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Luciana Nofal

Skin of Color Seminar Series roundup

By Media Coverage, Sessions

Source: Dermatology Times

Eliot F. Battle, Jr., MD

The most discussed topic and most controversial session (in a good way) at this year’s Skin of Color Seminar Series in New York City was the panel discussion on the increasing trend of total body skin lightening and the ethical and health concerns that shadow it.

I started the panel discussion by outlining the medical and ethical concerns facing dermatologists regarding patients who are seeking treatments for total body lightening. I was followed by comments and a slide presentation from Dr. Valerie Callender, some practical advice by Dr. Seemal Desai ― who is considered one of the leading experts on skin pigmentation, and the conference’s co-founder and skin of color expert, Dr. Andrew Alexis who shared pearls of wisdom on the subject.

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Acanthosis-Nigricans-Mimicking-Melasma-boost-768x578

Acanthosis Nigricans Mimicking Melasma

By Skin of Color Update Agenda

Case Report and Pearls for Accurate Diagnosis – An Interview with the Author

During the 2018 Skin of Color Seminar Series (now the Skin of Color Update), approximately twenty posters could be seen hanging in the poster viewing area.  Each of these posters highlights novel and exciting research in skin of color. In one such poster, Dr. Monica Huynh and colleagues presented a case of acanthosis nigricans mimicking melasma.

Case Report

The patient was a 45-year-old female with a pertinent past medical history of diabetes mellitus type 2. They presented with discoloration of the cheeks for several years.  She had been treated previously with hydroquinone 4% with minimal improvement. Physical examination revealed brown-gray hyperpigmented, velvety, lichenified plaques on the lateral zygoma and hollow of the cheeks bilaterally as well as on the posterior neck.  Given the patient’s clinical presentation and past medical history of diabetes mellitus, a diagnosis of acanthosis nigricans was made. The dermatology team initiated treatment with salicylic acid cleanser twice daily, hydroquinone 4% cream twice daily, and tretinoin 0.025% cream nightly. After 8 weeks, the patient was switched to triple combination cream with improvement in facial hyperpigmentation. Due to facial dryness, the cleansing regimen was changed to salicylic acid cleanser in the morning and mandelic acid cleanser plus toner in the evening.

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Hair Loss Callendar

Understanding Hair Loss in Skin of Color Patients

By Skin of Color Update Agenda

These are clinical pearls from SOCSS 2018 on hair loss in skin of color patients by Valerie Callender, MD

At the Skin of Color Seminar Series 2018 (now Skin of Color Update), Dr. Valerie Callender focused on how structural differences in afrocentric hair and cultural haircare practices contribute to the high prevalence of alopecia in African American women in particular.

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

Dr. Callender started her lecture with an introduction to alopecia – one of the most common dermatologic concerns of African American patients. Given that healthy hair is considered to be a sign of beauty, youth, and attractiveness, alopecia has a huge negative impact on the quality-of-life of affected individuals. The psychological comorbidity of hair loss makes it essential that physicians understand the etiology, diagnosis, and treatment of common causes of scarring and non-scarring alopecia. *It is important to note that patients can present with BOTH scarring and non-scarring alopecia, and both must be considered during the work-up*.

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Ask a mentor Amy McMichael

Ask a Mentor Q&A Recap – Dr. Amy McMichael

By Skin of Color Update Agenda

We had the opportunity to ask a mentor,  Dr. Amy McMichael, chair and professor of dermatology at Wake Forest University Health Sciences and Skin of Color Update faculty, questions about establishing a career in academics, finding a mentor, and better serving patients of color.  See all of her insightful answers below.

Q1: I previously attended the Skin of Color Seminar Series (now Skin of Color Update) and while sitting in the audience, I noticed that many of attendees appeared to be white physicians. Do you think there’s a representation problem in Dermatology, and could it be impacting our patients?

However, we know from other research in the house of medicine that Dermatology is second only to Orthopedics in having the worst representation of African Americans. Also identified as a major problem is the poor pipeline of under-represented minorities in college, medical school, and ultimately, in residency. We all have lots of work to do in terms of mentoring at every level to get the pipeline full of appropriate candidates.

In addition to this, we need to all be thoughtful about looking at residency applicants who may not be traditional, but who would make resilient and excellent dermatologists.

Q2: Most dermatologists (at least most of the ones I know) seem to think they don’t need special training for treating patients of color and can’t seem to acknowledge that a gap in training exists. As a dermatologist of color, I find it personally frustrating. Do you find this to be true among your peers?  If so, how do you address this with them?

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Psoriasis Skin of Color Alexis

Psoriasis in Skin of Color: Are there differences in Presentation and Treatment?

By Sessions

While previously thought to be a rare diagnosis in non-white racial ethnic groups, more recent data has shown that psoriasis in patients with skin of color is much more common than was once thought. Dr. Andrew Alexis spoke during the Skin of Color Seminar Series (now Skin of Color Update) in New York City on May 5th, 2018 on this condition and on the important differences in clinical characteristics, diagnosis, and treatment of psoriasis in skin of color.

Beginning with the diagnosis of psoriasis in skin of color, it is important to be aware that the classic red plaque typically seen in Caucasian skin may appear more violaceous or even red-brown in our skin of color patients.  This can be confusing with the similar appearing, but histologically unique entity, lichen planus. Pay close attention to the distribution of the plaques—extensor surfaces and asymptomatic will favor psoriasis whereas flexural and pruritic may favor lichen planus. Other conditions that may be more common in our skin of color patients such as sarcoidosis or hypertrophic discoid lupus also need to be considered.

Once a diagnosis of psoriasis is established, it is important to understand the intricacies of treating the psoriasis in skin of color patients. For example, when treating psoriasis of the scalp, it is important to select practices and treatments that are compatible with the patients’ hair care regimen and hair texture. It is critical to determine how frequently patients are washing their hair and how feasible it is for patients to use a daily solution or medication on the scalp. One potential option shown to have clinical benefit is a mixture of calcipotriene and betamethasone dipropionate in a castor oil vehicle.

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Excerpt provided with permission. Originally published by Next Steps in Dermatology. All rights reserved.
Keloids skin of color update Baldwin

Updates on the Prevention and Management of Earlobe Keloids

By Skin of Color Update Agenda

This article features a recap of Dr. Hilary Baldwin’s talk on the etiology, risk factors, and treatment of keloids 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 talk. Dr. Baldwin focused on earlobe keloids (cartilage piercing keloid) in particular, which may present with several different morphologies: anterior button, posterior button, wraparound, dumbbell, and lobular. *Clinical pearls* from this session are bolded, underlined and marked with asterisks.

Some patients develop cartilage keloids and others do not. Based on a study of 220 patients at Kings County Hospital, there appears to be no difference in rate of cartilage piercing, metal sensitivity, types of earrings worn, piercing method, hormonal influences, or age at piercing between keloid formers and non-keloid formers.  In the keloid former group, 12.8% of patients developed keloids at the first piercing, and the risk of keloid formation dramatically increased at each piercing thereafter (70.2% risk for 2nd piercing).

Important Points:

*Ear pierces on babies have a 0% risk of keloids*

*Piercings done pre-menarche have a significantly lower risk of keloids than those performed post-menarche*

*First pierces rarely keloid*

*The chances of subsequent pierce keloiding in a keloid former is at least 20% or higher*

*Earlobe keloids are significantly easier to treat than classic keloids on the body.* Earlobes are a discrete tissue with little to no tension, pressure dressings can be used, and patients tend to be very motivated and compliant. *For surgery alone, recurrence rate on the ear is 39-42% (vs. 100% on body). Surgery plus corticosteroids and surgery with radiation therapy for earlobe keloids are associated with a 1-3% (vs. 50% on body) and 0-25% (same for body) risk of recurrence.* Imiquimod helps prevent keloid recurrence when used on the earlobes, but does not appear to be effective on other body parts.

Dr. Baldwin’s method for excising dumbbell keloids called *dumbbell keloids for dummies:*

  • Shave off anterior button
  • Shave off posterior button
  • Measure diameter of keloid core
  • Select punch to be at least 1mm wider than core
  • Stabilize and punch through to a tongue depressor
  • Suture right/left anteriorly and superior/inferior posteriorly

Unfortunately, not all keloids can be surgically excised. The major dogma of keloid surgery is “don’t leave any keloid tissue behind.” *Hilary’s dogma of earlobe keloid surgery is “a non-functional earlobe is a treatment failure.* Dr. Baldwin performed a study in 5 patients in whom complete removal of keloids would leave a non-functional earlobe. She sculpted the keloid to earlobe shape, injected interferon-alpha 2b 1.5-million units/cm, covered the wound with a compression earring, and allowed for secondary intention healing. In the patients who completed therapy, there was no uncontrollable recurrence at 4-6 year follow-up, although all patients are continuing the use of pressure earrings. Based on these results, *the combination of targeted keloid removal, interferon-alpha 2b injection, and pressure earrings may be an option for patients with large, difficult-to-treat keloids.*

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Register for Skin of Color Update for lectures and pearls on keloids and more.

Poster Session

Poster Interview: Socioeconomic and Geographic Barriers to Dermatology Care in Urban and Rural U.S. Populations

By Skin of Color Update Agenda

Brianna Olamiju, Next Steps Correspondent, interviewed Toral S. Vaidya, Medical Student at the University of Cincinnati College of Medicine, to dig deeper on her research study titled “Socioeconomic and Geographic Barriers to Dermatology Care in Urban and Rural U.S. Populations” recently published in theJournal of the American Academy of Dermatology and presented at the Skin of Color Seminar Series (now Skin of Color Update) in May 2018.

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Avoid Antibiotics for Acne Treatment When Possible

By Media Coverage

Source: Dermatology Times

Years ago antibiotics were used to treat acne because it was thought that the condition was an infectious disease, says Dr. Hilary Baldwin of the Rutgers Robert Wood Johnson Medical School in New Jersey. However, it is now realized that while Propionibacterium (P) acnes is implicated in the pathophysiology of the condition by producing an inflammatory cascade, acne is not the result of a bacterial infection because all adults have P. acnes in follicles and the severity of acne does not correlate with P. acnes counts.

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Skin of Color Perez skin Cancer

Skin Cancer Detection and Treatments in Latino Patients

By Skin of Color Update Agenda

During the 2018 Skin of Color Seminar Series (now the Skin of Color Update), Dr. Maritza Perez, one of the foremost leaders in skin of color dermatology, took attendees inside the world of the U.S. Hispanic population shedding light on the sociological diversity, cultural lifestyle hazards, and the healthcare disparities that increases their risk of deadly melanomas. Many Hispanics believe erroneously that they are less likely to get skin cancer, a dangerous preconception shared with many physicians who believe that this population is invulnerable to skin cancer, resulting in a delay in diagnosis and an unnecessary higher mortality rate.

Next Steps correspondent, Brianna Olamiju, reports back on Dr. Perez’s lecture and shares high- yield information all dermatologists should know.

 

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Aging through the Decades

By Media Coverage

Source: Dermatology Times

Dermatologists have always known that different ethnic skin types age at different rates, but until now there hasn’t been clear evidence that these phenotypic differences have a pathophysiologic and histologic basis. Maritza Perez, M.D., Icahn School of Medicine at Mount Sinai, New York, presented new research illustrating the aging process across the decades and how it differs between ethnic skin types. Read more.

References:

“The Evaluation of the Aging Process Across Ethnic Variations,” Maritza Perez, M.D. Skin of Colour Seminar Series. 5-6 May, New York. May 5, 2018