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SOC Manuscripts

The Use of Deoxycholic Acid for the Clinical Reduction of Excess Submental Fat in Indian Patients

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Source: J Drugs Dermatol. 2019;18(3):266-272.

Debraj Shome MD FRCS, FACS, MBA Stuti Khare MD, Rinky Kapoor MD

The injectable adipocytolytic drug deoxycholic acid (DCA) is the first pharmacological intervention approved for the reduction of submental fat (SMF) and offers an alternative to invasive measures to improve the submental profile and the cervico-mental angle. DCA injection (ATX-101, Kybella [United States], Belkyra [Canada]; Kythera Biopharmaceuticals, Inc., Westlake Village, CA, acquired by Allergan, Inc.), are proprietary formulations of synthetically derived DCA that is FDA approved for improvement in the appearance of moderate to severe convexity or fullness associated with SMF.

Aim: As none of the aforementioned are available in India, we undertook this study to study the efficacy of generic DCA for SMF reduction in Indian patients.

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Latino JDD Rendon

Dermatological Concerns in the Latino Population

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Source: J Drugs Dermatol. 2019;18(3 Suppl):s112-114. 

Marta I. Rendon MD 

The Journal of Drugs in Dermatology (JDD) published a supplement on the dermatological concerns in the Latino population authored by Marta I. Rendon, MD.

The Latino, or Hispanics in the United States, are the drivers behind demographic growth. They are heterogeneous in many dimensions related to health risks and dermatological conditions. Understanding the heterogeneity and clinical manifestation of skin concerns in such population is essential for health care providers. At the annual meeting of the American Academy of Dermatology in 2018, Dr. Rendon chaired a special symposium titled “Skin Issues in Latino Patients”, with the objective of training clinical practitioners how to better provide care and education to our diverse patients.

Click “Download Original Article” here

  • Introduction: Dermatological Concerns in the Latino Population Marta I. Rendon MD
  • Hyperpigmentation Disorders in Hispanic Population in the United States Marta I. Rendon MD
  • Disorders of Hypopigmentation Yemisi Dina BS, Jacqueline McKesey MD MS, Amit G. Pandya MD
  • Skin Cancer in Hispanics in the United States Maritza I. Perez MD
  • Photoaging and Photoprotection in United States Hispanic Population Qian Zheng MD PhD, Janet Wangari-Talbot PhD, Charbel Bouez PhD, and Michele Verschoore MD
  • Acne and Rosacea: Special Considerations in the Treatment of Patients With Latin American Ancestry Mercedes Florez-White MD
  • Cosmetic Laser Procedures in Latin Skin Sheila Jalalat MD, Eduardo Weiss MD

Seborrheic Dermatitis in Skin of Color: Clinical Considerations

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Source: J Drugs Dermatol. 2019;18(1):24-27.

May Elgash BS, Ncoza Dlova MBChB FCDerm PhD, Temitayo Ogunleye MD, Susan C. Taylor MD

Skin of Color Update 2019 faculty Susan C. Taylor, MD and colleagues published a paper in the January 2019 issue of the Journal of Drugs in Dermatology on seborrheic dermatitis in skin of color.  Read the abstract below or login in to JDD for the full manuscript.

Abstract: Seborrheic dermatitis is a common, relapsing, inflammatory skin condition of unclear etiology. The Malassezia yeast genus are believed to play a role. Seborrheic dermatitis commonly affects areas of the skin with high sebum production, including the scalp, nasolabial folds, glabella, eyebrows, beard, ears, retroauricular skin, sternum, and other skin folds. Seborrheic dermatitis may present differently in individuals with skin of color. Darker-skinned individuals may present with scaly, hypopigmented macules and patches in typical areas of involvement. Arcuate or petal-like patches may be seen, specifically termed petaloid seborrheic dermatitis. Children of color often do not experience the classic “cradle cap” appearance of seborrheic dermatitis, and have erythema, flaking, and hypopigmentation of the affected areas and folds of skin. Seborrheic dermatitis tends to respond well to conventional treatments, although it tends to recur. Skin of color patients may require a modified treatment approach which takes into account differences in hair texture and hair washing frequency. This paper aims to highlight these differences to help reduce disparities in the management of seborrheic dermatitis in patients of color. To read the full manuscript with your JDD subscription, click here.

Clinical Evaluation of Safety and Efficacy of Fractional Radiofrequency Facial Treatment of Skin Type VI Patients

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Source: J Drugs Dermatol. 2018;17(11):1169-1172.

Eliot F. Battle Jr. MD and Sally Battle CNMT

We are excited to highlight a November 2018 published in the Journal of Drugs in Dermatology by our very own co-founder, Eliot F. Battle, MD.   The study was intended to evaluate the safety and efficacy of fractional RF technology for the treatment of patients with Fitzpatrick skin type VI. We recommend you read the abstract or login with your JDD subscription for the full manuscript here.

Epidemiology of Skin Diseases in a Diverse Patient Population

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Source: J Drugs Dermatol. 2018;17(10):1032-1036

Jewell V. Gaulding MD, Daniel Gutierrez MD, Bhavnit K. Bhatia MD, Xiaoxia Han PhD, Richard Krajenta BS, Christine Neslund-Dudas PhD, Henry W. Lim MD, Ellen N. Pritchett MD MPH

Abstract
BACKGROUND: Epidemiologic studies of patients who present to dermatology clinics are necessary to identify the needs of patients. OBJECTIVE: To quantify and compare diagnoses according to race, ethnicity, and socioeconomic status (SES) at 6 general dermatology clinics from January 2013 to December 2016. METHODS: A retrospective cohort of new patients was established using an electronic medical record database. Primary diagnoses and diagnostic codes were recorded. Geocoding was utilized to obtain SES. RESULTS: There were 65969 new patient visits. Racial and ethnic demographics were obtained with the overall top 3 conditions being eczema or dermatitis, benign skin neoplasm, and adnexal disease. In blacks, however, follicular disorders were the third most common condition seen. The most frequently encountered diagnoses at the clinics with the highest and lowest SES were benign skin neoplasm and eczema or dermatitis, respectively.

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Skin Type Classification: A Decennial Perspective

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Source: Journal of Drugs in Dermatology April 2018

Wendy E. Roberts MD FAAD 

The intent of this brief communication is to revisit the Roberts Skin Type Classification System published by Journal of Drugs in Dermatology (JDD) in 2008 with a 2018 lens and provide additional information for its wider acceptance and implementation. The key points of this communication are that the 2010 US census indicates rapid growth of the multiple race population up 30-50% from the 2000 census, cosmetic procedures have increased from 9.5 million to 12.8 million over the same 10 year period, and cosmetic procedures in SOC patients have increased 6% over the same 10 year period. We have come very far in our knowledge of skin safety and colorblind technology, however, as we experience rapid globalization and increasing diversity of traditionally diverse populations, this classification system is even more relevant now than it was 10 years ago. What standard are we using to predict our diverse patient outcomes to skin insult, injury, and inflammation? Why do we still use the limited Fitzpatrick Phototype System to communicate safety when the system does not address dyspigmentation and scarring, the most frequent complications in ill-fated skin trauma?

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Psoriasiform Pemphigus Foliaceus in an African American Female: An Important Clinical Manifestation

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Source: J Drugs Dermatol. 2018;17(4):471-473

Evan Austin BS, Jillian W. Millsop MD, Haines Ely MD, Jared Jagdeo MD MS and Joshua M. Schulman MD

A 50-year-old African-American woman presented to the dermatology clinic with a pruritic eruption of 3 years’ duration. On clinical examination, the patient had well-demarcated, pink, atrophic plaques and superficial erosions over the inframammary folds and mid-chest. She also had well-demarcated, hyperpigmented, hyperkeratotic scaly plaques over the abdomen, suprapubic region, elbows, knees, and back with sporadic small superficial blisters. A punch biopsy of the right abdomen was performed and revealed psoriasiform epidermal hyperplasia, focal parakeratosis, and acantholysis throughout the superficial spinous and granular layers. Only a sparse inflammatory infiltrate was present in the underlying dermis. Clinical and histological findings supported the diagnosis of pemphigus foliaceus (PF), but psoriasis was included in the differential diagnosis due to the presence of discrete plaques with an erythematous border. We hypothesize that patients with psoriasiform presentations of PF may be misdiagnosed with plaque psoriasis. It is important to distinguish between PF and psoriasis as there is evidence that ultraviolet light, a common treatment for psoriasis, may exacerbate PF. We document and highlight this atypical psoriasiform presentation of PF in a patient with skin of color to raise awareness and improve diagnosis and outcomes.

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Frontal Fibrosing Alopecia and Concomitant Lichen Planus Pigmentosus: A Case Series of Seven African American Women

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Source: J Drugs Dermatol. 2018;17(4):397-400.

Laura N. Uwakwe MD, Leah A. Cardwell MD, Emily H. Dothard MD, Bernice I. Baroudi BS, and Amy J. McMichael MD

The association of frontal fibrosing alopecia (FFA) and lichen planus pigmentosus (LPPigm) is rare. Prior reports suggest that FFA and LPPigm are on the same spectrum of disease, and a diagnosis of LPPigm may predict the future development of FFA. We aim to further characterize the association between FFA and LPPigm by reviewing the clinical cases of seven African American women. Seven patients with FFA were diagnosed clinically by recession of frontotemporal hairline and confirmed by histopathologic examination showing lymphocyte-mediated cicatricial alopecia. LPPigm was diagnosed by clinical evaluation alone based on the characteristic morphology, color, and distribution of the lesions. It is difficult to distinguish whether halted progression of FFA was due to the success of the treatment regimen or spontaneous stabilization of disease over time. Our case series supports the theory that FFA and LPPigm likely exist on the same spectrum of disease. Our observations demonstrate a likely positive correlation between FFA and LPPigm.

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Successful Treatment of Keloid With Fractionated Carbon Dioxide (CO2) Laser and Laser-Assisted Drug Delivery of Triamcinolone Acetonide Ointment in an African-American Man

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Source: J Drugs Dermatol. 2017;16(9):925-927.

Ekaterina Kraeva MD, Derek Ho MD, and Jared Jagdeo MD MS

Keloids are fibrous growths that occur as a result of abnormal response to dermal injury. Keloids are cosmetically disfiguring and may impair function, often resulting in decreased patient quality-of-life. Treatment of keloids remains challenging, and rate of recurrence is high. We present a case of a 39-year-old African-American man (Fitzpatrick VI) with a 10-year history of keloid, who was successfully treated with eight sessions of fractionated carbon dioxide (CO2) laser immediately followed by laser-assisted drug delivery (LADD) of topical triamcinolone acetonide (TAC) ointment and review the medical literature on fractionated CO2 laser treatment of keloids. To the best of our knowledge, this is the first report of successful treatment of a keloid using combination therapy of fractionated CO2 laser and LADD with topical TAC ointment in an African-American man (Fitzpatrick VI) with excellent cosmetic results sustained at 22 months post-treatment. We believe that this combination treatment modality may be safe and efficacious for keloids in skin of color (Fitzpatrick IV-VI) and other patients. This case highlights the ability of laser surgeons to safely use fractionated CO2 lasers in patients of all skin colors.

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Microneedling in All Skin Types: A Review

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Source: J Drugs Dermatol. 2017;16(4):308-314.

Lauren Meshkov Bonati MD, Gorana Kuka Epstein MD, and Tamara Lazic Strugar MD

Microneedling procedures are growing in popularity for a wide variety of skin conditions. This paper comprehensively reviews the medical literature regarding skin needling efficacy and safety in all skin types and in multiple dermatologic conditions. A PubMed literature search was conducted in all languages without restriction and bibliographies of relevant articles reviewed. Search terms included: “microneedling,” “percutaneous collagen induction,” “needling,” “skin needling,” and “dermaroller.” Microneedling is most commonly used for acne scars and cosmetic rejuvenation, however, treatment benefit has also been seen in varicella scars, burn scars, keloids, acne, alopecia, and periorbital melanosis, and has improved flap and graft survival, and enhanced transdermal delivery of topical products. Side effects were mild and self-limited, with few reports of post-inflammatory hyperpigmentation, and isolated reports of tram tracking, facial allergic granuloma, and systemic hypersensitivity.

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