1) Cultural competency toolkit for derms

The most-read and commented-upon edition of Skin Spectrum Weekly last year was the announcement of the Diversity & Inclusion Cultural Competency toolkit for dermatologists, developed by the Dermatology Industry Taskforce on Diversity, Inclusiveness & Equity (DiTiDE.) That issue was published on November 28th.

DiTiDE executive committee member Matthew Page, National Medical Relations Manager at L’Oréal Canada, was quoted in the article discussing the importance of the toolkit and supporting education on diversity and equity.

“Everyone in healthcare needs to have the ability to understand where patients are coming from, what they might be experiencing, and how to help them,” said Page.

The Toolkit, available online at this link, connects to cultural competency training materials, resources such as checklists for working with immigrant children, and articles on the history and impact of bias in healthcare.

2) AD morphology in darker skin

Coverage of Dr. Marissa Joseph’s presentation at the 7th annual Skin Spectrum Summit, reported on Jan. 17, 2022, was the second most-read feature.

Dr. Joseph, the Medical Director of the Ricky Kanee Schachter Dermatology Centre at Women’s College Hospital in Toronto, spoke on the differences in atopic dermatitis (AD) presentation in darker skin types and how understanding these differences can lead to more accurate and timely diagnoses.

Her presentation included these tips for improving experience and outcomes for patients with darker skin types and AD:

Consider the impact pruritus is having. Scratching is more likely to induce a nodular component to AD or cause dyspigmentation in dark skin.
Treating early and aggressively can help prevent inflammation-induced pigment changes and improve treatment adherence because some patients may mistakenly attribute pigment changes to their topical medications.
Treatment guidance should also consider the way the patient’s AD presents. Clinicians often recommend patients continue topical treatment until redness subsides, but this direction is not helpful when AD presents without erythema.

3) Cosmeceutical alternatives to hydroquinone

The third most popular post in 2022 was Dr. Heather Woolery-Lloyd’s discussion of skin-lightening alternatives to hydroquinone.

Dr. Woolery-Lloyd is the Director of the Skin of Color Division in the Department of Dermatology and Cutaneous Surgery at the University of Miami in Florida. She gave the talk at the 7th Annual Skin Spectrum Summit.

As part of her presentation, she listed several topical cosmeceuticals with growing bodies of research supporting their use as treatments for melasma. These included:

Topical vitamin C
Licorice extract
Niacinamide
Azelaic acid
Silymarin (Milk thistle)
Thiamidol
Cysteamine
Topical tranexamic acid

Watch for other articles on interest on skin of colour, cultural competency, and ethnodermatology through 2023.

Sault College in Sault Ste. Marie, Ont. and the not-for-profit skin and wound care organization WoundPedia have developed a skin and wound care education platform. This new platform includes a 15-session nursing virtual curriculum, an e-learning textbook, diabetic foot virtual reality and micro-credentials from the Challenge and Innovation fund sponsored by the Ontario Department of Colleges and Universities.

The new platform is supported by partners including the Northern Ontario School of Medicine (NOSM) University, Queen’s University, and Nurses Specialized in Wound, Ostomy and Continence, Canada (NSWOCC).

Sault College and WoundPedia say the mission of this project is “to improve skin and wound care throughout Ontario with a special focus on Indigenous, northern, remote, and isolated communities.”

Free virtual enrollment is available for two sessions:

Jan. 20: Dermatology for Non-Dermatologists—A case-based and key concept discussion will cover common dermatological conditions, including eczema, acne, rosacea, psoriasis, hair loss, infections, and more with a focus on approaches to diagnosis and treatment
Jan. 21: Long-Term Care—This session will feature common disorders of an elderly population including skin tears, fragile skin, red legs, pruritus, peripheral edema, skin ulcers and malignant/premalignant lesions

The content of these sessions will be relevant to medical students at a level for dermatological training, residents, family doctors, and specialists.

More details and registration at: www.pheedloop.com/healingweek/site/home

From the literature on dermatology in skin of colour

Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types

The authors of this paper aimed to stratify treatment outcomes to different systemic treatments for atopic dermatitis by Fitzpatrick skin type.

They evaluated data from the Dutch TREAT (TREatment of ATopic eczema) NL (treatregister.nl) and UK-Irish A-STAR (Atopic eczema Systemic TherApy Register; astar-register.org) registries. Data on outcomes with dupilumab, methotrexate and cyclosporine, and morphological phenotypes were included.

A total of 235 patients were included. Of those, 156 had Fitzpatrick skin types 1-3 (light skin type [LST]), and 68 had skin types 4-6 (dark skin types (DST)).

The patients in the DST group tended to be younger, were more likely to have follicular eczema, higher baseline Eczema Area and Severity Index (EASI) scores, less allergic contact dermatitis and less previous phototherapy use than LST patients.

When the researchers compared DST and LST corrected for covariates including baseline EASI, DST showed greater mean EASI reduction between baseline and six months only with dupilumab.

From "JAAD Int"

Racial and ethnic differences in barriers to care among US adults with chronic inflammatory skin diseases: A cross-sectional study of the All of Us Research Program

Researchers conducted a cross-sectional study of survey data on 16,986 people with chronic inflammatory skin diseases (CISDs). The data came from the All of Us Research Program, a U.S. National Institutes of Health project to collect health data on one million individuals across the country.

The data was analyzed to assess the relationship between race and ethnicity and patients experiencing barriers to care.

Investigators found that compared to White patients, Black and Hispanic patients were significantly more likely to delay care because of cost and a broad range of additional structural barriers, including transportation, work, childcare, adult care, living in a rural area, and the lack of healthcare workforce diversity.

However, associations between race and ethnicity and many barriers to care were substantially attenuated after controlling for insurance, income, and education.

The authors note two limitations of this study are that the studied population was not a representative sample of U.S. adults, and their responses were not specific to dermatologic care.

From "J Am Acad Dermatol"

Racial/ethnic variations in acne: A practical algorithm for treatment and maintenance, including skincare recommendations for skin of colour patients with acne

Because treating acne in patients with skin of colour (SOC) involves unique therapeutic considerations, a group of investigators developed an algorithm to help guide physicians in treatment and patient recommendations.

Using in-person discussions with online follow-up and a literature search, a group of advisors drafted an algorithm for the treatment and maintenance, including skincare recommendations, for skin of colour (SOC) patients with acne.

The panel then reviewed and adopted the algorithm using published evidence coupled with the panel's expert opinion and clinical experience.

Strategies identified for improving outcomes in SOC patients with acne include the early initiation and maintenance of treatment regimens; careful consideration of the tolerability of active ingredients, vehicle formulations, and dosing; and the use of skin care (e.g., pH-balanced, non-irritating cleansers, and non-comedogenic moisturizers) to minimize irritation or dryness.

From "J Drugs Dermatol"

Post-inflammatory hyperpigmentation in dark skin: Molecular mechanism and skincare implications

This review summarizes the current knowledge on histopathology and the likely molecular signatures of post-inflammatory hyperpigmentation (PIH). The authors discuss the proposed mechanisms of PIH in the context of other factors characterizing darker skin types. This includes the common cellular features, organization of upper skin layers, and major biomarkers, with particular emphasis on how dark skin is more prone to systemic and local inflammation.

The authors also summarize the major cosmetic treatments for PIH and their known anti-inflammatory targets, which can be beneficial for darker skin tones and combined with broad-spectrum filters against UVR.

From "Clin Cosmet Investig Dermatol"

VIDEO: Updates on atopic dermatitis in skin of colour: A dermatology and allergy perspective

At the intersection of skin and society

Two researchers from Edmonton won the 2022 Canadian Research Got Talent competition for their work on adultification bias and its impact on Black girls, CBC News reports.

According to the article, adultification is a form of gendered racial prejudice, largely impacting Black girls and children of colour who are denied the necessary protection society usually affords children. These children are treated as if they are older and more mature than their actual age, potentially leading to mental health and academic challenges.

Researchers Stella Igweamaka and Nana Appah researched adultification bias. The Canadian Research Insights Council organized the competition.

This research involved an online survey of 400 adult Canadians. The Logit and Maru group conducted the survey between June 30 and July 10, 2022.

Findings from their research showed that survey respondents viewed Black girls from zero to nine years of age as being more adult-like than their white counterparts—12% of respondents reported they felt Black girls aged five to eight years took on more adult responsibilities, compared to 8% who said White girls did. Black girls aged zero to four years were almost twice as likely to be seen as independent compared to similarly aged White girls.

“Because of that you rob them of that childhood innocence, you rob them of being seen as a child, you rob them of being able to act as a child,” Igweamaka told the news outlet.

More information on the research is available at: https://adultification.wixsite.com/blackgirls

This week

January is National Blood Donor Month in the U.S.

Jan. 17 is International Mentoring Day

Jan. 20 is International Day of Acceptance

Something to think about in the week ahead…

Next week

Coverage of the 2022 Skin Spectrum Summit resumes with Dr. Yvette Miller-Monthrope’s talk on the demographics of psoriasis in skin of colour, and challenges for research.

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 in print providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:

Dr. Kim Papp (Waterloo, Ont.) discusses recent research on the TYK2 inhibitor deucravacitinib as a treatment for psoriasis
A review of 2022’s new dermatology treatments, featuring interviews with Dr. Ben Barankin (Toronto), Dr. Kerri Purdi (Halifax, N.S.), and Dr. Marlene Dytoc (Edmonton)
Plus regular features, including the popular column “Vender on Psoriasis” by Hamilton, Ont. dermatologist Dr. Ron Vender

Read a recent online edition 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 new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.

Season two of the Shear Listening Pleasure podcast with Dr. Neil Shear has launched. Listen to the third episode here, where Dr. Shear speaks with Dr. Erin Dahlke about her varying interests and expertise in dermatology, Mohs micrographic surgery, and implementing skin of colour images into the dermatology curriculum.

And if you’re looking for a web destination for all things derm, please visit derm.city, “Where Dermatology Lives.” Please like it, rate it, and share it with your colleagues.

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