Effects of a skin type diversity seminar on undergraduate medical students' self-assessed competence in managing skin diseases in patients with skin of color.

BACKGROUND: Skin diseases in patients with skin of colour (Fitzpatrick skin types IV to VI) are underrepresented in dermatology training, which may lead to lower quality of care for these patients. To address this underrepresentation in medical education, a newly developed seminar on skin type diversity using an interactive teaching method was implemented in an undergraduate medical curriculum. This study examined the effects of a seminar on the self-assessed competence of medical students in managing skin conditions in patients with skin of colour. METHODS: A questionnaire survey was conducted among fourth-year undergraduate medical students at the University of Hamburg (Germany) between October 2023 and February 2024. Students' self-assessed competence was compared before and after the obligatory seminar (pre- and post-design). RESULTS: In total, 158 students participated in the survey. After the seminar, knowledge of the presentation of skin diseases in patients with skin of colour and the associated psychological burden, differences in the incidence of skin diseases in different skin types, and the ability to diagnose skin diseases in darker skin types increased. Most participants stated that they wanted to attend more courses on this topic. DISCUSSION: Appropriate courses for medical students can improve their competence in managing different skin diseases in patients with skin of colour. In the future, more attention should be paid to teaching the diversity of skin types in dermatology education.

Allergen content of popular chemical hair relaxers: A product analysis.

BACKGROUND: Chemical hair relaxers are widely utilized by black women, yet little research exists on the allergens present in these products. OBJECTIVE: This study aims to investigate allergen prevalence in the most popular chemical hair relaxers. METHODS: We analysed 41 products from five major retailers, identifying allergens through ingredient lists and comparing them to the 2020 American Contact Dermatitis Group Core allergen series. RESULTS: The most common contact allergens in chemical relaxers include propylene glycol, cetyl steryl alcohol, fragrance, D/L-a-tocopherol, tea tree oil and cocamidopropyl betaine. CONCLUSION: Understanding allergen exposure in products used by individuals with textured hair is needed for managing contact dermatitis in diverse populations. This analysis underscores the presence of potential allergens in hair relaxers, emphasizing the importance of dermatologists' awareness and patient scrutiny of ingredient lists.

Dermatoscopic evaluation of leprosy: A multi-centre cross-sectional study.

Background Leprosy is known to be a great mimicker. Its dermatoscopic evaluation may be of value in establishing diagnosis. Objective To study the dermatoscopic findings encountered across the leprosy spectrum. Methods This was a multi-centre cross-sectional study of leprosy patients, where after a thorough cutaneous and neurological evaluation, representative skin lesions from the study patients were photographed in standard settings, and the most representative skin lesions were chosen for dermatoscopic evaluation. Data was entered in a structured proforma and a descriptive analysis of dermatoscopic patterns was carried out. Results A total of 53 cases of ages between 14 and 80 years, ranging from tuberculoid to the lepromatous spectrum of disease, with active skin lesions in the form of patches and plaques were included. The spectrum of leprosy as per Ridley-Jopling classification at diagnosis was indeterminate in 1 (1.9%), tuberculoid in 1 (1.9%), borderline tuberculoid in 25 (21.5%), borderline lepromatous in 9 (17%), lepromatous in 14 (26.4%) and histoid in 3 (5.7%). Dermatoscopic features included distorted pigment network in 48 (90.6%), focal white areas in 40 (75.5%), reduced eccrine and follicular openings in 43 (81.1%), widened skin lines in 28 (52.8%), circle hairs in 15 (28.3%) and white shiny streaks in 17 (32.1%). Conclusion Dermatoscopy is a practical, non-invasive device to assess skin lesions of leprosy and provide cues to its diagnosis, spectral classification and differentiating it from other granulomatous disorders. However, dermatoscopy alone cannot reliably differentiate between the various types of leprosy and future large-scale studies are required. Limitations of the study The numbers for each subtype were variable and few in some spectrum of leprosy patients. A dermatoscopic-histologic correlation was not done.

A Clinicopathological and Immunohistochemical Profile of Primary Extra Mammary Paget's Disease in Skin of Colour: A Case Series.

Extramammary Paget's disease is an intraepithelial neoplasm, usually found in areas rich in apocrine gland concentration. The clinical features, histopathology, immunohistochemistry and management details of five patients (F = 3, M = 2) have been described here. While a well-defined persistent plaque with crusting and erosion was the most common presentation, hyperpigmentation, hypopigmentation and depigmentation were also observed in two patients. Characteristic Paget's cells with cytokeratin 7 and EMA positivity were seen on histopathology examination. Authors conclude that pigmentary alterations may be under-reported in extra mammary Paget's disease in the skin of colour.

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.

Reticular Erythematous Mucinosis in an African Woman with HIV Infection: Case Report and Literature Review.

Reticular erythematous mucinosis is a rare and persistent form of primary idiopathic mucinosis, often referred to as plaque-like cutaneous mucinosis or midline mucinosis. It presents with reticulate patches or erythematous plaques with predilection for the anterior and posterior trunk. Affected patients are frequently asymptomatic. Pruritus or burning sensations were reported after exposure to the sun. The aetiology remains obscure; its pathogenesis is poorly understood, particularly in immunocompromised patients such as HIV-infected patients. The disease associations are not uniformly documented. Antimalarial agents significantly improve and shorten the course of the disease. We report a case of a 31-year-old African woman with underlying HIV infection who displayed the classical clinical and histological features of reticular erythematous mucinosis. This condition is rare among the HIV-infected patients, particularly in those of African descent, in whom lichen myxoedematosus/scleromyxoedema variants and acral persistent papular mucinoses were most frequently reported. The higher incidence of photosensitivity in HIV-infected individuals including the patients with skin of colour may play a potential role in reticular erythematous mucinosis. Its relationship with lupus erythematosus and photosensitivity in the context of HIV infection is discussed. To the best of our knowledge, this is the first reported case of reticular erythematous mucinosis in an African HIV-infected patient. This case highlights the need for diagnostic awareness in cases presenting with erythematous plaques and patches in a net-like pattern developing on the midline and sun-exposed areas of the trunk.

A plague passing over: Clinical features of the 2022 mpox outbreak in patients of color living with HIV.

INTRODUCTION: Compared with previous geographically localized outbreaks of monkeypox (MPOX), the scale of the 2022 global mpox outbreak has been unprecedented, yet the clinical features of this outbreak remain incompletely characterized. METHODS: We identified patients diagnosed with mpox by polymerase chain reaction (PCR; n = 36) from July to September 2022 at a single, tertiary care institution in the USA. Demographics, clinical presentation, infection course, and histopathologic features were reviewed. RESULTS AND CONCLUSION: Men who have sex with men (89%) and people living with HIV (97%) were disproportionately affected. While fever and chills (56%) were common, some patients (23%) denied any prodromal symptoms. Skin lesions showed a wide range of morphologies, including papules and pustules, and lesions showed localized, not generalized, spread. Erythema was also less appreciable in skin of colour patients (74%). Atypical clinical features and intercurrent skin diseases masked the clinical recognition of several cases, which were ultimately diagnosed by PCR. Biopsies showed viral cytopathic changes consistent with Orthopoxvirus infections. All patients in this case series recovered without complications, although six patients (17%) with severe symptoms were treated with tecovirimat without complication.

Burden of Disease and Unmet Needs in the Diagnosis and Management of Atopic Dermatitis in Diverse Skin Types in Australia.

Atopic dermatitis (AD) is a common, chronic, inflammatory skin disease affecting Australians of all ages, races, ethnicities, and social classes. Significant physical, psychosocial, and financial burdens to both individuals and Australian communities have been demonstrated. This narrative review highlights knowledge gaps for AD in Australian skin of colour. We searched PubMed, Wiley Online Library, and Cochrane Library databases for review articles, systematic reviews, and cross-sectional and observational studies relating to AD in Australia for skin of colour and for different ethnicities. Statistical data from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics was collected. In recent years, there has been substantially increased awareness of and research into skin infections, such as scabies and impetigo, among various Australian subpopulations. Many such infections disproportionately affect First Nations Peoples. However, data for AD itself in these groups are limited. There is also little written regarding AD in recent, racially diverse immigrants with skin of colour. Areas for future research include AD epidemiology and AD phenotypes for First Nations Peoples and AD trajectories for non-Caucasian immigrants. We also note the evident disparity in both the level of understanding and the management standards of AD between urban and remote communities in Australia. This discrepancy relates to a relative lack of healthcare resources in marginalised communities. First Nations Peoples in particular experience socioeconomic disadvantage, have worse health outcomes, and experience healthcare inequality in Australia. Barriers to effective AD management must be identified and responsibly addressed for socioeconomically disadvantaged and remote-living communities to achieve healthcare equity.

Central Centrifugal Cicatricial Alopecia in the Adolescent Population: An Overview of Available Literature.

Central centrifugal cicatricial alopecia (CCCA) is a lymphocytic scarring alopecia that predominantly affects women of African descent. Recent studies have demonstrated prevalence in children and adolescents, as well as Asian populations. A thorough search of Pubmed, Cochrane Database of Systematic Reviews, OVID Medline and Google Scholar was conducted using keywords such as "central centrifugal cicatricial alopecia", "scarring hair loss", "scarring alopecia", "hot comb alopecia", "pediatric" and "adolescent". The results yielded few articles in the literature that directly addressed CCCA in the adolescent population, with three articles providing details of the presentation in the form of case series and retrospective reviews. The presentation in the adolescent population was found to be varied, ranging from asymptomatic to symptomatic and involving diffuse to patchy hair loss in only the vertex and/or frontal and parietal scalp. Genetic and environmental etiologies were found to be statistically significant, and markers of metabolic dysregulation predisposing patients to diabetes mellitus and breast cancer were also uncovered. The differential diagnosis of patients who present with hair loss in the adolescent population should therefore be broad, and a low threshold for biopsies should be adopted to confirm CCCA in suspected patients. This will have future implications for reduced morbidity and public health.

Skin of Colour Dermatoses Self-Learning Module: Assessing Student Comprehension.

BACKGROUND: Dermatology for diverse skin types is a globally growing area of medicine, but the inclusion of skin of color dermatology has not yet been formally included across all Canadian undergraduate medical education curricula. There is also a paucity of representation of diverse skin types in most medical textbooks, research, and clinical trials. OBJECTIVES: The main objective was to develop a concise, Skin of Colour Dermatoses Self-Learning Module (SOCSLM) that could be implemented at an undergraduate medical education level. The secondary objective was to analyze participant responses to improve and add to learning module content. METHODS: From March to May 2022, second-year medical students at the University of Ottawa completed pre- and post-SOCSLM questionnaires which were available in French and English through their online student learning portals. The pre-test consisted of five multiple choice questions relating to images of dermatoses seen in diverse skin types. The post-test repeated the same five questions, rearranged, with an additional five new ones, and responses were analyzed. RESULTS: Twenty-five participants completed the surveys, and twenty responses were included. Percent correct answers increased between pre- and post-test, 51% vs 87%. In the post-test, questions repeated from the pre-test had a mean score of 95% while the new post-test questions had a mean score of 80%. Interest in dermatology did not have an impact on correct response rates. CONCLUSIONS: Skin of color dermatology self-learning modules may be an effective way to integrate skin of color dermatology into undergraduate medical curricula.

Skin of colour: essentials for the non-dermatologist.

Doctors-in-training often receive an inadequate dermatology education. Furthermore, studies have highlighted the under-representation of skin of colour (SOC) in dermatological teaching, learning resources and research. Our image-based questionnaire, distributed to all internal medicine trainees in southwest England, highlighted knowledge gaps regarding SOC among training physicians. It is intrinsically more challenging for clinicians to confidently formulate dermatological diagnoses in SOC. In this review, we provide guidance for physicians to help make the diagnostic process more straightforward. First, we outline how skin colour is determined and classified. We discuss how inflammation presents in SOC, with the typical 'erythema' that physicians often associate with inflammation being a less prominent feature in darker skin tones. We then summarise nine important conditions that we believe physicians working in all specialties should be able to identify in patients with SOC, covering both conditions encountered on the medical take and conditions disproportionately affecting individuals with SOC. The population of the UK is rapidly diversifying; thus, as physicians, we have a professional duty to educate ourselves on dermatological conditions in SOC to provide the best quality of care for all our patients, regardless of their skin type.

Dermatology: how to manage facial hyperpigmentation in skin of colour.

Hyperpigmentation disorders, such as post-inflammatory hyperpigmentation and melasma, are common conditions affecting all skin types. These conditions are largely benign and are influenced by numerous endogenous and exogenous factors impacting melanocyte activity and melanin production. Current treatment modalities for these conditions fall into broad categories, including photoprotection, topical and systemic therapies, chemical peels, and laser or light-based therapies. Biological differences in skin of colour require additional consideration when deciding on treatment and management. This narrative review provides an inclusive summary of these conditions and compares the current treatment options with a specific focus on skin of colour. Photoprotection and sunscreens protective against both UV and visible light are recommended for all individuals. Topical therapy is the recommended first-line treatment, with the gold standard being hydroquinone, which can be used alone or in combination with other agents. Chemical peels and laser or light-based therapies are also effective adjunctive methods of treatment; however, caution should be taken when used in patients with richly pigmented skin due to the increased risk of post-inflammatory hyperpigmentation.

Dermatology: how to manage atopic dermatitis in patients with skin of colour.

Atopic dermatitis (AD) is a chronic inflammatory cutaneous disease prevalent in all skin types but can differ in pathogenesis and clinical presentation. It has been documented in the literature that AD is more prevalent in Asian and Black individuals than in white individuals. Genetic variations as well as cultural and socioeconomic factors have important implications for susceptibility to AD and response to treatment in skin of colour. In this narrative review, we discuss differences in the epidemiology, pathophysiology, clinical presentation and treatment of AD in skin of colour. Additionally, we highlight the need for greater inclusivity of non-white ethnic groups in clinical trials to develop targeted treatments for diverse populations. Moreover, awareness of differences in AD presentation amongst non-white individuals may encourage patients to seek medical care earlier, leading to timely management and improved outcomes.

Dermatology: how to manage rosacea in skin of colour.

Rosacea is a common inflammatory skin disorder affecting the face. Common cutaneous symptoms include papules, pustules, persistent centrofacial erythema, telangiectasias, recurrent flushing, phymatous changes and a variety of ocular manifestations. Previous epidemiological studies have demonstrated that the incidence of rosacea is much lower in people with darker Fitzpatrick phototypes compared to fair-skinned individuals. In patients with darker skin, the centrofacial erythema can be masked and difficult to appreciate, impacting the ability for providers to make diagnoses and leading to misdiagnoses. Thus, it is difficult to say with certainty that the disparities in prevalence in rosacea amongst fair-skinned and darker individuals are true. The primary aim of this article is to raise awareness that rosacea is a global disease and to provide healthcare professionals with strategies to identify and manage rosacea amongst individuals with skin of colour.