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Archives Volume 6 | Issue 1

Original Articles

Skin Cancer in Individuals of African, Asian, Latin-American, and American-Indian Descent: Differences in Incidence, Clinical Presentation, and Survival Compared to Caucasians

Katina Byrd-Miles MD, Ella L. Toombs MD, Gary L. Peck MD
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Skin cancer most commonly affects Caucasians and rarely affects individuals of African, Asian, Latin-American, and American-Indian descent. Although skin cancer is rare in these groups, the diagnosis may be associated with significant morbidity and mortality. Many factors may account for this discrepancy. Skin cancers in these groups may have atypical presentations. Melanoma usually involves areas not exposed to the sun, including palmoplantar skin and mucosal surfaces with the acral lentiginous melanoma being the most common histologic subtype. Basal cell carcinomas may involve sun-exposed areas such as the head and neck, while squamous cell carcinomas tend to involve unexposed areas in these groups. Because of the low index of suspicion in both the medical community and the ethnic groups, diagnosis is often delayed resulting in an advanced presentation and a worse prognosis.

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Sunscreen Use and Usefulness in African-Americans

James J. Briley Jr. DO, Yelva L. Lynfield MD, Krina Chavda DO
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Sunscreen use in the African-American population is much less than in Caucasians. Its use in African-Americans varies based on factors such as sex, age, skin type, socioeconomic status, occupation, aesthetic issues, and medical conditions. In order to investigate sunscreen usage and awareness among African-Americans, a questionnaire survey was conducted in a primary care office setting located in a beach community of Queens, New York. This article will review some of the issues, attitudes, and beliefs regarding sunscreen use within the African-American community with data compiled from the survey and a literature search.

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Dermatosis Papulosis Nigra: Treatment Options

Mary P. Lupo MD
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Dermatosis papulosis nigra (DPN) is a very prevalent skin condition among certain ethnic groups, especially African- Americans and Afro-Caribbeans. The histology is not significantly different from that of seborrheic keratosis. DPN does not pose any health dangers, but patients often seek removal due to aesthetic concerns since it occurs commonly on the face. When performing any elective procedure, it is important that great care is taken to prevent complications so as to not merely exchange one defect for another such as a scar or discoloration. This article will outline options for management of this common cosmetic problem.

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Insight into Skin Lightening Cosmeceuticals for Women of Color

Sonia Badreshia MD, Zoe Diana Draelos MD
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The changing face of America highlights the importance of understanding dermatologic conditions of skin of color. Hyperpigmentation is the most common and distressing condition afflicting this unique subset of the population. Dermatologists need to familiarize themselves with cosmeceutical skin lightening agents and corrective camouflage formulations. This article will highlight common over-the-counter agents addressing their advantages and disadvantages. Combination agents with sunscreen will often be the most effective treatment available.

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Comparison of Adverse Events of Laser and Light-Assisted Hair Removal Systems in Skin Types IV-VI

Jonith Y. Breadon MD, Chad A. Barnes
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Photoepilation, utilizing lasers and noncoherent light sources, is designed to irradiate as much of the follicular unit as possible, with melanin as the target chromophore. Wavelength absorption should generate energy sufficient to heat and destroy the hair follicle, while preserving the surrounding tissue. When performing photoepilation on African- American skin (Fitzpatrick skin types IV-VI) a greater risk of potential epidermal adverse events, such as dyspigmentation, blistering, crusting, edema, and subsequent scarring, is possible. To reduce epidermal melanin absorption of energy longer wavelengths are considered safer for use on Fitzpatrick skin types IV to VI. This article reviews and compares the reported incidences of adverse events in African-American skin, utilizing lasers and noncoherent light sources for assisted hair removal.

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Soft Tissue Augmentation in Skin of Color: Market Growth, Available Fillers, Successful Techniques

Cheryl Burgess MD
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In recent years, people of color have become an increasingly important market force for the cosmetics industry. Product lines have been expanded to accommodate a broader spectrum of skin colors and marketing strategies have been specialized in order to target specific ethnic populations. In addition, it is predicted that people with pigmented skin will eventually comprise a majority of the domestic and international population during the 21st century. Not surprisingly, people of color are increasingly seeking out products and procedures to fight the effects of aging, including an increase in surgical and nonsurgical cosmetic procedures. Among nonsurgical procedures, soft tissue augmentation has experienced dramatic growth. Today, clinicians are performing more and more of these procedures in people of color. As a result of these shifts in the cosmetics industry, clinicians performing soft tissue augmentation require increased expertise in the treatment of ethnic skin. This article reviews the important differences that exist between the appearance of the aging faces of Caucasians and people of color. In addition, soft tissue augmentation strategies and injection techniques that are specific to skin of color are discussed.

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Cultural and Ethnic Differences in the Acceptance or Rejection of Liposuction Instrumentation Entrance Marks

Lawrence M. Field MD FIACS
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The acceptance of visible marks on the skin as a result of surgical procedures varies by the necessity of the procedure (ie, cosmetic or not) and by the cultural interpretation of those sequelae. As liposuction has become the most commonly performed major cosmetic procedure in the US, and perhaps throughout the world, the visible stigmata resulting from the surgical invasion may be of major consequence to some while they remain of little or no consequence to others. This article explores the national, cultural, racial, and ethnic variations in the acceptance or rejection of visible marks on the skin in several parts of world.

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Hair Removal with the 3-msec Alexandrite Laser in Patients with Skin Types IV-VI: Efficacy, Safety, and the Role of Topical Corticosteroids in Preventing Side Effects

Mohammed S. Aldraibi MD PhD, Dany J. Touma MD, Amor Khachemoune MD CWS
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Background: Laser hair removal targets melanin in the hair shaft. The abundance of melanin in the epidermis of patients with dark skin color has always been regarded as hazardous due to the increased incidence of side effects in this patient population. Objective: To establish the efficacy and safety of using the 3-msec alexandrite laser in patients with skin types IV to VI, and evaluate the role of topical corticosteroids in preventing side effects. Methods: Thirty-seven patients with skin types IV to VI and brown or black hair were recruited and divided into 2 groups. Twenty-six patients were treated with the 18-mm spot size and 11 patients were treated with the 15-mm spot size. Hair shafts in the treatment and control areas were counted and clipped for measurement of the thickness at the base. The laser was used with fluences between 8 and 32 J/cm2. Two 16-cm2 areas were treated; one area was pretreated with a class I topical corticosteroid (TCS) cream (betamethasone dipropionate) 10 minutes prelaser and twice a day for 5 days postlaser. The dynamic cooling device (DCD) spray duration was set at 90 msec, and the delay was set at 20 msec. Pain was graded on a scale from 1 to 10. Patients were followed up on day 1 and day 7 and at 1, 3, and 6 months. Histological samples from the 2 treatment areas and control were obtained from 5 patients. At follow-up visits, side effects were graded on a scale from 1 to 3. Hair reduction was evaluated by performing hair counts. The thickness of hair was measured microscopically at the base. Average hair count reduction and hair thickness were recorded at the 3- and 6-month visits. Results: Thirty-one patients completed the study. The average hair count reduction at 6 months was 35.4%. The average hair thickness reduction was 31.2%. At one week hyperpigmentation was seen in 48.4% of the laser only treated area and in 45.2% of laser/TCS treated area. The effect of TCS was minimal and more prominent at 1 and 3 months. The incidence of hyperpigmentation was higher in the 15-mm group than the 18-mm group as a result of using higher fluence. Hypopigmentation was generally preceded by crust formation and lasted up to 3 months. Reducing spot size resulted in decreased peripheral crust formation. TCS appears to have a role in reducing the erythema and crusting. Histopathology of both groups at day one showed necrosis of the follicular infundibulum and the inner layer of the perifollicular epithelium. No vascular damage was seen. Conclusion: The 3-msec alexandrite laser utilized in this study provides a safe and effective treatment achieving longterm reduction of unwanted, pigmented hair in skin types IV and V, but is less safe in skin type VI. Using a TCS helps in minimizing post-treatment erythema and edema; it also decreases the duration of hyperpigmentation.

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Case Reports

Surgical Therapy of Acne Scars in Pigmented Skin

James M. Swinehart MD
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Problem: Surgical therapy of moderate or severe acne scars in African-Americans, Hispanics, and other individuals with darkly pigmented skin. Challenges: Dyspigmentation in more darkly complected individuals following surgical or resurfacing operations creates an additional risk in an already difficult series of procedures. Other challenges include the lack of response of deep acne scars to lasers in general, the unpredictability of various techniques, and the long learning curve involved with dermabrasion. Methods: Case reports are presented in which chemical peeling, punch grafting, punch elevation, subcision, dermal grafting, and wire brush and diamond fraise dermabrasion were employed in one Hispanic and one African-American patient. Results: A satisfactory outcome was attained in each patient.

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Selected Dermatoses in Children of Color

Roselyn E. Epps MD
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Three conditions, erythema dyschromicum perstans (EDP), granulomatous periorificial dermatitis (GPD), and Kawasaki disease (KD) are seen more frequently in children of color. EDP and GPD are benign and self-limited dermatoses; therapy can shorten the course of the diseases. KD, a systemic vasculitis, can have life threatening cardiac consequences and timely therapy is essential. In all 3 conditions, clinicians should proceed with prompt and appropriate evaluation, diagnosis, and intervention when indicated. A case representing each condition is presented, followed by a discussion.

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Features

Laser And Cosmetic News

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Washington Whispers

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Pipeline Previews

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Schools Of Pharmacology

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Clinical Trial Review

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Supplements

Poly-L-Lactic Acid: A New Class of Collagen Stimulators

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This supplement to the Journal of Drugs in Dermatology was supported by Dermik.

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Archives Volume 6 | Issue 1

Original Articles

Case Reports

Features

Supplements

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