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Skin of Color Update Agenda

Dermatology Concerns In Skin of Color Patients

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During the 16th Annual ODAC Dermatology, Aesthetics and Surgical Conference, I 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, Chair of Dermatology at Mount Sinai St. Luke’s and Mount Sinai West in New York City.

During a 45-minute working group session, Dr. Alexis covered three main themes: common dermatologic disorders with unique manifestations in skin of color, disorders that disproportionately affect patients of color and therapeutic nuances and unique treatment concerns in skin of color. Here are the main takeaways and pearls from this session.

Common Disorders With Unique Manifestations

Acne

Post-inflammatory hyperpigmentation is a major concern in patients of color and many times more bothersome than acne itself.  It is important to use agents that will treat both acne and PIH. Retinoids can be very effective –tretinoin, tazarotene and adapalene have been shown effect for PIH. Azelaic acid can be a good add on for patients with PIH.

Dr. Alexis doesn’t use much hydroquinone for these patients – the macules left behind by acne are usually too small to avoid creating halos around the lesion.  Chemical peels have been demonstrated to improve PIH in small studies.  The risks are higher in skin of color, so it advisable to stick to superficial peeling agents. Avoiding irritation is essential since it can lead to more dyspigmentation.

Maximize tolerability – adapalene and low concentration tretinoin or tazarotene are a good starting point.  Eliminate any irritating scrubs and other skincare products.  Use noncomedogenic moisturizers concurrently.

Disorders That Disproportionately Affect Patients of Color

Pseudofolliculitis barbae

Findings consist of papules and prominent hyperpigmentation.  This process can also trigger keloid formation. While more common in men, women with hirsutism may also develop PFB. It results from a foreign body reaction to hair reentering the dermis.

A very effective strategy is to discontinue shaving.  You may have to write letters to some patients’ employers in order to excuse them from shaving (Dr. Alexis keeps a form letter on file in his practice).

Chemical depilatory agents are a decent option.  Barium sulfide powder and calcium thioglycolate cream can be used every 2-4 days.  However, they can cause irritant dermatitis. Some patients may also find success by modifying their shaving practices.  Don’t assume your patients know how to shave – educate them.  Electric clippers are a good option – have patients leave 0.5-1 mm stubble. Traditionally single blade manual razors have been recommended.

One study sought to quantify the impact of blade number on PFB – 90 African American men were assigned to shave with a different number of blades.  There was no difference between any of the groups and everyone got better.

A small study showed decreased severity of PFB with daily shaving vs twice weekly shaving.

Dr. Alexis has a handout for patients with shaving instructions: before shaving use a mild cleanser and use a wash cloth in a circular motion to free hairs.  Use clean and sharp razor, shaving in the direction of hair growth.  Use topicals after such as clindamycin lotion or topical dapsone.  Apply a topical retinoid nightly. Avoid pulling or plucking embedded hairs, shaving against the grain.

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Skin of Color Update Co-Chair Dr. Eliot Battle Shares Insights into 2019 Faculty and Topics

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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/

Co-Chair Dr. Alexis Shares the Exciting 2019 Program Highlights

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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.

Medical Updates in Skin of Color

Medical Updates in Skin of Color

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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.

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Skin of Color STD Ted Rosen

Sexually Transmitted Diseases in Skin of Color: Crisis State

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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.

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Excerpt provided with permission. Originally published by Next Steps in Dermatology. All rights reserved.

 

 

Skin of Color Update CCCA

Pearls from Primary Cicatricial Alopecias in Black Women

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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.

 

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Hair disorders skin of color update

Clinical Approach to Hair Loss in Pediatric Patients

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Physicians from throughout the Washington DC area recently convened at a 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.

This is an excerpt from a multi-part series on Next Steps in Dermatology that summarizes salient points from each of the lectures, as well as strategies that physicians can add to their alopecia armamentarium.

This post is devoted to Dr. Leslie Castelo-Soccio’s lecture, “Clinical approach to hair loss in pediatric patients.” Dr. Castelo-Soccio is a pediatric dermatologist as well as the Dermatology Section’s Director of Clinical Research at Children’s Hospital of Philadelphia. She is an expert in alopecia as well as genetic skin disease. Her lecture provided an incredibly useful roadmap for residents learning to navigate the following aspects of caring for the pediatric alopecia patient…

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Acanthosis-Nigricans-Mimicking-Melasma-boost-768x578

Acanthosis Nigricans Mimicking Melasma

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Case Report and Pearls for Accurate Diagnosis – An Interview with the Author

During the 2018 Skin of Color Seminar Series (now the Skin of Color Update), approximately twenty posters could be seen hanging in the poster viewing area.  Each of these posters highlights novel and exciting research in skin of color. In one such poster, Dr. Monica Huynh and colleagues presented a case of acanthosis nigricans mimicking melasma.

Case Report

The patient was a 45-year-old female with a pertinent past medical history of diabetes mellitus type 2. They presented with discoloration of the cheeks for several years.  She had been treated previously with hydroquinone 4% with minimal improvement. Physical examination revealed brown-gray hyperpigmented, velvety, lichenified plaques on the lateral zygoma and hollow of the cheeks bilaterally as well as on the posterior neck.  Given the patient’s clinical presentation and past medical history of diabetes mellitus, a diagnosis of acanthosis nigricans was made. The dermatology team initiated treatment with salicylic acid cleanser twice daily, hydroquinone 4% cream twice daily, and tretinoin 0.025% cream nightly. After 8 weeks, the patient was switched to triple combination cream with improvement in facial hyperpigmentation. Due to facial dryness, the cleansing regimen was changed to salicylic acid cleanser in the morning and mandelic acid cleanser plus toner in the evening.

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Hair Loss Callendar

Understanding Hair Loss in Skin of Color Patients

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These are clinical pearls from SOCSS 2018 on hair loss in skin of color patients by Valerie Callender, MD

At the Skin of Color Seminar Series 2018 (now Skin of Color Update), Dr. Valerie Callender focused on how structural differences in afrocentric hair and cultural haircare practices contribute to the high prevalence of alopecia in African American women in particular.

*Clinical pearls* from this session are bolded, underlined, and marked with asterisks.

Dr. Callender started her lecture with an introduction to alopecia – one of the most common dermatologic concerns of African American patients. Given that healthy hair is considered to be a sign of beauty, youth, and attractiveness, alopecia has a huge negative impact on the quality-of-life of affected individuals. The psychological comorbidity of hair loss makes it essential that physicians understand the etiology, diagnosis, and treatment of common causes of scarring and non-scarring alopecia. *It is important to note that patients can present with BOTH scarring and non-scarring alopecia, and both must be considered during the work-up*.

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Ask a mentor Amy McMichael

Ask a Mentor Q&A Recap – Dr. Amy McMichael

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We had the opportunity to ask a mentor,  Dr. Amy McMichael, chair and professor of dermatology at Wake Forest University Health Sciences and Skin of Color Update faculty, questions about establishing a career in academics, finding a mentor, and better serving patients of color.  See all of her insightful answers below.

Q1: I previously attended the Skin of Color Seminar Series (now Skin of Color Update) and while sitting in the audience, I noticed that many of attendees appeared to be white physicians. Do you think there’s a representation problem in Dermatology, and could it be impacting our patients?

However, we know from other research in the house of medicine that Dermatology is second only to Orthopedics in having the worst representation of African Americans. Also identified as a major problem is the poor pipeline of under-represented minorities in college, medical school, and ultimately, in residency. We all have lots of work to do in terms of mentoring at every level to get the pipeline full of appropriate candidates.

In addition to this, we need to all be thoughtful about looking at residency applicants who may not be traditional, but who would make resilient and excellent dermatologists.

Q2: Most dermatologists (at least most of the ones I know) seem to think they don’t need special training for treating patients of color and can’t seem to acknowledge that a gap in training exists. As a dermatologist of color, I find it personally frustrating. Do you find this to be true among your peers?  If so, how do you address this with them?

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