Latest News from Dr. Taylor
In recognition of the excellent healthcare give by Dr. Taylor, a patient has donated $5000 to Pennsylvania Hospital in her honor. Congratulations to Dr. Taylor.
Upcoming International lectures:
South African Dermatology Society, Petoria, South Africa 4/28/11-5/1/11
World Congress of Dermatology, Seoul, South Korea 5/24/11-5/29/11
Upcoming Domestic lectures:
Winter Clinical, Mauha Lani, Kohala Coast, Hawaii 1/12/11-1/16/11
LETES Symposium
Dr. Susan Taylor accepted an invitation to visit the Kingdom of Saudi Arabia to present five lectures at the College of Medicine, King Saud University’s Inaugural Laser and Esthetic Therapy in Ethnic Skin (LETES) Symposium. One of only five distinguished American dermatologists invited, Taylor lectures included Management of Acne in Skin of Color; Postinflammatory Hyperpigmentation: Monitoring and Management; Sunscreens in Ethnic Populations; Fillers in Skin of Color; and Natural Ingredients in Products. LETES was held in Riyadh, Saudi Arabia on October 16-17, 2010.
Acne
Acne vulgaris is a disorder that is seemingly common in skin of color populations. It is likely that the pathogenesis of acne in racial and ethnic groups is similar. However, the chief complaint and predominating clinical lesion differ with hyperpigmentation dominating. Whereas comedonal acne occurs commonly in some skin of color individuals, nodulocystic acne is felt to occur less frequently in this population. Histology reveals that in a segment of the skin of color population, most acne lesions are inflammatory. A lymphocytic infiltrate was reported in comedonal lesions and a very brisk infiltrate was noted in papular lesions. Topical treatment regimens for acne are similar to those for Caucasian patients, but it is important to avoid topical medications that lead to dryness or irritation and subsequent postinflammatory hyperpigmentation. Various maneuvers to improve tolerability to potentially drying topical agents can be instituted for the skin of color patient. There is some evidence to support the use of certain acne combinations over others. Oral agents are effective for skin of color patients but adverse events of a pigmentary nature may occur. Long-term sequelae of acne vulgaris may include scar formation, including keloidal and hypertrophic scarring.
Postinflammatory Hyperpigmentation (PIH)
Postinflammatory Hyperpigmentation, a common disorder in skin of color patients, occurs after a stimulus that produces an inflammatory reaction in the skin. Although PIH may be more apparent in Fitzpatrick skin types III-VI, all skin types have the potential to develop PIH lesions. Inciting stimuli include inflammatory diseases, infections, allergic reactions, irritant reactions, injury, papulo-squamous disorder, vesiculo-bullous disease and medication reactions. When diagnosing PIH it is important to rule out other disorders such as melasma, exogenous ochronosis, drug induced pigmentation, Addison’s disease or systemic lupus erythematosus. In this condition, melanin is found in the dermis, epidermis or both, producing brown or grayish patches with undefined borders. There are several factors that influence the success of PIH treatment including the location of the pigmentation (epidermal or dermal), adequate treatment of any underlying inflammatory disease, patient compliance and the likely patient response. Once the source of inflammation is controlled, they resulting hyperpigmentation can be treated with the same concepts used in treating other pigmentation disorders: prevention (of the inflammatory process), protection (from ultraviolet radiation) and lightening the macules or patches. Tyrosinase inhibitors, particularly hydroquinone (the gold standard for treatment) are often utilized. Nevertheless, treatment may require six to twelve months to fade and longer for dermal pigmentation. Non-tyrosinase inhibitors may also be utilized. Adjunct therapy with chemical peeling agents and microdermabrasion may also be beneficial.
Fillers
All patients regardless of race or ethnicity will experience some degree of skin aging as they grow older. The signs of skin aging in Caucasians differ from those seen in patients with skin of color. Skin aging in this population takes on a unique pattern in which fine and deep rhytids are usually not a prominent feature. Rather, aging is primarily localized to midfacial region. Intrinsic (midfacial) aging in skin of color is manifested by the descent of malar fat pads, tear trough deformity, infraorbital hollowing, and deepening of the nasolabial folds. These features are a result of gravity-dependent sagging, volumetric loss, and soft tissue and skeletal changes for which soft tissue augmentation with dermal filler can produce an aesthetic improvement. Indications include the nasolabial folds, oral commissures (marionette lines), jowls, cheeks, perioral rhytids, glabellar lines and lips. The Federal Drug Administration in the U.S. has approved 9 dermal filler devices since 2003: collagen, hylauronic acid, calcium hydroxylapatite, poly-l-lactic acid. Fitzpatrick Skin Types IV-VI patients were under-represented in most pre-market clinical studies performed in the U.S. Adverse events of hyperpigmentation, keloidal and hypertrophic scarring are possible in the skin of color population and have not been adequately studied. Post marketing studies have identified potential problems.
Photoprotection
The use of photoprotection in skin of color patients has not received much attention. This is likely due to the inherent photoprotection in darker skin hues from the absorption of UV radiation by melanin pigment. However, the risk of skin cancer in this patient population is not absent. Furthermore, photoprotection assumes an important role in the prevention of as well as the improvement of pigmentary disorders. Public awareness campaigns and physician counseling have typically been directed toward fair-skinned individuals because these patients not only have the greatest risk but also a higher incidence and prevalence of skin cancer. This may have lead to an attitude among ethnic patients and some physicians as well that education about sun protection is not needed because darker skin is fully protective.
Most over-the-counter sunscreens block solar radiation through two mechanisms, reflection and absorption, by combining two different active ingredients. Inorganic ingredients such as zinc oxide and titanium dioxide reflect/scatter as well as absorb ultraviolet (UV) radiation and organic components also function to absorb it. The UV-A spectrum ranges from 320-400 nm and is absorbed by organic classes of UV filters in sunscreens like avobenzone, ecamsule, and oxybenzone. Octyl salicylate and octyl methoxycinnamate are also organic UV filters that absorb UV-B radiation, which covers the spectrum between 290-320 nm. Typically, a sun protection factor (SPF) of 30 is adequate for skin of color. However, proper photoprotection involves not only topical sunscreens but also avoidance measures. It is also important to educate patients regarding the use of protective clothing, sun avoidance during peak hours, and routine self examinations. Vitamin D deficiency has emerged as a major problem with individuals with skin of color and photoprotection is felt to exacerbate this problem. Supplementation with Vitamin D is therefore necessary.
Natural Ingredients
There has been renewed interest in products containing natural ingredients. Many natural ingredients have been used for centuries including use in ancient India and Egypt of plant psoralens to treat vitiligo, and sour milk (lactic acid) for skin softening baths; and traditional Chinese medicine utilizing soy for cleansing and soothing. Dermatologists currently utilize natural ingredients for skin care. There is empiric evidence that natural ingredients are effective and in many cases the mechanism of action of natural ingredients is being elucidated. Natural ingredients are either present in nature or produced by nature. Sources of natural ingredients include: botanicals (plants/extracts), herbs, fruits/florals, earth/minerals and sea/water. The function of natural ingredients is far ranging and includes: cleansing, toning, moisturizing, shaving and sun protection. Therapeutically, they are used as anti-acne, anti-aging, anti-pruritic, and anti-inflammatory agents as well as for addressing pigmentation and for aromatherapy. Finally, although complete consensus has not been achieved, product in the U.S. that are designated as natural are formulated to exclude: parabens, petrochemicals, phthalates, sulfates, synthetic fragrances, synthetic dyes or triclosan; and include: antioxidants, botanicals, essential oils, fruit extracts, marine bioactives, minerals and vitamins.
