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Luciana Nofal

Lymphomatoid Papulosis JDD Skin of Color

Black Patients with Lymphomatoid Papulosis

By | SOC Manuscripts | No Comments

Lymphomatoid papulosis (LyP) is a CD30+ T-cell lymphoproliferative disorder (LPD) presenting as a recurrent eruption of papules and nodules which resolve spontaneously. CD30+ LPD prevalence in African American (AA)/Black patients is lower compared to White patients. CD30+ LPD has been recently reported to have worse outcomes in AA patients compared to White patients.

A retrospective chart review identified eight AA patients with LyP. Authors Shamir Geller MD, Sarah J. Noor MD, and Patricia L. Myskowski MD describe their experience with these eight patients and review the literature on similar cases.

To view a synopsis of the case published in the Journal of Drugs in Dermatology, visit Next Steps in Derm. Log in to JDDOnline.com for full access of the manuscript.

Racial Differences in Incidence

Major racial differences in incidence among cutaneous lymphoma subtypes have been reported. AA/Blacks have statistically higher incidence ratios of CTCL and MF than other races and a trend towards lower incidence of CD30+ LPD was found in a national US database, which included 31 AAs with CD30+ LPD. A more recent study of another database included 153 AA patients with CD30+ LPD who had a significantly shorter overall survival compared to Caucasians after adjusting for patient disease characteristics, socioeconomic factors and types of treatment.

Discussion

The case series and three additional case reports suggest an indolent disease course of LyP in AA/Black patients. There are several possible explanations for the previous findings on poor survival in AA patients with CD30+ LPD.

  1. These results might be due to inclusion of ALCL and borderline cases with poorer prognosis compared to LyP.
  2. Another possibility is that patients with more aggressive CTCL variants (eg, transformed tumor-stage MF) might have been misdiagnosed or miscoded as CD30+ LPD.
  3. Results support previous reports on an earlier-onset of disease seen in AA/Black patients with LyP5 as well as with other CTCL subtypes, such as MF.  The self-healing crops of papules and nodules can be easily misdiagnosed as other malignant or inflammatory skin conditions (eg, arthropod bites).
  4. The diagnosis of early-stage patch stage MF may be more difficult in Black skin where erythema is less pronounced compared to lighter skin types.

Treatment Approaches

The case series highlights the need for additional studies before clinical recommendation can be made regarding prognosis and treatment in different race groups. Careful physical examination should be performed in Black patients who are diagnosed with LyP and no known history of MF. Once the diagnosis of LyP is made, several treatment approaches are possible.

  1. Noninterventional (“wait-and-see”) strategy is a legitimate approach, especially in patients with a limited number of lesions.
  2. Topical and skin-directed therapies (including topical steroids and phototherapy), and low-dose methotrexate are the best documented therapies for LyP.
  3. There is currently no curative therapy for LyP though the efficacy and safety of brentuximab vedotin, an antibody- drug conjugate directed against CD30, has recently been assessed for the treatment of LyP in 12 patients, including 2 AAs. Brentuximab vedotin was reported to be effective in treating LyP and has been suggested as a possible therapy in severe and refractory cases. Further studies are ongoing to optimize its dosing and to minimize adverse events.

In conclusion, a diagnosis of LyP should be considered in Black patients who present with recurring eruption of papules or nodules that resolve spontaneously. Patients with LyP should be carefully examined for concurrent or later development of MF. Although an indolent course may be expected in Black patients, residual hyperpigmentation and scars following resolution of the LyP lesions are common in this population, highlighting the need for better treatments of this disorder in the Black population.

The Journal of Drugs in Dermatology is available complimentary to US dermatologists, US dermatology residents and US dermatology NP/PA. Create an account on JDDonline.com and access over 15 years of PubMed/MEDLINE archived content.

Rosacea in Skin of Color

Rosacea in Skin of Color

By | Medical Dermatology, Sessions | No Comments

What is Rosacea? 

Rosacea is a common chronic inflammatory skin disease that primarily impacts the face, and includes papules, pustules, erythema, telangiectasias, perilesional redness, phymatous changes, and even eye involvement. Symptoms may vary among different patients and even vary over time in an individual patient. Central facial redness affects many adults and can be an indicator of the chronic inflammatory disease rosacea. Rosacea is a clinical diagnosis based on the patient’s history, physical examination, and exclusion of other disorders.

Rosacea is often under-diagnosed, particularly in individuals with skin of color. As a result, Skin of Color Update held a lecture on the topic at the most recent event.

Rosacea: Nuances in Clinical Presentation and Treatment 

At Skin of Color Update 2019, Dr. Fran Cook-Bolden aimed to catch us all up to speed in how to recognize rosacea in more richly pigmented skin. Her lecture on Rosacea: Nuances in Clinical Presentation and Treatment was brimming with practical tips on how to identify the often subtle and overlooked ways that rosacea can manifest in skin of color.  The following is an excerpt of an article by Kimberly Huerth, MD published on Next Steps in Derm.

Because rosacea can have a nuanced presentation in skin of color (SOC), with erythema and telangiectasias that may be difficult to discern in the setting of increased background pigmentation, it was incorrectly assumed for a long time to simply not be there. The reality is that the prevalence of rosacea in SOC is not well characterized but is likely underestimated.1Dermatologists who see a large number of SOC patients, however, will tell you that rosacea is by no means rare in this population. And I am one of these dermatologists—at my Howard University clinic, where I see predominantly black and Hispanic patients, I see several of cases of rosacea every week.

And because a diagnosis not considered is a diagnosis not made, there is often unnecessary progression of rosacea in SOC patients that results from delayed and/or inaccurate diagnosis, which in turn engenders inappropriate or inadequate treatment. As a consequence, this can lead to morbidity in the form of disfiguring, occasionally irreversible cutaneous findings, as well as intense and chronic emotional distress.

Pearls

  • Look for the nuanced clinical findings!!
  • Fixed centrofacial erythema may appear more reddish/violet
  • A patient complains of “acne,” but has no comedones. Additionally, papules and pustules are superimposed on an erythematous background. Inflammatory papules may also appear on the chest and back.
  • Telangiectasias can be difficult to appreciate with the naked eye in FST V – VI, so use your dermatoscope to help you find them
  • Check for scleral injection, which may be a sign of ocular rosacea. Be aware that the onset of ocular findings may proceed cutaneous ones.
  • Phymatous rosacea is a giveaway!
  • Facial edema of the upper 2/3 of the face in a patient who has complained of longstanding rosacea symptoms may represent progression to Morbihan disease. Case in point (quite literally)—a poster that I presented at the Skin of Color Update highlighted a case of Morbihan disease in a black man who had reported symptoms of rosacea to his non-dermatology providers for 16 YEARS before he came to see me and received a correct diagnosis. To learn more about this case, and Morbihan disease, check out Dr. Lola Adekunle’s interview on Next Steps in Derm.
  • Pertinent negatives are just as important as pertinent positives. Know that post-inflammatory hyperpigmentation (PIH) is ALMOST NEVER directly related to rosacea, unless the disease is very chronic and severe OR if the patient has been injured their skin in some way while trying to self-treat disease manifestations (picking at lesions, using harsh topical therapies)

For more rosacea pearls and AHA moments, visit the article on Next Steps in Derm.

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Skin of Color Update Skin Lightening

Skin Lightening in Skin of Color: What You Need to Know

By | Media Coverage | No Comments

The following is an excerpt from Next Steps in Dermatology based on a Pearl Grimes, MD lecture at Skin of Color Update 2019.

The topic of skin lightening can be very controversial, but the reality is that there is a large market for skin lightening and learning to treat patients in the safest way is the priority. At the 2019 Skin of Color Update, a lecture on skin lightening included panelists: Dr. Eliot Battle, Dr. Pearl Grimes, and Dr. Cheryl Burgess and featured their approaches to skin lightening.

  1. Skin lightening is still very common.
  2. Hydroquinone is still the gold standard.
  3. New therapies are on the horizon.
  4. More research needs to be done on glutathione.

Check out the full article on Next Steps in Derm for a more in-depth look.

Hispanic Skin Cancer Prevention

Hispanic Tattoo Artists and Skin Cancer Prevention

By | Uncategorized | No Comments

Hispanic Tattoo Artists Could Provide Skin Cancer Prevention via Aftercare Instructions and Social Media according to The Journal of Drugs in Dermatology (JDD).

Skin cancer, melanoma and non-melanoma, has increased recently in the Hispanic population.  When diagnosed with melanoma, the overall prognosis is generally worse for Hispanics and it presents at a later stage.

According to the authors, Cristian D. Gonzalez MD et al, the purpose of this study was to explore Hispanic tattoo artists’ skin cancer knowledge, sun safety recommendations, and their willingness to implement primary and secondary skin cancer prevention in their daily work routines.

Interesting to note, all Hispanic tattoo artists used some form of social media, 100% used Facebook and Instagram. Tattoo artists reported that a majority of their clients followed them on Facebook after their tattoo.

Ninety percent of Hispanic tattoo artists felt emotionally invested in their clients. None of the tattoo artists currently recommended sun protection involving the client’s whole body, all of the artists agreed they could influence skin cancer safety in young adults by providing full-body sun protection in their aftercare instruction on social media in English and in Spanish.

To read more of this article, head to JDDonline.com.

 

Skin of Color in Psoriasis Pearls from SOC Update

Psoriasis in Skin of Color: Pearls from SOC Update

By | Sessions, Skin of Color Update Agenda | No Comments

Andrew Alexis, MD, MPH, co-chair and co-founder of Skin of Color Update presented on Psoriasis in Skin of Color this past event.

Previously thought to be rare in patients of African ancestry, the prevalence of psoriasis is 1.6% in African Americans and 1.4% in Hispanics.

The talk, “Psoriasis: Distinct Clinical Features and Treatment Options of Psoriasis Patients of Color, ” was one of the top rated lectures of Skin of Color Update.

The lecture focused on the fundamentals of dermatology with an emphasis on several key characteristics.

  1. Color and distribution in the clinical presentation
  2. Recognizing common medical mimickers of psoriasis such as lichen planus, sarcoidosis, and cutaneous lupus erythematosus (.e. discoid lupus) in skin of color
  3. When in doubt, do not hesitate to biopsy

During the lecture, Dr. Alexis presented a game of “Psoriasis or Not?” allowing the audience to guess if the Kodachrome was psoriasis.  This illustrated the vast presentation of psoriasis and how papulosquamous disorders can be challenging to differentiate in skin of color.

To read more about this lecture and psoriasis in skin of color, visit the full article on Next Steps in Derm.

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Acne in Skin of Color Alexis

Acne in Skin of Color: What’s New and What’s to Come

By | Sessions, Skin of Color Update Agenda | No Comments

At Skin of Color Update 2019, our co-chair and co-founder, Andrew Alexis, MD, MPH  gave a lecture on Acne: What’s New and What’s to Come?  Our onsite correspondent, Kimberly Huerth, MD, M. Ed, provided the following recap of this is insightful session.  The read the full article, please visit Next Steps in Derm website.   Missed Skin of Color Update 2019? Purchase lectures like this on-demand

By: Kimberly Huerth, MD, M. Ed

I still treat my acne twice daily with a whole cabinet full of various topicals. I’ve tried and failed doxycycline because it disrupts every single molecule of bacterial flora in my body. I’ve tried and failed spironolactone because I was the poster child for nearly all of its annoying and inconvenient side effects. I’ve tried and failed several OCPs because my body was a little too convinced by the estrogen and progesterone that it was actually pregnant, and decided to make me persistently sleepy and nauseous. I could put the 650-microsecond Nd:YAG that we have in clinic to use, but can’t bring myself to bother my co-rezzys (or myself) at the end of a long day seeing patients. And yes, I’ve already done a course of isotretinoin…two courses in fact. And no, I don’t have PCOS. So when I settled in to hear Dr. Andrew Alexis’s lecture on Acne in Skin of Color: What’s new and what’s to come?, I was excited for some new strategies with which to help my patients, and myself.

Dr. Alexis not only shared expert insights and strategies on how to optimize treatment for acne in skin of color (SOC) patients, but he also laid out an overview of some of the new and emerging acne treatments that we will presently be able to add to our armamentarium!

This article will provide an overview of the following:

  • Understanding the unique presentation and needs of SOC patients with acne
  • Sarecycline, a new tetracycline class antibiotic
  • New topical acne medications in the pipeline

But first, let me share a few of the “A-ha” moments that I experienced during Dr. Alexis’s lecture, in the hope that they will entice you to read on…

Read more.

 

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Skin of Color Update On Demand Video

SOC Update Launches On-Demand Package

By | Sessions, Skin of Color Update Agenda | No Comments

New York (Nov. 5, 2019) Skin of Color Update launches on-demand video package. Skin of Color Update, the largest CE event dedicated to trending evidence-based research and new practical pearls for treating skin types III – VI expands educational offerings to include on-demand videos.

The demand for skin of color dermatology education is greater than Skin of Color Update’s ability to accommodate onsite. Therefore, SanovaWorks has produced and launched a Best of Skin of Color Update video package.  The video content is comprised of the highest attendee rated sessions of Skin of Color Update 2019.  On-demand videos include top-rated faculty lectures in-sync with PPT slides with accompanying audio files.

On-demand Lectures include:

  • Pearls for the Diagnosis and Treatment of Atopic Dermatitis and Eczema with Andrew Alexis, MD, MPH
  • Complex Medical Cases with Andrew Alexis, MD, MPH and Ted Rosen, MD
  • Surgical Approaches for Keloids with Maritza Perez, MD
  • Hair & Scalp Disorders Treatment Strategies: What, How and When? with Heather Woolery-Lloyd, MD
  • Pearls and Strategies for Preventing Laser Complications with Eliot F. Battle, Jr., MD.

The video content focuses on expert techniques, real-life clinical cases and expert pearls immediately useful in the practice.  For a video preview, click here.

Purchase the on-demand Best of Skin of Color Update video package and start learning from the experts today.

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Aesthetic Skin of Color

Consensus and Misconceptions Regarding the Aesthetic Skin of Color Consumer

By | Media Coverage, Sessions, Skin of Color Update Agenda | No Comments

Each month the Journal of Drugs in Dermatology JDD Podcast discusses a current issue in dermatology. During the month of September, podcast host Dr. Adam Friedman sat down with Skin of Color Update 2019 co-chair and co-founder,  Dr. Andrew Alexis, Chair of Dermatology at Mt. Sinai St. Lukes and Mount Sinai West to discuss misconceptions regarding the aesthetic skin of color consumer.

Dr. Angela Hou, PGY-3 dermatology resident at George Washington University School of Medicine and Health Sciences, shares key takeaways from Dr. Alexis’ JDD podcast titled ‘Capturing Consensus and Cutting Out misconceptions regarding the Aesthetic Skin of Color Consumer’.

Here is an excerpt recently published on our media partner, Next Steps in Dermatology.

Key Takeaways

  • There has been a rapid increase in the past 10 years in Fitzpatrick Skin Type IV-VI patient’s seeking aesthetic skin care, however the guidelines for skin of color is limited and more clarification and guidance is needed
  • This article helps reduce the gap in knowledge in regard to skin of color. This was difficult given the lack of evidence-based studies, therefore expert consensus was necessary for deciding on recommendations.
  • A common myth is that darker-skinned patients of African descent do not seek or need injectable fillers of the lips. Although lip enhancement is less common than in other populations, restoration of lip volume is still an important aesthetic concern, albeit at an older age than among Caucasian patients
  • Another knowledge gap is regarding skin of color patients with a history of keloids and the risks of developing keloids after filler injections. However, per the expert consensus, there are no known cases of keloids induced by soft tissue filler injections. Therefore, keloids should not be an absolute contraindication to fillers and should be evaluated on a case-by-case basis.
  • To read more of the key takeaways and words from the investigator, read the full article here.

To hear the JDD podcast, click here.

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Hair and scalp at skin of color

Hair and Scalp Disorders at the 2019 Skin of Color Update

By | Media Coverage, Sessions | No Comments

Heather Woolery-Lloyd, MD lectured on hair and scalp disorders at Skin of Color Update 2019.  Kimberly Huerth, MD, M Ed, provided top tips and salient pearls from the lecture in the Next Steps in Derm article.  Missed this lecture? Purchase it on-demand

Treatment Strategies for Hair and Scalp Disorders: Biotin & Beyond

By: Kimberly Huerth, MD, M Ed

A full head of hair. This is how I came away from Dr. Heather Woolery-Lloyd’s lecture on hair and scalp disorders at the 2019 Skin of Color Update. There were many aspects of her talk that challenged me to rethink how I approach the management of hair loss in my patients. In this post we will cover biotin’s role in treating alopecia, and important considerations in the treatment of central centrifugal cicatricial alopecia (CCCA)—two topics that Dr. Woolery-Lloyd took a deep dive into during her lecture.

So I have a potentially hair raising confession to make…I might start recommending biotin again to my alopecia patients! I have previously written about the use of biotin in the treatment hair loss, the gist of it being—don’t. The don’t is because most individuals are not biotin deficient, there are potential risks associated with supplementation (such as effects on the results of thyroid function and troponin testing), and scientific data supporting the use of biotin to promote hair growth are weak unless there is a proven biotin deficiency. But Dr. Woolery-Lloyd discussed the results of a recent study out of Switzerland that lead me to question whether I might want to rethink my previous stance on biotin—Bad hair day for me!

Biotin is a coenzyme that plays a role in protein synthesis, including the production of keratin (which explains its contribution to healthy nail and hair growth). Primary and secondary biotin deficiencies are both considered very rare. Secondary biotin deficiency is thought to be rare because our intestinal flora produce more than our daily requirement. However, there are certain risk factors that may predispose an individual to a secondary biotin deficiency, including gastrointestinal disease, certain medications (isotretinoin, antibiotics, anti-epileptics), smoking, alcoholism, advanced age, extreme athleticism, pregnancy, and lactation. Moreover, serum biotin levels can demonstrate daily fluctuations of up to 100%, which is important to keep in mind when trying to identify which patients have suboptimal or deficient levels of biotin.

Let’s examine this study with a fine toothed comb. Read more on NextStepsinDerm.com 

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Skin of Color update Medical Student scholarship for diversity

Skin of Color Update Offers Medical Student Scholarships

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By Lola Adenkule, MD and Skin of Color Update staff

Skin color comes in all shades. Similarly, dermatologists should reflect the diversity that is apparent in our patients. However, in the US, African-Americans make up 12.8% of the population while there are only 3% of Black dermatologists. Addressing this gap is beneficial because studies have shown race-concordant visits are longer and have higher levels of patient satisfaction and patient engagement.

Closing this gap could likely increase access to care for minority patients, greater interest and attention to diseases that disproportionately affect minorities, and create a more diverse work force of dermatologists. The challenge becomes how do we turn the tide. Expert faculty members from the Skin of Color Update have weighed in to offer their solutions to identifying barriers and the ways to overcome them. To read these solutions from the experts, visit this Next Steps in Derm article by Lola Adenkule, MD.

To help address this gap in dermatology, Skin of Color Update 2019 increased their scholarship program for medical students, fellows and dermatology residents. Scholarship awards were provided to 7 medical students, residents and fellows with an interest in dermatology or currently enrolled in dermatology training.

SOCU Experts

Susan Taylor, MD, Andrew Alexis, MD,MPH,  Heather Woolery-Lloyd, MD and Maritza Perez, MD were among the Skin of Color Update 2019 faculty experts to spend time with the scholarship awardees.

Apply for 2020

If you are currently a medical student or dermatology resident interested in applying for Skin of Color Update 2020 scholarships please continue to check back for additional information. When information is available, here are the items you may need to be considered.

  1. Letter of recommendation
  2. C.V.
  3. Letter describing why you want to come to Skin of Color Update