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Oct 14
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Patient Buzz: Eczema-Related Pigmentary Changes

By Medical Dermatology

eczema-related pigmentary changes

In recognition of Eczema Awareness Month, check out this Next Steps in Derm Patient Buzz commentary on eczema-related pigmentary changes. Rebecca Vasquez, MD, FAAD, associate professor with the UT Southwestern Medical Center Department of Dermatology, addresses the resulting hyperpigmentation or hypopigmentation that can be more distressing to patients than the eczema itself.

Dr. Vasquez outlines factors that influence the development of pigmentary alterations from inflammatory skin conditions as well as how to treat. Plus she shares her tips for distinguishing pigmentary sequelae from primary pigmentary disorders.

Sep 22
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SOCU Faculty Research: Low-dose Spironolactone for Hair Loss in Women

By Sessions

low-dose spironolactone

Skin of Color Update faculty member Maryanne Makredes Senna, MD, FAAD, published research in the Journal of Drugs in Dermatology on the efficacy of low-dose spironolactone for hair loss in women.

Dr. Makredes Senna and her colleagues conducted a retrospective chart review of adult women with female pattern hair loss who were treated with 50 mg or less daily of spironolactone either alone or in combination with other therapies. Results showed a statistically significant decline in the average Sinclair Score in patients treated with spironolactone as monotherapy (2.63 to 1.95) after one year. Including patients on other therapies, such as such as topical minoxidil 5% foam or low-level light laser treatment, results also showed a significant decrease (2.47 to 1.81) after one year.

Attend Dr. Makredes Senna’s hair loss sessions at Skin of Color Update for the latest in treatments for scarring and non-scarring alopecias. Register today!

Aug 28
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Spotlight on STDs in Skin of Color

By Sessions

STDs in skin of color

At the 2024 Skin of Color Update, Theodore Rosen, MD, FAAD, highlighted the critical role dermatologists play in recognizing and treating sexually transmitted diseases (STDs), many of which present with skin findings. His talk focused on the disproportionate burden of STDs in patients with skin of color, the unique clinical presentations of STDs, and the importance of early detection and equitable access to care.

  • Epidemiology & Disparities: In the U.S., 2.5 million STDs are diagnosed annually. African American, Hispanic, American Indian, and Alaska Native populations experience disproportionately high rates of STDs likely due to barriers in healthcare access and lack of knowledge of STD care.
  • Syphilis: Cases of primary, secondary, and congenital syphilis continue to rise, with a record number of congenital cases in 2022. Secondary syphilis in patients with skin of color may mimic psoriasis or appear as nodular or annular lesions. Early recognition is essential to reduce congenital syphilis.
  • Monkeypox (Mpox): Rates have declined since 2022, but Black and Hispanic men who have sex with men remain disproportionately affected. Full vaccination is underutilized due to lack of availability, and resistance to tecovirimat is emerging.
  • HSV (Herpes Simplex Virus): Overall rates are declining, but non-Hispanic Black individuals remain disproportionately affected. Hypertrophic/vegetative HSV-2, more common in immunocompromised patients with skin of color, requires biopsy, appropriate immunostaining, or viral culture (PCR) to make a diagnosis. Treatment requires multimodal therapy.
  • Other STDs: Chancroid, donovanosis, and lymphogranuloma venereum are now rare in the U.S., and mostly limited to specific populations.
  • Testing & Resources: Patients can access free or at-home STD testing through CDC resources.

Key Takeaway: Rising STD rates, especially syphilis, highlight the urgent need for targeted screening, culturally competent care, and better education and prevention strategies for patients with skin of color.

This session summary was written by Dr. Olive Osuoji and published on Next Steps in Derm.

Register for Skin of Color Update for more medical dermatology updates.

Aug 22
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Scarring Alopecias in Patients With Skin of Color – From SOCU 2024

By Sessions

scarring alopecias

At Skin of Color Update 2024, Susan Taylor, MD, FAAD, delivered an expert overview on diagnosing and treating scarring alopecias in patients with skin of color. Her talk emphasized the unique clinical presentations, dermoscopic features, comorbidities, and culturally sensitive care needed to optimize outcomes in this underserved population.

Key Conditions Covered:

  1. Central Centrifugal Cicatricial Alopecia (CCCA)
    Most common in women of African descent, CCCA typically affects the vertex scalp but may also appear in atypical patterns. Men are often underdiagnosed due to its similarity to androgenetic alopecia.
  • Dermoscopic clues include peripilar white halos, pinpoint white dots, honeycomb pigmentation, and a “starry sky” pattern.
  • CCCA is associated with systemic comorbidities such as diabetes, hypertension, obesity, and even breast cancer.
  1. Lichen Planopilaris (LPP)
    LPP causes scarring hair loss with perifollicular erythema and scaling, and can vary in pattern and speed of progression.
  • Dermoscopic features include perifollicular hyperkeratosis and depigmented scarred plaques.
  • Dr. Taylor noted that scalp burning (rather than itching) is a distinguishing symptom, and emphasized examining the skin, nails, and mucosa for related lichen planus involvement.
  1. Frontal Fibrosing Alopecia (FFA)
    A variant of LPP, FFA commonly affects postmenopausal women but is increasingly recognized in men.
  • Presents as band-like anterior hairline recession, often with eyebrow loss or facial pigmentation changes.
  • Dermoscopic signs include the “lonely hair” sign and perifollicular erythema.
  • Dr. Taylor highlighted potential links to actinic damage and sunscreen or hair product allergens, recommending patch testing in select cases.
  1. Traction Alopecia (TA)
    TA results from chronic tension on the hair, often due to tight hairstyles like braids or extensions.
  • Early recognition is critical to prevent permanent loss.
  • Dermoscopic features include the “fringe sign,” broken hairs, hair casts, and the “flambeau sign.”
  • Dr. Taylor urged clinicians to take thorough hairstyling histories and counsel patients on protective styling to prevent or reverse damage.

Conclusion:

Dr. Taylor’s presentation provided a comprehensive, culturally attuned framework for diagnosing and treating scarring alopecias in patients with skin of color. She emphasized the use of dermoscopy, early intervention, and awareness of comorbidities and lifestyle factors to improve care. Her insights reinforced the need for personalized and informed dermatologic approaches to better serve this frequently overlooked patient group.

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

Register for Skin of Color Update for more insights from Dr. Susan Taylor.

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 30
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Cosmetic Procedures in Patients with Skin of Color: Highlights from SOCU 2024

By Sessions

cosmetic procedures in patients with skin of color

At Skin of Color Update 2024, Dr. Cheryl Burgess delivered an insightful presentation on providing safe and effective cosmetic treatments for patients with skin of color. Her talk emphasized the importance of understanding both biological and cultural differences to minimize complications and enhance outcomes.

Dr. Burgess highlighted that, while all individuals have the same number of melanocytes, patients with darker skin have larger melanosomes, increasing their risk for hyperpigmentation. She also explained how cultural beauty ideals—such as preferences for lighter skin in Southeast Asia or fuller body figures in West Africa—can shape patient expectations and treatment goals.

Histologically, skin of color differs in fibroblast structure, melanin dispersion, and vascular reactivity, making it more prone to scarring and post-inflammatory hyperpigmentation. Dr. Burgess stressed careful diagnosis using tools like a Wood’s lamp and colorimeters, and advocated for test spots and low-concentration peels to ensure safety.

She identified the Nd:YAG 1064nm laser as the safest option for hair removal and pigmentation treatment, while advising against IPL due to risks of burns. Other effective technologies include radiofrequency and ultrasound-based treatments, which require cautious use.

Finally, Dr. Burgess underscored the need for cultural sensitivity in cosmetic enhancements, such as lip augmentation preferences among Black patients and body image norms in West Africa. Her presentation called for a personalized, informed approach to cosmetic dermatology that combines clinical skill with cultural understanding.

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.

Jul 02
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Laser End Points at SOCU with E. Victor Ross, MD

By Sessions

laser procedures in patients with skin of color

Safety in using lasers and other procedural treatments is a key educational focus of Skin of Color Update. At the 2024 conference, Next Steps in Derm interviewed E. Victor Ross, MD, FAAD, about his session on laser end points.

Watch as Dr. Ross shares end points for a few laser procedures and what you don’t want to see. Learn what tool Dr. Ross uses even in standard procedures to help with recognizing end points. Find out how a cooling device can be used in safely treating patients with skin of color. Hear how to protect surrounding skin when treating a lentigo. What happens if a laser doesn’t have an end point? Find out Dr. Ross’s tips on how to ensure safety and effectiveness in these situations.

Register for Skin of Color Update 2025 for more pearls in procedural treatments in patients with skin of color.

Jun 24
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Advancing Vitiligo Treatment: Highlights from SOCU 2024

By Sessions

overview of vitiligo

June is Vitiligo Awareness Month. At the 2024 Skin of Color Update, Rebecca Vasquez, MD, FAAD, of UT Southwestern Medical Center, shared a comprehensive overview of vitiligo, highlighting its significant psychological and medical impact.

Affecting 0.5% to 2% of the global population, Dr. Vasquez detailed the role of immune-mediated destruction of melanocytes, which is primarily driven by autoreactive CD8+ T cells. Environmental triggers, like sunburn or phenolic compounds, can trigger or exacerbate the condition, which often appears in areas prone to friction or trauma, such as the elbows and hands.

Clinical Types:

  • Nonsegmental Vitiligo (NSV): Most common, progressive, and often associated with autoimmune conditions.
  • Segmental Vitiligo (SV): Less common, typically stabilizes after rapid early progression.

Dr. Vasquez emphasized the emotional burden of the disease, especially in patients with skin of color, and the need to address psychological health alongside physical symptoms.

Treatment Options:

  • Topical Therapies: Corticosteroids and calcineurin inhibitors.
  • Phototherapy: Narrowband UVB (NbUVB) promotes repigmentation, especially when combined with topicals.
  • JAK Inhibitors: Topical ruxolitinib has shown strong results in trials; oral versions are in phase 3.
  • Surgical Treatments: Autologous skin cell suspension shows high repigmentation success in stable cases.
  • Combination Therapies: Approaches like ruxolitinib + NbUVB yield better outcomes.

Emerging Research:

  • Oral JAK inhibitors (ritlecitinib, povorcitinib, upadacitinib) show promise.
  • Targeting IL-15 as a way to go after tissue-resident memory T cells may offer long-term remission.

Conclusion:
There is no cure, but treatment is advancing. A personalized, multidisciplinary approach is essential to effectively manage both the physical and emotional aspects of vitiligo.

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

Register for SOCU 2025 for more education on pigmentary disorders, including vitiligo.

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