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Dana Turner

Dermatology Concerns In Skin of Color Patients

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During the 16th Annual ODAC Dermatology, Aesthetics and Surgical Conference, I had the pleasure of taking part in the Resident Career Development Mentorship Program (a program supported by an educational grant from Sun Pharmaceutical Industries, Inc.). and was paired with Dr. Andrew Alexis, Chair of Dermatology at Mount Sinai St. Luke’s and Mount Sinai West in New York City.

During a 45-minute working group session, Dr. Alexis covered three main themes: common dermatologic disorders with unique manifestations in skin of color, disorders that disproportionately affect patients of color and therapeutic nuances and unique treatment concerns in skin of color. Here are the main takeaways and pearls from this session.

Common Disorders With Unique Manifestations

Acne

Post-inflammatory hyperpigmentation is a major concern in patients of color and many times more bothersome than acne itself.  It is important to use agents that will treat both acne and PIH. Retinoids can be very effective –tretinoin, tazarotene and adapalene have been shown effect for PIH. Azelaic acid can be a good add on for patients with PIH.

Dr. Alexis doesn’t use much hydroquinone for these patients – the macules left behind by acne are usually too small to avoid creating halos around the lesion.  Chemical peels have been demonstrated to improve PIH in small studies.  The risks are higher in skin of color, so it advisable to stick to superficial peeling agents. Avoiding irritation is essential since it can lead to more dyspigmentation.

Maximize tolerability – adapalene and low concentration tretinoin or tazarotene are a good starting point.  Eliminate any irritating scrubs and other skincare products.  Use noncomedogenic moisturizers concurrently.

Disorders That Disproportionately Affect Patients of Color

Pseudofolliculitis barbae

Findings consist of papules and prominent hyperpigmentation.  This process can also trigger keloid formation. While more common in men, women with hirsutism may also develop PFB. It results from a foreign body reaction to hair reentering the dermis.

A very effective strategy is to discontinue shaving.  You may have to write letters to some patients’ employers in order to excuse them from shaving (Dr. Alexis keeps a form letter on file in his practice).

Chemical depilatory agents are a decent option.  Barium sulfide powder and calcium thioglycolate cream can be used every 2-4 days.  However, they can cause irritant dermatitis. Some patients may also find success by modifying their shaving practices.  Don’t assume your patients know how to shave – educate them.  Electric clippers are a good option – have patients leave 0.5-1 mm stubble. Traditionally single blade manual razors have been recommended.

One study sought to quantify the impact of blade number on PFB – 90 African American men were assigned to shave with a different number of blades.  There was no difference between any of the groups and everyone got better.

A small study showed decreased severity of PFB with daily shaving vs twice weekly shaving.

Dr. Alexis has a handout for patients with shaving instructions: before shaving use a mild cleanser and use a wash cloth in a circular motion to free hairs.  Use clean and sharp razor, shaving in the direction of hair growth.  Use topicals after such as clindamycin lotion or topical dapsone.  Apply a topical retinoid nightly. Avoid pulling or plucking embedded hairs, shaving against the grain.

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Skin of Color Update Announces 2019 Didactic, Case-Based Lectures, Hands-On-Training and Live Demonstrations

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The medical education event focused on the dermatologic treatment of skin of color has a new name. Skin of Color Update, previously the Skin of Color Seminar Series, provides dermatologists with evidence-based research and practical pearls in treating skin of color, including patients with multiracial backgrounds.

“Just as the treatment of skin of color has evolved, this event has also evolved,” says Skin of Color Update co-chair and founding dermatologist Eliot Battle, MD. “Thanks to audience feedback, nearly all general sessions will have additional time for Q&A, making this year’s event the most interactive yet.”

Skin of Color Update will now be held annually in the fall. The 2019 event will be held September 7 and 8 at the Crowne Plaza Times Square in New York.

Skin of Color Update uses a didactic, case-based approach through lectures, hands-on-training and live demonstrations. Co-founding dermatologist Andrew Alexis, MD, also serves as an event co-chair. Common skin, hair and nail conditions in diverse populations will be covered. In addition, advanced treatment protocols for pigmentary and hair disorders will be shared during mini symposiums.

Sessions will address medical, surgical and cosmetic dermatology. New sessions include:

  • “Challenging Challenges: Hidradenitis Suppurativa and the Skin of Color Patient” with Ted Rosen, MD
  • “Current Understanding and Novel Innovations in Photoprotection” with Henry Lim, MD
  • “Diagnosis and Management of Vitiligo in Skin of Color Patients: Where Do We Stand?” with Pearl Grimes, MD
  • Laser and Device-Based Treatment of Scars” with Paul Friedman, MD
  • “Surgical Approaches for Keloids” with Maritza Perez, MD

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View the full agenda

Patient Buzz: At-Home Laser Hair Removal – The Expert Weighs In

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Marie Clairerecently posted a list of the magazine’s top devices for at-home laser hair removal, noting their budget-friendly appeal. But are these devices safe and effective? How should you counsel your patients?

For an expert opinion, I consulted dermatologist Eliot F. Battle Jr., MD, CEO and co-founder of Cultura Dermatology & Laser Center in Washington, D.C., clinical instructor in the Howard University Department of Dermatology, and Co-Chair of the Skin of Color Update.

How do at-home laser hair removal devices compare in effectiveness with in-office laser hair removal?

At-home laser hair removal devices have now been available for more than a decade. Just like most gadgets, you get what you pay for, so buyer beware. The devices range from using an intense pulsed light source to using actual diode lasers, although with a much lower energy source then office-based devices. Regardless of which device patients choose, at-home devices do not compare with the efficacy and speed of office-based laser systems. At-home devices are very slow. Because of the amount of time it takes to treat an area and their decrease in efficacy as compared with office-based lasers, I view at-home devices more as “hair-growth delay” devices than “hair-reduction” devices. They can be used alone or as maintenance treatments to office-based hair removal. The main limitations are they are best utilized on smaller areas and are contraindicated on patients with skin of color or tanned skin.

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Skin of Color Update Co-Chair Dr. Eliot Battle Shares Insights into 2019 Faculty and Topics

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Skin of Color Update Co-Chair, Dr. Eliot Battle, discusses the elite faculty lineup and topics planned this year including hair loss, keloids, rosacea, acne, lasers, aesthetic treatments, skin cancer, medical dermatology, melasma, hyperpigmentation, vitiligo, inflammatory diseases and much, much more!

Skin of Color Update 2019 (previously Skin of Color Seminar Series) is the largest CE event dedicated to trending evidence-based research and new practical pearls for treating skin types III – VI. Attendees leave with critical annual updates and fresh practical pearls in skin of color dermatology.

Join us this year in New York City, September 7-8, 2019! Register today at https://skinofcolorupdate.com/registration-hotel-2019/

Co-Chair Dr. Alexis Shares the Exciting 2019 Program Highlights

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Skin of Color Update 2019 (previously Skin of Color Seminar Series) is the largest CE event dedicated to trending evidence-based research and new practical pearls for treating skin types III – VI. Attendees leave with critical annual updates and fresh practical pearls in skin of color dermatology. Earn CE in New York City with direct access to elite experts and an experience unmatched by any other event in dermatology.

Treating Scalp Psoriasis in Women of African Descent

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Dr. Andrew Alexis is the Chair of the Department of Dermatology at Mount Sinai St. Luke’s and Mount Sinai Roosevelt. He is also Associate Professor of Dermatology at the Icahn School of Medicine at Mount Sinai. Dr. Alexis is the Co-Chair of the Skin of Color Seminar Series in New York City. During the 2017 conference he provided practical pearls and treatment outlines for skin of color patients with scalp psoriasis.

Dr. Alexis recommends selecting a treatment regimen that is compatible with the patient’s hair care practices including less frequent hair washing in women of African descent (typically once per week to once every other week). Daily hair washing, especially with most prescription shampoos, is often associated with increased hair dryness and breakage. In addition, it is also very time consuming for most women of African descent due to common styling practices.

Suggested Regimen for African-American Females:

  • Once weekly washing with prescription shampoo. This may be increased to two times a week depending on the severity and patient preferences
  • Continue with usual conditioner
  • Once weekly topical fluocinolone acetonide in peanut oil vehicle applied to the scalp for 6-8 hours overnight prior to washing or several times per week without washing
  • Once to twice daily application of POTENT topical steroid in vehicle that is compatible with hair care practices and hair texture (e.g. lotion, emollient foam, oil > gel, solution, ethanolic foam) Ask the patient for vehicle preferences
  • Alternative: calcipotriene and betamethasone dipropionate topical suspension daily

Attendees at the Skin of Color Seminar Series May 5-6 in NYC will have the opportunity to dig deeper into psoriasis treatment in skin of color patients as Dr. Alexis gives his latest updates, pearls and therapeutic insights and also personally answers attendees’ most pressing questions.

 

 

Parameters for Success – Treating Skin of Color Patients with Dr. Eliot Battle

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Dr. Battle is CEO and founder of Washington, DC’s renowned Cultura Cosmetic Dermatology and Laser Center, a ground-breaking medical practice merging dermatology, laser surgery, plastic surgery, and spa therapy. His office is always filled with physicians seeking advance training and patients from all over the world who seek out his expertise. His 3 year pioneering research at Harvard helped to invent the new generation of non-invasive “color blind” cosmetic lasers opening up the field to patients of all cultures, regardless of skin of color or ethnicity. He is one of the most sought out teachers and lecturers in the field of cosmetic laser therapy.

Dr. Battle is the Co-Chair of the Skin of Color Seminar Series, May 5-6, 2018 in New York City. During the 2017 event, he shared his top parameters for success in treating skin of color patients with lasers and devices.

Parameters for Success – Treating Skin of Color Patients

  • Use the Correct Laser or Device
    • Choose the Appropriate Wavelength
    • Stay within Safe Parameters
    • Use Aggressive Skin Cooling
  • Become an Expert
  • Choose only treatments with proven success including:
    • Hair Removal
    • Pigment Improvement
    • Texture Improvement
    • Skin Tightening
    • Body Contouring
  • Do No Harm – Treat Conservatively
    • “Don’t rely on most parameters supplied by the laser manufacturers.  Treat more conservatively and minimize erythema or edema.”
  • Stay Under the Erythema & Edema Threshold
    • “When treating patients with skin of color, stay under the erythema threshold. Longer wavelengths, lower fluences, longer pulse durations, maximize cooling. Skin Cooling – Thermal  side effects happens when the epidermis heats up > 45 degrees. Treat all Skin of Color patients at max. of 1 hertz.”
  • Manage Patient Expectations 

Dr. Battle will share insights into his extensive laser knowledge at SOCSS 2018 where he will present the latest research, practical pearls and techniques during in-depth sessions including:

  • Live Laser and Device Demonstrations
  • Updates on New Technologies for Treating Aesthetic Concerns in Skin of Color
  • Ten Easy Steps to Improving Patient Experiences and Your Happiness
  • Minimizing Laser Complications in Skin of Color Patients
  • The Masters Share: Aesthetic Treatments Pearls in Skin of Color Patients  – Panel Discussion

Practical Pearls for Dermatology in Skin of Color Patients

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The Skin of Color Seminar Series (SOCSS) is the largest CE event dedicated to trending evidence-based research and new practical pearls for treating skin types III – VI. Each year, esteemed faculty provide attendees with fresh, practical pearls that are immediately useful in their practice.

In 2017, co-chairs Eliot Battle, MD and Andrew Alexis, MD gave their insight on everything from PIH to Lasers and everything in between.

3 Practical Pearls from Dr. Eliot Battle:

  1. Don’t rely on most parameters supplied by the laser manufacturers.  Treat more conservatively. Minimize erythema or edema.
  2. Inconsistent laser treatments on skin of color include: Vascular Lasers,  IPL (on Skin Type V & VI) and Resurfacing Lasers (on Skin Type V & VI).
  3. When treating patient with skin of color, stay under the erythema threshold. Longer wavelengths, lower fluences, longer pulse durations, maximize cooling. Skin Cooling – Thermal side effects happens when the epidermis heats up > 45 degrees. Treat all Skin of Color patients at max. of 1 hertz.

3 Practical Pearls from Dr. Andrew Alexis:

  1. Ethnicity does not predict skin color.
  2. Given that PIH can occur as a sequela of acne itself, or as a complication of treatment, treatment regimens must not only be aggressive enough to reduce inflammation and other pathogenic factors, but also well tolerated so that irritation is avoided.
  3. Daily hair washing, especially with most prescription shampoos, is often associated with increased hair dryness and breakage; it is also very time consuming for most women of African descent due to common styling practices.

 

 

Top 10 Sessions to Attend at the Skin of Color Seminar Series

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Now in its 10th year, the Skin of Color Seminar Series (SOCSS), May 5-6, 2018 in NYC, is the largest CE event dedicated to trending evidence-based research and new practical pearls for treating the dermatology needs of today’s patients.

Dermatology experts will gather in the Big Apple to witness world-renowned faculty discuss the latest research, new pearls, trending topics and perform live demonstrations. Always a highlight of the conference, attendees have the rare opportunity to ask their pressing questions to the world’s top skin of color dermatology experts.

While the agenda is overflowing with ground breaking, informative talks, here are the top 10 sessions you won’t want to miss…..

Understanding Hair Loss in Skin of Color Patients
Presented by: Valerie Callender, MD

Alopecia can be seen in woman and men, and in all nationalities. However, certain beauty habits such as hair styles, frequent chemical processing and innate genetic factors cause those with skin of color to be particularly susceptible to more forms of hair loss.Hair Loss Expert, Dr. Valerie Callender will review the most common types of hair loss in skin of color patients and share her concise and accurate assessment approach for alopecia. Enhance your existing treatment strategies with personal practical pearls from Dr. Callender’s practice, and increase your clinician confidence with medical management of hair loss in skin of color patients.

Panel Discussion on Cosmeceuticals: Effective Ingredient Choices for Skin of Color Patients [Hands-On session]
Presented by Maritza Perez, MD & Wendy Roberts, MD

With the thousands of skincare products on the market it can be difficult to know what’s the best for your patient. Dr. Maritza Perez & Dr. Wendy Roberts discuss their favorite products for pigmented skin, which ingredients to avoid, and which ingredients everyone should be using. Participants get the opportunity to touch, feel and experience the latest cosmeceuticals on the market.

Minimizing Laser Complications in Skin of Color Patients
Presented by: SOCSS Co-Chairman Eliot Battle, MD

Lasers have advanced dramatically to the point where we now have numerous devices that are safe and effective for SOC…….in the right hands. Laser Pioneer, Dr. Eliot Battle reviews how to minimize complications by selecting the ideal laser, precautions, and protocol for patients with skin of color.

Sexually Transmitted Diseases in Skin of Color: Crisis State
Presented by Ted Rosen, MD

The CDC announced at the end of 2017 that Sexually Transmitted Diseases are at record highs and continue to increase in incidence. Individuals who fall in the Skin of Color category are at increased risk of acquiring an STD. Dr. Ted Rosen will review epidemiology and clinical manifestations of STDs in the current crisis situation. Attendees will learn to recognize clinical manifestations, manage common manifestations and identify long term risks of STDs.

Acne Scarring Live Demonstration

Acne scarring is a physical condition that can have a huge psychological impact, occurring in up to 14% of women and 11% of men. It affects all ages and can destroy self-confidence, affect relationships and even shape the way people live their lives. Until recently, the prevailing opinion was that acne scars in skin of color were nearly impossible to treat given that past treatment options were so ineffective. Our expert faculty will demonstrate one of the most safe, effective, and comprehensive scar treatment programs currently available for pigmented skin.

The Skin Lightening Dilemma: A Candid Conversation with the Experts – Panel Discussion
Presented by: Eliot Battle, MD, Seemal Desai, MD, Valerie Callender, MD

The trend of darker skinned individuals seeking a lighter skin tone is a dangerous one that drives the demand for potentially harmful treatments such as high strength topical bleaching agents and intravenous Glutathione. This expert panel will discuss this sociological health trend, the dangers hiding in some OTC treatments, and the difference between healthy & safe skin lightening and unhealthy skin bleaching.

Disorders of Hyperpigmentation: Melasma & PIH
Presented by: Seemal Desai, MD

One of the most common dermatological complaints from patients with skin of color is dyspigmentation, particularly hyperpigmentation. The challenge for clinicians is to establish correct diagnoses along with consistently successful treatments to meet the needs of the increasingly diverse population served. Treatment modalities pose many limitations due to the number of treatments required, potential side effects, and overall efficacy. Fortunately, multiple therapies have been delineated that can be moderately to highly efficacious in treating hyperpigmentation in patients with skin of color. Review the newest research and literature surrounding these conditions with Dr. Seemal Desai as he shares his personal practical pearls regarding hyperpigmentation differential diagnosis, diagnostic techniques, and the latest in new and developing therapies.

Updates on the Prevention and Management of Keloids
Presented by: Hilary Baldwin, MD

Keloids are a common skin disorder in patients of color, and despite their benign nature, they may create severe aesthetic as well as functional problems that can negatively impact patients’ quality of life. While they are easy to treat, Keloids are characterized by a high rate of recurrence, and surgical intervention can possibly result in even larger lesions. Dr. Baldwin will explore how the patient expectation for surgical removal may not always reasonable/possible/appropriate, and the new evidence-basis alternate treatments available. You’re guaranteed to discover a new practical pearl to put into use in your practice!

Challenging Medical Dermatology Cases (Fungal Infections, CTCL, Sarcoidosis, AKN, PFB) – Case Based Panel Discussion
Presented by Andrew Alexis, MD and Ted Rosen, MD

Dermatological diseases may assume an unusual clinical morphology in skin of color, leading to diagnostic confusion, which in turn, leads to ineffective and untimely therapy. Dr. Alexis and Dr. Rosen will discuss unusual and atypical appearing cases and the proper diagnostic techniques to establish correct diagnosis’ and institute proper therapy.

Live Laser, Device and PRP Demonstrations

Enhance your consultation skills, improve your techniques, expand your anatomy knowledge and increase your understanding of complication management with guidance and live demonstrations from leading experts in aesthetic dermatology.