Acne sequelae a concern for darker-skinned patients
Lingering scars and pigment changes drive skin of colour patients to seek dermatologic care (1,500 words, 7 minutes)
Data from the U.S. shows that for African-Americans, Asian and Pacific Islanders and Hispanic or Latino patients, acne is the number one skin condition that drives patients to seek medical care, and the sequelae of that condition, not the lesions themselves, are the primary complaint. This message was part of a presentation by dermatologist Dr. Monica Li at the 9th annual Skin Spectrum Summit.
Dr. Li is a clinical instructor in the Department of Dermatology and Skin Science at the University of British Columbia and has a private cosmetic and medical dermatology practice in Vancouver.
Different skin types will have different presentations of acne, especially when it comes to sequelae, said Dr. Li. Patients of colour often see a physician because of the sequelae and are less bothered by the active acne lesions.
Dr. Li said that skin-of-colour patients with acne are at greater risk of scarring and dyspigmentation. This risk is related to the degree of inflammation, so treatment should be as aggressive and as early as possible to reduce those sequelae, which can be persistent, disfiguring, and bothersome.
While treating active lesions to prevent these persistent sequelae is important, physicians must balance tolerability and efficacy in treatment, said Dr. Li. With patients of colour, acne treatments often produce side effects that may lead to poor adherence, which can result in inadequate or slow response, she said. This can be mitigated by educating patients on when to expect to observe results and how to mitigate many side effects through a consistent skincare routine that supports skin barrier health.
Bottom line: Many patients with skin of colour are motivated to seek dermatologic care by the sequelae of acne rather than the acne itself. Good patient education, including setting expectations and encouraging a good skincare routine, can support treatment adherence and allow patients to achieve results sooner.
From the literature on acne in skin of colour
Efficacy and safety of solid-state dual-wavelength lasers for the treatment of moderate-to-severe inflammatory acne in Asian populations
In this study, conducted at a single clinic in Singapore, 40 individuals with moderate-to-severe acne received nightly topical retinoids and two to three weekly treatments with a 1,319 nm laser followed by a 589 nm laser (five sessions in total).
Investigators evaluated the patients at pretreatment baseline, monthly intervals, and one month after the last laser for pain, seborrhea, global aesthetic improvements, and satisfaction. Fifteen patients had an additional evaluation three months after the fifth session.
After the first month of the treatment period, all patients had improved inflammatory acne counts, with 72.5% having a greater than 75% reduction in acne count, 7.5% having a 51%-75% reduction, 17.5% having a 26%-50% reduction, and 2.5% having less than 25% reduction. Moreover, Global Assessment Scale evaluations showed that 62.5% of patients improved to almost clear and 37.5% to mild acne (p=0.0478), while improvements were sustained in patients with three-month follow-ups.
Erythema improved in 29 patients, with 65.5% of affected patients experiencing a greater than 75% reduction. Seventeen patients with pigmentation issues experienced lightening, with 52.9% of affected patients experiencing a greater than 75% reduction. The authors note that the treatment was well-tolerated, with low pain scores (mean 3.68 of 10, median 4 of 10).
All patients reported acne improvements, with 95% having much improved or very much improved and 95% either satisfied or very satisfied.
Facial adult female acne in China: An analysis based on artificial intelligence
Researchers used an artificial intelligence algorithm to analyze images taken by high-resolution mobile phones to further explore the severity of acne in Chinese adult women.
In addition to using a smartphone application to assess acne severity from selfie photographs, the investigators used a questionnaire to gather basic user information such as age, gender, skin sensitivity, and dietary habits.
The findings showed a gradual decrease in acne severity from the age of 25 years. A trough was reached between the ages of 40 and 44, followed by a gradual increase in acne severity.
Investigators found oily skin, hypersensitive skin, frequent makeup application, and unhealthy dietary habits can affect the severity of acne. They observed that the degree of city development, cold seasons, high altitude, and strong radiation affect acne severity in adult women.
The AI analyses revealed that the severity of blackheads, pores, dark circles, and skin roughness were positively associated with acne severity in adult women.
The psychosocial burden of skin disease and dermatology care insights among skin of colour consumers
Using an anonymous, web-based survey in August 2022, researchers explored skin-of-colour (SoC) consumers' perspectives on dermatologic care to provide insight into the psychosocial burden of skin disease.
There were 775 responses, 64.6% (n=501) with SoC. Among these, 94.2% (472/501) were female, 76.6% (384/501) Black/African American, and 48.9% (245/501) 18-24 years. Of the responders, 79.6% (399/501) reported a bothersome skin condition that was moderate to extremely bothersome (85.2%, 340/399) and 57.4% (229/399) reported skin condition(s) affected mental health.
The most common concerns were discolouration or acne-related post-inflammatory pigment changes (69.5%, 348/501), acne (58.5%, 293/501), and ingrown hairs (48.1%, 241/501).
The face was the most commonly affected body region (93.6%, 469/501).
Some 40.9% (205/501) of respondents reported they believed available skin products do not address their specific skin needs; 44.8% (179/399) said they had consulted a dermatologist; 46.4% (185/399) felt like the dermatologist did not know how to treat their skin; and 92.5% (369/399) did not believe most dermatologists or aestheticians are trained to treat darker skin tones.
The paper’s authors note the survey was not validated and may not be generalizable.
Racial, ethnic, and biologic sex disparities in outpatient laboratory monitoring of isotretinoin use: a cross-sectional study
This study explores disparities in laboratory monitoring of patients prescribed isotretinoin, factoring in the Covid-19 pandemic and its impacts on laboratory monitoring.
The researchers evaluated two populations: all patients taking isotretinoin and patients taking isotretinoin with no metabolic, cardiovascular, hematologic, hepatic, or renal comorbidities. The latter population was included to screen out patients who might receive increased laboratory testing for conditions besides isotretinoin use.
Investigators found African-American, Asian, and Hispanic patients prescribed isotretinoin were more likely than Caucasian patients to receive orders for outpatient laboratory monitoring. These disparities persisted independent of comorbidities that may prompt additional testing, suggesting that non-Caucasian patients bear an additional testing burden even when their comorbidities were matched to their peers. The disparities persisted in the setting of reduced laboratory monitoring due to the Covid-19 pandemic.
The authors write that there is an opportunity for testing standardization to improve medication access, decrease the burden and costs for patients and the healthcare system, and decrease racial disparities in the prescribing and monitoring of isotretinoin. They suggest dermatology clinics may benefit from standard operating procedures outlining for whom regular monitoring is needed.
At the intersection of skin and society
On April 17, 2024, the Marine Conservation Institute announced a marine protected area managed by Kitasoo Xai’xais Nation has been designated a ‘Blue Park’, reports The Narwhal. The designation shows the park is an internationally recognized example of excellence in marine protection.
The Institute is a U.S.-based nonprofit ocean conservation organization working to identify and protect vulnerable ocean ecosystems worldwide.
Encompassing 33.5 square kilometres, the Gitdisdzu Lugyeks Marine Protected Area is the first Indigenous-led blue park in the world and the first such park designated in Canada.
The protected area encompasses Kitasu Bay on the central coast of British Columbia, an area rich with herring, shorebirds, whales, sea lions, and juvenile fish. The nation unilaterally declared it a protected area in 2022 and began pursuing qualifications for Blue Park status shortly after.
According to the article, the decision to apply the designation considered the productivity and importance of a proposed park’s location and the rules and management enforced at the park.
The Kitasoo Xai’xais Nation established the protected area under its jurisdiction, which falls within the Great Bear Rainforest.
“Having lived on the surrounding lands for thousands of years, the Kitasoo Xai'xais know the Bay's waters better than anyone,” the Marine Conservation Institute’s website reads. “Already on the water daily as part of the Territory's management, the Kitasoo Xai'xais Guardian Watchmen will monitor and care for Gitdisdzu Lugyeks MPA. The leadership and stewardship of the Kitasoo Xai'xais Nation will ensure the continuity of their culture and protect the vital biodiversity and marine resources of the Bay for current and future generations.”
This week
May is Asian/Pacific American Heritage Month
May 6-11 is North American Occupational Safety and Health Week
May 6-11 is National Nurse’s Week in the U.S.
Something to think about in the week ahead. . .
—Bryant H. McGill, U.S. author (1969-present)
Next week
Halifax-based dermatopathology fellow Dr. Archana Kakadekar explains some of the cellular differences contributing to reactivity variations between skin types.
This coming Saturday is the Atopic Dermatitis Summit: Register now
On May 11, 2024, from 10 a.m. to 1 p.m. EDT, Skin Spectrum Summit presents the Atopic Dermatitis Summit, a one-day virtual medical education event seeking the highest-quality AD education to help Canadian patients receive the best care possible. Drs. Marissa Joseph and Neil Shear are the co-chairs of the event.
You can join your colleagues to learn more about the incidence of and the latest therapies for AD through live Q&As and lectures.
The Summit is a landmark opportunity to learn to:
Effectively communicate about AD with patient and their families
Diagnose AD across all skin phototypes
Prioritize sun protection in the management of AD
Address disparities among Indigenous communities
Understand the interplay between food allergies and AD
Registering for this compelling event is free, but space is limited. Reserve your (virtual) space now at tinyurl.com/ADSummit2024
Many thanks to L'Oréal, Procter & Gamble, Dermtek Pharma, Arcutis Biotherapeutics, and other event supporters.
Learn more at www.skinspectrum.ca/ad
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Brittany Waller (Regina, Sask.), Charles Lynde (Markham, Ont.), Gurbir Dhadwal (Surrey, B.C.), Ashley O’Toole (Scarborough, Ont.) and Monica Li (Vancouver) discuss new treatments for challenging diseases available or expected in 2024.
Dr. Afsanah Alavi (Rochester, Minn.) details recent research showing a link between lower limb lymphedema and skin cancer.
Drs. Reetesh Bose (Ottawa), Morvarid Hessami (Toronto), and Marissa Joseph (Toronto) describe the establishment of dermatology clinics specializing in skin colour and the outcomes they are achieving.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender.
Read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
And if you’re you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.