Heather Woolery-Lloyd

Squamous cell carcinoma in a patient with Netherton's syndrome

A 29‐year‐old white woman with a history of Nethertons syndrome presented with two squamous cell carcinomas on the right dorsal hand and the left upper arm. She reported a 2‐year history of these lesions, which were originally treated as warts. She denied excessive sun exposure, immunosuppressive therapy, or a previous history of skin cancer.

Treatment of hyperpigmentation.

Hyperpigmentation is a common dermatologic condition that is seen in all skin types but is most prominent in skin of color. In skin of color, any inflammation or injury to skin can almost immediately be accompanied by alterations in pigmentation, either hyperpigmentation or hypopigmentation. Post-inflammatory hyperpigmentation can be observed in many skin conditions including acne, eczema, and contact dermatitis and treatment can be challenging. The goal is to reduce the hyperpigmentation without causing undesirable hypopigmentation or irritation in the surrounding area. This review will discuss current research on treatments for hyperpigmentation and approaches to treating this condition.

Gene expression profiling reveals alteration of caspase 6 and 14 transcripts in normal skin of keloid-prone patients

Excessive scar formation in keloids points to altered tissue modeling and repair mechanisms. Dysregulation of cytokine and apoptotic cascades and their downstream signaling pathways might have a role in keloid development. Total RNA was isolated from biopsied keloidal tissue and adjacent normal skin of black patients, white patient’s scars, and normal skin of black and white patients, with normal wound healing. Apoptosis, cytokine and NFkB pathway microarrays were used to study and compare gene expression levels. Real-time PCR was used to verify microarray results in original samples and a separate, validation-set of samples. Significant differences were observed in the expression levels of members of caspase, cytokines and MAP kinase pathways, between the normal skin of keloid-prone and normal skin of keloid-resistant patients. Specifically, expression of caspase 6, and caspase 14 genes were different between normal skin of keloid-prone individuals and normal skin of keloid-resistant patients. Our results suggest that normal skin of keloid-prone individuals constitutively expresses a distinct gene profile which might contribute to their susceptibility to develop keloids.

Skin of color education in dermatology residency programs: Does residency training reflect the changing demographics of the United States?

BACKGROUND It is projected that by the year 2050, close to 50% of the US population will comprise people with skin of color. OBJECTIVE We sought to assess whether future dermatologists will be prepared to treat patients with skin of color. METHODS An e-mail with a link to a brief 9-question survey was sent to 109 program directors and chief residents. RESULTS A total of 41 (37.6%) program directors and 63 (50.0%) chief residents completed the online survey. In all, 14.3% (P<.001) of chief residents and 14.6% (P<.001) of program directors recognized an expert at their institutions who conducted a skin of color clinic. In all, 25.4% (P<.001) of chief residents and 19.5% (P<.001) of program directors reported having lectures on skin of color from an acknowledged expert. In all, 30.2% (P<.001) of chief residents and 12.2% (P<.001) of program directors reported a specific rotation in which residents gained specific experience in treating patients with skin of color. In all, 52.4% (P=.70) of chief residents and 65.9% (P<.02) of program directors reported to have either lectures or didactic sessions focusing on diseases in skin of color incorporated into their curriculums. In all, 84.1% (P<.001) of chief residents and 90.2% (P<.001) of program directors reported having training programs in which residents gained experience treating patients with central centrifugal cicatricial alopecia. In all, 100% (P<.001) of both chief residents and program directors reported having training programs in which residents gained experience treating patients with keloids and melasma. LIMITATIONS The limitations of this study included recall bias, an incomplete response rate, unsure respondents, and questions that may not have applied to certain programs. CONCLUSION The results indicate a need for increased exposure, educational sessions, and overall training in diseases pertaining to skin of color in US dermatology residencies.

Sodium L-ascorbyl-2-phosphate 5% lotion for the treatment of acne vulgaris: a randomized, double-blind, controlled trial

Background  Antioxidants are becoming increasingly important in the treatment of skin disease. In addition to their known anti‐inflammatory effects, antioxidants may act to prevent the oxidation of sebum which has been proposed to be comedogenic in acne patients. Sodium L‐ascorbyl‐2‐phosphate (APS) is a stable vitamin C derivative and highly effective antioxidant that has demonstrated efficacy in acne in open label studies.

Short anagen syndrome in an African American woman

Short anagen syndrome is an uncommon condition characterized by the inability to grow long hair and an increase in the number of hairs in telogen. The incidence of short anagen syndrome is poorly documented in the medical literature. In all reports, patients are Caucasian and usually have fine blond hair. We report a case of a 38-year-old African American woman with short anagen syndrome.

Laser therapy in black skin.

This article provides a systematic overview of laser, light, and other energy devices for patients of African descent. It also reviews complications in skin of color and some treatment options for these adverse events.

Skin tightening of aging upper arms using an infrared light device.

BACKGROUND Upper arm skin laxity is an important area of cosmetic concern. Recent studies using a noninvasive infrared device has demonstrated its efficacy in tightening skin in various body regions. The use of this device in upper arm loose skin has not been investigated. OBJECTIVES To determine the safety and efficacy of an infrared device to treat upper arm laxity in aged skin. PATIENTS AND METHODS Twenty women with mild to very loose aged upper arm skin underwent two treatments with an infrared device 1 month apart. Nineteen patients completed the study with a 3‐month follow‐up. Outcome measures included investigator and participant evaluations of skin laxity improvement, blinded photographic assessments of skin tightening, and differences in circumferences and spectrophotometric analysis of collagen content in the treated arms. Two patients participated in histological evaluations. RESULTS The patient and investigator clinical assessments showed minimal improvement in skin laxity. There was a statistically significant decrease in arm circumference. Blinded photographic assessments and spectrophotometric analysis revealed no statistical improvement in skin laxity. The immediate post‐treatment histological evaluations showed architectural disarray of dermal collagen and elastin. CONCLUSION An infrared device is safe, well tolerated, and minimally effective in treating aged upper arm skin laxity. Cutera, Inc. donated the Titan Device used for this study

Laser Treatment for Ethnic Skin

With the growth of new technology and products over the last 10 years, there has been an increased ability to improve a patients appearance with procedures that can be performed in an office setting, including laser procedures. Demand for these procedures has grown among all ethnic groups. Patients with ethnic skin can have varying response to lasers. This factor should be considered when planning their treatment. After laser treatment, Patients with ethnic skin are at greater risk for laser energy absorption by melanin, postinflammatory hyperpigmentation, and loss of pigment due to laser effects on melanin production leading to hypopigmentation. Therefore, any laser therapy should be planned carefully, especially in the treatment of patients with darker skin types.

Alteration in Hair Texture Following Regrowth in Alopecia Areata: A Case Report

BACKGROUND Alopecia areata is a common cause of hair loss seen in 3.8% of patients in dermatology clinics and in 0.2% to 2.0% of the general US population. The pathology of the disease remains poorly understood. Hair loss in alopecia areata can range from a single patch to 100% loss of body hair. When hair regrowth occurs in alopecia areata, the new hair may demonstrate pigment alterations, but a change in hair texture (ie, curly or straight) has rarely been reported as a consequence of alopecia areata. OBSERVATIONS We report a case of a 13-year-old African American boy who experienced an alteration of hair shape following regrowth after alopecia areata. The new hair recapitulated his hair shape from early childhood. CONCLUSIONS The precipitating factor for a change in hair texture in alopecia areata may be a result of treatment, pathophysiologic changes, or a combination of both. Whether the change is triggered at the level of stem cell differentiation, by cytokine or hormonal influences, gene expression during hair follicle development, a combination of all of these, or an unknown cause is a question that remains to be answered.