Evaluation of a Skin of Color Curriculum for Dermatology Residents.

The United States skin of color population is increasing. Consequently, the importance of skin of color education in dermatology residency programs will continue to grow. Previous data has shown a lack of formal education on skin of color across residency programs. In order to address this identified knowledge gap, we created a curriculum focusing exclusively on skin of color for dermatology residents. The purpose of this pilot study was to examine the effect of a week-long curriculum on the perception of dermatology residents’ comfort level treating patients of color and to determine if this type of curriculum could be expanded to other dermatology residents. Results demonstrated a significant increase when residents were asked to rate their overall confidence in managing patients with skin of color on a scale from 1 (minimally confident) to 10 (extremely confident) pre- and post-intervention. Overall, 100% of learners felt that their ability to care for patients of color was improved by this curriculum and that a skin of color curriculum should be an annual component of their dermatology academic curriculum. J Drugs Dermatol. 2021;20(7):786-789. doi:10.36849/JDD.6193.

Allergen Content of Best-Selling Ethnic Versus Nonethnic Shampoos, Conditioners, and Styling Products.

BACKGROUND: Hair products are a potential cause of allergic contact dermatitis. There are limited data on the allergen content of ethnic hair products. OBJECTIVE: To identify allergens unique to ethnic hair products (shampoos, conditioners, styling products) and provide a resource for low allergen hair care products for patients with ethnic hair types. METHODS: The top 100 best-selling shampoos, conditioners, and styling products for ethnic and nonethnic hair products were determined from 3 major online retailers (Walmart, Target, Walgreens). Allergen was defined as presence on the 2017 American Contact Dermatitis Society Core 80 allergen list. RESULTS: The 2017 American Contact Dermatitis Society Core 80 allergens were tabulated for ethnic and nonethnic shampoos, conditioners, and styling products. A list of low-allergen shampoos, conditioners, and styling products was identified. Fragrance was the most common allergen for ethnic shampoos, conditioners, and styling products. Other notable allergens included methylchloroisothiazolinone/methylisothiazolinone, formaldehyde releasers, cetyl steryl alcohol, tocopherol, decyl glucoside, sodium benzoate, and phenoxyethanol. CONCLUSIONS: This study identifies important differences in allergens found in products marketed for ethnic hair compared with those marketed for nonethnic hair.

Assessment of Black Patients' Perception of Their Dermatology Care.

IMPORTANCE: The availability and quality of skin and hair care for black patients in the United States has been a subject of growing interest in dermatology. There is limited understanding of the perceptions of black patients about the care they receive from dermatologists and the factors affecting their care satisfaction. OBJECTIVE: To elucidate black patients' perceptions of their dermatology experience in and outside of a skin of color clinic (SOCC). DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study involving a survey and focus groups was conducted including adult black patients treated in an SOCC. Recruitment was conducted April through June 2015 through clinic-posted flyers. Participants engaged in 1 of 4 focus groups on July 14, 15, 29, or 30, 2015, and completed a survey. Data were analyzed March 2016 through June 2017. MAIN OUTCOMES AND MEASURES: Planned outcomes of the focus groups were black patients' inductively generated themes on their perspectives and experiences in dermatology clinics. Planned outcomes of the survey were patients' ratings of SOCC and non-SOCC dermatologists in terms of interaction style, cultural awareness, and treatment satisfaction. Importance of patient-dermatologist racial concordance was a planned outcome in both measures. Given lack of existing prior research, no specific hypotheses were generated. RESULTS: Of the 19 adult black patients who participated in the study, 18 (95%) were women, and the mean (SD) age was 50.0 (14.2) years. All patients reported positive experiences in the SOCC. Compared with non-SOCC dermatology treatment experiences, patients reported higher levels of overall satisfaction with SOCC dermatologists (t13 = 2.85; P = .01). Patients perceived that SOCC dermatologists were better trained to care for black patients (t13 = 4.42; P = .001); showed patients greater respect and dignity (t13 = 3.37; P = .005), as well as understanding (t13 = 2.56, P = .02); and were more trustworthy (t13 = 3.47; P = .004). The majority of the comments in the focus groups (n = 207) described 2 themes: dermatologists' interaction style (62/207; 30.0%) and knowledge about black skin and hair (42/207; 20.3%). Other themes were partnering with patients on outcomes (17/207; 8.2%), shared life experiences (14/207; 6.8%), and economic sensitivity (7/207; 3.4%). These themes accounted for a large part of the participants' discussion. Of all respondents, 71% (12/17) stated that they would prefer a black (or race concordant) dermatologist; this included 91% (10/11) of the race-concordant group and 33% (2/6) of the race-discordant group. CONCLUSIONS AND RELEVANCE: Participants reported that the SOCC dermatologists provided unique and uniformly beneficial care to black patients. Care satisfaction appeared most related to dermatologists' interpersonal style and specialized knowledge in care of black skin and hair. Findings suggest that black patients' dermatologic care satisfaction would increase if dermatologists underwent enhanced residency training in skin of color, cultural competency, cost-conscious care, and empathic communication skills, and if there were greater dermatology workforce diversity.

Health care barriers and quality of life in central centrifugal cicatricial alopecia patients.

Central centrifugal cicatricial alopecia (CCCA) is known for delayed presentation and treatment. Identifying care barriers may shorten delays to treatment and improve outcomes. Understanding how CCCA impacts quality of life (QOL) also is important. Objectives of this pilot study were to elucidate the diagnostic experience for CCCA patients and understand how CCCA affects QOL. Patients completed a novel, 53-item, cross-sectional survey (CCCA Barriers to Care and Quality of Life Survey) that was developed by study investigators. The survey was completed in person or by telephone for English-speaking, adult, black female patients diagnosed with CCCA at the Northwestern University Department of Dermatology (Chicago, Illinois) between 2011 and 2017. The importance of the physician's experience with black hair and CCCA, the degree to which respondents were bothered by their CCCA, and median QOL score were noted. Central centrifugal cicatricial alopecia presents a unique set of challenges to obtain care. Lack of physician experience with black hair and CCCA is a barrier to care for many with this disease. Self-esteem of CCCA patients is affected by hair loss.

Melanoma Perception in People of Color: A Targeted Educational Intervention.

BACKGROUND: Although melanoma is more common in non-Hispanic Whites, ethnic minorities face a greater risk of melanoma-related mortality, which may be partially attributed to presentation at atypical sites and a lack of awareness. OBJECTIVE: Our objective was to assess the effectiveness of a melanoma educational intervention targeted towards people of color. DESIGN: Participants received one of two scripted melanoma educational interventions in the summer of 2015. They completed surveys before the intervention, immediately post-intervention, and 2 months post-intervention. SETTING: Dermatology clinic at an academic hospital. PARTICIPANTS: A consecutive sample of 100 participants who self-identified as African American, Asian, or Hispanic were recruited following their dermatology visit. In total, 70 participants completed the 2-month follow-up questionnaire. INTERVENTION: The comparison intervention group received an educational intervention using a conventional pamphlet on the 'ABCDEs' (Asymmetry, Borders, Color, Diameter, Evolution) of melanoma. The targeted intervention group received a modified pamphlet that included a skin of color section, the nomenclature "melanoma skin cancer", and an image of an individual performing a skin self-examination with the help of a friend. MAIN OUTCOMES AND MEASURES: Melanoma knowledge, perceived risk for developing melanoma, and skin self-examination practices were assessed through self-reported questionnaires. RESULTS: Among the 100 participants, 78% self-identified as African American, 11% as Asian, and 11% as Hispanic. Both groups experienced a similar increase in melanoma knowledge that was retained at 2 months. Perceived personal risk for developing melanoma increased more in the targeted intervention group immediately post-intervention (p = 0.015), but this difference no longer existed between the groups at the 2-month follow-up. The targeted intervention group also demonstrated a greater increase in skin self-examinations (p = 0.048) and knowledge of warning signs to look for when examining the skin (p = 0.002) at the 2-month follow-up. CONCLUSIONS AND RELEVANCE: The educational intervention targeted towards people of color resulted in increased skin self-examinations. Educational material that is relevant to ethnic minorities may better promote early detection and help to decrease the disparity in melanoma-related morality rates. TRIAL REGISTRATION: Clinicaltrials.gov registration number NCT02437305.

Dermatologic conditions in skin of color: part I. Special considerations for common skin disorders.

Skin of color traditionally refers to that of persons of African, Asian, Native American, Middle Eastern, and Hispanic backgrounds. Differences in cutaneous structure and function can result in skin conditions with distinct presentations and varying prevalence that require unique treatment. Skin cancers have different presentations in these populations. The ability to recognize and diagnose skin cancer in a timely manner is important for reducing morbidity and mortality. Basal cell carcinoma often is pigmented, squamous cell carcinoma occurs in areas of chronic scarring and inflammation, and melanoma presents in non-sun-exposed areas, such as the soles and nail beds. Diagnosis requires biopsy, with the technique depending on size and location of the lesion. Treatment options range from topical to surgical. Acne commonly results in postinflammatory hyperpigmentation and keloids. Combination therapy with topical antibiotics and benzoyl peroxide is generally more effective than monotherapy for treating acne. Use of retinoids at lower concentrations and at less frequent dosing can help prevent postinflammatory hyperpigmentation.

Dermatologic conditions in skin of color: part II. Disorders occurring predominately in skin of color.

Several skin conditions are more common in persons with skin of color, including dermatosis papulosa nigra, pseudofolliculitis barbae, acne keloidalis nuchae, and keloids. Dermatosis papulosa nigra is a common benign condition characterized by skin lesions that do not require treatment, although several options are available for removal to address cosmetic concerns. Pseudofolliculitis barbae occurs as a result of hair removal. Altering shaving techniques helps prevent lesions from recurring. In acne keloidalis nuchae, keloidal lesions are found on the occipital scalp and posterior neck. Early treatment with steroids, antibiotics, and retinoids prevents progression. A key part of the management of keloids is prevention. First-line medical therapy includes intralesional steroid injections. The distinct structure of the hair follicle in blacks results in hair care practices that can lead to common scalp disorders. For example, chemical relaxers decrease the strength of hair and may cause breakage. Better patient education, with early diagnosis and treatment, often leads to better outcomes.