Vitamin D is a hormone that can be generated in the skin upon ultraviolet light exposure or ingested through supplementation. Vitamin D deficiency may have numerous deleterious effects on health. Sun avoidance strategies should be avoided due to the unwanted health risks associated with hypovitaminosis D. We present an objective investigation of the benefits and risks of using sun exposure to increase vitamin D levels and how it impacts human health. A review of the literature was conducted using Embase and PubMed to examine the relationship between UV exposure, vitamin D levels, health benefits, and risks. UV exposure is the primary method of boosting serum vitamin D levels, which accounts for numerous health benefits. Higher levels of vitamin D are associated with protection against cancer development, including melanoma. Latitude, season, skin color, and sun protection determine UV absorption and vitamin D production. Public health sun protection guidelines decrease the incidence of skin cancer, but sun avoidance can cause hypovitaminosis D. Serum vitamin D levels less than 16 nmol/L increase morbidity through increased non-cutaneous disease. Sun protection strategies should still be implemented to reduce skin cancer, and sunscreen only minimally lowers vitamin D production. Vitamin D deficiency can increase chronic diseases and cancer, while adequate vitamin D levels can help prevent them. UV exposure and vitamin D production are dependent on many factors. Increasing UV exposure without causing sunburn maximizes vitamin D production.

Body mass index (BMI) is an anthropometric index that is commonly used in the medical setting and is a factor in assessing various disease risks but its origins are unknown by many. More importantly, BMI does not properly assess body fat percentage and muscle mass or distinguish abdominal fat from gluteofemoral fat, which is important to note because abdominal fat is associated with insulin resistance, metabolic disease, and cardiovascular complications. Using a less accurate index to assess the relationship between weight and disease risk is conceptually invalid because the use of BMI ultimately trickles into patient treatment, preventive medicine, and overall health outcomes. Several different anthropometric indices that more accurately assess abdominal adiposity through the incorporation of waist circumference exist and have been extensively studied, such as waist-to-hip ratio, waist-to-height ratio, and a body shape index. It is important that we consider replacing BMI’s usage in the healthcare setting with a different anthropometric index: one that considers height, sex, and race differences, accounts for abdominal adiposity, and more accurately predicts the relationship between obesity, mortality, and diseases such as cardiovascular disease, hypertension, insulin resistance, and diabetes.

Skin cancer is the most common cancer diagnosis worldwide. Many factors are involved in the development of skin cancers, but ultraviolet (UV) light exposure is the most modifiable. Our lifetime cumulative UV exposure may be a result of poor sun protection practices in childhood and adolescence. Modifying the attitudes and behaviors of children can be done in the classroom, at recreational activities, and at home. A review of the literature was conducted using Embase and PubMed to examine the relationship between attitudes and behaviors as they relate to sun protection strategies. Well-developed, standardized sun protection educational programs are needed to instruct children and adolescents. Individualized counseling from physicians or online programs is needed to help parents increase sun-safe standards for their children. Many young women utilize indoor tanning beds frequently, but many instructional programs increased their tanning bed usage. Time should be allotted at schools, sports practices, camps, and other outdoor activities for sunscreen reapplication. Many parents and children report the media is their primary source of information about sun safety. Media outlets may positively change attitudes and behaviors when reporting about sun safety. Parents and children need individualized programs or counseling to reduce ultraviolet (UV) exposure and increase sun protection. At-risk populations need tailored instruction, but few strategies have worked to decrease UV exposure.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic, uses the surface angiotensin-converting enzyme 2 (ACE2) receptor as the site of entry into host cardiac, respiratory, intestinal, renal, and nervous system cells. Predisposing risk factors such as cardiovascular disease increase the risk of developing severe disease. Hypertension is characterized by the stimulation of the renin-angiotensin-aldosterone system (RAAS). Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin 2 receptor blockers (ARBs), medications used to treat hypertension, inhibit RAAS and its downstream effects; however, they have also been shown to upregulate ACE2 receptors. In this review, we aim to evaluate the effectiveness of ACEi/ARBs as an adjunct therapy in patients with SARS-CoV-2 as well as examine the possible protective effects and impact on infection rate and disease severity. A PubMed literature search excluding sources outside the United States and duplicates was performed using the following search criteria: “COVID-19 AND cardiovascular disease AND ACEi AND ARB”, “SARS-COVID-19 OR COVID-19, AND ACEi AND ARB AND Infection rate”, “COVID-19 AND ACEi and ARB”, “Omicron BA.1 and BA.2 AND ACE2 OR ARBs”, “Omicron AND ACEi AND ARBs”. This resulted in 33 final sources. The review concluded that ACEi/ARB therapy may continue to improve COVID-19 survival as previous treatment is associated with positive clinical outcomes. Patients taking ACEis or ARBs were found to have a decreased risk of hospitalization, reduced severity of COVID-19 pneumonia, a lesser need for mechanical ventilation, and an overall reduction in mortality rate. No statistically significant association between ACEi/ARB use and enhanced COVID-19 infectivity was found. The Omicron variant is theoretically more infectious and was associated with increased negative clinical outcomes in those undertreated with ACEis/ARBs. The majority of the literature supports the current guidelines from the American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), and Heart Failure Society of America (HFSA), which state that ACEi and ARB medications should not be withdrawn from or initiated on patients with cardiovascular disease who are infected with SARS-CoV-2. More research needs to be conducted on the association between the emerging COVID-19 variants and ACEis/ARBs to give clinicians confidence when treating patients within this subgroup of the population.

Chronic pruritus is a common and difficult-to-manage feature of inflammatory skin conditions. It develops through complex interactions between the skin barrier, immune system, and peripheral nervous system. Interleukin-31 (IL-31) and oncostatin M (OSM), both members of the interleukin-6 (IL-6) cytokine family, share the same receptor subunit, OSM receptor β (OSMRβ), and activate common downstream intracellular pathways, particularly the Janus kinase-signal transducer and activator of transcription (JAK-STAT) cascade. This systematic review aims to synthesize evidence in the current literature that supports IL-31 and OSM signaling across chronic pruritic dermatoses, with an emphasis on downstream JAK1-STAT3 pathways. A comprehensive search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed, Embase, Ovid MEDLINE, and the Web of Science databases. Studies evaluating OSM, IL-31, their shared receptor components (IL-31 receptor A (IL-31RA) and OSMRβ), and downstream intracellular signaling in chronic pruritic dermatoses were included. Twenty-six studies met the eligibility criteria, comprising randomized controlled trials, case-control studies, cross-sectional studies, case series, and experimental laboratory studies. Across atopic dermatitis (AD), prurigo nodularis (PN), psoriasis, cutaneous T-cell lymphoma (CTCL), dermatomyositis, and primary localized cutaneous amyloidosis (PLCA), both IL-31 and OSM contribute to chronic itch through overlapping pathways, including shared receptor architecture and activation of JAK1-STAT3 signaling. They were found to differ, however, in the way they influence neuronal activation and sensitization. IL-31 acts as a direct pruritogenic cytokine through activation of the IL-31RA/OSMRβ receptor complex on sensory neurons. In contrast, OSM may act to increase neuronal sensitivity, enhance excitability, and strengthen the response to other pruritic-inducing stimuli through the gp130/OSMRβ receptor complex. Despite these differences, both cytokines converge on the JAK1-driven STAT3 signaling pathway, ultimately contributing to skin barrier dysfunction, ongoing inflammation, and persistent neural sensitization. Blocking IL-31RA with nemolizumab or targeting OSMRβ with vixarelimab has led to clinically significant improvements in itch severity, patient-reported quality of life, and sleep disturbance. Together, these findings suggest that the shared components of the IL-31 and OSM pathways, including OSMRβ and JAK1-STAT3, provide us with a big picture framework for understanding itch pathogenesis in chronic pruritic dermatoses and may help guide therapeutic strategies in the future.