated with progression of MF.Objective: To examine the associations between length of dupilumab treatment, age and sex, and onset of MF.Design, Setting, and Participants: An institutional data registry and literature search were used for a retrospective cross-sectional study. Only patients with a diagnosis of MF on dupilumab for the treatment of AD and eczematous dermatitis were included.Exposure: AD patients treated with dupilumab.Main Outcomes and Measures: The primary outcome was the length of dupilmab exposure, age and sex, and MF onset. Linear correlations (Pearson) and Cox regression analysis were used to assess the correlation and the risk.Results: Five eligible patients were identi ed at our institution. In addition, the PubMed review identi ed an additional 20 patients. The median age was 58 years, with 42% female. Disease history was signi cant for adult-onset AD in most patients (n=17, 65.4%) or recent are of AD previously in remission (n=3, 11.5%). All patients were diagnosed with MF, and one patient progressed to Sezary syndrome while on dupilumab, with an average duration of 13.5 months of therapy prior to diagnosis. Tumor stage was described in 19 of the cases and ranged from an early-stage disease (IA) to advanced disease (IV). Treatment strategies included narrow-band UVB therapy, topical corticosteroids, brentuximab, praladextrate, and acitretin. Male gender, advanced-stage disease, and older age correlated signi cantly with the hazard of MF onset and a shorter time to onset during dupilumab treatment.Conclusion and Relevance: Our results suggest a correlation between the duration of dupilumab treatment and the diagnosis of MF, the higher MF stage at diagnosis the shorter the duration of using dupilumab to MF onset. Furthermore, elderly male patients appeared to be more at risk as both male gender and older age correlated with hazard of MF diagnosis. The results raise the question as to whether the patients had MF misdiagnosed as AD that was unmasked by dupilumab or if MF truly is an adverse effect of treatment with dupilumab. Close Monitoring of these patients and further investigation of the relationship between dupilumab and MF can shed more light into this question.