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Medical Dermatology

Aug 12
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Inflammatory Skin Conditions in Children With Skin of Color – SOCU 2024

By Medical Dermatology

inflammatory skin conditions in children with skin of color

A keen eye is required when dermatology clinicians treat inflammatory skin conditions in patients with skin of color. Pediatric dermatologist Brandi Kenner-Bell, MD, FAAD, spoke with Next Steps in Derm at Skin of Color Update 2024 about what to look for when diagnosing inflammatory skin conditions in patients with darker skin tones, and what’s important to know when treating children.

Watch as Dr. Kenner-Bell shares the importance of knowing what treatments have FDA approval for use in children and which do not. Plus find out how pigmentary concerns should impact your course of treatment.

Register for Skin of Color Update for more pearls in treating inflammatory skin conditions in patients with skin of color.

Aug 05
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Understanding Psoriasis at SOCU with Dr. Amy McMichael

By Medical Dermatology, Sessions

diagnosing and treating psoriasis in skin of color

August is Psoriasis Awareness Month. At Skin of Color Update 2024, Amy McMichael, MD, FAAD, delivered a comprehensive presentation on the unique challenges of diagnosing and treating psoriasis in patients with skin of color. She emphasized the importance of early recognition, tailored treatment plans, and addressing racial disparities in clinical research.

Unique Presentation in Skin of Color
Psoriasis often appears differently in darker skin tones, with violaceous or hypertrophic plaques, hyperpigmented thin plaques, or guttate (raindrop-like) lesions rather than the classic red, scaly plaques seen in lighter skin. Dr. McMichael recommended biopsy confirmation, especially since the appearance may evolve during treatment.

Treatment Strategies

  • Topicals: Ultrapotent topical steroids are often first-line, but non-steroidal alternatives (e.g., calcipotriene, roflumilast, tapinarof) may be used to reduce steroid-related side effects.
  • Systemics: For more severe cases, systemic treatments like methotrexate, cyclosporine, and acitretin can be effective, particularly in hypertrophic lesions.
  • Biologics: Although effective across all skin types, biologics are underutilized in patients of color due to limited representation in clinical trials.
  • JAK inhibitors and UV phototherapy were also discussed as viable options, especially for refractory disease or patients seeking non-biologic treatments.

Special Considerations
Treating areas like the scalp or groin requires attention to hairstyling practices and vehicle compatibility. Post-inflammatory hyperpigmentation (PIH) is a frequent concern in patients of color, often lingering after psoriasis clears. Dr. McMichael stressed setting realistic expectations and suggested adjunctive use of retinoids or skin-lightening agents alongside psoriasis treatments.

Addressing Disparities
Despite the broad availability of effective therapies, patients of color remain underrepresented in psoriasis research. Dr. McMichael pointed to the VISIBLE trial, which enrolled a racially diverse patient group, as a model for more inclusive studies.

Conclusion
Dr. McMichael underscored the importance of aggressive early treatment, cultural and clinical sensitivity, and diversifying clinical research to improve outcomes for patients of color. Education on pigmentary changes and tailored treatment strategies are key to managing both the physical and psychological impacts of psoriasis in diverse populations.

This session summary was written by Dr. Nidhi Shah and published on Next Steps in Derm.

Jul 11
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Drug Approvals in Medical Dermatology at SOCU with Andrew F. Alexis, MD, MPH

By Medical Dermatology, Sessions

drug approvals in medical dermatology

In the last few years, the FDA has granted approval to several dermatologic therapies that impact patients with skin of color. At Skin of Color Update 2024, Conference Co-Chair Andrew F. Alexis, MD, MPH, spoke with Next Steps in Derm about some of the recently approved topical, biological, and oral therapies.

Watch and learn how these newly approved treatments address conditions that disproportionately affect and burden patients with skin of color. Wonder what’s coming? Dr. Alexis shares his take on what’s ahead in the drug pipeline.

Register for Skin of Color Update 2025 for more updates in medical therapies for patients with skin of color.

Jun 16
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JDD Buzz: Interview with SOCU 2025 Faculty Nada Elbuluk, MD, MSc

By Medical Dermatology

patients with skin of color

Skin of Color Update faculty member Nada Elbuluk, MD, MSc, spoke with Next Steps in Derm about her recent Journal of Drugs in Dermatology study that sheds light on the most common reasons why patients of color seek outpatient dermatologic care. Dr. Elbuluk will speak at Skin of Color Update on pigmentary disorders, including hyperpigmentation and hypopigmentation.

Dr. Elbuluk and the team of researchers conducted a retrospective chart review among patients with skin of color who sought care at the USC outpatient dermatology clinics. They found that the five most common skin concerns that initiated an office visit among skin of color patients were skin examinations, evaluation of bumps/growths, rashes, acne, and skin discoloration. The five most common diagnoses dermatologists made were benign nevi/neoplasms, dermatitis, acne, eczema and/or xerosis, and dyspigmentation.  

“Some of the results were surprising in that there were differences when we stratified the results by age, gender, and racial ethnic group,” Dr. Elbuluk said. “These results showed that it’s important that we don’t homogenize all the skin of color populations and recognize that other demographic factors can also make a difference in the most common concerns and diagnoses in these populations.”

Dr. Elbuluk says understanding these concerns and diagnoses can help dermatology clinicians improve health care outcomes and equity for patients with skin of color.

Click here to read the full article on Next Steps in Derm and to read more dermatology coverage.

Register for Skin of Color Update 2025 and learn from experts like Dr. Elbuluk on how to best diagnose and treat dermatologic disorders in patients with skin of color.

Apr 20
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SKIN OF COLOR UPDATE PRE-CONFERENCE VIRTUAL SYMPOSIUM

By Medical Dermatology, Sessions, Skin of Color Update Agenda
A Case-Based Conversation with The Experts: Treating Pigmentary Disorders in Skin of Color Patients
SKIN OF COLOR UPDATE PRE-CONFERNECE VIRTUAL SYMPOSIUM
TUESDAY, AUGUST 3RD | 6:00PM ET – 9:00PM ET
The Skin of Color Update invites you to join its pre-conference symposium where co-chairs Drs. Andrew Alexis and Eliot Battle will host an interactive, case-based conversation with pigmentary disorders experts. Faculty will review treatment options for common as well as challenging and less frequently discussed pigmentary conditions in skin of color patients. Through a detailed review of each case, panelists will provide guidance and evidence-based treatment protocols as well as practical pearls drawn from their clinical experience. You will walk away from this session armed with clinical pearls immediately useful in your practice. In addition, all panelists will participate in live Q&A sessions to answer your most pressing questions about treating pigmentary disorders in SOC.
AGENDA
6:00-6:05 PM – Welcome & Introductions from Symposium Moderators – Andrew F. Alexis, MD, MPH & Elliot F. Battle, MD
6:05-6:20 PM – A Challenging Case of Melasma – Heather Woolery-Lloyd, MD
6:20-6:35 PM – A Case of Vitiligo Treated with Pulsed Corticosteroids/JAK-Inhibitor – Seemal Desai, MD
6:35-6:50 PM – Post-Inflammatory Hyperpigmentation(PIH) Topical & Procedural Treatment – Neelam Vashi, MD
6:50-7:00 PM – Live Audience Q&A
7:00-8:00PM – For Patients with Plaque Psoriasis: An Oral, Non-Biologic Therapy With Data on Clearer Skin and Symptoms – Paul Wallace, MD, MPA (Non-CE Workshop)
8:00-8:05 PM – Welcome & Introductions from Symposium Moderators – Andrew F. Alexis, MD, MPH & Elliot F. Battle, MD
8:05-8:20 PM – A Challenging Case of Erythema Dyschromicum Perstans – Nada Elbuluk, MD, MSc
8:20-8:35 PM – A Case of Hypopigmented Mycosis Fungoides – Eva Kerby, MD
8:35-8:50 PM – Lichen Planus Pigmentosus – Mukta Sackdev, MD
8:50-9:00 PM – Live Audience Q&A
SYMPOSIUM CO-CHARIS
Andrew F. Alexis, MD, MPH
Eliot F. Battle, MD
EXPERT FACULTY
Seemal R. Desai, MD, FAAD
Nada Elbuluk MD, MSc
Eva Kerby, MD
Heather Woolery-Lloyd, MD
Mukta Sachdev, MD
Neelam Vashi, MD
Oct 01
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Top Black Hair Loss Videos and Black Hair Loss Treatment Videos on YouTube

By Aesthetic Dermatology, Media Coverage, Medical Dermatology, Sessions, Skin of Color Update Agenda
Thin on Top Abstract Image

Next Steps in Derm recently published a highlight from the Skin of Color Update Virtual 2020 poster session.

Thin on Top: A Cross-Sectional Analysis of the Top Black Hair Loss Videos and Black Hair Loss Treatment Videos on YouTube

Esther B. Henebeng BS¹, Uzoamaka Okoro MD, MSc², Ogechi Ezemma BA¹, Kristina Monteiro PhD¹, Afiya M. Mbilishaka PhD³, Chesahna Kindred MD, MBA4
¹The Warren Alpert Medical School, Brown University, Providence, RI, ²Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, ³University of the District of Columbia, Washington, DC,4Howard University College of Medicine, Washington, DC

Introduction

Alopecia, or hair loss, is a prevalent concern for both men and women, that has substantial impact on quality of life.¹ Many forms of alopecia in Black women are associated with or worsened by traumatic styling practices such as braiding, weaving, thermal or chemical hair straightening. Therapy is tailored to the specific diagnosis and can include altering haircare practices, topical or oral medications (ex. minoxidil), and in-office treatments (ex. intralesional injections, hair transplant).² However, studies have shown a considerable amount of Black women are concerned physicians may not understand their hair and fail to engage in discussions about hair issues for this reason.³ More than 50% of Black women experience hair loss, with a majority of women searching for treatment options from online resources instead of seeking care from a primary care physician or dermatologist.4 YouTube is one of the most frequently used websites, with 77% of Black adults using the social media platform.5 Although dermatologists have established an online presence, approximately 75% of the top dermatology-related videos on YouTube are from non-dermatologist sources.6 This is particularly concerning because videos from third parties have been found to suffer from incomplete information, overall poor quality, and can contribute to potential harm or delay in appropriate diagnosis.6,7

Behbahani et al showed that YouTube is a highly utilized resource for hair loss treatment information, but found no significant difference between the overall quality of board certified dermatologist and non-physician videos.7 However, videos from lay media or individuals have been shown to have lower accuracy in comparison to videos from health care sources.8 Examination of top YouTube videos regarding “hair” and “hair loss” demonstrated very few videos displaying more textured or tightly coiled hair types associated with Black hair. Consequently, our project will evaluate the accuracy, quality, viewer engagement, and viewer experience of “Black hair loss” and “Black hair loss treatment” videos on YouTube.

Objectives

    • Evaluate the accuracy of Black hair loss and Black hair loss treatment videos on YouTube in comparison to published, peer-reviewed articles found via PubMed literature review
    • Compare the quality, viewer engagement, and viewer experience of non-health care and health care sources

Methods

YouTube was searched for the following: “Black hair loss” and “Black hair loss treatment” on June 18, 2020. The first 60 videos per search term were examined and categorized into health care or non-health care sources. Two independent raters evaluated each video with four validated instruments: 1) Accuracy in Digital Health, 2) Accuracy Scale, 3) Armstrong Viewer Assessment, and 4) Global Quality Scale.8 Viewer engagement ratio was defined as (number of likes + dislikes + comments) / total views. Discrepancies between coders were resolved through discussion. Duplicate and non-English videos were excluded. Significant differences between health care and non-health care sources were determined using Mann- Whitney U test.

Results

Our search yielded a total of seventy-eight unique YouTube videos. Three videos made no claims to assess accuracy and were excluded from analysis (*).

Twenty-two (28.2%) of the videos were from health care sources and fifty-six (71.8%) from non-health care sources. Health care sources were made up of dermatologists, nondermatologist medical doctors, and university/professional organizations. Non-health care sources included individuals, hairstylists, companies, and lay media. Speakers in 45 of the YouTube videos (57.7%) self-identified as Black based on video content or a publicly accessible social media post. Of the 45, there were only 2 videos categorized as health-care sources that had a self-identified Black speaker.

Discussion

There are over 20 million total views for the top 78 videos on Black hair loss and Black hair loss treatment. These videos typically range from 1 minute to 10 minutes long, with varying levels of engagement. Videos by Black speakers were found to have higher levels of engagement (0.02 ± 0.02, P = <0.001). Many of the videos by non-health care sources were inaccurate or made claims with no evidence supported by PubMed literature review. A few speakers encouraged viewers to try potentially harmful practices to stimulate hair growth (ex. Vicks VapoRub to scalp, prolonged protective styles, intermittent fasting or detoxing). When compared to non-health care sources, health care sources had lower mean numbers of views (81,965 vs 330,113, P = 0.008). Furthermore, health care sources were less engaging than non-health care sources (0.01±0.01 vs 0.02 ±0.02, P = 0.012), but more accurate (Accuracy in Digital Health: 3.77 ±0.43 vs 2.00 ±1.57, P = <0.001; Accuracy Scale: 3.91 ±0.30 vs 2.15 ±1.25, P = <0.001). Most inaccuracies from health care sources were primarily associated with the promotion of a product or treatment that does not have proven efficacy. Fewer inaccuracies were related to incorrect comments regarding hair physiology and causes of hair loss. Nevertheless, health care sources provided a superior viewer experience (Armstrong Viewer Assessment: 3.09 ±0.53 vs 2.55 ±1.01, P = 0.023) and were of higher quality (Global Quality Scale: 3.64 ±0.85 vs 2.47 ±1.09, P = <0.001) in comparison to non-health care sources.

Conclusion

    • Social media platforms can improve a patient’s access to care and serve as an inclusive environment to share educational content.
    • Our findings suggest that many of the top YouTube videos on “Black hair loss” and “Black hair loss treatment” are inaccurate.
    • Health care sources should be cautious when suggesting products or treatments that are not evidence-based.
    • Even though health care sources were more accurate, they had less viewer engagement when compared to non-health care sources.
    • The data supports the need for further diversity in dermatology as Black speakers were found to have greater levels of engagement and participation.
    • Lastly, our results also underscore the need for dermatologists to work in tandem with non-health care sources (ex. hairstylists) who may have a larger following on social media in order to dispel misinformation online.

Click here to view the full summary and images

Jul 01
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Frontal Fibrosing Alopecia Presenting as Androgenetic Alopecia in an African American Woman

By Aesthetic Dermatology, Medical Dermatology, Sessions, Skin of Color Update Agenda
Alopecia patient picture

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.

DISCUSSION

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.

Read more…..

Jun 16
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The Business of Dermatology

By Aesthetic Dermatology, Medical Dermatology
The Business of Dermatology

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.

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May 06
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Ethnicity Matters: Medical Dermatology Concerns Across Ethnic Groups

By Medical Dermatology, Sessions
Wendy Roberts Presenting at SOCU

Source: Dermatology News

This is an excerpt from Dermatology News’ coverage of Skin of Color Update 2019.

For women with pseudofolliculitis barbae, an empirically-based strategy of microdermabrasion, laser treatment, emollients, and maintenance retinoids has been found highly effective, Wendy Roberts, MD, reported at the Skin of Color Update 2019.

“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,” Dr. Roberts, 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.

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