Clinicopathologic correlation of dermatologic diseases in patients with darker pigmentation.

OBJECTIVES: Cutaneous diseases that disproportionately affect patients with darker pigmentation and their histologic features are historically understudied and undertreated. This review article aims to highlight the key clinical features, histopathology, and diagnostic pearls of several cutaneous diseases that commonly present in patients with darker pigmentation. METHODS: A literature search was conducted, and a list of cutaneous diseases that frequently affect patients with darker pigmentation was compiled. A group of experts expounded upon those that were most common or misdiagnosed according to scientific evidence and clinical practice. RESULTS: The diseases were divided into hypopigmented disorders, hyperpigmented disorders, scarring disorders, and alopecic disorders. Within each category, the etiology, clinical features, histopathology, and key histologic differential diagnoses are described and discussed. CONCLUSIONS: As many clinicians are taught that there are no effective treatment options or that these diseases are considered "cosmetic" in nature, patients often do not get a thorough medical workup or skin biopsy. This article aims to decrease the knowledge gap and serve as a resource for anyone involved in the care of patients with these cutaneous conditions.

Cutaneous Sarcoidosis in Skin of Color.

Cutaneous sarcoidosis presents in 25% of all sarcoidosis cases. African American populations, particularly African American women, are more likely to develop the dermatologic manifestations of the disease. There are several types of skin manifestations of sarcoidosis, which can make it more difficult to diagnose it clinically. Given the higher incidence of sarcoidosis and the poorer outcomes in these populations, it is essential to understand and recognize the variety of dermatologic symptoms associated with sarcoidosis. By doing so, patients can be diagnosed and treated earlier in their disease progression. Williams JR, Frey C, Cohen GF. Cutaneous sarcoidosis in skin of color. J Drugs Dermatol. 2023;22(7):695-697. doi:10.36849/JDD.7008.

Case Report: Triple Combination Therapy for Recalcitrant Perineal Pyoderma Gangrenosum

Pyoderma gangrenosum (PG) is a destructive ulcerative process, which is usually idiopathic or associated with underlying systemic disease. Its pathogenesis remains unknown. A 30-year-old male with a history of Crohn's disease presented with an advanced perineal and inguinal ulcer consistent with pyoderma gangrenosum, which only partially responded to oral and intralesional corticosteroids and adalimumab 80mg biweekly. The patient was started on adjunct combination cyclosporine and thalidomide, which resulted in prompt relief and profound healing. Treatment of pyoderma gangrenosum is often challenging with no standardized treatment protocols. Combination therapy should be considered in patients with refractory disease, especially with failure of monotherapy. J Drugs Dermatol. 2019;18(3):307-310.

Recalcitrant Diffuse Cutaneous Sarcoidosis With Perianal Involvement Responding to Adalimumab.

Recalcitrant cutaneous sarcoidosis with perianal involvement is rare. To our knowledge we present the first documented case of cutaneous sarcoidosis with perianal involvement successfully treated with adalimumab.

J Drugs Dermatol. 2017;16(12):1305-1306.

Cutaneous lupus erythematosus in skin of color.

Cutaneous Lupus Erythematosus (CLE) is a common manifestation in patients with Systemic Lupus Erythematosus. In a significant population of patients, CLE is the predominant feature and, in some cases, patients suffer from cutaneous disease alone. Chronic Cutaneous Lupus Erythematosus (CCLE) is a scarring subtype, more prevalent in blacks. Patients with skin of color may pose a challenge to physicians due to exaggerated cutaneous findings and increased risk of post-inflammatory hyperpigmentation and hypertrophic scarring. With the demographics of the United States rapidly shifting towards a greater population of non-Caucasian racial and ethnic groups, it is imperative that we expand on the limited research into molecular variation, clinical presentation, and therapeutic efficacy in CLE. The purpose of this review is to bring attention to the unique and severe aspects of CLE in persons of color, which calls for early and aggressive treatment.

Sodium thiosulfate in the treatment of calciphylaxis.

The authors review the presentation, diagnosis, and treatment of calciphylaxis and also describe applications of a novel therapeutic option, sodium thiosulfate. Two cases of advanced uremic calciphylaxis from both clinic and hospital settings are presented. One patient, a 57-year-old woman with end-stage renal disease, was treated with surgical debridement and sodium thiosulfate 25g three times a week. After introducing sodium thiosulfate treatment, the affected sites continue to heal with encouraging improvement of ulcer depth. Sodium thiosulfate was well-tolerated and facilitated wound healing. The patient did not develop sepsis. Sodium thiosulfate appears to be a viable first-line treatment for calciphylaxis and should be seriously considered early in the course of treatment.

Mycophenolate mofetil as a first-line steroid-sparing agent in the treatment of pemphigus vulgaris.

Pemphigus vulgaris (PV) is a life-threatening autoimmune bullous disorder. Although systemic corticosteroids are the standard treatment for PV, efficient transition to a steroid-sparing immunosuppressant is critical. There is significant debate in the literature as to what the optimal, first-line steroid-sparing agent should be in patients with PV. Mycophenolate mofetil (MMF), in particular, is a promising agent that should be strongly considered as a first-line steroid-sparing agent. The authors review treatment options for PV and describe a severe case treated successfully with prednisone and MMF as a first-line steroid-sparing agent. The patient's clinical improvement was rapid, and all PV lesions completely resolved. The dosage of prednisone was safely tapered using MMF, and the patient did not experience any flares or significant side effects during the course of treatment. Therapy for PV with systemic corticosteroids and MMF therapy was effective and well tolerated.

Advanced treatment modalities for vitiligo.

BACKGROUND: Vitiligo is an acquired multifocal and polygenic dyschromia that affects 1% to 3% of the world and presents as multiple depigmented macules and patches. Traditionally, the treatment of vitiligo has focused on pharmacologic interventions, but nearly half of all treated patients fail to respond successfully. OBJECTIVE: Several advanced techniques exist that can aid dermatologists in treating vitiligo in patients who do not respond favorably to traditional pharmacologic treatments. These advanced interventions include the use of the 308-nm excimer laser, total body depigmentation therapy with monobenzyl ether of hydroquinone, microdermabrasion, micropigmentation, khellin-UVA therapy, and surgical management using miniature punch grafting, suction blister grafting, and epidermal cultures. MATERIALS AND METHODS: This article reviews the current literature on these advanced treatment modalities for vitiligo and provides a practical guide for application of these techniques. RESULTS AND CONCLUSION: Our ability to treat vitiligo may be imperfect, but through appropriate patient selection and careful application of one or more of these advanced therapies, successful treatment of vitiligo, even in patients refractory to treatment, can be achieved.

Idiopathic hemi-facial lipoatrophy treated with autologous fat transfer.

Facial lipoatrophy can be socially disfiguring, often prompting patients to seek correction. A variety of agents are used to treat facial lipoatrophy, but the quest for the ideal agent remains elusive. We present a case of non-HIV associated, idiopathic hemi-facial lipoatrophy successfully treated with autologous fat transfer (ATF). Because ATF has no complications from antigenicity, it is a safe and cost-effective treatment option for patients with non-HIV associated cases of facial lipoatrophy and abundant donor tissue.

Bowen's disease of the penis treated with topical imiquimod 5% cream.

Bowen's disease of the penis is relatively uncommon, but the prevalence has increased in recent years. Risk factors for penile squamous cell cancer include smoking, infection with human papilloma virus (HPV), immunosuppression, and a history of conditions such as balanitis, phimosis, and lichen sclerosis et atrophicus. Bowen's disease of the penis is often managed by local excision of the lesion. Less invasive methods are now employed more frequently and include laser ablation, electrodessication and curettage, cryosurgery, application of5-fluorouracil, and topical imiquimod 5% cream. This case report describes the successful treatment of Bowen's disease of the penis with topical imiquimod 5% cream in a 42-year-old African American male with human immunodeficiency virus (HIV) disease.

Medical and surgical therapies for alopecias in black women.

Hair loss is a common problem that challenges the patient and clinician with a host of cosmetic, psychological and medical issues. Alopecia occurs in both men and women, and in all racial and ethnic populations, but the etiology varies considerably from group to group. In black women, many forms of alopecia are associated with hair-care practices (e.g., traction alopecia, trichorrhexis nodosa, and central centrifugal cicatricial alopecia). The use of thermal or chemical hair straightening, and hair braiding or weaving are examples of styling techniques that place African American women at high risk for various "traumatic" alopecias. Although the exact cause of these alopecias is unknown, a multifactorial etiology including both genetic and environmental factors is suspected. A careful history and physical examination, together with an acute sensitivity to the patient's perceptions (e.g., self-esteem and social problems), are critical in determining the best therapy course. Therapeutic options for these patients range from alteration of current hair grooming practices or products, to use of specific medical treatments, to hair replacement surgery. Since early intervention is often a key to preventing irreversible alopecia, the purpose of the present article is to educate the dermatologist on all aspects of therapy for hair loss in black women--including not only a discussion of the main medical and surgical therapies but also an overview of ethnic hair cosmetics, specific suggestions for alterations of hair-care practices, and recommendations for patient education and compliance.