Pigmentation Disorders

One of the main reasons patients with darker skin don't apply sunscreen is because they believe they are at low or no risk for ultraviolet damage, according to the results of a survey that I conducted with Dr. Brooke Jackson and Dr. Chikoti Mibenge.

Our findings were presented in a poster at the American Academy of Dermatology's Summer Academy Meeting in Boston.

The study, conducted by surveying 105 patients in Chicago, revealed that 60% of black patients do not wear sunscreen regularly. Additionally, many darker skinned patients reported not liking the whitish or chalky appearance that sunscreens often leave.

However, sunscreen manufacturers are making more elegant formulations of both chemical and physical blockers that do not leave a whitish hue on darker skin.

Sun protective clothing, hats, parasols or umbrellas, avoiding peak hours of sun intensity, and avoiding tanning are all common methods we recommend to patients to protect themselves. Lesser known methods that we can also recommend to our patients include:

Heliocare

Heliocare tablets contain Polypodium leucotomos extract, a fern native to Central and South America rich in antioxidants which protect against formation of free radicals from UV exposure, particularly UVA. The science is based off of the fact that the fern, which was once aquatic, adapted to life on land and created its own protection from UV rays. The recommended dose is 1 tablet each morning or 2 tablets before intense sun exposure. The effect begins 30 minutes after consumption and is still active 2.5 hours after consumption. Total elimination is estimated to be about 8 hours, but pharmacokinetics for elimination have not been published. Numerous published studies have reported its benefits with regards to UV protection. A head-to-head study of UV protection from heliocare versus other powerful antioxidant supplements would be interesting.

Algae and Coral

At King's College in London, research is being done on the photoprotective effect of coral. In a press release last year, Dr. Paul Long reported that algae living within coral produces a sunscreen-like compound that not only protects the algae and coral from UV damage, but also the fish that feed on the coral. The part the algae play is thought to be part of the shikimate pathway found only in microbes and plants. A sunscreen tablet with this ingredient for human use is in the works.

Strawberries

thinkstockphotos.com

Strawberries, as well as other darker colored berries, are known to contain polyphenols, which are antioxidants. Researchers in Italy and Spain tested a strawberry extract on cultured human fibroblasts to see if there was a photoprotective effect. They added strawberry extract in different concentrations to all but the control group. They then exposed the samples to a dose of UV light "equivalent to 90 minutes of midday summer sun in the French Riviera," said lead investigator Maurizio Battino. The results demonstrated that strawberry extract, especially at a concentration of 0.5 mg/ml, provided UVA protection. It not only boosted cell survival and viability, but also minimized DNA damage when compared with control cells.

Perhaps there will be topical sunscreens that contain strawberry extract in the future. Other foods high in antioxidants that may have sun protective benefits include:

1. Colored peppers and yellow squash (high in carotenoids).

2. Tomatoes and watermelon (high in lycopene).

3. Dark berries, such as blueberries, acai, blackberries, cranberries (rich in anthocyanin).

4. Turmeric root (curcumin).

5. Pomegranate (ellegic acid).

6. Green and black tea (catechins).

7. Dark cocoa (flavanols).

8. Green leafy vegetables, such as spinach and kale (xanthophylls, oxygenated carotenoids).

9. Fish, such as mackerel, salmon, trout, herring, and sardines (omega 3 fatty acids).

These are not a replacement for the more common methods of sun protection, but they may certainly provide an added benefit.

- Naissan Wesley, M.D.

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

One of the main reasons patients with darker skin don't apply sunscreen is because they believe they are at low or no risk for ultraviolet damage, according to the results of a survey that I conducted with Dr. Brooke Jackson and Dr. Chikoti Mibenge.

Our findings were presented in a poster at the American Academy of Dermatology's Summer Academy Meeting in Boston.

The study, conducted by surveying 105 patients in Chicago, revealed that 60% of black patients do not wear sunscreen regularly. Additionally, many darker skinned patients reported not liking the whitish or chalky appearance that sunscreens often leave.

However, sunscreen manufacturers are making more elegant formulations of both chemical and physical blockers that do not leave a whitish hue on darker skin.

Sun protective clothing, hats, parasols or umbrellas, avoiding peak hours of sun intensity, and avoiding tanning are all common methods we recommend to patients to protect themselves. Lesser known methods that we can also recommend to our patients include:

Heliocare

Heliocare tablets contain Polypodium leucotomos extract, a fern native to Central and South America rich in antioxidants which protect against formation of free radicals from UV exposure, particularly UVA. The science is based off of the fact that the fern, which was once aquatic, adapted to life on land and created its own protection from UV rays. The recommended dose is 1 tablet each morning or 2 tablets before intense sun exposure. The effect begins 30 minutes after consumption and is still active 2.5 hours after consumption. Total elimination is estimated to be about 8 hours, but pharmacokinetics for elimination have not been published. Numerous published studies have reported its benefits with regards to UV protection. A head-to-head study of UV protection from heliocare versus other powerful antioxidant supplements would be interesting.

Algae and Coral

At King's College in London, research is being done on the photoprotective effect of coral. In a press release last year, Dr. Paul Long reported that algae living within coral produces a sunscreen-like compound that not only protects the algae and coral from UV damage, but also the fish that feed on the coral. The part the algae play is thought to be part of the shikimate pathway found only in microbes and plants. A sunscreen tablet with this ingredient for human use is in the works.

Strawberries

thinkstockphotos.com

Strawberries, as well as other darker colored berries, are known to contain polyphenols, which are antioxidants. Researchers in Italy and Spain tested a strawberry extract on cultured human fibroblasts to see if there was a photoprotective effect. They added strawberry extract in different concentrations to all but the control group. They then exposed the samples to a dose of UV light "equivalent to 90 minutes of midday summer sun in the French Riviera," said lead investigator Maurizio Battino. The results demonstrated that strawberry extract, especially at a concentration of 0.5 mg/ml, provided UVA protection. It not only boosted cell survival and viability, but also minimized DNA damage when compared with control cells.

Perhaps there will be topical sunscreens that contain strawberry extract in the future. Other foods high in antioxidants that may have sun protective benefits include:

1. Colored peppers and yellow squash (high in carotenoids).

2. Tomatoes and watermelon (high in lycopene).

3. Dark berries, such as blueberries, acai, blackberries, cranberries (rich in anthocyanin).

4. Turmeric root (curcumin).

5. Pomegranate (ellegic acid).

6. Green and black tea (catechins).

7. Dark cocoa (flavanols).

8. Green leafy vegetables, such as spinach and kale (xanthophylls, oxygenated carotenoids).

9. Fish, such as mackerel, salmon, trout, herring, and sardines (omega 3 fatty acids).

These are not a replacement for the more common methods of sun protection, but they may certainly provide an added benefit.

- Naissan Wesley, M.D.

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

One of the main reasons patients with darker skin don't apply sunscreen is because they believe they are at low or no risk for ultraviolet damage, according to the results of a survey that I conducted with Dr. Brooke Jackson and Dr. Chikoti Mibenge.

Our findings were presented in a poster at the American Academy of Dermatology's Summer Academy Meeting in Boston.

The study, conducted by surveying 105 patients in Chicago, revealed that 60% of black patients do not wear sunscreen regularly. Additionally, many darker skinned patients reported not liking the whitish or chalky appearance that sunscreens often leave.

However, sunscreen manufacturers are making more elegant formulations of both chemical and physical blockers that do not leave a whitish hue on darker skin.

Sun protective clothing, hats, parasols or umbrellas, avoiding peak hours of sun intensity, and avoiding tanning are all common methods we recommend to patients to protect themselves. Lesser known methods that we can also recommend to our patients include:

Heliocare

Heliocare tablets contain Polypodium leucotomos extract, a fern native to Central and South America rich in antioxidants which protect against formation of free radicals from UV exposure, particularly UVA. The science is based off of the fact that the fern, which was once aquatic, adapted to life on land and created its own protection from UV rays. The recommended dose is 1 tablet each morning or 2 tablets before intense sun exposure. The effect begins 30 minutes after consumption and is still active 2.5 hours after consumption. Total elimination is estimated to be about 8 hours, but pharmacokinetics for elimination have not been published. Numerous published studies have reported its benefits with regards to UV protection. A head-to-head study of UV protection from heliocare versus other powerful antioxidant supplements would be interesting.

Algae and Coral

At King's College in London, research is being done on the photoprotective effect of coral. In a press release last year, Dr. Paul Long reported that algae living within coral produces a sunscreen-like compound that not only protects the algae and coral from UV damage, but also the fish that feed on the coral. The part the algae play is thought to be part of the shikimate pathway found only in microbes and plants. A sunscreen tablet with this ingredient for human use is in the works.

Strawberries

thinkstockphotos.com

Strawberries, as well as other darker colored berries, are known to contain polyphenols, which are antioxidants. Researchers in Italy and Spain tested a strawberry extract on cultured human fibroblasts to see if there was a photoprotective effect. They added strawberry extract in different concentrations to all but the control group. They then exposed the samples to a dose of UV light "equivalent to 90 minutes of midday summer sun in the French Riviera," said lead investigator Maurizio Battino. The results demonstrated that strawberry extract, especially at a concentration of 0.5 mg/ml, provided UVA protection. It not only boosted cell survival and viability, but also minimized DNA damage when compared with control cells.

Perhaps there will be topical sunscreens that contain strawberry extract in the future. Other foods high in antioxidants that may have sun protective benefits include:

1. Colored peppers and yellow squash (high in carotenoids).

2. Tomatoes and watermelon (high in lycopene).

3. Dark berries, such as blueberries, acai, blackberries, cranberries (rich in anthocyanin).

4. Turmeric root (curcumin).

5. Pomegranate (ellegic acid).

6. Green and black tea (catechins).

7. Dark cocoa (flavanols).

8. Green leafy vegetables, such as spinach and kale (xanthophylls, oxygenated carotenoids).

9. Fish, such as mackerel, salmon, trout, herring, and sardines (omega 3 fatty acids).

These are not a replacement for the more common methods of sun protection, but they may certainly provide an added benefit.

- Naissan Wesley, M.D.

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

ATLANTA – Cryolipolysis appears as safe and effective in dark skin types as in lighter skin types, according to a review of outcomes in 396 patients.

The primary goal of the study was to assess whether this technology is safe in patients with dark skin types, given their increased risk for developing postinflammatory hyperpigmentation with cold exposure and other treatments such as laser treatments, Dr. Ava Shamban said at the annual meeting of the American Society for Dermatologic Surgery.

However, no differences were seen in efficacy or safety based on skin type or ethnicity in the patients who participated in the multicenter study, she said.

"Cryolipolysis is, indeed, a color-blind technology."

In fact, patients with darker skin types had slightly higher satisfaction with the procedure, raising the question of whether the treatment might even be more effective in these patients, said Dr. Shamban, a dermatologist in private practice in Santa Monica, Calif.

The patients were treated on the back, flank, and/or abdomen, with most having multiple areas treated. Fitzpatrick skin types II-VI were represented: 85 had type II, 185 had type III, 104 had type IV, 18 had type V, and 4 had type VI.

Numerous ethnicities also were represented: 7 patients were African American, 38 were Asian, 295 were white, 37 were Latino, 5 were Mediterranean, and 14 were of Middle Eastern descent.

Women comprised 84% of the study population, and patients ranged in age from 24 to 74 years, with most in their late 40s to early 50s, Dr. Shamban noted.

No major adverse events occurred. Some patients did, however, experience minor effects, including bruising in 16%, swelling in 20%, and both bruising and swelling in 4%, she said, adding that the incidence of these effects did not differ between those with Fitzpatrick skin types II-III and those with type IV-VI.

Satisfaction with the procedure and outcomes also did not differ between those groups in 201 patients who completed a patient-satisfaction assessment. Only 7% of 122 patients with skin types II-III and 4% of 79 patients with skin types IV-VI were unsatisfied with the results, Dr. Shamban said.

"Cryolipolysis is, indeed, a color-blind technology, and it is a safe and effective method to reduce fat and thickening in patients of all skin types and ethnicities," she concluded.

Dr. Shamban had no disclosures to report. Her coauthor, Dr. Vic Narurkar, reported serving as a consultant for Zeltiq, the maker of the CoolSculpting cryolipolysis system used in this study.

ATLANTA – Cryolipolysis appears as safe and effective in dark skin types as in lighter skin types, according to a review of outcomes in 396 patients.

The primary goal of the study was to assess whether this technology is safe in patients with dark skin types, given their increased risk for developing postinflammatory hyperpigmentation with cold exposure and other treatments such as laser treatments, Dr. Ava Shamban said at the annual meeting of the American Society for Dermatologic Surgery.

However, no differences were seen in efficacy or safety based on skin type or ethnicity in the patients who participated in the multicenter study, she said.

"Cryolipolysis is, indeed, a color-blind technology."

In fact, patients with darker skin types had slightly higher satisfaction with the procedure, raising the question of whether the treatment might even be more effective in these patients, said Dr. Shamban, a dermatologist in private practice in Santa Monica, Calif.

The patients were treated on the back, flank, and/or abdomen, with most having multiple areas treated. Fitzpatrick skin types II-VI were represented: 85 had type II, 185 had type III, 104 had type IV, 18 had type V, and 4 had type VI.

Numerous ethnicities also were represented: 7 patients were African American, 38 were Asian, 295 were white, 37 were Latino, 5 were Mediterranean, and 14 were of Middle Eastern descent.

Women comprised 84% of the study population, and patients ranged in age from 24 to 74 years, with most in their late 40s to early 50s, Dr. Shamban noted.

No major adverse events occurred. Some patients did, however, experience minor effects, including bruising in 16%, swelling in 20%, and both bruising and swelling in 4%, she said, adding that the incidence of these effects did not differ between those with Fitzpatrick skin types II-III and those with type IV-VI.

Satisfaction with the procedure and outcomes also did not differ between those groups in 201 patients who completed a patient-satisfaction assessment. Only 7% of 122 patients with skin types II-III and 4% of 79 patients with skin types IV-VI were unsatisfied with the results, Dr. Shamban said.

"Cryolipolysis is, indeed, a color-blind technology, and it is a safe and effective method to reduce fat and thickening in patients of all skin types and ethnicities," she concluded.

Dr. Shamban had no disclosures to report. Her coauthor, Dr. Vic Narurkar, reported serving as a consultant for Zeltiq, the maker of the CoolSculpting cryolipolysis system used in this study.

ATLANTA – Cryolipolysis appears as safe and effective in dark skin types as in lighter skin types, according to a review of outcomes in 396 patients.

The primary goal of the study was to assess whether this technology is safe in patients with dark skin types, given their increased risk for developing postinflammatory hyperpigmentation with cold exposure and other treatments such as laser treatments, Dr. Ava Shamban said at the annual meeting of the American Society for Dermatologic Surgery.

However, no differences were seen in efficacy or safety based on skin type or ethnicity in the patients who participated in the multicenter study, she said.

"Cryolipolysis is, indeed, a color-blind technology."

In fact, patients with darker skin types had slightly higher satisfaction with the procedure, raising the question of whether the treatment might even be more effective in these patients, said Dr. Shamban, a dermatologist in private practice in Santa Monica, Calif.

The patients were treated on the back, flank, and/or abdomen, with most having multiple areas treated. Fitzpatrick skin types II-VI were represented: 85 had type II, 185 had type III, 104 had type IV, 18 had type V, and 4 had type VI.

Numerous ethnicities also were represented: 7 patients were African American, 38 were Asian, 295 were white, 37 were Latino, 5 were Mediterranean, and 14 were of Middle Eastern descent.

Women comprised 84% of the study population, and patients ranged in age from 24 to 74 years, with most in their late 40s to early 50s, Dr. Shamban noted.

No major adverse events occurred. Some patients did, however, experience minor effects, including bruising in 16%, swelling in 20%, and both bruising and swelling in 4%, she said, adding that the incidence of these effects did not differ between those with Fitzpatrick skin types II-III and those with type IV-VI.

Satisfaction with the procedure and outcomes also did not differ between those groups in 201 patients who completed a patient-satisfaction assessment. Only 7% of 122 patients with skin types II-III and 4% of 79 patients with skin types IV-VI were unsatisfied with the results, Dr. Shamban said.

"Cryolipolysis is, indeed, a color-blind technology, and it is a safe and effective method to reduce fat and thickening in patients of all skin types and ethnicities," she concluded.

Dr. Shamban had no disclosures to report. Her coauthor, Dr. Vic Narurkar, reported serving as a consultant for Zeltiq, the maker of the CoolSculpting cryolipolysis system used in this study.

Despite a growing worldwide population, there is still limited data on the physiology and structural differences in ethnic skin. Although the increased presence of melanin in skin of color confers a photo-protective effect, there are various differences in the stratum corneum that will influence skin physiology in different racial groups.

Barrier function of the skin depends on the structure of the corneocytes, lipid content, and transepidermal water loss.

Compared to white skin, black skin has more corneocyte layers and a more compact stratum corneum with greater intercellular cohesiveness (Semin. Cutan. Med. Surg. 2009;28:115-29). 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 because of increased desquamatory enzyme levels, such as cathepsin L2 in the lamellar granules of darker pigmented individuals, leading to an "ashy" manifestation.

Black skin has the highest sebum content of all ethnicities but also the lowest ceramide level, and is, therefore, the most susceptible to transepidermal water loss and xerosis of the skin, when compared with other ethnic groups.

Asian skin has similar corneocyte architecture and transepidermal water loss when compared to white skin, but has decreased corneocyte cohesion, and, thus, a weaker barrier function when exposed to mechanical and chemical stimuli. Compared to white and black patients, Asian patients have the highest amount of ceramides and the least amount of transepidermal water loss.

Although no large, multiethnic group studies have been performed looking at all of the skin barrier physiologic properties and their relation to clinical signs of disease, several small studies do shed light on some of the ethnic variations in skin barrier function. In clinical practice, these small variations should play a role in ethnic-specific treatment regimens for common conditions, such as acne and atopic dermatitis.

In my practice, black patients with acne often have a high sebum content but cannot tolerate drying medications such as benzoyl peroxide. These patients often 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 concepts can help tailor skin treatments for ethnic patients.

- Lily Talakoub, M.D.

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

Despite a growing worldwide population, there is still limited data on the physiology and structural differences in ethnic skin. Although the increased presence of melanin in skin of color confers a photo-protective effect, there are various differences in the stratum corneum that will influence skin physiology in different racial groups.

Barrier function of the skin depends on the structure of the corneocytes, lipid content, and transepidermal water loss.

Compared to white skin, black skin has more corneocyte layers and a more compact stratum corneum with greater intercellular cohesiveness (Semin. Cutan. Med. Surg. 2009;28:115-29). 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 because of increased desquamatory enzyme levels, such as cathepsin L2 in the lamellar granules of darker pigmented individuals, leading to an "ashy" manifestation.

Black skin has the highest sebum content of all ethnicities but also the lowest ceramide level, and is, therefore, the most susceptible to transepidermal water loss and xerosis of the skin, when compared with other ethnic groups.

Asian skin has similar corneocyte architecture and transepidermal water loss when compared to white skin, but has decreased corneocyte cohesion, and, thus, a weaker barrier function when exposed to mechanical and chemical stimuli. Compared to white and black patients, Asian patients have the highest amount of ceramides and the least amount of transepidermal water loss.

Although no large, multiethnic group studies have been performed looking at all of the skin barrier physiologic properties and their relation to clinical signs of disease, several small studies do shed light on some of the ethnic variations in skin barrier function. In clinical practice, these small variations should play a role in ethnic-specific treatment regimens for common conditions, such as acne and atopic dermatitis.

In my practice, black patients with acne often have a high sebum content but cannot tolerate drying medications such as benzoyl peroxide. These patients often 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 concepts can help tailor skin treatments for ethnic patients.

- Lily Talakoub, M.D.

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

Despite a growing worldwide population, there is still limited data on the physiology and structural differences in ethnic skin. Although the increased presence of melanin in skin of color confers a photo-protective effect, there are various differences in the stratum corneum that will influence skin physiology in different racial groups.

Barrier function of the skin depends on the structure of the corneocytes, lipid content, and transepidermal water loss.

Compared to white skin, black skin has more corneocyte layers and a more compact stratum corneum with greater intercellular cohesiveness (Semin. Cutan. Med. Surg. 2009;28:115-29). 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 because of increased desquamatory enzyme levels, such as cathepsin L2 in the lamellar granules of darker pigmented individuals, leading to an "ashy" manifestation.

Black skin has the highest sebum content of all ethnicities but also the lowest ceramide level, and is, therefore, the most susceptible to transepidermal water loss and xerosis of the skin, when compared with other ethnic groups.

Asian skin has similar corneocyte architecture and transepidermal water loss when compared to white skin, but has decreased corneocyte cohesion, and, thus, a weaker barrier function when exposed to mechanical and chemical stimuli. Compared to white and black patients, Asian patients have the highest amount of ceramides and the least amount of transepidermal water loss.

Although no large, multiethnic group studies have been performed looking at all of the skin barrier physiologic properties and their relation to clinical signs of disease, several small studies do shed light on some of the ethnic variations in skin barrier function. In clinical practice, these small variations should play a role in ethnic-specific treatment regimens for common conditions, such as acne and atopic dermatitis.

In my practice, black patients with acne often have a high sebum content but cannot tolerate drying medications such as benzoyl peroxide. These patients often 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 concepts can help tailor skin treatments for ethnic patients.

- Lily Talakoub, M.D.

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

A recent article in the New York Times ("How Well you Sleep May Hinge on Race," Aug. 20, 2012), discussed a link between ethnicity and quality of sleep. According to the story, non-Hispanic white patients sleep longer with less interruption than people of other ethnicities. Black patients are also most likely to get shorter, more restless sleep, according to the article.

Poor sleep quality has been associated with high blood pressure, obesity, and insulin resistance, which might help explain why people in some minority groups experience higher rates of chronic health conditions.

Stockbyte/Thinkstock

The article highlighted racial disparity evidence presented at the annual Associated Professional Sleep Societies meeting in Boston in June. White patients from the Chicago area were found to get an average of 7.4 hours of sleep per night; Hispanic and Asian patients averaged 6.9 hours; and black patients averaged 6.8 hours. Sleep quality – defined as ease in falling asleep and length of uninterrupted sleep – was also higher for white patients than for black patients. Even after adjusting for cardiovascular disease, sleep apnea, and obesity, black patients and other ethnic minorities still got less, and more disruptive, sleep than white patients.

Could differences in quality of sleep also be associated with dermatologic conditions that occur at a higher rate in certain ethnic groups?

A study, published earlier this year, found that sleep disturbance correlated with immune system dysregulation (Am. J. Geriatr. Psychiatry 2012 Feb. 10 [epub ahead of print]), which could help explain why atopic dermatitis is seem more frequently in children of Asian and African-American descent?

Interestingly, there have been reports of sleep disturbances in both infants and older children with atopic dermatitis (Asian Pac. J. Allergy Immunol. 2012;30:26-31). But is it the atopic dermatitis that causes poor sleep or the poor sleep that exacerbates the atopic dermatitis?

I think there is probably a relationship in both directions. It would be interesting to study whether socioeconomic and living conditions, regardless of race and ethnicity, are contributing factors. Insights into sleep quality and ethnic disparities may also offer further information on the same disparities seen in skin conditions.

- Naissan Wesley, M.D.

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

A recent article in the New York Times ("How Well you Sleep May Hinge on Race," Aug. 20, 2012), discussed a link between ethnicity and quality of sleep. According to the story, non-Hispanic white patients sleep longer with less interruption than people of other ethnicities. Black patients are also most likely to get shorter, more restless sleep, according to the article.

Poor sleep quality has been associated with high blood pressure, obesity, and insulin resistance, which might help explain why people in some minority groups experience higher rates of chronic health conditions.

Stockbyte/Thinkstock

The article highlighted racial disparity evidence presented at the annual Associated Professional Sleep Societies meeting in Boston in June. White patients from the Chicago area were found to get an average of 7.4 hours of sleep per night; Hispanic and Asian patients averaged 6.9 hours; and black patients averaged 6.8 hours. Sleep quality – defined as ease in falling asleep and length of uninterrupted sleep – was also higher for white patients than for black patients. Even after adjusting for cardiovascular disease, sleep apnea, and obesity, black patients and other ethnic minorities still got less, and more disruptive, sleep than white patients.

Could differences in quality of sleep also be associated with dermatologic conditions that occur at a higher rate in certain ethnic groups?

A study, published earlier this year, found that sleep disturbance correlated with immune system dysregulation (Am. J. Geriatr. Psychiatry 2012 Feb. 10 [epub ahead of print]), which could help explain why atopic dermatitis is seem more frequently in children of Asian and African-American descent?

Interestingly, there have been reports of sleep disturbances in both infants and older children with atopic dermatitis (Asian Pac. J. Allergy Immunol. 2012;30:26-31). But is it the atopic dermatitis that causes poor sleep or the poor sleep that exacerbates the atopic dermatitis?

I think there is probably a relationship in both directions. It would be interesting to study whether socioeconomic and living conditions, regardless of race and ethnicity, are contributing factors. Insights into sleep quality and ethnic disparities may also offer further information on the same disparities seen in skin conditions.

- Naissan Wesley, M.D.

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

A recent article in the New York Times ("How Well you Sleep May Hinge on Race," Aug. 20, 2012), discussed a link between ethnicity and quality of sleep. According to the story, non-Hispanic white patients sleep longer with less interruption than people of other ethnicities. Black patients are also most likely to get shorter, more restless sleep, according to the article.

Poor sleep quality has been associated with high blood pressure, obesity, and insulin resistance, which might help explain why people in some minority groups experience higher rates of chronic health conditions.

Stockbyte/Thinkstock

The article highlighted racial disparity evidence presented at the annual Associated Professional Sleep Societies meeting in Boston in June. White patients from the Chicago area were found to get an average of 7.4 hours of sleep per night; Hispanic and Asian patients averaged 6.9 hours; and black patients averaged 6.8 hours. Sleep quality – defined as ease in falling asleep and length of uninterrupted sleep – was also higher for white patients than for black patients. Even after adjusting for cardiovascular disease, sleep apnea, and obesity, black patients and other ethnic minorities still got less, and more disruptive, sleep than white patients.

Could differences in quality of sleep also be associated with dermatologic conditions that occur at a higher rate in certain ethnic groups?

A study, published earlier this year, found that sleep disturbance correlated with immune system dysregulation (Am. J. Geriatr. Psychiatry 2012 Feb. 10 [epub ahead of print]), which could help explain why atopic dermatitis is seem more frequently in children of Asian and African-American descent?

Interestingly, there have been reports of sleep disturbances in both infants and older children with atopic dermatitis (Asian Pac. J. Allergy Immunol. 2012;30:26-31). But is it the atopic dermatitis that causes poor sleep or the poor sleep that exacerbates the atopic dermatitis?

I think there is probably a relationship in both directions. It would be interesting to study whether socioeconomic and living conditions, regardless of race and ethnicity, are contributing factors. Insights into sleep quality and ethnic disparities may also offer further information on the same disparities seen in skin conditions.

- Naissan Wesley, M.D.

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

BOSTON – Patients with a high grade of acanthosis nigricans should be screened for insulin resistance, according to Dr. Sandhya Venkatswami.

His cross-sectional study found that 47 of 150 acanthosis nigricans patients (31%) were insulin resistant, with an acanthosis nigricans grade of 3 or 4 being more predictive of the condition.

Wikimedia Commons/Dr. Vandana Mehta Rai

"We suggest that all patients with severe AN [acanthosis nigricans] grades should be evaluated for IR [insulin resistance] and thereby prevent further complications," wrote Dr. Venkatswami, who presented his findings during a poster session at the American Academy of Dermatology’s Summer Academy Meeting.

While previous studies have found acanthosis nigricans to be a marker for prediabetes, Dr. Venkatswami’s study found that taking severity into account helps to further identify patients who may be at risk.

He and his fellow investigators enrolled 150 consecutive patients with acanthosis nigricans of the neck (25 males), aged 18-64 years. The patients were graded according to acanthosis nigricans severity on a scale of I-IV.

Grade I was defined as acanthosis nigricans that was only visible on close inspection (21 patients); grade II was defined as acanthosis nigricans confined to the base of the skull (58 patients); grade III was defined as acanthosis nigricans that extended laterally to the posterior border of the sternocleidomastoid but was not visible when the patient was facing forward (48 patients); and grade IV was defined as acanthosis nigricans that was visible when the patient was facing forward, as the acanthosis nigricans encircled the neck (23 patients), said Dr. Venkatswami of the department of dermatology, Sri Ramachandra University, Chennai, India.

One patient with grade I acanthosis nigricans was found to be insulin resistant; 10 patients with grade II acanthosis nigricans were found to be insulin resistance; 20 patients with grade III acanthosis nigricans were insulin resistant; and 16 patients with grade IV showed a resistance to insulin.

Secondary study findings showed that patients with higher grades of texture of acanthosis nigricans were also more likely to be insulin resistant. That is, those with visible and extremely coarse "hills and valleys."

"AN lesions are asymptomatic and usually ignored by the patients unless they are of cosmetic concern. However, this is of clinical importance in diagnosing prediabetes," he noted in his poster.

Further studies will look to see if behavior modifications will help lower the risk for diabetes in patients with the condition.

Dr. Venkatswami did not disclose having any conflicts of interest.

BOSTON – Patients with a high grade of acanthosis nigricans should be screened for insulin resistance, according to Dr. Sandhya Venkatswami.

His cross-sectional study found that 47 of 150 acanthosis nigricans patients (31%) were insulin resistant, with an acanthosis nigricans grade of 3 or 4 being more predictive of the condition.

Wikimedia Commons/Dr. Vandana Mehta Rai

"We suggest that all patients with severe AN [acanthosis nigricans] grades should be evaluated for IR [insulin resistance] and thereby prevent further complications," wrote Dr. Venkatswami, who presented his findings during a poster session at the American Academy of Dermatology’s Summer Academy Meeting.

While previous studies have found acanthosis nigricans to be a marker for prediabetes, Dr. Venkatswami’s study found that taking severity into account helps to further identify patients who may be at risk.

He and his fellow investigators enrolled 150 consecutive patients with acanthosis nigricans of the neck (25 males), aged 18-64 years. The patients were graded according to acanthosis nigricans severity on a scale of I-IV.

Grade I was defined as acanthosis nigricans that was only visible on close inspection (21 patients); grade II was defined as acanthosis nigricans confined to the base of the skull (58 patients); grade III was defined as acanthosis nigricans that extended laterally to the posterior border of the sternocleidomastoid but was not visible when the patient was facing forward (48 patients); and grade IV was defined as acanthosis nigricans that was visible when the patient was facing forward, as the acanthosis nigricans encircled the neck (23 patients), said Dr. Venkatswami of the department of dermatology, Sri Ramachandra University, Chennai, India.

One patient with grade I acanthosis nigricans was found to be insulin resistant; 10 patients with grade II acanthosis nigricans were found to be insulin resistance; 20 patients with grade III acanthosis nigricans were insulin resistant; and 16 patients with grade IV showed a resistance to insulin.

Secondary study findings showed that patients with higher grades of texture of acanthosis nigricans were also more likely to be insulin resistant. That is, those with visible and extremely coarse "hills and valleys."

"AN lesions are asymptomatic and usually ignored by the patients unless they are of cosmetic concern. However, this is of clinical importance in diagnosing prediabetes," he noted in his poster.

Further studies will look to see if behavior modifications will help lower the risk for diabetes in patients with the condition.

Dr. Venkatswami did not disclose having any conflicts of interest.

BOSTON – Patients with a high grade of acanthosis nigricans should be screened for insulin resistance, according to Dr. Sandhya Venkatswami.

His cross-sectional study found that 47 of 150 acanthosis nigricans patients (31%) were insulin resistant, with an acanthosis nigricans grade of 3 or 4 being more predictive of the condition.

Wikimedia Commons/Dr. Vandana Mehta Rai

"We suggest that all patients with severe AN [acanthosis nigricans] grades should be evaluated for IR [insulin resistance] and thereby prevent further complications," wrote Dr. Venkatswami, who presented his findings during a poster session at the American Academy of Dermatology’s Summer Academy Meeting.

While previous studies have found acanthosis nigricans to be a marker for prediabetes, Dr. Venkatswami’s study found that taking severity into account helps to further identify patients who may be at risk.

He and his fellow investigators enrolled 150 consecutive patients with acanthosis nigricans of the neck (25 males), aged 18-64 years. The patients were graded according to acanthosis nigricans severity on a scale of I-IV.

Grade I was defined as acanthosis nigricans that was only visible on close inspection (21 patients); grade II was defined as acanthosis nigricans confined to the base of the skull (58 patients); grade III was defined as acanthosis nigricans that extended laterally to the posterior border of the sternocleidomastoid but was not visible when the patient was facing forward (48 patients); and grade IV was defined as acanthosis nigricans that was visible when the patient was facing forward, as the acanthosis nigricans encircled the neck (23 patients), said Dr. Venkatswami of the department of dermatology, Sri Ramachandra University, Chennai, India.

One patient with grade I acanthosis nigricans was found to be insulin resistant; 10 patients with grade II acanthosis nigricans were found to be insulin resistance; 20 patients with grade III acanthosis nigricans were insulin resistant; and 16 patients with grade IV showed a resistance to insulin.

Secondary study findings showed that patients with higher grades of texture of acanthosis nigricans were also more likely to be insulin resistant. That is, those with visible and extremely coarse "hills and valleys."

"AN lesions are asymptomatic and usually ignored by the patients unless they are of cosmetic concern. However, this is of clinical importance in diagnosing prediabetes," he noted in his poster.

Further studies will look to see if behavior modifications will help lower the risk for diabetes in patients with the condition.

Dr. Venkatswami did not disclose having any conflicts of interest.

We were recently asked by a reader if there is any scientific evidence on the benefits of using argan oil to treat dry hair and scalp.

Argan oil is native to Morocco and has been used for centuries in foods and topical preparations. It is a plant oil produced from the argan tree (Argania Spinosa L). Studies have found that the oil has cardioprotective and anti-thrombotic effects when ingested.

Courtesy Wikimedia Commons

Over the past several years, it has become popular in hair care products. While the benefits of consumption of argan oil have been well-studied, its use for hair has not been documented in peer-reviewed literature.

Argan oil may be used on any hair type. It is available in shampoos, conditioners, and leave-in products. I have found that argan oil is beneficial for patients with curly hair, particularly those of African or African-American descent, because it helps to reduce frizz and adds shine. A small amount may be applied to the scalp if dry.

In patients with fine hair, too much oil can be greasy and may weigh curls down. In those cases, small amounts of the oil may be more beneficial. If too much product is used, clarifying shampoos may help remove excess oil.

The number of personal care products on the U.S. market with argan oil as an ingredient increased from just 2 in 2007 to over 100 in 2011. There are many hair care brands that contain argan oil including Moroccanoil, DermOrganic, Josie Maran, One 'N Only, and Organix, among others.

There has been one report of anaphylaxis to argan oil in the literature (Allergy 2010;65:662–3). Studies must be done to assess its actual efficacy for dermatologic scalp conditions and use for ethnic hair.

- Naissan Wesley, M.D.

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

We were recently asked by a reader if there is any scientific evidence on the benefits of using argan oil to treat dry hair and scalp.

Argan oil is native to Morocco and has been used for centuries in foods and topical preparations. It is a plant oil produced from the argan tree (Argania Spinosa L). Studies have found that the oil has cardioprotective and anti-thrombotic effects when ingested.

Courtesy Wikimedia Commons

Over the past several years, it has become popular in hair care products. While the benefits of consumption of argan oil have been well-studied, its use for hair has not been documented in peer-reviewed literature.

Argan oil may be used on any hair type. It is available in shampoos, conditioners, and leave-in products. I have found that argan oil is beneficial for patients with curly hair, particularly those of African or African-American descent, because it helps to reduce frizz and adds shine. A small amount may be applied to the scalp if dry.

In patients with fine hair, too much oil can be greasy and may weigh curls down. In those cases, small amounts of the oil may be more beneficial. If too much product is used, clarifying shampoos may help remove excess oil.

The number of personal care products on the U.S. market with argan oil as an ingredient increased from just 2 in 2007 to over 100 in 2011. There are many hair care brands that contain argan oil including Moroccanoil, DermOrganic, Josie Maran, One 'N Only, and Organix, among others.

There has been one report of anaphylaxis to argan oil in the literature (Allergy 2010;65:662–3). Studies must be done to assess its actual efficacy for dermatologic scalp conditions and use for ethnic hair.

- Naissan Wesley, M.D.

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

We were recently asked by a reader if there is any scientific evidence on the benefits of using argan oil to treat dry hair and scalp.

Argan oil is native to Morocco and has been used for centuries in foods and topical preparations. It is a plant oil produced from the argan tree (Argania Spinosa L). Studies have found that the oil has cardioprotective and anti-thrombotic effects when ingested.

Courtesy Wikimedia Commons

Over the past several years, it has become popular in hair care products. While the benefits of consumption of argan oil have been well-studied, its use for hair has not been documented in peer-reviewed literature.

Argan oil may be used on any hair type. It is available in shampoos, conditioners, and leave-in products. I have found that argan oil is beneficial for patients with curly hair, particularly those of African or African-American descent, because it helps to reduce frizz and adds shine. A small amount may be applied to the scalp if dry.

In patients with fine hair, too much oil can be greasy and may weigh curls down. In those cases, small amounts of the oil may be more beneficial. If too much product is used, clarifying shampoos may help remove excess oil.

The number of personal care products on the U.S. market with argan oil as an ingredient increased from just 2 in 2007 to over 100 in 2011. There are many hair care brands that contain argan oil including Moroccanoil, DermOrganic, Josie Maran, One 'N Only, and Organix, among others.

There has been one report of anaphylaxis to argan oil in the literature (Allergy 2010;65:662–3). Studies must be done to assess its actual efficacy for dermatologic scalp conditions and use for ethnic hair.

- Naissan Wesley, M.D.

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

Melanoma accounts for 75% of all skin cancer deaths. Ultraviolet exposure is still targeted as the major etiologic factor, but for black patients, skin erythema has been estimated to occur at a UV radiation dose 6-to-33 times greater than that experienced by white patients. Many have concluded that this is why black patients experience lower rates of melanoma than white patients.

Black patients, however, present at a later stage and have a higher melanoma-specific mortality, both of which have been linked to time of diagnosis and the ability to seek care at the onset of localized disease. Thus, there still exists a barrier to the detection and treatment of melanoma in black patients.

Photos courtesy Dr. Gary Peck/Dr. Cherie Young

In the July issue of Archives of Dermatology (2012;148:797-801), an article highlighted the anatomic distribution of malignant melanoma in the non-Hispanic black patient in an effort to explore how distribution of melanoma relates to UV exposure.

Data from 46 population-based cancer registries were analyzed. The most frequent site of melanoma in non-Hispanic black patients – both male and female, between the years 1998 and 2007 – was found to be the lower limbs and hip (58.9%). Of those, 27% were of the acral lentiginous type, which is not associated with exposure to UV rays.

The second most common location was the trunk (16.5%), which affected patients at a younger age; 46% of females and 31% of males were less than 44 years of age. The median age was 56 years for males and 48 years for females at presentation.

This study reiterates the burden of melanoma in the black community. It also highlights gaps in the detection of melanoma, which may be because of site of diagnosis – such as those of the acral lentiginous types – and unclear risk factors, the general underestimation of risk, and access to care.

- Lily Talakoub, M.D.

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

Melanoma accounts for 75% of all skin cancer deaths. Ultraviolet exposure is still targeted as the major etiologic factor, but for black patients, skin erythema has been estimated to occur at a UV radiation dose 6-to-33 times greater than that experienced by white patients. Many have concluded that this is why black patients experience lower rates of melanoma than white patients.

Black patients, however, present at a later stage and have a higher melanoma-specific mortality, both of which have been linked to time of diagnosis and the ability to seek care at the onset of localized disease. Thus, there still exists a barrier to the detection and treatment of melanoma in black patients.

Photos courtesy Dr. Gary Peck/Dr. Cherie Young

In the July issue of Archives of Dermatology (2012;148:797-801), an article highlighted the anatomic distribution of malignant melanoma in the non-Hispanic black patient in an effort to explore how distribution of melanoma relates to UV exposure.

Data from 46 population-based cancer registries were analyzed. The most frequent site of melanoma in non-Hispanic black patients – both male and female, between the years 1998 and 2007 – was found to be the lower limbs and hip (58.9%). Of those, 27% were of the acral lentiginous type, which is not associated with exposure to UV rays.

The second most common location was the trunk (16.5%), which affected patients at a younger age; 46% of females and 31% of males were less than 44 years of age. The median age was 56 years for males and 48 years for females at presentation.

This study reiterates the burden of melanoma in the black community. It also highlights gaps in the detection of melanoma, which may be because of site of diagnosis – such as those of the acral lentiginous types – and unclear risk factors, the general underestimation of risk, and access to care.

- Lily Talakoub, M.D.

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

Melanoma accounts for 75% of all skin cancer deaths. Ultraviolet exposure is still targeted as the major etiologic factor, but for black patients, skin erythema has been estimated to occur at a UV radiation dose 6-to-33 times greater than that experienced by white patients. Many have concluded that this is why black patients experience lower rates of melanoma than white patients.

Black patients, however, present at a later stage and have a higher melanoma-specific mortality, both of which have been linked to time of diagnosis and the ability to seek care at the onset of localized disease. Thus, there still exists a barrier to the detection and treatment of melanoma in black patients.

Photos courtesy Dr. Gary Peck/Dr. Cherie Young

In the July issue of Archives of Dermatology (2012;148:797-801), an article highlighted the anatomic distribution of malignant melanoma in the non-Hispanic black patient in an effort to explore how distribution of melanoma relates to UV exposure.

Data from 46 population-based cancer registries were analyzed. The most frequent site of melanoma in non-Hispanic black patients – both male and female, between the years 1998 and 2007 – was found to be the lower limbs and hip (58.9%). Of those, 27% were of the acral lentiginous type, which is not associated with exposure to UV rays.

The second most common location was the trunk (16.5%), which affected patients at a younger age; 46% of females and 31% of males were less than 44 years of age. The median age was 56 years for males and 48 years for females at presentation.

This study reiterates the burden of melanoma in the black community. It also highlights gaps in the detection of melanoma, which may be because of site of diagnosis – such as those of the acral lentiginous types – and unclear risk factors, the general underestimation of risk, and access to care.

- Lily Talakoub, M.D.

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

Dr. Rossi discusses melanoma in the skin of color population including the incidence and presentation of melanoma as well as factors contributing to delayed diagnosis in these patients. He also gives recommendations to physicians to help educate their patients. For more information, read Dr. Rossi's article in the May 2012 issue, "Melanoma in Skin of Color." 

Dr. Rossi discusses melanoma in the skin of color population including the incidence and presentation of melanoma as well as factors contributing to delayed diagnosis in these patients. He also gives recommendations to physicians to help educate their patients. For more information, read Dr. Rossi's article in the May 2012 issue, "Melanoma in Skin of Color." 

Dr. Rossi discusses melanoma in the skin of color population including the incidence and presentation of melanoma as well as factors contributing to delayed diagnosis in these patients. He also gives recommendations to physicians to help educate their patients. For more information, read Dr. Rossi's article in the May 2012 issue, "Melanoma in Skin of Color."