Integrating skin color assessments into clinical practice and research: A review of current approaches.

Skin color classification can have importance in skin health, pigmentary disorders, and oncologic condition assessments. It is also critical for evaluating disease course and response to a variety of therapeutic interventions and aids in accurate classification of participants in clinical research studies. A panel of dermatologists conducted a literature review to assess the strengths and limitations of existing classification scales, as well as to compare their preferences and utilities. We identified 17 skin classification systems utilized in dermatologic settings. These systems include a range of parameters such as UV light reactivity, race, ethnicity, and degree of pigmentation. The Fitzpatrick skin type classification is most widely used and validated. However it has numerous limitations including its conflation with race, ethnicity, and skin color. There is a lack of validation data available for the remaining scales. There are significant deficiencies in current skin classification instruments. Consensus-based initiatives to drive the development of validated and reliable tools are critically needed.

Dermoscopy in vitiligo, diagnostic clues and markers of disease activity: a review of the literature.

Dermoscopy is a noninvasive, efficient and inexpensive tool used to aid diagnosis of skin conditions such as vitiligo. Furthermore, it aids in tracking patient progress, treatment response and disease activity. Vitiligo can be diagnosed on dermoscopy by the presence of white structureless areas signifying hypopigmentation with a typical glowing appearance. Other typical features are perilesional and perifollicular hyperpigmentation, pigmentation networks and leucotrichia. In total, 15 studies were reviewed to determine the dermoscopic signs of the three main stages of disease activity: active, stable and repigmenting vitiligo. Features that differentiate active, stable and repigmenting vitiligo are reviewed and discussed in this article. Notably, there is a conflict in the literature between various dermoscopic features and which type of vitiligo they are truly indicative of. However, dermoscopy can be coupled with other clinical, biological and physiological markers to strengthen diagnostic accuracy.

Review of dermoscopic features in hypopigmentary disorders.

Dermoscopy has seen increased utilisation in the diagnosis of hypopigmentary disorders. As a quick and effective adjunct to the clinician's toolbox, dermoscopy offers the opportunity to differentiate between hypopigmentary lesions that ostensibly present with clinically similar morphology on the macroscopic scale. The focus of this article is to review the various dermoscopic signs and patterns that have been elucidated for these disorders.

Study of the Pozzolanic Reactivity of Sugar Cane Straw Ashes (SCSA) Burned under Controlled Conditions.

The aims of this work were to evaluate the reactivity of sugarcane straw ashes (SCSA) burned under controlled conditions and to analyze their reactivity in blended cement and hydrated lime pastes by thermogravimetric analysis (TG) and calorimetry. Four different ashes were produced, and burned at 600 °C, 700 °C, 800 °C and 900 °C (SCSA600, SCSA700, SCSA800 and SCSA900, respectively). These ashes were characterized by X-ray fluorescence spectroscopy, X-ray diffractometry, particle size distribution by laser diffraction and specific area surfaces to assess their potential interest in the partial replacement of inorganic binders (Portland cement (OPC) and hydrated lime). The hydrated lime pastes were subjected to scanning electron microscopy (SEM) and TG. The blended cement pastes were analyzed by TG and calorimetry, compressive strength testing and mercury intrusion porosimetry. High lime fixation percentages were observed in the hydrated lime and OPC pastes and were higher than 75% and 50% for the ashes burned at 600 °C and 700 °C, respectively. Calorimetry showed a delay in the heat release of SCSA600 and SCSA700 compared to the control paste. These pastes also had higher compressive strength and a smaller total pore volume. The results indicate the positive response of preparing sugar cane ashes under controlled conditions (mainly for straw calcined within the 600-700 °C range) for their use as pozzolanic addition by partially replacing inorganic binders.

A cross-sectional study of pediatric dermatoses in a specialized pigment and skin-of-color center in Australia.

There is a paucity of literature on pediatric skin conditions in skin of color, of which old epidemiological data are likely to become outdated as the ethnic diversity in developed countries such as Australia continues to grow. We analyzed the prevalence of presenting conditions of pediatric patients with skin of color attending an urban dermatology clinic in Melbourne, Australia over an 18-month period. The major presenting issues were vitiligo, atopic dermatitis, and acne vulgaris, the majority of which did not significantly differ by ethnicity; however, there was a statistically significantly higher proportion of Chinese and Indian patients presenting with atopic dermatitis. Given the varying presentations of these conditions in skin of color, our findings highlight the importance of increasing education for dermatologists and health personnel in pigmentary disorders and the need for further focused studies comparing the prevalence of skin disease across ethnicities.

Importance of skin of colour dermatology in the primary care setting in Australia.

BACKGROUND: Australia is one of the most multicultural countries in the world. Basic knowledge in skin of colour dermatology is essential if we wish to strive for clinical excellence and improved patient outcomes for all Australians. A need for further training and education in this field has been highlighted by medical practitioners around the globe. OBJECTIVE: The aim of this paper is to demonstrate how skin in patients with skin of colour is biologically, functionally and structurally different to that of patients with lightly pigmented skin. This is captured through examples from common dermatological conditions and substantiated through relevant literature and expert opinion. DISCUSSION: Bias is inherent in classifications commonly used in dermatology. Morphological differences are important to recognise in those with skin of colour, and treatment needs to be carefully and individually crafted. Unique cultural consequences of a given diagnosis must also be considered when approaching the management of diverse populations.

Diagnosis, assessment and management of atopic dermatitis in children with skin of colour.

BACKGROUND: It is important to be able to manage patients regardless of ethnicities. The understanding of skin diseases, including atopic dermatitis, in patients with skin of colour (SOC) is lagging compared with that in patients with lighter skin and has been identified as an educational gap among medical practitioners. OBJECTIVE: This paper synthesises the latest literature on the diagnosis, assessment, treatment outcomes and cultural considerations for managing atopic dermatitis in children with SOC in the general practice setting. DISCUSSION: Atopic dermatitis in children with SOC can vary from traditional descriptions and appear psoriasiform, lichenoid, scaly, papular, hypopigmented or violaceous. It can be misdiagnosed and its severity underestimated. Complications from atopic dermatitis, as well as the treatments provided, might result in inadequate treatment unless the treating doctor is aware of specific nuances in children with SOC.

Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the International Vitiligo Task Force Part 1: towards a new management algorithm.

BACKGROUND: The treatment of vitiligo can be challenging and depends on several factors such as the subtype, disease activity, vitiligo extent, and treatment goals. Vitiligo usually requires a long-term approach. To improve the management of vitiligo worldwide, a clear and up-to-date guide based on international consensus with uniform stepwise recommendations is needed. OBJECTIVES: To reach an international consensus on the nomenclature and to develop a management algorithm for the diagnosis, assessment, and treatment of vitiligo. METHODS: In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence of topics included in the algorithms. A survey was utilized to resolve remaining issues among a core group of eight experts. Subsequently, the unanimous recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS: The algorithms highlight the importance of shared decision-making. Dermatologists are encouraged to provide patients with detailed explanations of the prognosis and expected therapeutic outcomes based on clinical examination. The treatment goal should be discussed and clearly emphasized to patients given the different approaches for disease stabilization and repigmentation. The evaluation of disease activity remains a cornerstone in the tailor-made approach to vitiligo patients. CONCLUSIONS: These new treatment algorithms are intended to guide clinical decision-making in clinical practice. Promising novel therapies for vitiligo are on the horizon, further highlighting the need for reliable outcome measurement instruments and greater emphasis on shared decision-making.

Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the international Vitiligo Task Force-Part 2: Specific treatment recommendations.

BACKGROUND: The treatment of vitiligo can be challenging. Up-to-date agreed consensus recommendations on the use of topical and systemic therapies to facilitate the clinical management of vitiligo are currently lacking. OBJECTIVES: To develop internationally agreed-upon expert-based recommendations for the treatment of vitiligo. METHODS: In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in different online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence for different topics included in the algorithms. A survey was then given to a core group of eight experts to resolve the remaining issues. Subsequently, the recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS: The recommendations provided summarize the latest evidence regarding the use of topical therapies (steroids, calcineurin inhibitors and Jak-inhibitors) and systemic therapies, including steroids and other systemic immunomodulating or antioxidant agents. The different modalities of phototherapies (NB-UVB, photochemotherapy, excimer devices and home phototherapy), which are often combined with other therapies, are also summarized. Interventional approaches as well as depigmentation strategies are presented for specific indications. Finally, the status of innovative and targeted therapies under development is discussed. CONCLUSIONS: This international consensus statement culminated in expert-based clinical practice recommendations for the treatment of vitiligo. The development of new therapies is ongoing in vitiligo, and this will likely improve the future management of vitiligo, a disease that still has many unmet needs.

Novel diamides inspired by protein kinase inhibitors as anti-Trypanosoma cruzi agents: in vitro and in vivo evaluations.

Background: Chagas disease is a life-threatening illness caused by Trypanosoma cruzi. The involvement of serine-/arginine-rich protein kinase in the T. cruzi life cycle is significant. Aims: To synthesize, characterize and evaluate the trypanocidal activity of diamides inspired by kinase inhibitor, SRPIN340. Material & Methods: Synthesis using a three-step process and characterization by infrared, nuclear magnetic resonance and high-resolution mass spectrometry were conducted. The selectivity index was obtained by the ratio of CC50/IC50 in two in vitro models. The most active compound, 3j, was evaluated using in vitro cytokine assays and assessing in vivo trypanocidal activity. Results: 3j activity in the macrophage J774 lineage showed an anti-inflammatory profile, and mice showed significantly reduced parasitemia and morbidity at low compound dosages. Conclusion: Novel diamide is active against T. cruzi in vitro and in vivo.

Optimisation of skin phototype classification.

Understanding individuals' skin pigmentation and photosensitivity is important in judging risk of skin cancer and response to certain treatment modalities. However, individuals with darkly pigmented skin are poorly represented in the widely used Fitzpatrick skin phototype (FST) system. Moreover, the FST system is prone to misuse, as it relies on subjective patient and clinician assessment of skin type, and does not clearly differentiate pigmentation from photosensitivity. By evaluating the key literature surrounding the FST system, its criticisms and proposed alternatives, this review serves to understand how skin phototype classification can be optimised.

Atopic dermatitis in skin of colour. Part 1: new discoveries in epidemiology and pathogenesis.

Atopic dermatitis (AD) is a global condition that has a rising prevalence in developing countries such as those within South-east Asia and Latin America. Recent research represents the condition as a heterogeneous disease of distinct endotypes among different ethnic groups. Variation between ethnic groups in physiological measures such as transepidermal water loss, ceramide/+, skin sensitivity, alongside pathological barrier and immune system dysfunction processes, may ultimately lead to the distinct phenotypes seen clinically. AD in patients of White ethnicities is typified by filaggrin dysfunction, more T helper (Th)1 and less Th17 involvement, with less epidermal thickness compared with patients of Black or Asian ethnicities. AD in patients of Black ethnic groups is Th2/Th22-skewed, with robust IgE expression, and less Th1 and Th17 involvement than patients of Asian or White ethnicities. AD across South Asian and East Asian populations is characterized by Th17/Th22 upregulation. Differences also exist in how AD psychosocially has an impact on individuals of different ethnic groups.

Atopic dermatitis in skin of colour. Part 2: considerations in clinical presentation and treatment options.

Recent advances in atopic dermatitis (AD) present the condition as a heterogeneous disease of distinct endotypes across ethnic groups. AD in people with skin of colour may appear psoriasiform, lichenoid, scaly or papular, with a violaceous colour and there is a higher prevalence of post-inflammatory dyspigmentation compared with affected individuals of White ethnicity. These differences in clinical presentation may limit the use of AD assessment tools in people with skin of colour, leading to the potential for misdiagnosis and underestimation of severity, particularly in relation to assessment of erythema. Recent targeted therapies for AD have been studied in multiple ethnic groups; however, ethnicity-based subgroup analysis is often not performed. Further research is required to understand whether treatment responses or safety may differ among ethnic groups.

Expert opinion about laser and intense pulsed light (IPL)-induced leukoderma or vitiligo: a cross-sectional survey study.

Vitiligo patients may desire laser hair removal, skin rejuvenation, vascular treatments, and other laser or intense pulsed light (IPL) assisted treatments. However, there is a risk of inducing new depigmented patches (Koebner phenomenon). In absence of guidelines on the safe use of laser or IPL in vitiligo patients, dermatologists tend to be reluctant to administer these treatments. The aim of this survey study was to provide an estimation of the occurrence and related risk factors of laser/IPL-induced leukoderma or vitiligo. A cross-sectional survey study was performed among 15 vitiligo experts from 11 countries, with 14 questions about affected patients, involved laser/IPL treatments and the physicians' approach. In a total of 11,300 vitiligo patients, laser/IPL-induced leukoderma or vitiligo was reported in 30 patients (0.27%). Of these, 12 (40%) patients had a medical history of vitiligo and seven (58%) of these patients had stable (> 12 months) vitiligo before the treatment. Most frequently reported were hair removal procedures and localization of the face and legs. Side effects like blistering, crusting, and erosions occurred in 56.7% of the cases. These vitiligo experts based their advice on the risk of the laser treatment on stability of the vitiligo (43%) and activity signs (50%), and 50% discuss the risks before starting a laser treatment. Relevant activity signs are the Koebner phenomenon (57.1%), confetti-like lesions (57.1%) and hypochromic borders (50%). Laser-induced leukoderma or vitiligo is an uncommon phenomenon. Remarkably, a minority had a medical history of vitiligo of which 58% were stable. Consequently, most cases could not have been prevented by not treating vitiligo patients. However, a majority had laser/IPL-induced skin damage. Therefore, caution is advised with aggressive settings and test-spots prior to the treatment are recommended. This study showed significant variation in the current recommendations and approach of vitiligo experts regarding laser/IPL-induced leukoderma or vitiligo.