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1.
J Cosmet Dermatol ; 2024 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-38553836

RESUMO

BACKGROUND: Skin of color (SOC) individuals represent a growing market for cosmetic injectables and can have different aesthetic goals and responses to treatment. OBJECTIVE: A review of the uses, safety, and effectiveness of injectable neuromodulators and dermal fillers in SOC individuals. METHODS AND MATERIALS: A search of the PubMed/MEDLINE database was conducted from August 1960 to December 2020. Studies that were included either had a focus on SOC (>20% SOC study participants) or dedicated article content commenting on the safety and/or efficacy of injectables in SOC participants. RESULTS: Of the 503 publications identified, a total of 88 articles were selected for this review. Differences in aging and cultural factors can influence aesthetic goals amongst SOC populations. Available data suggests that botulinum toxin (BTX) and dermal fillers are safe and effective in SOC populations, with the largest amount of data existing for Asian populations. There remains a paucity of research on Black and Latinx populations. CONCLUSION: BTX and dermal fillers are generally effective and well tolerated in SOC populations, particularly Asian populations for which the greatest amount of data exists. More high quality, randomized controlled trials in Black and Latinx populations are warranted.

2.
J Drugs Dermatol ; 23(2): 9-16, 2024 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-38306138

RESUMO

BACKGROUND: Modified Kligman's formula (mKF) is the gold standard treatment for melasma; however, its prolonged use is not recommended due to side effects. Cysteamine is a potent, safe, and effective depigmenting agent. Here, we conducted a double-blind, randomized, and placebo-controlled clinical trial to assess the efficacy of cysteamine isobionic-amide -- a complex with enhanced depigmenting efficacy -- and compared it to mKF for the treatment of melasma. METHODS: This study involved a total of 80 patients divided into 3 groups: cysteamine-isobionic amide, placebo, or mKF. The modified Melasma Area Severity Index (mMASI) score and spectrophotometric evaluation were conducted at baseline, week 4, week 8, and week 16. Dermatological assessment, patients’ feedback, and satisfaction including quality-of-life scores were also collected. RESULTS: At week 4, cysteamine isobionic-amide and mKF groups showed an equivalent onset of action in terms of mMASI and skin pigmentation contrast reduction. The 2 groups significantly reduced melasma severity and improved the overall skin condition with a comparable efficacy at week 16. Quality of life of melasma patients was significantly improved in the cysteamine isobionic-amide group at week 8 and further at week 16 (P<0.001) compared to the mKF group. Patients’ feedback and satisfaction were higher with the cysteamine isobionic-amide product compared to mKF. CONCLUSION: Cysteamine isobionic-amide provided a rapid onset of action and was as effective as the mKF for the treatment of melasma. The data suggest that cysteamine isobionic-amide could potentially be an acceptable alternative to mKF for the long-term treatment of melasma. J Drugs Dermatol. 2024;23(2):9-16.  doi:10.36849/JDD.7428.


Assuntos
Cisteamina , Melanose , Humanos , Cisteamina/efeitos adversos , Resultado do Tratamento , Qualidade de Vida , Melanose/diagnóstico , Melanose/tratamento farmacológico , Método Duplo-Cego
3.
J Am Acad Dermatol ; 2024 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-38342247

RESUMO

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.

4.
J Am Acad Dermatol ; 90(2): 269-279, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37748556

RESUMO

BACKGROUND: Melasma is a chronic hypermelanosis of the skin that affects approximately 1% of the global population, predominantly affects women, and is more prevalent in skin of color. Melasma is a common driver for patients with skin of color to seek out a dermatologist for treatment, and ensuring the right approach for these patients is important because some treatments may be associated with adverse side effects. Because of the chronicity of the disease and established psychosocial and emotional impacts, there is a large need to ensure care follows the best available evidence on the treatment of patients with melasma. OBJECTIVE: Here, we summarized current available topical treatments for melasma with considerations dermatologists should have for their patients with skin of color. METHODS: Steering committee consensus on clinical best practices. RESULTS: We describe a flexible and focused treatment algorithm that reflects both treatment and maintenance periods that is a consensus of our extensive clinical experience. LIMITATIONS: Use of real-world evidence and potential for individual practice bias. CONCLUSION: Melasma can be challenging to treat, particularly in patients with skin of color, and our recommendations for best practices for patients in the United States are an important step toward standardizing care.


Assuntos
Melanose , Tretinoína , Humanos , Feminino , Fluocinolona Acetonida/efeitos adversos , Pigmentação da Pele , Hidroquinonas , Melanose/tratamento farmacológico , Resultado do Tratamento
7.
J Drugs Dermatol ; 22(7): 712-713, 2023 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-37410040

RESUMO

Syder NC, Elbuluk N. rising interest in sunscreen for skin of color: an analysis of Google trends. J Drugs Dermatol. 2023;22(7):712-713. doi:10.36849/JDD.7373.


Assuntos
Neoplasias Cutâneas , Protetores Solares , Humanos , Ferramenta de Busca , Pele , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/etnologia , Neoplasias Cutâneas/prevenção & controle , Pigmentação da Pele
8.
Am J Clin Dermatol ; 24(5): 681-694, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37328614

RESUMO

Acne is a common, chronic inflammatory condition affecting millions of people worldwide, with significant negative impact on quality of life and mental health. Acne is characterized by comedones, inflammatory papules, pustules, and nodulocystic lesions, with long-lasting sequelae including scarring and dyspigmentation, the latter of which is more common in skin of color. The four main pillars of acne pathophysiology include alteration of sebum production and concentration, hyperkeratinization of the follicular unit, Cutibacterium acnes strains, and an inflammatory immune response. Newer research has provided greater insight into these pathophysiologic categories. This greater understanding of acne pathogenesis has led to numerous new and emerging treatment modalities. These modalities include combinations of existing treatments, repurposing of existing agents historically used for other conditions, new topical treatments, novel antibiotics, topical and oral probiotics, and various procedural devices. This article will provide an overview of emerging treatments of acne and their link to our current and improved understanding of acne pathogenesis.


Assuntos
Acne Vulgar , Qualidade de Vida , Humanos , Acne Vulgar/tratamento farmacológico , Acne Vulgar/etiologia , Pele/patologia , Administração Tópica , Antibacterianos/uso terapêutico , Inflamação/tratamento farmacológico
9.
Dermatol Clin ; 41(3): 393-405, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37236709

RESUMO

Disorders of hyperpigmentation are common and challenging conditions which can arise due to a myriad of etiologic factors. Many of them can present across skin types but are more common in skin of color individuals with Fitzpatrick skin types III-VI. Facial hyperpigmentation, in particular, can have a significant impact on the quality of life of affected individuals due to its increased visibility. This article provides a comprehensive review of disorders of facial hyperpigmentation including epidemiology, pathogenesis, diagnostic considerations, and treatment approaches for these conditions.


Assuntos
Hiperpigmentação , Melanose , Humanos , Melanose/diagnóstico , Qualidade de Vida , Resultado do Tratamento , Hiperpigmentação/etiologia , Hiperpigmentação/terapia , Pele
10.
Dermatol Clin ; 41(2): 351-358, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36933925

RESUMO

Clinical trials are an essential component of research for determining the safety and efficacy of treatments for medical diseases. In order for the results of clinical trials to be generalizable to diverse populations, they must include participants at ratios that are reflective of national and global populations. A significant number of dermatology studies not only lack racial/ethnic diversity but also fail to report data on minority recruitment and enrollment. Reasons for this are multifold and are discussed in this review. Although steps have been implemented to improve this issue, greater efforts are needed for sustained and meaningful change.


Assuntos
Grupos Minoritários , Grupos Raciais , Humanos , Projetos Piloto
11.
J Am Acad Dermatol ; 89(2): 316-323, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36924935

RESUMO

Acne vulgaris can be associated with hyperpigmentation, particularly in individuals with skin of color. This acne-induced macular hyperpigmentation (AMH), also called postinflammatory hyperpigmentation, is often long lasting and negatively impacts quality of life. Large-scale, randomized, controlled clinical trials with regard to the treatment of acne and AMH are lacking. For this reason, evidence-based treatment recommendations cannot be made. However, AMH is a common condition, and it is important for clinicians to have guidance on management strategies. The authors, a group of 10 board-certified dermatologists, conducted a modified Delphi consensus process to reach a consensus on first-line therapy for AMH and determine whether therapeutic choices change in different patient subgroups. We reached a consensus that most patients with acne and AMH should receive early and efficacious acne treatment with a topical retinoid and benzoyl peroxide. Therapies aimed at addressing AMH-including hydroquinone, azelaic acid, chemical peel, or antioxidants-may also be considered for enhancing the effect of the treatment regimen on acne and pigmentation. Chemical peels may be used as adjunctive or second-line therapy. This article details the results of the Delphi process, reviews relevant literature for providing recommendations for AMH, and discusses appropriate treatment options.


Assuntos
Acne Vulgar , Hiperpigmentação , Humanos , Qualidade de Vida , Consenso , Técnica Delfos , Acne Vulgar/complicações , Acne Vulgar/tratamento farmacológico , Hiperpigmentação/terapia , Hiperpigmentação/complicações
12.
J Drugs Dermatol ; 22(2): 217-218, 2023 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-36745362

RESUMO

Basal cell carcinoma (BCC) has several subclassifications, including pigmented basal cell carcinoma. In our clinical experience, we have found that pigmented basal cell carcinoma itself has multiple subtypes which can overlap with traditional basal cell carcinoma subclassifications. In this letter, we argue for the subclassification of pigmented basal cell carcinoma, as either superficial, nodular, or morpheaform. We believe further subclassification of pigmented BCCs may reveal important therapeutic and prognostic differences which could make an impact on the morbidity and mortality of this condition for those affected, many of whom are skin of color patients that are already disproportionately affected by health disparities related to skin cancer. J Drugs Dermatol. 2023;22(2): 217-218. doi:10.36849/JDD.6883.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Humanos , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Pele/patologia
13.
Dermatol Surg ; 49(5): 489-493, 2023 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-36826381

RESUMO

BACKGROUND: Radiofrequency (RF) and radiofrequency microneedling (RFM) for rhytides, scarring, and skin rejuvenation are believed to have a lower risk of postprocedural dyspigmentation in darker skin types. OBJECTIVE: To explore the safety and efficacy of RF and RFM in Fitzpatrick skin Types III to VI. METHODS AND MATERIALS: A systematic review of PubMed/MEDLINE databases from 2000 to 2021 using combinations of the terms radiofrequency, microneedling, skin of color, and Fitzpatrick was performed. Exclusion criteria included non-Fitzpatrick skin Types III-VI patient population, nonprimary articles, nonskin radiofrequency, and nonhuman studies. RESULTS: Thirty-five articles addressing the use of RF or RFM in skin of color were identified-22 for skin rejuvenation, 7 for acne scars, 4 for nonacne scars, 1 for hyperpigmentation, and 1 for acne treatment. Seven studies noted transient postinflammatory hyperpigmentation, 1 observed mild prolonged hyperpigmentation, and only 1 study reported permanent scarring. CONCLUSION: Radiofrequency and RFM seem to have a low risk of scarring or hyperpigmentation in skin of color. This review demonstrates that these procedures have been successfully used primarily for rhytides, acne scarring, and skin rejuvenation. However, a large proportion of the studies lack strong quality evidence.


Assuntos
Acne Vulgar , Técnicas Cosméticas , Hiperpigmentação , Humanos , Cicatriz/etiologia , Cicatriz/terapia , Pigmentação da Pele , Acne Vulgar/complicações , Acne Vulgar/terapia , Técnicas Cosméticas/efeitos adversos , Agulhas , Resultado do Tratamento
16.
J Am Acad Dermatol ; 89(5): 895-902, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35390428

RESUMO

Although racial and ethnic demographics are shifting in this country, it is not reflected in the diversity of clinical trial research participants; science, technology, engineering, and mathematics pipeline programs; or the workforce in the field of dermatology. Barriers to recruitment of minority patients for research studies also exist for numerous reasons including lack of education of prospective subjects, lack of awareness of ongoing trials, and mistrust within the health care system. Gaps in the science, technology, engineering, and mathematics pipeline for racial and ethnic minorities, particularly Black, Hispanic/Latinx, and American Indian or Alaska Native, are due in large part to structural racism. Lack of exposure as well as lack of educational, mentorship, and research opportunities contribute to gaps in the dermatology workforce. Having a representative population in the dermatology workforce and in clinical research trial patients is essential for optimum patient care, excellence in the specialty, and knowledge of appropriate treatments for minority populations. This article will discuss knowledge gaps for increasing minority subjects who participate in clinical research trials and discuss mechanisms to engage this community in trial recruitment. Additionally, this article addresses lack of racial and ethnic diversity of the dermatology workforce and performance gaps in the recruitment of racial/ethnic minorities into dermatology.

17.
J Am Acad Dermatol ; 89(5): 885-892, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35390429

RESUMO

Various studies have revealed a disproportionately low representation of skin of color (SOC) dermatology in the medical education system of the United States. This disparity contributes to adverse experiences, missed and/or delayed diagnoses, and overall health inequities for individuals of color. The lack of sufficient SOC education begins at the medical school level and continues throughout residency, fellowship, and beyond formal training. This lack of education can be seen in the dearth of images of common and uncommon skin conditions in darker skin in widely used textbooks and educational resources as well as in the lack of formal training in SOC in many residency programs. Thus far, there have been valuable strides to make dermatologic education more inclusive of all skin colors, but there remains significant work to be done. With the population of the United States expected to continue to diversify and with the expectation that SOC will be a trait of over half of the population of the United States by 2050, it is important to strive for health equity by ensuring that comprehensive and inclusive medical training incorporates SOC. This paper will explore the issue of gaps in medical education in SOC dermatology at all levels and offer a strategic call to action to aid in rectifying this situation.

19.
J Am Acad Dermatol ; 87(6): 1261-1270, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35817332

RESUMO

Skin of color (SOC) patients are projected to comprise the majority of the population by 2044, yet knowledge gaps in the clinical presentation and treatment of both common and uncommon dermatologic conditions in skin of color persist. Improved awareness of disparities that disproportionately impact SOC patients is necessary to address health inequity in the field of dermatology. The first part of this CME discussed structural, genetic, and immunophenotypic differences in SOC in common inflammatory disorders as well as cutaneous malignancies. The second part of this CME highlights clinical differences in the phenotypic presentation of the inflammatory disorders of atopic dermatitis, psoriasis, and hidradenitis suppurativa as well as the cutaneous malignancies of melanoma, basal cell carcinoma, and cutaneous T-cell lymphoma. Health disparities associated with each of these conditions are also discussed.


Assuntos
Linfoma Cutâneo de Células T , Neoplasias Cutâneas , Humanos , Pigmentação da Pele/genética , Linfoma Cutâneo de Células T/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Fenótipo , Biologia
20.
J Am Acad Dermatol ; 87(6): 1239-1258, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35809800

RESUMO

Skin of color (SOC) populations include those who identify as Black/African, Hispanic/Latinx, Asian/Pacific Islander, American Indian/Native Alaskan, Indigenous Australian, Middle Eastern, biracial/multiracial, or non-White; this list is far from exhaustive and may vary between and within cultures. Recent genetic and immunological studies have suggested that cutaneous inflammatory disorders (atopic dermatitis, psoriasis, and hidradenitis suppurativa) and malignancies (melanoma, basal cell carcinoma, and cutaneous T-cell lymphoma) may have variations in their immunophenotype among SOC. Additionally, there is growing recognition of the substantial role social determinants of health play in driving health inequalities in SOC communities. It is critically important to understand that social determinants of health often play a larger role than biologic or genetic factors attributed to "race" in health care outcomes. Herein, we describe the structural, genetic, and immunological variations and the potential implications of these variations in populations with SOC. This article underscores the importance of increasing the number of large, robust genetic studies of cutaneous disorders in SOC to create more targeted, effective therapies for this often underserved and understudied population. Part II of this CME will highlight the clinical differences in the phenotypic presentation of and the health disparities associated with the aforementioned cutaneous disorders in SOC.


Assuntos
Produtos Biológicos , Hidradenite Supurativa , Neoplasias Cutâneas , Humanos , Pigmentação da Pele/genética , Austrália , Fenótipo , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Biologia
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