Roopal V. Kundu

Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public

Skin cancer is less prevalent in people of color than in the white population. However, when skin cancer occurs in non-whites, it often presents at a more advanced stage, and thus the prognosis is worse compared with white patients. The increased morbidity and mortality associated with skin cancer in patients of color compared with white patients may be because of the lack of awareness, diagnoses at a more advanced stage, and socioeconomic factors such as access to care barriers. Physician promotion of skin cancer prevention strategies for all patients, regardless of ethnic background and socioeconomic status, can lead to timely diagnosis and treatment. Public education campaigns should be expanded to target communities of color to promote self-skin examination and stress importance of photoprotection, avoidance of tanning bed use, and early skin cancer detection and treatment. These measures should result in reduction or earlier detection of cutaneous malignancies in all communities. Furthermore, promotion of photoprotection practices may reduce other adverse effects of ultraviolet exposure including photoaging and ultraviolet-related disorders of pigmentation.

Widespread Use of Toxic Skin Lightening Compounds: Medical and Psychosocial Aspects

Hyperpigmentation disorders and skin lightening treatments have a significant impact on the dermatologic, physiologic, psychologic, economic, social, and cultural aspects of life. Skin lightening compounds, such as hydroquinone and topical corticosteroids, are often used to treat hyperpigmentation disorders, such as melasma, or lighten skin for cosmetic purposes. Despite their established effectiveness, a multitude of dermatologic and systemic complications have been associated with these agents. Regulatory agencies have also recognized the adverse effects of skin lighteners and many countries around the world now forbid the production and sale of these compounds, although this prohibition has not significantly curtailed distribution. Dermatologists and users of cosmetic products should be aware of the various components in bleaching compounds, their potential adverse effects, and alternative options for skin lightening.

Development and validation of a vitiligo-specific quality-of-life instrument (VitiQoL)

BACKGROUND Vitiligo significantly affects a persons health-related quality of life (HRQL). Although a small number of generic, and disease-specific, dermatologic HRQL measures exist, currently no vitiligo-specific instrument is available to capture disease-targeted concerns and issues. OBJECTIVE We sought to develop and validate a vitiligo-specific self-report instrument for HRQL. METHODS A pool of vitiligo-specific items was created based on in-depth interviews with patients with vitiligo (n = 16) and their responses to items in several previously validated HRQL measures. These items comprising our new instrument, VitiQoL, along with Skindex-16 and Dermatology Life Quality Index were administered to patients with vitiligo (n = 90) at two academic centers. This new instrument was validated using psychometric analysis. RESULTS The VitiQoL items showed high internal consistency (Cronbach alpha = 0.935). Exploratory factor analysis demonstrated 3 factors: participation limitation, stigma, and behavior. Concurrent validity was evidenced by large correlations between self-reported severity and VitiQoL scores (r = 0.51). Known groups validity was demonstrated for the VitiQoL behavior subscale between individuals with exposed and unexposed patches (P = .01). Convergent validity was shown by strong correlations between VitiQoL and outside dermatology scales measuring similar constructs (Skindex-16, r = 0.82; Dermatology Life Quality Index, r = 0.83). LIMITATIONS Potential selection bias was a limitation as most patients were recruited from academic centers. Reliability of the instrument was tested only with internal consistency and not reproducibility. Responsiveness of the instrument was not tested because of the prolonged time course necessary to observe clinically significant change in vitiligo. CONCLUSION VitiQoL is a reliable and valid HRQL instrument.

Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education

Objectives: To assess the level of melanoma awareness and risk perception among ethnic minorities and to identify ways to enhance the relevance of melanoma educational materials for ethnic minorities.

Effectiveness of a knowledge-based intervention for melanoma among those with ethnic skin

BACKGROUND Among patients with melanoma, ethnic minorities are 1.96 to 3.01 times as likely to die from melanoma as Caucasians of the same age and sex. OBJECTIVE We sought to assess the effectiveness of a melanoma early detection educational intervention among those with ethnic skin. METHODS A consecutive convenience sample of patients received instruction on the ABCDEs of melanoma and skin self-examination. Self-report questionnaires assessing knowledge, attitudes, and behaviors were completed before, and immediately and 3 months after, the intervention. RESULTS Among the 71 participants, 21% reported a skin phenotype with at least sometimes burning. Knowledge that melanoma is a skin cancer and of the warning signs of melanoma significantly increased after the intervention and was retained at 3 months. The perception of being at risk to develop a melanoma significantly increased after the intervention and was retained at 3 months (P < .001). Monthly checking of the skin, especially acral sites (palms, soles, periungual), increased significantly immediately after the intervention. LIMITATIONS A limitation is accrual from dermatology patients, who may be more inclined to perform skin self-examination compared with the general minority population. CONCLUSIONS People of color benefit from specific physician recommendations explaining their risk to develop melanoma and which anatomic sites to check. Acral lentiginous melanoma among ethnic minorities tends to present in non-sun-exposed but visible areas, particularly volar and subungual sites; therefore, skin self-examination educational materials for minority populations should incorporate these anatomic sites.

Dermatoses secondary to Asian cultural practices

Although Asian cultural practices, such as acupuncture and threading, are widely used, there is limited medical literature describing their cutaneous effects and complications. This review briefly describes therapeutic cultural practices (traditional Chinese medicine, acupuncture, cupping, moxibustion, coining, Ayurveda, and aromatherapy) and cosmetic cultural practices (hair oils, henna, bindis, saris, and threading), with particular attention to dermatoses secondary to these practices. Traditional Chinese medicine and Ayurveda may cause heavy metal toxicity, severe cutaneous adverse reactions, and contact dermatitis. Cupping, moxibustion, and coining lead to dermatoses that may be mistaken for abuse by people unfamiliar with the practices. Hair oils may cause contact dermatitis and folliculitis. Paraphenylenediamine in black henna and bindi dyes and adhesives can cause severe allergic contact dermatitis. The drawstring in saris causes frictional irritation, which can lead to tinea corporis, koebnerization, and even squamous cell carcinoma. Threading may cause folliculitis, impetigo, and verrucae. The increasing prevalence of Asian cultural practices, which are performed inside and outside of Asia in this era of globalization, demands that dermatologists be familiar with the secondary dermatoses that may develop.

Comparison of Electrodesiccation and Potassium‐Titanyl‐Phosphate Laser for Treatment of Dermatosis Papulosa Nigra

BACKGROUND There is a lack of randomized split‐face studies investigating treatments for dermatosis papulosa nigra (DPN) in dark skin. OBJECTIVE To compare the efficacy, safety, and tolerability of potassium‐titanyl‐phosphate (KTP) laser with efficacy, safety, and tolerability of electrodesiccation in the treatment of DPN in subjects with Fitzpatrick skin phototypes IV to VI. METHODS Fourteen subjects with Fitzpatrick skin phototypes IV to VI were randomized to receive two KTP laser treatments 4 weeks apart to half of the face. The contralateral half received two electrodesiccation treatments 4 weeks apart. Response was evaluated by photography reviewed by blinded dermatologists at 4 weeks after the second treatment. A treatment quality questionnaire about side effects and cosmetic outcome was also administered. RESULTS Difference in improvement of DPN between the KTP side and the electrodesiccation side per each rater (p=.99, p=.54) and per raters combined (p=.50) did not reach statistical significance. There was no treatment difference for subjective effectiveness (p=.06) or subjective confidence improvement (p=.99), although there was a significant treatment difference for subjective discomfort (p=.002) in favor of KTP. Both treatments were well tolerated without significant adverse effects. CONCLUSIONS Although treatment of DPN with KTP laser and electrodesiccation are comparable in efficacy, KTP laser is preferable for patient comfort. The authors have indicated no significant interest with commercial supporters.

Perception of Skin Cancer Risk by Those With Ethnic Skin

tology, Kyungpook National University Hospital, 50 Samdeok 2-ga, Chung-Gu, Daegu, South Korea, 700-721 (shinam73@hotmail.com). Author Contributions: Dr W. J. Lee had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Park, S.-J. Lee, D. W. Kim, B. S. Kim, H. Y. Kim, Choi, and W. J. Lee. Acquisition of data: Park, S.-J. Lee, D. W. Kim, B. S. Kim, H. Y. Kim, Choi, and W. J. Lee. Analysis and interpretation of data: Park, S.-J. Lee, D. W. Kim, B. S. Kim, H. Y. Kim, Choi, E.-S. Lee, and W. J. Lee. Drafting of the manuscript: Park, S.-J. Lee, D. W. Kim, B. S. Kim, H. Y. Kim, Choi, and W. J. Lee. Critical revision of the manuscript for important intellectual content: Park, S.-J. Lee, D. W. Kim, B. S. Kim, H. Y. Kim, Choi, E.-S. Lee, and W. J. Lee. Administrative, technical, and material support: Park, S.-J. Lee, D. W. Kim, B. S. Kim, H. Y. Kim, Choi, and W. J. Lee. Study supervision: Park, S.-J. Lee, D. W. Kim, B. S. Kim, H. Y. Kim, Choi, and W. J. Lee. Financial Disclosure: None reported.

Facial hyperpigmentation: causes and treatment

By midcentury, the U.S.A. will be more ethnically and racially diverse. Skin of colour will soon constitute nearly one‐half of the U.S. population, and a full understanding of skin conditions that affect this group is of great importance. Structural and functional differences in the skin, as well as the influence of cultural practices, produce variances in skin disease and presentation based on skin type. In the skin of colour population, dyschromia is a growing concern, and a top chief complaint when patients present to the physician. A thorough understanding of the aetiology and management strategies of facial hyperpigmentation is of importance in caring for those afflicted and also in the development of new therapies.

Follicular and Scarring Disorders in Skin of Color: Presentation and Management

Skin of color, also known as ethnic skin, is described as skin of individuals of African, Asian, Hispanic, Native-American, Middle Eastern, and Pacific Island backgrounds. Differences in hair morphology, hair grooming, cultural practices, and susceptibility to keloid scarring exist within these populations and have been implicated in hair, scalp, and skin disorders. Acne keloidalis (AK), central centrifugal cicatricial alopecia (CCCA), dissecting cellulitis of the scalp (DCS), pseudofolliculitis barbae (PFB), traction alopecia (TA), and keloids are the most prevalent follicular and scarring disorders in skin of color. They have been associated with disfigurement, permanent hair loss, emotional distress, and decreased quality of life. Hair grooming practices, such as the use of chemical relaxers, heat straightening, and tight braiding and weaving can cause scalp irritation and follicular damage and are linked to the pathogenesis of some of these conditions. Consequently, patient education and behavior modifications are integral to the prevention and management of these disorders. Scarring disorders are also of concern in ethnic populations. Keloid scarring is more prevalent in individuals of African, Asian, and Hispanic descent. The scarring alopecia CCCA is almost exclusively seen in patients of African descent. Therapeutic regimens such as intralesional corticosteroids, surgical excision, and laser therapy can be effective for these follicular and scarring disorders, but carry a risk of dyspigmentation and keloid scarring. Ethnic skin and hair may present unique challenges to the clinician, and knowledge of these differences is essential to providing quality care.