What is Rosacea?
Rosacea is a common chronic inflammatory skin disease that primarily impacts the face, and includes papules, pustules, erythema, telangiectasias, perilesional redness, phymatous changes, and even eye involvement. Symptoms may vary among different patients and even vary over time in an individual patient. Central facial redness affects many adults and can be an indicator of the chronic inflammatory disease rosacea. Rosacea is a clinical diagnosis based on the patient’s history, physical examination, and exclusion of other disorders.
Rosacea is often under-diagnosed, particularly in individuals with skin of color. As a result, Skin of Color Update held a lecture on the topic at the most recent event.
Rosacea: Nuances in Clinical Presentation and Treatment
At Skin of Color Update 2019, Dr. Fran Cook-Bolden aimed to catch us all up to speed in how to recognize rosacea in more richly pigmented skin. Her lecture on Rosacea: Nuances in Clinical Presentation and Treatment was brimming with practical tips on how to identify the often subtle and overlooked ways that rosacea can manifest in skin of color. The following is an excerpt of an article by Kimberly Huerth, MD published on Next Steps in Derm.
Because rosacea can have a nuanced presentation in skin of color (SOC), with erythema and telangiectasias that may be difficult to discern in the setting of increased background pigmentation, it was incorrectly assumed for a long time to simply not be there. The reality is that the prevalence of rosacea in SOC is not well characterized but is likely underestimated.1Dermatologists who see a large number of SOC patients, however, will tell you that rosacea is by no means rare in this population. And I am one of these dermatologists—at my Howard University clinic, where I see predominantly black and Hispanic patients, I see several of cases of rosacea every week.
And because a diagnosis not considered is a diagnosis not made, there is often unnecessary progression of rosacea in SOC patients that results from delayed and/or inaccurate diagnosis, which in turn engenders inappropriate or inadequate treatment. As a consequence, this can lead to morbidity in the form of disfiguring, occasionally irreversible cutaneous findings, as well as intense and chronic emotional distress.
Pearls
- Look for the nuanced clinical findings!!
- Fixed centrofacial erythema may appear more reddish/violet
- A patient complains of “acne,” but has no comedones. Additionally, papules and pustules are superimposed on an erythematous background. Inflammatory papules may also appear on the chest and back.
- Telangiectasias can be difficult to appreciate with the naked eye in FST V – VI, so use your dermatoscope to help you find them
- Check for scleral injection, which may be a sign of ocular rosacea. Be aware that the onset of ocular findings may proceed cutaneous ones.
- Phymatous rosacea is a giveaway!
- Facial edema of the upper 2/3 of the face in a patient who has complained of longstanding rosacea symptoms may represent progression to Morbihan disease. Case in point (quite literally)—a poster that I presented at the Skin of Color Update highlighted a case of Morbihan disease in a black man who had reported symptoms of rosacea to his non-dermatology providers for 16 YEARS before he came to see me and received a correct diagnosis. To learn more about this case, and Morbihan disease, check out Dr. Lola Adekunle’s interview on Next Steps in Derm.
- Pertinent negatives are just as important as pertinent positives. Know that post-inflammatory hyperpigmentation (PIH) is ALMOST NEVER directly related to rosacea, unless the disease is very chronic and severe OR if the patient has been injured their skin in some way while trying to self-treat disease manifestations (picking at lesions, using harsh topical therapies)
For more rosacea pearls and AHA moments, visit the article on Next Steps in Derm.
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Andrew Alexis, MD, MPH, co-chair and co-founder of Skin of Color Update presented on Psoriasis in Skin of Color this past event.
Previously thought to be rare in patients of African ancestry, the prevalence of psoriasis is 1.6% in African Americans and 1.4% in Hispanics.
The talk, “Psoriasis: Distinct Clinical Features and Treatment Options of Psoriasis Patients of Color, ” was one of the top rated lectures of Skin of Color Update.
The lecture focused on the fundamentals of dermatology with an emphasis on several key characteristics.
- Color and distribution in the clinical presentation
- Recognizing common medical mimickers of psoriasis such as lichen planus, sarcoidosis, and cutaneous lupus erythematosus (.e. discoid lupus) in skin of color
- When in doubt, do not hesitate to biopsy
During the lecture, Dr. Alexis presented a game of “Psoriasis or Not?” allowing the audience to guess if the Kodachrome was psoriasis. This illustrated the vast presentation of psoriasis and how papulosquamous disorders can be challenging to differentiate in skin of color.
To read more about this lecture and psoriasis in skin of color, visit the full article on Next Steps in Derm.
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At Skin of Color Update 2019, our co-chair and co-founder, Andrew Alexis, MD, MPH gave a lecture on Acne: What’s New and What’s to Come? Our onsite correspondent, Kimberly Huerth, MD, M. Ed, provided the following recap of this is insightful session. The read the full article, please visit Next Steps in Derm website. Missed Skin of Color Update 2019? Purchase lectures like this on-demand.
By: Kimberly Huerth, MD, M. Ed
I still treat my acne twice daily with a whole cabinet full of various topicals. I’ve tried and failed doxycycline because it disrupts every single molecule of bacterial flora in my body. I’ve tried and failed spironolactone because I was the poster child for nearly all of its annoying and inconvenient side effects. I’ve tried and failed several OCPs because my body was a little too convinced by the estrogen and progesterone that it was actually pregnant, and decided to make me persistently sleepy and nauseous. I could put the 650-microsecond Nd:YAG that we have in clinic to use, but can’t bring myself to bother my co-rezzys (or myself) at the end of a long day seeing patients. And yes, I’ve already done a course of isotretinoin…two courses in fact. And no, I don’t have PCOS. So when I settled in to hear Dr. Andrew Alexis’s lecture on Acne in Skin of Color: What’s new and what’s to come?, I was excited for some new strategies with which to help my patients, and myself.
Dr. Alexis not only shared expert insights and strategies on how to optimize treatment for acne in skin of color (SOC) patients, but he also laid out an overview of some of the new and emerging acne treatments that we will presently be able to add to our armamentarium!
This article will provide an overview of the following:
- Understanding the unique presentation and needs of SOC patients with acne
- Sarecycline, a new tetracycline class antibiotic
- New topical acne medications in the pipeline
But first, let me share a few of the “A-ha” moments that I experienced during Dr. Alexis’s lecture, in the hope that they will entice you to read on…
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New York (Nov. 5, 2019) Skin of Color Update launches on-demand video package. Skin of Color Update, the largest CE event dedicated to trending evidence-based research and new practical pearls for treating skin types III – VI expands educational offerings to include on-demand videos.
The demand for skin of color dermatology education is greater than Skin of Color Update’s ability to accommodate onsite. Therefore, SanovaWorks has produced and launched a Best of Skin of Color Update video package. The video content is comprised of the highest attendee rated sessions of Skin of Color Update 2019. On-demand videos include top-rated faculty lectures in-sync with PPT slides with accompanying audio files.
On-demand Lectures include:
- Pearls for the Diagnosis and Treatment of Atopic Dermatitis and Eczema with Andrew Alexis, MD, MPH
- Complex Medical Cases with Andrew Alexis, MD, MPH and Ted Rosen, MD
- Surgical Approaches for Keloids with Maritza Perez, MD
- Hair & Scalp Disorders Treatment Strategies: What, How and When? with Heather Woolery-Lloyd, MD
- Pearls and Strategies for Preventing Laser Complications with Eliot F. Battle, Jr., MD.
The video content focuses on expert techniques, real-life clinical cases and expert pearls immediately useful in the practice. For a video preview, click here.
Purchase the on-demand Best of Skin of Color Update video package and start learning from the experts today.
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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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
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.
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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Skin of Color Update Co-Chair, Dr. Eliot Battle, discusses the elite faculty lineup and topics planned this year including hair loss, keloids, rosacea, acne, lasers, aesthetic treatments, skin cancer, medical dermatology, melasma, hyperpigmentation, vitiligo, inflammatory diseases and much, much more!
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.
Join us this year in New York City, September 7-8, 2019! Register today at https://skinofcolorupdate.com/registration-hotel-2019/