The Skin of Color Society recently held their annual media day in New York City. Experts gave updates on the latest thinking when it comes to treating patients with skin of color.
Practical Dermatology® magazine caught up with the experts and asked about grows and glows in their areas of expertise. A “glow” is an area where there have been significant strides in treatment, diagnosis, or awareness, and a “grow” is where improvements are still needed. Here’s what they had to say.
Glow. My glow would be that we have gotten definitive research to show that there is a genetic component playing a role in the causation of Central Centrifugal Cicatricial Alopecia (CCCA). This was a five-year experiment with patients from both South Africa and the US.
Grow. My grow is that we now need to find out how to turn off the inflammation that occurs in CCCA to try to stop scarring.
Skin Cancer & Sun Protection in Melanin-Rich Skin
Glow. We glow in the fact that studies have been done demonstrating the similarities and differences in the aging process across ethnicities. Also, studies had demonstrated the influence of lifestyle selections on the aging process as demonstrated by molecular studies.
Grow. We need to grow into the fact that there are Hispanics, especially in Florida and California, who are dying of invasive malignant melanoma because they don’t get medical evaluation in time for early detection of their skin cancers.
Glow. We now know the importance of blocking visible light for the treatment of disorders of pigmentation, such as melasma and post-inflammatory hyperpigmentation. Hence, in addition to using a broad-spectrum SPF 30 or higher sunscreen, selecting one that contains iron oxide (which blocks visible light) it important in the prevention and treatment of melasma and post-inflammatory hyperpigmentation.
Grow. Many people of color prefer chemical sunscreens, which are less likely to leave a white hue on the skin than physical sunscreens that contain zinc oxide or titanium dioxide. However, there was a study indicating absorption in the blood stream of six chemical sunscreens. We need more studies to determine if the absorption has a negative effect on overall health.
Does hair styling and/or hair care matter?
Proper hair care ends up being one of the most important things that I talk about with my patients suffering from hair loss. Many women routinely outsource their hair care to their stylist. Asking them to care for their hair on a daily basis can be a big change. Really curly hair requires TLC almost every day. I like to break down the hair care routine from start to finish, including daily use of leave-in conditioner and weekly deep conditioning. I tell my patients to use products containing glycerin or silicone derivatives for added moisture and softening of the hair. I also tell them that tight braids, wigs, and weaves can lead to or worsen traction alopecia.
—Crystal Aguh, MD
Get more from Dr. Aguh:
Read the interview here.
External Manifestations of Internal Disease
Glow. A glow is that dermatology as a field is becoming more aware of how skin findings may signal internal disease (e.g., psoriasis and hidradenitis suppurativa as risk factors for cardiovascular disease).
Grow. A definite grow is the need for better awareness of and detection of erythema/inflammation in skin of color (especially when it comes to potential medical emergencies such as erythroderma or dermatomyositis).
Glow. I think we have a better understanding of how we treat hyperpigmentation. I usually use the compounded Skin Medicinals* melasma cream or options like tranexamic acid. I haven’t had to use a laser for anyone in over a year.
Grow. We need better options for deep scars where we can’t use aggressive laser treatments. Microneedling helps, but we are still a bit limited compared to what we can do for lighter skin types.
State-of-the-Art in Treating Pigmentation Disorders and Skincare Products
Glow. The pathophysiology of melasma continues to become better understood. We do know that vascular abnormalities play a part in pathogenesis, for example due to cellular markers like VEGF.
We also have discovered that tranexamic acid, either applied topically and/or though off-label oral administration, has helped to improve outcomes in our management of melasma.
Grow. We still need more data on long-term remission in vitiligo that has repigmented. We continue to make advances in JAK inhibitor therapy, but we need more studies.
We also need to see more skin of color patients being enrolled in vitiligo trials and in clinical dermatology trials in general.
*Dr. Bhanusali is founder of Skin Medicinals.