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.

The convergence theory for vitiligo: A reappraisal.

Vitiligo is characterized by progressive loss of skin pigmentation. The search for aetiologic factors has led to the biochemical, the neurologic and the autoimmune theory. The convergence theory was then proposed several years ago to incorporate existing theories of vitiligo development into a single overview of vitiligo aetiology. The viewpoint that vitiligo is not caused only by predisposing mutations, or only by melanocytes responding to chemical/radiation exposure, or only by hyperreactive T cells, but rather results from a combination of aetiologic factors that impact melanocyte viability, has certainly stood the test of time. New findings have since informed the description of progressive depigmentation. Understanding the relative importance of such aetiologic factors combined with a careful selection of the most targetable pathways will continue to drive the next phase in vitiligo research: the development of effective therapeutics. In that arena, it is likewise important to acknowledge that pathways affected in some patients may not be altered in others. Taken together, the convergence theory continues to provide a comprehensive viewpoint of vitiligo aetiology. The theory serves to intertwine aetiologic pathways and will help to define pathways amenable to disease intervention in individual patients.

Morphology of Mycosis Fungoides and Sézary Syndrome in Skin of Color.

Although mycosis fungoides (MF) and Sézary syndrome (SS) commonly affect Black patients, dermatologic educational resources primarily describe the appearance of these conditions in lighter skin types. Skin of color (SoC) patients with Fitzpatrick skin types (FSTs) IV to VI tend to have variable morphologies compared to the erythematous patches, plaques, or tumors in non-sun-exposed areas seen in non-SoC patients (FSTs I-III). We performed a single-institution review of clinical photographs of patients with FSTs I to VI with the primary outcome of determining the frequency of various morphologic features of MF/SS in SoC vs non-SoC patients. Providers need to be familiar with the differences in morphologic features across skin types to ensure early diagnosis and treatment.

Cutaneous Bacillary Angiomatosis in a Renal Transplant Patient.

A 37-year-old man with a history of renal transplantation in 2013 due to focal segmental glomerulosclerosis presented to the emergency room with a 2-week history of fever, chills, anorexia, weight loss, abdominal pain, diarrhea, and a new asymptomatic lesion on the right side of the neck. The patient worked as a truck driver and frequently traveled to Wisconsin; he had not traveled internationally in the past year. He lived with his brother who had a pet cat. He was compliant with his anti-rejection medication regimen, which included mycophenolate mofetil, tacrolimus, and prednisone. Physical examination of the neck revealed an 8-mm exophytic, friable, red papule with overlying blood crusts (Figure 1). The remainder of the mucocutaneous examination was unremarkable, and there was no palpable lymphadenopathy. The patient was started on empiric intravenous cefepime and metronidazole and admitted to the hospital for further management. A punch biopsy of the lesion was performed.