Source: JDD Online
The Journal of Drugs in Dermatology recently featured the article, The Relevance of Vitamin D Supplementation for People of Color in the Era of COVID-19, authored by Skin of Color Virtual Update faculty, Pearl E. Grimes MD, and Andrew F. Alexis MD MPH along with Nada Elbuluk MD MSU.
African Americans (AA) and other people of color are dying at highly disproportionate rates from COVID-19. The statistics are staggering: in New York City alone, per 100,000 population, death rates in AA were 92.3, and in Hispanics 74.3, compared to 45.2 in Whites and 34.5 in Asians.1 Similar numbers have been reported in other cities and are presumed underestimations, given limited racial/ethnic reporting. In the states currently releasing the number of COVID-19 deaths by race and ethnicity, Blacks make up roughly 13 percent of the population, but 27 percent of the deaths. According to the American Public Media Research Lab, the rate of COVID-19 deaths nationally for Blacks has been reported as twice the rate of deaths of Asians and Latinos in the US and more than 2.5 times the rate for White residents.
Socio-economic reasons, pre-existing comorbidities, work circumstances, inconsistent healthcare access, stress, and decreased immunity, amongst other factors, have been posited as reasons for this shocking disparity. People of color, in particular AA and Hispanics, are more likely to be uninsured and to be frontline workers during the COVID-19 pandemic. This is compounded by the fact that comorbidities such as hypertension, diabetes, asthma, obesity, and cardiovascular disease are more common in AA and are also associated with higher COVID-19 mortality rates. Emerging evidence suggests that Vitamin D deficiency may represent another risk factor for poor outcomes from COVID-19.
Relevance of Vitamin D
Vitamin D is a secosteroid hormone synthesized in the skin following exposure to UVB ultraviolet radiation where it mediates the conversion of 7-dehydrocholesterol to pre-Vitamin D3. Following transport to the liver, it is hydroxylated to 25(OH)D, the primary circulating form typically used to measure serum Vitamin D levels. 25(OH)D is subsequently converted to the biologically active form 1,25, dihydroxy vitamin D in the kidneys by 1-alpha hydrolase. This active form binds to its nuclear Vitamin D receptor to induce the transcription of over 200 genes, affecting a wide range of physiologic functions.
Multiple studies have documented significant Vitamin D deficiency in people of color, especially in AA. Heavily melanized skin retards the synthesis of Vitamin D and necessitates longer periods of sun exposure for adequate synthesis of Vitamin D. Ginde et al. assessed demographic differences and trends of Vitamin D insufficiency in a US population.2Serum 25(OH)D levels were compared over two time periods (1988–1994 and 2001–2004) from the Third National Health and Nutrition Examination Survey (NHANES III) data base including two large populations (n=18,883 and n=13,369, respectively). Non-Hispanic Blacks had a significantly higher prevalence of Vitamin D deficiency, increasing in severity in the later data base. Recent NHANES data from 2011–2014 further documented the high risk of deficiency in non-Hispanic Blacks. In a recent prospective cohort study of 14,319 subjects, an estimated 65.4% of non-Hispanic Blacks were deficient in Vitamin D, compared to 29% of Hispanics and 14% of non-Hispanic Whites.3
Vitamin D deficiency has been shown to be a risk factor for many of the comorbidities that disproportionately plague AA including diabetes, hypertension, cardiovascular disease, autoimmune diseases such as lupus erythematosus, as well as aggressive forms of breast and prostate cancer.4 While the classic role of Vitamin D involves calcium and phosphorus homeostasis for healthy bone metabolism, it exerts a spectrum of pleotropic effects impacting cell growth, differentiation, inflammation, and immune regulation. Healthy levels of Vitamin D have been linked to significantly reduced mortality and improved health outcomes. Numerous investigations document the prolific role of Vitamin D in antimicrobial defense and modulation of the innate and adaptive immune responses. It mediates the induction of key antimicrobial peptides in the respiratory epithelium including cathelicidin (LL37) and beta defensins, which destroy invading organisms. In addition, Vitamin D inhibits the production of pro-inflammatory cytokines including IL-2, IFN-γ, TNF-α, and IL-6, while promoting Th2 responses by increasing IL-4, IL-5, and IL-10 production, hence skewing T cell responses to a down regulated, anti-inflammatory state.4
For the general population, the US Institutes of Medicine (IOM) recommends Vitamin D supplementation at doses that vary according to age and are based primarily on bone health. Current IOM supplementation recommendations are 400 IU (10ug) for infants, 600 IU/d (15ug) for children, adolescents, and adults, and 800 IU/d (20ug) for adults aged over 70 years to maintain a 25(OH)D concentration of 20ng/mL or higher. However, in individuals who are deficient in Vitamin D (25(OH)D level <20 ng/ mL), of which patients with skin of color are at a higher risk, supplementation is considerably higher. These recommendations are summarized summarized in Table 1.5
Source: Next Steps in Derm
Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia that is currently regarded as a variant of lichen planopilaris. FFA has historically been considered rare in black patients, in whom traction alopecia, central centrifugal cicatricial alopecia, and androgenetic alopecia are frequently assumed to be more common. JDD author Kimberly Huerth, MD, ME describes a case of FFA in a black woman that both clinically resembled androgenetic alopecia and lacked many of the physical exam and dermoscopic findings associated with FFA. In doing so, she highlights the need for physicians to have a high index of suspicion for FFA in any black patient who presents with frontotemporal alopecia.
REPORT OF A CASE
A 53-year-old African American woman presented with a 6-month history of asymptomatic, moderately severe hair loss along the frontal hairline, which had not stabilized or improved with minoxidil 2% solution BID. Physical exam revealed decreased hair density affecting the frontal scalp, suggestive of androgenetic alopecia (Figure1). Dermoscopic examination showed decreased follicular ostia without perifollicular scaling or erythema. Eyebrow alopecia, facial papules, and glabellar red dots were absent, and there was no associated loss of body hair. A 4-mm punch biopsy sent for histopathologic examination revealed dense, chronic, perifollicular inflammation affecting the mid and upper portions of the follicles, with loss of associated sebaceous glands. Involved hairs demonstrated vacuolar interface disruption of the basilar and epibasilar layers at the level of the isthmus and infundibulum, with prominent exocytosis of lymphocytes into the outer root sheath. There was no miniaturization, dermal mucin, or inflammation affecting the epidermis, arrector pili muscles, and eccrine glands (Figure 2).
A diagnosis of FFA was confirmed by these findings. Our patient was managed with intralesional triamcinolone acetonide (10mg/cc) injections, clobetasol 0.05% ointment BID, hydroxychloroquine 200 mg PO BID, and minoxidil 5 mg PO daily. Unfortunately, her alopecia did not stabilize with these measures.
FFA is a primary lymphocytic cicatricial alopecia that is currently regarded as a variant of lichen planopilaris. It is characterized by band-like frontotemporal hairline recession, often with associated eyebrow alopecia, perifollicular erythema, and scaling. Clinical findings are frequently accompanied by pruritus and burning of the affected scalp. Since it was first described in 1994,1 FFA has largely been viewed as an alopecia of post-menopausal Caucasian women. This archetype has been maintained by patient demographics of subsequent published case series.2,3 FFA may thus be underdiagnosed in black women, in whom traction alopecia, central centrifugal cicatricial alopecia, and androgenetic alopecia are assumed to be more common. Furthermore, FFA can manifest uniquely in black women, who may be premenopausal4,5 and asymptomatic4 at the time of presentation. Classic signs of FFA may be subtle or absent among black patients, as increased pigmentation may render erythema difficult to appreciate, while oils and hair care products may diminish the appearance of scale.
It is important for dermatologists to both recognize that FFA is not uncommon in the black population,4,5 and to acknowledge how it initially came to be regarded as a disease of post-menopausal white women. Several of the larger published series come from geographic areas that lack a substantial skin of color population.2,3 There are also socioeconomic factors to consider. One series comprised exclusively of Caucasian women found their patients to be more affluent, which was speculated to be a surrogate marker for an unknown risk factor associated with the development of FFA.3 What these authors did not discuss, however, is that affluence enables access to specialty medical care. Affluence affects insurance status, which has been shown to vary widely among racial groups.6 Insurance status in turn bears upon who has access to dermatologic care, and who is ultimately included in a case series.
SKIN OF COLOR UPDATE 2020 MOVES TO VIRTUAL EXPERIENCE
Live sessions to be held September 12-13
New York (June 30, 2020) – Skin of Color Update, the largest medical education event focused on the dermatologic treatment of skin of color, is moving its 2020 event from an in-person to a virtual experience. The event will still be held September 12-13.
“We’ve made this difficult decision as a result of our goal to keep everyone safe, which was backed up by the wishes of the audience as demonstrated in a survey answered by more than 300 dermatologists,” said Shelley Tanner, CEO and president of SanovaWorks, which produces Skin of Color Update. “We know our mission of providing evidence-based research and practical pearls for treating skin of color is more important than ever. We are committed to providing the same essential content in a virtual setting.”
The Skin of Color Update agenda has been modified to reflect virtual learning. Live sessions, Q&A, poster sessions and panel discussions are included in the program.
Due to the change to virtual learning, the registration costs have been reduced. Registration is available to most medical professionals for $49. Registration includes unlimited access to on-demand content for the remainder of 2020.
“We hope the reduced costs and ease of attending will allow more dermatologists to learn how to care for the skin, hair and nails of our diversifying population,” said Skin of Color Update co-chair and founding dermatologist Eliot Battle, MD. “Everyone deserves safe and effective care no matter their skin color.”
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. Sessions will address medical, surgical and cosmetic dermatology.
Skin of Color Update is a product of SanovaWorks, the publisher of the Journal of Drugs in Dermatology (JDD) and the producer of the ODAC Dermatology, Aesthetics & Surgical Conference.
CE credits (AMA PRA Category 1™) can be earned. Registration is available at skinofcolorupdate.com.
Business intellect, a vital aspect of managing a practice, is not taught in residency. From the infancy of their training, dermatologists are trained to think broadly and scrupulously, using each clue, each corporeal sense, and each available tool to accurately diagnose and manage a plethora of cutaneous conditions. After residency, dermatologists set out armed with the knowledge and drive to deliver expert care to their future patients. However, despite their education and best intentions, lack of business acumen can hinder even the brightest and most motivated of practitioners. In order to enlighten oneself in the complicated field of business management, clinicians are left to fend for themselves, often learning as they go, sometimes making unnecessary mistakes, and adjusting their business practices reactively. Retrospective “trial and error” learning is time-consuming, cumbersome, and costly. Why not short track and get the goods without the trial and error, making costly mistakes and taking years. The new book, The Business of Dermatology is a cornerstone achievement in the standardization of business education for dermatologists.
Edited by Drs. Jeffrey S. Dover and Kavita Mariwalla, and authored by impressive experts in the field, The Business of Dermatology offers a comprehensive guide to opening, maintaining, and sustaining a practice. To start, the power of this textbook fundamentally lies in the experience and scope of its authorship. The authors were hand-selected by the editors ensuring that each chapter was written by a tried and true expert in that subject. Unlike other textbooks in the field of business management and administration that are primarily written by individuals from the business world, some of whom have no insight into the inner machinations of the medical world, or hands-on experience, the authors of this book are well-known, respected dermatologists that hail from thriving practices of their own. The reader has an unprecedented opportunity to learn from the firsthand experiences of top authorities who live and breathe dermatology. Using conversational prose, the authors depict their experiences, trials, and errors, employing specific real-world examples and scenarios while tackling each subject.
On behalf of Skin of Color Update co-chairs, Andrew Alexis, MD, MPH and Eliot F. Battle, Jr. MD, and conference organizers, we know the past months have been a very challenging time for everyone in our country and around the world and we stand together with you.
Based on the results of our Skin of Color Update audience survey, and with the safety of everyone in mind, we have taken this opportunity to reimagine the meeting for today’s landscape. We have made the decision to change the conference to a virtual learning experience.
This is a difficult, but necessary decision and we appreciate in advance your understanding. The mission of Skin of Color Update Virtual (SOCVU), to provide trending evidence-based research and new practical pearls for treating skin types III-VI, is now more important than ever and we are committed to providing the same essential content in a virtual setting.
Skin of Color Update Virtual will continue to be held virtually on September 12 -13, 2020 with a revised agenda to accommodate the updated setting. Live sessions, Q&A, poster sessions and panel discussions will be included in the program. The full agenda can be found here.
All registrants will receive access to the content, on-demand, following the event through December 31, 2020.
The below was sent to the employees of SanovaWorks.
This is an issue we should all be aware of, we should all be engaged in, and we should all be actively fighting together against for a solution. Each company, as a collective of humans, has a responsibility to do everything we can to protect our fellow humans and ensure that we all have access to the things we hold dear. We cannot stand by knowing that our fellow Americans are being targeted unjustly from all angles.
On the heels of the global and national devastation of the coronavirus pandemic, we are witness to the glaring evidence of an epidemic that has existed for hundreds of years in the USA, and that is the systematic racism and injustice against black Americans. The devastation that results from this affects lives in literally every facet: education, careers, health, families, finances, safety, etc.
The pandemic unveiled in clear numbers the disparity between black and white communities in this country, where only 13% of the population are African American, yet represent 23% of the deaths. In some states, like Georgia, African Americans make up little more than 30% of the population, yet almost 50% of deaths are from within this group.
On May 25th this year George Floyd, a black man from Minneapolis who is also a brother, a cousin, a nephew, a friend, a boyfriend, a son, and a fellow human, was murdered in a horrific incident that has reinvigorated people to stand up and say that this is not acceptable, spurring the nationwide protests that are not only just, but also necessary to demand change for a reality that has been accepted through complacency and inaction.
What can we do?
For our employees who are impacted by this, we need to support you. As a team and your friends we are here to back you up.
If you don’t already know how you can personally help, I hope you will take the time to learn what we can all be doing at this time to be a part of the solution. You might feel helpless or overwhelmed by this matter, and feel like there is nothing you can do, but this is part of the problem. Doing nothing is a choice and an action. The support we show for one another matters. One of my friends sent me this article on the weekend, for which I was extremely grateful, as it outlines many things we can all be doing for racial justice.
President Barack Obama
On June 1, President Obama published an article on how he believes we can use what is happening now as a turning point for real change that is definitely worth the read. In this article there is a link to a very detailed report and toolkit developed while he was in office by the Leadership Conference on Civil and Human Rights, along with a dedicated site of resources and organizations to learn about and get involved with.
Below is a list of grassroots organizations supporting this cause. I have personally donated, and I encourage you all to consider doing the same. There are many more that I have read about and perhaps that speak to you more personally. I encourage you to look up some of these groups and read about what they are doing.
On Wednesday June 3rd
We as a company will take a moment of silence at 1:30pm ET to reflect on these injustices, and how we personally might help. I would like us all to pause together and show solidarity. For those who choose to sit on their own, know we are with you.
I am committed to ensuring that this is not the end of the conversation for SanovaWorks. Stay tuned for more information and please get in touch with me directly if you have thoughts on this. I welcome all ideas and feedback.
And finally. To ALL of our friends of color: know that we see you, we appreciate you, and we will do everything we can to support you.
Shelley N. Tanner
Source: Journal of Drugs in Dermatology
The recommendations are noted in the article, Considerations of Managing Lichen Planopilaris With Hydroxychloroquine During the COVID-19 Pandemic, will be available in the June print issue of the Journal of Drugs in Dermatology.
Chloroquine (CQ) and hydroxychloroquine (HCQ), two well-known drugs among dermatologists, have shown their efficacy in the inhibition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication.1,2 HCQ is found to possess a better clinical safety profile, more potency, and fewer drug–drug interactions compared to chloroquine.3 HCQ has been reported to exert efficacy in the inhibition of SARS-CoV-2 in vitro replication through diverse mechanisms. First, it interferes with the glycosylation of angiotensin-converting enzyme 2 (ACE2), resulting in a subsequent reduction in the binding efficacy between ACE2 on host cells and the SARS-CoV-2 spike protein. Second, it blocks the fusion of the virus to the host cell. Finally, it suppresses the “cytokine storm” accountable for the disease progression to acute respiratory distress syndrome (ARDS). Although studies are underway to confirm the in vivo effectiveness of HCQ in the SARS-CoV-2 infection, promising primary results have led to a shortage of the drug for dermatologic purposes, which is a real concern in the current pandemic.1
While we are amid a pandemic with the possible shortage of HCQ, dermatologists should be reminded that:
- The anti-inflammatory effect of HCQ may improve the clinical signs of LPP; however, administration of this drug is insufficient to prevent the subclinical disease progression.9 Dermatologists may discontinue the use of HCQ in responders after 1 year with monitoring the patients for recurrence or relapse.5
- Topical and intralesional super potent corticosteroids are recommended as the first-line treatment in localized LPP.4
- Oral cyclosporine followed by systemic corticosteroid may be the most effective medications in LPP; however, disease relapse may be detected.10 Mycophenolate mofetil has a more favorable safety profile compared to cyclosporine11 but the immunosuppressive nature of these medications necessitates extreme caution toward their administration during COVID-19 pandemic.12
- Acitretin (25 mg/day) may be an appropriate alternative since it has shown improvement in 66% of patients.7
- Pioglitazone (hypoglycemic drug, 15–30 mg/day) has shown some efficacy in the treatment of LPP and can be considered as an alternative to HCQ.4
- Tetracyclines antibiotics can also be considered as an alternative due to favorable outcomes in previous studies.13
Source: Dermatology News
This is an excerpt from Dermatology News’ coverage of Skin of Color Update 2019.
For Wendy Roberts, MD, reported at the Skin of Color Update 2019.has been found highly effective,
“We didn’t have great treatments for this problem in the past, but the technology has evolved, and you can now get most women clear,”, a dermatologist who practices in Rancho Mirage, Calif., said at the meeting.
This approach is appropriate in all women, but Dr. Roberts focused on her experience with black patients, for whom an antioxidant cream is added to address the inflammatory-associated hyperpigmentation that often accompanies pseudofolliculitis barbae, a chronic inflammatory skin condition typically characterized by small, painful papules and pustules.
Start with microdermabrasion to treat the hypertrophic hair follicles and address keratin plugs, Dr. Roberts said. The microdermabrasion smooths the skin and increases penetration of subsequent creams and topics, she said.
“In the same session, I treat with Nd-YAG 1064 nm laser using short pulses,” she noted. For black women, she makes four passes with the laser at a level of moderate intensity. For those with lighter skin, she might perform as many as six passes with the laser set higher.
The microdermabrasion is repeated monthly for three or four treatments, but can be extended for those with persistent symptoms, Dr. Roberts pointed out. She presented a case of a patient who required seven treatments to achieve a satisfactory response.
This webinar was previously recorded on April 27th, 2020 and is now available on demand. Almirall has graciously supported the on-demand broadcast of this webinar.
Skin of Color Update (SOCU) and JDD invite you to attend “COVID-19: Special Considerations for the Skin of Color Patient – A Conversation with the Experts”. During this 90-minute webinar, Dr. Andrew Alexis will be joined by skin of color key opinion leaders to discuss special considerations and practical approaches to managing dermatologic disorders in skin of color during the COVID-19 pandemic.
Topics to be addressed include the following:
- Hair Disorders
- Pigmentary Disorders
- Aesthetic Concerns
- Inflammatory Disorders (including acne, atopic dermatitis, psoriasis, and others)
- How to stay connected with your skin of color patients on social media
- Vitamin D deficiency among people of color and its potential relevance to COVID-19 in patients of color
- COVID-19 related shifts in common dermatologic concerns in skin of color
- Impact on the practice of aesthetic dermatology for skin of color
Andrew Alexis, MD, MPH (Chair, Department of Dermatology, Mount Sinai West and Mount Sinai Morningside and Professor, Icahn School of Medicine at Mount Sinai)
Eliot F. Battle, Jr., MD (CEO and Co-Founder of Cultura Dermatology & Plastic Surgery)
Amy McMichael, MD (Professor and Chair of Dermatology, Wake Forest Baptist Medical Center)
Heather Woolery-Lloyd, MD (Director, Skin of Color Division, University of Miami School of Medicine)
Pearl Grimes, MD (Founder and Director, Vitiligo and Pigmentation Institute of Southern California)
Source: JDD Online
The following is an excerpt from the Journal of Drugs in Dermatology article, Long-Term Benefits of Daily Photo-Protection With a Broad-Spectrum Sunscreen in United States Hispanic Female Population.
The demographics of the United states are evolving with a large increase in racial and ethnic diversity driven by international migration of Hispanic, African, and Asian populations leading to a minority-majority shift in ~2050 towards persons of color (Fitzpatrick III, IV, V, and VI).1 Specifically, the Hispanic population is projected to be among the fastest growing population in the US, projected to increase from 55 million in 2014 to 119 million in 2060, a change of +115%.1
Subjects with skin of color are heterogeneous with multiple shades and tones and different reactions to intrinsic and extrinsic aging factors due to structural and physiologic differences.2,3 Skin of color individuals have fewer visible signs of aging (deep wrinkles, fine lines, rough surface texture, and sun spots). However, darker skin tones are more susceptible to certain skin conditions including post-inflammatory hyperpigmentation (may occur after acne, eczema, injury, laceration, melasma, post-inflammatory hypopigmentation, pityriasis alba (round, light patches covered with fine scales), dry or “ashy” skin, dermatosis papulosa nigra, and/or greater risk of keloid development.2,3 The incidence of skin cancer among US Hispanics has also increased 1.3% annually from 1992 to 2008.4
Photodamage is characterized histologically by degeneration of the connective tissue and abnormalities in keratinocytes and melanocytes. Clinically, it manifests primarily with wrinkles, dyschromia, texture changes, and, in more severe cases skin cancer.5 Formulations containing broad spectrum sunscreens against both UVA and UVB play an essential role in the prevention of photodamage and UV-induced skin cancers.6,7,8 However, the majority of clinical research on photoprotection has been conducted on subjects with Fitzpatrick types I to III skin and have reported improvements in signs associated with skin aging and texture.9,10 Verschoore et al was the first to conduct a short-term clinical study in India with Phototype IV and VI subjects, and provided first evidence on the effectiveness of daily sunscreen use on skin tone and radiance.11 Similar benefits were observed in an 8-week study in US.12
Although sun protection is highly recommended by dermatologists for skin cancer risk-reduction and the prevention of premature aging or pigmentary disorders, adherence to the recommendations is not commonly observed among US Hispanics.13 Moreover, a large number of US Hispanics reside in areas with high UV index with a high degree of sun seeking behavior. Among Hispanic adults who report engaging in sun protection, they do so mostly by staying in the shade (53.7%) rather than use of sunscreen (32.3%) or wearing sun protective clothes (18.1%); while 36.7% of the subjects surveyed indicated that they never use sunscreen.14,15 There are sociodemographic factors that contribute to the adherence to safe sun behaviour such as education, age, and gender, etc, therefore there is a need to raise awareness of skin cancer risks, advocate for preventive measures and educate on benefits of sunscreen and sun protection among US Hispanics.16
The benefits of topical agents for reversal of sun damage has been well established. Use of retinoic acid and its derivatives or other drugs to reverse and improve sun damaged skin has been demonstrated in many studies.17,18 Long-term sunscreenuse along with other topical agents have also been shown to prevent photodamage and hyperpigmentation in fair-skinned subjects.19 For effective photoprotection, sunscreen products containing both SPF and PPD are essential to battle the harmful UVB (skin cancer risks) and UVA (photo-aging risks).20 Daily use of a broad-spectrum sunscreen (SPF 30) over a one-year period has also been demonstrated to improve clinical parameters of photodamage in phototype I-III subjects.10 However, a comprehensive long-term sunscreen use study in skin of color is lacking. Therefore, this study was designed to assess the benefits of sunscreen of SPF30/PPD 20 in Hispanic women of Fitzpatrick skin types IV and V over 12 months in comparison to a real-life observational group with subjects who did not use sunscreen regularly.
Discussions and Conclusions
Effective photoprotection is critical for healthy skin, in preventing skin cancers, reducing photodamage, and improving aesthetic appearance. A broad spectrum sunscreen protecting against both UVA and UVB irradiation is essential. Protecting against the UVA spectrum needs special attention, especially under daily diffused exposure, as UVA is more penetrating and less affected by seasonality and impacts photoaging and skin oxidative stress.22 It has been reported that in order to receive effective photoprotection on skin, a PPD value of 18 is desired.20 In this study, the investigational product with SPF 30/PPD 20 is considered sufficient for daily activity without prolonged direct sun exposure when applied properly. Concerning skin of color population, the use of sunscreen is lower than in Caucasians despite high prevalence of sun-related pigmentary disorders and rising rates of cutaneous cancers.4 This study provides strong evidence to educate and advocate for daily use of a proper sunscreen product for populations with high phototype skin.
The clinical evaluation demonstrated significant visible improvement in sunscreen group starting from 3 months and progressive increased over time. Benefits on multiple facial areas and body sites were visible (upper, mid- and lower face, neck, and hands), not only on pigmentary-related concerns (skin tone evenness, overall hyperpigmentation, dark spots, and blotchiness), but also on aging parameters such as fine lines, skin texture, and overall skin quality. This suggests that beyond the preventative benefits, long-term persistent use of a proper sunscreen may also allow the photodamaged skin to self-heal and repair over time.
Histological observations further supported the clinical findings. The observation that the real-life group had higher tendency for pigmentation incontinence is of strong research interest. It has been reported that UV irradiation can destabilize and damage the dermal-epidermal junction (DEJ), which facilitates the entrapment of melanin in the dermis.23 The dermal melanin is extremely difficult to remove, often resulting in stubborn hyperpigmentation.24 This is especially important for skin of color population in whom dermal hyperpigmentation lesions are common and can be worsened with excessive sun exposure. This study provides the first evidence that effective daily photoprotection can be a strategy to prevent dermal melanin formation by protecting the DEJ. A larger sample size study with DEJ biomarkers will help to further elucidate this hypothesis. Infiltration of CD68-positive Macrophages is a hallmark of the inflammatory response after UV irradiation. In the dermis, 2 out of 3 of the real-life biopsy samples showed significant increase in CD68 positive macrophage cells at 12 months compared to baseline, while such change was not observed in the sunscreen group. This suggests the potential preventative benefits of sunscreen in subclinical skin inflammation induced by chronic exposure to UV. In all of the histological evaluations, thegeographical location in which the study was conducted (Los Angeles versus Washington, DC) was not a strong contributing factor to any of the observed differences. However, the histological findings in this study are limited by the small number of biopsies obtained.
In summary, this 12-month study on long-term persistent use of an SPF30/PPD20 sunscreen on phototype IV and V subjects demonstrated significant improvement in skin quality and improvement in skin color and photoaging parameters. To our knowledge, this is the first study of this kind in skin of color and Hispanic population. This study confirms that effective sunscreen use is not only protective and beneficial for light skin population but is also critical in improving skin condition for skin of color patients. Overall, the study demonstrates that daily use of sunscreen can protect skin from photo related damage and even reverse some of the photo-damage that has already occurred in skin. In addition to previous studies that demonstrated the photo-protective properties of sunscreen use in normal and diseased skin states7,8,9,10 and in view of the fact that good photoprotection behaviors are not common among Hispanics,14,15,16 studies of this type can help educate and stress the importance of daily use of sunscreen and other sun protection behaviors in Hispanic and other skin of color populations.
Source: Next Steps in Derm
In this case series, JDD authors evaluate the efficacy and safety of intralesional triamcinolone acetonide injections (ILK) when used with topical minoxidil in the management of traction alopecia in 6 African American women.
Traction alopecia (TA) is a form of hair loss secondary to repetitive and/or prolonged tension to a hair follicle over an extended period of time. This typically results from wearing tight hairstyles, or an acute traumatic event.1,2 As the etiology is mechanical trauma of the hair follicle, it can occur in any ethnic/racial demographic or gender. It has been observed in ballerinas, as well as Sikh Indian males, all of whom wear hairstyles that exert tension on the frontotemporal hairline. However, most cases of TA occur in women of African descent.1,3
The diagnosis of TA can be made clinically, as well as through the histological examination of a scalp biopsy. The earliest signs of TA are perifollicular erythema and pruritus with or without surrounding papules and pustules.4 The fringe sign of TA is a clinical finding characterized by the presence of retained hair along the frontal and/or temporal hairline, and it has been shown to have high sensitivity for detecting early and late disease of TA.5 On dermoscopy, one may observe reduced hair density with an absence of follicular openings in late stages, and in earlier stages an absence of hairs with preserved follicular openings outlined in brown, particularly at the periphery of the patch of affected scalp, corresponding to the pigmented basal cell layer of the follicular infundibulum that can be seen on histology.6,7 The histological findings can also vary depending on the stage of the disease. Early findings on histology include trichomalacia, normal number of terminal hairs, preserved sebaceous glands, and increased number of telogen and catagen hairs.8 Late disease findings include a decreased number of terminal hair follicles which have been replaced by fibrous tracts, vellus hairs, and retained sebaceous glands.8
Recommended treatment for traction alopecia includes the use of minoxidil and intralesional steroid injections. However, evidence-based proof of the efficacy of ILK in the improvement of TA has not been reported in the literature. In this case series, we evaluate the efficacy and safety of intralesional triamcinolone acetonide injections (ILK) when used with topical minoxidil in the management of TA in 6 African American women.
A retrospective chart review was performed in patients carrying a diagnosis of TA, who were seen at an active hair disorder clinic between January 2016 and December 2017. All patients who were treated with ILK, and whose treatment progress were recorded with photographs were included. Those who used minoxidil as an adjunct treatment were also noted. The management of TA was assessed by comparing the changes in hair density along the frontotemporal hairline. All patients had been instructed to avoid tension-related hair care practices.
This study shows that ILK, when used in conjunction with topical minoxidil, is effective in halting TA progression, and in improving frontotemporal hair density in patients with TA. Our patients reported no adverse systemic effects from the injections that are commonly associated with corticosteroids, and only one patient reported itch in the frontotemporal hairline, a symptom which is more likely a side effect of the topical minoxidil or a manifestation of the TA pathology itself.
Of the TA patients seen, 6 met the criteria for our observational study. All 6 were African American females presenting for evaluation of frontotemporal hair loss, with ages ranging from 32 to 61 years. All subjects reported a history of hairstyling that exerted tension to the frontotemporal hairline at some point in their lives, whether it was recent, during childhood, or both. The clinical diagnosis of TA was established through the presence of the fringe sign. Five subjects had 3 to 4 ILK injections done at 6 to 8-week intervals, performed at a concentration of 5 mg/mL, while one subject (Subject #2) received only one treatment with ILK (Table 1) also at a concentration of 5 mg/mL. Injections were done both at the border of the hair loss in the frontotemporal hairline and extending backwards to include the normal density hair. Subjects concurrently used topical minoxidil 5% daily, and one subject (Subject #2) also took oral doxycycline. All subjects reported the cessation of all hair care practices that exert tension to the frontotemporal hairline, including tight ponytails, tight hair braiding/weaving, twisting of locks, use of scarves to tie hair down, and the use of hair gel on the frontotemporal hairline. All subjects demonstrated a visible increase in hair density along the frontotemporal hairline following their third treatment (Figure 1). None of the subjects reported any serious adverse effects from the injections. The subject that received only one ILK treatment and continued dual therapy on minoxidil and doxycycline reported itch initially, which was improved with the use of a topical steroid.
On April, 1, 2020, the Journal of Drugs in Dermatology (JDD) and SanovaWorks brands, including Skin of Color Update, launched Part I of the webinar series: COVID-19: Urgent Dermatology and Aesthetic Issues for Dermatology.
Over the course of the 2 hours, Joel L. Cohen, MD and 6 different thought leaders joined the COVID-19 conversation, discussing the pressing questions that are on the minds of many dermatologists and providers in the country. The initial broadcast attracted 1,900 registrants and nearly 800 attendees comprised of physicians, residents, fellows, nurse practitioners and physician assistants. Attendees were interested and engaged throughout the entire 2 hours with a 76% average attentiveness and 72% average interest rating.
The on-demand broadcast has attracted over 500 registrants as of April 9th and is available on JDDonline.com.
On April 7, 2020, Part II of the webinar series was broadcasted: COVID-19: Your Questions Answered. Dermatology experts and thought leaders examined the legal and financial concerns of dermatology providers during the global coronavirus pandemic. Experts discussed furlough vs. layoffs; mortgage and rent relief programs; the CARES Act; the pros and cons of leveraging NPs or PAs for teledermatology and more. Then, hear questions answered by our panel of experts; discussed practical tips you can use in your practice right now; and how to move forward with patient care. Part II attracted 1,300 registrants with nearly 700 attendees. Attendees were engaged and interested throughout with an 82% attentiveness average and 75+% interest rating.
The on-demand broadcast of Part II will be available on April 11, 2020 on JDDonline.com.
Source: Next Steps in Derm
This year at the 17th Annual ODAC Dermatology, Aesthetic & Surgical Conference (ODAC), Dr Amy McMichael presented the audience with new pearls of advice on how to approach and diagnose complex medical dermatology cases in patients with skin of color. During her session, she addressed the important need for providers to be able to recognize disease in patients of all races. The majority of the global population consists of people with skin of color and the US population is changing to include a higher percentage of patients with diverse backgrounds. She covered a wide range of diagnoses from psoriasis to melasma and how these may present differently is darker skin types. As she walked the audience through each case it became apparent that being able to recognize and treat certain conditions in patients with skin of color is not only essential but also complex in nature.
First, Dr McMichael summarized the top conditions that African American patients were evaluated for during a dermatologist visit. The top 6 conditions included:
This helped to set the scene for the first case involving a 40-year-old African American female with hidradenitis suppurativa presenting with draining gluteal plaques. Even though the biopsy showed granulomatous dermatitis, the patient was not improving with multiple treatments and developed worsening pain and drainage from gluteal plaques. On a second biopsy the pathology showed psoriasis with granulomatous changes. The patient eventually improved with the systemic treatment Humira, a TNF-a inhibitor. Her major takeaways from this case included:
- Do a second biopsy if the patient’s skin is not responding as expected to the treatment you have prescribed
- Psoriasis can have a unique presentation similar to existing hidradenitis
- Use systemic treatments early to help control symptoms
Second, she tackled the challenge of treating melasma with combination therapies. In melasma, there is too much melanin being created by melanocytes and it is then carried by keratinocytes. These cells then release melanin into the dermis, causing blotchy pigmentation often on the face. Topical therapies are usually directed towards preventing increased creation of melanin by melanocytes. People often use hydroquinone 2% or 4% along with encouragement of consistent daily sunscreen use. If used at too high of a concentration, then hydroquinone may cause ochronosis (skin becomes bluish – grey).
Dr McMichael suggested adding a novel treatment called cysteamine to the regimen for melasma treatment for more effective results. Cysteamine is an aminothiol that is made in our cells from the amino acid cysteine. Although more interest is arising now for its use in treating melasma, cysteamine was actually researched in 1966 when scientist Dr Chavin injected it into black goldfish skin and observed partial depigmentation. Cysteamine 5% cream may be a more effect treatment for melasma with less side effects.
Another novel treatment Dr McMichael discussed was the use of tranexamic acid for resistant melasma. This is another derivative of an amino acid, lysine, and it works as an anti-fibrinolytic. It has the ability to block UV-induced plasmin activity within keratinocytes. Patients would need to be screened out by their providers for a past medical history of DVT, pulmonary embolism, heart disease, and stroke before starting the oral medication. She emphasized the importance of getting a good medical history related to these conditions since tranexamic acid could increase the risk of these conditions. For patients who are able to take the medication they are expected to experience a few side effects such as mild GI upset and palpitations. This medication could provide improvement for many patients with chronic melasma who have had to struggle with this condition.
Third, in the next case we were reminded by Dr McMichael that keloids can be very disfiguring and distressful to patients. She talked about using intralesional Kenalog with contact cryotherapy as effective treatments of keloids. Other options for treatment included combining cryosurgery, intralesional Kenalog, and doxycycline. It was eye opening for the audience to hear her say we should be thinking about keloids not just as scars but tumors representing overgrowth of tissue. This paradigm shift of how we think about keloids can further shape how we think about treatment modalities for keloids as well.
Join Dermatology Leadership Discussion of COVID-19
Over the course of the 2 hours, 8 different thought leaders will join the conversation, discussing questions that are on the mind of many dermatologists in the country. Click here to register.
Joel L. Cohen, MD (Director, About Skin Dermatology & Associate Clinical Professor, University of California at Irvine)
Neal Bhatia, MD (Vice President-elect of the AAD & Director of Clinical Dermatology, Therapeutics Clinical Research)
Adam Friedman, MD (Professor and Interim Chair of Dermatology, GW School of Medicine & Health Sciences)
William D. Humphries (President, Ortho Dermatologics)
Mark Kaufman, MD (Associate Clinical Professor, Icahn School of Medicine at Mount Sinai)
Sue Ellen Cox, MD (Founder, Aesthetic Solutions)
Kavita Mariwalla, MD (Founder, Mariwalla Dermatology)
Carrie Strom (Senior Vice President, US Medical Aesthetics at Allergan)
NEW YORK (Mar. 13, 2020) – A Note from Shelley Tanner, SanovaWorks CEO/President
First and foremost, in light of the rapidly evolving global COVID-19 situation, we hope that you and your family are safe and healthy. We send companywide thoughts and prayers to the individuals, families, and other groups who have been impacted by this situation, and hope that things will improve very soon.
While many things are uncertain surrounding this virus, as an organization, SanovaWorks believes in taking action early. We are dedicated to providing the best care and support we can to all our employees and business partners.
We have the extremely good fortune to be functioning already as a virtual company and because of this we hope to be able to provide support and resources to our entire network who might not have the experience we have. Please check our blog for our tips and recommendations for transitioning to and being successful in a remote work environment:https://sanovaworks.com/2020/03/11/top-immediate-needs-of-remote-employees/
In addition to this, in order to protect our teams and others, until further notice, we have issued a complete restriction on all business-related travel. While the CDC has not placed restrictions on domestic travel, they have recently posted travel warnings on their website: https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-in-the-us.html?mod=article_inline
The CDC also provide general recommendations that we should all be following to prevent the spread of this disease:https://www.cdc.gov/coronavirus/2019-ncov/about/prevention.html
We will be working diligently as teams to connect with many of you so that we can share some very interesting ways to accomplish our results in this new, virtual environment. We have many years of experience transitioning traditional programs to digital programs, and launching successful virtual programs. Because we are already positioned as a remote company that produces virtual programs, we hope that we are able to support your own initiatives and bridge the gap this global situation has caused.
And last but not least, with a shout out to Jim Collins who introduced me to the Stockdale Paradox in his book Good To Great, we all need to look squarely at the facts, but have confidence that together we will prevail, as we balance realism with optimism.
Shelley and the entire SanovaWorks Team
During the 2020 ODAC Dermatology, Aesthetic and Surgical Conference, Dr. Amy McMichael, Professor and Chair of Dermatology at the Wake Forest University School of Medicine, sat down with Next Steps in Derm to share important updates regarding treatments on the horizon for the most common forms of hair loss. Dr. McMichael will be presenting at Skin of Color Update 2020 with lectures including Hair & Scalp Disorders in SOC: Diagnostic Approaches and Hot Topics & Controversies in Photoprotection: Making sense of it all.
Click here to view the full Skin of Color Update agenda.
The following is a selection of scientific poster abstracts from the 2019 Skin of Color Update. Thank you to our poster presentations and faculty.
Skin of Color Update 2020 is the largest CE event dedicated to trending evidence-based research and new practical pearls for treating skin types III – VI. The 2020 event will be held September 12 – 13 at a new location, the Sheraton Times Square in New York City.
Skin of Color Update uses a didactic, case-based approach through lectures, hands-on-training and live demonstrations. Sessions will address medical, surgical and cosmetic dermatology. A few sessions this year include:
- “Conventional and New Treatment Options for Keloids (including LADD) – Expert Panel” with Maritza Perez, MD and Jared Jagdeo, MD
- “Laser Staples & The New Players: Brand Loyalty Aside, This is What the Experts Want You to Know- Panel Conversation” with Eliot Battle, MD, Maritza Perez, MD and Andrew Alexis, MD
- “Clinical Pearls for Kids, Tweens and Teens with Skin of Color” with Candrice Heath, MD
- “Hot Topics & Controversies in Photoprotection: Making Sense of it All” with Amy McMichael, MD
- “Hair & Scalp Disorders in SOC: Conventional Treatment Approaches” with Susan Taylor, MD
- “Dermatologic Concerns, Diseases, and Treatments Unique to Asian Skin” with Hye Jin Chung, MD, MMS
- “Consensus and Misconceptions Regarding the Aesthetic Skin of Color Patient: A Conversation with the Experts” with Andrew Alexis, MD and Maritza Perez, MD
- “Keys to Connecting with Skin of Color Patients on Social Media” with Candrice Heath, MD
- “New and Emerging Treatments in Vitiligo“
The full agenda can be viewed at skinofcolorupdate.com/agenda
The conference will also offer an exhibit hall featuring companies showcasing the latest innovations in dermatology. A poster session will also be available and up to 13 AMA PRA Category 1™ credit(s) can be earned. Registration is available at skinofcolorupdate.com.
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.
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.
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.
- These results might be due to inclusion of ALCL and borderline cases with poorer prognosis compared to LyP.
- Another possibility is that patients with more aggressive CTCL variants (eg, transformed tumor-stage MF) might have been misdiagnosed or miscoded as CD30+ LPD.
- 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).
- 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.
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.
- Noninterventional (“wait-and-see”) strategy is a legitimate approach, especially in patients with a limited number of lesions.
- Topical and skin-directed therapies (including topical steroids and phototherapy), and low-dose methotrexate are the best documented therapies for LyP.
- 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.
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.
- 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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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.
- Skin lightening is still very common.
- Hydroquinone is still the gold standard.
- New therapies are on the horizon.
- More research needs to be done on glutathione.
Check out the full article on Next Steps in Derm for a more in-depth look.
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.
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.
- Color and distribution in the clinical presentation
- Recognizing common medical mimickers of psoriasis such as lichen planus, sarcoidosis, and cutaneous lupus erythematosus (.e. discoid lupus) in skin of color
- 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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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…
Missed Skin of Color Update 2019? Purchase lectures like this on-demand.
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.
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.
- 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.
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
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.
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.
- Letter of recommendation
- Letter describing why you want to come to Skin of Color Update
NEW YORK (Oct. 16, 2019) Skin of Color Update 2019 continues to receive media coverage from various publications after producing a sold out event. Skin of Color Update, Sept. 7 & 8, 2019, held at the Crowne Plaza Times Square, hosted an expert faculty with 2 days education, networking and discovery. This 2-day event attracted over 300 dermatology providers from all over the US. Purchase Skin of Color Update On-demand here.
See what the media has to say about the event and register for Skin of Color Update 2020 before it sells out.
- The Dermatologist covered Wendy Roberts, MD session on Hair and Scalp Disorders: A Review of Alternative Therapies
- In an interview with The Dermatologist, Skin of Color Update presenter Cheryl M. Burgess, MD, discusses her lecture on common cosmetic concerns among patients with skin of color and the importance of recognizing adverse reactions. Read more.
- Sun protection in Skin of Color patients still matters. Find out what Henry Lim, MD had to say in an interview with The Dermatologist regarding his lecture at Skin of Color Update 2019. Read more.
- Skin of Color Update speaker Theodore Rosen, MD presented on hidradenitis suppurativa in the black community and the improvement of disease control. Read an overview of his session here.
- Andrew Alexis, MD presented clinical findings on new drugs that particularly benefit skin of color patients with acne. Read the overview on Dermatology News.
- Skin of color poses some unique challenges when it comes to diagnosing atopic dermatitis (AD). In a recent interview, co-founder and co-chair Andrew Alexis, MD discusses his challenges and pearls for treating AD in skin of color. Read more.
- Dermatology News recently covered Wendy Roberts, MD Skin of Color Update 2019 presentation on combination treatments for pseudofolliculitis barbae. Read the interview and more here.
- Whitening of skin remained charged topic at the recent Skin of Color Update, co-founder and co-chair Eliot F. Battle, Jr. MD lead the discussion with an interesting expert opinion on the topic. Read more.
Register for Skin of Color Update at the Sheridan Times Square, September 12 and 13, 2020.
The Dermatologist recently featured an interview with Dr. Andrew Alexis, Skin of Color Update co-founder and co-chair, regarding his lecture on challenges and pearls of treating atopic dermatitis (AD) inpatients with skin of color.
Associate Editor, Melissa Weiss posed the following questions:
- What are some of the challenges for diagnosing AD in patients with skin of color?
- What are your recommendations for clinically assessing AD in patients with skin of color?
- What are your recommendations and treatment considerations for AD?
- Do you discuss options for a patient who want to treat AD-associated pigmentary changes?
- Are there any other key takeaways you would like dermatologists to leave our audience with?
Visit The Dermatologist to read Dr. Alexis’s answers and more.
Missed Skin of Color Update 2019? Purchase this lecture and more on-demand.
We recently hosted an expert panel discussion on the topic of skin lightening in skin of color at the 2019 Skin of Color Update. Skin of Color Update co-chair and co-founder, Eliot F. Battle, MD took an informal audience poll and the results will surprise you.
“How many of you think total body skin whitening is wrong?” Dr. Battle asked the audience for a show of hands. The majority of the audience raised their hand.
“How many think breast augmentation is wrong?” he asked. “How many think changing your hair color is wrong? Before we cast judgment, let’s think a little about how our patients feel.”
Should physicians provide total body skin whitening for cosmetic purposes or should skin lightening be provided only for clinical indications, like melasma?
Dr. Pearl Grimes and Dr. Cheryl Burgess weighed in on this charged topic to provide compelling commentary. Read their insights and more here. Coverage provided by MDedge |Dermatology.
Purchase Skin of Color On-Demand Below
NEW YORK (Sept. 9, 2019)– The Journal of Drugs in Dermatology (JDD) presented dermatologist Andrew F. Alexis, MD, MPH, with the Innovations in Dermatology Award at Skin of Color Update, held September 7 and 8 in New York. The award recognizes individuals who have fostered innovation and improvement in dermatology through increased emphasis on education and research.
“Andrew F. Alexis, MD, MPH is committed and passionate — not only about being the best dermatologist he can be – but also about bringing skin of color education to dermatology,” said Shelley Tanner, CEO and president of SanovaWorks, which produces the JDD and Skin of Color Update. “Through his efforts, the changing landscape of patients can now thrive through treatment and management plans that address their specific needs.”
“Dr. Alexis is the top innovator in the dermatologic and cosmetic treatment of patients with skin of color,” said dermatologist Eliot F. Battle, MD, co-chair of Skin of Color Update along with Dr. Alexis. “His decades of pioneering research in dermatology have led to the development of new procedures and products that address a wide range of dermatologic conditions. He compassionately treats his patients, shares his expertise by presenting throughout the world and gives back through mentoring the next generation of dermatologists and researchers. I am honored to serve alongside this distinguished innovator.”
Dr. Alexis is chair of the department of dermatology and director of the Skin of Color Center at Mount Sinai St. Luke’s and Mount Sinai West, New York. As such, he is actively involved in advancing patient care, research and education pertaining to dermatologic disorders that are prevalent in ethnic skin. He is also professor of dermatology at the Icahn School of Medicine at Mount Sinai.
Dr. Alexis is the co-founder and co-chair of SOCU, now in it’s 10th year.
Dermatology has the most expensive residency application process. Refinery29 recently published an editorial article on diversity in dermatology, looking at medical school, residency and training. Nathan Rojek, MD and Next Steps in Dermatology reviewed the dermatology residency application process and put the statistics into numbers.
Dermatology is at high risk of becoming a specialty comprised of physicians that do not come close to representing the socio-economic diversity of the patients in this country. It is critical that those of us in the dermatology community make the necessary changes to attract the most promising medical students from all walks of life; otherwise we risk alienating the people we’ve vowed to help.
Purchase Skin of Color Update On-Demand. Click below.
Excerpt provided with permission. Originally published by Next Steps in Dermatology. All rights reserved.
US Dermatologists, Dermatology Residents and Dermatology NP and PAs can create a free account on JDDonline.com to read the following Skin of Color annual issue highlights:
Patient-focused Solutions in Rosacea Management: Treatment Challenges in Special Patient Groups by Ahuva Cices MD and Andrew F. Alexis MD MPH aims to expand awareness of the impact of rosacea on QoL of patients of all ages, genders, and skin types. (CE credit is available)
Myths and Knowledge Gaps in the Aesthetic Treatment of Patients With Skin of Color, Andrew Alexis, MD et al., identifies knowledge gaps and myths concerning facial aesthetic treatment in individuals with SOC.
An online study was designed to survey facial aesthetic concerns, treatment priorities, and future treatment considerations in 2 companion articles, Understanding the Female Hispanic and Latino American Facial Aesthetic Patient and Understanding the Female Asian American Facial Aesthetic Patient.
In Vitro and In Vivo Efficacy and Tolerability of a Non-Hydroquinone, Multi-Action Skin Tone Correcting Cream Pearl Grimes, MD evaluates an alternative to HQ for improving skin tone.
Topical Ozenoxacin Cream 1% for Impetigo: A Review explores the challenges of treating impetigo and growing concern of antimicrobial resistance.
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
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
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.
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 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.
- “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
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.
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/
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.
During the 16th Annual ODAC Dermatology, Aesthetics and Surgical Conference, ANGELO LANDRISCINA, MD 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, Co-Chair of the Skin of Color Update.
Dr. Alexis lectured on new developments in the treatment of skin of color focusing on two prevalent conditions: hyperpigmentation and central centrifugal cicatricial alopecia (CCCA). Below are Dr. Landriscina’s takeaways and pearls from this lecture.
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.
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
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.
Excerpt provided with permission. Originally published by Next Steps in Dermatology. All rights reserved.
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.
Excerpt provided with permission. Originally published by Next Steps in Dermatology. All rights reserved.
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.
Source: J Drugs Dermatol. 2019;18(3 Suppl):s112-114.
Marta I. Rendon MD
The Journal of Drugs in Dermatology (JDD) published a supplement on the dermatological concerns in the Latino population authored by Marta I. Rendon, MD.
The Latino, or Hispanics in the United States, are the drivers behind demographic growth. They are heterogeneous in many dimensions related to health risks and dermatological conditions. Understanding the heterogeneity and clinical manifestation of skin concerns in such population is essential for health care providers. At the annual meeting of the American Academy of Dermatology in 2018, Dr. Rendon chaired a special symposium titled “Skin Issues in Latino Patients”, with the objective of training clinical practitioners how to better provide care and education to our diverse patients.
Click “Download Original Article” here.
- Introduction: Dermatological Concerns in the Latino Population Marta I. Rendon MD
- Hyperpigmentation Disorders in Hispanic Population in the United States Marta I. Rendon MD
- Disorders of Hypopigmentation Yemisi Dina BS, Jacqueline McKesey MD MS, Amit G. Pandya MD
- Skin Cancer in Hispanics in the United States Maritza I. Perez MD
- Photoaging and Photoprotection in United States Hispanic Population Qian Zheng MD PhD, Janet Wangari-Talbot PhD, Charbel Bouez PhD, and Michele Verschoore MD
- Acne and Rosacea: Special Considerations in the Treatment of Patients With Latin American Ancestry Mercedes Florez-White MD
- Cosmetic Laser Procedures in Latin Skin Sheila Jalalat MD, Eduardo Weiss MD
Hair Apparent: A Multi-Part Series on Hair Disorders – Part II
Dermatology residents from throughout the Washington DC area recently convened at a recent hair disorders symposium, where distinguished experts in the field of hair disorders discussed the evaluation, work-up, and treatment of a wide variety of alopecias and scalp disorders. A treasure trove of clinical pearls was shared along the way, and the attendees learned a host of new strategies to apply to the management of hair loss, which is both widely prevalent and frequently undertreated. Attend Skin of Color Update in to learn more or continuing reading below.
This post is the second of a multi-part series that summarizes salient points from each of the lectures, as well as strategies that residents can add to their alopecia armamentarium.
Source: J Drugs Dermatol. 2019;18(1):24-27.
May Elgash BS, Ncoza Dlova MBChB FCDerm PhD, Temitayo Ogunleye MD, Susan C. Taylor MD
Skin of Color Update 2019 faculty Susan C. Taylor, MD and colleagues published a paper in the January 2019 issue of the Journal of Drugs in Dermatology on seborrheic dermatitis in skin of color. Read the abstract below or login in to JDD for the full manuscript.
Abstract: Seborrheic dermatitis is a common, relapsing, inflammatory skin condition of unclear etiology. The Malassezia yeast genus are believed to play a role. Seborrheic dermatitis commonly affects areas of the skin with high sebum production, including the scalp, nasolabial folds, glabella, eyebrows, beard, ears, retroauricular skin, sternum, and other skin folds. Seborrheic dermatitis may present differently in individuals with skin of color. Darker-skinned individuals may present with scaly, hypopigmented macules and patches in typical areas of involvement. Arcuate or petal-like patches may be seen, specifically termed petaloid seborrheic dermatitis. Children of color often do not experience the classic “cradle cap” appearance of seborrheic dermatitis, and have erythema, flaking, and hypopigmentation of the affected areas and folds of skin. Seborrheic dermatitis tends to respond well to conventional treatments, although it tends to recur. Skin of color patients may require a modified treatment approach which takes into account differences in hair texture and hair washing frequency. This paper aims to highlight these differences to help reduce disparities in the management of seborrheic dermatitis in patients of color. To read the full manuscript with your JDD subscription, click here.
Seborrheic dermatitis is a common, relapsing, inflammatory skin condition of unclear etiology. The Malassezia yeast genus are believed to play a role. Seborrheic dermatitis commonly affects areas of the skin with high sebum production, including the scalp, nasolabial folds, glabella, eyebrows, beard, ears, retroauricular skin, sternum, and other skin folds. Seborrheic dermatitis may present differently in individuals with skin of color. Darker-skinned individuals may present with scaly, hypopigmented macules and patches in typical areas of involvement. Arcuate or petal-like patches may be seen, specifically termed petaloid seborrheic dermatitis. Children of color often do not experience the classic “cradle cap” appearance of seborrheic dermatitis, and have erythema, flaking, and hypopigmentation of the affected areas and folds of skin. Seborrheic dermatitis tends to respond well to conventional treatments, although it tends to recur. Skin of color patients may require a modified treatment approach which takes into account differences in hair texture and hair washing frequency. This paper aims to highlight these differences to help reduce disparities in the management of seborrheic dermatitis in patients of color. J Drugs Dermatol. 2019;18(1):24-27.
Read the full article on JDDonline.com.
Physicians from throughout the Washington DC area recently convened at a hair disorders symposium, where distinguished experts in the field of hair disorders discussed the evaluation, work-up, and treatment of a wide variety of alopecias and scalp disorders. A treasure trove of clinical pearls was shared along the way, and the attendees learned a host of new strategies to apply to the management of hair loss, which is both widely prevalent and frequently undertreated.
This is an excerpt from a multi-part series on Next Steps in Dermatology that summarizes salient points from each of the lectures, as well as strategies that physicians can add to their alopecia armamentarium.
This post is devoted to Dr. Leslie Castelo-Soccio’s lecture, “Clinical approach to hair loss in pediatric patients.” Dr. Castelo-Soccio is a pediatric dermatologist as well as the Dermatology Section’s Director of Clinical Research at Children’s Hospital of Philadelphia. She is an expert in alopecia as well as genetic skin disease. Her lecture provided an incredibly useful roadmap for residents learning to navigate the following aspects of caring for the pediatric alopecia patient…
Source: J Drugs Dermatol. 2018;17(11):1169-1172.
Eliot F. Battle Jr. MD and Sally Battle CNMT
We are excited to highlight a November 2018 published in the Journal of Drugs in Dermatology by our very own co-founder, Eliot F. Battle, MD. The study was intended to evaluate the safety and efficacy of fractional RF technology for the treatment of patients with Fitzpatrick skin type VI. We recommend you read the abstract or login with your JDD subscription for the full manuscript here.
Eliot Battle, MD has been awarded the Innovations in Skin of Color Dermatology Award. The award was presented by The Journal of Drugs in Dermatology (JDD) at the Skin of Color Seminar Series (SOCSS) held May 5 and 6, 2018, in New York. The award recognizes individuals who have fostered innovation and improvement in dermatology through increased emphasis on skin of color education and research. Dr. Battle is a co-founder and co-chair of SOCSS.
“Dr. Battle’s tireless support and advocacy has been instrumental in starting the industry wide shift towards dermatology education that is inclusive of all skin types,” said Shelley Tanner, CEO and president of SanovaWorks, which produces the JDD and SOCSS. ”Dr. Battle received the award for his commitment to safe, accessible, and cutting-edge dermatology care for patients of all ethnicities and for being a champion for this cause.”
Source: J Drugs Dermatol. 2018;17(10):1032-1036
Jewell V. Gaulding MD, Daniel Gutierrez MD, Bhavnit K. Bhatia MD, Xiaoxia Han PhD, Richard Krajenta BS, Christine Neslund-Dudas PhD, Henry W. Lim MD, Ellen N. Pritchett MD MPH
BACKGROUND: Epidemiologic studies of patients who present to dermatology clinics are necessary to identify the needs of patients. OBJECTIVE: To quantify and compare diagnoses according to race, ethnicity, and socioeconomic status (SES) at 6 general dermatology clinics from January 2013 to December 2016. METHODS: A retrospective cohort of new patients was established using an electronic medical record database. Primary diagnoses and diagnostic codes were recorded. Geocoding was utilized to obtain SES. RESULTS: There were 65969 new patient visits. Racial and ethnic demographics were obtained with the overall top 3 conditions being eczema or dermatitis, benign skin neoplasm, and adnexal disease. In blacks, however, follicular disorders were the third most common condition seen. The most frequently encountered diagnoses at the clinics with the highest and lowest SES were benign skin neoplasm and eczema or dermatitis, respectively.
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.
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.
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.
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*.
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?
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.
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).
– *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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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.
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.
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.
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.
“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
SOURCE: Dermatology Times
If a Caucasian patient comes to my practice they will be looking for treatment for sun damage, wrinkles and capillaries, whereas, if it is a person of color, they will be looking for treatment for dark spots — dark spots from hair, dark spots from melasma, dark spots from scars, says Eliot F. Battle, Jr., M.D., CEO and Co-Founder, Cultura Dermatology and Laser Center, Washington, D.C.
Source: Dermatology Times
NEW YORK ― In skin of color, ultraviolet (UV) and visible light protection are crucial to maintaining a healthy and youthful appearance. Although the mechanism by which UVA, visible light, and infrared damages the skin is still under study, reactive oxygen species (ROS) are thought to play a major role, said Steven Q. Wang, M.D., at the Skin of Color Seminar Series held here in April. Read more.
The optimal treatments for skin of color patients seeking dermatologic care are constantly changing. Keeping up to date with the latest advances in the field, both medical and aesthetic, can prove to be difficult and overwhelm even the most brilliant dermatologist. With a growing recognition that constant training and direct access to skin of color thought leaders is necessary to be at the forefront of trending evidence-based research, leading experts in the field are joining forces to ensure skin of color patients receive the care they need. Among these experts are Dr. Andrew Alexis and Dr. Eliot Battle, co-chairs of the Skin of Color Seminar Series, the largest CE event dedicated to patients with skin types III – VI. With an unparalleled agenda and an esteemed faculty of KOL’s, this is probably THE event all dermatologists wanting to stay up to date on all skin of color medical and aesthetic advances must attend.
Always a highlight of the Skin of Color Seminar Series, attendees have the rare opportunity to ask their most pressing questions to the world’s top skin of color dermatology experts.
Source: Journal of Drugs in Dermatology April 2018
Wendy E. Roberts MD FAAD
The intent of this brief communication is to revisit the Roberts Skin Type Classification System published by Journal of Drugs in Dermatology (JDD) in 2008 with a 2018 lens and provide additional information for its wider acceptance and implementation. The key points of this communication are that the 2010 US census indicates rapid growth of the multiple race population up 30-50% from the 2000 census, cosmetic procedures have increased from 9.5 million to 12.8 million over the same 10 year period, and cosmetic procedures in SOC patients have increased 6% over the same 10 year period. We have come very far in our knowledge of skin safety and colorblind technology, however, as we experience rapid globalization and increasing diversity of traditionally diverse populations, this classification system is even more relevant now than it was 10 years ago. What standard are we using to predict our diverse patient outcomes to skin insult, injury, and inflammation? Why do we still use the limited Fitzpatrick Phototype System to communicate safety when the system does not address dyspigmentation and scarring, the most frequent complications in ill-fated skin trauma?
Source: J Drugs Dermatol. 2018;17(4):471-473
Evan Austin BS, Jillian W. Millsop MD, Haines Ely MD, Jared Jagdeo MD MS and Joshua M. Schulman MD
A 50-year-old African-American woman presented to the dermatology clinic with a pruritic eruption of 3 years’ duration. On clinical examination, the patient had well-demarcated, pink, atrophic plaques and superficial erosions over the inframammary folds and mid-chest. She also had well-demarcated, hyperpigmented, hyperkeratotic scaly plaques over the abdomen, suprapubic region, elbows, knees, and back with sporadic small superficial blisters. A punch biopsy of the right abdomen was performed and revealed psoriasiform epidermal hyperplasia, focal parakeratosis, and acantholysis throughout the superficial spinous and granular layers. Only a sparse inflammatory infiltrate was present in the underlying dermis. Clinical and histological findings supported the diagnosis of pemphigus foliaceus (PF), but psoriasis was included in the differential diagnosis due to the presence of discrete plaques with an erythematous border. We hypothesize that patients with psoriasiform presentations of PF may be misdiagnosed with plaque psoriasis. It is important to distinguish between PF and psoriasis as there is evidence that ultraviolet light, a common treatment for psoriasis, may exacerbate PF. We document and highlight this atypical psoriasiform presentation of PF in a patient with skin of color to raise awareness and improve diagnosis and outcomes.
The association of frontal fibrosing alopecia (FFA) and lichen planus pigmentosus (LPPigm) is rare. Prior reports suggest that FFA and LPPigm are on the same spectrum of disease, and a diagnosis of LPPigm may predict the future development of FFA. We aim to further characterize the association between FFA and LPPigm by reviewing the clinical cases of seven African American women. Seven patients with FFA were diagnosed clinically by recession of frontotemporal hairline and confirmed by histopathologic examination showing lymphocyte-mediated cicatricial alopecia. LPPigm was diagnosed by clinical evaluation alone based on the characteristic morphology, color, and distribution of the lesions. It is difficult to distinguish whether halted progression of FFA was due to the success of the treatment regimen or spontaneous stabilization of disease over time. Our case series supports the theory that FFA and LPPigm likely exist on the same spectrum of disease. Our observations demonstrate a likely positive correlation between FFA and LPPigm.
Prior studies suggested that LPPigm may be a herald sign for FFA, predicting the future onset of frontotemporal hair loss, though there has been at least one reported case of an individual simultaneously developing FFA and LPPigm. Our results do not support the hypothesis that LPPigm is a herald sign for FFA, but do support the theory that FFA and LPPigm likely exist on the same disease spectrum. Our findings parallel that of another case series which noted that there was no obvious trend pertaining to order of FFA and LPPigm development (Figure 1). A patient with one variant of lichen planus, either FFA or LPPigm, is likely at a higher risk to develop another variant of lichen planus. FFA patients with Fitzpatrick skin type III-V may be more likely to develop LPPigm because this condition commonly presents in darker skin types. Although few studies have previously reported on FFA with concomitant LPPigm, none of these studies specifically focused on the manifestation of this phenomenon in African American women. This is particularly worth investigating, as LPPigm, when it occurs, has a strong predilection for darker skin types, and FFA is most commonly found in women.
Source: J Drugs Dermatol. 2018;17(4):397-400.
Laura N. Uwakwe MD, Leah A. Cardwell MD, Emily H. Dothard MD, Bernice I. Baroudi BS, and Amy J. McMichael MD
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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 African American 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.
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
Source: Dermatology Times
This year, the Skin of Color Seminar Series (SOCSS) is scheduled to take place on May 5 and 6 at the Crowne Plaza Times Square in New York City, NY. Founded by Andrew Alexis, MD, and Eliot Battle, MD, the SOCSS provides dermatologists with practical pearls and research for treating patients with skin of color… Read More
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:
- Don’t rely on most parameters supplied by the laser manufacturers. Treat more conservatively. Minimize erythema or edema.
- Inconsistent laser treatments on skin of color include: Vascular Lasers, IPL (on Skin Type V & VI) and Resurfacing Lasers (on Skin Type V & VI).
- 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:
- Ethnicity does not predict skin color.
- 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.
- 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.
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.
Now in its tenth year, the Skin of Color Seminar Series (SOCSS) will be the largest medical education event of 2018 dedicated to providing dermatologists with evidence-based research and practical pearls in treating skin of color, including patients with multiracial backgrounds. SOCSS, which will take place May 5 and 6 at the Crowne Plaza Times Square in New York, uses a didactic, case-based approach through lectures, hands-on-training, and live demonstrations. Series co-chairs and founders are dermatologists Andrew Alexis, MD and Eliot Battle, MD…
Source: J Drugs Dermatol. 2017;16(9):925-927.
Ekaterina Kraeva MD, Derek Ho MD, and Jared Jagdeo MD MS
Keloids are fibrous growths that occur as a result of abnormal response to dermal injury. Keloids are cosmetically disfiguring and may impair function, often resulting in decreased patient quality-of-life. Treatment of keloids remains challenging, and rate of recurrence is high. We present a case of a 39-year-old African-American man (Fitzpatrick VI) with a 10-year history of keloid, who was successfully treated with eight sessions of fractionated carbon dioxide (CO2) laser immediately followed by laser-assisted drug delivery (LADD) of topical triamcinolone acetonide (TAC) ointment and review the medical literature on fractionated CO2 laser treatment of keloids. To the best of our knowledge, this is the first report of successful treatment of a keloid using combination therapy of fractionated CO2 laser and LADD with topical TAC ointment in an African-American man (Fitzpatrick VI) with excellent cosmetic results sustained at 22 months post-treatment. We believe that this combination treatment modality may be safe and efficacious for keloids in skin of color (Fitzpatrick IV-VI) and other patients. This case highlights the ability of laser surgeons to safely use fractionated CO2 lasers in patients of all skin colors.
Source: J Drugs Dermatol. 2017;16(4):308-314.
Lauren Meshkov Bonati MD, Gorana Kuka Epstein MD, and Tamara Lazic Strugar MD
Microneedling procedures are growing in popularity for a wide variety of skin conditions. This paper comprehensively reviews the medical literature regarding skin needling efficacy and safety in all skin types and in multiple dermatologic conditions. A PubMed literature search was conducted in all languages without restriction and bibliographies of relevant articles reviewed. Search terms included: “microneedling,” “percutaneous collagen induction,” “needling,” “skin needling,” and “dermaroller.” Microneedling is most commonly used for acne scars and cosmetic rejuvenation, however, treatment benefit has also been seen in varicella scars, burn scars, keloids, acne, alopecia, and periorbital melanosis, and has improved flap and graft survival, and enhanced transdermal delivery of topical products. Side effects were mild and self-limited, with few reports of post-inflammatory hyperpigmentation, and isolated reports of tram tracking, facial allergic granuloma, and systemic hypersensitivity.
Source: J Drugs Dermatol. 2017;16(4):344-350.
Saba Zabetian MD, Gordon Jacobson MS, Henry W. Lim MD, Melody J. Eide MD, and Richard H. Huggins MD
BACKGROUND: No study has examined the impact of vitiligo support group membership on vitiligo patient quality of life (QoL).
OBJECTIVE: We sought to examine the QoL impact of vitiligo support groups by comparing QoL and associated patient characteristics between vitiligo patients who are and are not members of a vitiligo support group.
METHODS: Members of a Henry Ford Hospital-sponsored, Southeast Michigan Vitiligo Support Group were compared to non-member vitiligo patients recruited from a previous study cohort.17 Eligible patients were asked to complete the Dermatology Life Quality Index (DLQI) and a study-specific questionnaire designed to collect relevant patient characteristics.
RESULTS: The mean DLQI scores for the support group members and non-members were similar (7.1 ± 5.4 and 6.0 ± 6.5, respectively; P-value 0.2), despite the support group members reporting more severe overall disease and increased disease severity in exposed portions of the body. The African-American: Caucasian ratio and the prevalence of unemployment were both significantly higher among the support group participants. Limitations: Small sample size may have limited the study’s ability to demonstrate the differences between the support group participants and the controls.