Skin of Color | MDedge

Cosmetic laser procedures as well as energy-based fat reduction and body-contouring devices are increasingly popular among individuals with skin of color (SOC). Innovations in cosmetic devices and procedures tailored for SOC have allowed for the optimization of outcomes in this patient population. In this article, SOC is defined as darker skin types, including Fitzpatrick skin types (FSTs) IV to VI and ethnic backgrounds such as LatinX, African American, Southeast Asian, Native American, Pacific Islander, Middle Eastern, Asian, and African. Indications for laser treatment include dermatosis papulosa nigrans (DPN), acne scars, skin rejuvenation, and hyperpigmentation. There currently are 6 procedures for nonsurgical fat reduction that are approved by the US Food and Drug Administration (FDA): high-frequency focused ultrasound, cryolipolysis, laser lipolysis, injection lipolysis, radiofrequency lipolysis, and magnetic resonance contouring (Supplementary Table S1).¹

In this review, our initial focus is cosmetic laser procedures, encompassing FDA-cleared indications along with the associated risks and benefits in SOC populations. Subsequently, we delve into the realms of energy-based fat reduction and body contouring, offering a comprehensive overview of these noninvasive therapies and addressing considerations for efficacy and safety in these patients.

Dermatosis Papulosa Nigra

In patients with SOC, scissor excision, curettage, or electrodesiccation are the mainstay treatments for removal of DPN (Figure 1). Curettage and electrodesiccation can cause temporary postinflammatory hyperpigmentation (PIH) in these populations, while cryotherapy is not a preferred method in patients with SOC due to the possibility of cryotherapy-induced depigmentation. In a 14-patient split-face study comparing the 532-nm potassium titanyl phosphate (KTP) laser vs electrodesiccation in FSTs IV to VI, the KTP-treated side showed an improvement rate of 96%, while the electrodesiccation side showed an improvement rate of 79%. There was a statistically significant favorable experience for KTP with regard to pain tolerability (P=.002).² Complete resolution of lesions may be seen after 3 to 4 sessions at 4-week intervals. Additionally, the 1064-nm Nd:YAG laser was assessed for treatment of DPN in 2 patients, with 70% to 90% of lesions resolved after a single treatment with no complications.³

CT116002058-Fig1_AB — FIGURE 1. A and B, Dermatosis papulosa nigrans and seborrheic keratosis removal before and after treatment with low-voltage electrodesiccation in an African American woman.

Most dermatologists still rely on curettage and electrodesiccation instead of laser therapy to remove DPNs in patients with SOC. The use of the Nd:YAG laser is promising yet expensive for the provider both to purchase and maintain. Electrodesiccation has been used by dermatology practices for decades and can be used without permanent discoloration. To minimize the risk for PIH, we recommend application of a healing ointment such as petroleum jelly or aloe vera gel to the treated lesions as well as lightening agents for PIH and daily use of sunscreen. Overall, providers do not need to purchase an expensive laser device for DPN removal.

Acne Scars

The invention of fractional technology in the early 2000s and its favorable safety profile have changed how dermatologists treat scarring in patients with SOC.^4,5 In fact, nonablative fractional (NAF) resurfacing is a preferred treatment modality for management of acne scars in patients with SOC.⁶ In one study of the 1550-nm erbium-doped fiber laser for treatment of acne scars (3 treatments at intervals of 2-3 weeks) in 10 Japanese patients, clinical improvement was seen in all patients and no severe adverse effects were reported.⁷ In another study, 27 Korean patients with FSTs IV and V were treated with an NAF resurfacing device for acne scars. Excellent results were reported in 30% (8/27) of patients, substantial improvement in 59% (16/27), and moderate improvement in 11% (3/27).⁸ To evaluate outcomes in patients treated with NAF resurfacing, a retrospective review of 961 treatments showed a hyperpigmentation rate of 11.6% in those with FST IV and 33% in FST V.⁹

In one study of the short-pulsed nonablative Nd:YAG laser, 9 patients with FSTs I to V and 2 patients with FSTs IV to V underwent 8 treatments at 2-week intervals. Three blinded observers found a 29% improvement in the Global Acne Scar Severity score, while 89% (8/9) of patients self-reported subjective improvement in their acne scars.¹⁰

The 755-nm picosecond laser and diffractive lens array also have been shown to reduce the appearance of acne scars in patients with SOC, as shown via serial photography in a retrospective study of 56 patients with FSTs IV to VI. Transient hyperpigmentation, erythema, and edema were reported.¹¹

Nonablative laser therapy is preferred for skin rejuvenation in patients with SOC due to a reduced risk for postprocedural hyperpigmentation.¹¹ Ablative resurfacing (eg, CO₂ laser) poses major risks for postprocedural hyperpigmentation, hypopigmentation, and scar formation and therefore should be avoided in these populations.^12,13 A study involving 30 Asian patients (FSTs III-IV) demonstrated that the 1550-nm fractional laser was well tolerated, though higher treatment densities and fluences may lead to temporary adverse effects such as increased redness, swelling, and pain (P<.01).¹⁴ Furthermore, greater density was shown to cause higher levels of redness, hyperpigmentation, and swelling in comparison to higher fluence settings. Of note, patient satisfaction was markedly higher in patients who underwent treatment with higher fluence settings but not in patients with higher densities (P<.05). Postprocedural hyperpigmentation was noted in 6.7% (2/30) of patients studied.¹⁴ In another study, 8 patients with FSTs II to V were treated with either the 1064-nm long-pulsed Nd:YAG laser or the grid fractional monopolar radiofrequency laser.¹⁵ All participants experienced a significant decrease in mean wrinkle count using the Lemperle wrinkle assessment (P<.05). A significant decrease in mean wrinkle assessment score from 3.5 to 3.17 in clinical assessment and a decrease from 3.165 to 2.33 for photographic assessment was noted in patients treated with the grid laser (P<.05). A similar decrease in mean wrinkle assessment score was observed in the Nd:YAG group, with a mean decrease of 3.665 to 2.83 after 2 months for clinical assessment and 3.5 to 2.67 for photographic assessment. Among all patients in the study, 68% (6/8) experienced erythema, 25% (2/8) had a burning sensation, and 25% (2/8) experienced urticaria immediately postprocedure.¹⁵

Nonablative fractional resurfacing is preferred for the management of acne scars in patients with SOC. Adverse effects such as hyperpigmentation typically are transient, and the risk may be minimized with strict photoprotective practices following the procedure. Furthermore, avoidance of topicals containing exfoliants or α-hydroxy acids applied to the treated area following the procedure also may mitigate the risk for postprocedural hyperpigmentation.¹⁶ If hyperpigmentation does occur, use of topical melanogenesis inhibitors such as hydroquinone, kojic acid, or azelaic acid has shown some utility in practice.

Skin Rejuvenation

Nonablative fractional lasers (NAFLs) continue to be popular for treatment of photoaging. One study including 10 Asian patients (FSTs III-V) assessed the 1440-nm diode-based fractional laser for facial rejuvenation.¹⁷ After 4 sessions at 2-week intervals, 80% (8/10) of patients reported decreased skin roughness after both the second and third treatments, while 90% (9/10) had improved texture 1 month after the final procedure. Adverse effects included moderate facial edema and one case of transient hyperpigmentation.¹⁷ Another study reported a significant reduction in pore score (P<.002), with patients noting an overall improvement in skin appearance with minimal erythema, dryness, and flaking following 6 sessions at 2-week intervals using the 1440-nm diode-based fractional laser.¹⁸

The 1550-nm diode fractional laser significantly improved skin pigmentation (P<.001) and texture (P<.001) in 10 patients with FSTs II to IV following 5 sessions at 2- to 3-week intervals, with self-resolving erythema and edema posttreatment (Supplementary Table S2).¹⁹ Overall, NAFLs for the treatment of photoaging are effective with minimal adverse effects (eg, facial edema), which can be reduced with application of cold compression to the face and elevation of the head following treatment as well as the use of additional pillows during overnight sleep.

Laser Treatment for Hyperpigmentation Disorders

Melasma—The FDA recently approved fractional photothermolysis for the treatment of melasma; however, due to the risk for hyperpigmentation given its pathogenesis linked to hyperactive melanocytes, this laser is not considered a first-line therapy for melasma.²⁰ In a split-face, randomized study, 22 patients with FSTs III to V who were diagnosed with either dermal or mixed-type melasma were treated with a low-fluence Q-switched Nd:YAG laser combined with hydroquinone 2% vs hydroquinone 2% alone (Supplementary Table S3).²¹ Each patient was treated weekly for 5 consecutive weeks. The laser-treated side was found to reach an average of 92.5% improvement compared with 19.7% on the hydroquinone-only side. Three of the 22 (13.6%) patients developed mottled hypopigmentation after 5 laser treatments, and 8 (36.4%) developed confetti-type hypopigmentation. Four (18.2%) patients developed rebound hyperpigmentation, and all 22 patients experienced recurrence of melasma by 12 weeks posttreatment.²¹

First-line treatment for melasma involves the application of topical lightening agents such as hydroquinone, azelaic acid, kojic acid, retinoids, or mild topical steroids. Combining laser technology with topical medications can enhance treatment outcomes, particularly yielding positive results for patients with persistent pigmentation concerns. Notably, utilization of 650-microsecond technology with the 1064-nm Nd:YAG laser is considered superior in clinical practice, especially for patients with FSTs IV through VI.

Postinflammatory Hyperpigmentation—A retrospective evaluation of 61 patients with FSTs IV to VI with PIH treated with a 1927-nm NAFL showed a mean improvement of 43.24%, as assessed by 2 dermatologists.²² Additionally, the Nd:YAG 1064-nm 650-microsecond pulse duration laser is an emerging treatment that delivers high and low fluences between 4 J/cm² and 255 J/cm² within a single 650-microsecond pulse duration.²³The short-pulse duration avoids overheating the skin, mitigating procedural discomfort and the risk for adverse effects commonly seen with the previous generation of low-pulsed lasers. In addition to PIH, this laser has been successfully used to treat pseudofolliculitis barbae.²⁴

Solar Lentigos—In a split-face study treating solar lentigos in Asian patients, 4 treatments with a low-pulsed KTP 532-nm laser were administered with and without a second treatment with a low-pulsed 1064-nm Nd:YAG laser.²⁵ Scoring of a modified pigment severity index and measurement of the melanin index showed that skin treated with the low-pulsed 532-nm laser alone and in combination with the low-pulsed 1064-nm Nd:YAG laser resulted in improvement at 3 months’ follow-up. However, there was no difference between the 2 sides of the face, leading the researchers to conclude that the low-pulsed 532-nm laser appears to be safe and effective for treatment of solar lentigos in Asian patients and does not require the addition of the low-pulsed 1064-nm laser.²⁵

To avoid hyperpigmentation in patients with SOC, strict photoprotection to the treated areas should be advised. Proper cooling of the laser-treated area is required to minimize PIH, as cooling decreases tissue damage and excessive thermal injury. Test spots should be considered prior to initiation of the full laser treatment. Hydroquinone in a 4% concentration applied daily for 2 weeks preprocedure commonly is employed to reduce the risk for postprocedural hyperpigmentation in clinical practice.^26,27

Skin Tightening and Body Contouring

In general, skin-tightening and body-contouring devices are among the most sought-after procedures. Studies performed in patients with SOC are limited. Herein, we provide background on why these devices are favorable for patients with SOC and our experiences in using them. A summary of these devices can be found in Supplementary Table S4.

Radiofrequency Skin Tightening—Radiofrequency devices are utilized for skin tightening as well as mild fat reduction; they commonly are used on the abdomen, thighs, buttocks, and face.²⁸ People with SOC are more responsive to radiofrequency skin-tightening therapy due to higher baseline collagen content and dermal thickness, more sebaceous activity and skin elasticity, and more melanin content which offers protective thermal buffering.^29,30 As the radiofrequency device emits heat, penetrating deep into the dermis, it generates collagen remodeling and synthesis within 4 to 6 months posttreatment.

Nonsurgical Fat Reduction

Procedures for nonsurgical fat reduction are favorable due to minimal recovery time, manageable cost, and an in-office procedure setting. As noted previously, there are 6 FDA-indicated interventions for nonsurgical fat reduction: ultrasonography, cryolipolysis, laser lipolysis, injection lipolysis, radiofrequency lipolysis, and magnetic resonance contouring.³¹

Ultrasonography—Ultrasound devices designed for body contouring are used for skin tightening and mild fat reduction through the use of acoustic energy.³² These devices can be divided into 2 categories: high frequency and low frequency, with the high-frequency devices being the most popular. High-frequency ultrasound energy produces heat at target sites, which induces necrosis of adipocytes and stimulates collagen remodeling within the tissue matrix.³³ Tissue temperatures above 56°C stimulate adipocyte necrosis while sparing nearby nerves and vessels.²⁸ Because of the short duration of the procedure, the risk for epidermal damage is minimal. Contrary to high-frequency ultrasonography, focus-pulsed ultrasonography employs low-frequency waves to induce the mechanical disruption of adipocytes, which is generally better tolerated due to its nonthermal mechanism. The latter may be advantageous in patients with SOC due to a reduced risk for thermal injury to the epidermis. Multiple treatments often are needed at 3- to 4-week intervals, resulting in gradual improvement observed over 2 to 6 months. One study of microfocused ultrasonography in 25 Asian patients for treatment of face and neck laxity reported that skin laxity was improved or much improved in 84% (21/25) of patients following treatment.³⁴ Adverse effects were reported as mild and transient, resolving within 90 days.³⁴ Ultrasound devices also were shown to improve wrinkles, texture, and overall appearance of the skin in a 71-year-old African American woman 4 months following treatment (Figure 2). These photographs highlight the clinical utility of a microfocused ultrasound skin-tightening treatment in African American patients.

CT116002058-Fig2_AB — FIGURE 2. A and B, Microfocused ultrasound skin-tightening treatment in a 71-year-old African American woman before and 4 months after treatment.

Cryolipolysis—Cryolipolysis is a noninvasive body contouring procedure that employs controlled cooling to induce subcutaneous panniculitis. Through cold-induced apoptosis of adipocytes, this procedure selectively reduces adipose tissue in localized areas such as the flank, abdomen, thighs, buttocks, back, submental area, and upper arms. The temperature used in cryolipolysis is approximately –10°C.³⁵ The lethal temperature for melanocytes is –4 °C, below which melanocyte apoptosis may be induced, resulting in depigmentation. Given the prolonged contact of the skin with a cryolipolysis device for up to 60 minutes during a body-contouring procedure, there is a risk for resultant depigmentation in darker skin types. Controlled studies are needed to fully evaluate the safety and efficacy of cryolipolysis in patients with SOC. One retrospective study of cryolipolysis applied to the abdomen and upper arm of 4122 Asian patients reported a significant (P<.05) reduction in the circumference of the abdomen and the upper-arm areas. No long-term adverse effects were reported.³⁶

Laser Lipolysis—The 1060-nm diode laser for body contouring selectively destroys adipose tissue, resulting in body contouring via thermally induced inflammation. Hyperthermic exposure for 15 minutes selectively elevates adipocyte temperature between 42°C to 47°C, which triggers apoptosis and the eventual clearance of destroyed cells from the interstitial space.³⁷ The selectivity of the 1060-nm wavelength coupled with the device’s contact cooling system preserves the overlying skin and adnexa during the procedure,³⁷ which would minimize epidermal damage that may induce dyspigmentation in patients with SOC. No notable adverse effects or dyspigmentation have been reported using this device.

Injection Lipolysis—Deoxycholic acid is an injectable adipocytolytic for the reduction of submental fat. It nonselectively lyses muscle and other adjacent nonfatty tissue. One study of 50 Indian patients demonstrated a substantial reduction of submental fat in 90% (45/50).³⁸ For each treatment, 5 mL of 30 mg/mL deoxycholic acid was injected. Serial sessions were conducted at 2-month intervals, and most (64% [32/50]) patients required 3 sessions to see a treatment effect. Adverse effects included transient swelling, lumpiness, and tenderness. A phase 2a investigation of the novel injectable small-molecule drug CBL-514 in 43 Asian and White participants found a significant improvement in the reduction in abdominal fat volume (P<.00001) and thickness (P<.0001) relative to baseline at higher doses (unit dose, 2.0 mg/cm² and 1.6 mg/cm²).³⁹ In addition to the adverse effects mentioned previously, pruritus, repeated urticaria, body rash, and fever also were reported.³⁹

Radiofrequency Lipolysis—Radiofrequency is used for adipolysis through heat-induced apoptosis. To achieve this effect, adipose tissue must sustain a temperature of 42 °C to 45 °C for at least 15 minutes.⁴⁰ In one study, 4 treatments performed at 7-day intervals resulted in a statistically significant reduction in circumference to the treated areas of the inner and outer thighs without any reported adverse effects (P<0.001).⁴¹ Of note, there was 1 cm of distance between the applicator and the skin. The absence of direct contact with the skin is likely to reduce the risk for postprocedural complications in patients with SOC.

Magnetic Resonance Contouring—Magnetic resonance contouring with high-intensity focused electromagnetic technology is an emerging treatment modality for noninvasive body contouring. One distinguishing characteristic from other currently available noninvasive fat-reduction therapies is that magnetic resonance may improve strength, tone, and muscle thickness.⁴² This modality is FDA approved for contouring of the buttocks and abdomen and employs electromagnetic energy to stimulate approximately 20,000 muscle contractions within a time frame of 30 minutes. Though the mechanisms causing benefits to muscular and adipose tissue have not been elucidated, current findings suggest that the contractions stimulate substantial lipolysis of adipocytes, resulting in the release of large amounts of free fatty acids that cause damage to nearby adipose tissue.⁴³ Multiple treatments are required over time to maintain effect. No major adverse effects have been reported. The likely mechanism of action of magnetic resonance contouring does not appear to pose an increased risk to patients with SOC.

Final Thoughts

One of the major roadblocks in distilling indications along with associated risks and benefits for nonsurgical cosmetic practices for patients with SOC is a void in the primary literature involving these populations. Clinical experience serves to address this deficit in combination with a thorough review of the literature. The 1064-nm Nd:YAG laser has shown clinical utility in the treatment of DPN, melanoma, and acne scars, but it poses financial constraints to the provider in comparison to modalities used for many years. Notably, NAF resurfacing is preferred for the management of acne scars in patients with SOC and continues to gain popularity for the treatment of photoaging. Regarding skin-tightening and body-contouring devices, studies performed in patients with SOC are limited and affected by factors such as small sample sizes, underrepresentation of FSTs IV through VI, short follow-up durations, and a lack of standardized outcome measures. Additionally, few studies assess pigmentary adverse effects or stratify results by skin type, which is critical given the higher risk for PIH in SOC. Ultrasound devices showed clinical utility in improvement of skin laxity, texture, and overall improvement. Patients with SOC respond well to skin-tightening devices due to the increased collagen synthesis. Regarding emerging devices for reduction of adipocytes, deoxycholic acid when injected showed notable improvement in fat reduction but also had adverse effects. As additional studies on cosmetic procedures in SOC emerge, an expansion of treatment options could be offered to this demographic group with confidence, provided proper treatment and follow-up protocols are in place.

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Author and Disclosure Information

Dr. Sheppard is from the Department of Internal Medicine, University of California Los Angeles-Olive View. Dr. Quiñonez is from the Department of Dermatology, Henry Ford Health, Detroit, Michigan. Dr. Burgess is from the Center for Dermatology and Dermatologic Surgery, Washington, DC. Dr. Taylor is from the Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dr. Agbai is from the Department of Dermatology, University of California Davis School of Medicine, Sacramento.

Drs. Sheppard and Quiñonez have no relevant financial disclosures to report. Dr. Burgess is a consultant for Allergan, ISDIN, Merz, and Revance. Dr. Taylor serves on the advisory board of and/or is a consultant for Aclaris Therapeutics Inc, Allergan, Almirall, Arcutis Biotherapeutics, The Avon Company, Beiersdorf, Croma, Eli Lilly and Company, Evolus, Galderma, GLODERM, Johnson & Johnson, KGL Skin Study Center, L’Oréal, LuminDx, Ortho Dermatologics, Pfizer, Senate Laboratories, Vichy Laboratories, and Walgreen Boots Alliance. Dr. Agbai is a consultant for AbbVie, Unilever, and VisualDx.

Correspondence: Oma N. Agbai, MD, University of California Davis School of Medicine, Department of Dermatology, 3301 C St, Ste 1400, Sacramento, CA 95605 ([email protected]).

Cutis. 2025 August;116(2):58-64. doi:10.12788/cutis.1254

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Dermatosis Papulosa Nigra

Acne Scars

Skin Rejuvenation

Laser Treatment for Hyperpigmentation Disorders

Skin Tightening and Body Contouring

Nonsurgical Fat Reduction

Final Thoughts

Dermatosis Papulosa Nigra

Acne Scars

Skin Rejuvenation

Laser Treatment for Hyperpigmentation Disorders

Skin Tightening and Body Contouring

Nonsurgical Fat Reduction

Final Thoughts

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Cosmetic Laser Procedures and Nonsurgical Body Contouring in Patients With Skin of Color

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Mazzoni D, Lin MJ, Dubin DP, et al. Review of non-invasive body contouring devices for fat reduction, skin tightening and muscle definition. Australas J Dermatol. 2019;60:278-283. doi:10.1111/ajd.13090
Kundu RV, Joshi SS, Suh KY, et al. Comparison of electrodesiccation and potassium-titanyl-phosphate laser for treatment of dermatosis papulosa nigra. Dermatol Surg. 2009;35:1079-1083. doi:10.1111/j.1524-4725.2009.01186.x&
Schweiger ES, Kwasniak L, Aires DJ. Treatment of dermatosis papulosa nigra with a 1064 nm Nd:YAG laser: report of two cases. J Cosmet Laser Ther. 2008;10:120-122. doi:10.1080/14764170801950070
Manstein D, Herron GS, Sink RK, et al. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34:426-438. doi:10.1002/lsm.20048
Alajlan AM, Alsuwaidan SN. Acne scars in ethnic skin treated with both non-ablative fractional 1,550 nm and ablative fractional CO2 lasers: comparative retrospective analysis with recommended guidelines. Lasers Surg Med. 2011;43effi:787-791. doi:10.1002/lsm.21092
Ke R, Cai B, Ni X, et al. Efficacy and safety of non-ablative vs. ablative lasers for acne scarring: a meta-analysis. J Deutschen Dermatologischen Gesellschaft. Published online March 11, 2025. doi: 10.1111/ddg.15651
Goel A, Krupashankar DS, Aurangabadkar S, et al. Fractional lasers in dermatology—current status and recommendations. Indian J Dermatol Venereol Leprol. 2011;77:369. doi:10.4103/0378-6323.79732
Lee HS, Lee JH, Ahn GY, et al. Fractional photothermolysis for the treatment of acne scars: a report of 27 Korean patients. J Dermatolog Treat. 2008;19:45-49. doi:10.1080/09546630701691244
Zhang AD, Clovie J, Lazar M, et al. Treatment of benign pigmented lesions using lasers: a scoping review. J Clin Med. 2025;14li:3985. doi:10.3390/jcm14113985
Lipper GM, Perez M. Nonablative acne scar reduction after a series of treatments with a short-pulsed 1,064-nm neodymium:YAG laser. Dermatol Surg. 2006;32:998-1006. doi:10.1111/j.1524-4725.2006.32222.x
Mar K, Khalid B, Maazi M, et al. Treatment of post-inflammatory hyperpigmentation in skin of colour: a systematic review. J Cutan Med Surg. 2024;28:473-480. doi:10.1177/12034754241265716
Kono T, Chan HH, Groff WF, et al. Prospective direct comparison study of fractional resurfacing using different fluences and densities for skin rejuvenation in Asians. Lasers Surg Med. 2007;39:311-314. doi:10.1002/lsm.20484
Sharkey JR, Sharf BF, St John JA. “Una persona derechita (staying right in the mind)”: perceptions of Spanish-speaking Mexican American older adults in South Texas colonias. Gerontologist. 2009;49 suppl 1:S79-85. doi:10.1093/geront/gnp086
Wu X, Cen Q, Jin J, et al. An effective and safe laser treatment strategy of fractional carbon dioxide laser for Chinese populations with periorbital wrinkles: a randomized split-face trial. Dermatol Therapy. 2025;15:1307-1317.
Milante RR, Doria-Ruiz MJ, Beloso MB, et al. Split-face comparison of grid fractional radiofrequency vs 1064-nm Nd-YAG laser treatment of periorbital rhytides among Filipino patients. Dermatol Ther. 2020;33:e14031. doi:10.1111/dth.14031
Alexis AF, Andriessen A, Beach RA, et al. Periprocedural skincare for nonenergy and nonablative energy-based aesthetic procedures in patients with skin of color. J Cosmet Dermatol. 2025;24:E16712. doi:10.1111/jocd.16712
Marmon S, Shek SYN, Yeung CK, et al. Evaluating the safety and efficacy of the 1,440-nm laser in the treatment of photodamage in Asian skin. Lasers Surg Med. 2014;46:375-379. doi:10.1002/lsm.22242
Saedi N, Petrell K, Arndt K, et al. Evaluating facial pores and skin texture after low-energy nonablative fractional 1440-nm laser treatments. J Am Acad Dermatol. 2013;68:113-118. doi:10.1016/j.jaad.2012.08.041
Jih MH, Goldberg LH, Kimyai-Asadi A. Fractional photothermolysis for photoaging of hands. Dermatol Surg. 2008;34:73-78. doi:10.1111/j.1524-4725.2007.34011.x
Prohaska J, Hohman MH. Laser complications. StatPearls. Updated August 28, 2023. Accessed July 23, 2025. http://www.ncbi.nlm.nih.gov/books/NBK532248/
Trivedi MK, Yang FC, Cho BK. A review of laser and light therapy in melasma. Int J Womens Dermatol. 2017;3:11-20. doi:10.1016/j.ijwd.2017.01.004
Brauer JA, Kazlouskaya V, Alabdulrazzaq H, et al. Use of a picosecond pulse duration laser with specialized optic for treatment of facial acne scarring. JAMA Dermatol. 2015;151:278-284. doi:10.1001/jamadermatol.2014.3045
Greywal T, Ortiz A. Treating melasma with the 1064 nm Nd:YAG laser with a 650-microsecond pulse duration: a clinical evaluation. J Cosmet Dermatol. 2021;20:3889-3892. doi:10.1111/jocd.14558
Weaver SM, Sagaral EC. Treatment of pseudofolliculitis barbae using the long-pulse Nd:YAG laser on skin types V and VI. Dermatol Surg. 2003;29:1187-1191. doi:10.1111/j.1524-4725.2003.29387.x
Negishi K, Tanaka S, Tobita S. Prospective, randomized, evaluator-blinded study of the long pulse 532-nm KTP laser alone or in combination with the long pulse 1064-nm Nd:YAG laser on facial rejuvenation in Asian skin. Lasers Surg Med. 2016;48:844-851. doi:10.1002/lsm.22582
Kaushik S, Alexis AF. Nonablative fractional laser resurfacing in skin of color: evidence-based review. J Clin Aesthetic Dermatol. 2017;10:51-67.
Garg S, Vashisht KR, Garg D, et al. Advancements in laser therapies for dermal hyperpigmentation in skin of color: a comprehensive literature review and experience of sequential laser treatments in a cohort of 122 Indian patients. J Clin Med. 2024;13:2116. doi:10.3390/jcm13072116
Alizadeh Z, Halabchi F, Mazaheri R, et al. Review of the mechanisms and effects of noninvasive body contouring devices on cellulite and subcutaneous fat. Int J Endocrinol Metab. 2016;14:e36727. doi:10.5812/ijem.36727
Rawlings AV. Ethnic skin types: are there differences in skin structure and function? Int J Cosmet Sci. 2006;28:79-93. doi:10.1111/j.1467-2494.2006.00302.x
El-Domyati M, El-Ammawi TS, Medhat W, et al. Radiofrequency facial rejuvenation: Evidence-based effect. J Am Acad Dermatol. 2011;64:524-535. doi:10.1016/j.jaad.2010.06.045
US Food and Drug Administration. Non-invasive body contouring technologies. Published December 7, 2022. Accessed July 23, 2025. https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/non-invasive-body-contouring-technologies
Robinson DM, Kaminer MS, Baumann L, et al. High-intensity focused ultrasound for the reduction of subcutaneous adipose tissue using multiple treatment techniques. Dermatol Surg. 2014;40:641-651. doi:10.1111/dsu.0000000000000022
Biskanaki F, Tertipi N, Sfyri E, et al. Complications and risks of high-intensity focused ultrasound (HIFU) in esthetic procedures: a review. Applied Sciences. 2025;15:4958. doi:10.3390/app15094958
Lu PH, Yang CH, Chang YC. Quantitative analysis of face and neck skin tightening by microfocused ultrasound with visualization in Asians. Dermatol Surg. 2017;43:1332-1338. doi:10.1097/DSS.0000000000001181
Avram MM, Harry RS. Cryolipolysis for subcutaneous fat layer reduction. Lasers Surg Med. 2009;41:703-708. doi:10.1002/lsm.20864
Nishikawa A, Aikawa Y. Quantitative assessment of the cryolipolysis method for body contouring in Asian patients. Clin Cosmet Investig Dermatol. 2021;14:1773-1781. doi:10.2147/CCID.S337487
Bass LS, Doherty ST. Safety and efficacy of a non-invasive 1060 nm diode laser for fat reduction of the abdomen. J Drugs Dermatol. 2018;17:106-112
Shome D, Khare S, Kapoor R. The use of deoxycholic acid for the clinical reduction of excess submental fat in Indian patients. J Drugs Dermatol. 2019;18:266-272.
Goodman GJ, Ho WWS, Chang KJ, et al. Efficacy of a novel injection lipolysis to induce targeted adipocyte apoptosis: a randomized, phase IIa study of CBL-514 injection on abdominal subcutaneous fat reduction. Aesthetic Surg J. 2022;42:NP662-NP674. doi:10.1093/asj/sjac162
McDaniel D, Lozanova P. Human adipocyte apoptosis immediately following high frequency focused field radio frequency: case study.J Drugs Dermatol. 2015;14:622-623.
Fritz K, Samková P, Salavastru C, et al. A novel selective RF applicator for reducing thigh circumference: a clinical evaluation. Dermatol Ther. 2016;29:92-95. doi:10.1111/dth.12304
Kinney BM, Lozanova P. High intensity focused electromagnetic therapy evaluated by magnetic resonance imaging: safety and efficacy study of a dual tissue effect based non-invasive abdominal body shaping. Lasers Surg Med. 2019;51:40-46. doi:10.1002/lsm.23024
Negosanti F, Cannarozzo G, Zingoni T, et al. Is it possible to reshape the body and tone it at the same time? Schwarzy: the new technology for body sculpting. Bioengineering (Basel). 2022;9:284. doi:10.3390/bioengineering9070284

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Nonablative fractional lasers are preferred for acne scars in skin of color (SOC), minimizing hyperpigmentation risk.
The 1064-nm Nd:YAG and picosecond lasers are safe and effective when used with SOC-appropriate settings.
Photoprotection and topical lightening agents reduce postprocedure pigmentation risks.

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Evaluating Factors Impacting Hidradenitis Suppurativa Disease Severity in Patients With Darker Skin Types

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Evaluating Factors Impacting Hidradenitis Suppurativa Disease Severity in Patients With Darker Skin Types

Author(s)

Kareena S. Garg, BS

Desiree Pinto, MD, MPH

Bonnie C. Carney, PhD

Hidradenitis suppurativa (HS) is a debilitating chronic skin disease that often affects apocrinebearing regions of the skin such as the axillae, perineum, and groin.¹ Although current research on the etiology and pathogenesis of HS is limited, the disease is known to have a considerable psychosocial impact on patient quality of life.

Clinically, HS lesions manifest as tender subcutaneous nodules that rupture to form painful and deep dermal abscesses.² These lesions typically develop due to hair follicle occlusion, followed by a cyclic process of inflammation, healing, re-inflammation, and scarring. Often, they are mistaken for cysts or a simple abscess in the early stages of the disease, leading to a delay in diagnosis.¹ Disease severity is categorized based on Hurley staging: stage 1 involves abscess formation without scarring; stage 2 involves limited sinus tracts and recurrent abscesses with scarring and/or multiple separated lesions; and stage 3 is the most advanced stage, with diffuse involvement or multiple interconnected sinus tracts across an area with scarring. The condition primarily is medically managed with antibiotics and immunomodulators, but patients who have refractory disease can benefit from surgical excision.^1,2

The prevalence of HS in the United States ranges from 0.77% to 1.19%, and individuals who self-identify as Black have 3-fold higher odds of having this condition compared with all other racial groups.^3-5 Black patients also are thought to have a greater number and size of apocrine glands compared with patients who self-identify as White, suggesting an anatomic predisposition to developing HS and greater disease severity.⁶ However, despite HS disproportionately impacting individuals with skin of color (SOC), the majority of published HS research includes predominantly White patient cohorts.⁵ There is insufficient research assessing HS epidemiology, comorbidities, and treatment responses in patients with SOC.

A 2020 review reported the notable lack of clinical trials that sufficiently examine systemic medication treatment response in HS patients with SOC.⁷ Of the 15 HS treatment trials published from 2000 to 2019, only 16.4% (138/840) of the patient population were of African descent.⁷ Clinical trials investigating the efficacy of adalimumab in reducing HS burden also did not adequately evaluate clinical response in patients with SOC. One clinical trial did not include any Black patients as part of the cohort,⁸ and in 3 other studies, 80% to 85% of the study participants self-identified as White.⁹ The current literature does not reflect the patient populations most affected by HS, as several studies have reported that 65% of patients diagnosed with HS in the United States annually are Black.^5,7 These results emphasize the underrepresentation of SOC populations in the current HS literature and the need for more research that investigates the disease processes, comorbidities, and treatment outcomes of the diverse patient population impacted by HS.

Methods

Study Population and Data Extraction—Following a protocol reviewed and approved by the MedStar Health/Georgetown University institutional review board (IRB #00006783), a retrospective chart review of 31 adult patients with HS who underwent surgery at a regional verified burn center from April 2014 to April 2023 was conducted. The following variables were collected from the electronic medical record (EMR): baseline demographics including age, sex, body mass index (BMI), obesity status, race, ethnicity, Fitzpatrick skin type, smoking status, substance use, employment status, and family history of HS; HS-specific details including Hurley staging, affected areas, and age at initial diagnosis; comorbidities such as dermatologic conditions, autoimmune disorders, infectious diseases, cardiovascular and associated diseases, ovarian disorders, gastrointestinal diseases, and othother common chronic comorbidities (psychiatric illness, kidney disease, type 2 diabetes [T2D], asthma, allergies, lymphedema, and inflammatory eye disease); and use of pharmacologics such as topical medications, oral antibiotics, immunomodulators, and steroids.

Study Definitions—Obesity was defined as both a continuous and categorical variable. Each patient’s BMI at the surgery date was recorded from the EMR as a continuous variable. Patients with obesity also had this condition listed under their complaints and problem list in the EMR, which was recorded as a categorical variable. Race and ethnicity were self-reported by patients. Comorbidity data, including T2D and hyperlipidemia, were defined by previously diagnosed diseases listed in the EMR. Pharmacologic medication data were included in the study if a patient was recommended/prescribed a medication and they had confirmed use of the medication in a subsequent office visit.

Statistical Analysis—Descriptive statistics were calculated for demographics, HS characteristics (eg, location, Hurley stage), and comorbidities. Continuous variables were presented as mean and standard deviation or median and interquartile range and were evaluated using a t test or Mann-Whitney U test when appropriate. Categorical variables were presented as frequencies and percentages and tested for associations using the X² or Fisher exact test. Data analyses were performed using SAS software version 9.4 (SAS Institute Inc.).

Results

Thirty-one patients (17 females, 14 males; mean age, 40.9 years) were included in the study. Twenty-nine (93.5%) patients identified as Black. All study patients had at least 1 comorbidity. Obesity was diagnosed in 22 (71.0%) patients (mean BMI, 35.5 kg/m²). A total of 16 (51.6%) patients were current smokers, 3 (9.7%) were past smokers, 22 (71%) reported alcohol use, and 17 (54.8%) were active marijuana users. Only 3 (9.7%) patients had a family history of HS (Table 1).

Other common comorbidities associated with HS were anemia (64.5% [20/31]), a non–inflammatory bowel disease gastrointestinal disease (61.3% [19/31]), allergies (54.8% [17/31]), hypertension (41.9% [13/31]), cardiovascular disease (41.9% [13/31]), T2D (32.3% [10/31]), asthma (32.3% [10/31]), kidney disease (29.0% [9/31]), and atopic dermatitis (25.8% [8/31]). More than half (54.8% [17/31]) of patients were diagnosed with psychiatric illnesses, including depression, anxiety, bipolar depression, psychosis, anorexia, impulsive anger, hallucinations, delusion, attention deficit-hyperactivity disorder, and panic disorder (Table 2). Depression was diagnosed in 38.7% (12/31) of patients, and 22.6% (7/31) were diagnosed with anxiety.

The most common anatomic locations for HS were the right axilla (74.2% [23/31]), left axilla (74.2% [23/31]), groin (71% [22/31]), perineum (61.3% [19/31]), buttocks (41.9% [13/31]), and thigh (41.9% [13/31]). Other locations included the breast, lower back, posterior neck, dorsal foot, and scalp (all 3.2% [1/31])(Table 3). Twenty (64.5%) patients had Hurley staging recorded in the EMR. Seventeen (54.8%) were categorized as Hurley stage 3, and 3 (9.7%) were categorized as Hurley stage 2.

Twenty-nine (93.5%) patients were prescribed an oral antibiotic regimen. The most common oral antibiotics were clindamycin (35.5% [11/31]), doxycycline (35.5% [11/31]), rifampin (29% [9/31]), trimethoprim/sulfamethoxazole (22.6% [7/31]), and cephalexin (22.6% [7/31]). Of the patients who were prescribed rifampin, 87.5% (8/9) also were prescribed an adjunct oral clindamycin regimen. Twenty-nine percent (9/31) of patients were prescribed a biologic regimen; 22.6% (7/31) were prescribed adalimumab, 3.2% (1/31) were prescribed secukinumab, and 3.2% (1/31) were prescribed ustekinumab (Table 4).

Twenty-five (80.6%) patients were prescribed a topical treatment regimen, the most common being topical clindamycin (45.2% [14/31]). Other topical medications included triamcinolone (12.9% [4/31]), chlorhexidine gluconate wash (9.7% [3/31]), clobetasol (3.2% [1/31]), hydrocortisone (3.2% [1/31]), and hydroquinone (3.2% [1/31])(Table 4).

Other medical treatments for HS included metformin (25.8% [8/31]), spironolactone (16.1% [5/31]), and zinc supplements (12.9% [4/31]). Four patients (12.9%) were prescribed clindamycin plus rifampin as well as a combination of metformin, spironolactone, and/or zinc (Table 4).

Twenty-two (71.0%) patients had a history of receiving incision and drainage procedures as treatment for HS. All 31 patients underwent excisional surgery followed by appropriate reconstruction. The total number of excisional surgeries a single patient underwent for HS treatment ranged from 1 to 9, with a mean of 2 excisional surgeries per patient.

Comment

Our regional verified burn center in Washington, DC, serves a large population of patients with SOC, making it a unique and important sample to study for HS. Our results suggest that Black patients with HS may be at a higher risk for depression and anxiety. Twelve (38.7%) of our patients were diagnosed with depression, which is substantially higher than the 17% to 21% depression prevalence rate among all HS patients reported in meta-analyses.^10,11 Additionally, 22.6% (7/31) of our patients were diagnosed with anxiety, which is higher than the 5% to 12% prevalence rate of anxiety among HS patients reported in meta-analyses.^10,11 The stress of chronic disease management, psychosocial impact of living with HS, social stigma, sexual dysfunction, pain, and financial concerns make mental illness a debilitating yet common comorbidity for patients with HS. The results of our study suggest that anxiety and depression are highly prevalent among Black patients with HS. It is important to identify if this finding is due to the interplay of health care disparities and social determinants of health; the cause likely is multifactorial, as race and ethnicity may be potential predictors for increased disease severity. Hidradenitis suppurativa is known to be a major economic burden on patients, and race-dependent structural and societal inequalities may be influencing the increased prevalence of anxiety and depression among Black patients with HS.¹² Therefore, clinicians must be vigilant for the signs and symptoms of mental illnesses to refer patients for psychiatric treatment when appropriate. Implementing self-report Patient Health Questionnaire-9, General Anxiety Disorder-7 depression and anxiety screening tools, and Dermatology Life Quality Index questionnaires at primary care and dermatology office visits may be a beneficial step toward identifying patients who could benefit from additional mental health resources.¹³

The patients included in our study predominantly self-identified as Black, and the current smoker prevalence rate was 51.6% (16/31). This percentage is lower than the smoking rates of other published HS studies conducted in predominantly White patient populations, which report up to a 76.5% smoking prevalence rate.^14-16 One review article published in 2022 reported that approximately 90% of HS patients are current or former smokers.¹⁷ Additionally, a retrospective cohort analysis identifying HS cases among 3,924,310 tobacco smokers in the United States reported that tobacco smokers diagnosed with HS most commonly racially self-identified as White (66.2%).¹⁸ Tobacco chemicals and smoke can increase inflammatory cytokine levels, and the activation of nicotinic acetylcholine receptors surrounding pilosebaceous-apocrine units can increase follicular occlusion.¹⁴ While several studies^1-3,14,19,20 support the strong correlation between tobacco smoking and HS, there are very few that specifically investigate the association between smoking and HS disease in SOC populations. It is possible that smoking rates may be lower in Black patients with HS compared with White patients with HS, which would suggest a multifactorial nature of HS disease pathophysiology. Future large, multicenter studies are needed that investigate smoking rates and HS disease severity in patients across various racial groups.

Prior research has shown a strong correlation between cigarette smoking and HS, but there is minimal data on the role of use of marijuana and other illicit drugs in HS disease pathophysiology.²¹ A total of 54.8% of our patients were active marijuana users with daily or weekly usage. Further research is needed to investigate whether marijuana use is linked with HS disease pathophysiology and severity or if patients with HS may be using marijuana to relieve pain, anxiety, and depression. Additional studies that survey the method of marijuana use (eg, joint, vape devices, or edibles) would clarify the relationship between not only HS and marijuana but also a potential link between disease severity and the process of inhaling large amounts of smoke vs a link with the active ingredients in the marijuana plant itself.

Approximately 61% (19/31) of our patients were diagnosed with a gastrointestinal disease in addition to HS. Current research reports the link between HS and inflammatory bowel disease, but few studies have investigated if a relationship exists between the gut microbiome and HS, as well as the incidence of general gastrointestinal disease among Black patients with HS.^14,22 Our patients were diagnosed with gastrointestinal conditions such as colonic polyps, gastroesophageal reflux disease, benign neoplasms of the cecum and sigmoid colons, small bowel obstruction and perforation, biliary tract diseases, ileus, abdominal hernia, peritonitis, and diverticulosis. Further research is warranted to identify if there is a true relationship between gastrointestinal disease, the gut microbiome, and skin conditions such as HS.²² Biochemical research on the common genetic and inflammatory cytokine pathways involved in HS and gastrointestinal manifestations could help predict disease severity and management in HS patients with SOC.

Several research studies have reported the association between obesity and HS, likely due to adipose cells producing increased estrogen and leading to an estrogen-dominant hormone profile and increased local androgen production in adipose tissue.^14,23,24 Antiandrogenic drugs such as finasteride and spironolactone lead to positive results in HS treatment compared to oral antibiotics alone.²⁴ While 71.9% (22/31) of our patients were diagnosed with obesity, only 16.1% (5/31) were prescribed antiandrogen therapy such as spironolactone. It is unclear if this result reflects a health disparity due to insufficient insurance coverage and low prescribing rates or if there is patient hesitancy to taking antiandrogen medications. Additional clinical trials are needed to investigate the efficacy of antiandrogen therapies for HS. If proven to be efficacious, providers should consider adding these medications to the pharmacologic regimen of HS patients with SOC prior to recommending wide-excision surgeries. Furthermore, in addition to antiandrogen medication, weight-management interventions may be helpful in reducing HS disease. The results of a survey conducted in 35 HS patients who underwent bariatric surgery reported 48.6% (17/35) experienced complete disease remission after more than a 15% weight reduction.^25,26 Investigating the impact of weight-management practices on disease severity would be helpful in outlining nonpharmacologic treatments for patients with HS.

Limitations

Our study was limited by the constraints of a retrospective chart review and small sample size. Retrospective chart reviews are susceptible to recall bias, variability in providers’ charting practices, and human error from data collectors. We acknowledge that a control group of non-HS patients should be the next step in furthering our research on HS disease comorbidities. Also, since 35.5% (11/31) of our patients did not have Hurley staging recorded in the EMR, it would be beneficial to conduct a future study comprehensive of all 3 Hurley stages. Since 93.5% (29/31) of the patients in our study racially identified as Black, having a control group of racially diverse HS patients would help further our understanding of HS pathophysiology. Lastly, since the inclusion criteria required patients to have undergone excisional surgery for HS, future studies that consider comorbidities among both surgical and nonsurgical patients with HS will aid in our understanding of HS patients with SOC.

Conclusion

The results of our study demonstrate a descriptive analysis of the demographics, most common comorbidities, lesion sites, pharmacologic treatments, and surgical profiles in patients with SOC who underwent surgical treatment for HS. Our data show that HS patients with SOC may be more likely to experience anxiety, depression, and gastrointestinal disease than other HS patients. Additionally, our patients had a high prevalence of marijuana use but lower prevalence of current cigarette use compared to studies conducted in predominantly White HS patient populations, emphasizing the multifactorial nature of HS pathophysiology. Furthermore, despite published research on the efficacy of immunomodulator therapy for HS, most of our HS patients with SOC underwent surgical intervention without first attempting biologic treatment regimens, indicating possible gaps in health care access for minority patients that may be impacting disease severity and outcomes. Studies such as this one that investigate disease pathophysiology and risk factors in SOC patient populations with HS are imperative in minimizing the health care disparity gap, improving disease outcomes, and providing more equitable health care for all patients.

References

Wieczorek M, Walecka I. Hidradenitis suppurativa—known and unknown disease. Reumatologia. 2018;56:337-339. doi:10.5114/reum.2018.80709
Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 2009;60:539-563. doi:10.1016/j. jaad.2008.11.911
Garg A, Lavian J, Lin G, et al. Incidence of hidradenitis suppurativa in the United States: a sex- and age-adjusted population analysis. J Am Acad Dermatol. 2017;77:118-122. doi:10.1016/j.jaad.2017.02.005
Ingram JR, Jenkins-Jones S, Knipe DW, et al. Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa. Br J Dermatol. 2018;178:917-924. doi:10.1111/bjd.16101
Lee DE, Clark AK, Shi VY. Hidradenitis suppurativa: disease burden and etiology in skin of color. Dermatology. 2017;233:456-461. doi:10.1159/000486741
Brown-Korsah JB, McKenzie S, Omar D, et al. Variations in genetics, biology, and phenotype of cutaneous disorders in skin of color—part I: genetic, biologic, and structural differences in skin of color. J Am Acad Dermatol. 2022;87:1239-1258. doi:10.1016/j.jaad.2022.06.1193
Narla S, Lyons AB, Hamzavi IH. The most recent advances in understanding and managing hidradenitis suppurativa. F1000Res. 2020;9:F1000 Faculty Rev-1049. doi:10.12688/f1000research.26083.1
Arenbergerova M, Gkalpakiotis S, Arenberger P. Effective long-term control of refractory hidradenitis suppurativa with adalimumab after failure of conventional therapy. Int J Dermatol. 2010;49:1445-1449. doi:10.1111/j.1365-4632.2010.04638.x
Kimball AB, Okun MM, Williams DA, et al. Two phase 3 trials of adalimumab for hidradenitis suppurativa. N Engl J Med. 2016;375:422-434. doi:10.1056/NEJMoa1504370
Jalenques I, Ciortianu L, Pereira B, et al. The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: systematic review and meta-analysis. J Am Acad Dermatol. 2020;83:542-553. doi:10.1016/j.jaad.2020.03.041
Machado MO, Stergiopoulos V, Maes M, et al. Depression and anxiety in adults with hidradenitis suppurativa: a systematic review and meta-analysis. JAMA Dermatol. 2019;155:939-945. doi:10.1001 /jamadermatol.2019.0759
Kilgour JM, Li S, Sarin KY. Hidradenitis suppurativa in patients of color is associated with increased disease severity and healthcare utilization: a retrospective analysis of 2 U.S. cohorts. JAAD Int. 2021;3:42-52. doi:10.1016/j.jdin.2021.01.007
Rymaszewska JE, Krajewski PK, Szcze² ch J, et al. Depression and anxiety in hidradenitis suppurativa patients: a cross-sectional study among Polish patients. Postep Dermatol Alergol. 2023;40:35-39. doi:10.5114ada.2022.119080
Johnston LA, Alhusayen R, Bourcier M, et al. Practical guidelines for managing patients with hidradenitis suppurativa: an update. J Cutan Med Surg. 2022;26(2 suppl):2S-24S. doi:10.1177/12034754221116115
Vazquez BG, Alikhan A, Weaver AL, et al. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol. 2013;133:97-103. doi:10.1038/jid.2012.255
Seyed Jafari SM, Knüsel E, Cazzaniga S, et al. A retrospective cohort study on patients with hidradenitis suppurativa. Dermatology. 2018;234:71-78. doi:10.1159/000488344
Lewandowski M, S´ wierczewska Z, Baran´ ska-Rybak W. Hidradenitis suppurativa: a review of current treatment options. Int J Dermatol. 2022;61:1152-1164. doi:10.1111/ijd.16115
Garg A, Papagermanos V, Midura M, et al. Incidence of hidradenitis suppurativa among tobacco smokers: a population-based retrospective analysis in the U.S.A. Br J Dermatol. 2018;178:709-714. doi:10.1111/bjd.15939
Garg A, Malviya N, Strunk A, et al. Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2022;86:1092-1101. doi:10.1016/j.jaad.2021.01.059
Tzellos T, Zouboulis CC. Which hidradenitis suppurativa comorbidities should I take into account? Exp Dermatol. 2022;31(suppl 1):29-32. doi:10.1111/exd.14633
Metko D, Mehta S, Piguet V. Cannabis usage among patients with hidradenitis suppurativa: a scoping review. J Cutan Med Surg. 2024;28:307-308. doi:10.1177/12034754241238719
Mahmud MR, Akter S, Tamanna SK, et al. Impact of gut microbiome on skin health: gut-skin axis observed through the lenses of therapeutics and skin diseases. Gut Microbes. 2022;14:2096995. doi:10.1080/194 90976.2022.2096995
Mair KM, Gaw R, MacLean MR. Obesity, estrogens and adipose tissue dysfunction—implications for pulmonary arterial hypertension. Pulm Circ. 2020;10:2045894020952019. doi:10.1177/2045894020952023
Abu Rached N, Gambichler T, Dietrich JW, et al. The role of hormones in hidradenitis suppurativa: a systematic review. Int J Mol Sci. 2022;23:15250. doi:10.3390/ijms232315250
Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part I: diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol. 2019;81:76-90. doi:10.1016 /j.jaad.2019.02.067
Choi ECE, Phan PHC, Oon HH. Hidradenitis suppurativa: racial and socioeconomic considerations in management. Int J Dermatol. 2022;61:1452-1457. doi:10.1111/ijd.16163

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Author and Disclosure Information

Kareena S. Garg and Drs. Pinto, Le, Moffatt, Shupp, and Carney are from the Firefighters’ Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC. Kareena S. Garg also is from the Georgetown University School of Medicine, Washington, DC. Drs. Moffatt, Shupp, and Carney also are from the Departments of Biochemistry and Molecular & Cellular Biology and Surgery, Georgetown University School of Medicine, Washington, DC. Dr. Shupp also is from the Department of Plastic and Reconstructive Surgery. Drs. Moffatt, Shupp, and Carney also are from The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC. Dr. Frey is from the Department of Dermatology, Howard University Hospital, Washington, DC.

The authors have no relevant financial disclosures to report.

Correspondence: Bonnie C. Carney, PhD, 110 Irving St NW, Suite 3B-55, Washington, DC 20010 ([email protected]).

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Desiree Pinto, MD, MPH

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Kareena S. Garg, BS

Desiree Pinto, MD, MPH

Bonnie C. Carney, PhD

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The authors have no relevant financial disclosures to report.

Correspondence: Bonnie C. Carney, PhD, 110 Irving St NW, Suite 3B-55, Washington, DC 20010 ([email protected]).

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Correspondence: Bonnie C. Carney, PhD, 110 Irving St NW, Suite 3B-55, Washington, DC 20010 ([email protected]).

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Methods

Results

Comment

Limitations

Conclusion

Methods

Results

Comment

Limitations

Conclusion

References

Wieczorek M, Walecka I. Hidradenitis suppurativa—known and unknown disease. Reumatologia. 2018;56:337-339. doi:10.5114/reum.2018.80709
Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 2009;60:539-563. doi:10.1016/j. jaad.2008.11.911
Garg A, Lavian J, Lin G, et al. Incidence of hidradenitis suppurativa in the United States: a sex- and age-adjusted population analysis. J Am Acad Dermatol. 2017;77:118-122. doi:10.1016/j.jaad.2017.02.005
Ingram JR, Jenkins-Jones S, Knipe DW, et al. Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa. Br J Dermatol. 2018;178:917-924. doi:10.1111/bjd.16101
Lee DE, Clark AK, Shi VY. Hidradenitis suppurativa: disease burden and etiology in skin of color. Dermatology. 2017;233:456-461. doi:10.1159/000486741
Brown-Korsah JB, McKenzie S, Omar D, et al. Variations in genetics, biology, and phenotype of cutaneous disorders in skin of color—part I: genetic, biologic, and structural differences in skin of color. J Am Acad Dermatol. 2022;87:1239-1258. doi:10.1016/j.jaad.2022.06.1193
Narla S, Lyons AB, Hamzavi IH. The most recent advances in understanding and managing hidradenitis suppurativa. F1000Res. 2020;9:F1000 Faculty Rev-1049. doi:10.12688/f1000research.26083.1
Arenbergerova M, Gkalpakiotis S, Arenberger P. Effective long-term control of refractory hidradenitis suppurativa with adalimumab after failure of conventional therapy. Int J Dermatol. 2010;49:1445-1449. doi:10.1111/j.1365-4632.2010.04638.x
Kimball AB, Okun MM, Williams DA, et al. Two phase 3 trials of adalimumab for hidradenitis suppurativa. N Engl J Med. 2016;375:422-434. doi:10.1056/NEJMoa1504370
Jalenques I, Ciortianu L, Pereira B, et al. The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: systematic review and meta-analysis. J Am Acad Dermatol. 2020;83:542-553. doi:10.1016/j.jaad.2020.03.041
Machado MO, Stergiopoulos V, Maes M, et al. Depression and anxiety in adults with hidradenitis suppurativa: a systematic review and meta-analysis. JAMA Dermatol. 2019;155:939-945. doi:10.1001 /jamadermatol.2019.0759
Kilgour JM, Li S, Sarin KY. Hidradenitis suppurativa in patients of color is associated with increased disease severity and healthcare utilization: a retrospective analysis of 2 U.S. cohorts. JAAD Int. 2021;3:42-52. doi:10.1016/j.jdin.2021.01.007
Rymaszewska JE, Krajewski PK, Szcze² ch J, et al. Depression and anxiety in hidradenitis suppurativa patients: a cross-sectional study among Polish patients. Postep Dermatol Alergol. 2023;40:35-39. doi:10.5114ada.2022.119080
Johnston LA, Alhusayen R, Bourcier M, et al. Practical guidelines for managing patients with hidradenitis suppurativa: an update. J Cutan Med Surg. 2022;26(2 suppl):2S-24S. doi:10.1177/12034754221116115
Vazquez BG, Alikhan A, Weaver AL, et al. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol. 2013;133:97-103. doi:10.1038/jid.2012.255
Seyed Jafari SM, Knüsel E, Cazzaniga S, et al. A retrospective cohort study on patients with hidradenitis suppurativa. Dermatology. 2018;234:71-78. doi:10.1159/000488344
Lewandowski M, S´ wierczewska Z, Baran´ ska-Rybak W. Hidradenitis suppurativa: a review of current treatment options. Int J Dermatol. 2022;61:1152-1164. doi:10.1111/ijd.16115
Garg A, Papagermanos V, Midura M, et al. Incidence of hidradenitis suppurativa among tobacco smokers: a population-based retrospective analysis in the U.S.A. Br J Dermatol. 2018;178:709-714. doi:10.1111/bjd.15939
Garg A, Malviya N, Strunk A, et al. Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2022;86:1092-1101. doi:10.1016/j.jaad.2021.01.059
Tzellos T, Zouboulis CC. Which hidradenitis suppurativa comorbidities should I take into account? Exp Dermatol. 2022;31(suppl 1):29-32. doi:10.1111/exd.14633
Metko D, Mehta S, Piguet V. Cannabis usage among patients with hidradenitis suppurativa: a scoping review. J Cutan Med Surg. 2024;28:307-308. doi:10.1177/12034754241238719
Mahmud MR, Akter S, Tamanna SK, et al. Impact of gut microbiome on skin health: gut-skin axis observed through the lenses of therapeutics and skin diseases. Gut Microbes. 2022;14:2096995. doi:10.1080/194 90976.2022.2096995
Mair KM, Gaw R, MacLean MR. Obesity, estrogens and adipose tissue dysfunction—implications for pulmonary arterial hypertension. Pulm Circ. 2020;10:2045894020952019. doi:10.1177/2045894020952023
Abu Rached N, Gambichler T, Dietrich JW, et al. The role of hormones in hidradenitis suppurativa: a systematic review. Int J Mol Sci. 2022;23:15250. doi:10.3390/ijms232315250
Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part I: diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol. 2019;81:76-90. doi:10.1016 /j.jaad.2019.02.067
Choi ECE, Phan PHC, Oon HH. Hidradenitis suppurativa: racial and socioeconomic considerations in management. Int J Dermatol. 2022;61:1452-1457. doi:10.1111/ijd.16163

References

Wieczorek M, Walecka I. Hidradenitis suppurativa—known and unknown disease. Reumatologia. 2018;56:337-339. doi:10.5114/reum.2018.80709
Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 2009;60:539-563. doi:10.1016/j. jaad.2008.11.911
Garg A, Lavian J, Lin G, et al. Incidence of hidradenitis suppurativa in the United States: a sex- and age-adjusted population analysis. J Am Acad Dermatol. 2017;77:118-122. doi:10.1016/j.jaad.2017.02.005
Ingram JR, Jenkins-Jones S, Knipe DW, et al. Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa. Br J Dermatol. 2018;178:917-924. doi:10.1111/bjd.16101
Lee DE, Clark AK, Shi VY. Hidradenitis suppurativa: disease burden and etiology in skin of color. Dermatology. 2017;233:456-461. doi:10.1159/000486741
Brown-Korsah JB, McKenzie S, Omar D, et al. Variations in genetics, biology, and phenotype of cutaneous disorders in skin of color—part I: genetic, biologic, and structural differences in skin of color. J Am Acad Dermatol. 2022;87:1239-1258. doi:10.1016/j.jaad.2022.06.1193
Narla S, Lyons AB, Hamzavi IH. The most recent advances in understanding and managing hidradenitis suppurativa. F1000Res. 2020;9:F1000 Faculty Rev-1049. doi:10.12688/f1000research.26083.1
Arenbergerova M, Gkalpakiotis S, Arenberger P. Effective long-term control of refractory hidradenitis suppurativa with adalimumab after failure of conventional therapy. Int J Dermatol. 2010;49:1445-1449. doi:10.1111/j.1365-4632.2010.04638.x
Kimball AB, Okun MM, Williams DA, et al. Two phase 3 trials of adalimumab for hidradenitis suppurativa. N Engl J Med. 2016;375:422-434. doi:10.1056/NEJMoa1504370
Jalenques I, Ciortianu L, Pereira B, et al. The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: systematic review and meta-analysis. J Am Acad Dermatol. 2020;83:542-553. doi:10.1016/j.jaad.2020.03.041
Machado MO, Stergiopoulos V, Maes M, et al. Depression and anxiety in adults with hidradenitis suppurativa: a systematic review and meta-analysis. JAMA Dermatol. 2019;155:939-945. doi:10.1001 /jamadermatol.2019.0759
Kilgour JM, Li S, Sarin KY. Hidradenitis suppurativa in patients of color is associated with increased disease severity and healthcare utilization: a retrospective analysis of 2 U.S. cohorts. JAAD Int. 2021;3:42-52. doi:10.1016/j.jdin.2021.01.007
Rymaszewska JE, Krajewski PK, Szcze² ch J, et al. Depression and anxiety in hidradenitis suppurativa patients: a cross-sectional study among Polish patients. Postep Dermatol Alergol. 2023;40:35-39. doi:10.5114ada.2022.119080
Johnston LA, Alhusayen R, Bourcier M, et al. Practical guidelines for managing patients with hidradenitis suppurativa: an update. J Cutan Med Surg. 2022;26(2 suppl):2S-24S. doi:10.1177/12034754221116115
Vazquez BG, Alikhan A, Weaver AL, et al. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol. 2013;133:97-103. doi:10.1038/jid.2012.255
Seyed Jafari SM, Knüsel E, Cazzaniga S, et al. A retrospective cohort study on patients with hidradenitis suppurativa. Dermatology. 2018;234:71-78. doi:10.1159/000488344
Lewandowski M, S´ wierczewska Z, Baran´ ska-Rybak W. Hidradenitis suppurativa: a review of current treatment options. Int J Dermatol. 2022;61:1152-1164. doi:10.1111/ijd.16115
Garg A, Papagermanos V, Midura M, et al. Incidence of hidradenitis suppurativa among tobacco smokers: a population-based retrospective analysis in the U.S.A. Br J Dermatol. 2018;178:709-714. doi:10.1111/bjd.15939
Garg A, Malviya N, Strunk A, et al. Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2022;86:1092-1101. doi:10.1016/j.jaad.2021.01.059
Tzellos T, Zouboulis CC. Which hidradenitis suppurativa comorbidities should I take into account? Exp Dermatol. 2022;31(suppl 1):29-32. doi:10.1111/exd.14633
Metko D, Mehta S, Piguet V. Cannabis usage among patients with hidradenitis suppurativa: a scoping review. J Cutan Med Surg. 2024;28:307-308. doi:10.1177/12034754241238719
Mahmud MR, Akter S, Tamanna SK, et al. Impact of gut microbiome on skin health: gut-skin axis observed through the lenses of therapeutics and skin diseases. Gut Microbes. 2022;14:2096995. doi:10.1080/194 90976.2022.2096995
Mair KM, Gaw R, MacLean MR. Obesity, estrogens and adipose tissue dysfunction—implications for pulmonary arterial hypertension. Pulm Circ. 2020;10:2045894020952019. doi:10.1177/2045894020952023
Abu Rached N, Gambichler T, Dietrich JW, et al. The role of hormones in hidradenitis suppurativa: a systematic review. Int J Mol Sci. 2022;23:15250. doi:10.3390/ijms232315250
Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part I: diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol. 2019;81:76-90. doi:10.1016 /j.jaad.2019.02.067
Choi ECE, Phan PHC, Oon HH. Hidradenitis suppurativa: racial and socioeconomic considerations in management. Int J Dermatol. 2022;61:1452-1457. doi:10.1111/ijd.16163

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PRACTICE POINTS

Anxiety and depression are highly prevalent among Black patients with hidradenitis suppurativa (HS). Implementing self-report questionnaires at medical office visits are crucial to identifying patients who could benefit from additional psychiatric resources.
Hidradenitis suppurativa patients with skin of color may have a higher incidence of comorbid gastrointestinal disease than other HS patients.
Investigating the impact of weight-management practices on disease severity would be helpful in outlining nonpharmacologic treatments for patients with HS.
The patient cohort described here had a high prevalence of marijuana use but lower prevalence of current cigarette use compared to studies conducted in predominantly White HS patient populations, emphasizing the multifactorial nature of HS pathophysiology.

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Treatment of Seborrheic Dermatitis in Black Patients

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Treatment of Seborrheic Dermatitis in Black Patients

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Camille Robinson, MD

Rohan Shah, MD

Chiagoziem Ogbonna, MD

Amy J. McMichael, MD

Seborrheic dermatitis (SD) is a common chronic inflammatory skin condition that predominantly affects areas with high concentrations of sebaceous glands such as the scalp and face. Up to 5% of the worldwide population is affected by SD each year, causing a major burden of disease for patients and the health care system.¹ In 2023, the cost of medical treatment for SD in the United States was $300 million, with outpatient office visits alone costing $58 million and prescription drugs costing $109 million. Indirect costs of disease (eg, lost workdays) account for another $51 million.¹ Since SD frequently manifests on the face, it tends to have negative effects on the patient’s quality of life, resulting in psychological distress and low self-esteem.²

Patients with SD may describe symptoms of excessive dandruff and itching along with hyperpigmentation or hypopigmentation of the skin; Black patients tend to present with the classic manifestations: a combination of scaling, flaking, and erythematous patches on the scalp, ears, and face, particularly around the eyebrows, eyelids, and nose. With SD being the second most common diagnosis in Black patients who seek care from a dermatologist, it is important to have effective treatment approaches for SD in this patient population.³

In this study, we aimed to evaluate medical and nonmedical treatment options for SD in Black patients by identifying common practices and products mentioned on consumer websites and in the medical literature.

Methods

A Google search was conducted during 2 time periods (September 2022—October 2022 and March 2023—April 2023) using the terms products for itchy scalp in Black patients, products for dandruff in Black patients, itchy scalp in Black women, itchy scalp in Black men, treatment for scalp itch in Black patients, and dry scalp in Black hair. Products that were recommended by at least 1 website on the first page of search results were included in our list of products, and the ingredients were reviewed by the authors. We excluded individual retailer websites as well as those that did not provide specific recommendations on products or ingredients to use when treating SD. To ensure reliability and standardization, we did not review products that were suggested by ads in the shopping section on the first page of search results.

We also evaluated medical treatments used for SD in dermatology literature. A PubMed search of articles indexed for MEDLINE using the terms seborrheic dermatitis treatment for Black patients, treatment for dandruff for Black patients, and seborrheic dermatitis and skin of color was conducted. We excluded articles that did not address treatment options for SD, were specific to treating SD in patient populations with specific comorbidities being studied, discussed SD in animals, or were published prior to 1990.

Results

We identified 16 unique consumer websites with product or ingredient recommendations for SD in Black patients, none of which were provided by authors with a medical or scientific background; however, 4 (25%) websites included insights from board-certified dermatologists. A total of 16 ingredients were recommended, 15 (94%) of which were mentioned at least twice in our search results (eTable 1).

Overall, we noticed that ingredients labeled as natural or organic were common in over-the-counter (OTC) products, and ingredients such as sulfates and parabens were avoided. Common OTC ingredients for antidandruff and anti-itch shampoos and conditioners include zinc pyrithione, selenium sulfide, coal tar, salicylic acid, and citric acid. Additionally, coconut oil, tea tree oil, apple cider vinegar, and charcoal are common natural alternatives used to address SD symptoms.

Our review of the literature yielded limited recommendations tailored specifically to Black patients with SD. Of 108 abstracts, articles, or textbook chapters providing treatment recommendations for SD, 6 (6%) specifically discussed treatments for Black patients. All articles were written by authors with medical or scientific backgrounds. Of the treatment options discussed, topical antifungals generally were considered first-line for SD in all patients, with ketoconazole shampoo being a common first choice.^4,5

Comment

Our study indicated that many consumer websites recommend unstudied nonmedical treatments for SD. Zinc pyrithione was one of the most commonly mentioned ingredients in OTC products to treat SD targeted toward Black patients, as its properties have contributed to ease of hair combing and less frizz.⁶ Zinc pyrithione has antifungal properties that reduce the proliferation of Malassezia furfur as well as anti-inflammatory properties that reduce irritation, pruritus, and erythema in areas affected by SD.⁷ Tea tree and peppermint oils also were commonly mentioned; the theory is that these oils mitigate SD by reducing yeast growth and soothing inflammation through antioxidant activity.^8,9 Coal tar also is used due to its keratoplastic properties, which slow the growth of skin cells and ultimately reduce scaling and dryness.¹⁰ Yeast thrives in basic pH conditions; apple cider vinegar is used as an ingredient in OTC products for SD because its acidic pH creates a less favorable environment for yeast to grow.¹¹ Although many of the ingredients found in OTC products we identified have not yet been studied, they have properties that theoretically would be helpful in treating SD.

Our review of the medical literature revealed that while there are treatments that are effective for SD, the recommended use may not consider the cultural differences that exist for Black patients. For instance, reports in the literature regarding ketoconazole shampoo revealed that ketoconazole increases the risk for hair shaft dryness, damage, and subsequent breakage, especially in Black women who also may be using heat styling or chemical relaxers.⁵ As a result, ketoconazole should be used with caution in Black women, with an emphasis on direct application to the scalp rather than the hair shafts.¹² Additional options reported for Black patients include ciclopirox olamine and zinc pyrithione, which may have fewer risks.¹³

When prescribing medicated shampoos, traditional instructions regarding frequency of use to control symptoms of SD range from 2 to 3 times weekly to daily for a specified period of time determined by the dermatologist.¹⁴ However, frequency of hair washing varies greatly among Black patients, sometimes occurring only once monthly. The frequency also may change based on styling techniques (eg, braids, weaves, and wigs).¹⁵ Based on previous research underscoring the tendency for Black patients to use medicated shampoos less frequently than White patients, it is important for clinicians to understand that these cultural practices can undermine the effectiveness when medicated shampoos are prescribed for SD.¹⁶

Additionally, topical corticosteroids often are used in conjunction with antifungals to help decrease inflammation of the scalp.¹⁷ An option reported for Black patients is topical fluocinolone 0.01%; however, package instructions state to apply topically to the scalp nightly and wash the hair thoroughly each morning, which may not be feasible for Black patients based on previously mentioned differences in hair-washing techniques. An alternative option may be to apply the medication 3 to 4 times per week, washing the hair weekly rather than daily.¹⁸ Fluocinolone can be used as an ointment, solution, oil, or cream.^19,20 When comparing treatment vehicles for SD, a study conducted by Chappell et al²¹ found that Black patients preferred using ointment or oil vehicles; White patients preferred foams and sprays, which may not be suitable for Afro hair patterns. As such, using less-drying modalities may increase compliance and treatment success in Black patients. For patients who may have involvement on the hairline, face, or ears along with hypopigmentation (which is a common skin concern associated with SD), calcineurin inhibitors can be used until resolution occurs.^5,22 High et al¹⁵ found that twice-daily use of pimecrolimus rapidly normalized skin pigmentation during the first 2 weeks of use. Overall, personalization of treatment may not only avoid adverse effects but also ensure patient compliance, with the overall goal of treating to reduce yeast activity, pruritus, and dyschromia.²²

Interestingly, after the website searches were completed for this study, the US Food and Drug Administration approved topical roflumilast foam for SD. In a phase III trial of 457 total patients, 36 Black patients were included.²³ It was determined that 79.5% of patients overall throughout the trial achieved Investigator Global Assessment success (score of 0 [clear] or 1 [almost clear]) plus ≥2-point improvement from baseline (on a scale of 0 [clear] to 4 [severe]) at weeks 2, 4, and 8. Although there currently are no long-term studies, roflumilast may be a promising option for Black patients with SD.²³

Aside from developing an individualized treatment approach for Black patients with SD, it is important to ask targeted questions during the clinical encounter to identify factors that may be exacerbating symptoms, especially due to the wide range of hair care practices used by the Black community (eTable 2). Asking targeted questions is especially important, as prior studies have shown that extensions, hair relaxers, and particular hair products can irritate the scalp and increase the likelihood of developing SD.^21,24 Rucker Wright et al²⁵ evaluated different hair care practices among young Black females and their association with the development of SD. The authors found that using hair extensions (either braided, cornrowed, or ponytails), chemical relaxers, and hair oils every 2 weeks was associated with SD. The study also found that SD rates were roughly 20% higher among Black girls with extensions compared to Black girls without extensions, regardless of how frequently hair was washed.²⁵

Many Black patients grease the scalp with oils that are beneficial for lubrication and reduction of abrasive damage caused by grooming; however, they also may increase incidence of SD.²⁶ Tight curls worn by Black patients also can impede sebum from traveling down the hair shaft, leading to oil buildup on the scalp. This is the ideal environment for increased Malassezia density and higher risk for SD development.²⁷ To balance the beneficial effects of hair oils with the increased susceptibility for SD, providers should emphasize applying these oils only to distal hair shafts, which are more likely to be damaged, and avoiding application to the scalp.¹⁹

Conclusion

Given its long-term relapsing and remitting nature, SD can be distressing for Black patients, many of whom may seek additional treatment options aside from those recommended by health care professionals. In order to better educate patients, it is important for dermatologists to know not only the common ingredients that may be present in OTC products but also the thought process behind why patients use them. Additionally, prescription treatments for Black patients with SD may require nuanced alterations to the product instructions that may prevent health disparities and provide culturally sensitive care. Overall, the literature regarding treatment for Black patients with SD is limited, and more high-quality studies are needed.

References

Tucker D, Masood S. Seborrheic dermatitis. StatPearls [Internet]. Updated March 1, 2024. Accessed December 19, 2024. https://www.ncbi.nlm.nih.gov/books/NBK551707/
Borda LJ, Wikramanayake TC. Seborrheic dermatitis and dandruff: a comprehensive review. J Clin Investig Dermatol. 2015;3:10.13188 /2373-1044.1000019.
American Academy of Dermatology. Seborrheic dermatitis by the numbers. American Academy of Dermatology Skin Disease Briefs. Updated May 5, 2018. Accessed November 22, 2024. https://www.aad.org/asset/49w949DPcF8RSJYIRHfDon
Davis SA, Naarahari S, Feldman SR, et al. Top dermatologic conditions in patients of color: an analysis of nationally representative data. J Drugs Dermatol. 2012;11:466-473.
Borda LJ, Perper M, Keri JE. Treatment of seborrheic dermatitis: a comprehensive review. J Dermatolog Treat. 2019;30:158-169.
Draelos ZD, Kenneally DC, Hodges LT, et al. A comparison of hair quality and cosmetic acceptance following the use of two anti-dandruff shampoos. J Investig Dermatol Symp Proc. 2005;10:201-214.
Barak-Shinar D, Green LJ. Scalp seborrheic dermatitis and dandruff therapy using a herbal and zinc pyrithione-based therapy of shampoo and scalp lotion. J Clin Aesthet Dermatol. 2018;11:26-31.
Satchell AC, Saurajen A, Bell C, et al. Treatment of dandruff with 5% tea tree oil shampoo. J Am Acad Dermatol. 2002;47:852-855.
Herro E, Jacob SE. Mentha piperita (peppermint). Dermatitis. 2010;21:327-329.
Sanfilippo A, English JC. An overview of medicated shampoos used in dandruff treatment. Pharm Ther. 2006;31:396-400.
Arun PVPS, Vineetha Y, Waheed M, et al. Quantification of the minimum amount of lemon juice and apple cider vinegar required for the growth inhibition of dandruff causing fungi Malassezia furfur. Int J Sci Res in Biological Sciences. 2019;6:144-147.
Gao HY, Li Wan Po A. Topical formulations of fluocinolone acetonide. Are creams, gels and ointments bioequivalent and does dilution affect activity? Eur J Clin Pharmacol. 1994;46:71-75.
Pauporte M, Maibach H, Lowe N, et al. Fluocinolone acetonide topical oil for scalp psoriasis. J Dermatolog Treat. 2004;15:360-364.
Elgash M, Dlova N, Ogunleye T, et al. Seborrheic dermatitis in skin of color: clinical considerations. J Drugs Dermatol. 2019;18:24-27.
High WA, Pandya AG. Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation. J Am Acad Dermatol. 2006;54:1083-1088.
Hollins LC, Butt M, Hong J, et al. Research in brief: survey of hair care practices in various ethnic and racial pediatric populations. Pediatr Dermatol. 2022;39:494-496.
Halder RM, Roberts CI, Nootheti PK. Cutaneous diseases in the black races. Dermatol Clin. 2003;21:679-687, ix.
Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007;80:387-394.
Friedmann DP, Mishra V, Batty T. Progressive facial papules in an African- American patient: an atypical presentation of seborrheic dermatitis. J Clin Aesthet Dermatol. 2018;11:44-45.
Clark GW, Pope SM, Jaboori KA. Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician. 2015;91:185-190.
Chappell J, Mattox A, Simonetta C, et al. Seborrheic dermatitis of the scalp in populations practicing less frequent hair washing: ketoconazole 2% foam versus ketoconazole 2% shampoo. three-year data. J Am Acad Dermatol. 2014;70:AB54.
Dadzie OE, Salam A. The hair grooming practices of women of African descent in London, United Kingdom: findings of a cross-sectional study. J Eur Acad Dermatol Venereol. 2016;30:1021-1024.
Blauvelt A, Draelos ZD, Stein Gold L, et al. Roflumilast foam 0.3% for adolescent and adult patients with seborrheic dermatitis: a randomized, double-blinded, vehicle-controlled, phase 3 trial. J Am Acad Dermatol. 2024;90:986-993.
Taylor SC, Barbosa V, Burgess C, et al. Hair and scalp disorders in adult and pediatric patients with skin of color. Cutis. 2017;100:31-35.
Rucker Wright D, Gathers R, Kapke A, et al. Hair care practices and their association with scalp and hair disorders in African American girls. J Am Acad Dermatol. 2011;64:253-262.
Raffi J, Suresh R, Agbai O. Clinical recognition and management of alopecia in women of color. Int J Womens Dermatol. 2019;5:314-319.
Mayo T, Dinkins J, Elewski B. Hair oils may worsen seborrheic dermatitis in Black patients. Skin Appendage Disord. 2023;9:151-152.

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Author and Disclosure Information

Dr. Robinson is from the Department of Dermatology and Cutaneous Surgery/Jackson Memorial Health System, University of Miami, Florida. Dr. Shah is from Rutgers New Jersey Medical School, Newark. Drs. Ogbonna and McMichael are from Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Drs. Robinson, Shah, and Ogbonna have no relevant financial disclosures to report. Dr. McMichael is a consultant for AbbVie, Almirall, Arcutis, Bristol Meyers Squibb, CeraVe, Eli Lilly and Company, Galderma, Janssen, Johnson & Johnson, LEO Pharma, L’Oreal, Pelage Pharmaceuticals, Pfizer, Procter & Gamble, Sanofi Regeneron, Sun Pharmaceutical Industries Ltd, Revian, and UCB.

Correspondence: Camille Robinson, MD, 1600 NW 10th Ave RMSB 2023A, Miami, FL 33136 ([email protected]).

Cutis. 2025 January;115(1):15-17, E4. doi:10.12788/cutis.1157

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Rohan Shah, MD

Chiagoziem Ogbonna, MD

Amy J. McMichael, MD

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Cutis. 2025 January;115(1):15-17, E4. doi:10.12788/cutis.1157

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References

Tucker D, Masood S. Seborrheic dermatitis. StatPearls [Internet]. Updated March 1, 2024. Accessed December 19, 2024. https://www.ncbi.nlm.nih.gov/books/NBK551707/
Borda LJ, Wikramanayake TC. Seborrheic dermatitis and dandruff: a comprehensive review. J Clin Investig Dermatol. 2015;3:10.13188 /2373-1044.1000019.
American Academy of Dermatology. Seborrheic dermatitis by the numbers. American Academy of Dermatology Skin Disease Briefs. Updated May 5, 2018. Accessed November 22, 2024. https://www.aad.org/asset/49w949DPcF8RSJYIRHfDon
Davis SA, Naarahari S, Feldman SR, et al. Top dermatologic conditions in patients of color: an analysis of nationally representative data. J Drugs Dermatol. 2012;11:466-473.
Borda LJ, Perper M, Keri JE. Treatment of seborrheic dermatitis: a comprehensive review. J Dermatolog Treat. 2019;30:158-169.
Draelos ZD, Kenneally DC, Hodges LT, et al. A comparison of hair quality and cosmetic acceptance following the use of two anti-dandruff shampoos. J Investig Dermatol Symp Proc. 2005;10:201-214.
Barak-Shinar D, Green LJ. Scalp seborrheic dermatitis and dandruff therapy using a herbal and zinc pyrithione-based therapy of shampoo and scalp lotion. J Clin Aesthet Dermatol. 2018;11:26-31.
Satchell AC, Saurajen A, Bell C, et al. Treatment of dandruff with 5% tea tree oil shampoo. J Am Acad Dermatol. 2002;47:852-855.
Herro E, Jacob SE. Mentha piperita (peppermint). Dermatitis. 2010;21:327-329.
Sanfilippo A, English JC. An overview of medicated shampoos used in dandruff treatment. Pharm Ther. 2006;31:396-400.
Arun PVPS, Vineetha Y, Waheed M, et al. Quantification of the minimum amount of lemon juice and apple cider vinegar required for the growth inhibition of dandruff causing fungi Malassezia furfur. Int J Sci Res in Biological Sciences. 2019;6:144-147.
Gao HY, Li Wan Po A. Topical formulations of fluocinolone acetonide. Are creams, gels and ointments bioequivalent and does dilution affect activity? Eur J Clin Pharmacol. 1994;46:71-75.
Pauporte M, Maibach H, Lowe N, et al. Fluocinolone acetonide topical oil for scalp psoriasis. J Dermatolog Treat. 2004;15:360-364.
Elgash M, Dlova N, Ogunleye T, et al. Seborrheic dermatitis in skin of color: clinical considerations. J Drugs Dermatol. 2019;18:24-27.
High WA, Pandya AG. Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation. J Am Acad Dermatol. 2006;54:1083-1088.
Hollins LC, Butt M, Hong J, et al. Research in brief: survey of hair care practices in various ethnic and racial pediatric populations. Pediatr Dermatol. 2022;39:494-496.
Halder RM, Roberts CI, Nootheti PK. Cutaneous diseases in the black races. Dermatol Clin. 2003;21:679-687, ix.
Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007;80:387-394.
Friedmann DP, Mishra V, Batty T. Progressive facial papules in an African- American patient: an atypical presentation of seborrheic dermatitis. J Clin Aesthet Dermatol. 2018;11:44-45.
Clark GW, Pope SM, Jaboori KA. Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician. 2015;91:185-190.
Chappell J, Mattox A, Simonetta C, et al. Seborrheic dermatitis of the scalp in populations practicing less frequent hair washing: ketoconazole 2% foam versus ketoconazole 2% shampoo. three-year data. J Am Acad Dermatol. 2014;70:AB54.
Dadzie OE, Salam A. The hair grooming practices of women of African descent in London, United Kingdom: findings of a cross-sectional study. J Eur Acad Dermatol Venereol. 2016;30:1021-1024.
Blauvelt A, Draelos ZD, Stein Gold L, et al. Roflumilast foam 0.3% for adolescent and adult patients with seborrheic dermatitis: a randomized, double-blinded, vehicle-controlled, phase 3 trial. J Am Acad Dermatol. 2024;90:986-993.
Taylor SC, Barbosa V, Burgess C, et al. Hair and scalp disorders in adult and pediatric patients with skin of color. Cutis. 2017;100:31-35.
Rucker Wright D, Gathers R, Kapke A, et al. Hair care practices and their association with scalp and hair disorders in African American girls. J Am Acad Dermatol. 2011;64:253-262.
Raffi J, Suresh R, Agbai O. Clinical recognition and management of alopecia in women of color. Int J Womens Dermatol. 2019;5:314-319.
Mayo T, Dinkins J, Elewski B. Hair oils may worsen seborrheic dermatitis in Black patients. Skin Appendage Disord. 2023;9:151-152.

References

Tucker D, Masood S. Seborrheic dermatitis. StatPearls [Internet]. Updated March 1, 2024. Accessed December 19, 2024. https://www.ncbi.nlm.nih.gov/books/NBK551707/
Borda LJ, Wikramanayake TC. Seborrheic dermatitis and dandruff: a comprehensive review. J Clin Investig Dermatol. 2015;3:10.13188 /2373-1044.1000019.
American Academy of Dermatology. Seborrheic dermatitis by the numbers. American Academy of Dermatology Skin Disease Briefs. Updated May 5, 2018. Accessed November 22, 2024. https://www.aad.org/asset/49w949DPcF8RSJYIRHfDon
Davis SA, Naarahari S, Feldman SR, et al. Top dermatologic conditions in patients of color: an analysis of nationally representative data. J Drugs Dermatol. 2012;11:466-473.
Borda LJ, Perper M, Keri JE. Treatment of seborrheic dermatitis: a comprehensive review. J Dermatolog Treat. 2019;30:158-169.
Draelos ZD, Kenneally DC, Hodges LT, et al. A comparison of hair quality and cosmetic acceptance following the use of two anti-dandruff shampoos. J Investig Dermatol Symp Proc. 2005;10:201-214.
Barak-Shinar D, Green LJ. Scalp seborrheic dermatitis and dandruff therapy using a herbal and zinc pyrithione-based therapy of shampoo and scalp lotion. J Clin Aesthet Dermatol. 2018;11:26-31.
Satchell AC, Saurajen A, Bell C, et al. Treatment of dandruff with 5% tea tree oil shampoo. J Am Acad Dermatol. 2002;47:852-855.
Herro E, Jacob SE. Mentha piperita (peppermint). Dermatitis. 2010;21:327-329.
Sanfilippo A, English JC. An overview of medicated shampoos used in dandruff treatment. Pharm Ther. 2006;31:396-400.
Arun PVPS, Vineetha Y, Waheed M, et al. Quantification of the minimum amount of lemon juice and apple cider vinegar required for the growth inhibition of dandruff causing fungi Malassezia furfur. Int J Sci Res in Biological Sciences. 2019;6:144-147.
Gao HY, Li Wan Po A. Topical formulations of fluocinolone acetonide. Are creams, gels and ointments bioequivalent and does dilution affect activity? Eur J Clin Pharmacol. 1994;46:71-75.
Pauporte M, Maibach H, Lowe N, et al. Fluocinolone acetonide topical oil for scalp psoriasis. J Dermatolog Treat. 2004;15:360-364.
Elgash M, Dlova N, Ogunleye T, et al. Seborrheic dermatitis in skin of color: clinical considerations. J Drugs Dermatol. 2019;18:24-27.
High WA, Pandya AG. Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation. J Am Acad Dermatol. 2006;54:1083-1088.
Hollins LC, Butt M, Hong J, et al. Research in brief: survey of hair care practices in various ethnic and racial pediatric populations. Pediatr Dermatol. 2022;39:494-496.
Halder RM, Roberts CI, Nootheti PK. Cutaneous diseases in the black races. Dermatol Clin. 2003;21:679-687, ix.
Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007;80:387-394.
Friedmann DP, Mishra V, Batty T. Progressive facial papules in an African- American patient: an atypical presentation of seborrheic dermatitis. J Clin Aesthet Dermatol. 2018;11:44-45.
Clark GW, Pope SM, Jaboori KA. Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician. 2015;91:185-190.
Chappell J, Mattox A, Simonetta C, et al. Seborrheic dermatitis of the scalp in populations practicing less frequent hair washing: ketoconazole 2% foam versus ketoconazole 2% shampoo. three-year data. J Am Acad Dermatol. 2014;70:AB54.
Dadzie OE, Salam A. The hair grooming practices of women of African descent in London, United Kingdom: findings of a cross-sectional study. J Eur Acad Dermatol Venereol. 2016;30:1021-1024.
Blauvelt A, Draelos ZD, Stein Gold L, et al. Roflumilast foam 0.3% for adolescent and adult patients with seborrheic dermatitis: a randomized, double-blinded, vehicle-controlled, phase 3 trial. J Am Acad Dermatol. 2024;90:986-993.
Taylor SC, Barbosa V, Burgess C, et al. Hair and scalp disorders in adult and pediatric patients with skin of color. Cutis. 2017;100:31-35.
Rucker Wright D, Gathers R, Kapke A, et al. Hair care practices and their association with scalp and hair disorders in African American girls. J Am Acad Dermatol. 2011;64:253-262.
Raffi J, Suresh R, Agbai O. Clinical recognition and management of alopecia in women of color. Int J Womens Dermatol. 2019;5:314-319.
Mayo T, Dinkins J, Elewski B. Hair oils may worsen seborrheic dermatitis in Black patients. Skin Appendage Disord. 2023;9:151-152.

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Cultural awareness when treating Black patients with seborrheic dermatitis is vital to providing appropriate care, as hair care practices may impact treatment options and regimen.
Knowledge about over-the-counter products that are targeted toward Black patients and the ingredients they contain can assist in providing better counseling to patients and improve shared decision-making.

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Disparities in Skin Cancer Outcomes in the Latine/Hispanic Population

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Disparities in Skin Cancer Outcomes in the Latine/Hispanic Population

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Jesus Valencia, MD

Fabiola Ramirez, MSN

Claudia Dubocq-Ortiz, BS

Rebecca Vasquez, MD

The Latine/Hispanic population in the United States comprises one of the largest and youngest skin of color communities.^1,2 In 2020, this group accounted for 19% of all Americans—a percentage expected to increase to more than 25% by 2060.³

It must be emphasized that the Latine/Hispanic community in the United States is incredibly diverse.⁴ Approximately one-third of individuals in this group are foreign-born, and this community is made up of people from all racialized groups, religions, languages, and cultural identities.² The heterogeneity of the Latine/Hispanic population translates into a wide representation of skin tones, reflecting a rich range of ancestries, ethnicities, and cultures. The percentage of individuals from each origin group may differ according to where they live in the United States; for instance, individuals who identify as Mexican comprise more than 80% of the Latine/Hispanic population in both Texas and California but only 17% in Florida, where more than half of Latine/Hispanic people identify as Cuban or Puerto Rican.^4,5 As a result, when it comes to skin cancer epidemiology, variations in incidence and mortality may exist within each of these subgroups who identify as part of the Latine/Hispanic community, as reported for other cancers.^6,7 Further research is needed to investigate these potential differences.Unfortunately, considerable health disparities persist among this rapidly growing population, including increased morbidity and mortality from melanoma and keratinocyte carcinomas (KCs) despite overall low lifetime incidence.^8,9 In this review, the epidemiology, clinical manifestation, and ethnic disparities for skin cancer among the US Latine/Hispanic population are summarized; other factors impacting overall health and health care, including sociocultural factors, also are briefly discussed.

Terminology

Before a meaningful dialogue can be had about skin cancer in the Latine/Hispanic population, it is important to contextualize the terms used to identify this patient population, including Latino/Latine and Hispanic. In the early 1970s, the United States adopted the term Hispanic as a way of conglomerating Spanish-speaking individuals from Spain, the Caribbean, and Central and South America. The goal was to implement a common identifier that enabled the US government to study the economic and social development of these groups.¹⁰ Nevertheless, considerable differences (eg, variations in skin pigmentation, sun sensitivity) exist among Hispanic communities, with some having stronger European, African, or Amerindian influences due to colonization of their distinct countries.¹¹

In contrast, Latino is a geographic term and refers to people with roots in Latin America and the Caribbean (Table 1).^12,13 For example, a person from Brazil may be considered Latino but not Hispanic as Brazilians speak Portuguese; alternatively, Spaniards (who are considered Hispanic) are not Latino because Spain is not a Latin American country. A person from Mexico would be considered both Latino and Hispanic.¹³

More recently, the term Latine has been introduced as an alternative to the gender binary inherent in the Spanish language.¹² For the purposes of this article, the terms Latine and Hispanic will be used interchangeably (unless otherwise specified) depending on how they are cited in the existing literature. Furthermore, the term non-Hispanic White (NHW) will be used to refer to individuals who have been socially ascribed or who self-identify as White in terms of race or ethnicity.

Melanoma

Melanoma, the deadliest form of skin cancer, is more likely to metastasize compared to other forms of skin cancer, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). For Latine/Hispanic individuals living in the United States, the lifetime risk for melanoma is 1 in 200 compared to 1 in 33 for NHW individuals.¹⁴ While the lifetime risk for melanoma is low for the Latine/Hispanic population, Hispanic individuals are diagnosed with melanoma at an earlier age (mean, 56 years), and the rate of new cases is marginally higher for women (4.9 per 100,000) compared to men (4.8 per 100,000).¹^5,16

Typical sites of melanoma manifestation in Latine/Hispanic individuals include the torso (most common site in Hispanic men), lower extremities (most common site in Hispanic women), and acral sites (palms, soles, and nails).^9,16,17 Anatomic location also can vary according to age for both men and women. For men, the incidence of melanoma on the trunk appears to decrease with age, while the incidence on the head and neck may increase. For women, the incidence of melanoma on the lower extremities and hip increases with age. Cutaneous melanoma may manifest as a lesion with asymmetry, irregular borders, variation in pigmentation, large diameter (>6 mm), and evolution over time. In patients with skin of color, melanoma easily can be missed, as it also typically mimics more benign skin conditions and may develop from an existing black- or dark brown–pigmented macule.¹⁸ The most common histologic subtype reported among Latine/Hispanic individuals in the United States is superficial spreading melanoma (20%–23%) followed by nodular melanoma and acral lentiginous melanoma.^16,19 Until additional risk factors associated with melanoma susceptibility in Hispanic/Latine people are better elucidated, it may be appropriate to use an alternative acronym, such as CUBED (Table 2), in addition to the standard ABCDE system to help recognize potential melanoma on acral sites.¹⁸

Although the lifetime risk for melanoma among Hispanic individuals in the United States is lower than that for NHW individuals, Hispanic patients who are diagnosed with melanoma are more likely to present with increased tumor thickness and later-stage diagnosis compared to NHW individuals.^8,16,20 In a recent study by Qian et al,⁸ advanced stage melanoma—defined as regional or distant stage disease—was present in 12.6% of NHW individuals. In contrast, the percentage of Hispanics with advanced disease was higher at 21%.⁸ Even after controlling for insurance and poverty status, Hispanic individuals were at greater risk than NHW individuals for late-stage diagnosis.^16,20

Morbidity and mortality also have been shown to be higher in Hispanic patients with cutaneous melanoma.^9,17 Reasons for this are multifactorial, with studies specific to melanoma citing challenges associated with early detection in individuals with deeply pigmented skin, a lack of awareness and knowledge about skin cancer among Latine/Hispanic patients, and treatment disparities.^21-23 Moreover, very few studies have reported comprehensive data on patients from Africa and Latin America. Studies examining the role of genetic ancestry, epigenetic variants, and skin pigmentation and the risk for melanoma among the Latine/Hispanic population therefore are much needed.²⁴

Keratinocyte Carcinomas

Keratinocyte carcinomas, also known as nonmelanoma skin cancers, include BCC and SCC. In comparison to the high-quality data available for melanoma from cancer registries, there are less reliable incidence data for KCs, especially among individuals with skin of color.²⁵ As a result, KC epidemiology in the United States is drawn largely from case series (especially for individuals with skin of color) or claims data from small data sets often from geographically restricted regions within the United States.^25,26

Basal Cell Carcinoma—Basal cell carcinoma is the most common malignant skin cancer in Latine/Hispanic individuals. Among those with lighter skin tones, the lifetime risk for BCC is about 30%.^27,28 Men typically are affected at a higher rate than women, and the median age for diagnosis is 68 years.²⁹ The development of BCC primarily is linked to lifetime accumulated UV radiation exposure. Even though BCC has a low mortality rate, it can lead to substantial morbidity due to factors such as tumor location, size, and rate of invasion, resulting in cosmetic and functional issues. Given its low metastatic potential, treatment of BCC typically is aimed at local control.³⁰ Options for treatment include Mohs micrographic surgery (MMS), curettage and electrodessication, cryosurgery, photodynamic therapy, radiation therapy, and topical therapies. Systemic therapies are reserved for patients with locally advanced or metastatic disease.³⁰

Latine/Hispanic patients characteristically present with BCCs on sun-exposed areas of the skin such as the head and neck region. In most patients, BCC manifests as a translucent pearly nodule with superficial telangiectasias and/or a nonhealing ulcer with a central depression and rolled nontender borders. However, in patients with skin of color, 66% of BCCs manifest with pigmentation; in fact, pigmented BCC (a subtype of BCC) has been shown to have a higher prevalence among Hispanic individuals, with an incidence twice as frequent as in NHW individuals.³¹ In addition, there are reports of increased tendency among Latine/Hispanic individuals to develop multiple BCCs.^32,33

The relationship between UV exposure and KCs could explain the relatively higher incidence in populations with skin of color living in warmer climates, including Hispanic individuals.³⁴ Even so, the development of BCCs appears to correlate directly with the degree of pigmentation in the skin, as it is most common in individuals with lighter skin tones within the Hispanic population.^25,34,35 Other risk factors associated with BCC development include albinism, arsenic ingestion, chronic infections, immunosuppression, history of radiation treatment, and history of scars or ulcers due to physical/thermal trauma.³^5-37

Squamous Cell Carcinoma—Squamous cell carcinoma is the second most common skin cancer among Latine/Hispanic patients. In contrast with NHW patients, evidence supporting the role of UV exposure as a primary risk factor for SCC in patients with skin of color remains limited.^25,38 Reports linking UV exposure and KCs in Hispanic and Black individuals predominantly include case series or population-based studies that do not consider levels of UV exposure.²⁵

More recently, genetic ancestry analyses of a large multiethnic cohort found an increased risk for cutaneous SCC among Latine/Hispanic individuals with European ancestry compared to those with Native American or African ancestry; however, these genetic ancestry associations were attenuated (although not eliminated) after considering skin pigmentation (using loci associated with skin pigmentation), history of sun exposure (using actinic keratoses as a covariate for chronic sun exposure), and sun-protected vs sun-exposed anatomic sites, supporting the role of other environmental or sociocultural factors in the development of SCC.³⁹ Similar to BCCs, immunosuppression, chronic scarring, skin irritation, and inflammatory disease also are documented risk factors.^9,32

Among NHW individuals with lighter skin tones, SCC characteristically manifests on sun-exposed areas of the skin such as the head and neck region. Typically, a lesion may appear as a scaly erythematous papule or plaque that may be verrucous in nature or a nonhealing bleeding ulcer. In patients with more deeply pigmented skin, SCC tends to develop in the perianal region and on the penis and lower legs; pigmented lesions also may be present (as commonly reported in BCCs).^9,32,36

Unfortunately, the lower incidence of KCs and lack of surveillance in populations with skin of color result in a low index of clinical suspicion, leading to delayed diagnoses and increased morbidity.⁴⁰ Keratinocyte carcinomas are more costly to treat and require more health care resources for Latine/Hispanic and Black patients compared to their NHW counterparts; for example, KCs are associated with more ambulatory visits, more prescription medications, and greater cost on a per-person, per-year basis in Latine/Hispanic and Black patients compared with NHW patients.⁴¹ Moreover, a recent multicenter retrospective study found Hispanic patients had 17% larger MMS defects following treatment for KCs compared to NHW patients after adjustment for age, sex, and insurance type.⁴²

Hispanic patients tend to present initially with SCCs in areas associated with advanced disease, such as the anogenital region, penis, and the lower extremities. Latine and Black men have the highest incidence of penile SCC, which is rare with high morbidity and mortality.^32,43,44 The higher incidence of penile SCC among Hispanic individuals living in southern states could correspond to circumcision or HPV infection rates,⁴⁴ ultimately impacting incidence.⁴⁵

Dermatofibrosarcoma Protuberans

Dermatofibrosarcoma protuberans (DFSP) is a rare locally aggressive cutaneous sarcoma. According to population studies, overall incidence of DFSP is around 4.1 to 4.2 per million in the United States. Population-based studies on DFSP are limited, but available data suggest that Black patients as well as women have the highest incidence.⁴⁶

Dermatofibrosarcoma protuberans is characterized by its capacity to invade surrounding tissues in a tentaclelike pattern.⁴⁷ This characteristic often leads to inadequate initial resection of the lesion as well as a high recurrence rate despite its low metastatic potential.⁴⁸ In early stages, DFSP typically manifests as an asymptomatic plaque with a slow growth rate. The color of the lesion ranges from reddish brown to flesh colored. The pigmented form of DFSP, known as Bednar tumor, is the most common among Black patients.⁴⁷ As the tumor grows, it tends to become firm and nodular. The most common location for DFSP is on the trunk or the upper and lower extremities.⁴⁷

Although current guidelines designate MMS as the first-line treatment for DFSP, the procedure may be inaccessible for certain populations.⁴⁹ Patients with skin of color are more likely to undergo wide local excision (WLE) than MMS; however, WLE is less effective, with a recurrence rate of 30% compared with 3% in those treated with MMS.⁵⁰ A retrospective cohort study of more than 2000 patients revealed that Hispanic and Black patients were less likely to undergo MMS. In addition, the authors noted that WLE recipients more commonly were deceased at the end of the study.⁵¹

Despite undergoing treatment for a primary DFSP, Hispanic patients also appear to be at increased risk for a second surgery.⁵² Additional studies are needed to elucidate the reasons behind higher recurrence rates in Latine/Hispanic patients compared to NHW individuals.

Factors Influencing Skin Cancer Outcomes

In recent years, racial and ethnic disparities in health care use, medical treatment, and quality of care among minoritized populations (including Latine/Hispanic groups) have been documented in the medical literature.^53,54 These systemic inequities, which are rooted in structural racism,⁵⁵ have contributed to poorer health outcomes, worse health status, and lower-quality care for minoritized patients living in the United States, including those impacted by dermatologic conditions.^8,43,55-57 Becoming familiar with the sociocultural factors influencing skin cancer outcomes in the Latine/Hispanic community (including the lack of or inadequate health insurance, medical mistrust, language, and other cultural elements) and the paucity of research in this domain could help eliminate existing health inequities in this population.

Health Insurance Coverage—Although the uninsured rates in the Latine population have decreased since the passage of the Affordable Care Act (from 30% in 2013 to a low of 19% in 2017),⁵⁸ inadequate health insurance coverage remains one of the largest barriers to health care access and a contributor to health disparities among the Latine community. Nearly 1 in 5 Latine individuals in the United States are uninsured compared to 8% of NHW individuals.⁵⁸ Even though Latine individuals are more likely than non-Latine individuals to be part of the workforce, Latine employees are less likely to receive employer-sponsored coverage (27% vs 53% for NHW individuals).⁵⁹

Not surprisingly, noncitizens are far less likely to be insured; this includes lawfully present immigrants (ie, permanent residents or green card holders, refugees, asylees, and others who are authorized to live in the United States temporarily or permanently) and undocumented immigrants (including individuals who entered the country without authorization and individuals who entered the country lawfully and stayed after their visa or status expired). The higher uninsured rate among noncitizens reflects not only limited access to employer-sponsored coverage but includes immigrant eligibility restrictions for federal programs such as Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act Marketplace coverage.⁶⁰

With approximately 9 million Americans living in mixed-status families (and nearly 10% of babies born each year with at least one undocumented parent), restrictive federal or state health care policies may extend beyond their stated target and impact both Latine citizens and noncitizens.^61-65 For instance, Vargas et al⁶⁴ found that both Latine citizens and noncitizens who lived in states with a high number of immigration-related laws had decreased odds of reporting optimal health as compared to Latine respondents in states with fewer immigration-related laws.Other barriers to enrollment include fears and confusion about program qualification, even if eligible.⁵⁸

Medical Mistrust and Unfamiliarity—Mistrust of medical professionals has been shown to reduce patient adherence to treatment as prescribed by their medical provider and can negatively influence health outcomes.⁵³ For racial/ethnic minoritized groups (including Latine/Hispanic patients), medical mistrust may be rooted in patients’ experience of discrimination in the health care setting. In a recent cross-sectional study, results from a survey of California adults (including 704 non-Hispanic Black, 711 Hispanic, and 913 NHW adults) found links between levels of medical mistrust and perceived discrimination based on race/ethnicity and language as well as perceived discrimination due to income level and type or lack of insurance.⁵³ Interestingly, discrimination attributed to income level and insurance status remained after controlling for race/ethnicity and language. As expected, patients reliant on public insurance programs such as Medicare have been reported to have greater medical mistrust and suspicion compared with private insurance holders.⁶⁵ Together, these findings support the notion that individuals who have low socioeconomic status and lack insurance coverage—disproportionately historically marginalized populations—are more likely to perceive discrimination in health care settings, have greater medical mistrust, and experience poorer health outcomes.⁵³

It also is important for health care providers to consider that the US health care system is unfamiliar to many Latine/Hispanic individuals. Costs of medical services tend to be substantially higher in the United States, which can contribute to mistrust in the system.⁶⁶ In addition, unethical medical experimentations have negatively affected both Latine and especially non-Hispanic Black populations, with long-lasting perceptions of deception and exploitation.⁶⁷ These beliefs have undermined the trust that these populations have in clinicians and the health care system.^54,67

Language and Other Cultural Elements—The inability to effectively communicate with health care providers could contribute to disparities in access to and use of health care services among Latine/Hispanic individuals. In a Medical Expenditure Panel Survey analysis, half of Hispanic patients with limited comfort speaking English did not have a usual source of care, and almost 90% of those with a usual source of care had a provider who spoke Spanish or used interpreters—indicating that few Hispanic individuals with limited comfort speaking English selected a usual source of care without language assistance.^68,69 In other examples, language barriers contributed to disparities in cancer screening, and individuals with limited English proficiency were more likely to have difficulty understanding their physician due to language barriers.^68,70

Improving cultural misconceptions regarding skin conditions, especially skin cancer, is another important consideration in the Latine/Hispanic community. Many Latine/Hispanic individuals wrongly believe they cannot develop skin cancer due to their darker skin tones and lack of family history.²⁶ Moreover, multiple studies assessing melanoma knowledge and perception among participants with skin of color (including one with an equal number of Latine/Hispanic, Black/African American, and Asian individuals for a total of 120 participants) revealed that many were unaware of the risk for melanoma on acral sites.⁷¹ Participants expressed a need for more culturally relevant content from both clinicians and public materials (eg, images of acral melanoma in a person with skin of color).^71-73

Paucity of Research—There is limited research regarding skin cancer risks and methods of prevention for patients with skin of color, including the Latine/Hispanic population. Efforts to engage and include patients from these communities, as well as clinicians or investigators from similar backgrounds, in clinical studies are desperately needed. It also is important that clinical studies collect data beyond population descriptors to account for both clinical and genetic variations observed in the Latine/Hispanic population.

Latine/Hispanic individuals are quite diverse with many variable factors that may influence skin cancer outcomes. Often, cancer surveillance data are available in aggregate only, which could mask this heterogeneity.⁷⁴ Rigorous studies that collect more granular data, including objective measures of skin pigmentation beyond self-reported Fitzpatrick skin type, culture/beliefs, lifestyle/behavior, geographic location, socioeconomic status, genetics, or epigenetics could help fully elucidate skin cancer risks and mitigate health disparities among individuals who identify as part of this population.

Final Thoughts

The Latine/Hispanic community—the largest ethnic minoritized group in the United States—is disproportionately affected by dermatologic health disparities. We hope this review helps to increase recognition of the clinical manifestations of skin cancer in Latine/Hispanic patients. Other factors that may impact skin cancer outcomes in this population include (but are not limited to) lack of or inadequate health insurance, medical mistrust, linguistic barriers and/or individual/cultural perspectives, along with limited research. Recognizing and addressing these (albeit complex) barriers that contribute to the inequitable access to health care in this population remains a critical step toward improving skin cancer outcomes.

References

Noe-Bustamnate L, Lopez MH, Krogstad JM. US Hispanic population surpassed 60 million in 2019, but growth has slowed. July 7, 2020. Accessed September 3, 2024. https://www.pewresearch.org/short-reads/2020/07/07/u-s-hispanic-population-surpassed-60-million-in-2019-but-growth-has-slowed/
Frank C, Lopez MH. Hispanic Americans’ trust in and engagement with science. Pew Research Center. June 14, 2022. Accessed September 3, 2024. https://www.pewresearch.org/wp-content/uploads/sites/20/2022/06/PS_2022.06.14_hispanic-americans-science_REPORT.pdf
US Census Bureau. Projections of the size and composition of the US population: 2014 to 2060. US Government Printing Office; 2015. Accessed September 5, 2024. https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf
Zong J. A mosaic, not a monolith: a profile of the U.S. Latino population, 2000-2020. October 26, 2022. Accessed September 3, 2024. https://latino.ucla.edu/research/latino-population-2000-2020/
Latinos in California, Texas, New York, Florida and New Jersey. Pew Research Center. March 19, 2004. Accessed September 3, 2024. https://www.pewresearch.org/hispanic/2004/03/19/latinos-in-california-texas-new-york-florida-and-new-jersey/
Pinheiro PS, Sherman RL, Trapido EJ, et al. Cancer incidence in first generation US Hispanics: Cubans, Mexicans, Puerto Ricans, and new Latinos. Cancer Epidemiol Biomarkers Prev. 2009;18:2162-2169.
Pinheiro PS, Callahan KE, Kobetz EN. Disaggregated Hispanic groups and cancer: importance, methodology, and current knowledge. In: Ramirez AG, Trapido EJ, eds. Advancing the Science of Cancer in Latinos. Springer; 2020:17-34.
Qian Y, Johannet P, Sawyers A, et al. The ongoing racial disparities in melanoma: an analysis of the Surveillance, Epidemiology, and End Results database (1975-2016). J Am Acad Dermatol. 2021;84:1585-1593.
Hogue L, Harvey VM. Basal cell carcinoma, squamous cell carcinoma, and cutaneous melanoma in skin of color patients. Dermatol Clin. 2019;37:519-526.
Cruzval-O’Reilly E, Lugo-Somolinos A. Melanoma in Hispanics: we may have it all wrong. Cutis. 2020;106:28-30.
Borrell LN, Elhawary JR, Fuentes-Afflick E, et al. Race and genetic ancestry in medicine—a time for reckoning with racism. N Engl J Med. 2021;384:474-480.
Lopez MH, Krogstad JM, Passel JS. Who is Hispanic? September 5, 2023. Accessed September 3, 2024. https://www.pewresearch.org/short-reads/2023/09/05/who-is-hispanic/
Carrasquillo OY, Lambert J, Merritt BG. Comment on “Disparities in nonmelanoma skin cancer in Hispanic/Latino patients based on Mohs micrographic surgery defect size: a multicenter retrospective study.”J Am Acad Dermatol. 2022;87:E129-E130.
American Cancer Society. Key statistics for melanoma skin cancer. Updated January 17, 2024. Accessed September 3, 2024. https://www.cancer.org/cancer/types/melanoma-skin-cancer/about/key-statistics.html
National Cancer Institute. Melanoma of the skin: recent trends in SEER age-adjusted incidence rates, 2000-2021. Updated June 27, 2024. Accessed September 3, 2024. https://seer.cancer.gov/statistics-network/explorer/application.htmlsite=53&data_type=1&graph_type=2&compareBy=sex&chk_sex_3=3&chk_sex_2=2&rate_type=2&race=6&age_range=1&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_display=2
Garnett E, Townsend J, Steele B, et al. Characteristics, rates, and trends of melanoma incidence among Hispanics in the USA. Cancer Causes Control. 2016;27:647-659.
Higgins S, Nazemi A, Feinstein S, et al. Clinical presentations of melanoma in African Americans, Hispanics, and Asians. Dermatol Surg. 2019;45:791-801.
Bristow IR, de Berker DA, Acland KM, et al. Clinical guidelines for the recognition of melanoma of the foot and nail unit. J Foot Ankle Res. 2010;3:25.
Fernandez JM, Mata EM, Behbahani S, et al. Survival of Hispanic patients with cutaneous melanoma: a retrospective cohort analysis of 6016 cases from the National Cancer Database. J Am Acad Dermatol. 2023;88:1135-1138.
Hu S, Sherman R, Arheart K, et al. Predictors of neighborhood risk for late-stage melanoma: addressing disparities through spatial analysis and area-based measures. J Investigative Dermatol. 2014;134:937-945.
Buster KJ, You Z, Fouad M, et al. Skin cancer risk perceptions: a comparison across ethnicity, age, education, gender, and income. J Am Acad Dermatol. 2012;66:771-779.
Halpern MT, Ward EM, Pavluck AL, et al. Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. Lancet Oncology. 2008;9:222-231.
Weiss J, Kirsner RS, Hu S. Trends in primary skin cancer prevention among US Hispanics: a systematic review. J Drugs Dermatol. 2012;11:580-586.
Carvalho LAD, Aguiar FC, Smalley KSM, et al. Acral melanoma: new insights into the immune and genomic landscape. Neoplasia. 2023;46:100947.
Kolitz E, Lopes F, Arffa M, et al. UV Exposure and the risk of keratinocyte carcinoma in skin of color: a systematic review. JAMA Dermatol. 2022;158:542-546.
Lukowiak TM, Aizman L, Perz A, et al. Association of age, sex, race, and geographic region with variation of the ratio of basal cell to cutaneous squamous cell carcinomas in the United States. JAMA Dermatol. 2020;156:1192-1198.
Basset-Seguin N, Herms F. Update in the management of basal cell carcinoma. Acta Derm Venereol. 2020;100:adv00140.
McDaniel B, Badri T, Steele RB. Basal cell carcinoma. StatPearls [Internet]. Updated March 13, 2024. Accessed September 3, 2024. https://www.ncbi.nlm.nih.gov/books/NBK482439/
Dessinioti C, Antoniou C, Katsambas A, et al. Basal cell carcinoma: what’s new under the sun. Photochem Photobiol. 2010;86:481-491.
Kim DP, Kus KJB, Ruiz E. Basal cell carcinoma review. Hematol Oncol Clin North Am. 2019;33:13-24.
Bigler C, Feldman J, Hall E, et al. Pigmented basal cell carcinoma in Hispanics. J Am Acad Dermatol. 1996;34(5 pt 1):751-752.
Higgins S, Nazemi A, Chow M, et al. Review of nonmelanoma skin cancer in African Americans, Hispanics, and Asians. Dermatol Surg. 2018;44:903-910.
Byrd-Miles K, Toombs EL, Peck GL. Skin cancer in individuals of African, Asian, Latin-American, and American-Indian descent: differences in incidence, clinical presentation, and survival compared to Caucasians. J Drugs Dermatol. 2007;6:10-16.
Rivas M, Rojas E, Calaf GM, et al. Association between non-melanoma and melanoma skin cancer rates, vitamin D and latitude. Oncol Lett. 2017;13:3787-3792.
Bradford PT. Skin cancer in skin of color. Dermatol Nurs. 2009;21:170-177, 206.
Davis DS, Robinson C, Callender VD. Skin cancer in women of color: epidemiology, pathogenesis and clinical manifestations. Int J Womens Dermatol. 2021;7:127-134.
Maafs E, De la Barreda F, Delgado R, et al. Basal cell carcinoma of trunk and extremities. Int J Dermatol. 1997;36:622-628.
Munjal A, Ferguson N. Skin cancer in skin of color. Dermatol Clin. 2023;41:481-489.
Jorgenson E, Choquet H, Yin J, et al. Genetic ancestry, skin pigmentation, and the risk of cutaneous squamous cell carcinoma in Hispanic/Latino and non-Hispanic white populations. Commun Biol. 2020;3:765.
Soliman YS, Mieczkowska K, Zhu TR, et al. Characterizing basal cell carcinoma in Hispanic individuals undergoing Mohs micrographic surgery: a 7-year retrospective review at an academic institution in the Bronx. Brit J Dermatol. 2022;187:597-599.
Sierro TJ, Blumenthal LY, Hekmatjah J, et al. Differences in health care resource utilization and costs for keratinocyte carcinoma among racioethnic groups: a population-based study. J Am Acad Dermatol. 2022;86:373-378.
Blumenthal LY, Arzeno J, Syder N, et al. Disparities in nonmelanoma skin cancer in Hispanic/Latino patients based on Mohs micrographic surgery defect size: a multicenter retrospective study. J Am Acad Dermatol. 2022;86:353-358.
Slopnick EA, Kim SP, Kiechle JE, et al. Racial disparities differ for African Americans and Hispanics in the diagnosis and treatment of penile cancer. Urology. 2016;96:22-28.
Goodman MT, Hernandez BY, Shvetsov YB. Demographic and pathologic differences in the incidence of invasive penile cancer in the United States, 1995-2003. Cancer Epidemiol Biomarkers Prev. 2007;16:1833-1839.
Thompson EL, Rosen BL, Maness SB. Social determinants of health and human papillomavirus vaccination among young adults, National Health Interview Survey 2016. J Community Health. 2019;44:149-158.
Hao X, Billings SD, Wu F, et al. Dermatofibrosarcoma protuberans: update on the diagnosis and treatment. J Clin Med. 2020;9:1752.
Mosallaei D, Lee EB, Lobl M, et al. Rare cutaneous malignancies in skin of color. Dermatol Surg. 2022;48:606-612.
Criscito MC, Martires KJ, Stein JA. Prognostic factors, treatment, and survival in dermatofibrosarcoma protuberans. JAMA Dermatol. 2016;152:1365-1371.
Orenstein LAV, Nelson MM, Wolner Z, et al. Differences in outpatient dermatology encounter work relative value units and net payments by patient race, sex, and age. JAMA Dermatol. 2021;157:406-412.
Lowe GC, Onajin O, Baum CL, et al. A comparison of Mohs micrographic surgery and wide local excision for treatment of dermatofibrosarcoma protuberans with long-term follow-up: the Mayo Clinic experience. Dermatol Surg. 2017;43:98-106.
Moore KJ, Chang MS, Weiss J, et al. Racial and ethnic differences in the surgical treatment of dermatofibrosarcoma protuberans: a retrospective cohort analysis. J Am Acad Dermatol. 2022;87:245-247.
Trofymenko O, Bordeaux JS, Zeitouni NC. Survival in patients with primary dermatofibrosarcoma protuberans: National Cancer Database analysis. J Am Acad Dermatol. 2018;78:1125-1134.
Bazargan M, Cobb S, Assari S. Discrimination and medical mistrust in a racially and ethnically diverse sample of California adults. Ann Fam Med. 2021;19:4-15.
Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC; 2003.
Bailey ZD, Krieger N, Agenor M, et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389:1453-1463.
Tackett KJ, Jenkins F, Morrell DS, et al. Structural racism and its influence on the severity of atopic dermatitis in African American children. Pediatric Dermatol. 2020;37:142-146.
Greif C, Srivastava D, Nijhawan RI. A retrospective cohort study of dermatofibrosarcoma protuberans at a large metropolitan academic center. JAAD Int. 2022;6:104-106.
Office of the Assistant Secretary for Planning and Evaluation. Health insurance coverage and access to care among Latinos: recent rrends and key challenges (HP-2021-22). October 8, 2021. Accessed September 3, 2024. https://aspe.hhs.gov/reports/health-insurance-coverage-access-care-among-latinos
Keisler-Starkey K, Bunch LN. Health insurance coverage in the United States: 2020 (Current Population Reports No. P60-274). US Census Bureau; 2021. https://www.census.gov/content/dam/Census/library/publications/2021/demo/p60-274.pdf
Kaiser Family Foundation. Key facts on health coverage of immigrants. Updated June 26, 2024. Accessed September 3, 2024. https://www.kff.org/racial-equity-and-health-policy/fact-sheet/key-facts-on-health-coverage-of-immigrants/
Pew Research Center. Unauthorized immigrants: length of residency, patterns of parenthood. Published December 1, 2011. Accessed October 28, 2024. https://www.pewresearch.org/race-and-ethnicity/2011/12/01/unauthorized-immigrants-length-of-residency-patterns-of-parenthood/
Schneider J, Schmitt M. Understanding the relationship between racial discrimination and mental health among African American adults: a review. SAGE Open. 2015;5:1-10.
Philbin MM, Flake M, Hatzenbuehler ML, et al. State-level immigration and immigrant-focused policies as drivers of Latino health disparities in the United States. Soc Sci Med. 2018;199:29-38.
Vargas ED, Sanchez GR, Juarez M. The impact of punitive immigrant laws on the health of Latina/o Populations. Polit Policy. 2017;45:312-337.
Sutton AL, He J, Edmonds MC, et al. Medical mistrust in Black breast cancer patients: acknowledging the roles of the trustor and the trustee. J Cancer Educ. 2019;34:600-607.
Jacobs J. An overview of Latin American healthcare systems. Pacific Prime Latin America. July 31, 2023. Accessed September 3, 2024. https://www.pacificprime.lat/blog/an-overview-of-latin-american-healthcare-systems/
CDC. Unfair and unjust practices and conditions harm Hispanic and Latino people and drive health disparities. May 15, 2024. Accessed September 3, 2024. https://www.cdc.gov/tobacco-health-equity/collection/hispanic-latino-unfair-and-unjust.html
Hall IJ, Rim SH, Dasari S. Preventive care use among Hispanic adults with limited comfort speaking English: an analysis of the Medical Expenditure Panel Survey data. Prev Med. 2022;159:107042.
Brach C, Chevarley FM. Demographics and health care access and utilization of limited-English-proficient and English-proficient Hispanics. Agency for Healthcare Research and Quality. February 2008. http://meps.ahrq.gov/mepsweb/data_files/publications//rf28/rf28.pdf
Berdahl TA, Kirby JB. Patient-provider communication disparities by limited English proficiency (LEP): trends from the US Medical Expenditure Panel Survey, 2006-2015. J General Intern Med. 2019;34:1434-1440.
Robinson JK, Joshi KM, Ortiz S, et al. Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education. Psychooncology. 2011;20:313-320.
Robinson JK, Nodal M, Chavez L, et al. Enhancing the relevance of skin self-examination for Latinos. JAMA Dermatol. 2017;153:717-718.
Buchanan Lunsford N, Berktold J, Holman DM, et al. Skin cancer knowledge, awareness, beliefs and preventive behaviors among black and hispanic men and women. Prev Med Rep. 2018;12:203-209.
Madrigal JM, Correa-Mendez M, Arias JD, et al. Hispanic, Latino/a, Latinx, Latine: disentangling the identities of Hispanic/Latino Americans. National Cancer Institute Division of Cancer Epidemiology & Genetics. October 20, 2022. Accessed September 3, 2024. https://dceg.cancer.gov/about/diversity-inclusion/inclusivity-minute/2022/disentangling-identities-hispanic-latino-americans

Article PDF

CT114005146.pdf

Author and Disclosure Information

Dr. Valencia is from the Department of Internal Medicine, John Hopkins Bayview Medical Center, Baltimore, Maryland. Fabiola Ramirez is from the Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso. Claudia Dubocq-Ortiz is from the University of Puerto Rico School of Medicine, Medical School Campus, San Juan. Dr. Vasquez is from the Department of Dermatology, UT Southwestern Medical Center, Dallas.

The authors have no relevant financial disclosures to report.

Correspondence: Rebecca Vasquez, MD, Department of Dermatology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Box 9190, Dallas, TX 75390 ([email protected]).

Cutis. 2024 November;114(5):146-152. doi:10.12788/cutis.1129

Issue

Cutis - 114(5)

Publications

MDedge Dermatology

Cutis

Topics

Diversity in Medicine

Melanoma

Nonmelanoma Skin Cancer

Page Number

146-152

Read more about Disparities in Skin Cancer Outcomes in the Latine/Hispanic Population

Sections

Skin of Color

Author(s)

Jesus Valencia, MD

Fabiola Ramirez, MSN

Claudia Dubocq-Ortiz, BS

Rebecca Vasquez, MD

Author(s)

Jesus Valencia, MD

Fabiola Ramirez, MSN

Claudia Dubocq-Ortiz, BS

Rebecca Vasquez, MD

Author and Disclosure Information

Cutis. 2024 November;114(5):146-152. doi:10.12788/cutis.1129

Author and Disclosure Information

Cutis. 2024 November;114(5):146-152. doi:10.12788/cutis.1129

Article PDF

CT114005146.pdf

Article PDF

CT114005146.pdf

Terminology

Melanoma

Keratinocyte Carcinomas

Dermatofibrosarcoma Protuberans

Factors Influencing Skin Cancer Outcomes

Final Thoughts

Terminology

Melanoma

Keratinocyte Carcinomas

Dermatofibrosarcoma Protuberans

Factors Influencing Skin Cancer Outcomes

Final Thoughts

References

Noe-Bustamnate L, Lopez MH, Krogstad JM. US Hispanic population surpassed 60 million in 2019, but growth has slowed. July 7, 2020. Accessed September 3, 2024. https://www.pewresearch.org/short-reads/2020/07/07/u-s-hispanic-population-surpassed-60-million-in-2019-but-growth-has-slowed/
Frank C, Lopez MH. Hispanic Americans’ trust in and engagement with science. Pew Research Center. June 14, 2022. Accessed September 3, 2024. https://www.pewresearch.org/wp-content/uploads/sites/20/2022/06/PS_2022.06.14_hispanic-americans-science_REPORT.pdf
US Census Bureau. Projections of the size and composition of the US population: 2014 to 2060. US Government Printing Office; 2015. Accessed September 5, 2024. https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf
Zong J. A mosaic, not a monolith: a profile of the U.S. Latino population, 2000-2020. October 26, 2022. Accessed September 3, 2024. https://latino.ucla.edu/research/latino-population-2000-2020/
Latinos in California, Texas, New York, Florida and New Jersey. Pew Research Center. March 19, 2004. Accessed September 3, 2024. https://www.pewresearch.org/hispanic/2004/03/19/latinos-in-california-texas-new-york-florida-and-new-jersey/
Pinheiro PS, Sherman RL, Trapido EJ, et al. Cancer incidence in first generation US Hispanics: Cubans, Mexicans, Puerto Ricans, and new Latinos. Cancer Epidemiol Biomarkers Prev. 2009;18:2162-2169.
Pinheiro PS, Callahan KE, Kobetz EN. Disaggregated Hispanic groups and cancer: importance, methodology, and current knowledge. In: Ramirez AG, Trapido EJ, eds. Advancing the Science of Cancer in Latinos. Springer; 2020:17-34.
Qian Y, Johannet P, Sawyers A, et al. The ongoing racial disparities in melanoma: an analysis of the Surveillance, Epidemiology, and End Results database (1975-2016). J Am Acad Dermatol. 2021;84:1585-1593.
Hogue L, Harvey VM. Basal cell carcinoma, squamous cell carcinoma, and cutaneous melanoma in skin of color patients. Dermatol Clin. 2019;37:519-526.
Cruzval-O’Reilly E, Lugo-Somolinos A. Melanoma in Hispanics: we may have it all wrong. Cutis. 2020;106:28-30.
Borrell LN, Elhawary JR, Fuentes-Afflick E, et al. Race and genetic ancestry in medicine—a time for reckoning with racism. N Engl J Med. 2021;384:474-480.
Lopez MH, Krogstad JM, Passel JS. Who is Hispanic? September 5, 2023. Accessed September 3, 2024. https://www.pewresearch.org/short-reads/2023/09/05/who-is-hispanic/
Carrasquillo OY, Lambert J, Merritt BG. Comment on “Disparities in nonmelanoma skin cancer in Hispanic/Latino patients based on Mohs micrographic surgery defect size: a multicenter retrospective study.”J Am Acad Dermatol. 2022;87:E129-E130.
American Cancer Society. Key statistics for melanoma skin cancer. Updated January 17, 2024. Accessed September 3, 2024. https://www.cancer.org/cancer/types/melanoma-skin-cancer/about/key-statistics.html
National Cancer Institute. Melanoma of the skin: recent trends in SEER age-adjusted incidence rates, 2000-2021. Updated June 27, 2024. Accessed September 3, 2024. https://seer.cancer.gov/statistics-network/explorer/application.htmlsite=53&data_type=1&graph_type=2&compareBy=sex&chk_sex_3=3&chk_sex_2=2&rate_type=2&race=6&age_range=1&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_display=2
Garnett E, Townsend J, Steele B, et al. Characteristics, rates, and trends of melanoma incidence among Hispanics in the USA. Cancer Causes Control. 2016;27:647-659.
Higgins S, Nazemi A, Feinstein S, et al. Clinical presentations of melanoma in African Americans, Hispanics, and Asians. Dermatol Surg. 2019;45:791-801.
Bristow IR, de Berker DA, Acland KM, et al. Clinical guidelines for the recognition of melanoma of the foot and nail unit. J Foot Ankle Res. 2010;3:25.
Fernandez JM, Mata EM, Behbahani S, et al. Survival of Hispanic patients with cutaneous melanoma: a retrospective cohort analysis of 6016 cases from the National Cancer Database. J Am Acad Dermatol. 2023;88:1135-1138.
Hu S, Sherman R, Arheart K, et al. Predictors of neighborhood risk for late-stage melanoma: addressing disparities through spatial analysis and area-based measures. J Investigative Dermatol. 2014;134:937-945.
Buster KJ, You Z, Fouad M, et al. Skin cancer risk perceptions: a comparison across ethnicity, age, education, gender, and income. J Am Acad Dermatol. 2012;66:771-779.
Halpern MT, Ward EM, Pavluck AL, et al. Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. Lancet Oncology. 2008;9:222-231.
Weiss J, Kirsner RS, Hu S. Trends in primary skin cancer prevention among US Hispanics: a systematic review. J Drugs Dermatol. 2012;11:580-586.
Carvalho LAD, Aguiar FC, Smalley KSM, et al. Acral melanoma: new insights into the immune and genomic landscape. Neoplasia. 2023;46:100947.
Kolitz E, Lopes F, Arffa M, et al. UV Exposure and the risk of keratinocyte carcinoma in skin of color: a systematic review. JAMA Dermatol. 2022;158:542-546.
Lukowiak TM, Aizman L, Perz A, et al. Association of age, sex, race, and geographic region with variation of the ratio of basal cell to cutaneous squamous cell carcinomas in the United States. JAMA Dermatol. 2020;156:1192-1198.
Basset-Seguin N, Herms F. Update in the management of basal cell carcinoma. Acta Derm Venereol. 2020;100:adv00140.
McDaniel B, Badri T, Steele RB. Basal cell carcinoma. StatPearls [Internet]. Updated March 13, 2024. Accessed September 3, 2024. https://www.ncbi.nlm.nih.gov/books/NBK482439/
Dessinioti C, Antoniou C, Katsambas A, et al. Basal cell carcinoma: what’s new under the sun. Photochem Photobiol. 2010;86:481-491.
Kim DP, Kus KJB, Ruiz E. Basal cell carcinoma review. Hematol Oncol Clin North Am. 2019;33:13-24.
Bigler C, Feldman J, Hall E, et al. Pigmented basal cell carcinoma in Hispanics. J Am Acad Dermatol. 1996;34(5 pt 1):751-752.
Higgins S, Nazemi A, Chow M, et al. Review of nonmelanoma skin cancer in African Americans, Hispanics, and Asians. Dermatol Surg. 2018;44:903-910.
Byrd-Miles K, Toombs EL, Peck GL. Skin cancer in individuals of African, Asian, Latin-American, and American-Indian descent: differences in incidence, clinical presentation, and survival compared to Caucasians. J Drugs Dermatol. 2007;6:10-16.
Rivas M, Rojas E, Calaf GM, et al. Association between non-melanoma and melanoma skin cancer rates, vitamin D and latitude. Oncol Lett. 2017;13:3787-3792.
Bradford PT. Skin cancer in skin of color. Dermatol Nurs. 2009;21:170-177, 206.
Davis DS, Robinson C, Callender VD. Skin cancer in women of color: epidemiology, pathogenesis and clinical manifestations. Int J Womens Dermatol. 2021;7:127-134.
Maafs E, De la Barreda F, Delgado R, et al. Basal cell carcinoma of trunk and extremities. Int J Dermatol. 1997;36:622-628.
Munjal A, Ferguson N. Skin cancer in skin of color. Dermatol Clin. 2023;41:481-489.
Jorgenson E, Choquet H, Yin J, et al. Genetic ancestry, skin pigmentation, and the risk of cutaneous squamous cell carcinoma in Hispanic/Latino and non-Hispanic white populations. Commun Biol. 2020;3:765.
Soliman YS, Mieczkowska K, Zhu TR, et al. Characterizing basal cell carcinoma in Hispanic individuals undergoing Mohs micrographic surgery: a 7-year retrospective review at an academic institution in the Bronx. Brit J Dermatol. 2022;187:597-599.
Sierro TJ, Blumenthal LY, Hekmatjah J, et al. Differences in health care resource utilization and costs for keratinocyte carcinoma among racioethnic groups: a population-based study. J Am Acad Dermatol. 2022;86:373-378.
Blumenthal LY, Arzeno J, Syder N, et al. Disparities in nonmelanoma skin cancer in Hispanic/Latino patients based on Mohs micrographic surgery defect size: a multicenter retrospective study. J Am Acad Dermatol. 2022;86:353-358.
Slopnick EA, Kim SP, Kiechle JE, et al. Racial disparities differ for African Americans and Hispanics in the diagnosis and treatment of penile cancer. Urology. 2016;96:22-28.
Goodman MT, Hernandez BY, Shvetsov YB. Demographic and pathologic differences in the incidence of invasive penile cancer in the United States, 1995-2003. Cancer Epidemiol Biomarkers Prev. 2007;16:1833-1839.
Thompson EL, Rosen BL, Maness SB. Social determinants of health and human papillomavirus vaccination among young adults, National Health Interview Survey 2016. J Community Health. 2019;44:149-158.
Hao X, Billings SD, Wu F, et al. Dermatofibrosarcoma protuberans: update on the diagnosis and treatment. J Clin Med. 2020;9:1752.
Mosallaei D, Lee EB, Lobl M, et al. Rare cutaneous malignancies in skin of color. Dermatol Surg. 2022;48:606-612.
Criscito MC, Martires KJ, Stein JA. Prognostic factors, treatment, and survival in dermatofibrosarcoma protuberans. JAMA Dermatol. 2016;152:1365-1371.
Orenstein LAV, Nelson MM, Wolner Z, et al. Differences in outpatient dermatology encounter work relative value units and net payments by patient race, sex, and age. JAMA Dermatol. 2021;157:406-412.
Lowe GC, Onajin O, Baum CL, et al. A comparison of Mohs micrographic surgery and wide local excision for treatment of dermatofibrosarcoma protuberans with long-term follow-up: the Mayo Clinic experience. Dermatol Surg. 2017;43:98-106.
Moore KJ, Chang MS, Weiss J, et al. Racial and ethnic differences in the surgical treatment of dermatofibrosarcoma protuberans: a retrospective cohort analysis. J Am Acad Dermatol. 2022;87:245-247.
Trofymenko O, Bordeaux JS, Zeitouni NC. Survival in patients with primary dermatofibrosarcoma protuberans: National Cancer Database analysis. J Am Acad Dermatol. 2018;78:1125-1134.
Bazargan M, Cobb S, Assari S. Discrimination and medical mistrust in a racially and ethnically diverse sample of California adults. Ann Fam Med. 2021;19:4-15.
Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC; 2003.
Bailey ZD, Krieger N, Agenor M, et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389:1453-1463.
Tackett KJ, Jenkins F, Morrell DS, et al. Structural racism and its influence on the severity of atopic dermatitis in African American children. Pediatric Dermatol. 2020;37:142-146.
Greif C, Srivastava D, Nijhawan RI. A retrospective cohort study of dermatofibrosarcoma protuberans at a large metropolitan academic center. JAAD Int. 2022;6:104-106.
Office of the Assistant Secretary for Planning and Evaluation. Health insurance coverage and access to care among Latinos: recent rrends and key challenges (HP-2021-22). October 8, 2021. Accessed September 3, 2024. https://aspe.hhs.gov/reports/health-insurance-coverage-access-care-among-latinos
Keisler-Starkey K, Bunch LN. Health insurance coverage in the United States: 2020 (Current Population Reports No. P60-274). US Census Bureau; 2021. https://www.census.gov/content/dam/Census/library/publications/2021/demo/p60-274.pdf
Kaiser Family Foundation. Key facts on health coverage of immigrants. Updated June 26, 2024. Accessed September 3, 2024. https://www.kff.org/racial-equity-and-health-policy/fact-sheet/key-facts-on-health-coverage-of-immigrants/
Pew Research Center. Unauthorized immigrants: length of residency, patterns of parenthood. Published December 1, 2011. Accessed October 28, 2024. https://www.pewresearch.org/race-and-ethnicity/2011/12/01/unauthorized-immigrants-length-of-residency-patterns-of-parenthood/
Schneider J, Schmitt M. Understanding the relationship between racial discrimination and mental health among African American adults: a review. SAGE Open. 2015;5:1-10.
Philbin MM, Flake M, Hatzenbuehler ML, et al. State-level immigration and immigrant-focused policies as drivers of Latino health disparities in the United States. Soc Sci Med. 2018;199:29-38.
Vargas ED, Sanchez GR, Juarez M. The impact of punitive immigrant laws on the health of Latina/o Populations. Polit Policy. 2017;45:312-337.
Sutton AL, He J, Edmonds MC, et al. Medical mistrust in Black breast cancer patients: acknowledging the roles of the trustor and the trustee. J Cancer Educ. 2019;34:600-607.
Jacobs J. An overview of Latin American healthcare systems. Pacific Prime Latin America. July 31, 2023. Accessed September 3, 2024. https://www.pacificprime.lat/blog/an-overview-of-latin-american-healthcare-systems/
CDC. Unfair and unjust practices and conditions harm Hispanic and Latino people and drive health disparities. May 15, 2024. Accessed September 3, 2024. https://www.cdc.gov/tobacco-health-equity/collection/hispanic-latino-unfair-and-unjust.html
Hall IJ, Rim SH, Dasari S. Preventive care use among Hispanic adults with limited comfort speaking English: an analysis of the Medical Expenditure Panel Survey data. Prev Med. 2022;159:107042.
Brach C, Chevarley FM. Demographics and health care access and utilization of limited-English-proficient and English-proficient Hispanics. Agency for Healthcare Research and Quality. February 2008. http://meps.ahrq.gov/mepsweb/data_files/publications//rf28/rf28.pdf
Berdahl TA, Kirby JB. Patient-provider communication disparities by limited English proficiency (LEP): trends from the US Medical Expenditure Panel Survey, 2006-2015. J General Intern Med. 2019;34:1434-1440.
Robinson JK, Joshi KM, Ortiz S, et al. Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education. Psychooncology. 2011;20:313-320.
Robinson JK, Nodal M, Chavez L, et al. Enhancing the relevance of skin self-examination for Latinos. JAMA Dermatol. 2017;153:717-718.
Buchanan Lunsford N, Berktold J, Holman DM, et al. Skin cancer knowledge, awareness, beliefs and preventive behaviors among black and hispanic men and women. Prev Med Rep. 2018;12:203-209.
Madrigal JM, Correa-Mendez M, Arias JD, et al. Hispanic, Latino/a, Latinx, Latine: disentangling the identities of Hispanic/Latino Americans. National Cancer Institute Division of Cancer Epidemiology & Genetics. October 20, 2022. Accessed September 3, 2024. https://dceg.cancer.gov/about/diversity-inclusion/inclusivity-minute/2022/disentangling-identities-hispanic-latino-americans

References

Noe-Bustamnate L, Lopez MH, Krogstad JM. US Hispanic population surpassed 60 million in 2019, but growth has slowed. July 7, 2020. Accessed September 3, 2024. https://www.pewresearch.org/short-reads/2020/07/07/u-s-hispanic-population-surpassed-60-million-in-2019-but-growth-has-slowed/
Frank C, Lopez MH. Hispanic Americans’ trust in and engagement with science. Pew Research Center. June 14, 2022. Accessed September 3, 2024. https://www.pewresearch.org/wp-content/uploads/sites/20/2022/06/PS_2022.06.14_hispanic-americans-science_REPORT.pdf
US Census Bureau. Projections of the size and composition of the US population: 2014 to 2060. US Government Printing Office; 2015. Accessed September 5, 2024. https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf
Zong J. A mosaic, not a monolith: a profile of the U.S. Latino population, 2000-2020. October 26, 2022. Accessed September 3, 2024. https://latino.ucla.edu/research/latino-population-2000-2020/
Latinos in California, Texas, New York, Florida and New Jersey. Pew Research Center. March 19, 2004. Accessed September 3, 2024. https://www.pewresearch.org/hispanic/2004/03/19/latinos-in-california-texas-new-york-florida-and-new-jersey/
Pinheiro PS, Sherman RL, Trapido EJ, et al. Cancer incidence in first generation US Hispanics: Cubans, Mexicans, Puerto Ricans, and new Latinos. Cancer Epidemiol Biomarkers Prev. 2009;18:2162-2169.
Pinheiro PS, Callahan KE, Kobetz EN. Disaggregated Hispanic groups and cancer: importance, methodology, and current knowledge. In: Ramirez AG, Trapido EJ, eds. Advancing the Science of Cancer in Latinos. Springer; 2020:17-34.
Qian Y, Johannet P, Sawyers A, et al. The ongoing racial disparities in melanoma: an analysis of the Surveillance, Epidemiology, and End Results database (1975-2016). J Am Acad Dermatol. 2021;84:1585-1593.
Hogue L, Harvey VM. Basal cell carcinoma, squamous cell carcinoma, and cutaneous melanoma in skin of color patients. Dermatol Clin. 2019;37:519-526.
Cruzval-O’Reilly E, Lugo-Somolinos A. Melanoma in Hispanics: we may have it all wrong. Cutis. 2020;106:28-30.
Borrell LN, Elhawary JR, Fuentes-Afflick E, et al. Race and genetic ancestry in medicine—a time for reckoning with racism. N Engl J Med. 2021;384:474-480.
Lopez MH, Krogstad JM, Passel JS. Who is Hispanic? September 5, 2023. Accessed September 3, 2024. https://www.pewresearch.org/short-reads/2023/09/05/who-is-hispanic/
Carrasquillo OY, Lambert J, Merritt BG. Comment on “Disparities in nonmelanoma skin cancer in Hispanic/Latino patients based on Mohs micrographic surgery defect size: a multicenter retrospective study.”J Am Acad Dermatol. 2022;87:E129-E130.
American Cancer Society. Key statistics for melanoma skin cancer. Updated January 17, 2024. Accessed September 3, 2024. https://www.cancer.org/cancer/types/melanoma-skin-cancer/about/key-statistics.html
National Cancer Institute. Melanoma of the skin: recent trends in SEER age-adjusted incidence rates, 2000-2021. Updated June 27, 2024. Accessed September 3, 2024. https://seer.cancer.gov/statistics-network/explorer/application.htmlsite=53&data_type=1&graph_type=2&compareBy=sex&chk_sex_3=3&chk_sex_2=2&rate_type=2&race=6&age_range=1&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_display=2
Garnett E, Townsend J, Steele B, et al. Characteristics, rates, and trends of melanoma incidence among Hispanics in the USA. Cancer Causes Control. 2016;27:647-659.
Higgins S, Nazemi A, Feinstein S, et al. Clinical presentations of melanoma in African Americans, Hispanics, and Asians. Dermatol Surg. 2019;45:791-801.
Bristow IR, de Berker DA, Acland KM, et al. Clinical guidelines for the recognition of melanoma of the foot and nail unit. J Foot Ankle Res. 2010;3:25.
Fernandez JM, Mata EM, Behbahani S, et al. Survival of Hispanic patients with cutaneous melanoma: a retrospective cohort analysis of 6016 cases from the National Cancer Database. J Am Acad Dermatol. 2023;88:1135-1138.
Hu S, Sherman R, Arheart K, et al. Predictors of neighborhood risk for late-stage melanoma: addressing disparities through spatial analysis and area-based measures. J Investigative Dermatol. 2014;134:937-945.
Buster KJ, You Z, Fouad M, et al. Skin cancer risk perceptions: a comparison across ethnicity, age, education, gender, and income. J Am Acad Dermatol. 2012;66:771-779.
Halpern MT, Ward EM, Pavluck AL, et al. Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. Lancet Oncology. 2008;9:222-231.
Weiss J, Kirsner RS, Hu S. Trends in primary skin cancer prevention among US Hispanics: a systematic review. J Drugs Dermatol. 2012;11:580-586.
Carvalho LAD, Aguiar FC, Smalley KSM, et al. Acral melanoma: new insights into the immune and genomic landscape. Neoplasia. 2023;46:100947.
Kolitz E, Lopes F, Arffa M, et al. UV Exposure and the risk of keratinocyte carcinoma in skin of color: a systematic review. JAMA Dermatol. 2022;158:542-546.
Lukowiak TM, Aizman L, Perz A, et al. Association of age, sex, race, and geographic region with variation of the ratio of basal cell to cutaneous squamous cell carcinomas in the United States. JAMA Dermatol. 2020;156:1192-1198.
Basset-Seguin N, Herms F. Update in the management of basal cell carcinoma. Acta Derm Venereol. 2020;100:adv00140.
McDaniel B, Badri T, Steele RB. Basal cell carcinoma. StatPearls [Internet]. Updated March 13, 2024. Accessed September 3, 2024. https://www.ncbi.nlm.nih.gov/books/NBK482439/
Dessinioti C, Antoniou C, Katsambas A, et al. Basal cell carcinoma: what’s new under the sun. Photochem Photobiol. 2010;86:481-491.
Kim DP, Kus KJB, Ruiz E. Basal cell carcinoma review. Hematol Oncol Clin North Am. 2019;33:13-24.
Bigler C, Feldman J, Hall E, et al. Pigmented basal cell carcinoma in Hispanics. J Am Acad Dermatol. 1996;34(5 pt 1):751-752.
Higgins S, Nazemi A, Chow M, et al. Review of nonmelanoma skin cancer in African Americans, Hispanics, and Asians. Dermatol Surg. 2018;44:903-910.
Byrd-Miles K, Toombs EL, Peck GL. Skin cancer in individuals of African, Asian, Latin-American, and American-Indian descent: differences in incidence, clinical presentation, and survival compared to Caucasians. J Drugs Dermatol. 2007;6:10-16.
Rivas M, Rojas E, Calaf GM, et al. Association between non-melanoma and melanoma skin cancer rates, vitamin D and latitude. Oncol Lett. 2017;13:3787-3792.
Bradford PT. Skin cancer in skin of color. Dermatol Nurs. 2009;21:170-177, 206.
Davis DS, Robinson C, Callender VD. Skin cancer in women of color: epidemiology, pathogenesis and clinical manifestations. Int J Womens Dermatol. 2021;7:127-134.
Maafs E, De la Barreda F, Delgado R, et al. Basal cell carcinoma of trunk and extremities. Int J Dermatol. 1997;36:622-628.
Munjal A, Ferguson N. Skin cancer in skin of color. Dermatol Clin. 2023;41:481-489.
Jorgenson E, Choquet H, Yin J, et al. Genetic ancestry, skin pigmentation, and the risk of cutaneous squamous cell carcinoma in Hispanic/Latino and non-Hispanic white populations. Commun Biol. 2020;3:765.
Soliman YS, Mieczkowska K, Zhu TR, et al. Characterizing basal cell carcinoma in Hispanic individuals undergoing Mohs micrographic surgery: a 7-year retrospective review at an academic institution in the Bronx. Brit J Dermatol. 2022;187:597-599.
Sierro TJ, Blumenthal LY, Hekmatjah J, et al. Differences in health care resource utilization and costs for keratinocyte carcinoma among racioethnic groups: a population-based study. J Am Acad Dermatol. 2022;86:373-378.
Blumenthal LY, Arzeno J, Syder N, et al. Disparities in nonmelanoma skin cancer in Hispanic/Latino patients based on Mohs micrographic surgery defect size: a multicenter retrospective study. J Am Acad Dermatol. 2022;86:353-358.
Slopnick EA, Kim SP, Kiechle JE, et al. Racial disparities differ for African Americans and Hispanics in the diagnosis and treatment of penile cancer. Urology. 2016;96:22-28.
Goodman MT, Hernandez BY, Shvetsov YB. Demographic and pathologic differences in the incidence of invasive penile cancer in the United States, 1995-2003. Cancer Epidemiol Biomarkers Prev. 2007;16:1833-1839.
Thompson EL, Rosen BL, Maness SB. Social determinants of health and human papillomavirus vaccination among young adults, National Health Interview Survey 2016. J Community Health. 2019;44:149-158.
Hao X, Billings SD, Wu F, et al. Dermatofibrosarcoma protuberans: update on the diagnosis and treatment. J Clin Med. 2020;9:1752.
Mosallaei D, Lee EB, Lobl M, et al. Rare cutaneous malignancies in skin of color. Dermatol Surg. 2022;48:606-612.
Criscito MC, Martires KJ, Stein JA. Prognostic factors, treatment, and survival in dermatofibrosarcoma protuberans. JAMA Dermatol. 2016;152:1365-1371.
Orenstein LAV, Nelson MM, Wolner Z, et al. Differences in outpatient dermatology encounter work relative value units and net payments by patient race, sex, and age. JAMA Dermatol. 2021;157:406-412.
Lowe GC, Onajin O, Baum CL, et al. A comparison of Mohs micrographic surgery and wide local excision for treatment of dermatofibrosarcoma protuberans with long-term follow-up: the Mayo Clinic experience. Dermatol Surg. 2017;43:98-106.
Moore KJ, Chang MS, Weiss J, et al. Racial and ethnic differences in the surgical treatment of dermatofibrosarcoma protuberans: a retrospective cohort analysis. J Am Acad Dermatol. 2022;87:245-247.
Trofymenko O, Bordeaux JS, Zeitouni NC. Survival in patients with primary dermatofibrosarcoma protuberans: National Cancer Database analysis. J Am Acad Dermatol. 2018;78:1125-1134.
Bazargan M, Cobb S, Assari S. Discrimination and medical mistrust in a racially and ethnically diverse sample of California adults. Ann Fam Med. 2021;19:4-15.
Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC; 2003.
Bailey ZD, Krieger N, Agenor M, et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389:1453-1463.
Tackett KJ, Jenkins F, Morrell DS, et al. Structural racism and its influence on the severity of atopic dermatitis in African American children. Pediatric Dermatol. 2020;37:142-146.
Greif C, Srivastava D, Nijhawan RI. A retrospective cohort study of dermatofibrosarcoma protuberans at a large metropolitan academic center. JAAD Int. 2022;6:104-106.
Office of the Assistant Secretary for Planning and Evaluation. Health insurance coverage and access to care among Latinos: recent rrends and key challenges (HP-2021-22). October 8, 2021. Accessed September 3, 2024. https://aspe.hhs.gov/reports/health-insurance-coverage-access-care-among-latinos
Keisler-Starkey K, Bunch LN. Health insurance coverage in the United States: 2020 (Current Population Reports No. P60-274). US Census Bureau; 2021. https://www.census.gov/content/dam/Census/library/publications/2021/demo/p60-274.pdf
Kaiser Family Foundation. Key facts on health coverage of immigrants. Updated June 26, 2024. Accessed September 3, 2024. https://www.kff.org/racial-equity-and-health-policy/fact-sheet/key-facts-on-health-coverage-of-immigrants/
Pew Research Center. Unauthorized immigrants: length of residency, patterns of parenthood. Published December 1, 2011. Accessed October 28, 2024. https://www.pewresearch.org/race-and-ethnicity/2011/12/01/unauthorized-immigrants-length-of-residency-patterns-of-parenthood/
Schneider J, Schmitt M. Understanding the relationship between racial discrimination and mental health among African American adults: a review. SAGE Open. 2015;5:1-10.
Philbin MM, Flake M, Hatzenbuehler ML, et al. State-level immigration and immigrant-focused policies as drivers of Latino health disparities in the United States. Soc Sci Med. 2018;199:29-38.
Vargas ED, Sanchez GR, Juarez M. The impact of punitive immigrant laws on the health of Latina/o Populations. Polit Policy. 2017;45:312-337.
Sutton AL, He J, Edmonds MC, et al. Medical mistrust in Black breast cancer patients: acknowledging the roles of the trustor and the trustee. J Cancer Educ. 2019;34:600-607.
Jacobs J. An overview of Latin American healthcare systems. Pacific Prime Latin America. July 31, 2023. Accessed September 3, 2024. https://www.pacificprime.lat/blog/an-overview-of-latin-american-healthcare-systems/
CDC. Unfair and unjust practices and conditions harm Hispanic and Latino people and drive health disparities. May 15, 2024. Accessed September 3, 2024. https://www.cdc.gov/tobacco-health-equity/collection/hispanic-latino-unfair-and-unjust.html
Hall IJ, Rim SH, Dasari S. Preventive care use among Hispanic adults with limited comfort speaking English: an analysis of the Medical Expenditure Panel Survey data. Prev Med. 2022;159:107042.
Brach C, Chevarley FM. Demographics and health care access and utilization of limited-English-proficient and English-proficient Hispanics. Agency for Healthcare Research and Quality. February 2008. http://meps.ahrq.gov/mepsweb/data_files/publications//rf28/rf28.pdf
Berdahl TA, Kirby JB. Patient-provider communication disparities by limited English proficiency (LEP): trends from the US Medical Expenditure Panel Survey, 2006-2015. J General Intern Med. 2019;34:1434-1440.
Robinson JK, Joshi KM, Ortiz S, et al. Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education. Psychooncology. 2011;20:313-320.
Robinson JK, Nodal M, Chavez L, et al. Enhancing the relevance of skin self-examination for Latinos. JAMA Dermatol. 2017;153:717-718.
Buchanan Lunsford N, Berktold J, Holman DM, et al. Skin cancer knowledge, awareness, beliefs and preventive behaviors among black and hispanic men and women. Prev Med Rep. 2018;12:203-209.
Madrigal JM, Correa-Mendez M, Arias JD, et al. Hispanic, Latino/a, Latinx, Latine: disentangling the identities of Hispanic/Latino Americans. National Cancer Institute Division of Cancer Epidemiology & Genetics. October 20, 2022. Accessed September 3, 2024. https://dceg.cancer.gov/about/diversity-inclusion/inclusivity-minute/2022/disentangling-identities-hispanic-latino-americans

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Disparities in Skin Cancer Outcomes in the Latine/Hispanic Population

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The Latine/Hispanic community—the largest ethnic minoritized group in the United States—is disproportionately affected by disparities in skin cancer outcomes.
Factors influencing skin cancer outcomes in Latine/Hispanic patients in the United States are complex and multidimensional, including lack of familiarity among dermatologists with skin cancer manifestation in this population compared to non-Hispanic White individuals as well as limited data elucidating risk factors for skin cancer in patients with skin of color and sociocultural factors.

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The State of Skin of Color Centers in the United States: A Cross-Sectional Survey Study

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The State of Skin of Color Centers in the United States: A Cross-Sectional Survey Study

IN COLLABORATION WITH THE SKIN OF COLOR SOCIETY

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Simone N. Montgomery, MD, MPH

Eva Kerby, MD

Arielle Carolina Mora Hurtado, BS

Nada Elbuluk, MD, MSc

Although individuals with skin of color (SoC) are expected to become at least half of the US population by the year 2044, there remains a paucity of education and exposure to treatment of patients with SoC at many dermatology residency programs across the country.¹ One way to improve SoC education has been the formation of specialized clinics, centers, and programs. The first SoC center (SoCC) was established in 1999 at Mount Sinai–St. Luke’s Roosevelt in New York, New York²; since then, at least 13 additional formal SoCCs or SoC specialty clinics (SoCSCs) at US academic dermatology programs have been established.

Skin of color centers serve several important purposes: they improve dermatologic care in patients with SoC, increase research efforts focused on SoC dermatologic conditions, and educate dermatology resident and fellow trainees about SoC. Improving dermatologic care of patients with SoC in the United States is important in providing equitable health care and improving health disparities. Studies have shown that patient-physician racial and cultural concordance can positively impact patient care, increase patient trust and rapport, and improve patient-physician communication, and it can even influence patient decision-making to seek care.^3,4 Unfortunately, even though the US population continues to diversify, the racial/ethnic backgrounds of dermatologists do not parallel this trend; Hispanic and Black physicians comprise 18.9% and 13.6% of the general population, respectively, but represent only 4.2% and 3.0% of dermatologists, respectively.^5-7 This deficit is mirrored by resident and faculty representation, with Black and Latino representation ranging from 3% to 7%.^8-10

Many SoCC’s engage in research focused on dermatologic conditions affecting patients with SoC, which is vital to improving the dermatologic care in this underserved population. Despite increasing recognition of the importance of SoC research, there remains a paucity of clinical trials and research specifically focused on or demonstrating equitable representation of SoC.^11,12

The education and training of future dermatologists is another important area that can be improved by SoCCs. A 2008 study involving 63 chief residents showed that approximately half (52.4% [33/63]) of graduating dermatology residents reported receiving SoC-specific didactics, sessions, or lectures, and 30.2% (19/63) reported having a dedicated rotation where they gained specific experience treating patients with SoC.¹³ A later study in 2022 (N=125) found that 63.2% of graduating dermatology residents reported receiving SoC-specific didactics, sessions, or lectures, and only 11.2% reported having a dedicated rotation where they gained experience treating patients with SoC.¹⁴ These findings suggest that in the last 14 years, formal SoC education—specifically SoC clinical training—has not increased sufficiently.

We conducted a cross-sectional survey study to provide an in-depth analysis of SoCCs and SoCSCs in the United States, including their patient care focus, research, and program diversity.

Methods

We conducted an investigator-initiated, multicenter, cross-sectional survey study of all SoCCs in the United States and their respective academic residency programs. Fifteen formal SoCCs and/or SoCSCs were identified by dermatology program websites and an article by Tull et al² on the state of ethnic skin centers. All programs and centers identified were associated with a dermatology residency program accredited by the Accreditation Council for Graduate Medical Education.

A 42-item questionnaire was sent via email to the directors of these centers and clinics with the intent to collect descriptive information about each of the SoCCs, the diversity of the faculty and residents of the associated dermatology department, current research and funding, diversity and inclusion initiatives, and trainee education from March through April 2020. Data were analyzed using Excel and SPSS statistical software to obtain descriptive statistics including the mean value numeric trends across programs.

This study underwent expedited review and was approved by the University of Southern California (Los Angeles, California) institutional review board (IRB #HS-20-00113). Patient consent was not applicable, as no information was collected about patients.

Results

Fourteen directors from SoCCs/SoCSCs completed the questionnaire (93.3% response rate). Most centers were located in urban areas (12/14 [85.71%]), except for 2 in rural or suburban settings (Table). Most of the SoCCs/SoCSCs were located in the South (5/14 [35.71%]), followed by the Northeast (4/14 [28.57%]), West (3/14 [21.43%]), and Midwest (2/14 [14.29%])(Table). Six (42.86%) of the programs had a SoCSC, 3 (21.43%) had a formal SoCC, and 5 (35.71%) had both. Across all centers, the most common population seen and treated was Black/African American followed by Hispanic/Latino and Asian, respectively. The most commonly seen dermatologic conditions were acne, pigmentary disorders, alopecia, and atopic dermatitis (Figure). The most common cosmetic practice performed for patients with SoC was dermatosis papulosa nigra/seborrheic keratosis removal, followed by laser treatments, skin tag removal, chemical peels, and neuromodulator injections, respectively.

Faculty and Resident Demographics and Areas of Focus—The demographics and diversity of the dermatology faculty and residents at each individual institution also were assessed. The average number of full-time faculty at each institution was 19.4 (range, 2–48), while the average number of full-time faculty who identified as underrepresented in medicine (URiM) was 2.1 (range, 0–5). The average number of residents at each institution was 17.1 (range, 10–31), while the average number of URiM residents was 1.7 (range, 1–3).

Top dermatologic conditions treated in skin of color centers and skin of color specialty clinics. The values for each of the diagnoses (ranked 1 [least common] through 6 [most common]) were added for each individual diagnosis. The sum total for each condition was divided by the total number of potential points (6 conditions x 6 ranking points for each) to determine the percentage for each diagnosis.

The average number of full-time faculty members at each SoCC was 1.6 (range, 1–4). The majority of program directors reported having other specialists in their department that also treated dermatologic conditions predominantly affecting patients with SoC (10/14 [71.43%]). The 3 most common areas of expertise were alopecia, including central centrifugal cicatricial alopecia (CCCA); cutaneous lupus; and traction alopecia (eTable 1).

Faculty SoC Research—Only a minority of programs had active clinical trials related to SoC (5/14 [35.71%]). Clinical research was the most common type of research being conducted (11/14 [78.57%]), followed by basic science/translational (4/14 [28.57%]) and epidemiologic research (2/14 [14.29%]). The most commonly investigated conditions for observational studies included CCCA, keloids/hypertrophic scarring, and atopic dermatitis (eTable 2). Only 8 of 14 programs had formal SoC research opportunities for residents (57.14%), while 9 had opportunities for medical students (64.29%).

Few institutions had internal funding (3/14 [21.43%]) or external funding (4/14 [28.57%]) for SoC research. Extramural fun ding sources included the Skin of Color Society, the Dermatology Foundation, and the Radiation Oncology Institute, as well as industry funding. No federal funding was received by any of the sites.

Skin of Color Education and Diversity Initiatives—All 14 programs had residents rotating through their SoCC and/or SoCSCs. The vast majority (12/14 [85.71%]) indicated resident exposure to clinical training at the SoCC and/or SoCSC during all 3 years of training. Residents at most of the programs spent 1 to 3 months rotating at the SoCC/SoCSC (6/14 [42.86%]). The other programs indicated residents spent 3 to 6 months (3/14 [21.43%]) or longer than 6 months (3/14 [21.4%]), and only 2 programs (14.29%) indicated that residents spent less than 1 month in the SoCC/SoCSC.

The majority of programs offered a SoC didactic curriculum for residents (10/14 [71.43%]), with an average of 3.3 SoC-related lectures per year (range, 0–5). Almost all programs (13/14 [92.86%]) invited SoC specialists from outside institutions as guest lecturers. Half of the programs (7/14 [50.0%]) used a SoC textbook for resident education. Only 3 programs (21.43%) offered at least 1 introductory SoC dermatology lecture as part of the preclinical medical student dermatology curriculum.

Home institution medical students were able to rotate at their respective SoCC/SoCSC at 11 of 14 institutions (78.57%), while visiting students were able to rotate at half of the programs (7/14 [50.0%]). At some programs, rotating at the SoCC/SoCSC was optional and was not formally integrated into the medical student rotation schedule for both home and visiting students (1/14 [7.14%] and 4/14 [28.57%], respectively). A majority of the programs (8/14 [57.14%]) offered scholarships and/or grants for home and/or visiting URiM students to help fund away rotations.

Despite their SoC focus, only half of the programs with SoCCs/SoCSCs had a formal committee focused on diversity and inclusion (7/14 [50.0%]) Additionally, only 5 of 14 (35.71%) programs had any URiM outreach programs with the medical school and/or the local community.

Comment

As the number of SoCCs/SoCSCs in the United States continues to grow, it is important to highlight their programmatic, research, and educational accomplishments to show the benefits of such programs, including their ability to increase access to culturally competent and inclusive care for diverse patient populations. One study found that nearly 92% of patients in the United States seen by dermatologists are White.¹⁵ Although studies have shown that Hispanic/Latino and Black patients are less likely to seek care from a dermatologist,^16,17 there is no indication that these patients have a lesser need for such specialty care. Additionally, outcomes of common dermatologic conditions often are poorer in SoC populations.¹⁵ The dermatologists leading SoCCs/SoCSCs are actively working to reverse these trends, with Black and Hispanic/Latino patients representing the majority of their patients.

Faculty and Resident Demographics and Areas of Focus—Although there are increased diversity efforts in dermatology and the medical profession more broadly, there still is much work to be done. While individuals with SoC now comprise more than 35% of the US population, only 12% of dermatology residents and 6% of academic dermatology faculty identify as either Black or Hispanic/Latino.^5,8,10 These numbers are even more discouraging when considering other URiM racial groups such as Pacific Islander/Native Hawaiians or Native American/American Indians who represent 0% and 0.1% of dermatology faculty, respectively.^8,10 Academic programs with SoCCs/SoCSCs are working to create a space in which these discrepancies in representation can begin to be addressed. Compared to the national 6.8% rate of URiM faculty at academic institutions, those with SoCCs/SoCSCs report closer to 10% of faculty identifying as URiM.¹⁸ Moreover, almost all programs had faculty specialized in at least 1 condition that predominantly affects patients with SoC. This is of critical importance, as the conditions that most commonly affect SoC populations—such as CCCA, hidradenitis suppurativa, and cutaneous lupus—often are understudied, underfunded, underdiagnosed, and undertreated.^19-22

Faculty SoC Research—An important step in narrowing the knowledge gap and improving health care disparities in patients with SoC is to increase SoC research and/or to increase the representation of patients with SoC in research studies. In a 2021 study, a PubMed search of articles indexed for MEDLINE using the terms race/ethnicity, dyschromia, atopic dermatitis, and acne was conducted to investigate publications pertaining to the top 3 most common chief concerns in patients with SoC. Only 1.6% of studies analyzed (N=74,941) had a specific focus on SoC.¹² A similar study found that among the top 5 dermatology-focused research journals, only 3.4% of all research (N=11,003) on the top 3 most common chief concerns in patients with SOC was conducted in patients with SoC.²³ Research efforts focused on dermatologic issues that affect patients with SoC are a priority at SoCCs/SoCSCs. In our study, all respondents indicated that they had at least 1 ongoing observational study; the most commonly studied conditions were CCCA, keloids/hypertrophic scarring, and atopic dermatitis, all of which are conditions that either occur in high frequency or primarily occur in SoC. Only 35.71% (5/14) of respondents had active clinical trials related to SoC, and only 21.43% (3/14) and 28.57% (4/14) had internal and external funding, respectively. Although research efforts are a priority at SoCCs/SoCSCs, our survey study highlights the continued paucity of formal clinical trials as well as funding for SoC-focused research. Improved research efforts for SoC must address these deficits in funding, academic support, and other resources.

It also is of great importance for institutions to provide support for trainees wanting to pursue SoC research. Encouragingly, more than half (57.14%) of SoCCs/SoCSCs have developed formal research opportunities for residents, and nearly 64.29% have formal opportunities for medical students. These efforts to provide early experiences in SoC research are especially impactful by cultivating interest in working with populations with SoC and hopefully inspiring future dermatologists to engage in further SoC research.

SoC Education and Diversity Initiatives—Although it is important to increase representation of URiM physicians in dermatology and to train more SoC specialists, it is imperative that all dermatologists feel comfortable recognizing and treating dermatologic conditions in patients of all skin tones and all racial/ethnic backgrounds; however, many studies suggest that residents not only lack formal didactics and education in SoC, but even more unsettling, they also lack confidence in treating SoC.^13,24 However, one study showed that this can be changed; Mhlaba et al²⁵ assessed a SoC curriculum for dermatology residents, and indeed all of the residents indicated that the curriculum improved their ability to treat SoC patients. This deficit in dermatology residency training is specifically addressed by SoCCs/SoCSCs. In our study, all respondents indicated that residents rotate through their centers. Moreover, our study found that most of the academic institutions with SoCCs/SoCSCs provide a SoC didactic curriculum for residents, and almost all of the programs invited SoC specialists to give guest lectures. This is in contrast to a 2022 study showing that 63.2% (N=125) of graduating dermatology residents reported receiving SoC-specific didactics, sessions, or lectures.¹⁴ These findings highlight the critical role that SoCCs/SoCSCs can provide in dermatology residency training.

Although SoCCs/SoCSCs have made considerable progress, there is still much room for improvement. Namely, only half of the respondents in our study indicated that their program has formally incorporated a SoC textbook into resident education (eTable 3). Representation of SoC in the textbooks that dermatology residents use is critically important because these images form the foundation of the morphologic aids of diagnosis. Numerous studies have analyzed popular dermatologic textbooks used by residency programs nationwide, finding the number of SoC images across dermatology textbooks ranging from 4% to 18%.^26,27 The use of standard dermatology textbooks is not enough to train residents to be competent in diagnosing and treating patients with SoC. There should be a concerted effort across the field of dermatology to encourage the development of a SoC educational curriculum at every academic dermatology program, including SoC textbooks, Kodachromes, and online/electronic resources.

Efforts to increase diversity in dermatology and dermatologic training should start in medical school preclinical curriculums and medical student rotations. Although our survey did not assess current medical student curricula, the benefits of academic institutions with SoCCs/SoCSCs are highlighted by the ability for both home and visiting medical students to rotate through the centers and gain early exposure to SoC dermatology. Most of the programs even provide scholarships and/or grants for URiM students to help fund their rotations, which is of critical importance considering the mounting data that the financial burden of visiting rotations disproportionately affects URiM students.²⁸

Study Limitations—Although we did an extensive search and believe to have correctly identified all 15 formal SoCCs/SoCSCs with a high response rate (93.3%), there are institutions that do not have formalized SoCCs/SoCSCs but are known to serve SoC populations. Likewise, there are private dermatology practices not associated with academic centers that have SoC specialists and positively contribute to SoC patient care, research, and education that were not included in this study. Additionally, the data for this study were collected in 2020 and analyzed in 2021, so it is possible that not all SoCCs, divisions, or clinics were included in this study, particularly if established after 2021.

Conclusion

As the United States continues to diversify, the proportion of patients with SoC will continue to grow, and it is imperative that this racial, ethnic, and cultural diversity is reflected in the dermatology workforce as well as research and training. The current deficits in medical training related to SoC populations and the importance for patients with SoC to find dermatologists who can appropriately treat them is well known.²⁹ Skin of color centers/SoCSCs strive to increase access to care for patients with SoC, improve cultural competency, promote diversity among faculty and trainees, and encourage SoC research and education at all levels. We urge academic dermatology training programs to make SoC education, research, and patient care a departmental priority. Important first steps include departmental diversification at all levels, incorporating SoC into curricula for residents, providing and securing funding for SoC research, and supporting the establishment of more formal SoCCs and/or SoCSCs to help reduce dermatologic health care disparities among patients with SoC and improve health equity.

Appendix

References

Colby SL, Jennifer JM. Projections of the size and composition of the U.S. population: 2014 to 2060. United States Census Bureau website. March 3, 2015. Accessed June 18, 2024. https://www.census.gov/library/publications/2015/demo/p25-1143.html
Tull RZ, Kerby E, Subash JJ, et al. Ethnic skin centers in the United States: where are we in 2020? J Am Acad Dermatol. 2020;83:1757-1759. doi:10.1016/j.jaad.2020.03.054
Shen MJ, Peterson EB, Costas-Muñiz R, et al. The effects of race and racial concordance on patient-physician communication: a systematic review of the literature. J Racial Ethn Health Disparities. 2018;5:117-140. doi:10.1007/s40615-017-0350-4
Saha S, Beach MC. Impact of physician race on patient decision-making and ratings of physicians: a randomized experiment using video vignettes. J Gen Intern Med. 2020;35:1084-1091. doi:10.1007/s11606-020-05646-z
Quick Facts: United States. US Census Bureau website. Accessed June 18, 2024. https://www.census.gov/quickfacts/fact/table/US/PST045221
Pandya AG, Alexis AF, Berger TG, et al. Increasing racial and ethnic diversity in dermatology: a call to action. J Am Acad Dermatol. 2016;74:584-587. doi:10.1016/j.jaad.2015.10.044
Van Voorhees AS, Enos CW. Diversity in dermatology residency programs. J Investig Dermatol Symp Proc. 2017;18:S46-S49. doi:10.1016/j.jisp.2017.07.001
Association of American Medical Colleges. Table B5. number of active MD residents, by race/ethnicity (alone or in combination) and GME specialty. Accessed June 18, 2024. https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2022/table-b5-md-residents-race-ethnicity-and-specialty
Association of American Medical Colleges. Table B6. number of active DO residents, by race/ethnicity (alone or in combination) and GME specialty. Accessed June 18, 2024. https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2022/table-b6-do-residents-race-ethnicity-and-specialty
Association of American Medical Colleges. Table 16. U.S. medical school faculty by gender, race/ethnicity, and department, 2022. Accessed June 24, 2024. https://www.aamc.org/media/8456/download
Chen V, Akhtar S, Zheng C, et al. Assessment of changes in diversity in dermatology clinical trials between 2010-2015 and 2015-2020: a systematic review. JAMA Dermatol. 2022;158:288-292. doi:10.1001/jamadermatol.2021.5596
Montgomery SNB, Elbuluk N. A quantitative analysis of research publications focused on the top chief complaints in patients withskinof color. J Am Acad Dermatol. 2021;85:241-242. doi:10.1016/j.jaad.2020.08.031
Nijhawan RI, Jacob SE, Woolery-Lloyd H. Skin of color education in dermatology residency programs: does residency training reflect the changing demographics of the United States? J Am Acad Dermatol. 2008;59:615-618. doi:10.1016/j.jaad.2008.06.024
Ibraheim MK, Gupta R, Dao H, et al. Evaluating skin of color education in dermatology residency programs: data from a national survey. Clin Dermatol. 2022;40:228-233. doi:10.1016/j.clindermatol.2021.11.015
Buster KJ, Stevens EI, Elmets CA. Dermatologic health disparities. Dermatol Clin. 2012;30:53-59, viii. doi:10.1016/j.det.2011.08.002
Tripathi R, Knusel KD, Ezaldein HH, et al. Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States. JAMA Dermatol. 2018;154:1286-1291. doi:10.1001/jamadermatol.2018.3114
Barbieri JS, Shin DB, Wang S, et al. Association of race/ethnicity and sex with differences in health care use and treatment for acne. JAMA Dermatol. 202;156:312-319. doi:10.1001/jamadermatol.2019.4818
Dlova NC, Salkey KS, Callender VD, et al. Central centrifugal cicatricial alopecia: new insights and a call for action. J Investig Dermatol Symp Proc. 2017;18:S54-S56. doi:10.1016/j.jisp.2017.01.004
Okeke CAV, Perry JD, Simmonds FC, et al. Clinical trials and skin of color: the example of hidradenitis suppurativa. dermatology. 2022;238:180-184. doi:10.1159/000516467
Robles J, Anim T, Wusu MH, et al. An Approach to Faculty Development for Underrepresented Minorities in Medicine. South Med J. 2021;114(9):579-582. doi:10.14423/SMJ.0000000000001290
Serrano L, Ulschmid C, Szabo A, et al. Racial disparities of delay in diagnosis and dermatologic care for hidradenitis suppurativa. J Natl Med Assoc. 2022;114:613-616. doi:10.1016/j.jnma.2022.08.002
Drenkard C, Lim SS. Update on lupus epidemiology: advancinghealth disparities research through the study of minority populations. Curr Opin Rheumatol. 2019;31:689-696. doi:10.1097/BOR.0000000000000646
Militello M, Szeto MD, Presley CL, et al. A quantitative analysis of research publications focused on skin of color: representation in academic dermatology journals. J Am Acad Dermatol. 2021;85:E189-E192. doi:10.1016/j.jaad.2021.04.053
Cline A, Winter RP, Kourosh S, et al. Multiethnic training in residency: a survey of dermatology residents. Cutis. 2020;105:310-313.
Mhlaba JM, Pontes DS, Patterson SS, et al. Evaluation of a skin of color curriculum for dermatology residents. J Drugs Dermatol. 2021;20:786-789. doi:10.36849/JDD.6193
Adelekun A, Onyekaba G, Lipoff JB. Skin color in dermatology textbooks: an updated evaluation and analysis. J Am Acad Dermatol. 2021;84:194-196. doi:10.1016/j.jaad.2020.04.084
Harp T, Militello M, McCarver V, et al. Further analysis of skin of color representation in dermatology textbooks used by residents. J Am Acad Dermatol. 2022;87:E39-E41. doi:10.1016/j.jaad.2022.02.069
Muzumdar S, Grant-Kels JM, Feng H. Strategies to improve medical student visiting rotations. Clin Dermatol. 2021;39:727-728. doi:10.1016/j.clindermatol.2020.11.001
Gorbatenko-Roth K, Prose N, Kundu RV, et al. Assessment of Black patients’ perception of their dermatology care. JAMA Dermatol. 2019;155:1129-1134. doi:10.1001/jamadermatol.2019.2063

Article PDF

CT114001016.pdf

Author and Disclosure Information

Drs. Montgomery and Elbuluk are from the Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles. Dr. Kerby is from the Department of Dermatology, Weill Cornell Medicine, New York, New York. Arielle Carolina Mora Hurtado is from the University of Wisconsin School of Medicine and Public Health, Madison.

Dr. Montgomery and Arielle Carolina Mora Hurtado report no conflict of interest. Dr. Kerby was an advisory board member for Sanofi. Dr. Elbuluk has served as an advisory board member, consultant, investigator, and/or speaker for Abbvie, Allergan, Avita, Beiersdorf, Dior, Eli Lilly and Company, Galderma, Incyte, La Roche-Posay, L’Oreal, McGraw-Hill, Medscape, Pfizer, Sanofi, Takeda, and VisualDx; has received royalties from McGraw-Hill; and has stock options in VisualDx.

The eTables are available in the Appendix online at www.mdedge.com/dermatology.

Correspondence: Nada Elbuluk, MD, MSc, Department of Dermatology, University of Southern California, Keck School of Medicine, 830 S Flower St, Ste 100, Los Angeles, CA 90017 ([email protected]).

Cutis. 2024 July;114(1):16-20, E1. doi:10.12788/cutis.1054

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IN COLLABORATION WITH THE SKIN OF COLOR SOCIETY

Methods

Results

Comment

Conclusion

Appendix

Methods

Results

Comment

Conclusion

Appendix

References

Colby SL, Jennifer JM. Projections of the size and composition of the U.S. population: 2014 to 2060. United States Census Bureau website. March 3, 2015. Accessed June 18, 2024. https://www.census.gov/library/publications/2015/demo/p25-1143.html
Tull RZ, Kerby E, Subash JJ, et al. Ethnic skin centers in the United States: where are we in 2020? J Am Acad Dermatol. 2020;83:1757-1759. doi:10.1016/j.jaad.2020.03.054
Shen MJ, Peterson EB, Costas-Muñiz R, et al. The effects of race and racial concordance on patient-physician communication: a systematic review of the literature. J Racial Ethn Health Disparities. 2018;5:117-140. doi:10.1007/s40615-017-0350-4
Saha S, Beach MC. Impact of physician race on patient decision-making and ratings of physicians: a randomized experiment using video vignettes. J Gen Intern Med. 2020;35:1084-1091. doi:10.1007/s11606-020-05646-z
Quick Facts: United States. US Census Bureau website. Accessed June 18, 2024. https://www.census.gov/quickfacts/fact/table/US/PST045221
Pandya AG, Alexis AF, Berger TG, et al. Increasing racial and ethnic diversity in dermatology: a call to action. J Am Acad Dermatol. 2016;74:584-587. doi:10.1016/j.jaad.2015.10.044
Van Voorhees AS, Enos CW. Diversity in dermatology residency programs. J Investig Dermatol Symp Proc. 2017;18:S46-S49. doi:10.1016/j.jisp.2017.07.001
Association of American Medical Colleges. Table B5. number of active MD residents, by race/ethnicity (alone or in combination) and GME specialty. Accessed June 18, 2024. https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2022/table-b5-md-residents-race-ethnicity-and-specialty
Association of American Medical Colleges. Table B6. number of active DO residents, by race/ethnicity (alone or in combination) and GME specialty. Accessed June 18, 2024. https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2022/table-b6-do-residents-race-ethnicity-and-specialty
Association of American Medical Colleges. Table 16. U.S. medical school faculty by gender, race/ethnicity, and department, 2022. Accessed June 24, 2024. https://www.aamc.org/media/8456/download
Chen V, Akhtar S, Zheng C, et al. Assessment of changes in diversity in dermatology clinical trials between 2010-2015 and 2015-2020: a systematic review. JAMA Dermatol. 2022;158:288-292. doi:10.1001/jamadermatol.2021.5596
Montgomery SNB, Elbuluk N. A quantitative analysis of research publications focused on the top chief complaints in patients withskinof color. J Am Acad Dermatol. 2021;85:241-242. doi:10.1016/j.jaad.2020.08.031
Nijhawan RI, Jacob SE, Woolery-Lloyd H. Skin of color education in dermatology residency programs: does residency training reflect the changing demographics of the United States? J Am Acad Dermatol. 2008;59:615-618. doi:10.1016/j.jaad.2008.06.024
Ibraheim MK, Gupta R, Dao H, et al. Evaluating skin of color education in dermatology residency programs: data from a national survey. Clin Dermatol. 2022;40:228-233. doi:10.1016/j.clindermatol.2021.11.015
Buster KJ, Stevens EI, Elmets CA. Dermatologic health disparities. Dermatol Clin. 2012;30:53-59, viii. doi:10.1016/j.det.2011.08.002
Tripathi R, Knusel KD, Ezaldein HH, et al. Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States. JAMA Dermatol. 2018;154:1286-1291. doi:10.1001/jamadermatol.2018.3114
Barbieri JS, Shin DB, Wang S, et al. Association of race/ethnicity and sex with differences in health care use and treatment for acne. JAMA Dermatol. 202;156:312-319. doi:10.1001/jamadermatol.2019.4818
Dlova NC, Salkey KS, Callender VD, et al. Central centrifugal cicatricial alopecia: new insights and a call for action. J Investig Dermatol Symp Proc. 2017;18:S54-S56. doi:10.1016/j.jisp.2017.01.004
Okeke CAV, Perry JD, Simmonds FC, et al. Clinical trials and skin of color: the example of hidradenitis suppurativa. dermatology. 2022;238:180-184. doi:10.1159/000516467
Robles J, Anim T, Wusu MH, et al. An Approach to Faculty Development for Underrepresented Minorities in Medicine. South Med J. 2021;114(9):579-582. doi:10.14423/SMJ.0000000000001290
Serrano L, Ulschmid C, Szabo A, et al. Racial disparities of delay in diagnosis and dermatologic care for hidradenitis suppurativa. J Natl Med Assoc. 2022;114:613-616. doi:10.1016/j.jnma.2022.08.002
Drenkard C, Lim SS. Update on lupus epidemiology: advancinghealth disparities research through the study of minority populations. Curr Opin Rheumatol. 2019;31:689-696. doi:10.1097/BOR.0000000000000646
Militello M, Szeto MD, Presley CL, et al. A quantitative analysis of research publications focused on skin of color: representation in academic dermatology journals. J Am Acad Dermatol. 2021;85:E189-E192. doi:10.1016/j.jaad.2021.04.053
Cline A, Winter RP, Kourosh S, et al. Multiethnic training in residency: a survey of dermatology residents. Cutis. 2020;105:310-313.
Mhlaba JM, Pontes DS, Patterson SS, et al. Evaluation of a skin of color curriculum for dermatology residents. J Drugs Dermatol. 2021;20:786-789. doi:10.36849/JDD.6193
Adelekun A, Onyekaba G, Lipoff JB. Skin color in dermatology textbooks: an updated evaluation and analysis. J Am Acad Dermatol. 2021;84:194-196. doi:10.1016/j.jaad.2020.04.084
Harp T, Militello M, McCarver V, et al. Further analysis of skin of color representation in dermatology textbooks used by residents. J Am Acad Dermatol. 2022;87:E39-E41. doi:10.1016/j.jaad.2022.02.069
Muzumdar S, Grant-Kels JM, Feng H. Strategies to improve medical student visiting rotations. Clin Dermatol. 2021;39:727-728. doi:10.1016/j.clindermatol.2020.11.001
Gorbatenko-Roth K, Prose N, Kundu RV, et al. Assessment of Black patients’ perception of their dermatology care. JAMA Dermatol. 2019;155:1129-1134. doi:10.1001/jamadermatol.2019.2063

References

Colby SL, Jennifer JM. Projections of the size and composition of the U.S. population: 2014 to 2060. United States Census Bureau website. March 3, 2015. Accessed June 18, 2024. https://www.census.gov/library/publications/2015/demo/p25-1143.html
Tull RZ, Kerby E, Subash JJ, et al. Ethnic skin centers in the United States: where are we in 2020? J Am Acad Dermatol. 2020;83:1757-1759. doi:10.1016/j.jaad.2020.03.054
Shen MJ, Peterson EB, Costas-Muñiz R, et al. The effects of race and racial concordance on patient-physician communication: a systematic review of the literature. J Racial Ethn Health Disparities. 2018;5:117-140. doi:10.1007/s40615-017-0350-4
Saha S, Beach MC. Impact of physician race on patient decision-making and ratings of physicians: a randomized experiment using video vignettes. J Gen Intern Med. 2020;35:1084-1091. doi:10.1007/s11606-020-05646-z
Quick Facts: United States. US Census Bureau website. Accessed June 18, 2024. https://www.census.gov/quickfacts/fact/table/US/PST045221
Pandya AG, Alexis AF, Berger TG, et al. Increasing racial and ethnic diversity in dermatology: a call to action. J Am Acad Dermatol. 2016;74:584-587. doi:10.1016/j.jaad.2015.10.044
Van Voorhees AS, Enos CW. Diversity in dermatology residency programs. J Investig Dermatol Symp Proc. 2017;18:S46-S49. doi:10.1016/j.jisp.2017.07.001
Association of American Medical Colleges. Table B5. number of active MD residents, by race/ethnicity (alone or in combination) and GME specialty. Accessed June 18, 2024. https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2022/table-b5-md-residents-race-ethnicity-and-specialty
Association of American Medical Colleges. Table B6. number of active DO residents, by race/ethnicity (alone or in combination) and GME specialty. Accessed June 18, 2024. https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2022/table-b6-do-residents-race-ethnicity-and-specialty
Association of American Medical Colleges. Table 16. U.S. medical school faculty by gender, race/ethnicity, and department, 2022. Accessed June 24, 2024. https://www.aamc.org/media/8456/download
Chen V, Akhtar S, Zheng C, et al. Assessment of changes in diversity in dermatology clinical trials between 2010-2015 and 2015-2020: a systematic review. JAMA Dermatol. 2022;158:288-292. doi:10.1001/jamadermatol.2021.5596
Montgomery SNB, Elbuluk N. A quantitative analysis of research publications focused on the top chief complaints in patients withskinof color. J Am Acad Dermatol. 2021;85:241-242. doi:10.1016/j.jaad.2020.08.031
Nijhawan RI, Jacob SE, Woolery-Lloyd H. Skin of color education in dermatology residency programs: does residency training reflect the changing demographics of the United States? J Am Acad Dermatol. 2008;59:615-618. doi:10.1016/j.jaad.2008.06.024
Ibraheim MK, Gupta R, Dao H, et al. Evaluating skin of color education in dermatology residency programs: data from a national survey. Clin Dermatol. 2022;40:228-233. doi:10.1016/j.clindermatol.2021.11.015
Buster KJ, Stevens EI, Elmets CA. Dermatologic health disparities. Dermatol Clin. 2012;30:53-59, viii. doi:10.1016/j.det.2011.08.002
Tripathi R, Knusel KD, Ezaldein HH, et al. Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States. JAMA Dermatol. 2018;154:1286-1291. doi:10.1001/jamadermatol.2018.3114
Barbieri JS, Shin DB, Wang S, et al. Association of race/ethnicity and sex with differences in health care use and treatment for acne. JAMA Dermatol. 202;156:312-319. doi:10.1001/jamadermatol.2019.4818
Dlova NC, Salkey KS, Callender VD, et al. Central centrifugal cicatricial alopecia: new insights and a call for action. J Investig Dermatol Symp Proc. 2017;18:S54-S56. doi:10.1016/j.jisp.2017.01.004
Okeke CAV, Perry JD, Simmonds FC, et al. Clinical trials and skin of color: the example of hidradenitis suppurativa. dermatology. 2022;238:180-184. doi:10.1159/000516467
Robles J, Anim T, Wusu MH, et al. An Approach to Faculty Development for Underrepresented Minorities in Medicine. South Med J. 2021;114(9):579-582. doi:10.14423/SMJ.0000000000001290
Serrano L, Ulschmid C, Szabo A, et al. Racial disparities of delay in diagnosis and dermatologic care for hidradenitis suppurativa. J Natl Med Assoc. 2022;114:613-616. doi:10.1016/j.jnma.2022.08.002
Drenkard C, Lim SS. Update on lupus epidemiology: advancinghealth disparities research through the study of minority populations. Curr Opin Rheumatol. 2019;31:689-696. doi:10.1097/BOR.0000000000000646
Militello M, Szeto MD, Presley CL, et al. A quantitative analysis of research publications focused on skin of color: representation in academic dermatology journals. J Am Acad Dermatol. 2021;85:E189-E192. doi:10.1016/j.jaad.2021.04.053
Cline A, Winter RP, Kourosh S, et al. Multiethnic training in residency: a survey of dermatology residents. Cutis. 2020;105:310-313.
Mhlaba JM, Pontes DS, Patterson SS, et al. Evaluation of a skin of color curriculum for dermatology residents. J Drugs Dermatol. 2021;20:786-789. doi:10.36849/JDD.6193
Adelekun A, Onyekaba G, Lipoff JB. Skin color in dermatology textbooks: an updated evaluation and analysis. J Am Acad Dermatol. 2021;84:194-196. doi:10.1016/j.jaad.2020.04.084
Harp T, Militello M, McCarver V, et al. Further analysis of skin of color representation in dermatology textbooks used by residents. J Am Acad Dermatol. 2022;87:E39-E41. doi:10.1016/j.jaad.2022.02.069
Muzumdar S, Grant-Kels JM, Feng H. Strategies to improve medical student visiting rotations. Clin Dermatol. 2021;39:727-728. doi:10.1016/j.clindermatol.2020.11.001
Gorbatenko-Roth K, Prose N, Kundu RV, et al. Assessment of Black patients’ perception of their dermatology care. JAMA Dermatol. 2019;155:1129-1134. doi:10.1001/jamadermatol.2019.2063

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Skin of color centers in the United States work to reverse the paucity of research, education, and training in skin of color dermatology and promote the diversification of residents and faculty.
Skin of color centers expand access to culturally competent and inclusive care for diverse patient populations.

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Advancements in Targeted Therapies for Vitiligo: Prioritizing Equity in Drug Development

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Advancements in Targeted Therapies for Vitiligo: Prioritizing Equity in Drug Development

IN COLLABORATION WITH THE SKIN OF COLOR SOCIETY

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Camile Delva, BS

Todd F. Pearson, PhD

John E. Harris, MD, PhD

Vitiligo is a common acquired autoimmune disease that causes depigmented patches to develop throughout the skin , with descriptions dating back more than 3000 years to the earliest known Indian and Egyptian texts. Approximately 1.4% of the worldwide population has vitiligo,¹ and onset follows a bimodal age distribution with an early-onset population (mean age at onset, 10.3 years) as well as an adult-onset population (mean age at onset, 34 years).² Vitiligo manifests as well-defined, irregular, depigmented macules and patches surrounded by normal skin. The patches can vary in size from a few millimeters to several centimeters. There may be signs of inflammation, and the lesions can be itchy, but in most cases vitiligo is asymptomatic. In nonsegmental vitiligo, the depigmented patches are ymmetrical, can appear in any area of the body, and commonly progress slowly. In segmental vitiligo, the patches are unilateral, rarely cross the midline of the body, and are localized to one area. Segmental vitiligo commonly appears in childhood and progresses rapidly but stops abruptly within 6 to 12 months and remains stable, usually for life.³ Although the condition may be more apparent in patients with skin of color, vitiligo manifests at a similar rate in individuals of all races and ethnicities.⁴

Similar to most autoimmune diseases, vitiligo has a strong genetic predisposition. Although the overall prevalence of vitiligo is less than 2%, having a family history of vitiligo (ie, a first-degree relative with vitiligo) increases an individual’s risk to 6%, while concordance in identical twins is 23%.⁵ Beyond genetic predisposition, there is strong evidence that environmental exposures, such as hair dyes, contribute to risk for disease.⁶ Interestingly, vitiligo is associated with polyautoimmunity—the presence of multiple autoimmune diseases in a single patient,⁷ such as type 1 diabetes mellitus, rheumatoid arthritis, autoimmune thyroid disease, pernicious anemia, and Addison disease. Similar to vitiligo itself, polyautoimmunity likely is driven by a combination of genetic and environmental factors.⁵

We provide a brief overview of clinical trial results of Janus kinase (JAK) inhibitors for treating vitiligo and discuss the trial cohorts, with an emphasis on the impact of cohort demographic composition for individuals with skin of color. We recommend factors that investigators should consider to ensure equitable representation of individuals with skin of color in future clinical trials.

Autoimmune Pathogenesis and Treatment With JAK Inhibitors

Vitiligo is driven by autoreactive CD8⁺ T cells that target melanocytes and secrete IFN-g. Signaling of IFN-g occurs through the JAK–signal transducer and activator of transcription (JAK-STAT) pathway, leading to transcriptional changes that activate proinflammatory genes such as the chemokine CXCL10, which is required for the directed accumulation of melanocyte-specific CD8⁺ T cells at the epidermis where melanocytes reside.⁸ Once vitiligo has been initiated, the disease persists due to the presence of resident memory T cells that remain in the skin and destroy new melanocytes.^9,10

Given the central role of IFN-g signaling in the pathogenesis of vitiligo, drugs that inhibit JAK signaling are appealing to treat the disease. These JAK inhibitors bind to the kinase domain of JAK to prevent its activation, thus preventing downstream signaling events including STAT phosphorylation and its translocation to the nucleus, which ultimately stops the upregulation of inflammatory gene transcription. This process attenuates the autoimmune response in the skin and results in repigmentation of vitiligo lesions. In 2022, the US Food and Drug Administration approved the topical JAK inhibitor ruxolitinib for the treatment of vitiligo. Additional clinical trials have been initiated to test oral JAK inhibitors—ritlecitinib (ClinicalTrials.gov identifiers NCT06163326, NCT06072183, NCT05583526), povorcitinib (NCT04818346, NCT06113445, NCT06113471), and upadacitinib (NCT04927975, NCT06118411)—with strong results reported so far.¹¹

The effects of JAK inhibitors can be striking, as shown in the Figure. A patient of one of the authors (J.E.H.) used topical ruxolitinib on only the left arm for approximately 36 weeks and results were as expected—strong repigmentation of only the treated area, which is possible with JAK inhibitors. Indeed, 2 phase 3 studies—Topical Ruxolitinib Evaluation in Vitiligo (TRuE-V1 and TRuE-V2)—showed that approximately 30% of participants in TRuE-V1 (N=330) and 30.9% of participants in TRuE-V2 (N=344) achieved at least 75% improvement over baseline in the facial vitiligo area scoring index (VASI).¹² In the oral ritlecitinib phase 2b study, 12.1% of the 187 participants on the highest tested dose of ritlecitinib (loading dose of 200 mg/d for 28 days, followed by 50 mg/d maintenance dose) achieved at least 75% improvement over baseline in the VASI at 24 weeks.¹¹ Although this rate is lower than for topical ruxolitinib, this trial required all participants to have active disease (unlike the TRuE-V trials of ruxolitinib), which likely created a higher bar for repigmentation and thus resulted in fewer participants achieving the primary outcome at the early 6-month end point. Extension of treatment through 48 weeks demonstrated continued improvement over baseline without any evidence of plateau.¹¹ Although treatment with JAK inhibitors can result in dramatic repigmentation of vitiligo patches, it falls short of providing a permanent cure, as stopping treatment results in relapse (ie, the return of depigmented lesions).

Vitiligo on the patient’s left arm was treated with ruxolitinib over a period of 36 weeks with remarkable repigmentation. In contrast, the patient’s right arm was not treated.

Racial Disparities in Clinical Trials

Even though vitiligo affects all skin types and races/ethnicities with similar prevalence and severity, the proportion of individuals with darker skin types enrolled in these clinical trials fails to match their representation in the population as a whole. A study examining the prevalence of vitiligo in the United States reported that Black or African American individuals represented 15.8% of vitiligo diagnoses in the United States⁴ even though they are only 12.7% of the total US population. However, Black or African American individuals comprised only 5% of the combined participants in the TRuE-V clinical trials for topical ruxolitinib¹² and 2.7% of the participants in the phase 2b study of oral ritlecitinib.¹¹ This lack of appropriate representation is not unique to JAK inhibitors or other vitiligo trials. Indeed, the US Food and Drug Administration reported that Black or African American individuals comprised only 8% of participants for all clinical trials in 2020.¹³

Efficacy Metrics Beyond Repigmentation

Disparities in quality-of-life (QOL) metrics in diseases affecting individuals with skin of color also exist. In vitiligo, the contrast between affected and unaffected skin is greater in patients with skin of color, which means that for a given VASI score, the visibility of depigmentation as well as repigmentation may be variable among patients. Additionally, there is evidence that QOL concerns vary between patients with skin of color and those with lighter skin types. Ezzedine et al¹⁴ found that QOL concerns in vitiligo patients with darker skin focused more on appearance, while concerns in vitiligo patients with lighter skin focused more on skin cancer risk. In addition to QOL differences among individuals with different skin types, there also are well-documented differences in attitudes to vitiligo among certain ethnic or cultural groups.¹⁵ For example, the Rigveda (an ancient Hindu text) indicates that individuals with vitiligo and their progeny are disqualified from marriage. Although the JAK inhibitor clinical trials for vitiligo did not appear to show differences in the degree of repigmentation among different skin types or races/ethnicities, QOL measures were not collected as a secondary end point in these studies—despite the fact that at least 1 study had documented that QOL measures were not uniform across patients when stratified by age and extent of disease.^1,11,12 This same study also presented limited data suggestive of lower QOL in patients with the darkest skin phototype.¹

Considerations for Future Clinical Trials

It is logical to assume that every clinical trialist in dermatology seeks equitable representation among a diverse set of races, ethnicities, and skin types, but achieving this goal remains elusive. Two recent publications^16,17 outlined the challenges and examined solutions to address enrollment disparities, including several barriers to diversity among clinical trial participants: awareness of the clinical trials among minority populations; easy access to clinical trial sites; reluctance to participate because of prior experiences of discrimination, even if unrelated to clinical trials; and a lack of workforce diversity among the clinical trialist teams. To overcome these barriers, a multifaceted approach is needed that requires action at the level of the patient, provider, community, and institution. Once diverse representation is achieved, investigators should consider the need for QOL metrics as a secondary outcome in their trials, which will ensure that the intended clinical effect is matched by patient expectations across different races and ethnicities based on the potential differential impact that diseases such as vitiligo can have on patients with skin of color.

References

Bibeau K, Pandya AG, Ezzedine K, et al. Vitiligo prevalence and quality of life among adults in Europe, Japan and the USA. J Eur Acad Dermatol Venereol. 2022;36:1831-1844.
Jin Y, Roberts GHL, Ferrara TM, et al. Early-onset autoimmune vitiligo associated with an enhancer variant haplotype that upregulates class II HLA expression. Nat Commun. 2019;10:391.
Rodrigues M, Ezzedine K, Hamzavi I, et al; Vitiligo Working Group. New discoveries in the pathogenesis and classification of vitiligo. J Am Acad Dermatol. 2017;77:1-13.
Gandhi K, Ezzedine K, Anastassopoulos KP, et al. Prevalence of vitiligo among adults in the United States. JAMA Dermatol. 2022;158:43-50.
Spritz RA, Santorico SA. The genetic basis of vitiligo. J Invest Dermatol. 2021;141:265-73.
Harris JE. Chemical-induced vitiligo. Dermatol Clin. 2017;35:151-161.
Ahmed F, Moseley I, Ragi SD, et al. Vitiligo in underrepresented communities: an all of us database analysis. J Am Acad Dermatol. 2023;88:945-948.
Frisoli ML, Essien K, Harris JE. Vitiligo: mechanisms of pathogenesis and treatment. Annu Rev Immunol. 2020;38:621-648.
Richmond JM, Strassner JP, Zapata L Jr, et al. Antibody blockade of IL-15 signaling has the potential to durably reverse vitiligo. Sci Transl Med. 2018;10:eaam7710.
Richmond JM, Strassner JP, Rashighi M, et al. Resident memory and recirculating memory T cells cooperate to maintain disease in a mouse model of vitiligo. J Invest Dermatol. 2019;139:769-778.
Ezzedine K, Peeva E, Yamaguchi Y, et al. Efficacy and safety of oral ritlecitinib for the treatment of active nonsegmental vitiligo: a randomized phase 2b clinical trial. J Am Acad Dermatol. 2023;88:395-403.
Rosmarin D, Passeron T, Pandya AG, et al. Two phase 3, randomized, controlled trials of ruxolitinib cream for vitiligo. N Engl J Med. 2022;387:1445-1455.
Cavazzoni P, Anagnostiadis E, Lolic M. Drug trials snapshots summary report. US Food and Drug Administration website. Accessed March 19, 2024. https://www.fda.gov/media/145718/download
Ezzedine K, Grimes PE, Meurant JM, et al. Living with vitiligo: results from a national survey indicate differences between skin phototypes. Br J Dermatol. 2015;173:607-609.
Elbuluk N, Ezzedine K. Quality of life, burden of disease, co-morbidities, and systemic effects in vitiligo patients. Dermatol Clin. 2017;35:117-128.
Kahn JM, Gray DM 2nd, Oliveri JM, et al. Strategies to improve diversity, equity, and inclusion in clinical trials. Cancer. 2022;128:216-221.
Nolan TS, McKoy A, Gray DM 2nd, et al. Virtual community engagement for retention of black men in clinical research. Am J Mens Health. 2023;17:15579883221147767.

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Camile Delva is from the CUNY School of Medicine, New York, New York. Drs. Pearson and Harris are from the Department of Dermatology, UMass Chan Medical School, Worcester.

Camile Delva and Dr. Pearson report no conflict of interest. Dr. Harris is a consultant for AbbVie, Incyte, and Pfizer, as well as an investigator and stockholder for Incyte.

Correspondence: John E. Harris, MD, PhD, Department of Dermatology, UMass Chan Medical School, 364 Plantation St, LRB 1010, Worcester, MA 01605 ([email protected]).

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Todd F. Pearson, PhD

John E. Harris, MD, PhD

Author and Disclosure Information

Camile Delva is from the CUNY School of Medicine, New York, New York. Drs. Pearson and Harris are from the Department of Dermatology, UMass Chan Medical School, Worcester.

Camile Delva and Dr. Pearson report no conflict of interest. Dr. Harris is a consultant for AbbVie, Incyte, and Pfizer, as well as an investigator and stockholder for Incyte.

Correspondence: John E. Harris, MD, PhD, Department of Dermatology, UMass Chan Medical School, 364 Plantation St, LRB 1010, Worcester, MA 01605 ([email protected]).

Author and Disclosure Information

Camile Delva is from the CUNY School of Medicine, New York, New York. Drs. Pearson and Harris are from the Department of Dermatology, UMass Chan Medical School, Worcester.

Camile Delva and Dr. Pearson report no conflict of interest. Dr. Harris is a consultant for AbbVie, Incyte, and Pfizer, as well as an investigator and stockholder for Incyte.

Correspondence: John E. Harris, MD, PhD, Department of Dermatology, UMass Chan Medical School, 364 Plantation St, LRB 1010, Worcester, MA 01605 ([email protected]).

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IN COLLABORATION WITH THE SKIN OF COLOR SOCIETY

Autoimmune Pathogenesis and Treatment With JAK Inhibitors

Racial Disparities in Clinical Trials

Efficacy Metrics Beyond Repigmentation

Considerations for Future Clinical Trials

Autoimmune Pathogenesis and Treatment With JAK Inhibitors

Racial Disparities in Clinical Trials

Efficacy Metrics Beyond Repigmentation

Considerations for Future Clinical Trials

References

Bibeau K, Pandya AG, Ezzedine K, et al. Vitiligo prevalence and quality of life among adults in Europe, Japan and the USA. J Eur Acad Dermatol Venereol. 2022;36:1831-1844.
Jin Y, Roberts GHL, Ferrara TM, et al. Early-onset autoimmune vitiligo associated with an enhancer variant haplotype that upregulates class II HLA expression. Nat Commun. 2019;10:391.
Rodrigues M, Ezzedine K, Hamzavi I, et al; Vitiligo Working Group. New discoveries in the pathogenesis and classification of vitiligo. J Am Acad Dermatol. 2017;77:1-13.
Gandhi K, Ezzedine K, Anastassopoulos KP, et al. Prevalence of vitiligo among adults in the United States. JAMA Dermatol. 2022;158:43-50.
Spritz RA, Santorico SA. The genetic basis of vitiligo. J Invest Dermatol. 2021;141:265-73.
Harris JE. Chemical-induced vitiligo. Dermatol Clin. 2017;35:151-161.
Ahmed F, Moseley I, Ragi SD, et al. Vitiligo in underrepresented communities: an all of us database analysis. J Am Acad Dermatol. 2023;88:945-948.
Frisoli ML, Essien K, Harris JE. Vitiligo: mechanisms of pathogenesis and treatment. Annu Rev Immunol. 2020;38:621-648.
Richmond JM, Strassner JP, Zapata L Jr, et al. Antibody blockade of IL-15 signaling has the potential to durably reverse vitiligo. Sci Transl Med. 2018;10:eaam7710.
Richmond JM, Strassner JP, Rashighi M, et al. Resident memory and recirculating memory T cells cooperate to maintain disease in a mouse model of vitiligo. J Invest Dermatol. 2019;139:769-778.
Ezzedine K, Peeva E, Yamaguchi Y, et al. Efficacy and safety of oral ritlecitinib for the treatment of active nonsegmental vitiligo: a randomized phase 2b clinical trial. J Am Acad Dermatol. 2023;88:395-403.
Rosmarin D, Passeron T, Pandya AG, et al. Two phase 3, randomized, controlled trials of ruxolitinib cream for vitiligo. N Engl J Med. 2022;387:1445-1455.
Cavazzoni P, Anagnostiadis E, Lolic M. Drug trials snapshots summary report. US Food and Drug Administration website. Accessed March 19, 2024. https://www.fda.gov/media/145718/download
Ezzedine K, Grimes PE, Meurant JM, et al. Living with vitiligo: results from a national survey indicate differences between skin phototypes. Br J Dermatol. 2015;173:607-609.
Elbuluk N, Ezzedine K. Quality of life, burden of disease, co-morbidities, and systemic effects in vitiligo patients. Dermatol Clin. 2017;35:117-128.
Kahn JM, Gray DM 2nd, Oliveri JM, et al. Strategies to improve diversity, equity, and inclusion in clinical trials. Cancer. 2022;128:216-221.
Nolan TS, McKoy A, Gray DM 2nd, et al. Virtual community engagement for retention of black men in clinical research. Am J Mens Health. 2023;17:15579883221147767.

References

Bibeau K, Pandya AG, Ezzedine K, et al. Vitiligo prevalence and quality of life among adults in Europe, Japan and the USA. J Eur Acad Dermatol Venereol. 2022;36:1831-1844.
Jin Y, Roberts GHL, Ferrara TM, et al. Early-onset autoimmune vitiligo associated with an enhancer variant haplotype that upregulates class II HLA expression. Nat Commun. 2019;10:391.
Rodrigues M, Ezzedine K, Hamzavi I, et al; Vitiligo Working Group. New discoveries in the pathogenesis and classification of vitiligo. J Am Acad Dermatol. 2017;77:1-13.
Gandhi K, Ezzedine K, Anastassopoulos KP, et al. Prevalence of vitiligo among adults in the United States. JAMA Dermatol. 2022;158:43-50.
Spritz RA, Santorico SA. The genetic basis of vitiligo. J Invest Dermatol. 2021;141:265-73.
Harris JE. Chemical-induced vitiligo. Dermatol Clin. 2017;35:151-161.
Ahmed F, Moseley I, Ragi SD, et al. Vitiligo in underrepresented communities: an all of us database analysis. J Am Acad Dermatol. 2023;88:945-948.
Frisoli ML, Essien K, Harris JE. Vitiligo: mechanisms of pathogenesis and treatment. Annu Rev Immunol. 2020;38:621-648.
Richmond JM, Strassner JP, Zapata L Jr, et al. Antibody blockade of IL-15 signaling has the potential to durably reverse vitiligo. Sci Transl Med. 2018;10:eaam7710.
Richmond JM, Strassner JP, Rashighi M, et al. Resident memory and recirculating memory T cells cooperate to maintain disease in a mouse model of vitiligo. J Invest Dermatol. 2019;139:769-778.
Ezzedine K, Peeva E, Yamaguchi Y, et al. Efficacy and safety of oral ritlecitinib for the treatment of active nonsegmental vitiligo: a randomized phase 2b clinical trial. J Am Acad Dermatol. 2023;88:395-403.
Rosmarin D, Passeron T, Pandya AG, et al. Two phase 3, randomized, controlled trials of ruxolitinib cream for vitiligo. N Engl J Med. 2022;387:1445-1455.
Cavazzoni P, Anagnostiadis E, Lolic M. Drug trials snapshots summary report. US Food and Drug Administration website. Accessed March 19, 2024. https://www.fda.gov/media/145718/download
Ezzedine K, Grimes PE, Meurant JM, et al. Living with vitiligo: results from a national survey indicate differences between skin phototypes. Br J Dermatol. 2015;173:607-609.
Elbuluk N, Ezzedine K. Quality of life, burden of disease, co-morbidities, and systemic effects in vitiligo patients. Dermatol Clin. 2017;35:117-128.
Kahn JM, Gray DM 2nd, Oliveri JM, et al. Strategies to improve diversity, equity, and inclusion in clinical trials. Cancer. 2022;128:216-221.
Nolan TS, McKoy A, Gray DM 2nd, et al. Virtual community engagement for retention of black men in clinical research. Am J Mens Health. 2023;17:15579883221147767.

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Advancements in Targeted Therapies for Vitiligo: Prioritizing Equity in Drug Development

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Advancements in Targeted Therapies for Vitiligo: Prioritizing Equity in Drug Development

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Vitiligo is an autoimmune disease of the skin that affects all skin types but can be particularly disfiguring in those with skin of color.
Ruxolitinib, a topical Janus kinase (JAK) inhibitor, is the only US Food and Drug Administration–approved treatment to repigment the skin in vitiligo and has shown efficacy for individuals with all skin phototypes.
Individuals with skin of color are underrepresented in patient cohorts for JAK inhibitor clinical trials for vitiligo, mirroring a phenomenon seen in the majority of clinical trials. Ensuring diverse participant enrollment and measuring quality-of-life metrics will strengthen future clinical trials for treatment of vitiligo and other skin diseases impacting patients with skin of color.

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Depression As a Potential Contributing Factor in Hidradenitis Suppurativa and Associated Racial Gaps

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Depression As a Potential Contributing Factor in Hidradenitis Suppurativa and Associated Racial Gaps

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Nwanneka Okwundu, DO

Amy J. McMichael, MD

Hidradenitis suppurativa (HS)—a chronic, relapsing, inflammatory disorder involving terminal hair follicles in apocrine gland–rich skin—manifests as tender inflamed nodules that transform into abscesses, sinus tracts, and scarring.^1,2 The etiology of HS is multifactorial, encompassing lifestyle, microbiota, hormonal status, and genetic and environmental factors. These factors activate the immune system around the terminal hair follicles and lead to hyperkeratosis of the infundibulum of the hair follicles in intertriginous regions. This progresses to follicular occlusion, stasis, and eventual rupture. Bacterial multiplication within the plugged pilosebaceous units further boosts immune activation. Resident and migrated cells of the innate and adaptive immune system then release proinflammatory cytokines such as tumor necrosis factor, IL-1β, and IL-17, which further enhance immune cell influx and inflammation.^3,4 This aberrant immune response propagates the production of deep-seated inflammatory nodules and abscesses.^3-8

The estimated prevalence of HS is 1% worldwide.⁹ It is more prevalent in female and Black patients (0.30%) than White patients (0.09%) and is intermediate in prevalence in the biracial population (0.22%).¹⁰ Hidradenitis suppurativa is thought to be associated with lower socioeconomic status (SES). In a retrospective analysis of HS patients (N=375), approximately one-third of patients were Black, had advanced disease, and had a notably lower SES.¹¹ Furthermore, HS has been reported to be associated with systemic inflammation and comorbidities such as morbid obesity (38.3%) and hypertension (39.6%) as well as other metabolic syndrome–related disorders and depression (48.1%).¹

Hidradenitis suppurativa may contribute to the risk for depression through its substantial impact on health-related quality of life, which culminates in social withdrawal, unemployment, and suicidal thoughts.¹² The high prevalence of depression in individuals with HS¹ and its association with systemic inflammation¹³ increases the likelihood that a common genetic predisposition also may exist between both conditions. Because depression frequently has been discovered as a concomitant diagnosis in patients with HS, we hypothesize that a shared genetic susceptibility also may exist between the 2 disorders. Our study sought to explore data on the co-occurrence of depression with HS, including its demographics and racial data.

Methods

We conducted a PubMed search of articles indexed for MEDLINE as well as Google Scholar using the terms depression and hidradenitis suppurativa to obtain all research articles published from 2000 to 2022. Articles were selected based on relevance to the topic of exploration. English-language articles that directly addressed the epidemiology, etiology, pathophysiology, and co-occurrence of both depression and HS with numerical data were included. Articles were excluded if they did not explore the information of interest on these 2 disorders or did not contain clear statistical data of patients with the 2 concurrent medical conditions.

Results

Twenty-two cross-sectional, prospective, and retrospective studies that fit the search criteria were identified and included in the analysis (eTable).^1,14-34 Sixteen (72.7%) studies were cross-sectional, 5 (22.7%) were retrospective, and only 1 (4.5%) was a prospective study. Only 6 of the studies provided racial data,^{1,14,17,26,28,32} and of them, 4 had predominately White patients,^1,14,26,32 whereas the other 2 had predominantly Black patients.^17,28

Studies on Depression and Hidradenitis Suppurativa

Hidradenitis suppurativa was found to coexist with depression in all the studies, with a prevalence of 1.2% to 48.1%. There also was a higher prevalence of depression in HS patients than in the control patients without HS. Furthermore, a recent study by Wright and colleagues¹⁴ stratified the depression prevalence data by age and found a higher prevalence of depression in adults vs children with HS (30% vs 12%).

Comment

Major depression—a chronic and debilitating illness—is the chief cause of disability globally and in the United States alone and has a global lifetime prevalence of 17%.³⁵ In a study of 388 patients diagnosed with depression and 404 community-matched controls who were observed for 10 years, depressed patients had a two-thirds higher likelihood of developing a serious physical illness than controls. The depression-associated elevated risk for serious physical illness persisted after controlling for confounding variables such as alcohol abuse, smoking, and level of physical activity.³⁶ Studies also have demonstrated that HS is more prevalent in Black individuals¹⁰ and in individuals of low SES,³⁷ who are mostly the Black and Hispanic populations that experience the highest burden of racial microaggression³⁸ and disparities in health access and outcomes.^39,40 The severity and chronicity of major depressive disorder also is higher in Black patients compared with White patients (57% vs 39%).⁴¹ Because major depression and HS are most common among Black patients who experience the highest-burden negative financial and health disparities, there may be a shared genetic disposition to both medical conditions.

Moreover, the common detrimental lifestyle choices associated with patients with depression and HS also suggest the possibility of a collective genetic susceptibility. Patients with depression also report increased consumption of alcohol, tobacco, and illicit substances; sedentary lifestyle leading to obesity; and poor compliance with prescribed medical treatment.⁴² Smoking and obesity are known contributors to the pathogenesis of HS, and their modification also is known to positively impact the disease course. In a retrospective single-cohort study, 50% of obese HS patients (n=35) reported a substantial decrease in disease severity after a reduction of more than 15% in body mass index over 2 years following bariatric surgery (n=35).⁴³ Patients with HS also have reported disease remission following extensive weight loss.⁴⁴ In addition, evidence has supported smoking cessation in improving the disease course of HS.⁴³ Because these detrimental lifestyle choices are prevalent in both patients with HS and those with depression, a co-genetic susceptibility also may exist.

Furthermore, depression is characterized by a persistent inflammatory state,^13,45 similar to HS.⁴⁶ Elevated levels of a variety of inflammatory markers, such as C-reactive protein (CRP), IL-6, and soluble intercellular adhesion molecule 1, have been reported in patients with depression compared with healthy controls.^13,45 Further analysis found a positive correlation and a strong association between depression and these inflammatory markers.⁴⁷ Moreover, adipokines regulate inflammatory responses, and adipokines play a role in the pathogenesis of HS. Adipokine levels such as elevated omentin-1 (a recently identified adipokine) were found to be altered in patients with HS compared with controls.⁴⁸ Results from clinical studies and meta-analyses of patients with depression also have demonstrated that adipokines are dysregulated in this population,^49,50 which may be another potential genetic link between depression and HS.

In addition, genetic susceptibility to depression and HS may be shared because the inflammatory markers that have a strong association with depression also have been found to play an important role in HS treatment and disease severity prediction. In a retrospective cohort study of 404 patients, CRP or IL-6 levels were found to be reliable predictors of HS disease severity, which may explain why anti–tumor necrosis factor antibody regimens such as adalimumab and infliximab have clinically ameliorated disease activity in several cases of HS.⁵¹ In a study evaluating these drugs, high baseline levels of high-sensitivity CRP and IL-6 were predictive of patient response to infliximab.⁵² In a meta-analysis evaluating 20,791 participants, an association was found between concurrent depression and CRP. Furthermore, inflammation measured by high levels of CRP or IL-6 was observed to predict future depression.⁵³ If the same inflammatory markers—CRP and IL-6—both play a major role in the disease activity of depression and HS, then a concurrent genetic predisposition may exist.

Conclusion

Understanding the comorbidities, etiologies, and risk factors for the development and progression of HS is an important step toward improved disease management. Available studies on comorbid depression in HS largely involve White patients, and more studies are needed in patients with skin of color, particularly the Black population, who have the highest prevalence of HS.¹⁰ Given the evidence for an association between depression and HS, we suggest a large-scale investigation of this patient population that includes a complete medical history, onset of HS in comparison to the onset of depression, and specific measures of disease progress and lifetime management of depression, which may help to increase knowledge about the role of depression in HS and encourage more research in this area. If shared genetic susceptibility is established, aggressive management of depression in patients at risk for HS may reduce disease incidence and severity as well as the psychological burden on patients.

References

Crowley JJ, Mekkes JR, Zouboulis CC, et al. Association of hidradenitis suppurativa disease severity with increased risk for systemic comorbidities. Br J Dermatol. 2014;171:1561-1565.
Napolitano M, Megna M, Timoshchuk EA, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105-115.
Sabat R, Jemec GBE, Matusiak Ł, et al. Hidradenitis suppurativa. Nat Rev Dis Prim. 2020;6:1-20.
Wolk K, Warszawska K, Hoeflich C, et al. Deficiency of IL-22 contributes to a chronic inflammatory disease: pathogenetic mechanisms in acne inversa. J Immunol. 2011;186:1228-1239.
von Laffert M, Helmbold P, Wohlrab J, et al. Hidradenitis suppurativa (acne inversa): early inflammatory events at terminal follicles and at interfollicular epidermis. Exp Dermatol. 2010;19:533-537.
Van Der Zee HH, De Ruiter L, Van Den Broecke DG, et al. Elevated levels of tumour necrosis factor (TNF)-α, interleukin (IL)-1β and IL-10 in hidradenitis suppurativa skin: a rationale for targeting TNF-α and IL-1β. Br J Dermatol. 2011;164:1292-1298.
Schlapbach C, Hänni T, Yawalkar N, et al. Expression of the IL-23/Th17 pathway in lesions of hidradenitis suppurativa. J Am Acad Dermatol. 2011;65:790-798.
Kelly G, Hughes R, McGarry T, et al. Dysregulated cytokine expression in lesional and nonlesional skin in hidradenitis suppurativa. Br J Dermatol. 2015;173:1431-1439.
Jemec GBE, Kimball AB. Hidradenitis suppurativa: epidemiology and scope of the problem. J Am Acad Dermatol. 2015;73(5 Suppl 1):S4-S7.
Garg A, Kirby JS, Lavian J, et al. Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States. JAMA Dermatol. 2017;153:760-764.
Soliman YS, Hoffman LK, Guzman AK, et al. African American patients with hidradenitis suppurativa have significant health care disparities: a retrospective study. J Cutan Med Surg. 2019;23:334-336.
Garg A, Malviya N, Strunk A, et al. Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2022;86:1092-1101.
Beatriz Currier M, Nemeroff CB. Inflammation and mood disorders: proinflammatory cytokines and the pathogenesis of depression. Antiinflamm Antiallergy Agents Med Chem. 2012;9:212-220.
Wright S, Strunk A, Garg A. Prevalence of depression among children, adolescents, and adults with hidradenitis suppurativa. J Am Acad Dermatol. 2022;86:55-60.
Sampogna F, Fania L, Mastroeni S, et al. Correlation between depression, quality of life and clinical severity in patients with hidradenitis suppurativa. Acta Derm Venereol. 2020;100:1-6.
Theut Riis P, Pedersen OB, Sigsgaard V, et al. Prevalence of patients with self-reported hidradenitis suppurativa in a cohort of Danish blood donors: a cross-sectional study. Br J Dermatol. 2019;180:774-781.
Senthilnathan A, Kolli SS, Cardwell LA, et al. Depression in hidradenitis suppurativa. Br J Dermatol. 2019;181:1087-1088.
Pavon Blanco A, Turner MA, Petrof G, et al. To what extent do disease severity and illness perceptions explain depression, anxiety and quality of life in hidradenitis suppurativa? Br J Dermatol. 2019;180:338-345.
Butt M, Sisic M, Silva C, et al. The associations of depression and coping methods on health-related quality of life for those with hidradenitis suppurativa. J Am Acad Dermatol. 2019;80:1137-1139.
Calao M, Wilson JL, Spelman L, et al. Hidradenitis suppurativa (HS) prevalence, demographics and management pathways in Australia: a population-based cross-sectional study. PLoS One. 2018;13:e0200683.
Ingram JR, Jenkins-Jones S, Knipe DW, et al. Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa. Br J Dermatol. 2018;178:917-924.
Kimball AB, Sundaram M, Gauthier G, et al. The comorbidity burden of hidradenitis suppurativa in the United States: a claims data analysis. Dermatol Ther (Heidelb). 2018;8:557.
Thorlacius L, Cohen AD, Gislason GH, et al. Increased suicide risk in patients with hidradenitis suppurativa. J Invest Dermatol. 2018;138:52-57.
Tiri H, Jokelainen J, Timonen M, et al. Somatic and psychiatric comorbidities of hidradenitis suppurativa in children and adolescents. J Am Acad Dermatol. 2018;79:514-519.
Huilaja L, Tiri H, Jokelainen J, et al. Patients with hidradenitis suppurativa have a high psychiatric disease burden: a Finnish nationwide registry study. J Invest Dermatol. 2018;138:46-51.
Kirby JS, Butt M, Esmann S, et al. Association of resilience with depression and health-related quality of life for patients with hidradenitis suppurativa. JAMA Dermatol. 2017;153:1263.
Egeberg A, Gislason GH, Hansen PR. Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa. JAMA Dermatol. 2016;152:429-434.
Vangipuram R, Vaidya T, Jandarov R, et al. Factors contributing to depression and chronic pain in patients with hidradenitis suppurativa: results from a single-center retrospective review. Dermatology. 2016;232:692-695.
Rayner L, Jackson K, Turner M, et al. Integrated mental health assessment in a tertiary medical dermatology service: feasibility and the prevalence of common mental disorder. Br J Dermatol. 2015;173:201.
Shavit E, Dreiher J, Freud T, et al. Psychiatric comorbidities in 3207 patients with hidradenitis suppurativa [published online June 9, 2014]. J Eur Acad Dermatol Venereol. 2015;29:371-376.
Kurek A, Johanne Peters EM, Sabat R, et al. Depression is a frequent co-morbidity in patients with acne inversa. J Dtsch Dermatol Ges. 2013;11:743-749.
Vazquez BG, Alikhan A, Weaver AL, et al. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol. 2013;133:97.
Onderdijk AJ, Van Der Zee HH, Esmann S, et al. Depression in patients with hidradenitis suppurativa [published online February 20, 2012]. J Eur Acad Dermatol Venereol. 2013;27:473-478.
Matusiak Ł, Bieniek A, Szepietowski JC. Psychophysical aspects of hidradenitis suppurativa. Acta Derm Venereol. 2010;90:264-268.
Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617-627.
Holahan CJ, Pahl SA, Cronkite RC, et al. Depression and vulnerability to incident physical illness across 10 years. J Affect Disord. 2009;123:222-229.
Deckers IE, Janse IC, van der Zee HH, et al. Hidradenitis suppurativa (HS) is associated with low socioeconomic status (SES): a cross-sectional reference study. J Am Acad Dermatol. 2016;75:755-759.e1.
Williams MT, Skinta MD, Kanter JW, et al. A qualitative study of microaggressions against African Americans on predominantly White campuses. BMC Psychol. 2020;8:1-13.
Dunlop DD, Song J, Lyons JS, et al. Racial/ethnic differences in rates of depression among preretirement adults. Am J Public Health. 2003;93:1945-1952.
Williams DR, Priest N, Anderson NB. Understanding associations among race, socioeconomic status, and health: patterns and prospects. Health Psychol. 2016;35:407-411.
Williams DR, González HM, Neighbors H, et al. Prevalence and distribution of major depressive disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites: results from the National Survey of American Life. Arch Gen Psychiatry. 2007;64:305-315.
Druss BG, Bradford DW, Rosenheck RA, et al. Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA. 2000;283:506-511.
Kromann CB, Deckers IE, Esmann S, et al. Risk factors, clinical course and long-term prognosis in hidradenitis suppurativa: a cross-sectional study. Br J Dermatol. 2014;171:819-824.
Sivanand A, Gulliver WP, Josan CK, et al. Weight loss and dietary interventions for hidradenitis suppurativa: a systematic review. J Cutan Med Surg . 2020;24:64-72.
Raedler TJ. Inflammatory mechanisms in major depressive disorder. Curr Opin Psychiatry. 2011;24:519-525.
Rocha VZ, Libby P. Obesity, inflammation, and atherosclerosis. Nat Rev Cardiol. 2009;6:399-409.
Davidson KW, Schwartz JE, Kirkland SA, et al. Relation of inflammation to depression and incident coronary heart disease (from the Canadian Nova Scotia Health Survey [NSHS95] Prospective Population Study). Am J Cardiol. 2009;103:755-761.
González-López MA, Ocejo-Viñals JG, Mata C, et al. Evaluation of serum omentin-1 and apelin concentrations in patients with hidradenitis suppurativa. Postepy Dermatol Alergol. 2021;38:450-454.
Taylor VH, Macqueen GM. The role of adipokines in understanding the associations between obesity and depression. J Obes. 2010;2010:748048.
Setayesh L, Ebrahimi R, Pooyan S, et al. The possible mediatory role of adipokines in the association between low carbohydrate diet and depressive symptoms among overweight and obese women. PLoS One. 2021;16:e0257275 .
Andriano TM, Benesh G, Babbush KM, et al. Serum inflammatory markers and leukocyte profiles accurately describe hidradenitis suppurativa disease severity. Int J Dermatol. 2022;61:1270-1275.
Montaudié H, Seitz-Polski B, Cornille A, et al. Interleukin 6 and high-sensitivity C-reactive protein are potential predictive markers of response to infliximab in hidradenitis suppurativa. J Am Acad Dermatol. 2017;6:156-158.
Colasanto M, Madigan S, Korczak DJ. Depression and inflammation among children and adolescents: a meta-analysis. J Affect Disord. 2020;277:940-948.

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Dr. Okwundu is from the University of Washington, Trios Health Family Medicine Residency, Kennewick. Dr. McMichael is from the Department of Dermatology, Wake Forest Baptist Health, Winston-Salem, North Carolina.

The authors report no conflict of interest.

The eTable is available in the Appendix online at www.mdedge.com/dermatology.

Correspondence: Nwanneka Okwundu, DO, University of Washington, Trios Health Family Medicine Residency, 320 W 10th Ave, #202, Kennewick, WA 99336 ([email protected]).

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The eTable is available in the Appendix online at www.mdedge.com/dermatology.

Correspondence: Nwanneka Okwundu, DO, University of Washington, Trios Health Family Medicine Residency, 320 W 10th Ave, #202, Kennewick, WA 99336 ([email protected]).

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References

Crowley JJ, Mekkes JR, Zouboulis CC, et al. Association of hidradenitis suppurativa disease severity with increased risk for systemic comorbidities. Br J Dermatol. 2014;171:1561-1565.
Napolitano M, Megna M, Timoshchuk EA, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105-115.
Sabat R, Jemec GBE, Matusiak Ł, et al. Hidradenitis suppurativa. Nat Rev Dis Prim. 2020;6:1-20.
Wolk K, Warszawska K, Hoeflich C, et al. Deficiency of IL-22 contributes to a chronic inflammatory disease: pathogenetic mechanisms in acne inversa. J Immunol. 2011;186:1228-1239.
von Laffert M, Helmbold P, Wohlrab J, et al. Hidradenitis suppurativa (acne inversa): early inflammatory events at terminal follicles and at interfollicular epidermis. Exp Dermatol. 2010;19:533-537.
Van Der Zee HH, De Ruiter L, Van Den Broecke DG, et al. Elevated levels of tumour necrosis factor (TNF)-α, interleukin (IL)-1β and IL-10 in hidradenitis suppurativa skin: a rationale for targeting TNF-α and IL-1β. Br J Dermatol. 2011;164:1292-1298.
Schlapbach C, Hänni T, Yawalkar N, et al. Expression of the IL-23/Th17 pathway in lesions of hidradenitis suppurativa. J Am Acad Dermatol. 2011;65:790-798.
Kelly G, Hughes R, McGarry T, et al. Dysregulated cytokine expression in lesional and nonlesional skin in hidradenitis suppurativa. Br J Dermatol. 2015;173:1431-1439.
Jemec GBE, Kimball AB. Hidradenitis suppurativa: epidemiology and scope of the problem. J Am Acad Dermatol. 2015;73(5 Suppl 1):S4-S7.
Garg A, Kirby JS, Lavian J, et al. Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States. JAMA Dermatol. 2017;153:760-764.
Soliman YS, Hoffman LK, Guzman AK, et al. African American patients with hidradenitis suppurativa have significant health care disparities: a retrospective study. J Cutan Med Surg. 2019;23:334-336.
Garg A, Malviya N, Strunk A, et al. Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2022;86:1092-1101.
Beatriz Currier M, Nemeroff CB. Inflammation and mood disorders: proinflammatory cytokines and the pathogenesis of depression. Antiinflamm Antiallergy Agents Med Chem. 2012;9:212-220.
Wright S, Strunk A, Garg A. Prevalence of depression among children, adolescents, and adults with hidradenitis suppurativa. J Am Acad Dermatol. 2022;86:55-60.
Sampogna F, Fania L, Mastroeni S, et al. Correlation between depression, quality of life and clinical severity in patients with hidradenitis suppurativa. Acta Derm Venereol. 2020;100:1-6.
Theut Riis P, Pedersen OB, Sigsgaard V, et al. Prevalence of patients with self-reported hidradenitis suppurativa in a cohort of Danish blood donors: a cross-sectional study. Br J Dermatol. 2019;180:774-781.
Senthilnathan A, Kolli SS, Cardwell LA, et al. Depression in hidradenitis suppurativa. Br J Dermatol. 2019;181:1087-1088.
Pavon Blanco A, Turner MA, Petrof G, et al. To what extent do disease severity and illness perceptions explain depression, anxiety and quality of life in hidradenitis suppurativa? Br J Dermatol. 2019;180:338-345.
Butt M, Sisic M, Silva C, et al. The associations of depression and coping methods on health-related quality of life for those with hidradenitis suppurativa. J Am Acad Dermatol. 2019;80:1137-1139.
Calao M, Wilson JL, Spelman L, et al. Hidradenitis suppurativa (HS) prevalence, demographics and management pathways in Australia: a population-based cross-sectional study. PLoS One. 2018;13:e0200683.
Ingram JR, Jenkins-Jones S, Knipe DW, et al. Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa. Br J Dermatol. 2018;178:917-924.
Kimball AB, Sundaram M, Gauthier G, et al. The comorbidity burden of hidradenitis suppurativa in the United States: a claims data analysis. Dermatol Ther (Heidelb). 2018;8:557.
Thorlacius L, Cohen AD, Gislason GH, et al. Increased suicide risk in patients with hidradenitis suppurativa. J Invest Dermatol. 2018;138:52-57.
Tiri H, Jokelainen J, Timonen M, et al. Somatic and psychiatric comorbidities of hidradenitis suppurativa in children and adolescents. J Am Acad Dermatol. 2018;79:514-519.
Huilaja L, Tiri H, Jokelainen J, et al. Patients with hidradenitis suppurativa have a high psychiatric disease burden: a Finnish nationwide registry study. J Invest Dermatol. 2018;138:46-51.
Kirby JS, Butt M, Esmann S, et al. Association of resilience with depression and health-related quality of life for patients with hidradenitis suppurativa. JAMA Dermatol. 2017;153:1263.
Egeberg A, Gislason GH, Hansen PR. Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa. JAMA Dermatol. 2016;152:429-434.
Vangipuram R, Vaidya T, Jandarov R, et al. Factors contributing to depression and chronic pain in patients with hidradenitis suppurativa: results from a single-center retrospective review. Dermatology. 2016;232:692-695.
Rayner L, Jackson K, Turner M, et al. Integrated mental health assessment in a tertiary medical dermatology service: feasibility and the prevalence of common mental disorder. Br J Dermatol. 2015;173:201.
Shavit E, Dreiher J, Freud T, et al. Psychiatric comorbidities in 3207 patients with hidradenitis suppurativa [published online June 9, 2014]. J Eur Acad Dermatol Venereol. 2015;29:371-376.
Kurek A, Johanne Peters EM, Sabat R, et al. Depression is a frequent co-morbidity in patients with acne inversa. J Dtsch Dermatol Ges. 2013;11:743-749.
Vazquez BG, Alikhan A, Weaver AL, et al. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol. 2013;133:97.
Onderdijk AJ, Van Der Zee HH, Esmann S, et al. Depression in patients with hidradenitis suppurativa [published online February 20, 2012]. J Eur Acad Dermatol Venereol. 2013;27:473-478.
Matusiak Ł, Bieniek A, Szepietowski JC. Psychophysical aspects of hidradenitis suppurativa. Acta Derm Venereol. 2010;90:264-268.
Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617-627.
Holahan CJ, Pahl SA, Cronkite RC, et al. Depression and vulnerability to incident physical illness across 10 years. J Affect Disord. 2009;123:222-229.
Deckers IE, Janse IC, van der Zee HH, et al. Hidradenitis suppurativa (HS) is associated with low socioeconomic status (SES): a cross-sectional reference study. J Am Acad Dermatol. 2016;75:755-759.e1.
Williams MT, Skinta MD, Kanter JW, et al. A qualitative study of microaggressions against African Americans on predominantly White campuses. BMC Psychol. 2020;8:1-13.
Dunlop DD, Song J, Lyons JS, et al. Racial/ethnic differences in rates of depression among preretirement adults. Am J Public Health. 2003;93:1945-1952.
Williams DR, Priest N, Anderson NB. Understanding associations among race, socioeconomic status, and health: patterns and prospects. Health Psychol. 2016;35:407-411.
Williams DR, González HM, Neighbors H, et al. Prevalence and distribution of major depressive disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites: results from the National Survey of American Life. Arch Gen Psychiatry. 2007;64:305-315.
Druss BG, Bradford DW, Rosenheck RA, et al. Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA. 2000;283:506-511.
Kromann CB, Deckers IE, Esmann S, et al. Risk factors, clinical course and long-term prognosis in hidradenitis suppurativa: a cross-sectional study. Br J Dermatol. 2014;171:819-824.
Sivanand A, Gulliver WP, Josan CK, et al. Weight loss and dietary interventions for hidradenitis suppurativa: a systematic review. J Cutan Med Surg . 2020;24:64-72.
Raedler TJ. Inflammatory mechanisms in major depressive disorder. Curr Opin Psychiatry. 2011;24:519-525.
Rocha VZ, Libby P. Obesity, inflammation, and atherosclerosis. Nat Rev Cardiol. 2009;6:399-409.
Davidson KW, Schwartz JE, Kirkland SA, et al. Relation of inflammation to depression and incident coronary heart disease (from the Canadian Nova Scotia Health Survey [NSHS95] Prospective Population Study). Am J Cardiol. 2009;103:755-761.
González-López MA, Ocejo-Viñals JG, Mata C, et al. Evaluation of serum omentin-1 and apelin concentrations in patients with hidradenitis suppurativa. Postepy Dermatol Alergol. 2021;38:450-454.
Taylor VH, Macqueen GM. The role of adipokines in understanding the associations between obesity and depression. J Obes. 2010;2010:748048.
Setayesh L, Ebrahimi R, Pooyan S, et al. The possible mediatory role of adipokines in the association between low carbohydrate diet and depressive symptoms among overweight and obese women. PLoS One. 2021;16:e0257275 .
Andriano TM, Benesh G, Babbush KM, et al. Serum inflammatory markers and leukocyte profiles accurately describe hidradenitis suppurativa disease severity. Int J Dermatol. 2022;61:1270-1275.
Montaudié H, Seitz-Polski B, Cornille A, et al. Interleukin 6 and high-sensitivity C-reactive protein are potential predictive markers of response to infliximab in hidradenitis suppurativa. J Am Acad Dermatol. 2017;6:156-158.
Colasanto M, Madigan S, Korczak DJ. Depression and inflammation among children and adolescents: a meta-analysis. J Affect Disord. 2020;277:940-948.

References

Crowley JJ, Mekkes JR, Zouboulis CC, et al. Association of hidradenitis suppurativa disease severity with increased risk for systemic comorbidities. Br J Dermatol. 2014;171:1561-1565.
Napolitano M, Megna M, Timoshchuk EA, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105-115.
Sabat R, Jemec GBE, Matusiak Ł, et al. Hidradenitis suppurativa. Nat Rev Dis Prim. 2020;6:1-20.
Wolk K, Warszawska K, Hoeflich C, et al. Deficiency of IL-22 contributes to a chronic inflammatory disease: pathogenetic mechanisms in acne inversa. J Immunol. 2011;186:1228-1239.
von Laffert M, Helmbold P, Wohlrab J, et al. Hidradenitis suppurativa (acne inversa): early inflammatory events at terminal follicles and at interfollicular epidermis. Exp Dermatol. 2010;19:533-537.
Van Der Zee HH, De Ruiter L, Van Den Broecke DG, et al. Elevated levels of tumour necrosis factor (TNF)-α, interleukin (IL)-1β and IL-10 in hidradenitis suppurativa skin: a rationale for targeting TNF-α and IL-1β. Br J Dermatol. 2011;164:1292-1298.
Schlapbach C, Hänni T, Yawalkar N, et al. Expression of the IL-23/Th17 pathway in lesions of hidradenitis suppurativa. J Am Acad Dermatol. 2011;65:790-798.
Kelly G, Hughes R, McGarry T, et al. Dysregulated cytokine expression in lesional and nonlesional skin in hidradenitis suppurativa. Br J Dermatol. 2015;173:1431-1439.
Jemec GBE, Kimball AB. Hidradenitis suppurativa: epidemiology and scope of the problem. J Am Acad Dermatol. 2015;73(5 Suppl 1):S4-S7.
Garg A, Kirby JS, Lavian J, et al. Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States. JAMA Dermatol. 2017;153:760-764.
Soliman YS, Hoffman LK, Guzman AK, et al. African American patients with hidradenitis suppurativa have significant health care disparities: a retrospective study. J Cutan Med Surg. 2019;23:334-336.
Garg A, Malviya N, Strunk A, et al. Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2022;86:1092-1101.
Beatriz Currier M, Nemeroff CB. Inflammation and mood disorders: proinflammatory cytokines and the pathogenesis of depression. Antiinflamm Antiallergy Agents Med Chem. 2012;9:212-220.
Wright S, Strunk A, Garg A. Prevalence of depression among children, adolescents, and adults with hidradenitis suppurativa. J Am Acad Dermatol. 2022;86:55-60.
Sampogna F, Fania L, Mastroeni S, et al. Correlation between depression, quality of life and clinical severity in patients with hidradenitis suppurativa. Acta Derm Venereol. 2020;100:1-6.
Theut Riis P, Pedersen OB, Sigsgaard V, et al. Prevalence of patients with self-reported hidradenitis suppurativa in a cohort of Danish blood donors: a cross-sectional study. Br J Dermatol. 2019;180:774-781.
Senthilnathan A, Kolli SS, Cardwell LA, et al. Depression in hidradenitis suppurativa. Br J Dermatol. 2019;181:1087-1088.
Pavon Blanco A, Turner MA, Petrof G, et al. To what extent do disease severity and illness perceptions explain depression, anxiety and quality of life in hidradenitis suppurativa? Br J Dermatol. 2019;180:338-345.
Butt M, Sisic M, Silva C, et al. The associations of depression and coping methods on health-related quality of life for those with hidradenitis suppurativa. J Am Acad Dermatol. 2019;80:1137-1139.
Calao M, Wilson JL, Spelman L, et al. Hidradenitis suppurativa (HS) prevalence, demographics and management pathways in Australia: a population-based cross-sectional study. PLoS One. 2018;13:e0200683.
Ingram JR, Jenkins-Jones S, Knipe DW, et al. Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa. Br J Dermatol. 2018;178:917-924.
Kimball AB, Sundaram M, Gauthier G, et al. The comorbidity burden of hidradenitis suppurativa in the United States: a claims data analysis. Dermatol Ther (Heidelb). 2018;8:557.
Thorlacius L, Cohen AD, Gislason GH, et al. Increased suicide risk in patients with hidradenitis suppurativa. J Invest Dermatol. 2018;138:52-57.
Tiri H, Jokelainen J, Timonen M, et al. Somatic and psychiatric comorbidities of hidradenitis suppurativa in children and adolescents. J Am Acad Dermatol. 2018;79:514-519.
Huilaja L, Tiri H, Jokelainen J, et al. Patients with hidradenitis suppurativa have a high psychiatric disease burden: a Finnish nationwide registry study. J Invest Dermatol. 2018;138:46-51.
Kirby JS, Butt M, Esmann S, et al. Association of resilience with depression and health-related quality of life for patients with hidradenitis suppurativa. JAMA Dermatol. 2017;153:1263.
Egeberg A, Gislason GH, Hansen PR. Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa. JAMA Dermatol. 2016;152:429-434.
Vangipuram R, Vaidya T, Jandarov R, et al. Factors contributing to depression and chronic pain in patients with hidradenitis suppurativa: results from a single-center retrospective review. Dermatology. 2016;232:692-695.
Rayner L, Jackson K, Turner M, et al. Integrated mental health assessment in a tertiary medical dermatology service: feasibility and the prevalence of common mental disorder. Br J Dermatol. 2015;173:201.
Shavit E, Dreiher J, Freud T, et al. Psychiatric comorbidities in 3207 patients with hidradenitis suppurativa [published online June 9, 2014]. J Eur Acad Dermatol Venereol. 2015;29:371-376.
Kurek A, Johanne Peters EM, Sabat R, et al. Depression is a frequent co-morbidity in patients with acne inversa. J Dtsch Dermatol Ges. 2013;11:743-749.
Vazquez BG, Alikhan A, Weaver AL, et al. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol. 2013;133:97.
Onderdijk AJ, Van Der Zee HH, Esmann S, et al. Depression in patients with hidradenitis suppurativa [published online February 20, 2012]. J Eur Acad Dermatol Venereol. 2013;27:473-478.
Matusiak Ł, Bieniek A, Szepietowski JC. Psychophysical aspects of hidradenitis suppurativa. Acta Derm Venereol. 2010;90:264-268.
Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617-627.
Holahan CJ, Pahl SA, Cronkite RC, et al. Depression and vulnerability to incident physical illness across 10 years. J Affect Disord. 2009;123:222-229.
Deckers IE, Janse IC, van der Zee HH, et al. Hidradenitis suppurativa (HS) is associated with low socioeconomic status (SES): a cross-sectional reference study. J Am Acad Dermatol. 2016;75:755-759.e1.
Williams MT, Skinta MD, Kanter JW, et al. A qualitative study of microaggressions against African Americans on predominantly White campuses. BMC Psychol. 2020;8:1-13.
Dunlop DD, Song J, Lyons JS, et al. Racial/ethnic differences in rates of depression among preretirement adults. Am J Public Health. 2003;93:1945-1952.
Williams DR, Priest N, Anderson NB. Understanding associations among race, socioeconomic status, and health: patterns and prospects. Health Psychol. 2016;35:407-411.
Williams DR, González HM, Neighbors H, et al. Prevalence and distribution of major depressive disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites: results from the National Survey of American Life. Arch Gen Psychiatry. 2007;64:305-315.
Druss BG, Bradford DW, Rosenheck RA, et al. Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA. 2000;283:506-511.
Kromann CB, Deckers IE, Esmann S, et al. Risk factors, clinical course and long-term prognosis in hidradenitis suppurativa: a cross-sectional study. Br J Dermatol. 2014;171:819-824.
Sivanand A, Gulliver WP, Josan CK, et al. Weight loss and dietary interventions for hidradenitis suppurativa: a systematic review. J Cutan Med Surg . 2020;24:64-72.
Raedler TJ. Inflammatory mechanisms in major depressive disorder. Curr Opin Psychiatry. 2011;24:519-525.
Rocha VZ, Libby P. Obesity, inflammation, and atherosclerosis. Nat Rev Cardiol. 2009;6:399-409.
Davidson KW, Schwartz JE, Kirkland SA, et al. Relation of inflammation to depression and incident coronary heart disease (from the Canadian Nova Scotia Health Survey [NSHS95] Prospective Population Study). Am J Cardiol. 2009;103:755-761.
González-López MA, Ocejo-Viñals JG, Mata C, et al. Evaluation of serum omentin-1 and apelin concentrations in patients with hidradenitis suppurativa. Postepy Dermatol Alergol. 2021;38:450-454.
Taylor VH, Macqueen GM. The role of adipokines in understanding the associations between obesity and depression. J Obes. 2010;2010:748048.
Setayesh L, Ebrahimi R, Pooyan S, et al. The possible mediatory role of adipokines in the association between low carbohydrate diet and depressive symptoms among overweight and obese women. PLoS One. 2021;16:e0257275 .
Andriano TM, Benesh G, Babbush KM, et al. Serum inflammatory markers and leukocyte profiles accurately describe hidradenitis suppurativa disease severity. Int J Dermatol. 2022;61:1270-1275.
Montaudié H, Seitz-Polski B, Cornille A, et al. Interleukin 6 and high-sensitivity C-reactive protein are potential predictive markers of response to infliximab in hidradenitis suppurativa. J Am Acad Dermatol. 2017;6:156-158.
Colasanto M, Madigan S, Korczak DJ. Depression and inflammation among children and adolescents: a meta-analysis. J Affect Disord. 2020;277:940-948.

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Hidradenitis suppurativa (HS) is known to be associated with systemic inflammation and comorbidities, including depression.
Depression may be a potential contributing factor to HS in affected patients, and studies on HS with comorbid depression in patients with skin of color are lacking.

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Analysis of Online Diet Recommendations for Vitiligo

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Analysis of Online Diet Recommendations for Vitiligo

IN COLLABORATION WITH THE SKIN OF COLOR SOCIETY

Author(s)

Yasmeen Ali, MD

Ishani Majmudar, BA

Stephanie M. Rangel, PhD

Roopal V. Kundu, MD

Internet platforms have become a common source of medical information for individuals with a broad range of skin conditions including vitiligo. The prevalence of vitiligo among US adults ranges from 0.76% to 1.11%, with approximately 40% of adult cases of vitiligo in the United States remaining undiagnosed.¹ The vitiligo community has become more inquisitive of the relationship between diet and vitiligo, turning to online sources for suggestions on diet modifications that may be beneficial for their condition. Although there is an abundance of online information, few diets or foods have been medically recognized to definitively improve or worsen vitiligo symptoms. We reviewed the top online web pages accessible to the public regarding diet suggestions that affect vitiligo symptoms. We then compared these online results to published peer-reviewed scientific literature.

Methods

Two independent online searches were performed by Researcher 1 (Y.A.) and Researcher 2 (I.M.) using Google Advanced Search. The independent searches were performed by the reviewers in neighboring areas of Chicago, Illinois, using the same Internet browser (Google Chrome). The primary search terms were diet and vitiligo along with the optional additional terms dietary supplement(s), food(s), nutrition, herb(s), or vitamin(s). Our search included any web pages published or updated from January 1, 2010, to December 31, 2021, and originally scribed in the English language. The domains “.com,” “.org,” “.edu,” and “.cc” were included.

From this initial search, Researcher 1 identified 312 web pages and Researcher 2 identified 314 web pages. Each reviewer sorted their respective search results to identify the number of eligible records to be screened. Records were defined as unique web pages that met the search criteria. After removing duplicates, Researcher 1 screened 102 web pages and Researcher 2 screened 76 web pages. Of these records, web pages were excluded if they did not include any diet recommendations for vitiligo patients. Each reviewer independently created a list of eligible records, and the independent lists were then merged for a total of 58 web pages. Among these 58 web pages, there were 24 duplicate records and 3 records that were deemed ineligible for the study due to lack of subject matter relevance. A final total of 31 web pages were included in the data analysis (Figure). Of the 31 records selected, the reviewers jointly evaluated each web page and recorded the diet components that were recommended for individuals with vitiligo to either include or avoid (eTable).

Summary of Diet Recommendations for Vitiligo From Online Web Pages (N=31)

For comparison and support from published scientific literature, a search of PubMed articles indexed for MEDLINE was conducted using the terms diet and vitiligo. Relevant human clinical studies published in the English-language literature were reviewed for content regarding the relationship between diet and vitiligo.

Results

Our online search revealed an abundance of information regarding various dietary modifications suggested to aid in the management of vitiligo symptoms. Most web pages (27/31 [87%]) were not authored by medical professionals or dermatologists. There were 27 diet components mentioned 8 or more times within the 31 total web pages. These diet components were selected for further review via PubMed. Each item was searched on PubMed using the term “[respective diet component] and vitiligo” among all published literature in the English language. Our study focused on summarizing the data on dietary components for which we were able to gather scientific support. These data have been organized into the following categories: vitamins, fruits, omega-3 fatty acids, grains, minerals, vegetables, and nuts.

Vitamins—The online literature recommended inclusion of vitamin supplements, in particular vitamins D and B₁₂, which aligned with published scientific literature.^2,3 Eleven of 31 (35%) web pages recommended vitamin D in vitiligo. A 2010 study analyzing patients with vitiligo vulgaris (N=45) found that 68.9% of the cohort had insufficient (<30 ng/mL) 25-hydroxyvitamin D levels.² A prospective study of 30 individuals found that the use of tacrolimus ointment plus oral vitamin D supplementation was found to be more successful in repigmentation than topical tacrolimus alone.³ Vitamin D dosage ranged from 1500 IU/d if the patient’s serum 25-hydroxyvitamin D levels were less than 20 ng/mL to 3000 IU/d if the serum levels were less than 10 ng/mL for 6 months.

Dairy products are a source of vitamin D.^2,3 Of the web pages that mentioned dairy, a subtle majority (4/7 [57%]) recommended the inclusion of dairy products. Although many web pages did not specify whether oral vitamin D supplementation vs dietary food consumption is preferred, a 2013 controlled study of 16 vitiligo patients who received high doses of vitamin D supplementation with a low-calcium diet found that 4 patients showed 1% to 25% repigmentation, 5 patients showed 26% to 50% repigmentation, and 5 patients showed 51% to 75% repigmentation of the affected areas.⁴

Eleven of 31 (35%) web pages recommended inclusion of vitamin B₁₂ supplementation in vitiligo. A 2-year study with 100 participants showed that supplementation with folic acid and vitamin B₁₂ along with sun exposure yielded more effective repigmentation than either vitamins or sun exposure alone.⁵ An additional hypothesis suggested vitamin B₁₂ may aid in repigmentation through its role in the homocysteine pathway. Although the theory is unproven, it is proposed that inhibition of homocysteine via vitamin B₁₂ or folic acid supplementation may play a role in reducing melanocyte destruction and restoring melanin synthesis.⁶

There were mixed recommendations regarding vitamin C via supplementation and/or eating citrus fruits such as oranges. Although there are limited clinical studies on the use of vitamin C and the treatment of vitiligo, a 6-year prospective study from Madagascar consisting of approximately 300 participants with vitiligo who were treated with a combination of topical corticosteroids, oral vitamin C, and oral vitamin B₁₂ supplementation showed excellent repigmentation (defined by repigmentation of more than 76% of the originally affected area) in 50 participants.⁷

Fruits—Most web pages had mixed recommendations on whether to include or avoid certain fruits. Interestingly, inclusion of mangoes and apricots in the diet were highly recommended (9/31 [29%] and 8/31 [26%], respectively) while fruits such as oranges, lemons, papayas, and grapes were discouraged (10/31 [32%], 8/31 [26%], 6/31 [19%], and 7/31 [23%], respectively). Although some web pages suggested that vitamin C–rich produce including citrus and berries may help to increase melanin formation, others strongly suggested avoiding these fruits. There is limited information on the effects of citrus on vitiligo, but a 2022 study indicated that 5-demethylnobiletin, a flavonoid found in sweet citrus fruits, may stimulate melanin synthesis, which can possibly be beneficial for vitiligo.⁸

Omega-3 Fatty Acids—Seven of 31 (23%) web pages recommended the inclusion of omega-3 fatty acids for their role as antioxidants to improve vitiligo symptoms. Research has indicated a strong association between vitiligo and oxidative stress.⁹ A 2007 controlled clinical trial that included 28 vitiligo patients demonstrated that oral antioxidant supplementation in combination with narrowband UVB phototherapy can significantly decrease vitiligo-associated oxidative stress (P<.05); 8 of 17 (47%) patients in the treatment group saw greater than 75% repigmentation after antioxidant treatment.¹⁰

Grains—Five of 31 (16%) web pages suggested avoiding gluten—a protein naturally found in some grains including wheat, barley, and rye—to improve vitiligo symptoms. A 2021 review suggested that a gluten-free diet may be effective in managing celiac disease, and it is hypothesized that vitiligo may be managed with similar dietary adjustments.¹¹ Studies have shown that celiac disease and vitiligo—both autoimmune conditions—involve IL-2, IL-6, IL-7, and IL-21 in their disease pathways.^12,13 Their shared immunogenic mechanism may account for similar management options.

Upon review, 2 case reports were identified that discussed a relationship between a gluten-free diet and vitiligo symptom improvement. In one report, a 9-year-old child diagnosed with both celiac disease and vitiligo saw intense repigmentation of the skin after adhering to a gluten-free diet for 1 year.¹⁴ Another case study reported a 22-year-old woman with vitiligo whose symptoms improved after 1 month of a gluten-free diet following 2 years of failed treatment with a topical steroid and phototherapy.¹⁵

Seven of 31 (23%) web pages suggested that individuals with vitiligo should include wheat in their diet. There is no published literature discussing the relationship between vitiligo and wheat. Of the 31 web pages reviewed, 10 (32%) suggested including whole grain. There is no relevant scientific evidence or hypotheses describing how whole grains may be beneficial in vitiligo.

Minerals—Eight of 31 (26%) web pages suggested including zinc in the diet to improve vitiligo symptoms. A 2020 study evaluated how different serum levels of zinc in vitiligo patients might be affiliated with interleukin activity. Fifty patients diagnosed with active vitiligo were tested for serum levels of zinc, IL-4, IL-6, and IL-17.¹⁶ The results showed that mean serum levels of zinc were lower in vitiligo patients compared with patients without vitiligo. The study concluded that zinc could possibly be used as a supplement to improve vitiligo, though the dosage needs to be further studied and confirmed.¹⁶

Vegetables—Eleven of 31 (35%) web pages recommended leafy green vegetables and 13 of 31 (42%) recommended spinach for patients with vitiligo. Spinach and other leafy green vegetables are known to be rich in antioxidants, which may have protective effects against reactive oxygen species that are thought to contribute to vitiligo progression.^17,18

Nuts—Walnuts were recommended in 11 of 31 (35%) web pages. Nuts may be beneficial in reducing inflammation and providing protection against oxidative stress.⁹ However, there is no specific scientific literature that supports the inclusion of nuts in the diet to manage vitiligo symptoms.

Comment

With a growing amount of research suggesting that diet modifications may contribute to management of certain skin conditions, vitiligo patients often inquire about foods or supplements that may help improve their condition.¹⁹ Our review highlighted what information was available to the public regarding diet and vitiligo, with preliminary support of the following primary diet components: vitamin D, vitamin B₁₂, zinc, and omega-3 fatty acids. Our review showed no support in the literature for the items that were recommended to avoid. It is important to note that 27 of 31 (87%) web pages from our online search were not authored by medical professionals or dermatologists. Additionally, many web pages suggested conflicting information, making it difficult to draw concrete conclusions about what diet modifications will be beneficial to the vitiligo community. Further controlled clinical trials are warranted due to the lack of formal studies that assess the relationship between diet and vitiligo.

References

Gandhi K, Ezzedine K, Anastassopoulos KP, et al. Prevalence of vitiligo among adults in the United States. JAMA Dermatol. 2022;158:43-50. doi:10.1001/jamadermatol.2021.4724
Silverberg JI, Silverberg AI, Malka E, et al. A pilot study assessing the role of 25 hydroxy vitamin D levels in patients with vitiligo vulgaris. J Am Acad Dermatol. 2010;62:937-941. doi:10.1016/j.jaad.2009.11.024
Karagüzel G, Sakarya NP, Bahadır S, et al. Vitamin D status and the effects of oral vitamin D treatment in children with vitiligo: a prospective study. Clin Nutr ESPEN. 2016;15:28-31. doi:10.1016/j.clnesp.2016.05.006.
Finamor DC, Sinigaglia-Coimbra R, Neves LC, et al. A pilot study assessing the effect of prolonged administration of high daily doses of vitamin D on the clinical course of vitiligo and psoriasis. Dermatoendocrinol. 2013;5:222-234. doi:10.4161/derm.24808
Juhlin L, Olsson MJ. Improvement of vitiligo after oral treatment with vitamin B₁₂ and folic acid and the importance of sun exposure. Acta Derm Venereol. 1997;77:460-462. doi:10.2340/000155555577460462
Chen J, Zhuang T, Chen J, et al. Homocysteine induces melanocytes apoptosis via PERK-eIF2α-CHOP pathway in vitiligo. Clin Sci (Lond). 2020;134:1127-1141. doi:10.1042/CS20200218
Sendrasoa FA, Ranaivo IM, Sata M, et al. Treatment responses in patients with vitiligo to very potent topical corticosteroids combined with vitamin therapy in Madagascar. Int J Dermatol. 2019;58:908-911. doi:10.1111/ijd.14510
Wang HM, Qu LQ, Ng JPL, et al. Natural citrus flavanone 5-demethylnobiletin stimulates melanogenesis through the activation of cAMP/CREB pathway in B16F10 cells. Phytomedicine. 2022;98:153941. doi:10.1016/j.phymed.2022.153941
Ros E. Health benefits of nut consumption. Nutrients. 2010;2:652-682.
Dell’Anna ML, Mastrofrancesco A, Sala R, et al. Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial. Clin Exp Dermatol. 2007;32:631-636.
Xingxing Wu, Lin Qian, Kexin Liu, et al. Gastrointestinal microbiome and gluten in celiac disease. Ann Med. 2021;53:1797-1805. doi:10.1080/07853890.2021.1990392
Forabosco P, Neuhausen SL, Greco L, et al. Meta-analysis of genome-wide linkage studies in celiac disease. Hum Hered. 2009;68:223-230. doi:10.1159/000228920
Akbulut UE, Çebi AH, Sag˘ E, et al. Interleukin-6 and interleukin-17 gene polymorphism association with celiac disease in children. Turk J Gastroenterol. 2017;28:471-475. doi:10.5152/tjg.2017.17092
Rodríguez-García C, González-Hernández S, Pérez-Robayna N, et al. Repigmentation of vitiligo lesions in a child with celiac disease after a gluten-free diet. Pediatr Dermatol. 2011;28:209-210. doi:10.1111/j.1525-1470.2011.01388.x
Khandalavala BN, Nirmalraj MC. Rapid partial repigmentation ofvitiligo in a young female adult with a gluten-free diet. Case Rep Dermatol. 2014;6:283-287.
Sanad EM, El-Fallah AA, Al-Doori AR, et al. Serum zinc and inflammatory cytokines in vitiligo. J Clin Aesthet Dermatol. 2020;13:(12 suppl 1):S29-S33.
Ames BN, Shigenaga MK, Hagen TM. Oxidants, antioxidants, and the degenerative diseases of aging. Proc Natl Acad Sci U S A. 1993;90:7915-7922. doi:10.1073/pnas.90.17.7915
Xian D, Guo M, Xu J, et al. Current evidence to support the therapeutic potential of flavonoids in oxidative stress-related dermatoses. Redox Rep. 2021;26:134-146. doi:10.1080 /13510002.2021.1962094
Katta R, Kramer MJ. Skin and diet: an update on the role of dietary change as a treatment strategy for skin disease. Skin Therapy Lett. 2018;23:1-5.

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From the Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

The authors report no conflict of interest.

The eTable is available in the Appendix online at www.mdedge.com/dermatology.

Correspondence: Roopal V. Kundu, MD, 676 N St. Clair St, Ste 1600, Chicago, IL 60611 ([email protected]).

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Ishani Majmudar, BA

Stephanie M. Rangel, PhD

Roopal V. Kundu, MD

Author(s)

Yasmeen Ali, MD

Ishani Majmudar, BA

Stephanie M. Rangel, PhD

Roopal V. Kundu, MD

Author and Disclosure Information

From the Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

The authors report no conflict of interest.

The eTable is available in the Appendix online at www.mdedge.com/dermatology.

Correspondence: Roopal V. Kundu, MD, 676 N St. Clair St, Ste 1600, Chicago, IL 60611 ([email protected]).

Author and Disclosure Information

From the Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

The authors report no conflict of interest.

The eTable is available in the Appendix online at www.mdedge.com/dermatology.

Correspondence: Roopal V. Kundu, MD, 676 N St. Clair St, Ste 1600, Chicago, IL 60611 ([email protected]).

Article PDF

CT113001018.pdf

Article PDF

CT113001018.pdf

IN COLLABORATION WITH THE SKIN OF COLOR SOCIETY

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References

Gandhi K, Ezzedine K, Anastassopoulos KP, et al. Prevalence of vitiligo among adults in the United States. JAMA Dermatol. 2022;158:43-50. doi:10.1001/jamadermatol.2021.4724
Silverberg JI, Silverberg AI, Malka E, et al. A pilot study assessing the role of 25 hydroxy vitamin D levels in patients with vitiligo vulgaris. J Am Acad Dermatol. 2010;62:937-941. doi:10.1016/j.jaad.2009.11.024
Karagüzel G, Sakarya NP, Bahadır S, et al. Vitamin D status and the effects of oral vitamin D treatment in children with vitiligo: a prospective study. Clin Nutr ESPEN. 2016;15:28-31. doi:10.1016/j.clnesp.2016.05.006.
Finamor DC, Sinigaglia-Coimbra R, Neves LC, et al. A pilot study assessing the effect of prolonged administration of high daily doses of vitamin D on the clinical course of vitiligo and psoriasis. Dermatoendocrinol. 2013;5:222-234. doi:10.4161/derm.24808
Juhlin L, Olsson MJ. Improvement of vitiligo after oral treatment with vitamin B₁₂ and folic acid and the importance of sun exposure. Acta Derm Venereol. 1997;77:460-462. doi:10.2340/000155555577460462
Chen J, Zhuang T, Chen J, et al. Homocysteine induces melanocytes apoptosis via PERK-eIF2α-CHOP pathway in vitiligo. Clin Sci (Lond). 2020;134:1127-1141. doi:10.1042/CS20200218
Sendrasoa FA, Ranaivo IM, Sata M, et al. Treatment responses in patients with vitiligo to very potent topical corticosteroids combined with vitamin therapy in Madagascar. Int J Dermatol. 2019;58:908-911. doi:10.1111/ijd.14510
Wang HM, Qu LQ, Ng JPL, et al. Natural citrus flavanone 5-demethylnobiletin stimulates melanogenesis through the activation of cAMP/CREB pathway in B16F10 cells. Phytomedicine. 2022;98:153941. doi:10.1016/j.phymed.2022.153941
Ros E. Health benefits of nut consumption. Nutrients. 2010;2:652-682.
Dell’Anna ML, Mastrofrancesco A, Sala R, et al. Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial. Clin Exp Dermatol. 2007;32:631-636.
Xingxing Wu, Lin Qian, Kexin Liu, et al. Gastrointestinal microbiome and gluten in celiac disease. Ann Med. 2021;53:1797-1805. doi:10.1080/07853890.2021.1990392
Forabosco P, Neuhausen SL, Greco L, et al. Meta-analysis of genome-wide linkage studies in celiac disease. Hum Hered. 2009;68:223-230. doi:10.1159/000228920
Akbulut UE, Çebi AH, Sag˘ E, et al. Interleukin-6 and interleukin-17 gene polymorphism association with celiac disease in children. Turk J Gastroenterol. 2017;28:471-475. doi:10.5152/tjg.2017.17092
Rodríguez-García C, González-Hernández S, Pérez-Robayna N, et al. Repigmentation of vitiligo lesions in a child with celiac disease after a gluten-free diet. Pediatr Dermatol. 2011;28:209-210. doi:10.1111/j.1525-1470.2011.01388.x
Khandalavala BN, Nirmalraj MC. Rapid partial repigmentation ofvitiligo in a young female adult with a gluten-free diet. Case Rep Dermatol. 2014;6:283-287.
Sanad EM, El-Fallah AA, Al-Doori AR, et al. Serum zinc and inflammatory cytokines in vitiligo. J Clin Aesthet Dermatol. 2020;13:(12 suppl 1):S29-S33.
Ames BN, Shigenaga MK, Hagen TM. Oxidants, antioxidants, and the degenerative diseases of aging. Proc Natl Acad Sci U S A. 1993;90:7915-7922. doi:10.1073/pnas.90.17.7915
Xian D, Guo M, Xu J, et al. Current evidence to support the therapeutic potential of flavonoids in oxidative stress-related dermatoses. Redox Rep. 2021;26:134-146. doi:10.1080 /13510002.2021.1962094
Katta R, Kramer MJ. Skin and diet: an update on the role of dietary change as a treatment strategy for skin disease. Skin Therapy Lett. 2018;23:1-5.

References

Gandhi K, Ezzedine K, Anastassopoulos KP, et al. Prevalence of vitiligo among adults in the United States. JAMA Dermatol. 2022;158:43-50. doi:10.1001/jamadermatol.2021.4724
Silverberg JI, Silverberg AI, Malka E, et al. A pilot study assessing the role of 25 hydroxy vitamin D levels in patients with vitiligo vulgaris. J Am Acad Dermatol. 2010;62:937-941. doi:10.1016/j.jaad.2009.11.024
Karagüzel G, Sakarya NP, Bahadır S, et al. Vitamin D status and the effects of oral vitamin D treatment in children with vitiligo: a prospective study. Clin Nutr ESPEN. 2016;15:28-31. doi:10.1016/j.clnesp.2016.05.006.
Finamor DC, Sinigaglia-Coimbra R, Neves LC, et al. A pilot study assessing the effect of prolonged administration of high daily doses of vitamin D on the clinical course of vitiligo and psoriasis. Dermatoendocrinol. 2013;5:222-234. doi:10.4161/derm.24808
Juhlin L, Olsson MJ. Improvement of vitiligo after oral treatment with vitamin B₁₂ and folic acid and the importance of sun exposure. Acta Derm Venereol. 1997;77:460-462. doi:10.2340/000155555577460462
Chen J, Zhuang T, Chen J, et al. Homocysteine induces melanocytes apoptosis via PERK-eIF2α-CHOP pathway in vitiligo. Clin Sci (Lond). 2020;134:1127-1141. doi:10.1042/CS20200218
Sendrasoa FA, Ranaivo IM, Sata M, et al. Treatment responses in patients with vitiligo to very potent topical corticosteroids combined with vitamin therapy in Madagascar. Int J Dermatol. 2019;58:908-911. doi:10.1111/ijd.14510
Wang HM, Qu LQ, Ng JPL, et al. Natural citrus flavanone 5-demethylnobiletin stimulates melanogenesis through the activation of cAMP/CREB pathway in B16F10 cells. Phytomedicine. 2022;98:153941. doi:10.1016/j.phymed.2022.153941
Ros E. Health benefits of nut consumption. Nutrients. 2010;2:652-682.
Dell’Anna ML, Mastrofrancesco A, Sala R, et al. Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial. Clin Exp Dermatol. 2007;32:631-636.
Xingxing Wu, Lin Qian, Kexin Liu, et al. Gastrointestinal microbiome and gluten in celiac disease. Ann Med. 2021;53:1797-1805. doi:10.1080/07853890.2021.1990392
Forabosco P, Neuhausen SL, Greco L, et al. Meta-analysis of genome-wide linkage studies in celiac disease. Hum Hered. 2009;68:223-230. doi:10.1159/000228920
Akbulut UE, Çebi AH, Sag˘ E, et al. Interleukin-6 and interleukin-17 gene polymorphism association with celiac disease in children. Turk J Gastroenterol. 2017;28:471-475. doi:10.5152/tjg.2017.17092
Rodríguez-García C, González-Hernández S, Pérez-Robayna N, et al. Repigmentation of vitiligo lesions in a child with celiac disease after a gluten-free diet. Pediatr Dermatol. 2011;28:209-210. doi:10.1111/j.1525-1470.2011.01388.x
Khandalavala BN, Nirmalraj MC. Rapid partial repigmentation ofvitiligo in a young female adult with a gluten-free diet. Case Rep Dermatol. 2014;6:283-287.
Sanad EM, El-Fallah AA, Al-Doori AR, et al. Serum zinc and inflammatory cytokines in vitiligo. J Clin Aesthet Dermatol. 2020;13:(12 suppl 1):S29-S33.
Ames BN, Shigenaga MK, Hagen TM. Oxidants, antioxidants, and the degenerative diseases of aging. Proc Natl Acad Sci U S A. 1993;90:7915-7922. doi:10.1073/pnas.90.17.7915
Xian D, Guo M, Xu J, et al. Current evidence to support the therapeutic potential of flavonoids in oxidative stress-related dermatoses. Redox Rep. 2021;26:134-146. doi:10.1080 /13510002.2021.1962094
Katta R, Kramer MJ. Skin and diet: an update on the role of dietary change as a treatment strategy for skin disease. Skin Therapy Lett. 2018;23:1-5.

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There are numerous online dietary and supplement recommendations that claim to impact vitiligo but most are not authored by medical professionals or dermatologists.
Scientific evidence supporting specific dietary and supplement recommendations for vitiligo is limited.
Current preliminary data support the potential recommendation for dietary supplementation with vitamin D, vitamin B₁₂, zinc, and omega-3 fatty acids.

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Attitudes Toward Utilization of Minimally Invasive Cosmetic Procedures in Black Women: Results of a Cross-sectional Survey

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Attitudes Toward Utilization of Minimally Invasive Cosmetic Procedures in Black Women: Results of a Cross-sectional Survey

IN COLLABORATION WITH THE SKIN OF COLOR SOCIETY

Author(s)

Sara Marie Asbeck, MD, MPH

Funmilayo Ogunbufunmi, MPH

Brenda Umenita Imo, MS

Laura Scott, MD

Heather Woolery-Lloyd, MD

Beauty has been a topic of interest for centuries. Treatments and technologies have advanced, and more women are utilizing cosmetic procedures than ever before, especially neuromodulators, minimally invasive procedures, and topical treatments.¹ Over the last decade, there was a 99% increase in minimally invasive cosmetic procedures in the United States.² There also has been an observable increase in the utilization of cosmetic procedures by Black patients in recent years; the American Society of Plastic Surgeons reported that the number of cosmetic plastic surgery procedures performed on “ethnic patients” (referring to Asian, Black, or Hispanic patients) increased 243% from 2000 to 2013,³ possibly attributed to increased accessibility, awareness of procedures due to social media, cultural acceptance, and affordability. Minimally invasive procedures are considerably less expensive than major surgical procedures and are becoming progressively more affordable, with numerous financing options available.² Additionally, neuromodulators and fillers are now commonly administered by nonaesthetic health professionals including dentists and nurses, which has increased accessibility of these procedures among patients who typically may not seek out a consultation with a plastic surgeon or dermatologist.⁴

When examining the most common cosmetic procedures collectively sought out by patients with skin of color (SOC), it has been found that an even skin tone is a highly desirable feature that impacts the selection of products and procedures in this particular patient population.⁵ Black, Hispanic, and Asian women report fewer signs of facial aging compared to White women in the glabellar lines, crow’s-feet, oral commissures, perioral lines, and lips.⁶ Increased melanocytes in darker skin types help prevent photoaging but also increase susceptibility to dyschromia. Prior studies have reported the most common concerns by patients with SOC are dyschromic disorders such as postinflammatory hyperpigmentation, postinflammatory hypopigmentation, and melasma.⁷ Common minimally invasive cosmetic procedures utilized by the SOC population include chemical peels, laser treatments, and injectables. Fillers are utilized more for volume loss in SOC patients rather than for the deep furrows and rhytides commonly seen in the lower face of White patients.⁸

We conducted a survey among Black women currently residing in the United States to better understand attitudes toward beauty and aging as well as the utilization of minimally invasive cosmetic procedures in this patient population.

Methods

An in-depth questionnaire comprised of 17 questions was created for this cross-sectional observational study. The study was submitted to and deemed exempt by the institutional review board at the University of Miami (Miami, Florida)(IRB #20211184). Survey participants primarily were recruited via social media posts on personal profiles of Black dermatologists, medical residents, and medicalstudents, including the authors, targeting Black women in the United States. Utilizing a method called snowball sampling, whereby study participants are used to recruit future participants, individuals were instructed to share the survey with their social network to assist with survey distribution. After participants provided informed consent, data were captured using the REDCap secure online data collection software. The questionnaire was structured to include a sociodemographic profile of respondents, attitudes toward beauty and aging, current usage of beauty products, prior utilization of cosmetic procedures, and intentions to use cosmetic procedures in the future. Surveys with incomplete consent forms, incomplete responses, and duplicate responses, as well as surveys from participants who were not residing in the United States at the time of survey completion, were excluded.

Data characteristics were summarized by frequency and percentage. A χ² test was performed to compare participants’ age demographics with their attitudes toward beauty and aging, utilization of cosmetic procedures, and intention to try cosmetic procedures in the future. The Fisher exact test was used instead of the χ² test when the expected cell count was less than 5. For all tests, P<.05 was considered statistically significant. All statistical analyses were performed using SPSS software version 28.

Results

General Characteristics of Participants—A sample of 475 self-identified Black women aged 21 to 70 years participated in the study, and 352 eligible participants were included in the final analysis. Of the 352 eligible participants, 48.3% were aged 21 to 30 years, 47.2% were aged 31 to 40 years, and 4.5% were aged 41 to 50 years. All survey participants identified their race as Black; among them, 4% specified Hispanic or Latino ethnicity, and 9% indicated that they held multiracial identities including White/Caucasian, Asian, and Native American backgrounds. Regarding the participants’ citizenship status, 54.3% reported that both they and their parents were born in the United States; 2.3% were not US citizens or permanent residents, 13.1% identified as first-generation Americans (born outside of the United States), and 30.4% identified as second-generation Americans (one or both parents born outside of the United States). Participant education levels (based on highest level) varied greatly: 4.5% were high school graduates, 1.1% attended trade or technical schools, 3.4% had associate’s degrees, 39.8% had bachelor’s degrees, 35.2% had master’s degrees, and 15.9% had doctorate degrees. Regarding household income, 6.3% earned less than $25,000 per year, 16.8% earned from $25,000 to $99,999, 75.6% earned from $100,000 to $499,999, and 1.4% earned $500,000 or more. Patient demographics are provided in Table 1.

Cosmetic Skin Concerns—The top 3 aging skin concerns among participants were fine lines and wrinkles (51.9%), dark circles (33.8%), and uneven skin tone (31.8%) (Table 2). Approximately 5.4% of participants reported no desire to avoid the natural aging process. Among age groups, fine lines and wrinkles were a major concern for 51.7% of 21- to 30-year-olds, 47.6% of 31- to 40-year-olds, and 43.5% of 41- to 50-year-olds. Dark circles were a major concern for 61.3% of 21- to 30-year-olds, 44.4% of 31- to 40-year-olds, and 46.8% of 41- to 50-year-olds. Uneven skin tone was a major concern for 56.2% of 21- to 30-year-olds, 46.5% of 31- to 40-year-olds, and 31.2% of 41- to 50-year-olds. There was no statistically significant association between participants’ age and their concern with aging skin concerns.

Differences in Cosmetic Procedure Experience and Aging Skin Concerns

Differences in Experience and Acceptance of Cosmetic Procedures—Regarding participants’ prior experience with cosmetic procedures, 22.3% had tried 1 or more procedures. Additionally, 67.0% reported having intentions of trying cosmetic procedures in the future, while 10.8% reported no intentions. Of those who were uninterested in trying cosmetic procedures, 78.9% (30/38) believed it unnecessary while 47.3% (18/38) reported a fear of looking unnatural. Other perceived deterrents to cosmetic procedures among this subset of participants were the need to repeat treatment for lasting results (28.9% [11/38]), too expensive (31.6% [12/38]), and fear of side effects (39.5% [15/38]). A significant difference was found between participants’ age and their experience with cosmetic procedures (P=.020). Participants aged 21 to 30 years reported they were more likely to want to try cosmetic procedures in the future. Participants aged 31 to 40 years were more likely to have already tried a cosmetic procedure. Participants aged 41 to 50 years were more likely to report no desire to try cosmetic procedures in the future. There was no significant difference in cosmetic procedure acceptance according to citizenship status, education level, or household income.

Differences in Cosmetic Procedure Experience—Study participants indicated awareness of typically practiced cosmetic procedures. Of the 78 participants who have tried cosmetic procedures (Figure 1), the most common were laser hair removal (46.2% [36/78]), chemical peels (37.2% [29/78]), and microdermabrasion (24.4% [19/78])(Table 2). Age significantly influenced the type of cosmetic procedures utilized by participants (P<.001). Laser hair removal was the most common cosmetic procedure utilized by participants aged 21 to 30 years (64.7%) and chemical peels in participants aged 31 to 40 years (47.8%); participants aged 41 to 50 years reported equal use of chemical peels (50.0%) and microdermabrasion (50.0%).

Cosmetic procedure experience among survey respondents (N=352).

Two hundred thirty-six participants reported interest in trying cosmetic procedures, specifically laser hair removal (57.6%), chemical peels (51.7%), and neuromodulators (41.9%)(Table 2). Although not statistically significant, age appeared to influence interest levels in cosmetic procedures. Participants aged 21 to 30 years and 31 to 40 years were most interested in trying laser hair removal (60.7% and 58.3%, respectively). Participants aged 41 to 50 years were most interested in trying neuromodulators (36.4%). There was no significant association between age and intention to try neuromodulators, chemical peels, or laser hair removal.

Attitudes Toward Beauty—Approximately 40.6% of participants believed that peak beauty occurs when women reach their 20s, and 38.6% believed that peak beauty occurs when women reach their 30s. Participants’ strategies for maintaining beauty were assessed through their regular use of certain skin care products. The most frequently used skin care products were face wash or cleanser (92.6%), moisturizer (90.1%), lip balm (76.1%), and facial sunscreen (62.2%). Other commonly used items were serum (34.7%), toner (34.9%), topical vitamin C (33.2%), and retinol/retinoid products (33.0%). Only 2.3% of participants reported not using any skin care products regularly.

Perceptions of Aging—Concerning perceived external age, most respondents believed they looked younger than their true age (69.9%); 24.4% believed they looked their true age, and 5.7% believed they looked older. Perception of age also varied considerably by age group, though most believed they looked younger than their true age.

Comment

This survey helped to identify trends in cosmetic procedure acceptance and utilization in Black women. As expected, younger Black women were more receptive to cosmetic procedures, which was consistent with a recent finding that cosmetic procedures tend to be more widely accepted among younger generations overall.⁸ Participants aged 21 to 30 years had greater intentions to try a cosmetic procedure, while those aged 31 to 40 years were more likely to have tried 1 or more cosmetic procedures already, which may be because they are just beginning to see the signs of aging and are motivated to address these concerns. Additionally, women in this age group may be more likely to have a stable source of income and be able to afford these procedures. It is important to note that the population surveyed had a much higher reported household income than the average Black household income, with most respondents reporting an average annual income of $100,000 to $499,000. Our data also showed a trend toward greater acceptance and utilization of cosmetic procedures in those with higher levels of income, though the results were not statistically significant.

Respondents were most concerned about fine lines and wrinkles, followed by dark circles and uneven skin tone. One report in the literature (N=2000) indicated that the most common cosmetic concerns in women with SOC were hyperpigmentation/dark spots (86%) and blotchy or uneven skin (80%).⁹ Interestingly, sunscreen was one of the more commonly used products in our survey, which historically has not been the case among individuals with SOC¹⁰ and suggests that the attitudes and perceptions of SOC patients are changing to favor more frequent sunscreen use, at least among the younger generations. Because we did not specify moisturizer vs moisturizer with sun protection factor, the use of facial sunscreen may even be underestimated in our survey.

Compared to cosmetic surgery or dermal fillers, the procedures found to be most frequently utilized in our study population—microdermabrasion, chemical peels, and laser hair removal—are less invasive and fairly accessible with minimal downtime. An interesting topic for further research would be to investigate how the willingness of women to openly share their cosmetic procedure usage has changed over time. The rise of social media and influencer culture has undoubtedly had an impact on the sharing of such information. It also would have been interesting to ask participants where they receive the majority of their health/beauty information.

All skin types are susceptible to photoaging; however, melanin is known to have a natural photoprotective effect, resulting in a lesser degree and later onset of photoaging in patients with darker vs lighter skin.¹¹ It has been reported that individuals with SOC show signs of facial aging on average a decade later than those with lighter skin tones,¹² which may be why the majority of participants believed they look younger than they truly are. As expected, dyspigmentation was among the top skin concerns in our study population. Although melanin does offer some degree of protection against UVA and UVB, melanocyte lability with inflammation may make darker skin types more susceptible to pigmentary issues.¹³

Study Limitations—The income levels of our study population were not representative of typical Black American households, which is a limitation. Seventy-seven percent of our study population earned more than $100,000 annually, while only 18% of Black American households earned more than $100,000 in 2019.¹⁴ Another major limitation of our study was the lack of representation from older generations, as most participants were aged 21 to 40 years, which was expected, as it is the younger generation who typically is targeted by a snowball sampling method primarily shared through social media. Additionally, because participants were recruited from the social media profiles of medical professionals, followers of these accounts may be more interested in cosmetic procedures, skewing the study results. Finally, because geographic location was not captured in our initial data collection, we were unable to determine if results from a particular location within the United States were overrepresented in the data set.

Conclusion

Although the discourse around beauty and antiaging is constantly evolving, data about Black women frequently are underrepresented in the literature. The results of this study highlight the changing attitudes and perceptions of Black women regarding beauty, aging, and minimally invasive cosmetic procedures. Dermatologists should stay abreast of current trends in this population to be able to make appropriate, culturally sensitive recommendations to their Black patients—for example, pointing them to sunscreen brands that are best suited for darker skin.

References

Ahn CS, Suchonwanit P, Foy CG, et al. Hair and scalp care in African American women who exercise. JAMA Dermatol. 2016;152:579-580.
Prendergast TI, Ong’uti SK, Ortega G, et al. Differential trends in racial preferences for cosmetic surgery procedures. Am Surg. 2011;77:1081-1085.
American Society of Plastic Surgeons. Briefing paper: plastic surgeryfor ethnic patients. Accessed October 20, 2023. https://www.plasticsurgery.org/news/briefing-papers/briefing-paper-plastic-surgery-for-ethnic-patients
Small K, Kelly KM, Spinelli HM. Are nurse injectors the new norm? Aesthetic Plast Surg. 2014;38:946-955.
Quiñonez RL, Agbai ON, Burgess CM, et al. An update on cosmetic procedures in people of color. part 1: scientific background, assessment, preprocedure preparation. J Am Acad Dermatol. 2022;86:715-725.
Alexis AF, Grimes P, Boyd C, et al. Racial and ethnic differences in self-assessed facial aging in women: results from a multinational study. Dermatol Surg. 2019;45:1635-1648.
Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin Cutan Med Surg. 2009;28:115-129.
Alotaibi AS. Demographic and cultural differences in the acceptance and pursuit of cosmetic surgery: a systematic literature review. Plast Reconstr Surg Glob Open. 2021;9:E3501.
Grimes PE. Skin and hair cosmetic issues in women of color. Dermatol Clin. 2000;18:659-665.
Buchanan Lunsford N, Berktold J, Holman DM, et al. Skin cancer knowledge, awareness, beliefs and preventive behaviors among black and Hispanic men and women. Prev Med Rep. 2018;12:203-209.
Alexis AF, Rossi, A. Photoaging in skin of color. Cosmet Dermatol. 2011;24:367-370.
Vashi NA, de Castro Maymone MB, Kundu RV. Aging differences in ethnic skin. J Clin Aesthet Dermatol. 2016;9:31-38.
Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007;80:387-394.
Tamir C, Budiman A, Noe-Bustamante L, et al. Facts about the U.S. Black population. Pew Research Center website. Published March 2, 2023. Accessed October 20, 2023. https://www.pewresearch.org/social-trends/fact-sheet/facts-about-the-us-black-population/

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Author and Disclosure Information

Drs. Asbeck, Scott, and Woolery-Lloyd and Funmilayo Ogunbufunmi are from the Phillip Frost Department of Dermatology, Miller School of Medicine, University of Miami, Florida. Brenda Umenita Imo is from the Georgetown University School of Medicine, Washington, DC.

Dr. Asbeck, Funmilayo Ogunbufunmi, and Brenda Umenita Imo report no conflict of interest. Dr. Scott has received income working in collaboration with Amorepacific, Beiersdorf, Johnson & Johnson, L’Oreal, Sanofi, and Unilever. Dr. Woolery-Lloyd is a consultant for AbbVie, Incyte, Johnson & Johnson Consumer Inc, LivDerm, and L’Oreal; a speaker for Eli Lilly and Company, Incyte, L’Oreal, and Ortho Dermatologics; and a researcher/investigator for AbbVie, Allergan, Eirion Therapeutics, Galderma, Pfizer, Sanofi, and Vyne Therapeutics.

Correspondence: Sara Marie Asbeck, MD, MPH, 1295 NW 14th St, Ste K, Miami, FL 33136 ([email protected]).

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Funmilayo Ogunbufunmi, MPH

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Heather Woolery-Lloyd, MD

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IN COLLABORATION WITH THE SKIN OF COLOR SOCIETY

Methods

Results

Comment

Conclusion

Methods

Results

Comment

Conclusion

References

Ahn CS, Suchonwanit P, Foy CG, et al. Hair and scalp care in African American women who exercise. JAMA Dermatol. 2016;152:579-580.
Prendergast TI, Ong’uti SK, Ortega G, et al. Differential trends in racial preferences for cosmetic surgery procedures. Am Surg. 2011;77:1081-1085.
American Society of Plastic Surgeons. Briefing paper: plastic surgeryfor ethnic patients. Accessed October 20, 2023. https://www.plasticsurgery.org/news/briefing-papers/briefing-paper-plastic-surgery-for-ethnic-patients
Small K, Kelly KM, Spinelli HM. Are nurse injectors the new norm? Aesthetic Plast Surg. 2014;38:946-955.
Quiñonez RL, Agbai ON, Burgess CM, et al. An update on cosmetic procedures in people of color. part 1: scientific background, assessment, preprocedure preparation. J Am Acad Dermatol. 2022;86:715-725.
Alexis AF, Grimes P, Boyd C, et al. Racial and ethnic differences in self-assessed facial aging in women: results from a multinational study. Dermatol Surg. 2019;45:1635-1648.
Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin Cutan Med Surg. 2009;28:115-129.
Alotaibi AS. Demographic and cultural differences in the acceptance and pursuit of cosmetic surgery: a systematic literature review. Plast Reconstr Surg Glob Open. 2021;9:E3501.
Grimes PE. Skin and hair cosmetic issues in women of color. Dermatol Clin. 2000;18:659-665.
Buchanan Lunsford N, Berktold J, Holman DM, et al. Skin cancer knowledge, awareness, beliefs and preventive behaviors among black and Hispanic men and women. Prev Med Rep. 2018;12:203-209.
Alexis AF, Rossi, A. Photoaging in skin of color. Cosmet Dermatol. 2011;24:367-370.
Vashi NA, de Castro Maymone MB, Kundu RV. Aging differences in ethnic skin. J Clin Aesthet Dermatol. 2016;9:31-38.
Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007;80:387-394.
Tamir C, Budiman A, Noe-Bustamante L, et al. Facts about the U.S. Black population. Pew Research Center website. Published March 2, 2023. Accessed October 20, 2023. https://www.pewresearch.org/social-trends/fact-sheet/facts-about-the-us-black-population/

References

Ahn CS, Suchonwanit P, Foy CG, et al. Hair and scalp care in African American women who exercise. JAMA Dermatol. 2016;152:579-580.
Prendergast TI, Ong’uti SK, Ortega G, et al. Differential trends in racial preferences for cosmetic surgery procedures. Am Surg. 2011;77:1081-1085.
American Society of Plastic Surgeons. Briefing paper: plastic surgeryfor ethnic patients. Accessed October 20, 2023. https://www.plasticsurgery.org/news/briefing-papers/briefing-paper-plastic-surgery-for-ethnic-patients
Small K, Kelly KM, Spinelli HM. Are nurse injectors the new norm? Aesthetic Plast Surg. 2014;38:946-955.
Quiñonez RL, Agbai ON, Burgess CM, et al. An update on cosmetic procedures in people of color. part 1: scientific background, assessment, preprocedure preparation. J Am Acad Dermatol. 2022;86:715-725.
Alexis AF, Grimes P, Boyd C, et al. Racial and ethnic differences in self-assessed facial aging in women: results from a multinational study. Dermatol Surg. 2019;45:1635-1648.
Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin Cutan Med Surg. 2009;28:115-129.
Alotaibi AS. Demographic and cultural differences in the acceptance and pursuit of cosmetic surgery: a systematic literature review. Plast Reconstr Surg Glob Open. 2021;9:E3501.
Grimes PE. Skin and hair cosmetic issues in women of color. Dermatol Clin. 2000;18:659-665.
Buchanan Lunsford N, Berktold J, Holman DM, et al. Skin cancer knowledge, awareness, beliefs and preventive behaviors among black and Hispanic men and women. Prev Med Rep. 2018;12:203-209.
Alexis AF, Rossi, A. Photoaging in skin of color. Cosmet Dermatol. 2011;24:367-370.
Vashi NA, de Castro Maymone MB, Kundu RV. Aging differences in ethnic skin. J Clin Aesthet Dermatol. 2016;9:31-38.
Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007;80:387-394.
Tamir C, Budiman A, Noe-Bustamante L, et al. Facts about the U.S. Black population. Pew Research Center website. Published March 2, 2023. Accessed October 20, 2023. https://www.pewresearch.org/social-trends/fact-sheet/facts-about-the-us-black-population/

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Attitudes Toward Utilization of Minimally Invasive Cosmetic Procedures in Black Women: Results of a Cross-sectional Survey

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Cosmetic procedures may be more widely accepted among younger Black women than older Black women.
Age has a considerable influence on the types of cosmetic procedures that Black women are interested in trying.
Microdermabrasion, chemical peels, and laser hair removal were the most frequently utilized procedures in this study population.
As attitudes and perceptions of young Black women are changing and favoring more frequent sunscreen use, dermatologists should remain on top of current trends to provide culturally sensitive and relevant recommendations to patients with darker skin tones.

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Improving Diagnostic Accuracy in Skin of Color Using an Educational Module

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Improving Diagnostic Accuracy in Skin of Color Using an Educational Module

IN COLLABORATION WITH THE SKIN OF COLOR SOCIETY

Author(s)

Priscilla Ly Kojder, MD

Catherine Pisano, MD

Maria Leszczynska, MD

Ashley Riddle, MD

Lucia Diaz, MD

Ammar M. Ahmed, MD

Dermatologic disparities disproportionately affect patients with skin of color (SOC). Two studies assessing the diagnostic accuracy of medical students have shown disparities in diagnosing common skin conditions presenting in darker skin compared to lighter skin at early stages of training.^1,2 This knowledge gap could be attributed to the underrepresentation of SOC in dermatologic textbooks, journals, and educational curricula.^3-6 It is important for dermatologists as well as physicians in other specialties and ancillary health care workers involved in treating or triaging dermatologic diseases to recognize common skin conditions presenting in SOC. We sought to evaluate the effectiveness of a focused educational module for improving diagnostic accuracy and confidence in treating SOC among interprofessional health care providers.

Methods

Interprofessional health care providers—medical students, residents/fellows, attending physicians, advanced practice providers (APPs), and nurses practicing across various medical specialties—at The University of Texas at Austin Dell Medical School and Ascension Medical Group (both in Austin, Texas) were invited to participate in an institutional review board–exempt study involving a virtual SOC educational module from February through May 2021. The 1-hour module involved a pretest, a 15-minute lecture, an immediate posttest, and a 3-month posttest. All tests included the same 40 multiple-choice questions of 20 dermatologic conditions portrayed in lighter and darker skin types from VisualDx.com, and participants were asked to identify the condition in each photograph. Questions appeared one at a time in a randomized order, and answers could not be changed once submitted.

For analysis, the dermatologic conditions were categorized into 4 groups: cancerous, infectious, inflammatory, and SOC-associated conditions. Cancerous conditions included basal cell carcinoma, squamous cell carcinoma, and melanoma. Infectious conditions included herpes zoster, tinea corporis, tinea versicolor, staphylococcal scalded skin syndrome, and verruca vulgaris. Inflammatory conditions included acne, atopic dermatitis, pityriasis rosea, psoriasis, seborrheic dermatitis, contact dermatitis, lichen planus, and urticaria. Skin of color–associated conditions included hidradenitis suppurativa, acanthosis nigricans, keloid, and melasma. Two questions utilizing a 5-point Likert scale assessing confidence in diagnosing light and dark skin also were included.

The pre-recorded 15-minute video lecture was given by 2 dermatology residents (P.L.K. and C.P.), and the learning objectives covered morphologic differences in lighter skin and darker skin, comparisons of common dermatologic diseases in lighter skin and darker skin, diseases more commonly affecting patients with SOC, and treatment considerations for conditions affecting skin and hair in patients with SOC. Photographs from the diagnostic accuracy assessment were not reused in the lecture. Detailed explanations on morphology, diagnostic pearls, and treatment options for all conditions tested were provided to participants upon completion of the 3-month posttest.

Statistical Analysis—Test scores were compared between conditions shown in lighter and darker skin types and from the pretest to the immediate posttest and 3-month posttest. Multiple linear regression was used to assess for intervention effects on lighter and darker skin scores controlling for provider type and specialty. All tests were 2-sided with significance at P<.05. Analyses were conducted using Stata 17.

Results

One hundred participants completed the pretest and immediate posttest, 36 of whom also completed the 3-month posttest (Table). There was no significant difference in baseline characteristics between the pretest and 3-month posttest groups.

Test scores were correlated with provider type and specialty but not age, sex, or race/ethnicity. Specializing in dermatology and being a resident or attending physician were independently associated with higher test scores. Mean pretest diagnostic accuracy and confidence scores were higher for skin conditions shown in lighter skin compared with those shown in darker skin (13.6 vs 11.3 and 2.7 vs 1.9, respectively; both P<.001). Pretest diagnostic accuracy was significantly higher for skin conditions shown in lighter skin compared with darker skin for cancerous, inflammatory, and infectious conditions (72% vs 50%, 68% vs 55%, and 57% vs 47%, respectively; P<.001 for all)(Figure 1). Skin of color–associated conditions were not associated with significantly different scores for lighter skin compared with darker skin (79% vs 75%; P=.059).

**FIGURE 1.** Pretest percentage correct score in lighter skin compared with darker skin categorized by type of skin condition. Asterisk indicates P<.001.

Controlling for provider type and specialty, significantly improved diagnostic accuracy was seen in immediate posttest scores compared with pretest scores for conditions shown in both lighter and darker skin types (lighter: 15.2 vs 13.6; darker: 13.3 vs 11.3; both P<.001)(Figure 2). The immediate posttest demonstrated higher mean diagnostic accuracy and confidence scores for skin conditions shown in lighter skin compared with darker skin (diagnostic accuracy: 15.2 vs 13.3; confidence: 3.0 vs 2.6; both P<.001), but the disparity between scores was less than in the pretest.

**FIGURE 2.** Mean scores for diagnostic accuracy overall and in lighter and darker skin following pretest, immediate posttest, and 3-month posttest. Single asterisk indicates P<.05; double asterisk, P<.01; triple asterisk, P<.001.

Following the 3-month posttest, improvement in diagnostic accuracy was noted among both lighter and darker skin types compared with the pretest, but the difference remained significant only for conditions shown in darker skin (mean scores, 11.3 vs 13.3; P<.01). Similarly, confidence in diagnosing conditions in both lighter and darker skin improved following the immediate posttest (mean scores, 2.7 vs 3.0 and 1.9 vs 2.6; both P<.001), and this improvement remained significant for only darker skin following the 3-month posttest (mean scores, 1.9 vs 2.3; P<.001). Despite these improvements, diagnostic accuracy and confidence remained higher for skin conditions shown in lighter skin compared with darker skin (diagnostic accuracy: 14.7 vs 13.3; P<.01; confidence: 2.8 vs 2.3; P<.001), though the disparity between scores was again less than in the pretest.

Comment

Our study showed that there are diagnostic disparities between lighter and darker skin types among interprofessional health care providers. Education on SOC should extend to interprofessional health care providers and other medical specialties involved in treating or triaging dermatologic diseases. A focused educational module may provide long-term improvements in diagnostic accuracy and confidence for conditions presenting in SOC. Differences in diagnostic accuracy between conditions shown in lighter and darker skin types were noted for the disease categories of infectious, cancerous, and inflammatory conditions, with the exception of conditions more frequently seen in patients with SOC. Learning resources for SOC-associated conditions are more likely to have greater representation of images depicting darker skin types.⁷ Future educational interventions may need to focus on dermatologic conditions that are not preferentially seen in patients with SOC. In our study, the pretest scores for conditions shown in darker skin were lowest among infectious and cancerous conditions. For infections, certain morphologic clues such as erythema are important for diagnosis but may be more subtle or difficult to discern in darker skin. It also is possible that providers may be less likely to suspect skin cancer in patients with SOC given that the morphologic presentation and/or anatomic site of involvement for skin cancers in SOC differs from those in lighter skin. Future educational interventions targeting disparities in diagnostic accuracy should focus on conditions that are not specifically associated with SOC.

Limitations of our study included the small number of participants, the study population came from a single institution, and a possible selection bias for providers interested in dermatology.

Conclusion

Disparities exist among interprofessional health care providers when treating conditions in patients with lighter skin compared to darker skin. An educational module for health care providers may provide long-term improvements in diagnostic accuracy and confidence for conditions presenting in patients with SOC.

References

Fenton A, Elliott E, Shahbandi A, et al. Medical students’ ability to diagnose common dermatologic conditions in skin of color. J Am Acad Dermatol. 2020;83:957-958. doi:10.1016/j.jaad.2019.12.078
Mamo A, Szeto MD, Rietcheck H, et al. Evaluating medical student assessment of common dermatologic conditions across Fitzpatrick phototypes and skin of color. J Am Acad Dermatol. 2022;87:167-169. doi:10.1016/j.jaad.2021.06.868
Guda VA, Paek SY. Skin of color representation in commonly utilized medical student dermatology resources. J Drugs Dermatol. 2021;20:799. doi:10.36849/JDD.5726
Wilson BN, Sun M, Ashbaugh AG, et al. Assessment of skin of color and diversity and inclusion content of dermatologic published literature: an analysis and call to action. Int J Womens Dermatol. 2021;7:391-397. doi:10.1016/j.ijwd.2021.04.001
Ibraheim MK, Gupta R, Dao H, et al. Evaluating skin of color education in dermatology residency programs: data from a national survey. Clin Dermatol. 2022;40:228-233. doi:10.1016/j.clindermatol.2021.11.015
Gupta R, Ibraheim MK, Dao H Jr, et al. Assessing dermatology resident confidence in caring for patients with skin of color. Clin Dermatol. 2021;39:873-878. doi:10.1016/j.clindermatol.2021.08.019
Chang MJ, Lipner SR. Analysis of skin color on the American Academy of Dermatology public education website. J Drugs Dermatol. 2020;19:1236-1237. doi:10.36849/JDD.2020.5545

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Author and Disclosure Information

Drs. Kojder, Leszczynska, Riddle, Diaz, and Ahmed are from The University of Texas at Austin Dell Medical School. Drs. Kojder, Riddle, Diaz, and Ahmed are from the Division of Dermatology and Dermatologic Surgery, Department of Internal Medicine, and Dr. Leszczynska is from the Division of Pediatric Dermatology, Department of Pediatrics. Dr. Pisano is from the Department of Dermatology, Harvard Medical School, Boston, Massachusetts.

The authors report no conflict of interest.

Correspondence: Ammar M. Ahmed, MD, Division of Dermatology, The University of Texas at Austin Dell Medical School, 1601 Trinity St, Ste 7.802, Austin, TX 78701 ([email protected]).

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Priscilla Ly Kojder, MD

Catherine Pisano, MD

Maria Leszczynska, MD

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Lucia Diaz, MD

Ammar M. Ahmed, MD

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Priscilla Ly Kojder, MD

Catherine Pisano, MD

Maria Leszczynska, MD

Ashley Riddle, MD

Lucia Diaz, MD

Ammar M. Ahmed, MD

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Correspondence: Ammar M. Ahmed, MD, Division of Dermatology, The University of Texas at Austin Dell Medical School, 1601 Trinity St, Ste 7.802, Austin, TX 78701 ([email protected]).

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Correspondence: Ammar M. Ahmed, MD, Division of Dermatology, The University of Texas at Austin Dell Medical School, 1601 Trinity St, Ste 7.802, Austin, TX 78701 ([email protected]).

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IN COLLABORATION WITH THE SKIN OF COLOR SOCIETY

Methods

Results

Comment

Limitations of our study included the small number of participants, the study population came from a single institution, and a possible selection bias for providers interested in dermatology.

Conclusion

Methods

Results

Comment

Limitations of our study included the small number of participants, the study population came from a single institution, and a possible selection bias for providers interested in dermatology.

Conclusion

References

Fenton A, Elliott E, Shahbandi A, et al. Medical students’ ability to diagnose common dermatologic conditions in skin of color. J Am Acad Dermatol. 2020;83:957-958. doi:10.1016/j.jaad.2019.12.078
Mamo A, Szeto MD, Rietcheck H, et al. Evaluating medical student assessment of common dermatologic conditions across Fitzpatrick phototypes and skin of color. J Am Acad Dermatol. 2022;87:167-169. doi:10.1016/j.jaad.2021.06.868
Guda VA, Paek SY. Skin of color representation in commonly utilized medical student dermatology resources. J Drugs Dermatol. 2021;20:799. doi:10.36849/JDD.5726
Wilson BN, Sun M, Ashbaugh AG, et al. Assessment of skin of color and diversity and inclusion content of dermatologic published literature: an analysis and call to action. Int J Womens Dermatol. 2021;7:391-397. doi:10.1016/j.ijwd.2021.04.001
Ibraheim MK, Gupta R, Dao H, et al. Evaluating skin of color education in dermatology residency programs: data from a national survey. Clin Dermatol. 2022;40:228-233. doi:10.1016/j.clindermatol.2021.11.015
Gupta R, Ibraheim MK, Dao H Jr, et al. Assessing dermatology resident confidence in caring for patients with skin of color. Clin Dermatol. 2021;39:873-878. doi:10.1016/j.clindermatol.2021.08.019
Chang MJ, Lipner SR. Analysis of skin color on the American Academy of Dermatology public education website. J Drugs Dermatol. 2020;19:1236-1237. doi:10.36849/JDD.2020.5545

References

Fenton A, Elliott E, Shahbandi A, et al. Medical students’ ability to diagnose common dermatologic conditions in skin of color. J Am Acad Dermatol. 2020;83:957-958. doi:10.1016/j.jaad.2019.12.078
Mamo A, Szeto MD, Rietcheck H, et al. Evaluating medical student assessment of common dermatologic conditions across Fitzpatrick phototypes and skin of color. J Am Acad Dermatol. 2022;87:167-169. doi:10.1016/j.jaad.2021.06.868
Guda VA, Paek SY. Skin of color representation in commonly utilized medical student dermatology resources. J Drugs Dermatol. 2021;20:799. doi:10.36849/JDD.5726
Wilson BN, Sun M, Ashbaugh AG, et al. Assessment of skin of color and diversity and inclusion content of dermatologic published literature: an analysis and call to action. Int J Womens Dermatol. 2021;7:391-397. doi:10.1016/j.ijwd.2021.04.001
Ibraheim MK, Gupta R, Dao H, et al. Evaluating skin of color education in dermatology residency programs: data from a national survey. Clin Dermatol. 2022;40:228-233. doi:10.1016/j.clindermatol.2021.11.015
Gupta R, Ibraheim MK, Dao H Jr, et al. Assessing dermatology resident confidence in caring for patients with skin of color. Clin Dermatol. 2021;39:873-878. doi:10.1016/j.clindermatol.2021.08.019
Chang MJ, Lipner SR. Analysis of skin color on the American Academy of Dermatology public education website. J Drugs Dermatol. 2020;19:1236-1237. doi:10.36849/JDD.2020.5545

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Disparities exist among interprofessional health care providers when diagnosing conditions in patients with lighter and darker skin, specifically for infectious, cancerous, or inflammatory conditions vs conditions that are preferentially seen in patients with skin of color (SOC).
A focused educational module for health care providers may provide long-term improvements in diagnostic accuracy and confidence for conditions presenting in patients with SOC.

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Dermatosis Papulosa Nigra

Acne Scars

Skin Rejuvenation

Laser Treatment for Hyperpigmentation Disorders

Skin Tightening and Body Contouring

Nonsurgical Fat Reduction

Final Thoughts

Dermatosis Papulosa Nigra

Acne Scars

Skin Rejuvenation

Laser Treatment for Hyperpigmentation Disorders

Skin Tightening and Body Contouring

Nonsurgical Fat Reduction

Final Thoughts

Dermatosis Papulosa Nigra

Acne Scars

Skin Rejuvenation

Laser Treatment for Hyperpigmentation Disorders

Skin Tightening and Body Contouring

Nonsurgical Fat Reduction

Final Thoughts

Methods

Results

Comment

Limitations

Conclusion

Methods

Results

Comment

Limitations

Conclusion

Methods

Results

Comment

Limitations

Conclusion

Methods

Results

Comment

Conclusion

Methods

Results

Comment

Conclusion

Methods

Results

Comment

Conclusion

Terminology

Melanoma

Keratinocyte Carcinomas

Dermatofibrosarcoma Protuberans

Factors Influencing Skin Cancer Outcomes

Final Thoughts

Terminology

Melanoma

Keratinocyte Carcinomas

Dermatofibrosarcoma Protuberans

Factors Influencing Skin Cancer Outcomes

Final Thoughts

Terminology

Melanoma

Keratinocyte Carcinomas

Dermatofibrosarcoma Protuberans

Factors Influencing Skin Cancer Outcomes

Final Thoughts

Methods

Results

Comment

Conclusion

Appendix

Methods

Results

Comment

Conclusion

Appendix

Methods

Results

Comment