Effective and durable repigmentation for stable vitiligo: A randomized within-subject controlled trial assessing treatment with autologous skin cell suspension transplantation.

BACKGROUND: Vitiligo lesions are often challenging to repigment with conventional medical therapies. Surgical autologous melanocyte transfer methods can be utilized for stable vitiligo but demand specialized skills and equipment. A point-of-care autologous cell harvesting device was designed enabling simple preparation of autologous skin cell suspension (ASCS) containing melanocytes, keratinocytes, and fibroblasts providing a straightforward approach for cellular transplantation. OBJECTIVE: To evaluate the safety and effectiveness of ASCS for repigmentation of stable vitiligo lesions among adults. METHODS: A US multicenter, randomized, within-subject controlled trial compared ASCS to narrow band ultraviolet B only (Control) in similar vitiligo lesions. ASCS was applied after laser skin resurfacing and followed by narrow band ultraviolet B treatment. The primary effectiveness endpoint was the proportion of lesions achieving ≥80% repigmentation at week-24. Repigmentation durability was assessed at week-52. RESULTS: Among 25 subjects, 36% of ASCS-treated lesions achieved ≥80% repigmentation at week-24 compared to 0% for Control (P < .025), with durability through week-52. The safety profile of ASCS was acceptable, with favorable patient- and investigator-reported outcomes. LIMITATIONS: Study sample size limited robust subgroup analyses. CONCLUSION: Application of ASCS has potential as a treatment for repigmentation of stable vitiligo lesions with the potential to improve health-related quality of life and reduce burden of disease.

Therapeutic interventions to lessen the psychosocial effect of vitiligo in children: A review.

Vitiligo commonly affects children, with half of affected individuals experiencing disease onset before the age of 20. Because childhood is a time of advancement in social and psychological development, understanding the extent of the effect of the disease and means of alleviation is crucial. Vitiligo has been shown to decrease children's quality of life, with greater distress in children with highly visible lesions and darker skin tones. This article reviews the literature regarding interventions that have been analyzed in children. Studies evaluating the effect of camouflage, cognitive behavioral therapy, psychological self-help tools, and support groups on the psychosocial aspects of vitiligo were included. The review highlights the ongoing need for studies to better understand the modalities described in this article, as well as others, such as skin dyes, bleaching creams, medical tattooing; week-long camps that cater to children with chronic skin disease; and biofeedback, that might have a role in preventing the psychosocial sequelae of childhood vitiligo.

Excimer Light Treatment for Idiopathic Guttate Hypomelanosis: A Pilot Study.

BACKGROUND: Idiopathic guttate hypomelanosis (IGH) is a commonly acquired benign leukoderma characterized by multiple discrete, hypo- or depigmented macules often on extremities that can be aesthetically undesirable for patients. This is the first study using excimer laser for treatment. OBJECTIVE: To determine the effectiveness of excimer laser for repigmentation of idiopathic guttate hypomelanosis. METHODS AND MATERIALS: In this longitudinal, split-body controlled, single-blinded pilot study, 6 patients were treated with excimer laser for 12 weeks using the vitiligo protocol. Effectiveness was graded by the blinded observer scale through photographic comparisons at the end of the study. Participants also graded their progress at intervals during the study. A descriptive trend analysis and an ANOVA model were used to determine outcomes. RESULTS: Lesions that received the excimer treatment had significantly higher repigmentation by the end of the study compared with baseline and untreated lesions. CONCLUSION: Excimer laser treatments are already considered to be a safe modality for a variety of skin conditions. This study suggests that excimer is an effective treatment option with acceptable cosmetic outcomes for IGH.

Cutaneous Rosai-Dorfman Disease.

A 48-year-old Hispanic man presented with a nodule on the right cheek. The lesion had started as a papule 4 months previously that had slowly enlarged and then plateaued at its present size. The nodule was asymptomatic, and the patient denied bleeding, draining, or preceding trauma. Review of systems was negative for fevers, weight loss, night sweats, lymphadenopathy, or other skin findings. Past medical history was significant only for type 2 diabetes mellitus, hyperlipidemia, and hypertension.

Top DEI Topics to Incorporate Into Dermatology Residency Training: An Electronic Delphi Consensus Study.

Current dermatology residency education may be deficient in curricular topics and training related to diversity, equity, and inclusion (DEI). Integrating more DEI topics within residency curricula may improve clinical care delivered to diverse populations and improve cultural humility among trainees. The objective of this electronic Delphi (e-Delphi) study was to reach a consensus on the most important DEI topics for inclusion in dermatology residency program curricula nationwide. Sixty-one DEI-related topics were proposed by an expert panel consisting of dermatologists from the Association of Professors of Dermatology DEI subcommittee and the American Academy of Dermatology Diversity Task Force. Two rounds of anonymous electronic surveys based on a 5-point Likert scale were administered using a modified e-Delphi design. Voluntary participants including residents and academic dermatologists were self-selected after an email was sent to the Association of Professors of Dermatology listserve.

Psychosocial considerations in the management of vitiligo.

Vitiligo is a depigmenting skin disease that can carry significant psychosocial impact. Health care providers play a crucial role in shaping patients' understanding of their condition, approach to treatment, and coping mechanisms. In this contribution, we review the psychosocial aspects of vitiligo management, including the debate over the "disease-ification" of vitiligo, its effects on quality of life and mental health, and methods to holistically assist affected individuals beyond just treatment of the vitiligo itself.

How to Advise Medical Students Interested in Dermatology: A Survey of Academic Dermatology Mentors.

Dermatology residency programs are among the most competitive residencies of medical specialties. To navigate this competitive process, students seek advice from dermatology mentors who provide a range of responses depending on their experience or preferences. To consolidate this range of advice, we surveyed members of the Association of Professors of Dermatology (APD) on their responses to common questions from medical students regarding quantity of program applications, research gap year, internship year, letters of intent, away rotations, letters of recommendation (LORs), and the new Electronic Residency Application Service (ERAS) supplemental application. Although recommendations given to students remain individualized, our study describes the range of advice received and details the differences between mentor advice and common student practices throughout the application cycle. We hope these data will help mentors in advising students as well as inform organizations seeking to create standards and official recommendations regarding aspects of the application process.

Psychosocial and quality-of-life factors associated with depigmentation therapy for vitiligo.

BACKGROUND: There is a paucity of data examining the psychosocial factors relevant to depigmentation therapy, an irreversible treatment for vitiligo. This study explores patients' perspective and experience while undergoing depigmentation therapy and quality-of-life effects of such therapy. METHODS: An online instrument assessing the impact of depigmentation therapy on various psychosocial variables and including the validated Dermatology Life Quality Index (DLQI) were administered to two groups of participants with vitiligo: (1) those who are currently undergoing or have completed depigmentation therapy and (2) those with vitiligo who have not undergone depigmentation therapy but had considered it. Data were collected on psychosocial factors such as length of time until depigmentation therapy was offered, duration, financial burden, level of satisfaction, impact on life activities, and challenges faced during and after depigmentation therapy. DLQI scores were also measured. RESULTS: Thirty-five vitiligo patients who did not undergo depigmentation and 42 patients who did undergo depigmentation therapy were included in the study. Baseline characteristics were comparable between groups. Mean DLQI was higher for patients who did not undergo depigmentation than for those who underwent depigmentation (10.2 versus 5.3, p = 0.002), indicating worse quality-of-life in those not depigmenting. Patients who underwent depigmentation reported significantly less discomfort in various social situations after undergoing depigmentation therapy compared to how they felt before undergoing therapy and reported significantly less discomfort in these situations than patients who did not undergo depigmentation therapy. CONCLUSIONS: Despite potential challenges, depigmentation therapy appears to augment quality-of-life across various domains in individuals with vitiligo.

Improving Diagnostic Accuracy in Skin of Color Using an Educational Module.

Dermatologic disparities disproportionately affect patients with skin of color (SOC). This study evaluated the effectiveness of a focused educational module for improving diagnostic accuracy and confidence in the treatment of patients with SOC among interprofessional health care providers. An SOC educational module involving a pretest, 15-minute lecture, immediate posttest, and 3-month posttest was created. One hundred participants completed the pretest and immediate posttest; 36 of them also completed the 3-month post-test. Our results suggest that a focused educational module may provide long-term improvements in diagnostic accuracy and confidence for conditions presenting in patients with SOC.

The indelible marks on dermatology: Impacts of COVID-19 on dermatology residency Match using the Texas STAR database.

With changes to interview format and away rotations, the COVID-19 pandemic has reshaped the residency application process. In this retrospective cohort study of data from the nationwide Texas Seeking Transparency in Applications to Residency (STAR) survey, we sought to understand how the pandemic has affected applicants in the 2021 dermatology Match. We compared applicants in the post-COVID-19 Match year (2021) with those in pre-COVID-19 Match years (2018-2020) regarding match rates, interview costs, residency geographic connections, and number of interviews attended. A total of 439 dermatology applicants who completed the Texas STAR survey were included. There was no difference in percentage of applicants with a geographic connection to their matched program (43.88% vs 47.20%). Compared with prior cycles, applicants in the 2021 Match had a higher percentage of interview offers (96% vs 90%, P < .0001), and more applicants attended 16 or more interviews (P = .0489). Applicants in the 2021 Match reported an average savings of $5,000 compared with prior cycles. Virtual interviews offer savings for applicants but may encourage interview hoarding. Though applicants did not perform away rotations, there was no increase in geographic connection for matched applicants. Stakeholders should consider these data when evaluating the pros and cons of virtual interviewing postpandemic.

The utility of teledermatology in the evaluation of skin lesions.

INTRODUCTION: Past studies have shown mixed results about the accuracy of store-and-forward (SAF) teledermatology in the evaluation of skin lesions. The objective of this study is to determine the accuracy of SAF teledermatology in the diagnosis of skin lesions and biopsy decision compared to in-person clinical evaluation. METHODS: Histories and photographs of skin lesions gathered at clinic visits were sent as SAF consults to teledermatologists, whose diagnoses and biopsy decisions were recorded and compared statistically to the clinic data.Results and Discussion: We enrolled 206 patients with 308 lesions in the study. The study population was composed of 50% males (n = 104), and most patients were white (n = 179, 87%) and not Hispanic/Latino (n = 167, 81%). There was good concordance for biopsy decision between the clinic dermatologist (CD) and teledermatologist (TD) (Cohen's kappa (κ) = 0.51), which did not significantly differ when melanocytic lesions were excluded (κ = 0.54). The sensitivity and specificity of teledermatology based on biopsy decision was 0.71 and 0.85, respectively. Overall concordance in first diagnosis between the CD and TD was good (κ = 0.60). While there was no difference between CD and TD in proportion of correct diagnoses compared to histopathology, two skin cancers presentations were missed by TD. Study limitations included sample size, enrolment bias and differing amounts of teledermatologist case experience. Teledermatology has good concordance in diagnosis and biopsy decision when compared to clinic dermatology. Teledermatology may be utilized in the evaluation of skin lesions to expand access to dermatologic care.

The ERAS Supplemental Application: Current Status and Recommendations for Dermatology Applicants and Programs.

The 2021-2022 dermatology residency program application cycle involved an optional common supplemental application piloted by the Association of American Medical Colleges' (AAMC) Electronic Residency Application Service (ERAS). In this article we present data on the utilization and opinions of applicants and programs regarding the supplemental application, discuss changes to the supplemental application for the upcoming application cycle, and offer recommendations to applicants and programs entering year 2 of the ERAS supplemental application.

Assessing Treatment Delays for Vitiligo Patients: A Retrospective Chart Review.

Many barriers to care exist for vitiligo patients that can impact patients' quality of life. Because early treatment of vitiligo is more efficacious, we investigated the factors associated with delay to treatment via a retrospective chart review of 102 consecutive patients attending an academic outpatient clinic over a 36-month time frame. Demographic information, clinical characteristics of vitiligo, and treatment details were obtained via a standardized questionnaire given to all patients with vitiligo. Our findings emphasize the need to investigate barriers to care to reduce health disparities among individuals with vitiligo.

Pigmentation Disorders in the Elderly.

Aging skin is subject to morphological change due to both intrinsic (skin tone, genetics, endogenous hormones) and extrinsic (chronic sun exposure, medications, exogenous pigments) factors. The broad spectrum of transformation includes both hypo- and hyperpigmentation. Although cutaneous pigmentary disorders are common in younger individuals, certain disorders are more prevalent in the geriatric population. This article reviews the epidemiology, pathophysiology, clinical appearance, treatment, and prognosis of pigmentary lesions that are predominant in the elderly.

Familial alopecia areata and chronic thrombocytopenia.

Alopecia areata (AA) has a strong hereditary component and is associated with a number of other autoimmune diseases. There is no established relationship between AA and any of the congenital thrombocytopenias. We report a family in which multiple members are affected with AA and with a hereditary thrombocytopenia, most consistent with pseudo-von Willebrand disease. This raises the possibility of a genetic association between AA and one or more of the inherited thrombocytopenias, possibly both related to mutations in genes on chromosome 17.

Disseminated Syringomas of the Upper Extremities in a Young Woman.

Syringomas are benign, eccrine sweat gland tumors frequently found on the eyelids and neck in post-pubescent women and may present in healthy individuals or be associated with various medical comorbidities. We present a case of an otherwise healthy 19-year-old female with an abrupt onset of disseminated syringomas on the bilateral forearms and dorsal hands. Eruptive acral syringomas have not been previously reported in adolescents, and this diagnosis should be considered in patients presenting with a papular eruption on the hands and forearms.