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.