alopecia lichen Planus pigmentosus

Frontal Fibrosing Alopecia and Concomitant Lichen Planus Pigmentosus: A Case Series of Seven African American Women

By Case Reports, SOC Manuscripts

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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Treating Scalp Psoriasis in Women of African Descent

By Sessions, Skin of Color Update Agenda

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.



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

By Sessions, Skin of Color Update Agenda

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

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

Parameters for Success – Treating Skin of Color Patients

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

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

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

Practical Pearls for Dermatology in Skin of Color Patients

By Sessions, Skin of Color Update Agenda

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

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

3 Practical Pearls from Dr. Eliot Battle:

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

3 Practical Pearls from Dr. Andrew Alexis:

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



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

By Sessions, Skin of Color Update Agenda

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.

Skin of Color Seminar Series to Provide Latest Research and Practical Pearls for Dermatologic Treatment of Skin of Color

By Media Coverage

Source: DermWire

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…

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Successful Treatment of Keloid With Fractionated Carbon Dioxide (CO2) Laser and Laser-Assisted Drug Delivery of Triamcinolone Acetonide Ointment in an African-American Man

By SOC Manuscripts

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.

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Microneedling in All Skin Types: A Review

By SOC Manuscripts

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.

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Quality of Life in a Vitiligo Support Group

By SOC Manuscripts

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.

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