Pigmentation Disorders

In this episode of our monthly dermatology podcast, we bring you an expert update on vitiligo research, a dose of humor from our columnist, Dr. Alan Rockoff, and the top news on edermatologynews.com.

In this episode of our monthly dermatology podcast, we bring you an expert update on vitiligo research, a dose of humor from our columnist, Dr. Alan Rockoff, and the top news on edermatologynews.com.

In this episode of our monthly dermatology podcast, we bring you an expert update on vitiligo research, a dose of humor from our columnist, Dr. Alan Rockoff, and the top news on edermatologynews.com.

DENVER – Vitiligo has been known for thousands of years, but only in the past six decades have researchers begun to better understand it and uncover genes associated with the disorder.

Dr. Richard A. Spritz, one of the leaders in vitiligo research, says that scientists are very close to understanding the condition’s pathogenesis. He is embarking on another analysis of data from a large genetic study, which could double the number of known vitiligo genes, putting the disorder on par with other autoimmune diseases such as type 1 diabetes and rheumatoid arthritis.

At the Society of Pediatric Dermatology’s annual meeting, held immediately before the annual meeting of the American Academy of Dermatology, Dr. Spritz spoke about what is known so far about vitiligo and what the future holds. Dr. Spritz is professor and director of the Human Medical Genetics and Genomics Program at the University of Colorado, Aurora.

[email protected]

On Twitter @naseemsmiller

DENVER – Vitiligo has been known for thousands of years, but only in the past six decades have researchers begun to better understand it and uncover genes associated with the disorder.

Dr. Richard A. Spritz, one of the leaders in vitiligo research, says that scientists are very close to understanding the condition’s pathogenesis. He is embarking on another analysis of data from a large genetic study, which could double the number of known vitiligo genes, putting the disorder on par with other autoimmune diseases such as type 1 diabetes and rheumatoid arthritis.

At the Society of Pediatric Dermatology’s annual meeting, held immediately before the annual meeting of the American Academy of Dermatology, Dr. Spritz spoke about what is known so far about vitiligo and what the future holds. Dr. Spritz is professor and director of the Human Medical Genetics and Genomics Program at the University of Colorado, Aurora.

[email protected]

On Twitter @naseemsmiller

DENVER – Vitiligo has been known for thousands of years, but only in the past six decades have researchers begun to better understand it and uncover genes associated with the disorder.

Dr. Richard A. Spritz, one of the leaders in vitiligo research, says that scientists are very close to understanding the condition’s pathogenesis. He is embarking on another analysis of data from a large genetic study, which could double the number of known vitiligo genes, putting the disorder on par with other autoimmune diseases such as type 1 diabetes and rheumatoid arthritis.

At the Society of Pediatric Dermatology’s annual meeting, held immediately before the annual meeting of the American Academy of Dermatology, Dr. Spritz spoke about what is known so far about vitiligo and what the future holds. Dr. Spritz is professor and director of the Human Medical Genetics and Genomics Program at the University of Colorado, Aurora.

[email protected]

On Twitter @naseemsmiller

The American Academy’s 2014 annual meeting in Denver will feature new CME sessions and updates on the latest dermatology research.

This year’s program features expert commentary on key issues in medical dermatology, including "Melanoma Multidisciplinary Care 2014: What You Need to Know" on Sunday, March 23, from 1 p.m. to 3 p.m. in Room 705/707 and "Dermatologic Manifestations of New Oncology Drugs," also on Sunday, March 23, from 1 p.m. to 3 p.m. in the Mile High Ballroom 3B. Looking for the latest in aesthetic dermatology? Check out the "Advanced Botulinum Toxin" live demonstration session on Saturday, March 22, from 2 p.m. to 5 p.m. in the Bellco Theater.

There will be expert sessions on pregnancy dermatoses, cutaneous T-cell lymphoma, pediatric dermatology, skin of color, and the latest on treatments for hair and nail conditions. The full scientific session list is available online.

A series of practice management lectures includes topics such as "How to Have an Unforgettably Positive Office Visit" on Saturday, March 22, from 10:00 a.m. to 12:00 p.m. in Room 709/7111 and "Hot Buttons: Recognizing What Sets You Off and Managing Your Triggers" on Sunday, March 23, from 1:00 p.m. to 3:00 p.m. in Room 702.

There is also a mobile device app that meeting attendees can download that contains session schedules, exhibitor and attendee lists, and more.

Can’t attend the meeting? Visit www.eDermatologyNews.com for live conference coverage.

[email protected]

On Twitter @Sknews

The American Academy’s 2014 annual meeting in Denver will feature new CME sessions and updates on the latest dermatology research.

This year’s program features expert commentary on key issues in medical dermatology, including "Melanoma Multidisciplinary Care 2014: What You Need to Know" on Sunday, March 23, from 1 p.m. to 3 p.m. in Room 705/707 and "Dermatologic Manifestations of New Oncology Drugs," also on Sunday, March 23, from 1 p.m. to 3 p.m. in the Mile High Ballroom 3B. Looking for the latest in aesthetic dermatology? Check out the "Advanced Botulinum Toxin" live demonstration session on Saturday, March 22, from 2 p.m. to 5 p.m. in the Bellco Theater.

There will be expert sessions on pregnancy dermatoses, cutaneous T-cell lymphoma, pediatric dermatology, skin of color, and the latest on treatments for hair and nail conditions. The full scientific session list is available online.

A series of practice management lectures includes topics such as "How to Have an Unforgettably Positive Office Visit" on Saturday, March 22, from 10:00 a.m. to 12:00 p.m. in Room 709/7111 and "Hot Buttons: Recognizing What Sets You Off and Managing Your Triggers" on Sunday, March 23, from 1:00 p.m. to 3:00 p.m. in Room 702.

There is also a mobile device app that meeting attendees can download that contains session schedules, exhibitor and attendee lists, and more.

Can’t attend the meeting? Visit www.eDermatologyNews.com for live conference coverage.

[email protected]

On Twitter @Sknews

The American Academy’s 2014 annual meeting in Denver will feature new CME sessions and updates on the latest dermatology research.

This year’s program features expert commentary on key issues in medical dermatology, including "Melanoma Multidisciplinary Care 2014: What You Need to Know" on Sunday, March 23, from 1 p.m. to 3 p.m. in Room 705/707 and "Dermatologic Manifestations of New Oncology Drugs," also on Sunday, March 23, from 1 p.m. to 3 p.m. in the Mile High Ballroom 3B. Looking for the latest in aesthetic dermatology? Check out the "Advanced Botulinum Toxin" live demonstration session on Saturday, March 22, from 2 p.m. to 5 p.m. in the Bellco Theater.

There will be expert sessions on pregnancy dermatoses, cutaneous T-cell lymphoma, pediatric dermatology, skin of color, and the latest on treatments for hair and nail conditions. The full scientific session list is available online.

A series of practice management lectures includes topics such as "How to Have an Unforgettably Positive Office Visit" on Saturday, March 22, from 10:00 a.m. to 12:00 p.m. in Room 709/7111 and "Hot Buttons: Recognizing What Sets You Off and Managing Your Triggers" on Sunday, March 23, from 1:00 p.m. to 3:00 p.m. in Room 702.

There is also a mobile device app that meeting attendees can download that contains session schedules, exhibitor and attendee lists, and more.

Can’t attend the meeting? Visit www.eDermatologyNews.com for live conference coverage.

[email protected]

On Twitter @Sknews

Many dermatologists continue to battle an overwashing epidemic. From bar soaps to antibacterial washes, dermatologists continue to educate patients that the extensive lather, the alkaline pH, and the antibacterial components of our washing rituals can strip the natural oils from the skin and leave it dry, cracked, and damaged.

This phenomenon is well reported in the literature, and industry has taken notice by developing more "no-soap" soaps than ever before.

But does the same philosophy apply to hair care practices? Hair washing is more complicated, particularly in skin of color patients.

Overwashing the hair often leads to dry hair, split ends, and the need for compensatory conditioners to replace lost moisture. In African American hair, especially that of patients who use chemical or heat treatments, the lost oil and sebum from overwashing can cause even more damage.

Many skin of color patients wash their hair infrequently to protect it from breakage, and they may use topical oils to smooth and protect the fragile hair shaft.

However, can underwashing the scalp and hair cause problems? Yes, in some cases.

You might see African American patients in your practice who are suffering from scalp folliculitis, itchy scalp, seborrheic dermatitis, or alopecia that can be traced to infrequent hair washing. The infrequency of washing and the application of oils to the hair does help the hair shaft, but the buildup of oils and sebum on the scalp itself can lead to scalp inflammation, follicular plugging, extensive seborrhea, acneiform eruptions, and folliculitis.

Depending on its level and degree, the inflammation can cause pruritus and burning of the scalp and can even lead to temporary or permanent hair loss. Although topical and oral antibiotics, topical steroids, and medicated shampoos do help, proper washing also plays an important preventative role.

For skin of color patients with some of the chronic scalp problems mentioned above, decreasing heat and chemical treatments, along with increasing hair washing to two or three times a week can help prevent scalp dermatitides without compromising the hair integrity. In addition, the use of sulfate-free shampoos, use of shampoo on the scalp only (without lathering the ends of the hair), or use of a dry shampoo between washes can help control the oil and product buildup on the scalp itself.

Ultimately, it may take some trial and error to find the right hair washing regimen for skin of color patients. Determining how often to wash the scalp depends on many patient-specific factors including ethnicity, hair type, frequency of chemical and heat treatments, cost, and level of scalp inflammation. Experimenting with new hair care products and possibly a new hairstyle also may be part of a successful treatment plan.

Dr. Talakoub is in private practice at McLean (Va.) Dermatology Center. A graduate of Boston University School of Medicine, Dr. Talakoub did her residency in dermatology at the University of California, San Francisco. She is the author of multiple scholarly articles and a textbook chapter.

Many dermatologists continue to battle an overwashing epidemic. From bar soaps to antibacterial washes, dermatologists continue to educate patients that the extensive lather, the alkaline pH, and the antibacterial components of our washing rituals can strip the natural oils from the skin and leave it dry, cracked, and damaged.

This phenomenon is well reported in the literature, and industry has taken notice by developing more "no-soap" soaps than ever before.

But does the same philosophy apply to hair care practices? Hair washing is more complicated, particularly in skin of color patients.

Overwashing the hair often leads to dry hair, split ends, and the need for compensatory conditioners to replace lost moisture. In African American hair, especially that of patients who use chemical or heat treatments, the lost oil and sebum from overwashing can cause even more damage.

Many skin of color patients wash their hair infrequently to protect it from breakage, and they may use topical oils to smooth and protect the fragile hair shaft.

However, can underwashing the scalp and hair cause problems? Yes, in some cases.

You might see African American patients in your practice who are suffering from scalp folliculitis, itchy scalp, seborrheic dermatitis, or alopecia that can be traced to infrequent hair washing. The infrequency of washing and the application of oils to the hair does help the hair shaft, but the buildup of oils and sebum on the scalp itself can lead to scalp inflammation, follicular plugging, extensive seborrhea, acneiform eruptions, and folliculitis.

Depending on its level and degree, the inflammation can cause pruritus and burning of the scalp and can even lead to temporary or permanent hair loss. Although topical and oral antibiotics, topical steroids, and medicated shampoos do help, proper washing also plays an important preventative role.

For skin of color patients with some of the chronic scalp problems mentioned above, decreasing heat and chemical treatments, along with increasing hair washing to two or three times a week can help prevent scalp dermatitides without compromising the hair integrity. In addition, the use of sulfate-free shampoos, use of shampoo on the scalp only (without lathering the ends of the hair), or use of a dry shampoo between washes can help control the oil and product buildup on the scalp itself.

Ultimately, it may take some trial and error to find the right hair washing regimen for skin of color patients. Determining how often to wash the scalp depends on many patient-specific factors including ethnicity, hair type, frequency of chemical and heat treatments, cost, and level of scalp inflammation. Experimenting with new hair care products and possibly a new hairstyle also may be part of a successful treatment plan.

Dr. Talakoub is in private practice at McLean (Va.) Dermatology Center. A graduate of Boston University School of Medicine, Dr. Talakoub did her residency in dermatology at the University of California, San Francisco. She is the author of multiple scholarly articles and a textbook chapter.

Many dermatologists continue to battle an overwashing epidemic. From bar soaps to antibacterial washes, dermatologists continue to educate patients that the extensive lather, the alkaline pH, and the antibacterial components of our washing rituals can strip the natural oils from the skin and leave it dry, cracked, and damaged.

This phenomenon is well reported in the literature, and industry has taken notice by developing more "no-soap" soaps than ever before.

But does the same philosophy apply to hair care practices? Hair washing is more complicated, particularly in skin of color patients.

Overwashing the hair often leads to dry hair, split ends, and the need for compensatory conditioners to replace lost moisture. In African American hair, especially that of patients who use chemical or heat treatments, the lost oil and sebum from overwashing can cause even more damage.

Many skin of color patients wash their hair infrequently to protect it from breakage, and they may use topical oils to smooth and protect the fragile hair shaft.

However, can underwashing the scalp and hair cause problems? Yes, in some cases.

You might see African American patients in your practice who are suffering from scalp folliculitis, itchy scalp, seborrheic dermatitis, or alopecia that can be traced to infrequent hair washing. The infrequency of washing and the application of oils to the hair does help the hair shaft, but the buildup of oils and sebum on the scalp itself can lead to scalp inflammation, follicular plugging, extensive seborrhea, acneiform eruptions, and folliculitis.

Depending on its level and degree, the inflammation can cause pruritus and burning of the scalp and can even lead to temporary or permanent hair loss. Although topical and oral antibiotics, topical steroids, and medicated shampoos do help, proper washing also plays an important preventative role.

For skin of color patients with some of the chronic scalp problems mentioned above, decreasing heat and chemical treatments, along with increasing hair washing to two or three times a week can help prevent scalp dermatitides without compromising the hair integrity. In addition, the use of sulfate-free shampoos, use of shampoo on the scalp only (without lathering the ends of the hair), or use of a dry shampoo between washes can help control the oil and product buildup on the scalp itself.

Ultimately, it may take some trial and error to find the right hair washing regimen for skin of color patients. Determining how often to wash the scalp depends on many patient-specific factors including ethnicity, hair type, frequency of chemical and heat treatments, cost, and level of scalp inflammation. Experimenting with new hair care products and possibly a new hairstyle also may be part of a successful treatment plan.

Dr. Talakoub is in private practice at McLean (Va.) Dermatology Center. A graduate of Boston University School of Medicine, Dr. Talakoub did her residency in dermatology at the University of California, San Francisco. She is the author of multiple scholarly articles and a textbook chapter.

Dry skin occurs throughout the year, but for many people it’s most prevalent and problematic in winter. Cold temperatures, low humidity, and strong, harsh winds deplete the skin of its natural lipid layer, which would normally help keep the skin from drying out. Skin of color in particular, can become very flaky, dry, and "ashy" in the winter. Differences in the stratum corneum barrier in skin of color may contribute to the propensity toward ashiness.

The barrier function of the skin depends on the structure of the corneocytes, lipid content, and transepidermal water loss. Compared with skin in white people, black skin has more corneocyte layers and a more compact stratum corneum with greater intercellular cohesiveness. The epidermal barrier in darker skin has been shown to be stronger when exposed to mechanical or chemical challenge. Although the size of the individual corneocytes is the same in black and white skin, the desquamation rate in certain locations is higher in black skin. This is likely due to increased desquamatory enzyme levels such as cathepsin L2 in the lamellar granules of darker pigmented individuals leading to an ashy manifestation of the skin.

Black skin also has the highest sebum content of all ethnicities, but has the lowest ceramide level, and is thus the most susceptible to transepidermal water loss and xerosis of any ethnic group. Of note, one study has shown that the use of a certain type of fatty acid body wash or a synthetic "syndet" bar reduced ashiness.

Although no large, multiethnic group studies have been performed to examine the skin barrier physiologic properties and their relation to clinical signs of disease, these small studies do shed light on some of the ethnic variation in skin barrier function.

In clinical practice, these small variations should play a role in personalized treatment regimens for common conditions such as acne and atopic dermatitis. In my practice, black patients with acne often have high sebum content, but they cannot tolerate drying medications such as benzoyl peroxide because of their skin sensitivity and intolerance to skin drying. These patients often also present with ashy, dry skin in certain areas, and oily, acne-prone skin in other areas, leading to more complex skin care regimens. Understanding these basic concepts can help better tailor our basic skin treatments and education for skin of color patients in the winter and throughout the year.

Sources:

Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin. Cutan. Med. Surg. 2009;28:115-29.

Feng L, Hawkins S. Reduction of "ashiness" in skin of color with a lipid-rich moisturizing body wash. J. Clin. Aesthet. Dermatol. 2011;4:41-4.

Dr. Wesley practices dermatology in Beverly Hills, Calif. Do you have questions about treating patients with dark skin? If so, send them to [email protected].

Dry skin occurs throughout the year, but for many people it’s most prevalent and problematic in winter. Cold temperatures, low humidity, and strong, harsh winds deplete the skin of its natural lipid layer, which would normally help keep the skin from drying out. Skin of color in particular, can become very flaky, dry, and "ashy" in the winter. Differences in the stratum corneum barrier in skin of color may contribute to the propensity toward ashiness.

The barrier function of the skin depends on the structure of the corneocytes, lipid content, and transepidermal water loss. Compared with skin in white people, black skin has more corneocyte layers and a more compact stratum corneum with greater intercellular cohesiveness. The epidermal barrier in darker skin has been shown to be stronger when exposed to mechanical or chemical challenge. Although the size of the individual corneocytes is the same in black and white skin, the desquamation rate in certain locations is higher in black skin. This is likely due to increased desquamatory enzyme levels such as cathepsin L2 in the lamellar granules of darker pigmented individuals leading to an ashy manifestation of the skin.

Black skin also has the highest sebum content of all ethnicities, but has the lowest ceramide level, and is thus the most susceptible to transepidermal water loss and xerosis of any ethnic group. Of note, one study has shown that the use of a certain type of fatty acid body wash or a synthetic "syndet" bar reduced ashiness.

Although no large, multiethnic group studies have been performed to examine the skin barrier physiologic properties and their relation to clinical signs of disease, these small studies do shed light on some of the ethnic variation in skin barrier function.

In clinical practice, these small variations should play a role in personalized treatment regimens for common conditions such as acne and atopic dermatitis. In my practice, black patients with acne often have high sebum content, but they cannot tolerate drying medications such as benzoyl peroxide because of their skin sensitivity and intolerance to skin drying. These patients often also present with ashy, dry skin in certain areas, and oily, acne-prone skin in other areas, leading to more complex skin care regimens. Understanding these basic concepts can help better tailor our basic skin treatments and education for skin of color patients in the winter and throughout the year.

Sources:

Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin. Cutan. Med. Surg. 2009;28:115-29.

Feng L, Hawkins S. Reduction of "ashiness" in skin of color with a lipid-rich moisturizing body wash. J. Clin. Aesthet. Dermatol. 2011;4:41-4.

Dr. Wesley practices dermatology in Beverly Hills, Calif. Do you have questions about treating patients with dark skin? If so, send them to [email protected].

Dry skin occurs throughout the year, but for many people it’s most prevalent and problematic in winter. Cold temperatures, low humidity, and strong, harsh winds deplete the skin of its natural lipid layer, which would normally help keep the skin from drying out. Skin of color in particular, can become very flaky, dry, and "ashy" in the winter. Differences in the stratum corneum barrier in skin of color may contribute to the propensity toward ashiness.

The barrier function of the skin depends on the structure of the corneocytes, lipid content, and transepidermal water loss. Compared with skin in white people, black skin has more corneocyte layers and a more compact stratum corneum with greater intercellular cohesiveness. The epidermal barrier in darker skin has been shown to be stronger when exposed to mechanical or chemical challenge. Although the size of the individual corneocytes is the same in black and white skin, the desquamation rate in certain locations is higher in black skin. This is likely due to increased desquamatory enzyme levels such as cathepsin L2 in the lamellar granules of darker pigmented individuals leading to an ashy manifestation of the skin.

Black skin also has the highest sebum content of all ethnicities, but has the lowest ceramide level, and is thus the most susceptible to transepidermal water loss and xerosis of any ethnic group. Of note, one study has shown that the use of a certain type of fatty acid body wash or a synthetic "syndet" bar reduced ashiness.

Although no large, multiethnic group studies have been performed to examine the skin barrier physiologic properties and their relation to clinical signs of disease, these small studies do shed light on some of the ethnic variation in skin barrier function.

In clinical practice, these small variations should play a role in personalized treatment regimens for common conditions such as acne and atopic dermatitis. In my practice, black patients with acne often have high sebum content, but they cannot tolerate drying medications such as benzoyl peroxide because of their skin sensitivity and intolerance to skin drying. These patients often also present with ashy, dry skin in certain areas, and oily, acne-prone skin in other areas, leading to more complex skin care regimens. Understanding these basic concepts can help better tailor our basic skin treatments and education for skin of color patients in the winter and throughout the year.

Sources:

Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin. Cutan. Med. Surg. 2009;28:115-29.

Feng L, Hawkins S. Reduction of "ashiness" in skin of color with a lipid-rich moisturizing body wash. J. Clin. Aesthet. Dermatol. 2011;4:41-4.

Dr. Wesley practices dermatology in Beverly Hills, Calif. Do you have questions about treating patients with dark skin? If so, send them to [email protected].

Many clinicians are unaware that ethnic populations in North America do not achieve optimal serum 25-hydroxyvitamin D (abbreviated 25[OH]D) because of the increased pigmentation in their skin, which reduces vitamin D production. Vitamin D insufficiency is more prevalent among individuals with darker skin, compared with those with lighter skin at any time of year, even during the winter months. Contributing to the deficiency, the dietary intake of vitamin D intake among African Americans in particular is often below the recommended intakes in every age group after puberty. However, data have shown vitamin D protects against Sjögren’s syndrome, psoriasis, type 1 and type 2 diabetes, multiple sclerosis, and rheumatoid arthritis.

Vitamin D also may protect against cardiovascular disease through its anti-inflammatory effects and may reduce the risk for colorectal cancer, breast cancer, and prostate cancer by promoting cell differentiation and down-regulating hyperproliferative cell growth. Most of these conditions have been shown to be as prevalent, if not more prevalent, among blacks than whites.

While vitamin D can be obtained from sun exposure, this is not always a viable option. UV exposure is linked to skin cancer, which leads clinicians to encourage sun avoidance, but they may disregard the need for vitamin D. In addition, darker pigmentation of the skin reduces vitamin D synthesis in the skin.

How can you help your skin of color patients get enough vitamin D, especially in the winter? Nutritional sources of vitamin D include salmon, sardines, and cows’ milk; however, many individuals do not achieve optimal vitamin D status from food intake alone.

Since UV exposure and diet are not sufficient sources of vitamin D, supplementation has become crucial to our patients, particularly those with darker skin. Dietary reference intakes for vitamin D have been under considerable scrutiny, and many experts now believe that intakes of 25 mcg/d (1,000 IU) or more may be needed for most people to achieve optimal blood levels of 25(OH)D. The two forms of vitamin D used in dietary supplements are ergocalciferol (vitamin D₂) and cholecalciferol (vitamin D₃). Cholecalciferol, the D₃ form of the vitamin, is the form of choice when supplementing with vitamin D. Types of D₃ supplements include gel caps, liquid, powders, and tablets. Vitamin D is often measured in International Units (IU) or mcg. One mcg of cholecalciferol is equal to 40 IU of vitamin D.

The debate continues over the most effective forms of vitamin D acquisition; however, many health professionals agree that vitamin D supplementation, particularly in winter months, should be an integral part of our armamentarium of therapeutics for ethnic patients, and especially those who suffer from psoriasis and other autoimmune and inflammatory skin conditions.

Dr. Talakoub is in private practice in McLean, Va.

Do you have questions about treating patients with dark skin? If so, send them to [email protected].

Many clinicians are unaware that ethnic populations in North America do not achieve optimal serum 25-hydroxyvitamin D (abbreviated 25[OH]D) because of the increased pigmentation in their skin, which reduces vitamin D production. Vitamin D insufficiency is more prevalent among individuals with darker skin, compared with those with lighter skin at any time of year, even during the winter months. Contributing to the deficiency, the dietary intake of vitamin D intake among African Americans in particular is often below the recommended intakes in every age group after puberty. However, data have shown vitamin D protects against Sjögren’s syndrome, psoriasis, type 1 and type 2 diabetes, multiple sclerosis, and rheumatoid arthritis.

Vitamin D also may protect against cardiovascular disease through its anti-inflammatory effects and may reduce the risk for colorectal cancer, breast cancer, and prostate cancer by promoting cell differentiation and down-regulating hyperproliferative cell growth. Most of these conditions have been shown to be as prevalent, if not more prevalent, among blacks than whites.

While vitamin D can be obtained from sun exposure, this is not always a viable option. UV exposure is linked to skin cancer, which leads clinicians to encourage sun avoidance, but they may disregard the need for vitamin D. In addition, darker pigmentation of the skin reduces vitamin D synthesis in the skin.

How can you help your skin of color patients get enough vitamin D, especially in the winter? Nutritional sources of vitamin D include salmon, sardines, and cows’ milk; however, many individuals do not achieve optimal vitamin D status from food intake alone.

Since UV exposure and diet are not sufficient sources of vitamin D, supplementation has become crucial to our patients, particularly those with darker skin. Dietary reference intakes for vitamin D have been under considerable scrutiny, and many experts now believe that intakes of 25 mcg/d (1,000 IU) or more may be needed for most people to achieve optimal blood levels of 25(OH)D. The two forms of vitamin D used in dietary supplements are ergocalciferol (vitamin D₂) and cholecalciferol (vitamin D₃). Cholecalciferol, the D₃ form of the vitamin, is the form of choice when supplementing with vitamin D. Types of D₃ supplements include gel caps, liquid, powders, and tablets. Vitamin D is often measured in International Units (IU) or mcg. One mcg of cholecalciferol is equal to 40 IU of vitamin D.

The debate continues over the most effective forms of vitamin D acquisition; however, many health professionals agree that vitamin D supplementation, particularly in winter months, should be an integral part of our armamentarium of therapeutics for ethnic patients, and especially those who suffer from psoriasis and other autoimmune and inflammatory skin conditions.

Dr. Talakoub is in private practice in McLean, Va.

Do you have questions about treating patients with dark skin? If so, send them to [email protected].

Many clinicians are unaware that ethnic populations in North America do not achieve optimal serum 25-hydroxyvitamin D (abbreviated 25[OH]D) because of the increased pigmentation in their skin, which reduces vitamin D production. Vitamin D insufficiency is more prevalent among individuals with darker skin, compared with those with lighter skin at any time of year, even during the winter months. Contributing to the deficiency, the dietary intake of vitamin D intake among African Americans in particular is often below the recommended intakes in every age group after puberty. However, data have shown vitamin D protects against Sjögren’s syndrome, psoriasis, type 1 and type 2 diabetes, multiple sclerosis, and rheumatoid arthritis.

Vitamin D also may protect against cardiovascular disease through its anti-inflammatory effects and may reduce the risk for colorectal cancer, breast cancer, and prostate cancer by promoting cell differentiation and down-regulating hyperproliferative cell growth. Most of these conditions have been shown to be as prevalent, if not more prevalent, among blacks than whites.

While vitamin D can be obtained from sun exposure, this is not always a viable option. UV exposure is linked to skin cancer, which leads clinicians to encourage sun avoidance, but they may disregard the need for vitamin D. In addition, darker pigmentation of the skin reduces vitamin D synthesis in the skin.

How can you help your skin of color patients get enough vitamin D, especially in the winter? Nutritional sources of vitamin D include salmon, sardines, and cows’ milk; however, many individuals do not achieve optimal vitamin D status from food intake alone.

Since UV exposure and diet are not sufficient sources of vitamin D, supplementation has become crucial to our patients, particularly those with darker skin. Dietary reference intakes for vitamin D have been under considerable scrutiny, and many experts now believe that intakes of 25 mcg/d (1,000 IU) or more may be needed for most people to achieve optimal blood levels of 25(OH)D. The two forms of vitamin D used in dietary supplements are ergocalciferol (vitamin D₂) and cholecalciferol (vitamin D₃). Cholecalciferol, the D₃ form of the vitamin, is the form of choice when supplementing with vitamin D. Types of D₃ supplements include gel caps, liquid, powders, and tablets. Vitamin D is often measured in International Units (IU) or mcg. One mcg of cholecalciferol is equal to 40 IU of vitamin D.

The debate continues over the most effective forms of vitamin D acquisition; however, many health professionals agree that vitamin D supplementation, particularly in winter months, should be an integral part of our armamentarium of therapeutics for ethnic patients, and especially those who suffer from psoriasis and other autoimmune and inflammatory skin conditions.

Dr. Talakoub is in private practice in McLean, Va.

Do you have questions about treating patients with dark skin? If so, send them to [email protected].

Pseudofolliculitis barbae (PFB) is a common complaint among darker-skinned patients with coarse curly hair. Patients present with follicular papules in the beard from ingrown hairs that can eventually result in postinflammatory pigmentary alternation and scarring. While these symptoms are most common in men, women may be affected as well, as PFB is not limited to the beard area; it may occur in any other area with thick, coarse curly hair, including the bikini area and axillae.

Some tips for treating PFB:

If the patient doesn’t mind growing a beard, advise him to grow one! The chances of having ingrown hairs that stimulate this condition are less if the hairs are not plucked or shaved, or are kept at least a few millimeters long.

If hair removal/grooming is a must, options include clipping the hairs with a protector; using a self-cleaning electric razor (replacing the blades at least every 2 years); and using thick shaving gel with either a single or twin blade razor, or a chemical depilatory.

Laser hair removal is also an option in the right candidate, particularly with longer pulsed (1,064 nm or 810 nm) lasers in darker-skinned individuals. Eflornithine 12% twice daily for 16 weeks has been shown to work synergistically with laser hair removal. Electrolysis may be helpful for hairs that do not respond to laser hair removal with longer pulsed lasers, such as grey hairs.

If shaving is a must, advise patients to:

• Apply warm compresses to the beard area for a few minutes prior to shaving. In addition, using a mild exfoliant or loofah or toothbrush in a circular motion will help allow any ingrown hairs to be more easily plucked or released at the skin surface.

• Use shaving gel and a sharp razor each time.

• Do not pull the skin taut.

• Do not shave against the direction of hair growth.

• Take short strokes and do not shave back and forth over the same areas.

• After shaving, use a soothing aftershave or hydrocortisone 1% lotion.

Products such as PFB Vanish, which contain salicylic, glycolic, and/or lactic acid, are helpful in some patients after hair removal to prevent ingrown hairs. One version of PFB Vanish contains antipigment ingredients to also address hyperpigmentation.

If inflammatory papules or pustules are present, a combination benzoyl peroxide/clindamycin topical gels (such as Benzaclin, Duac, or Acanya) can be used. Patients with severe inflammation may require oral antibiotics.

Using a topical retinoid at night or a combination retinoid product with hydroquinone can be helpful especially in cases of postinflammatory hyperpigmentation. However, use caution when prescribing retinoids for patients with darker skin, as irritation from these products may lead to postinflammatory pigmentary alteration. Remind patients to avoid drying products, such as toners, if topical retinoids are used.

For severe or refractory postinflammatory hyperpigmentation or inflammatory papules, chemical peels with 20%-30% salicylic acid can be helpful.

What are your PFB solutions? The more we share our clinical insights, the better we will be able to achieve improved treatment results for our patients.

Dr. Wesley practices dermatology in Beverly Hills, Calif. Do you have questions about treating patients with dark skin? If so, send them to [email protected].

Pseudofolliculitis barbae (PFB) is a common complaint among darker-skinned patients with coarse curly hair. Patients present with follicular papules in the beard from ingrown hairs that can eventually result in postinflammatory pigmentary alternation and scarring. While these symptoms are most common in men, women may be affected as well, as PFB is not limited to the beard area; it may occur in any other area with thick, coarse curly hair, including the bikini area and axillae.

Some tips for treating PFB:

If the patient doesn’t mind growing a beard, advise him to grow one! The chances of having ingrown hairs that stimulate this condition are less if the hairs are not plucked or shaved, or are kept at least a few millimeters long.

If hair removal/grooming is a must, options include clipping the hairs with a protector; using a self-cleaning electric razor (replacing the blades at least every 2 years); and using thick shaving gel with either a single or twin blade razor, or a chemical depilatory.

Laser hair removal is also an option in the right candidate, particularly with longer pulsed (1,064 nm or 810 nm) lasers in darker-skinned individuals. Eflornithine 12% twice daily for 16 weeks has been shown to work synergistically with laser hair removal. Electrolysis may be helpful for hairs that do not respond to laser hair removal with longer pulsed lasers, such as grey hairs.

If shaving is a must, advise patients to:

• Apply warm compresses to the beard area for a few minutes prior to shaving. In addition, using a mild exfoliant or loofah or toothbrush in a circular motion will help allow any ingrown hairs to be more easily plucked or released at the skin surface.

• Use shaving gel and a sharp razor each time.

• Do not pull the skin taut.

• Do not shave against the direction of hair growth.

• Take short strokes and do not shave back and forth over the same areas.

• After shaving, use a soothing aftershave or hydrocortisone 1% lotion.

Products such as PFB Vanish, which contain salicylic, glycolic, and/or lactic acid, are helpful in some patients after hair removal to prevent ingrown hairs. One version of PFB Vanish contains antipigment ingredients to also address hyperpigmentation.

If inflammatory papules or pustules are present, a combination benzoyl peroxide/clindamycin topical gels (such as Benzaclin, Duac, or Acanya) can be used. Patients with severe inflammation may require oral antibiotics.

Using a topical retinoid at night or a combination retinoid product with hydroquinone can be helpful especially in cases of postinflammatory hyperpigmentation. However, use caution when prescribing retinoids for patients with darker skin, as irritation from these products may lead to postinflammatory pigmentary alteration. Remind patients to avoid drying products, such as toners, if topical retinoids are used.

For severe or refractory postinflammatory hyperpigmentation or inflammatory papules, chemical peels with 20%-30% salicylic acid can be helpful.

What are your PFB solutions? The more we share our clinical insights, the better we will be able to achieve improved treatment results for our patients.

Dr. Wesley practices dermatology in Beverly Hills, Calif. Do you have questions about treating patients with dark skin? If so, send them to [email protected].

Pseudofolliculitis barbae (PFB) is a common complaint among darker-skinned patients with coarse curly hair. Patients present with follicular papules in the beard from ingrown hairs that can eventually result in postinflammatory pigmentary alternation and scarring. While these symptoms are most common in men, women may be affected as well, as PFB is not limited to the beard area; it may occur in any other area with thick, coarse curly hair, including the bikini area and axillae.

Some tips for treating PFB:

If the patient doesn’t mind growing a beard, advise him to grow one! The chances of having ingrown hairs that stimulate this condition are less if the hairs are not plucked or shaved, or are kept at least a few millimeters long.

If hair removal/grooming is a must, options include clipping the hairs with a protector; using a self-cleaning electric razor (replacing the blades at least every 2 years); and using thick shaving gel with either a single or twin blade razor, or a chemical depilatory.

Laser hair removal is also an option in the right candidate, particularly with longer pulsed (1,064 nm or 810 nm) lasers in darker-skinned individuals. Eflornithine 12% twice daily for 16 weeks has been shown to work synergistically with laser hair removal. Electrolysis may be helpful for hairs that do not respond to laser hair removal with longer pulsed lasers, such as grey hairs.

If shaving is a must, advise patients to:

• Apply warm compresses to the beard area for a few minutes prior to shaving. In addition, using a mild exfoliant or loofah or toothbrush in a circular motion will help allow any ingrown hairs to be more easily plucked or released at the skin surface.

• Use shaving gel and a sharp razor each time.

• Do not pull the skin taut.

• Do not shave against the direction of hair growth.

• Take short strokes and do not shave back and forth over the same areas.

• After shaving, use a soothing aftershave or hydrocortisone 1% lotion.

Products such as PFB Vanish, which contain salicylic, glycolic, and/or lactic acid, are helpful in some patients after hair removal to prevent ingrown hairs. One version of PFB Vanish contains antipigment ingredients to also address hyperpigmentation.

If inflammatory papules or pustules are present, a combination benzoyl peroxide/clindamycin topical gels (such as Benzaclin, Duac, or Acanya) can be used. Patients with severe inflammation may require oral antibiotics.

Using a topical retinoid at night or a combination retinoid product with hydroquinone can be helpful especially in cases of postinflammatory hyperpigmentation. However, use caution when prescribing retinoids for patients with darker skin, as irritation from these products may lead to postinflammatory pigmentary alteration. Remind patients to avoid drying products, such as toners, if topical retinoids are used.

For severe or refractory postinflammatory hyperpigmentation or inflammatory papules, chemical peels with 20%-30% salicylic acid can be helpful.

What are your PFB solutions? The more we share our clinical insights, the better we will be able to achieve improved treatment results for our patients.

Dr. Wesley practices dermatology in Beverly Hills, Calif. Do you have questions about treating patients with dark skin? If so, send them to [email protected].