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Media Coverage

Challenging Cases in Skin of Color Dermatology Patients

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Skin of Color patient dermatology cases

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.

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Skin of Color Update Skin Lightening

Skin Lightening in Skin of Color: What You Need to Know

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The following is an excerpt from Next Steps in Dermatology based on a Pearl Grimes, MD lecture at Skin of Color Update 2019.

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.

  1. Skin lightening is still very common.
  2. Hydroquinone is still the gold standard.
  3. New therapies are on the horizon.
  4. More research needs to be done on glutathione.

Check out the full article on Next Steps in Derm for a more in-depth look.

Aesthetic Skin of Color

Consensus and Misconceptions Regarding the Aesthetic Skin of Color Consumer

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

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.

Key Takeaways

  • 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.

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Hair and scalp at skin of color

Hair and Scalp Disorders at the 2019 Skin of Color Update

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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 

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Skin of Color update Medical Student scholarship for diversity

Skin of Color Update Offers Medical Student Scholarships

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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.

SOCU Experts

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.

  1. Letter of recommendation
  2. C.V.
  3. Letter describing why you want to come to Skin of Color Update

 

 

 

Eliot Battle discusses Skin of Color Updates in 2019

Skin of Color Update 2019 Press Coverage

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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.

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Andrew Alexis atopic dermatitis skin of color lecture

Treating Atopic Dermatitis in Patients With Skin of Color

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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.

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Skin Lightening at Skin of Color Update Eliot Battle

Skin Lightening in Skin of Color Remains Charged Topic

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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.

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Journal of Drugs in Dermatology Andrew Alexis MD MPH Skin of color Update Award from JDD

ANDREW F. ALEXIS, MD, MPH, PRESENTED WITH INNOVATIONS AWARD

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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.

Read more.

 

Patient Buzz: At-Home Laser Hair Removal – The Expert Weighs In

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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.

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