Acquired perforating dermatosis in a skin graft.

Acquired perforating dermatosis (APD) is characterized by pruritic craterlike lesions with a predilection for patients affected by chronic kidney disease or diabetes mellitus (DM). We present a case of a 57-year-old black woman admitted for chest pain and dyspnea who was found to have 2 teardrop-shaped yellow-white-chalky plaques consistent with APD that developed at the site of a preexisting split-thickness skin graft (STSG). We also review the literature on APD.

Are Natural Ingredients Effective in the Management of Hyperpigmentation? A Systematic Review.

BACKGROUND: Hyperpigmentation disorders are commonly encountered in dermatology clinics. Botanical and natural ingredients have gained popularity as alternative depigmenting products. OBJECTIVE: We sought to review clinical studies evaluating the use of different natural products in treating hyperpigmentation so clinicians are better equipped to educate their patients. Specific ingredients reviewed include azelaic acid, aloesin, mulberry, licorice extracts, lignin peroxidase, kojic acid, niacinamide, ellagic acid, arbutin, green tea, turmeric, soy, and ascorbic acid. METHODS: Systematic searches of PubMed and SCOPUS databases were performed in March 2016 using the various ingredient names, "melasma"and "hyperpigmentation." Two reviewers independently screened titles, leading to the selection of 30 clinical studies. RESULTS: Review of the literature revealed few clinical trials that evaluated the treatment of hyperpigmentation with natural ingredients. Despite the limited evidence-based research, several natural ingredients did show efficacy as depigmenting agents, including azelaic acid, soy, lignin peroxidase, ascorbic acid iontophoresis, arbutin, ellagic acid, licorice extracts, niacinamide, and mulberry. CONCLUSION: The aforementioned ingredients show promise as natural treatments for patients with hyperpigmentation disorders. These agents might also provide clinicians and researchers with a way to further characterize the pathogenesis of dyschromia. However, the paucity of clinical studies is certainly a limitation. Additionally, many of the in-vivo studies are limited by the short length of the trials, and questions remain about the long-term efficacy and safety of the ingredients used in these studies. Lastly, we suggest a standardized objective scoring system be implemented in any further comparative studies.

Sweet syndrome induced by oral acetaminophen-codeine following repair of a facial fracture.

Sweet syndrome (SS), also known as acute febrile neutrophilic dermatosis, is an uncommon condition that is clinically characterized by painful, well-demarcated, indurated, erythematous plaques or nodules that typically favor the head, neck, and arms, and are accompanied by fever. The disease is divided into several categories based on the underlying etiology, with the drug-induced variant comprising a rising number of the total cases and being reported in association with an increasing number of medications. We report a rare case of SS induced by an oral acetaminophen-codeine suspension and tablets. The importance of this case lies in the ability to educate both physicians and pharmacists alike regarding a newly recognized cutaneous adverse effect of acetaminophen-codeine so that the medication may be discontinued or substituted upon recognition of this adverse reaction to decrease patient morbidity.

Folliculitis keloidalis nuchae and pseudofolliculitis barbae: are prevention and effective treatment within reach?

Pseudofolliculitis barbae and folliculitis keloidalis nuchae are chronic follicular disorders disproportionately affecting men of African ancestry. This article explores the etiology, pathogenesis, treatment, and prevention strategies of these conditions. Effective treatment and prevention of these disorders involves pharmacologic and procedural interventions as well as behavioral modifications.

Hair and scalp disorders in ethnic populations.

Human hair has been classified into 3 major groups, as determined by ethnic origin. In these populations, significant structural and biochemical variations of the hair follicle and shaft are seen, as well as unique hair grooming practices. These structural variations of the hair are closely linked to the common disorders of the hair and scalp, such as acquired trichorrhexis nodosa, seborrheic dermatitis, traction alopecia, central centrifugal cicatricial alopecia, dissecting cellulitis, frontal fibrosing alopecia, and pseudofolliculitis barbae.

New horizons in treating disorders of hyperpigmentation in skin of color.

Pigmentary abnormalities are among the most common reasons why patients with skin of color visit a dermatologist. Hydroquinone has been a cornerstone for the treatment of hyperpigmentation; however, concerns regarding adverse effects have prompted a search for alternative agents. Some promising topical treatments include soy, licorice, rucinol, mulberry, niacinamide, ellagic acid, resveratrol, and dioic acid. Oral agents, primarily used for the prevention of postprocedural hyperpigmentation, include procyanidins, tranexamic acid, and Polypodium leucotomos. Advances in Q-switched lasers, intense pulse light, fractional photothermolysis, and the advent of tretinoin peeling add to the clinician's armamentarium for treating hyperpigmentation.

Comparative evaluation of men's depilatory composition versus razor in black men.

Shaving with razors often is problematic for men with sensitive skin, especially black individuals who are generally prone to developing pseudofolliculitis barbae (PFB). For patients with PFB, physicians often recommend shaving with depilatory creams that chemically remove hair from the skin surface by dissolving keratin. This 1-week, controlled, single-center, split-faced, randomized trial compared shaving with 3 different depilatory compositions to shaving with a manual razor in black men. One depilatory composition was withdrawn during the study because of the high incidence of adverse events. The depilatory compositions produced fewer papules and more irritation immediately after use and to a greater extent than the manual razor; the irritation was transient and more often subjective than objective. In this preliminary study, the result of using depilatory compositions was that the skin looked and felt smoother compared to shaving with a razor. Depilatory products are recommended for patients who develop PFB or are unsatisfied with the results of shaving with a manual razor.

Topical retinoids for pigmented skin.

Topical retinoids are an important class of drugs for treating several dermatoses occurring more frequently in patients with pigmented skin, such as melasma, post-inflammatory hyperpigmentation, pseudofolliculits barbae and keloids. They also play a role in managing acne, psoriasis, photoaging, cutaneous T-cell lymphoma, Kaposi sarcoma and disorder of hyperkeratosis in this demographic as well. In general, topical retinoids are well tolerated in pigmented skins. There is little evidence to suggest that patients with darker skin are at increased risk of irritation. However, retinoid dermatitis can induce post-inflammatory hyperpigmentation and attempts should be made to reduce its occurrence by modifying treatment regimens in patients with pigmented skins.

Vitiligo update.

Vitiligo is an acquired dyschromia of the skin in which there is a loss of epidermal melanocytes. The prevalence of vitiligo is approximately 1% in the United States and 0.1-2% worldwide. The exact pathogenesis of vitiligo remains elusive and is likely multifactorial. After completing this update, participants should be able to discuss the epidemiology of vitiligo and summarize the proposed mechanisms for development of this disease. In addition, they should be able to discuss physical findings, approach to the patient, and some of the therapeutic modalities for this disorder.

Photoaging and nonablative photorejuvenation in ethnic skin.

BACKGROUND: Advances in nonablative skin rejuvenation technologies have sparked a renewed interest in the cosmetic treatment of aging skin. More options exist now than ever before for reversing cutaneous changes caused by long-term exposure to sunlight. Although Caucasian skin is more prone to ultraviolet light injury, ethnic skin (typically classified as types IV to VI) also exhibits characteristic photoaging changes. Widespread belief that inevitable or irreversible textural changes or dyspigmentation occurs following laser- or light-based treatments has been challenged in recent years by new classes of devices capable of protecting the epidermis from injury during treatment. Demographic changes in the US population favor an increasing trend of older, ethnically diverse patients requesting treatment to recapture a youthful appearance. OBJECTIVE: The purpose of this article is to review the recent literature regarding clinical recognition and treatment of photoaging changes in ethnic skin. This article provides a basis for classification of current and future nonablative technologies with regard to the safety and efficacy of treatment in ethnic skin. CONCLUSIONS: Nonablative technologies have emerged to meet the public demand for no-downtime treatment of aging skin. As these technologies continue to evolve and improve, physicians are challenged to define realistic goals, expectations, and limitations for treatment. Whenever possible, ongoing and future studies should attempt to address treatment in ethnic skin types. Photoaging changes in ethnic skin can be recognized and successfully treated with nonablative technology with minimal risk and downtime.

Management of dyschromias in ethnic skin.

Pigmentary disorders are one of the most common skin disorders among people of color. Dyspigmentation in the form of either hyperpigmentation or hypopigmentation is often psychologically devastating to patients with darker skin. There is marked contrast between normally pigmented hyperpigmented, hypopigmented or depigmented skin in people of color. Despite being common, pigmentary disorders remain difficult to treat.

Ethnic skin disorders overview.

With the changing demographics of the US population, there is a need to understand the variety of dermatologic disorders that manifest in ethnic groups of non-Caucasian skin types. This article provides a review of presentations and current treatments of several common dermatologic diagnoses in black, Hispanic, and Asian racial groups and compares them with the presentations in Caucasian skin. The specific diagnoses discussed in the different racial groups include acne; pigmentary disorders such as postinflammatory hyperpigmentation and hypopigmentation, vitiligo, and melasma; and photoaging. Because the majority of the world's population already consists of people with pigmented skin and the population within the United States is approximately one-third non-Caucasian, physicians who practice in the field of dermatology today need a thorough understanding of non-Caucasian dermatoses.

Structure and function of ethnic skin and hair.

Differences have been found among blacks, whites, Asians, and Hispanics in various areas of skin structure and function. Among them is the stratum corneum lipid (ceramide) content, which is highest in Asians, then Hispanics, then whites, and lowest in blacks. Melanosomal packaging and percutaneous absorption rates for specific compounds also vary among the different races. Reports supporting the occurrence of difference in TEWL, tyrosinase levels, skin elasticity, and water absorption rates between blacks and whites, and reaction to skin irritation have been conflicting. No significant differences in corneocyte size, skin thickness, and skin biomechanics have been reported.

Acne in ethnic skin.

Acne is the most common disorder observed in ethnic skin. Clinical presentation is different than in white skin. Postinflammatory hyperpigmentation is a common sequelae of acne in darker skin. The management of acne in ethnic skin is based largely on the prevention and treatment of hyperpigmentation.

Pigmentary disorders in ethnic skin.

Pigmentary disorders are commonly seen in ethnic skin. They are psychologically problematic in darker skin. Treatment of many of these disorders remains difficult.

Cutaneous diseases in the black races.

Laser therapy is routinely used today to treat a myriad of general and cosmetic dermatologic conditions. Most laser procedures are performed on lighter skin types with an abundance of published literature. There is a dearth of information about lasers on darker ethnic skin types. The demand for laser procedures on ethnic skin is growing dramatically. The dermatologic surgeon needs a conservative approach combined with ingenuity, sound judgment, and a clear understanding of laser optics in treating ethnic skin.

Skin cancer and photoaging in ethnic skin.

Skin cancer prevalence in ethnic skin is low. Squamous cell carcinoma, hypopigmented mycosis fungoides, and acral lentiginous melanoma are the most serious types of skin cancer noted in the darker-skinned population. Photoaging occurs less frequently and is less severe in ethnic skin.