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

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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.

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Avoid Antibiotics for Acne Treatment When Possible

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Source: Dermatology Times

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

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Skin of Color Perez skin Cancer

Skin Cancer Detection and Treatments in Latino Patients

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

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

 

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Aging through the Decades

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Source: Dermatology Times

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

References:

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

Cosmetic Needs Differ for Skin of Color Patients

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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.

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UV Protection Still Lags in Skin of Color

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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.

Staying Ahead of the Game in Skin of Color Dermatologic Care

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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.

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Skin Type Classification: A Decennial Perspective

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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?

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Psoriasiform Pemphigus Foliaceus in an African American Female: An Important Clinical Manifestation

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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.

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

By | SOC Manuscripts | No Comments

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

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.

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Treating Scalp Psoriasis in Women of African Descent

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

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

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

Suggested Regimen for African-American Females:

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

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

 

 

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

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

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

Parameters for Success – Treating Skin of Color Patients

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

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

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

Practical Pearls for Dermatology in Skin of Color Patients

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

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

3 Practical Pearls from Dr. Eliot Battle:

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

3 Practical Pearls from Dr. Andrew Alexis:

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

 

 

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

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

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

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

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

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

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

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

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

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

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

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

Acne Scarring Live Demonstration

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

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

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

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

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

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

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

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

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

Live Laser, Device and PRP Demonstrations

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