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Approach to Hair Loss in Women of Color
Jennifer M. Fu, MD, and Vera H. Price, MD, FRCP(C)
Hair loss in women of color represents a unique diagnostic challenge that requires a systematic approach. In women of color, clinical examination of the hair and scalp is most helpful when performed first and used to guide subsequent history-taking to arrive at a clinical assessment. The most common hair problems in women of color are hair breakage, traction alopecia, and central centrifugal cicatricial alopecia. A careful detailed clinical examination and history will guide the clinician to appropriate counseling and management. It is important to recognize that a patient may have more than one of these 3 diagnoses and each requires separate attention. Traction alopecia is completely preventable with appropriate education of the public and medical establishment.
*For a PDF of the full article, click on the link to the left of this introduction.
Jennifer M. Fu, MD, and Vera H. Price, MD, FRCP(C)
Hair loss in women of color represents a unique diagnostic challenge that requires a systematic approach. In women of color, clinical examination of the hair and scalp is most helpful when performed first and used to guide subsequent history-taking to arrive at a clinical assessment. The most common hair problems in women of color are hair breakage, traction alopecia, and central centrifugal cicatricial alopecia. A careful detailed clinical examination and history will guide the clinician to appropriate counseling and management. It is important to recognize that a patient may have more than one of these 3 diagnoses and each requires separate attention. Traction alopecia is completely preventable with appropriate education of the public and medical establishment.
*For a PDF of the full article, click on the link to the left of this introduction.
Jennifer M. Fu, MD, and Vera H. Price, MD, FRCP(C)
Hair loss in women of color represents a unique diagnostic challenge that requires a systematic approach. In women of color, clinical examination of the hair and scalp is most helpful when performed first and used to guide subsequent history-taking to arrive at a clinical assessment. The most common hair problems in women of color are hair breakage, traction alopecia, and central centrifugal cicatricial alopecia. A careful detailed clinical examination and history will guide the clinician to appropriate counseling and management. It is important to recognize that a patient may have more than one of these 3 diagnoses and each requires separate attention. Traction alopecia is completely preventable with appropriate education of the public and medical establishment.
*For a PDF of the full article, click on the link to the left of this introduction.
Differences in Perceptions of Beauty and Cosmetic Proceudres Performed in Ethnic Patients
Lily Talakoub, MD and Naissan O. Wesley, MD
The United States has become progressively more multicultural, with the ethnic population growing at record rates. The US Census Bureau projects that, by the year 2056, greater than 50% of the US population will be of non-Caucasian descent. Ethnic patients have different cosmetic concerns and natural features that are unique. The cosmetic concerns of ethnic patients also differ as the result of differences in skin pathophysiology, mechanisms of aging, and unique anatomic structure. There is no longer a single standard of beauty. We must now adapt to the more diverse population and understand how to accommodate the diversity of beauty in the United States. Ethnic patients do not necessarily want a Westernized look because what constitutes beauty is determined by racial, cultural, and environmental influences. We as leaders in skin care must understand these differences and adapt our practices accordingly. This article will focus on the differences in aging in different ethnic populations and highlight procedures unique to skin of color.
*For a PDF of the full article, click on the link to the left of this introduction.
Lily Talakoub, MD and Naissan O. Wesley, MD
The United States has become progressively more multicultural, with the ethnic population growing at record rates. The US Census Bureau projects that, by the year 2056, greater than 50% of the US population will be of non-Caucasian descent. Ethnic patients have different cosmetic concerns and natural features that are unique. The cosmetic concerns of ethnic patients also differ as the result of differences in skin pathophysiology, mechanisms of aging, and unique anatomic structure. There is no longer a single standard of beauty. We must now adapt to the more diverse population and understand how to accommodate the diversity of beauty in the United States. Ethnic patients do not necessarily want a Westernized look because what constitutes beauty is determined by racial, cultural, and environmental influences. We as leaders in skin care must understand these differences and adapt our practices accordingly. This article will focus on the differences in aging in different ethnic populations and highlight procedures unique to skin of color.
*For a PDF of the full article, click on the link to the left of this introduction.
Lily Talakoub, MD and Naissan O. Wesley, MD
The United States has become progressively more multicultural, with the ethnic population growing at record rates. The US Census Bureau projects that, by the year 2056, greater than 50% of the US population will be of non-Caucasian descent. Ethnic patients have different cosmetic concerns and natural features that are unique. The cosmetic concerns of ethnic patients also differ as the result of differences in skin pathophysiology, mechanisms of aging, and unique anatomic structure. There is no longer a single standard of beauty. We must now adapt to the more diverse population and understand how to accommodate the diversity of beauty in the United States. Ethnic patients do not necessarily want a Westernized look because what constitutes beauty is determined by racial, cultural, and environmental influences. We as leaders in skin care must understand these differences and adapt our practices accordingly. This article will focus on the differences in aging in different ethnic populations and highlight procedures unique to skin of color.
*For a PDF of the full article, click on the link to the left of this introduction.
The Use of Lasers in Darker Skin Types
Eliot F. Battle, Jr, MD and Cylburn E. Soden, Jr, MD, MA
The demographics of the US population continue to change at an extremely rapid pace. As of 2008, Asians, Hispanics, and African Americans accounted for 31% of the US population, and it is estimated that by the year 2050 half of the population of America will be represented by darker ethnic skin types. With the increase in the total number of individuals of skin of color, the demand for safe and effective laser therapy in darker skin types continues to increase. However, despite the increase in demand, the current literature regarding the use of lasers in darker skin remains limited. Most of the treatment parameters defined for laser platforms have been established primarily through extensive testing on skin phototypes I to III, and those studies that have been conducted on darker skin phototypes have been overwhelmingly conducted on Asian skin. Nevertheless, it has become clear that effective cutaneous laser surgery in darker skin types can be accomplished despite a relative overall greater risk for complications. Therefore, as the diversity of America continues to grow, the laser surgeon needs to maintain a clear understanding of the complexities associated with treating ethnic skin and remain mindful of the current, and ever-changing, therapeutic modalities available. This will allow the conscientious physician to maximize outcome and minimize risk when performing laser surgery on darker skin types.
*For a PDF of the full article, click on the link to the left of this introduction.
Eliot F. Battle, Jr, MD and Cylburn E. Soden, Jr, MD, MA
The demographics of the US population continue to change at an extremely rapid pace. As of 2008, Asians, Hispanics, and African Americans accounted for 31% of the US population, and it is estimated that by the year 2050 half of the population of America will be represented by darker ethnic skin types. With the increase in the total number of individuals of skin of color, the demand for safe and effective laser therapy in darker skin types continues to increase. However, despite the increase in demand, the current literature regarding the use of lasers in darker skin remains limited. Most of the treatment parameters defined for laser platforms have been established primarily through extensive testing on skin phototypes I to III, and those studies that have been conducted on darker skin phototypes have been overwhelmingly conducted on Asian skin. Nevertheless, it has become clear that effective cutaneous laser surgery in darker skin types can be accomplished despite a relative overall greater risk for complications. Therefore, as the diversity of America continues to grow, the laser surgeon needs to maintain a clear understanding of the complexities associated with treating ethnic skin and remain mindful of the current, and ever-changing, therapeutic modalities available. This will allow the conscientious physician to maximize outcome and minimize risk when performing laser surgery on darker skin types.
*For a PDF of the full article, click on the link to the left of this introduction.
Eliot F. Battle, Jr, MD and Cylburn E. Soden, Jr, MD, MA
The demographics of the US population continue to change at an extremely rapid pace. As of 2008, Asians, Hispanics, and African Americans accounted for 31% of the US population, and it is estimated that by the year 2050 half of the population of America will be represented by darker ethnic skin types. With the increase in the total number of individuals of skin of color, the demand for safe and effective laser therapy in darker skin types continues to increase. However, despite the increase in demand, the current literature regarding the use of lasers in darker skin remains limited. Most of the treatment parameters defined for laser platforms have been established primarily through extensive testing on skin phototypes I to III, and those studies that have been conducted on darker skin phototypes have been overwhelmingly conducted on Asian skin. Nevertheless, it has become clear that effective cutaneous laser surgery in darker skin types can be accomplished despite a relative overall greater risk for complications. Therefore, as the diversity of America continues to grow, the laser surgeon needs to maintain a clear understanding of the complexities associated with treating ethnic skin and remain mindful of the current, and ever-changing, therapeutic modalities available. This will allow the conscientious physician to maximize outcome and minimize risk when performing laser surgery on darker skin types.
*For a PDF of the full article, click on the link to the left of this introduction.
Erythema Dyschromicum Perstans: Successful Treatment With Clofazimine Under a Single-Patient Investigational New Drug Study
Mechanisms of Action of Azelaic Acid 15% Gel: Assessing Its Broad Antioxidant and Comedolytic Effects
Efficacious and Safe Cosmetic Procedures in Skin of Color
A Stepwise Approach to Melasma Management and Treatment
Bathing Trunks Nevus: Case Report of Giant Congenital Melanocytic Nevus
Diode Laser Tx Clears Dermatosis Papulosis Nigra : Of the lesions, 98% cleared or improved.
PHOENIX — A 532-nm diode laser was highly effective at clearing extensive dermatosis papulosis nigra lesions while avoiding the pigmentary complications that are the bane of conventional treatments for this disorder of darker skin, according to the results of a study involving 40 patients with a total of 1,312 lesions.
In the study, patients with Fitzgerald skin types IV-VI were treated with the Iridex 532-nm KTP DioLiteXP laser for extensive lesions of dermatosis papulosis nigra (DPN) that they found distressing and aesthetically unappealing, Dr. Ayman El-Attar said at the annual meeting of the American Academy of Cosmetic Surgery.
Of the 1,312 DPN lesions on the face, neck, and upper torso addressed over the course of three or four sessions, 98% were cleared or significantly improved at follow-up. The other 2% were located close to the eyelid margins, so Dr. El-Attar elected to leave them untreated.
“Using eye shields, you could easily treat those,” however, noted Dr. El-Attar, who is a laser and cosmetic skin surgeon in Somerset, N.J.
For purposes of the study, efficacy and patient satisfaction were assessed 4 weeks after each treatment session and again 6 months after the final treatment. Patient evaluations of their outcome ranged from “satisfied” to “very satisfied.”
The 532-nm DioliteXP laser, a diode-pumped, frequency-doubled Nd:YAG laser, is widely used in office-based dermatology for treatment of facial telangiectasias.
The green light wavelength laser is extremely lightweight, affordable, easy to use, and readily moved between treatment rooms. The small spot size and limited depth of penetration permit the operator to avoid laser-induced purpura, Dr. El-Attar explained.
The 532-nm diode laser enables patients being treated for DPN to go straight back to work with no downtime for recovery. The key to excellent results, Dr. El-Attar stressed, is to treat cautiously, spreading the work over three or four sessions separated by about 4 weeks in patients with numerous lesions.
“The end point of treating these lesions is graying of the lesion. You don't want to go past this end point. Because African Americans and others with darker skin types are very prone to pigmentary changes, we try to be very conservative. That's why we use several sessions. We never go overboard. We always undertreat,” he said.
Depending upon the size and thickness of a lesion, he uses a repetition rate of 5-7 Hz at 10-16 J/cm
Most patients can tolerate the procedure without a topical anesthetic. When needed, Dr. El-Attar applies EMLA cream for about 15 minutes prior to treatment.
The treated lesions immediately turn gray and then become black and exfoliate over the course of a few days to a week. Because patients occasionally have developed mild itching as a reaction to topical antibiotics, Dr. El-Attar generally has patients apply Vaseline or another bland oil-based topical product to treated areas as they heal.
“Occasionally there are footprints: changes in coloration where the lesions were. The easiest treatment for this is tincture of time, but if the patient is in a rush we can do some mild chemical peeling and that takes care of it 100%,” he said in an interview.
Dermatosis papulosis nigra is an extremely common benign cutaneous condition in African Americans and others who have Fitzgerald skin types IV-VI. DPN is believed to have a strong genetic component and is analogous to seborrheic keratoses in lighter-skinned patients. The small, hyperpigmented lesions tend to become numerous through adulthood.
Conventional treatments of DPN include cryotherapy, curettage, excision, and electrodesiccation. All are notoriously associated with increased risks of hyper- and hypopigmentation in darker skin types, said Dr. El-Attar, who had no financial conflicts of interest to disclose in connection with this study.
This patient—like the others in the study—was distressed by her lesions.
Significant clearance can be seen after treatment with the 532-nm laser. PHOTOS COURTESY DR. AYMAN EL-ATTAR
PHOENIX — A 532-nm diode laser was highly effective at clearing extensive dermatosis papulosis nigra lesions while avoiding the pigmentary complications that are the bane of conventional treatments for this disorder of darker skin, according to the results of a study involving 40 patients with a total of 1,312 lesions.
In the study, patients with Fitzgerald skin types IV-VI were treated with the Iridex 532-nm KTP DioLiteXP laser for extensive lesions of dermatosis papulosis nigra (DPN) that they found distressing and aesthetically unappealing, Dr. Ayman El-Attar said at the annual meeting of the American Academy of Cosmetic Surgery.
Of the 1,312 DPN lesions on the face, neck, and upper torso addressed over the course of three or four sessions, 98% were cleared or significantly improved at follow-up. The other 2% were located close to the eyelid margins, so Dr. El-Attar elected to leave them untreated.
“Using eye shields, you could easily treat those,” however, noted Dr. El-Attar, who is a laser and cosmetic skin surgeon in Somerset, N.J.
For purposes of the study, efficacy and patient satisfaction were assessed 4 weeks after each treatment session and again 6 months after the final treatment. Patient evaluations of their outcome ranged from “satisfied” to “very satisfied.”
The 532-nm DioliteXP laser, a diode-pumped, frequency-doubled Nd:YAG laser, is widely used in office-based dermatology for treatment of facial telangiectasias.
The green light wavelength laser is extremely lightweight, affordable, easy to use, and readily moved between treatment rooms. The small spot size and limited depth of penetration permit the operator to avoid laser-induced purpura, Dr. El-Attar explained.
The 532-nm diode laser enables patients being treated for DPN to go straight back to work with no downtime for recovery. The key to excellent results, Dr. El-Attar stressed, is to treat cautiously, spreading the work over three or four sessions separated by about 4 weeks in patients with numerous lesions.
“The end point of treating these lesions is graying of the lesion. You don't want to go past this end point. Because African Americans and others with darker skin types are very prone to pigmentary changes, we try to be very conservative. That's why we use several sessions. We never go overboard. We always undertreat,” he said.
Depending upon the size and thickness of a lesion, he uses a repetition rate of 5-7 Hz at 10-16 J/cm
Most patients can tolerate the procedure without a topical anesthetic. When needed, Dr. El-Attar applies EMLA cream for about 15 minutes prior to treatment.
The treated lesions immediately turn gray and then become black and exfoliate over the course of a few days to a week. Because patients occasionally have developed mild itching as a reaction to topical antibiotics, Dr. El-Attar generally has patients apply Vaseline or another bland oil-based topical product to treated areas as they heal.
“Occasionally there are footprints: changes in coloration where the lesions were. The easiest treatment for this is tincture of time, but if the patient is in a rush we can do some mild chemical peeling and that takes care of it 100%,” he said in an interview.
Dermatosis papulosis nigra is an extremely common benign cutaneous condition in African Americans and others who have Fitzgerald skin types IV-VI. DPN is believed to have a strong genetic component and is analogous to seborrheic keratoses in lighter-skinned patients. The small, hyperpigmented lesions tend to become numerous through adulthood.
Conventional treatments of DPN include cryotherapy, curettage, excision, and electrodesiccation. All are notoriously associated with increased risks of hyper- and hypopigmentation in darker skin types, said Dr. El-Attar, who had no financial conflicts of interest to disclose in connection with this study.
This patient—like the others in the study—was distressed by her lesions.
Significant clearance can be seen after treatment with the 532-nm laser. PHOTOS COURTESY DR. AYMAN EL-ATTAR
PHOENIX — A 532-nm diode laser was highly effective at clearing extensive dermatosis papulosis nigra lesions while avoiding the pigmentary complications that are the bane of conventional treatments for this disorder of darker skin, according to the results of a study involving 40 patients with a total of 1,312 lesions.
In the study, patients with Fitzgerald skin types IV-VI were treated with the Iridex 532-nm KTP DioLiteXP laser for extensive lesions of dermatosis papulosis nigra (DPN) that they found distressing and aesthetically unappealing, Dr. Ayman El-Attar said at the annual meeting of the American Academy of Cosmetic Surgery.
Of the 1,312 DPN lesions on the face, neck, and upper torso addressed over the course of three or four sessions, 98% were cleared or significantly improved at follow-up. The other 2% were located close to the eyelid margins, so Dr. El-Attar elected to leave them untreated.
“Using eye shields, you could easily treat those,” however, noted Dr. El-Attar, who is a laser and cosmetic skin surgeon in Somerset, N.J.
For purposes of the study, efficacy and patient satisfaction were assessed 4 weeks after each treatment session and again 6 months after the final treatment. Patient evaluations of their outcome ranged from “satisfied” to “very satisfied.”
The 532-nm DioliteXP laser, a diode-pumped, frequency-doubled Nd:YAG laser, is widely used in office-based dermatology for treatment of facial telangiectasias.
The green light wavelength laser is extremely lightweight, affordable, easy to use, and readily moved between treatment rooms. The small spot size and limited depth of penetration permit the operator to avoid laser-induced purpura, Dr. El-Attar explained.
The 532-nm diode laser enables patients being treated for DPN to go straight back to work with no downtime for recovery. The key to excellent results, Dr. El-Attar stressed, is to treat cautiously, spreading the work over three or four sessions separated by about 4 weeks in patients with numerous lesions.
“The end point of treating these lesions is graying of the lesion. You don't want to go past this end point. Because African Americans and others with darker skin types are very prone to pigmentary changes, we try to be very conservative. That's why we use several sessions. We never go overboard. We always undertreat,” he said.
Depending upon the size and thickness of a lesion, he uses a repetition rate of 5-7 Hz at 10-16 J/cm
Most patients can tolerate the procedure without a topical anesthetic. When needed, Dr. El-Attar applies EMLA cream for about 15 minutes prior to treatment.
The treated lesions immediately turn gray and then become black and exfoliate over the course of a few days to a week. Because patients occasionally have developed mild itching as a reaction to topical antibiotics, Dr. El-Attar generally has patients apply Vaseline or another bland oil-based topical product to treated areas as they heal.
“Occasionally there are footprints: changes in coloration where the lesions were. The easiest treatment for this is tincture of time, but if the patient is in a rush we can do some mild chemical peeling and that takes care of it 100%,” he said in an interview.
Dermatosis papulosis nigra is an extremely common benign cutaneous condition in African Americans and others who have Fitzgerald skin types IV-VI. DPN is believed to have a strong genetic component and is analogous to seborrheic keratoses in lighter-skinned patients. The small, hyperpigmented lesions tend to become numerous through adulthood.
Conventional treatments of DPN include cryotherapy, curettage, excision, and electrodesiccation. All are notoriously associated with increased risks of hyper- and hypopigmentation in darker skin types, said Dr. El-Attar, who had no financial conflicts of interest to disclose in connection with this study.
This patient—like the others in the study—was distressed by her lesions.
Significant clearance can be seen after treatment with the 532-nm laser. PHOTOS COURTESY DR. AYMAN EL-ATTAR