Register today for this Saturday's Skin Spectrum Summit Colloquium on the Black and Brown Dermatology Patient (registration's free)
Register today for this Saturday's Skin Spectrum Summit Colloquium on the Black and Brown Dermatology Patient (registration's free)
The Aug. 21 virtual forum will explore important dermatologic issues in Fitzpatrick skin types V and VI (1,439 words, 7.5 minutes)
This coming Saturday, Aug. 21, at 11:00 a.m. (EST), we invite you to attend the first-ever Live Colloquium, concluding our Summer of Dialogue on Brown and Black Skin. The colloquium is a live, virtual discussion of a range of topics related to dermatology in richly pigmented skin types.
In today’s Skin Spectrum Weekly, we review some of the important messages from the Summer of Dialogue podcast and e-newsletter series so far. One recurring theme was that Brown and Black skin is much more reactive to trauma and inflammation than lighter skin.
Drs. Renita Ahluwalia and Juthika Thakur noted in their discussion about managing acne-related hyperpigmentation that preventing inflammation in the first place was much more effective than working to reduce pigmentation changes later. That informed their recommendation of retinoid treatments for patients with mild to moderate acne that was not hormone-driven.
“[Retinoid treatment] works on two fronts,” said Dr. Thakur. “The first is it reduces blackheads and whiteheads and prevents future recurrence of acne. It also inhibits the melanin production that contributes to post-inflammatory hyperpigmentation.”
Post-inflammatory pigmentation changes are also a concern when treating melasma in darker skin. Drs. Yvette Miller-Monthrope and Vincent Richer noted that there are good treatments for the condition, but there is room for improved outcomes in patients with dark skin types. In particular, Dr. Richer noted that laser-based treatments for melasma risk making pigment changes worse in these patients.
However, there are some new or improved medication options, they noted. Dr. Miller-Monthrope mentioned topical cysteamine cream.
“The studies have shown phenomenal results, especially in melasma,” Dr. Miller-Monthrope said. “I think the major issue with the topical cystiamine cream, for years, was the odour. [Producers] were not able to manufacture this this product, without it having a very strong sulphur type odour. However, there is one company that has managed to to mitigate that odour a little bit. And so now it is available as a 5% topical preparation and is doing wonders for many patients.”
Keloids, too, are much more common in very dark skin due to that skin’s reactivity, Drs. Richer and Miller-Monthrope said. Because of this, sometimes dermatologists and patients need to more carefully ‘pick their battles.’
Dr. Richer said elective procedures should be considered carefully in these patients around the ears or shoulder girdle area.
“I have quite a few patients in my practice that had a small cyst removed up in the front of the neck or a little mole by the bra line. And now we have to deal with this keloid, which is a much more problematic thing to deal with. So, certainly, as dermatologists and healthcare practitioners, that is something we must keep in mind as a potential risk from small procedures in those areas,” he said.
While dark skin can react more aggressively, scarring and pigment changes are not typically dangerous. Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but potentially fatal reactions to certain medications. The risk of developing these reactions seems to have a genetic basis, noted Dr. Bruce Carleton in a podcast episode with Dr. Neil Shear. However, Dr. Carleton said the actual risks of SJS/TEN in many dark-skinned populations is not well understood.
“Many of these drugs were approved in the 1960s and ‘70s, from [trials conducted in] very large countries such as the United States and Canada. [The populations of those nations] are [now], in fact, different, genetically than they were in those previous decades,” he said.
Key take-aways
There remain persistent health gaps experienced by Black Canadians. The Summer of Dialogue podcast series and upcoming Colloquium on Black skin is dedicated to promoting and advancing medical knowledge of Black skin health.
Registration for the 90-minute virtual colloquium is open now. The discussion will be moderated by Dr. Andrew Alexis, Vice Chair for Diversity and Inclusion at the Department of Dermatology at Weill Cornell Medical College in New York. It will feature a keynote presentation by Dr. Ncoza Dlova, dermatologist and Dean of the University of KwaZulu-Natal’s School of Clinical Medicine in South Africa. This keynote lecture is in honour and celebration of Dr. Mercy Alexis of Toronto, an influential figure in Ethnodermatology and Black skin health in Canada.
This program will qualify for personal learning credit in most professional healthcare organizations. There is no charge to participate.
Please click here to register and join us on Aug. 21, 2021, from 11:00 a.m.–12:30 p.m. EDT.
From the literature on dark skin representation in scientific writing
Publication rates on the topic of racial and ethnic diversity in dermatology versus other specialties
The authors of this study conducted a review of publications promoting diversity in dermatology and other medical specialties. They looked at papers indexed in PubMed, published between Jan. 2008 and July 2019. In that time window, they found 25 publications focused on diversity in dermatology, six in radiology, two in ophthalmology, two in anesthesiology, 12 in orthopedic surgery, 23 in family medicine, nine in internal medicine, and seven in general surgery.
They conclude that while there has been a lack of racial and ethnic dermatology in dermatology, efforts to promote diversity through increased publications in the last four years have been stronger in dermatology compared to many other fields.
Novel education modules addressing the underrepresentation of skin of colour in dermatology training
Researchers evaluated whether online Perceptual and Adaptive Learning Modules (PALMs) composed of representative dark skin images could efficiently train University of Botswana medical students to describe and diagnose common skin conditions in their community more accurately.
As part of this study, the investigators had year 4 and 5 medical students voluntarily complete PALMs that teach skin morphology, configuration, and distribution terminology and diagnose the most common dermatologic conditions in their community.
They found that training using the PALMs resulted in statistically significant improvements in accuracy and fluency and good retention after a 12.5 to 21-week median delay.
The representation of skin colours in images of patients with lupus erythematosus
This paper reviews published images of patients with lupus from rheumatology, dermatology and internal medicine textbooks and medical journals, SOC (skin of colour) atlases, online image libraries, UpToDateTM and GoogleTM Images. Investigators rated the skin colour in each image, sorting them into light, medium or dark.
Of 1,417 images, most (56.4%) represented light skin (χ2 = 490.14, p<0.001). SOC atlases and journals were the most inclusive of images of dark skin. The specialty of dermatology was most inclusive of medium and darker skin tones. Overall, the authors concluded that published images of lupus under-represent SOC.
International Dermoscopy Society criteria for non-neoplastic dermatoses (general dermatology): validation for skin of colour through a Delphi expert consensus
The authors of this paper note that the new criteria released by the International Dermoscopy Society (IDS) for the use of dermoscopy in non-neoplastic dermatoses were developed, taking into account Caucasian and Asian skin. As a result, they say there may be limitations to the criteria if used in dark skin.
This paper aimed to validate the criteria in dark-skinned patients using a two-round Delphi method for reaching an expert consensus.
The 22 participating panellists agreed that nearly all the dermoscopic criteria originally proposed by the IDS apply even to darker phototypes but that several additional variables need to be assessed.
VIDEO: Lack of images of skin of colour in Covid-19 studies
At the intersection of skin and society
Small museums across Canada are adapting their programming and exhibitions to represent the Indigenous community better, according to The Globe and Mail (July 31, 2021).
The news outlet reports the North West Mounted Police Barracks, a historical site in Canmore, Alta. run by the Canmore Museum, now acknowledges police's role in forcibly removing children from their homes and transporting them to residential schools. There are also educational materials on how the law enforcement body monitored the Pass system, which limited the movement of Indigenous people.
“We don’t shy away from talking about that,” said the museum’s executive officer, Ron Ulrich, in the article. Ulrich also noted that before the change, there had been no information on Indigenous history at the Barracks or the nearby Canmore Museum.
“We feel museums should play a big role in reconciliation, in presenting the truth. That’s our job.”
Other museums mentioned in the article include the Burnaby Village Museum in Metro Vancouver and the Whyte Museum of the Canadian Rockies in Banff, Alta.
The former opened the Indigenous Learning House in 2019, which is staffed by an Indigenous education team. The latter has had picnic tables painted by Dene and Stoney Nakoda artists, erected welcome messages in seven languages and is planning Indigenous-led nature walks and a project about traditional Indigenous trade routes in the Banff area.
As well, the Whyte Museum’s archives have been working to identify Indigenous people in historical photographs.
More information on movement in Canadian museums can be read in the original article here.
This Week:
August is Summer Sun Safety Month in the US
August 19 is World Humanitarian Day
Something to think about in the week ahead . . .
