Monthly Archives

March 2019

Mar 27
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Panel discussion at dermatology conference

The Skin Lightening Dilemma: A Candid Conversation with the Experts

By Sessions

This article features a recap of the Skin Lightening Panel at the 2018 Skin of Color Seminar Series, now known as the Skin of Color Update. Dr. Bridget Kaufman, onsite correspondent for the meeting, shares highlights directly from the experts, Drs. Eliot Battle, Seemal Desai and Valerie Callender.

Each panelist started with a PowerPoint presentation on skin lightening, followed by a panel discussion. Rather than reporting on the session chronologically, I have divided the session into key points. Under each key point, I have indicated each faculty member’s contributions and opinions on the topic.  *Clinical pearls* from this session are bolded, underlined and marked with asterisks.

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Mar 23
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Poster Session

2018 Scientific Poster Abstracts from Skin of Color Update

By Sessions

A selection of scientific poster abstracts from Skin of Color Seminar Series 2018 (now known as Skin of Color Update.) Thank you to our poster presentations and faculty. 

 

Cutaneous Crohn’s Disease of the Vulva in an Elderly African American Patient

Authors: Leah Wells, MS & David Kent, MD

We present a case of a 79-year-old African American female with painful vulvar ulcers of several years duration. She presented to an OB-GYN and was tested for syphilis, lymphoproliferative granulomatosis, herpes, TB, and fungal infection. Once these etiologies were ruled out, she was referred to dermatology where the knife-like lesions prompted suspicion for cutaneous Crohn’s disease. However, the patient had not been previously diagnosed with Crohn’s and had no gastrointestinal symptoms of the disease. Biopsy revealed non-caseating granulomas, confirming a probable diagnosis of vulvar Crohn’s. The patient was initially treated with oral steroids, and her lesions showed improvement after one month of therapy. Due to the severity of her case, infliximab was recently added to her regimen to further promote healing.
Less than 200 cases of vulvar Crohn’s disease have been reported in the literature. The mean age of onset is 35, making our patient’s advanced age uncommon. Vulvar Crohn’s is often difficult to diagnose, due to the multitude of differential diagnoses for genital ulcers. Further, a significant amount of patients with vulvar Crohn’s disease will not exhibit any gastrointestinal symptoms and vulvar Crohn’s will be the initial manifestation of underlying disease. As a result, many patients suffer from the disease for many years before it is recognized as cutaneous Crohn’s. A biopsy is necessary to achieve definite diagnosis.
Treatment recommendations for vulvar Crohn’s have not been well-established. However, initial treatment often includes metronidazole, steroids, and/or immunosuppressants. Recent case-reports have shown success in treating severe, or refractory, vulvar Crohn’s with infliximab.  Read More

Mar 16
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Seemal Desai Melasma Skin of Color Update

Melasma and PIH – Disorders of Hyperpigmentation

By Sessions, Skin of Color Update Agenda

During his talk at the 2018 Skin of Color Seminar Series (now known as the Skin of Color Update), Dr. Seemal Desai discussed the treatment of melasma (post inflammatory hyperpigmentation PIH) with a particular emphasis on new and emerging therapies. Dr. Bridget Kaufman, onsite correspondent for the meeting, shares highlights directly from the talk.  *Clinical pearls* from this session are bolded, underlined, and marked with asterisks.

Dr. Desai started by stressing the importance of having an honest and upfront conversation with your melasma patients about realistic expectations for treatment. *You must emphasize to patients that this is a chronic condition and set their expectations accordingly.*While improvement with treatment is likely, there will always be underlying pigmentary changes even despite treatment. Patients must understand from the beginning that they cannot be cured of this condition.

Dr. Desai then addressed the large vasodilatation/vascular component of melasma. Although the predominant feature of melasma is the hyperpigmented patch, a pink hue becomes apparent after treatment of the brown pigment. Historically, the redness was thought to be a side effect of Modified Kligman’s Formula, but more recent research suggests that this due to an inherent expression of vascular markers in melasma lesions. This vascular component can be treated with low fluence pulsed dye laser; oral tranexamic acid has also been helpful in Dr. Desai’s practice.

Dr. Desai then addressed the relationship between thyroid disease and melasma. There are a few studies showing thyroid disease in patients with recalcitrant melasma. *If, after optimal treatment, a patient does not improve within 3-6 months, you may want to get a free T4 and TSH to screen for thyroid disease.*

So now onto the treatment of melasma! Given that triple combination cream (TCC) is the gold standard therapy for melasma, it makes sense that Dr. Desai started with a discussion of research on this product. A randomized controlled trial of TCC in Southeast and East Asian patients with melasma found that, after 8 weeks of treatment, *TCC was superior to monotherapy with hydroquinone, although it was associated with more adverse effects.* Dr. Desai has found this to be true in his practice and, therefore, he rarely prescribes hydroquinone alone. The retinoid and steroid in TCC help with desquamation and exhibit anti-inflammatory properties that counter the upregulation of prostaglandins and tyrosinase in melasma.

For more pearls like this – register for Skin of Color Update in NYC now before it is sold out.

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Excerpt provided with permission. Originally published by Next Steps in Dermatology. All rights reserved.
Mar 15
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Skin of Color STD Ted Rosen

Sexually Transmitted Diseases in Skin of Color: Crisis State

By Skin of Color Update Agenda

As one would expect, Dr. Ted Rosen’s session at the Skin of Color Seminar Series 2018 (now Skin of Color Update) on Sexually Transmitted Diseases (STDs) in Skin of Color was engaging, informative, and shocking to many in the audience. Dr. Rosen addressed the increasing rates of STDs in the United States and highlighted the alarming predominance in non-white ethnic groups.

*Clinical pearls* from this session are bolded, underlined, and marked with asterisks.

The STD data from 2017 is worse than 2016, which was worse than 2015, and so on. *Every year, 20×106new STDs are diagnosed!*Over 50% of Americans will contract an STD during their lifetime, often before the age of 25. Teenagers are at high risk as well, with 1 in 4 teenagers developing an STD. First piece of good news: *Sex in high school is decreasing*in the US, with the exception of a few states(from east to west): North Carolina, Michigan, North Dakota, Wyoming, and Arizona. Perhaps this will correlate with decreased STD transmission among teenagers in the coming years.

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Excerpt provided with permission. Originally published by Next Steps in Dermatology. All rights reserved.

 

 

Mar 01
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The Use of Deoxycholic Acid for the Clinical Reduction of Excess Submental Fat in Indian Patients

By SOC Manuscripts

Source: J Drugs Dermatol. 2019;18(3):266-272.

Debraj Shome MD FRCS, FACS, MBA Stuti Khare MD, Rinky Kapoor MD

The injectable adipocytolytic drug deoxycholic acid (DCA) is the first pharmacological intervention approved for the reduction of submental fat (SMF) and offers an alternative to invasive measures to improve the submental profile and the cervico-mental angle. DCA injection (ATX-101, Kybella [United States], Belkyra [Canada]; Kythera Biopharmaceuticals, Inc., Westlake Village, CA, acquired by Allergan, Inc.), are proprietary formulations of synthetically derived DCA that is FDA approved for improvement in the appearance of moderate to severe convexity or fullness associated with SMF.

Aim: As none of the aforementioned are available in India, we undertook this study to study the efficacy of generic DCA for SMF reduction in Indian patients.

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