1
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Harvey VM, Alexis A, Okeke CAV, McKinley-Grant L, Taylor SC, Desai SR, Jaleel T, Heath CR, Kang S, Vashi N, Lester J, Vasquez R, Rodrigues M, Elbuluk N, Hamzavi I, Kwatra SG, Sundaram H, Cobb C, Brown SG, Kohli I, Callender VD. Integrating skin color assessments into clinical practice and research: A review of current approaches. J Am Acad Dermatol 2024:S0190-9622(24)00215-9. [PMID: 38342247 DOI: 10.1016/j.jaad.2024.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/13/2024]
Abstract
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.
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Affiliation(s)
- Valerie M Harvey
- Director, Hampton Roads Center for Dermatology, Newport News, Virginia; President, Skin of Color Society, Newport News, Virginia.
| | - Andrew Alexis
- Clinical Dermatology, Weill Cornell Medical College, New York, New York
| | - Chidubem A V Okeke
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Lynn McKinley-Grant
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Seemal R Desai
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Innovative Dermatology, Dallas, Texas
| | - Tarannum Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Candrice R Heath
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Neelam Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Jenna Lester
- Department of Dermatology, School of Medicine, University of California, San Francisco, California
| | | | - Michelle Rodrigues
- Department of Dermatology, Royal Children's Hospital, Victoria, Australia
| | - Nada Elbuluk
- Department of Dermatology, Keck Medicine, University of Southern California, Los Angeles, California
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hema Sundaram
- Private Practice, Rockville, Maryland; Private Practice, Fairfax, Virginia; Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Caryn Cobb
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Stafford G Brown
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia
| | - Indermeet Kohli
- The Henry W Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; Department of Physics and Astronomy, Wayne State University, Detroit, Michigan
| | - Valerie D Callender
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
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2
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Desai SR, Alexis AF, Elbuluk N, Grimes PE, Weiss J, Hamzavi IH, Taylor SC. Best practices in the treatment of melasma with a focus on patients with skin of color. J Am Acad Dermatol 2024; 90:269-279. [PMID: 37748556 DOI: 10.1016/j.jaad.2023.07.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/16/2023] [Accepted: 07/22/2023] [Indexed: 09/27/2023]
Abstract
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.
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Affiliation(s)
- Seemal R Desai
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Innovative Dermatology, Plano, Texas.
| | - Andrew F Alexis
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine Dermatology, University of South California, Los Angeles, California
| | - Pearl E Grimes
- Division of Dermatology, Vitiligo & Pigmentation Institute of Southern California, David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Hospital; Hamzavi Dermatology/Dermatology Specialists, Detroit, Michigan
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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3
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Sachdev M, Grimes PE, Callender V, Hartman CL, Taylor SC, Elbuluk N, Badawi A, Funasaka Y, Lim J, Ng CY, Desai SR. Cysteamine Isobionic-Amide Complex Versus Kligman's Formula for the Treatment of Melasma: Equal Efficacy and Rapid Onset of Action. J Drugs Dermatol 2024; 23:9-16. [PMID: 38306138 DOI: 10.36849/jdd.7428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
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.
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4
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Gonzalez S, Syder N, McKenzie SA, Price KN, Ngo B, Mora Hurtado AC, Rodman J, Elbuluk N. Racial diversity in academic dermatology: A cross-sectional analysis of Black academic dermatology faculty in the United States. J Am Acad Dermatol 2024; 90:182-184. [PMID: 37734667 DOI: 10.1016/j.jaad.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Sarah Gonzalez
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nicole Syder
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Shanice A McKenzie
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kyla N Price
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Binh Ngo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Jack Rodman
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, California
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California.
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5
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Montgomery SN, Syder N, Barajas G, Elbuluk N. Psychological comorbidities of vitiligo: a retrospective cross-sectional analysis in an urban population. Arch Dermatol Res 2023; 316:14. [PMID: 38047925 DOI: 10.1007/s00403-023-02771-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/22/2023] [Accepted: 10/05/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Simone N Montgomery
- Department of Dermatology, Keck School of Medicine of the University of Southern California, 830 S Flower St Ste 100, Los Angeles, CA, 90017, USA
| | - Nicole Syder
- Department of Dermatology, Keck School of Medicine of the University of Southern California, 830 S Flower St Ste 100, Los Angeles, CA, 90017, USA
| | - Gabrielle Barajas
- Department of Dermatology, Keck School of Medicine of the University of Southern California, 830 S Flower St Ste 100, Los Angeles, CA, 90017, USA
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine of the University of Southern California, 830 S Flower St Ste 100, Los Angeles, CA, 90017, USA.
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6
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Syder NC, Omar D, McKenzie S, Brown-Korsah JB, Taylor SC, Elbuluk N. Gaps in medical education curricula on skin of color in medical school, residency, and beyond: Part 1. J Am Acad Dermatol 2023; 89:885-892. [PMID: 35390429 DOI: 10.1016/j.jaad.2022.03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Nicole C Syder
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Deega Omar
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; George Washington School of Medicine and Health Sciences, Washington, DC
| | - Shanice McKenzie
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jessica B Brown-Korsah
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California.
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7
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Omar D, Syder N, Brown-Korsah JB, McKenzie S, Elbuluk N, Taylor S. Racial and ethnic disparities in clinical research and the dermatology workforce: Part 2. J Am Acad Dermatol 2023; 89:895-902. [PMID: 35390428 DOI: 10.1016/j.jaad.2022.03.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Deega Omar
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicole Syder
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jessica B Brown-Korsah
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Shanice McKenzie
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Susan Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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8
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Syder NC, Elbuluk N. Vitiligo and makeup: analyzing interest and usage trends in the 21st century. Int J Dermatol 2023; 62:e505-e506. [PMID: 36691783 DOI: 10.1111/ijd.16600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/24/2022] [Accepted: 01/07/2023] [Indexed: 01/25/2023]
Affiliation(s)
- Nicole C Syder
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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9
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Abstract
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.
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Affiliation(s)
- Sebastian Cruz
- Department of Dermatology, Keck School of Medicine, University of Southern California, 830 S Flower St Ste 100, Los Angeles, CA, 90017, USA
| | - Natalia Vecerek
- Department of Dermatology, Keck School of Medicine, University of Southern California, 830 S Flower St Ste 100, Los Angeles, CA, 90017, USA
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, 830 S Flower St Ste 100, Los Angeles, CA, 90017, USA.
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10
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Syder NC, Elbuluk N. Rising Interest in Sunscreen for Skin of Color: An Analysis of Google Trends. J Drugs Dermatol 2023; 22:712-713. [PMID: 37410040 DOI: 10.36849/jdd.7373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
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.
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11
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Syder NC, Quarshie C, Elbuluk N. Disorders of Facial Hyperpigmentation. Dermatol Clin 2023; 41:393-405. [PMID: 37236709 DOI: 10.1016/j.det.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
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.
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Affiliation(s)
- Nicole C Syder
- Department of Dermatology, Keck School of Medicine of University of Southern California, Keck School of Medicine, University of Southern California, 830 South Flower Street, Suite 100, Los Angeles, CA 90017, USA
| | - Claudia Quarshie
- Department of Dermatology, Keck School of Medicine of University of Southern California, Keck School of Medicine, University of Southern California, 830 South Flower Street, Suite 100, Los Angeles, CA 90017, USA
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine of University of Southern California, Keck School of Medicine, University of Southern California, 830 South Flower Street, Suite 100, Los Angeles, CA 90017, USA.
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12
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Syder NC, Elbuluk N. Racial and Ethnic Disparities in Research and Clinical Trials. Dermatol Clin 2023; 41:351-358. [PMID: 36933925 DOI: 10.1016/j.det.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Nicole C Syder
- Department of Dermatology, Keck School of Medicine, University of Southern California, 830 South Flower Street, Ste 100, Los Angeles, CA 90017, USA
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, 830 South Flower Street, Ste 100, Los Angeles, CA 90017, USA.
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13
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Krueger L, Hijab E, Latkowski JA, Elbuluk N. Clinical decision-making bias in darker skin types: a prospective survey study identifying diagnostic bias in decision to biopsy. Int J Dermatol 2023; 62:e252-e253. [PMID: 35388461 DOI: 10.1111/ijd.16213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Loren Krueger
- School of Medicine, The Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA.,The Ronald O. Perelman Department of Dermatology, New York University, New York City, NY, USA
| | - Eman Hijab
- School of Medicine, The Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jo-Ann Latkowski
- The Ronald O. Perelman Department of Dermatology, New York University, New York City, NY, USA
| | - Nada Elbuluk
- Keck School of Medicine, Department of Dermatology, University of Southern California, Los Angeles, CA, USA
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14
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Taylor S, Elbuluk N, Grimes P, Chien A, Hamzavi I, Alexis A, Gonzalez N, Weiss J, Kang S, Desai SR. TREATMENT RECOMMENDATIONS FOR ACNE-ASSOCIATED HYPERPIGMENTATION: RESULTS OF A DELPHI CONSENSUS PROCESS AND LITERATURE REVIEW. J Am Acad Dermatol 2023:S0190-9622(23)00366-3. [PMID: 36924935 DOI: 10.1016/j.jaad.2023.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/17/2023]
Abstract
Acne vulgaris can be associated with hyperpigmentation, particularly in individuals with skin of color. This acne-induced macular hyperpigmentation (AMH), also called post-inflammatory hyperpigmentation or PIH, is often long-lasting and negatively impacts quality of life. Large-scale randomized controlled clinical trials regarding treatment of acne and AMH are lacking. For this reason, evidence-based treatment recommendations cannot be made. Yet 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 consensus on first-line therapy for AMH and whether therapeutic choices may change in different patient sub-groups. We reached 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 to enhance the effect of the treatment regimen on acne and pigmentation. Chemical peels may be used as adjunctive or second-line therapy. This publication details the results of the Delphi process, reviews relevant literature in providing recommendations for AMH and discusses appropriate treatment options.
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Affiliation(s)
- Susan Taylor
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Pearl Grimes
- Department of Dermatology, David Geffen School of Medicine, University of California - Los Angeles, CA
| | - Anna Chien
- 9 Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Andrew Alexis
- Department of Dermatology, Weill Cornell Medicine, New York, NY
| | | | - Jonathan Weiss
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Seemal R Desai
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX; Innovative Dermatology, Plano, TX
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15
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Saizan A, Taylor S, Elbuluk N. Pigmented Basal Cell Carcinoma: An Argument for Sub-Classification. J Drugs Dermatol 2023; 22:217-218. [PMID: 36745362 DOI: 10.36849/jdd.6883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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.
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16
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Montgomery SNB, Elbuluk N. Skin Manifestations of Complex Regional Pain Syndrome. Cutis 2022; 110:E16-E18. [PMID: 36735983 DOI: 10.12788/cutis.0677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles
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Brown-Korsah JB, McKenzie S, Omar D, Syder NC, Elbuluk N, Taylor SC. Variations in genetics, biology, and phenotype of cutaneous disorders in skin of color - Part I: Genetic, biologic, and structural differences in skin of color. J Am Acad Dermatol 2022; 87:1239-1258. [PMID: 35809800 DOI: 10.1016/j.jaad.2022.06.1193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Jessica B Brown-Korsah
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Shanice McKenzie
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Deega Omar
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia
| | - Nicole C Syder
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Khan S, Saizan AL, O'Brien K, Kim G, Elbuluk N. Diffuse hyperpigmented lichenoid drug eruption secondary to Enzalutamide. Current Problems in Cancer: Case Reports 2022. [DOI: 10.1016/j.cpccr.2021.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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19
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Wilson BN, McMichael A, Alexis A, Agbai O, Elbuluk N, Callender V, Burgess CM, Taylor SC. Telemedicine Alopecia Assessment: Highlighting Patients With Skin of Color. Cutis 2022; 109:40-42. [PMID: 35180055 DOI: 10.12788/cutis.0419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Alopecia has been one of the more common concerns reported at teledermatology (TD) visits during the COVID-19 pandemic. In light of the growing use of TD, a team of experts were consulted to develop workflows for virtual hair and scalp examinations, with particular consideration for skin of color patients.
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Affiliation(s)
- Britney N Wilson
- Ms. Wilson is from Rutgers New Jersey Medical School, Newark, New Jersey. Dr. McMichael is from the Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Alexis is from the Department of Dermatology, Weill Cornell Medicine, New York, New York. Dr. Agbai is from the Department of Dermatology, UC Davis School of Medicine, Sacramento, California. Dr. Elbuluk is from the Department of Dermatology, University of Southern California, Los Angeles. Dr. Callender is from private practice, Glenn Dale, Maryland. Dr. Burgess is from Howard University College of Medicine, Washington, DC, and private practice, Glenn Dale. Dr. Taylor is from the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Amy McMichael
- Ms. Wilson is from Rutgers New Jersey Medical School, Newark, New Jersey. Dr. McMichael is from the Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Alexis is from the Department of Dermatology, Weill Cornell Medicine, New York, New York. Dr. Agbai is from the Department of Dermatology, UC Davis School of Medicine, Sacramento, California. Dr. Elbuluk is from the Department of Dermatology, University of Southern California, Los Angeles. Dr. Callender is from private practice, Glenn Dale, Maryland. Dr. Burgess is from Howard University College of Medicine, Washington, DC, and private practice, Glenn Dale. Dr. Taylor is from the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Andrew Alexis
- Ms. Wilson is from Rutgers New Jersey Medical School, Newark, New Jersey. Dr. McMichael is from the Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Alexis is from the Department of Dermatology, Weill Cornell Medicine, New York, New York. Dr. Agbai is from the Department of Dermatology, UC Davis School of Medicine, Sacramento, California. Dr. Elbuluk is from the Department of Dermatology, University of Southern California, Los Angeles. Dr. Callender is from private practice, Glenn Dale, Maryland. Dr. Burgess is from Howard University College of Medicine, Washington, DC, and private practice, Glenn Dale. Dr. Taylor is from the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Oma Agbai
- Ms. Wilson is from Rutgers New Jersey Medical School, Newark, New Jersey. Dr. McMichael is from the Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Alexis is from the Department of Dermatology, Weill Cornell Medicine, New York, New York. Dr. Agbai is from the Department of Dermatology, UC Davis School of Medicine, Sacramento, California. Dr. Elbuluk is from the Department of Dermatology, University of Southern California, Los Angeles. Dr. Callender is from private practice, Glenn Dale, Maryland. Dr. Burgess is from Howard University College of Medicine, Washington, DC, and private practice, Glenn Dale. Dr. Taylor is from the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nada Elbuluk
- Ms. Wilson is from Rutgers New Jersey Medical School, Newark, New Jersey. Dr. McMichael is from the Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Alexis is from the Department of Dermatology, Weill Cornell Medicine, New York, New York. Dr. Agbai is from the Department of Dermatology, UC Davis School of Medicine, Sacramento, California. Dr. Elbuluk is from the Department of Dermatology, University of Southern California, Los Angeles. Dr. Callender is from private practice, Glenn Dale, Maryland. Dr. Burgess is from Howard University College of Medicine, Washington, DC, and private practice, Glenn Dale. Dr. Taylor is from the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Valerie Callender
- Ms. Wilson is from Rutgers New Jersey Medical School, Newark, New Jersey. Dr. McMichael is from the Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Alexis is from the Department of Dermatology, Weill Cornell Medicine, New York, New York. Dr. Agbai is from the Department of Dermatology, UC Davis School of Medicine, Sacramento, California. Dr. Elbuluk is from the Department of Dermatology, University of Southern California, Los Angeles. Dr. Callender is from private practice, Glenn Dale, Maryland. Dr. Burgess is from Howard University College of Medicine, Washington, DC, and private practice, Glenn Dale. Dr. Taylor is from the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Cheryl M Burgess
- Ms. Wilson is from Rutgers New Jersey Medical School, Newark, New Jersey. Dr. McMichael is from the Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Alexis is from the Department of Dermatology, Weill Cornell Medicine, New York, New York. Dr. Agbai is from the Department of Dermatology, UC Davis School of Medicine, Sacramento, California. Dr. Elbuluk is from the Department of Dermatology, University of Southern California, Los Angeles. Dr. Callender is from private practice, Glenn Dale, Maryland. Dr. Burgess is from Howard University College of Medicine, Washington, DC, and private practice, Glenn Dale. Dr. Taylor is from the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Susan C Taylor
- Ms. Wilson is from Rutgers New Jersey Medical School, Newark, New Jersey. Dr. McMichael is from the Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Alexis is from the Department of Dermatology, Weill Cornell Medicine, New York, New York. Dr. Agbai is from the Department of Dermatology, UC Davis School of Medicine, Sacramento, California. Dr. Elbuluk is from the Department of Dermatology, University of Southern California, Los Angeles. Dr. Callender is from private practice, Glenn Dale, Maryland. Dr. Burgess is from Howard University College of Medicine, Washington, DC, and private practice, Glenn Dale. Dr. Taylor is from the Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Krueger L, Saizan AL, Meehan SA, Ezzedine K, Hamzavi I, Elbuluk N. Seborrheic macular hypopigmentation: a case series proposing a new pigmentary disorder. J Eur Acad Dermatol Venereol 2021; 36:e361-e362. [PMID: 34927764 DOI: 10.1111/jdv.17884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- L Krueger
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - A L Saizan
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - S A Meehan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - K Ezzedine
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, UPEC, Créteil, France
| | - I Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - N Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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21
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Elbuluk N, Grimes P, Chien A, Hamzavi I, Alexis A, Taylor S, Gonzalez N, Weiss J, Desai SR, Kang S. The Pathogenesis and Management of Acne-Induced Post-inflammatory Hyperpigmentation. Am J Clin Dermatol 2021; 22:829-836. [PMID: 34468934 DOI: 10.1007/s40257-021-00633-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 12/11/2022]
Abstract
Acne vulgaris is a common inflammatory disease. Among patients with darker skin phototypes (Fitzpatrick III-VI), the inflammatory processes of acne stimulate excess melanogenesis and abnormal melanin deposition, leading to pigmentary sequelae known as post-inflammatory hyperpigmentation and post-inflammatory erythema in all skin tones, although post-inflammatory hyperpigmentation is more common in darker skin and post-inflammatory erythema in lighter skin. These pigmentary alterations can be long lasting and are often more distressing to patients than the active acne lesions. This article discusses what is known about acne-related pigmentation, much of which is extrapolated from general study of nonspecific pigment deposition. Because dyspigmentation poses both a significant clinical concern to patients and a therapeutic challenge to clinicians, we formed a working group consisting of pigmentary experts with the aim of increasing awareness and education of acne-related pigmentary sequelae.
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Affiliation(s)
- Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, 830 S Flower Street, Suite 100, Los Angeles, CA, 90017, USA.
| | - Pearl Grimes
- Department of Dermatology, David Geffen School of Medicine, University of California - Los Angeles, CA, Los Angeles, USA
| | - Anna Chien
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Andrew Alexis
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Susan Taylor
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jonathan Weiss
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Dermatology Partners and Gwinnett Clinical Research Center, Snellville, GA, USA
| | - Seemal R Desai
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Innovative Dermatology, Plano, TX, USA
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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22
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Krueger L, Saizan A, Stein JA, Elbuluk N. Dermoscopy of acquired pigmentary disorders: a comprehensive review. Int J Dermatol 2021; 61:7-19. [PMID: 34235719 DOI: 10.1111/ijd.15741] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 12/17/2022]
Abstract
Dermoscopy has traditionally been used for the diagnosis of neoplasms and more recently in the evaluation of inflammatory conditions. Recent observational studies have suggested a role for dermoscopy in identifying and differentiating acquired pigmentary disorders. This comprehensive review will summarize the growing literature on the use of dermoscopy for pigmentary disorders. A literature review was performed on PubMed dating from inception to October 2020. The following pigmentary disorders were included in this study: melasma, solar lentigines, poikiloderma of Civatte, exogenous ochronosis, lichen planus pigmentosus, erythromelanosis follicularis faciei et colli, pigmented contact dermatitis, Riehl's melanosis, postinflammatory hyperpigmentation, erythema dyschromicum perstans, ashy dermatosis, confluent and reticulated papillomatosis, acanthosis nigricans, pityriasis versicolor, tinea versicolor, idiopathic guttate hypomelanosis, and vitiligo. Search terms used included each pigmentary disorder along with the terms "dermoscopy" or "dermatoscopy." Relevant case reports and case series were included. Many pigmentary disorders have unique and distinguishable features on dermoscopy. Given that these disorders can be clinically challenging for clinicians and emotionally distressing for patients, dermoscopy provides an additional, useful tool in the evaluation and assessment process.
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Affiliation(s)
- Loren Krueger
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Autumn Saizan
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Nada Elbuluk
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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23
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Smith ZI, Wang JF, Elbuluk N, Huggins RH, Birnbaum MR, Rzepecki A, Bhatia BK, Kratschmer C, McLellan B, Kutner A. A Multi-Centered Case-Control Study of Vitiligo Support Groups and Quality of Life. J Drugs Dermatol 2021; 20:672-675. [PMID: 34076392 DOI: 10.36849/jdd.2021.5706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is limited research on the association between vitiligo support group membership and patient quality of life (QoL). OBJECTIVES To explore the association between support groups and QoL in those with vitiligo by evaluating and comparing the QoL of vitiligo support group members and non-support group members. METHODS Support group members (n=135) and non-support group members (n=129) were recruited from the Global Vitiligo Foundation (GVF), and three academic medical centers respectively. Patients completed the Vitiligo-Specific Quality of Life (VitiQoL) instrument and a demographic survey. RESULTS Mean VitiQoL scores for support group members were higher than non-support group members (48.6 ± 23.6 vs 33.0 ± 23.8; P-value < 0.0001), highlighting more negatively impacted QoL. Support group members were less likely to be undergoing treatment (27.4% vs 53.5%; P-value = <0.0001) and were more likely to report duration of vitiligo for >20 years (38.5% vs 19.4%; P-value = 0.0007). CONCLUSIONS Vitiligo support group membership is associated with worse QoL. Individuals with vitiligo who have worse QoL, chronic, and/or untreated vitiligo may be more likely to seek out vitiligo support groups. Support group referral should be considered in the therapeutic management of vitiligo, particularly in patients whose QoL is more significantly impacted, who fail or are who are without access to treatment or have longstanding disease. J Drugs Dermatol. 2021;20(6):672-675. doi:10.36849/JDD.5706.
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Nahas SJ, Hindiyeh N, Friedman DI, Elbuluk N, Kellerman DJ, Foreman PK, Schmidt P. Long term safety, tolerability, and efficacy of intracutaneous zolmitriptan (M207) in the acute treatment of migraine. J Headache Pain 2021; 22:37. [PMID: 34001002 PMCID: PMC8127195 DOI: 10.1186/s10194-021-01249-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine the long-term safety and tolerability profile of M207 in the acute treatment of migraine. BACKGROUND M207 is an investigational microneedle-based system for intracutaneous delivery of zolmitriptan for the treatment of migraine attacks. Following on the positive results of a Phase 2/3 placebo-controlled efficacy study (ZOTRIP), this study was designed to evaluate the safety of this novel product during repeated use for the treatment of migraine attacks. METHODS In this 6-12 month open-label, multicenter observational study, participants used an eDiary to record headache symptoms and adverse events at specified intervals up to 48 h following treatment of a qualifying attack with M207 3.8 mg (intracutaneous zolmitriptan). Participants underwent clinical evaluations at specified intervals up to 12 months. RESULTS Among 335 participants who treated ≥1 migraine attack, 257 completed 6 months and 127 completed 1 year of treatment. The most common reason for withdrawal from the study was a low frequency of reported attacks post randomization. Overall, 5963 migraine attacks were treated. Most participants (96%) experienced at least 1 adverse event, the vast majority of which concerned the application site, and > 95% of which were mild. Fifteen participants (4%) withdrew due to adverse events; 4 withdrew due to 7 application site reactions, 6 of which were mild. Participants achieved pain freedom in 2477/5617 (44%) of attacks, most bothersome symptom freedom in 3315/5330 (62%) of attacks, and pain relief 2 h post-dose in 4552/5617 (81%) of attacks. Sustained pain freedom 2-24 h was seen in 1761/4698 (38%) of attacks, and 2-48 h in 1534/4429 (35%) of attacks. CONCLUSIONS The majority of participants experienced cutaneous adverse reactions such as application site erythema, swelling, and bleeding, and most reactions were scored as mild. These results are consistent with what was observed in the single migraine attack treatment ZOTRIP trial indicating that M207 is well tolerated in the setting of longer-term repeated use. Efficacy findings were also similar to those in the ZOTRIP trial. TRIAL REGISTRATION Clinicaltrials.gov on September 13, 2017 ( NCT03282227 ).
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Affiliation(s)
- Stephanie J Nahas
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nada Hindiyeh
- Department of Neurology, Stanford University Medical Center, Stanford, CA, USA
| | | | - Nada Elbuluk
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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Saizan AL, Douglas A, Elbuluk N, Taylor S. A diverse nation calls for a diverse healthcare force. EClinicalMedicine 2021; 34:100846. [PMID: 33997735 PMCID: PMC8102711 DOI: 10.1016/j.eclinm.2021.100846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 10/29/2022] Open
Affiliation(s)
- Autumn L. Saizan
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- Corresponding author at: University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Annyella Douglas
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nada Elbuluk
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Susan Taylor
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Wiznia LE, Wang J, Steuer AB, Elbuluk N. Direct-to-consumer dermatology-related advertising differs in magazines targeted to women of color: A cross-sectional analysis of top-circulating consumer magazines. Int J Womens Dermatol 2021; 7:191-194. [PMID: 33937491 PMCID: PMC8072494 DOI: 10.1016/j.ijwd.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/23/2020] [Accepted: 01/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background Advertisements for dermatology-related products in consumer magazines serve as a potential source of health literacy, which varies by demographic group. Objective This study sought to examine differences in advertisements for dermatology-related products in the top U.S. consumer magazines targeted at women of color compared with three other demographic groups: teenagers, adult women, and adult men. Methods Dermatology advertisements in the most circulated U.S. consumer magazines targeting these four demographic groups were analyzed. Descriptive statistics were obtained. Simple logistic regressions were used to compare the product indications, language used, and the sex, age, ethnicity, and skin type of models between magazine categories. Limitations of this study included that certain magazines could not be included due to a lack of accessibility, and subjective assessments were made when necessary because not all data collected were explicitly stated. Results Significant differences exist in print media advertising for women of color in comparison with other demographic groups, including skin-of-color magazines having an increased number of darker-skin models, more advertisements related to products that target pigmentation, and differences in advertisement word choices. Conclusion The differences in print media advertising for women of color in comparison with other demographic groups may influence the dermatologic concerns of this population, including their dermatology-related knowledge base, grooming practices, beauty perceptions, and utilization of dermatology as a specialty.
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Affiliation(s)
- Lauren E Wiznia
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, United States
| | - Jenny Wang
- University of Pennsylvania, Philadelphia, PA, United States
| | - Alexa B Steuer
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, United States
| | - Nada Elbuluk
- USC Department of Dermatology, Keck School of Medicine, Los Angeles, CA, United States
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Affiliation(s)
- Pamela N. Madu
- USC Department of Dermatology, Keck School of Medicine, Los Angeles, CA, USA
| | - Nicole Syder
- USC Department of Dermatology, Keck School of Medicine, Los Angeles, CA, USA
| | - Nada Elbuluk
- USC Department of Dermatology, Keck School of Medicine, Los Angeles, CA, USA
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Bakhtiar M, Elbuluk N, Lipoff JB. The digital divide: How COVID-19's telemedicine expansion could exacerbate disparities. J Am Acad Dermatol 2020; 83:e345-e346. [PMID: 32682890 PMCID: PMC7365110 DOI: 10.1016/j.jaad.2020.07.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Mina Bakhtiar
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Jules B Lipoff
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Grimes PE, Elbuluk N, Alexis AF. The Relevance of Vitamin D Supplementation for People of Color in the Era of COVID-19. J Drugs Dermatol 2020; 19:782-783. [PMID: 33528149 DOI: 10.36849/jdd.2021.5414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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30
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Montgomery SNB, Elbuluk N. Evaluating Population Interest in Vitiligo Through an Analysis of Google Trends and Social Media. J Drugs Dermatol 2020; 19:661-665. [PMID: 32574016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Soleymani T, Soter NA, Folan LM, Elbuluk N, Cohen DE. Why can we see our narrowband UVB lights? J Am Acad Dermatol 2020; 82:e251-e252. [PMID: 32109539 DOI: 10.1016/j.jaad.2020.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Teo Soleymani
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California.
| | - Nicholas A Soter
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine
| | | | - Nada Elbuluk
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine
| | - David E Cohen
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine
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Curtiss P, Riley K, Meehan SA, Elbuluk N. Photolichenoid dermatitis: a presenting sign of human immunodeficiency virus. Cutis 2019; 104:242-244. [PMID: 31809532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Photolichenoid dermatitis is an uncommon eruptive dermatitis that often occurs in association with a photosensitizing drug. Photodermatitis, in general, is an uncommon clinical manifestation of human immunodeficiency virus (HIV), most often affecting patients of African and Native American descent. Photolichenoid dermatitis has infrequently been reported in patients with HIV who have not been exposed to a photosensitizing drug. We report a case of an African patient with a photodistributed depigmenting eruption without exposure to a photosensitizing drug. Histologic examination revealed a patchy perivascular and bandlike lymphocytic infiltrate with melanophages, interface changes, and dyskeratotic keratinocytes, consistent with photolichenoid dermatitis. Laboratory examination was significant for a positive HIV-2 antibody. Photolichenoid dermatitis may be a presenting sign of HIV infection and may not necessarily be associated with exposure to a photosensitizing drug. Testing for HIV should be done in patients who present with photodistributed depigmenting eruptions, even in the absence of exposure to a photosensitizing drug, and particularly in patients of African and Native American descent.
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Affiliation(s)
- Paul Curtiss
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Kathryn Riley
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Shane A Meehan
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Nada Elbuluk
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
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Hadi A, Wang JF, Uppal P, Penn LA, Elbuluk N. Comorbid diseases of vitiligo: A 10-year cross-sectional retrospective study of an urban US population. J Am Acad Dermatol 2019; 82:628-633. [PMID: 31325552 DOI: 10.1016/j.jaad.2019.07.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 07/07/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Vitiligo is associated with medical conditions, primarily autoimmune disorders; however, only a few studies in the United States have investigated these associations. OBJECTIVE Our purpose was to investigate the diseases associated with vitiligo in the New York, New York, population and evaluate if these associations differ by race/ethnicity and sex. METHODS In this retrospective study, we analyzed data collected from the medical records of 1487 vitiligo patients seen at New York University during a 10-year period. RESULTS Vitiligo patients had a statistically significant higher prevalence of hypothyroidism, multiple sclerosis, rheumatoid arthritis, idiopathic thrombocytopenic purpura, seronegative arthritis, pernicious anemia, myasthenia gravis, inflammatory bowel disease, lymphoma, and systemic lupus erythematosus. Rates of comorbid autoimmune diseases varied by race and sex. LIMITATIONS Medical charts did not consistently report race/ethnicity, type of vitiligo, and total body surface area affected. Information from nondermatology medical visits was also included. CONCLUSION This study revealed multiple new disease associations for vitiligo, including multiple sclerosis, idiopathic thrombocytopenic purpura, and lymphoma, as well as confirmed previously reported associations with other autoimmune diseases, the most common being hypothyroidism followed by rheumatoid arthritis. Associations did vary by race/ethnicity and sex.
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Affiliation(s)
- Ali Hadi
- Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jason F Wang
- The Ronald O. Perelman Department of Dermatology, New York University, New York, New York
| | - Pushpinder Uppal
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, California.
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Eleftheriadou V, Hamzavi I, Pandya A, Grimes P, Harris J, Huggins R, Lim H, Elbuluk N, Bhatia B, Tovar‐Garza A, Nahhas A, Braunberger T, Ezzedine K. International Initiative for Outcomes for vitiligo trials (INFO). Br J Dermatol 2019. [DOI: 10.1111/bjd.17544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eleftheriadou V, Hamzavi I, Pandya A, Grimes P, Harris J, Huggins R, Lim H, Elbuluk N, Bhatia B, Tovar‐Garza A, Nahhas A, Braunberger T, Ezzedine K. 针对白癜风试验结局的国际行动计划 (INFO). Br J Dermatol 2019. [DOI: 10.1111/bjd.17560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Krueger L, Svigos K, Brinster N, Elbuluk N. Frontal fibrosing alopecia: cutaneous associations in women with skin of color. Cutis 2018; 102:335-338. [PMID: 30566548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Frontal fibrosing alopecia (FFA) was first described as a progressive recession of the frontal hairline in postmenopausal women. Since its initial description, recognition and understanding of FFA has expanded. The condition is now defined as a patterned, symmetric, frontotemporal scarring alopecia that is considered to be histopathologically indistinguishable from lichen planopilaris. Numerous case reports and series have suggested clinical variants of and associations with FFA. In addition to reviewing the literature on FFA's associations, this article includes a case series of 5 women with skin of color (Hispanic and black) who presented with various cutaneous findings in association with FFA, including lichen planus pigmentosus (LPP), facial papules, and eyebrow loss. Recognition of the conditions that can occur in association with FFA in individuals with skin of color is important in further expanding our knowledge and understanding of FFA as a disease entity.
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Affiliation(s)
- Loren Krueger
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Katerina Svigos
- New York University School of Medicine, New York, New York, USA
| | - Nooshin Brinster
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Nada Elbuluk
- Department of Dermatology, University of Southern California, Los Angeles, California, USA
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Wiznia LE, Wang J, Steuer AB, Elbuluk N. Deficiency of sun protection advertising exists in consumer magazines across demographic groups and varies by target demographic. J Am Acad Dermatol 2018; 80:1139-1141. [PMID: 30315819 DOI: 10.1016/j.jaad.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/22/2018] [Accepted: 10/01/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Lauren E Wiznia
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Jenny Wang
- New York University School of Medicine, New York, New York
| | - Alexa B Steuer
- New York University School of Medicine, New York, New York
| | - Nada Elbuluk
- University of Southern California Department of Dermatology, Keck School of Medicine, Los Angeles, California.
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Eleftheriadou V, Hamzavi I, Pandya AG, Grimes P, Harris JE, Huggins RH, Lim HW, Elbuluk N, Bhatia B, Tovar-Garza A, Nahhas AF, Braunberger T, Ezzedine K. International Initiative for Outcomes (INFO) for vitiligo: workshops with patients with vitiligo on repigmentation. Br J Dermatol 2018; 180:574-579. [PMID: 30030843 DOI: 10.1111/bjd.17013] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is no cure or firm clinical recommendations for the treatment of vitiligo. One of the main issues is the heterogeneity of outcome measures used in randomized controlled trials for vitiligo. OBJECTIVES To define successful repigmentation from the patients' point of view and to propose how and when repigmentation should be evaluated in clinical trials in vitiligo. METHODS We conducted three workshops with patients with vitiligo and their parents or caregivers. Workshop 1 was held at World Vitiligo Day (Detroit, MI), workshop 2 at the University of Texas Southwestern Medical Center and workshop 3 at the Vitiligo and Pigmentation Institute of Southern California, University of California. RESULTS Seventy-three participants were recruited. Consensus on the following questions was achieved unanimously: (i) the definition of 'successful repigmentation' was 80-100% of repigmentation of a target lesion and (ii) both an objective and a subjective scale to measure repigmentation should be used. CONCLUSIONS This was the largest patients' outcomes workshop. We followed the guidance from the CSG-COUSIN and the Vitiligo Global Issues Consensus Group. Our recommendations to use percentage of repigmentation quartiles (0-25%, 26-50%, 51-79%, 80-100%) and the Vitiligo Noticeability Scale are based on the best available current evidence. A limitation of the research is that the workshops were conducted only in the U.S.A., due to pre-existing organisational support and the availability of funding.
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Affiliation(s)
- V Eleftheriadou
- Centre of Evidence Based Dermatology, Kings Meadow Campus, University of Nottingham, Nottingham, U.K
| | - I Hamzavi
- Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI, U.S.A
| | - A G Pandya
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A
| | - P Grimes
- Vitiligo and Pigmentation Institute of Southern California, Los Angeles, CA, U.S.A
| | - J E Harris
- Department of Dermatology, Vitiligo Clinic and Research Center, University of Massachusetts, Medical School, Worcester, MA, U.S.A
| | - R H Huggins
- Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI, U.S.A
| | - H W Lim
- Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI, U.S.A
| | - N Elbuluk
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, U.S.A
| | - B Bhatia
- Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI, U.S.A
| | - A Tovar-Garza
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A
| | - A F Nahhas
- Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI, U.S.A
| | - T Braunberger
- Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI, U.S.A
| | - K Ezzedine
- Department of Dermatology, Hospital Henri Mondor, UPEC-Université Paris-Est Créteil, Paris, France
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Rzepecki AK, McLellan BN, Elbuluk N. Beyond Traditional Treatment: The Importance of Psychosocial Therapy in Vitiligo. J Drugs Dermatol 2018; 17:688-691. [PMID: 29879259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Vitiligo is an acquired depigmentation disorder of the skin. Patients with vitiligo often face a challenging disease course, having to cope with a condition that is known to be physically disfiguring, psychologically devastating, and socially stigmatizing. Although an extensive amount of research has been directed towards the dermatologic treatment of vitiligo, an overall lack of data exists investigating treatment of the psychological and emotional burden of patients with vitiligo. This paper reviews the literature for treatment options in patients with vitiligo that specifically target the psychosocial domain. Despite being limited in quantity, several studies have proven the benefits of adjuvant care in the form of group therapy, cognitive behavioral therapy, and self-help programs. Although preliminary evidence is promising, larger prospective studies are needed to further define the role of these psychosocial interventions before integrating them in a more official capacity into the standard of care for patients with vitiligo. Because of the considerable impact of vitiligo beyond its physical symptoms, dermatologists ought to consider the utility of adjuvant therapies to adequately address impairments in self-esteem, body image, and quality of life in patients with vitiligo. J Drugs Dermatol. 2018;17(6):688-691.
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Arowojolu OA, Orlow SJ, Elbuluk N, Manga P. The nuclear factor (erythroid-derived 2)-like 2 (NRF2) antioxidant response promotes melanocyte viability and reduces toxicity of the vitiligo-inducing phenol monobenzone. Exp Dermatol 2018; 26:637-644. [PMID: 28370349 DOI: 10.1111/exd.13350] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 12/29/2022]
Abstract
Vitiligo, characterised by progressive melanocyte death, can be initiated by exposure to vitiligo-inducing phenols (VIPs). VIPs generate oxidative stress in melanocytes and activate the master antioxidant regulator NRF2. While NRF2-regulated antioxidants are reported to protect melanocytes from oxidative stress, the role of NRF2 in the melanocyte response to monobenzone, a clinically relevant VIP, has not been characterised. We hypothesised that activation of NRF2 may protect melanocytes from monobenzone-induced toxicity. We observed that knockdown of NRF2 or NRF2-regulated antioxidants NQO1 and PRDX6 reduced melanocyte viability, but not viability of keratinocytes and fibroblasts, suggesting that melanocytes were preferentially dependent upon NRF2 activity for growth compared to other cutaneous cells. Furthermore, melanocytes activated the NRF2 response following monobenzone exposure and constitutive NRF2 activation reduced monobenzone toxicity, supporting NRF2's role in the melanocyte stress response. In contrast, melanocytes from individuals with vitiligo (vitiligo melanocytes) did not activate the NRF2 response as efficiently. Dimethyl fumarate-mediated NRF2 activation protected normal and vitiligo melanocytes against monobenzone-induced toxicity. Given the contribution of oxidant-antioxidant imbalance in vitiligo, modulation of this pathway may be of therapeutic interest.
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Affiliation(s)
- Omotayo A Arowojolu
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Nada Elbuluk
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Prashiela Manga
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
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Soleymani T, Cohen DE, Folan LM, Okereke UR, Elbuluk N, Soter NA. Disparity in Cutaneous Pigmentary Response to LED vs Halogen Incandescent Visible Light: Results from a Single Center, Investigational Clinical Trial Determining a Minimal Pigmentary Visible Light Dose. J Drugs Dermatol 2017; 16:1105-1110. [PMID: 29141058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED <p>Background: While most of the attention regarding skin pigmentation has focused on the effects of ultraviolet radiation, the cutaneous effects of visible light (400 to 700nm) are rarely reported. OBJECTIVE The purpose of this study was to investigate the cutaneous pigmentary response to pure visible light irradiation, examine the difference in response to different sources of visible light irradiation, and determine a minimal pigmentary dose of visible light irradiation in melanocompetent subjects with Fitzpatrick skin type III - VI. METHODS The study was designed as a single arm, non-blinded, split-side dual intervention study in which subjects underwent visible light irradiation using LED and halogen incandescent light sources delivered at a fluence of 0.14 Watts/cm2 with incremental dose progression from 20 J/cm2 to 320 J/cm2. Pigmentation was assessed by clinical examination, cross-polarized digital photography, and analytic colorimetry. RESULTS Immediate, dose-responsive pigment darkening was seen with LED light exposure in 80% of subjects, beginning at 60 Joules. No pigmentary changes were seen with halogen incandescent light exposure at any dose in any subject. CONCLUSION This study is the first to report a distinct difference in cutaneous pigmentary response to different sources of visible light, and the first to demonstrate cutaneous pigment darkening from visible LED light exposure. Our findings raise the concern that our increasing daily artificial light surroundings may have clandestine effects on skin biology.</p> <p><em>J Drugs Dermatol. 2017;16(11):1105-1110.</em></p>.
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Abstract
Vitiligo is a complex, systemic disease associated with many autoimmune and autoinflammatory conditions. Additionally, the cutaneous changes of vitiligo have significant effects on quality of life and self-esteem. Further efforts are needed to increase our understanding of vitiligo comorbidities as well as to increase awareness of the psychological effects of vitiligo.
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Affiliation(s)
- Nada Elbuluk
- Ronald O. Perelman Department of Dermatology, NYU Ambulatory Care Center, NYU Langone Medical Center, 240 East 38th Street, 12th Floor, New York, NY 10016, USA.
| | - Khaled Ezzedine
- Department of Dermatology, EpiDermE, Henri Mondor Hospital, Université Paris-Est Créteil Val-de-Marne, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
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Abstract
Melasma is a common acquired condition of symmetric hyperpigmentation, typically occurring on the face, with higher prevalence in females and darker skin types. Multiple etiologies, including light exposure, hormonal influences, and family history, have been implicated in the pathogenesis of this disorder. Overall prevalence ranges widely at 1-50%, since values are typically calculated within a specific ethnic population within a geographic region. Histologically, melasma can display increased epidermal and/or dermal pigmentation, enlarged melanocytes, increased melanosomes, solar elastosis, dermal blood vessels, and, occasionally, perivascular lymphohistiocytic infiltrates. Various topical, oral, and procedural therapies have been successfully used to treat melasma. Traditional topical therapies including hydroquinone, tretinoin, corticosteroids, and triple combination creams; however, other synthetic and natural topical compounds have also shown varying efficacies. Promising oral therapies for melasma include tranexamic acid, Polypodium leucotomos, and glutathione. Procedures, including chemical peels, microneedling, radiofrequency, and lasers, are also often used as primary or adjunctive treatments for melasma. Notably, combination therapies within or across treatment modalities generally result in better efficacies than monotherapies. This review serves as a comprehensive update on the current understanding of the epidemiology, pathogenesis, clinical and histologic features of melasma, as well as treatments for this common, yet therapeutically challenging, condition.
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Affiliation(s)
| | - Nada Elbuluk
- Ronald O. Perelman Department of Dermatology, New York University, New York, NY, USA.
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Soleymani T, Soter NA, Folan LM, Elbuluk N, Okereke UR, Cohen DE. A Difference in Cutaneous Pigmentary Response to LED Versus Halogen Incandescent Visible Light: A Case Report from a Single Center, Investigational Clinical Trial Determining a Minimal Pigmentary Visible Light Dose. J Drugs Dermatol 2017; 16:388-392. [PMID: 28403275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
<p>BACKGROUND: While most of the attention regarding skin pigmentation has focused on the effects on ultraviolet radiation, the cutaneous effects of visible light (400 to 700nm) are rarely reported. In this report, we describe a case of painful erythema and induration that resulted from direct irradiation of UV-naïve skin with visible LED light in a patient with Fitzpatrick type II skin.</p> <p>METHODS AND RESULTS: A 24-year-old healthy woman with Fitzpatrick type II skin presented to our department to participate in a clinical study. As part of the study, the subject underwent visible light irradiation with an LED and halogen incandescent visible light source. After 5 minutes of exposure, the patient complained of appreciable pain at the LED exposed site. Evaluation demonstrated erythema and mild induration. There were no subjective or objective findings at the halogen incandescent irradiated site, which received equivalent fluence (0.55 Watts / cm2). The study was halted as the subject was unable to tolerate the full duration of visible light irradiation.</p> <p>CONCLUSION: This case illustrates the importance of recognizing the effects of visible light on skin. While the vast majority of investigational research has focused on ultraviolet light, the effects of visible light have been largely overlooked and must be taken into consideration, in all Fitzpatrick skin types.</p> <p><em>J Drugs Dermatol. 2017;16(4):388-392.</em></p>.
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Soleymani T, Folan LM, Soter NA, Elbuluk N, Cohen DE. Daily indoor light exposure: A spectral analysis of ambient light sources and its relevance to occupational dermatology. J Am Acad Dermatol 2017; 76:763-765. [PMID: 28325397 DOI: 10.1016/j.jaad.2016.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/05/2016] [Accepted: 11/09/2016] [Indexed: 10/19/2022]
Affiliation(s)
- Teo Soleymani
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York University, New York, New York.
| | - Lorcan M Folan
- The Tandon School of Engineering, New York University, New York, New York
| | - Nicholas A Soter
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York University, New York, New York
| | - Nada Elbuluk
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York University, New York, New York
| | - David E Cohen
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York University, New York, New York
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Dillon AB, Sideris A, Hadi A, Elbuluk N. Advances in Vitiligo: An Update on Medical and Surgical Treatments. J Clin Aesthet Dermatol 2017; 10:15-28. [PMID: 28210378 PMCID: PMC5300730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Vitiligo is one of the most common cutaneous disorders of depigmentation. Although its underlying causes are still being studied and no definitive cure currently exists, recent research has provided insight into pathogenic mechanisms and new treatment options. Objective: The aim of this paper is to provide a comprehensive overview of the medical and surgical therapies for vitiligo with emphasis on the most recent treatment modalities. Design: This review was conducted through a literature search using PubMed and the National institutes of Health's clinicalTrials.gov databases from January 2010 to July 2015. This yielded 86 studies, 12 of which were excluded, and 74 of which were reviewed. Results: Recent studies and ongoing clinical trials indicate that there are many promising new medical and surgical treatment modalities for this chronic condition. Conclusion: A combination of traditional and newer treatments may work synergistically to provide additional improvement in patients' disease state and quality of life.
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Affiliation(s)
- Alexander B Dillon
- The Ronald O. Perelman Department of Dermatology, New York University, New York, New York
| | - Andrew Sideris
- The Ronald O. Perelman Department of Dermatology, New York University, New York, New York
| | - Ali Hadi
- The Ronald O. Perelman Department of Dermatology, New York University, New York, New York
| | - Nada Elbuluk
- The Ronald O. Perelman Department of Dermatology, New York University, New York, New York
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Orme CM, Kim RH, Brinster N, Elbuluk N, Franks AG. Lichen planus pigmentosus. Dermatol Online J 2016; 22:13030/qt3t24c55s. [PMID: 28329536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023] Open
Abstract
Lichen planus pigmentosus (LPP) is a type oflichenoid dermatitis with superficial dermalmelanophages that presents as symmetrical,hyperpigmented macules and patches that aredistributed over the forehead, temples, cheeks, andneck. The condition most often occurs in darkerskinned individuals and is frequently resistant totreatment. Here we present a patient of Egyptiandecent with a lacy reticulated LPP eruption on theface.
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Affiliation(s)
- Charisse M Orme
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine, NYU Langone Medical Center
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Cobos G, Kim RH, Meehan S, Elbuluk N. Lichen planus pigmentosus and lichen planopilaris. Dermatol Online J 2016; 22:13030/qt7hp8n6dn. [PMID: 28329547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023] Open
Abstract
Lichen planus is an inflammatory skin conditionwith characteristic histopathological findings thathas many clinical variants. Recently, there have been25 cases reported in the literature of lichen planuspigmentosus (LPPi) that preceded the developmentof frontal fibrosing alopecia (FFA), which is a variantof lichen planopilaris (LPP). We review the literatureregarding LPPi, LPP, and FFA and present a case of a40-year-old African American woman with LPPi andLPP.
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Affiliation(s)
- Gabriela Cobos
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine, NYU Langone Medical Center
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