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Hobbs LK, Rajabi-Estarabadi A, Anagnostis S, Nousari CH, Cohen C. Gianotti-Crosti syndrome-like reaction in skin of color: An underreported sequela of molluscum contagiosum. JAAD Case Rep 2024; 49:4-7. [PMID: 38873246 PMCID: PMC11170342 DOI: 10.1016/j.jdcr.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Affiliation(s)
- Landon K. Hobbs
- Department of Dermatology, Broward Health Medical Center, Fort Lauderdale, Florida
| | | | - Sophia Anagnostis
- Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida
| | - Carlos H. Nousari
- Department of Dermatology, Broward Health Medical Center, Fort Lauderdale, Florida
| | - Carlos Cohen
- Department of Dermatology, Broward Health Medical Center, Fort Lauderdale, Florida
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Wang JY, Bitterman D, Patel P, Kabakova M, Zafar K, Cohen M, Jagdeo J. Gender, racial, ethnic, and Fitzpatrick skin type representation in Acanthosis nigricans clinical trials. Arch Dermatol Res 2024; 316:332. [PMID: 38842735 DOI: 10.1007/s00403-024-02996-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/12/2024] [Accepted: 04/26/2024] [Indexed: 06/07/2024]
Abstract
Acanthosis nigricans (AN) is characterized by dark, velvety patches and thin plaques primarily in the body folds. AN is more prevalent in skin of color populations, including Black/African American, Native American, and Hispanic patients. As the U.S. population becomes increasingly diverse, the need for inclusive dermatologic research becomes more pressing. Given the increased prevalence of AN in skin of color patients, there is a need to evaluate representation in AN clinical trials. This study aims to uncover gender, race, ethnicity, and Fitzpatrick skin type (FST) representation in AN clinical trials. A systematic literature search was performed across PubMed, Embase, and Cochrane databases to identify participant characteristics in clinical trials focused on AN treatment. Our review yielded 21 clinical trials, totaling 575 participants, with an identified predominance of female participants (69.0%) and a surprising absence of race or ethnicity data. Out of the 11 studies that included FST data, 1.2% of participants were type II, 20.6% were type III, 50.0% were type IV, and 28.2% were type V. None of the participants were FST I or VI. Herein, we highlight a predominate inclusion of female and FST III-V patients in AN clinical trials, the populations most impacted by this condition. We also highlight the need for improved race and ethnicity reporting and the importance of including all FSTs in clinical studies. Addressing this gap is critical for developing safe, efficacious, patient-centered, and equitable treatments for all AN patients. Future research should prioritize comprehensive inclusion of race, ethnicity, and the full spectrum of FSTs.
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Affiliation(s)
- Jennifer Y Wang
- Department of Dermatology, State University of New York, Downstate Health Sciences University/Medical Center, 450 Clarkson Avenue, 8th Floor, Brooklyn, NY, 11203, USA
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System - Brooklyn Campus, Brooklyn, NY, USA
| | - David Bitterman
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System - Brooklyn Campus, Brooklyn, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Paras Patel
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System - Brooklyn Campus, Brooklyn, NY, USA
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Margaret Kabakova
- Department of Dermatology, State University of New York, Downstate Health Sciences University/Medical Center, 450 Clarkson Avenue, 8th Floor, Brooklyn, NY, 11203, USA
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System - Brooklyn Campus, Brooklyn, NY, USA
| | - Kayla Zafar
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System - Brooklyn Campus, Brooklyn, NY, USA
- St. George's University School of Medicine, St. George's, Grenada
| | - Marc Cohen
- Department of Dermatology, State University of New York, Downstate Health Sciences University/Medical Center, 450 Clarkson Avenue, 8th Floor, Brooklyn, NY, 11203, USA
| | - Jared Jagdeo
- Department of Dermatology, State University of New York, Downstate Health Sciences University/Medical Center, 450 Clarkson Avenue, 8th Floor, Brooklyn, NY, 11203, USA.
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System - Brooklyn Campus, Brooklyn, NY, USA.
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Gandham AR, Geller S, Dusza SW, Kupper TS, Myskowski PL. Racial Disparities in Mycosis Fungoides/Sézary Syndrome-A Single-Center Observational Study of 292 Patients. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e174-e180. [PMID: 38245472 PMCID: PMC10981557 DOI: 10.1016/j.clml.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Clinical presentation of Mycosis fungoides/Sézary syndrome (MF/SS) in Black and African American (AA) patients can be heterogeneous with poor survival reported in AA/black patients. In this study, we aim to characterize differences between AA/black and white patients with MF/SS. PATIENTS AND METHODS A retrospective single-center hospital-based case-control study including 292 MF/SS patients (146 AA/black matched with 146 white patients). We analyzed demographic, clinical and survival differences. RESULTS AA/black patients were diagnosed at an earlier age (9 years younger), were predominantly females, had higher rates of Medicaid/Medicare insurance and lower income compared to matched white patients (P <.001). Adjusting for age, sex, insurance type, and income bracket, AA/black patients had significantly worse overall survival (hazard ratio [HR] 2.88, 95%CI 1.21-6.85, P = .017). Association of clinical MF phenotype with survival showed that hypopigmentation was associated with survival in AA/black patients but not in white patients. Erythroderma and ulceration were associated with worse survival risk in AA/black patients. CONCLUSIONS AA/black patients with MF/SS have a significant worse survival outcome compared to white patients. The association between clinical phenotypes and survival differed between these groups. Further studies are required to investigate whether race-specific pathogenesis or genetic factors may explain these differences.
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Affiliation(s)
- Ashley R Gandham
- Dermatology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Harvard Medical School, Boston, MA
| | - Shamir Geller
- Dermatology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Stephen W Dusza
- Dermatology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thomas S Kupper
- Harvard Medical School, Boston, MA; Department of Dermatology, Brigham and Women's Hospital, Boston, MA
| | - Patricia L Myskowski
- Dermatology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Paul D, Todd A, Baum C. Squamous cell carcinoma incidence, demographics, and outcomes in skin of color patients. J Am Acad Dermatol 2024; 90:665-666. [PMID: 38008406 DOI: 10.1016/j.jaad.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Affiliation(s)
- Deborah Paul
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
| | - Austin Todd
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Christian Baum
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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Peterson H, Huang MY, Lee K, Kingston P, Yee D, Korouri E, Agüero R, Armstrong AW. Comorbidity Burden in Psoriasis Patients with Skin of Color. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2024; 9:16-22. [PMID: 38516030 PMCID: PMC10957134 DOI: 10.1177/24755303231198482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Background Psoriasis is a chronic disease with increased risk of numerous comorbidities. Known differences exist regarding treatment outcomes for psoriasis patients with skin of color (SOC). However, factors contributing to these differences are relatively unknown. Objectives This study aims to compare the comorbidity burden in SOC psoriasis patients vs. White patients, as measured by the Charlson Comorbidity Index (CCI) score. Methods We utilized the National Ambulatory Medical Care Survey (NAMCS) to identify visits for adult psoriasis patients occurring in the years 2002-2016 and 2018. The CCI was used to objectively measure comorbidity burden. Patients were identified by race, and SOC was defined as any reported race besides White Only. A multiple linear regression was run to compare the CCI among adult psoriasis patients based on race and ethnicity, controlling for age, sex, insurance status, and geographic region. Results A total of 39,176,928 weighted visits were analyzed. Compared to White patients, patients with SOC did not have statistically significant differences in comorbidity burden, as measured by CCI score (p=0.073 for Black/African American Only vs. White Only, p=0.073 for American Indian/Alaska Native Only vs. White Only, p=0.435 for Asian Only vs. White Only, p=0.403 for Native Hawaiian/Pacific Islander Only vs. White Only, p=0.195 for Other vs. White Only). Conclusion Patients with SOC were not found to have differences in comorbidity burden compared to White patients. These results highlight that social factors such as socioeconomic status and access to healthcare may contribute more directly to psoriasis treatment outcomes than patient race.
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Affiliation(s)
- Hannah Peterson
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Margaret Y. Huang
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Kathryn Lee
- Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Paige Kingston
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Danielle Yee
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Edwin Korouri
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, Illinois, USA
| | - Rosario Agüero
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - April W. Armstrong
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
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Carter BM, Newberry D, Leonard C. Color Does Matter: Nursing Assessment of Varying Skin Tones/Pigmentation. Adv Neonatal Care 2023; 23:525-531. [PMID: 37820356 DOI: 10.1097/anc.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND The observation of color is an integral part of the nursing assessment. However, the current understanding of individual skin qualities and pigmentation has not yet been integrated thoroughly into foundational assessment courses, clinical education, simulation, and textbooks. EVIDENCE ACQUISITION Literature is scarce regarding racial groups, skin color, and physical assessment for patients across the lifespan, but even more so for the neonatal population. Historically, many nursing textbooks did not provide visual pictures or observational assessment strategies for the assessment of the Black, Indigenous, and people of color (BIPOC) population. This is improving in some nursing textbooks; however, the descriptors of and visual differences and anticipated assessment findings for the BIPOC population are not comprehensive. RESULTS Evidence-based assessment findings, which may occur in newborns with varying skin tones/pigmentations, are presented. IMPLICATIONS FOR PRACTICE AND RESEARCH The most essential step to having an accurate assessment is acknowledging the importance of color awareness. Color blindness, while thought to support inclusivity, only contributes to exclusion of one of the most important components of a person's being-their color.
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Affiliation(s)
- Brigit M Carter
- American Association of Colleges of Nursing, Washington, District of Columbia (Dr Carter); and Duke University School of Nursing, Durham, North Carolina (Drs Newberry and Leonard)
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Silverberg JI, Shi VY, Alexis A, Pierce E, Cronin A, McLean RR, Roberts-Toler C, Rueda MJ, Atwater AR, Simpson E. Racial and Ethnic Differences in Sociodemographic, Clinical, and Treatment Characteristics Among Patients with Atopic Dermatitis in the United States and Canada: Real-World Data from the CorEvitas Atopic Dermatitis Registry. Dermatol Ther (Heidelb) 2023; 13:2045-2061. [PMID: 37481484 PMCID: PMC10442294 DOI: 10.1007/s13555-023-00980-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/07/2023] [Indexed: 07/24/2023] Open
Abstract
INTRODUCTION This real-world, cross-sectional study compared sociodemographic, clinical and treatment characteristics, and patient-reported outcomes (PROs) among racial/ethnic groups in patients with atopic dermatitis (AD) who are candidates for systemic therapy. METHODS This study included adults with dermatologist- or dermatology practitioner-diagnosed AD enrolled in the CorEvitas AD Registry (July 2020-July 2021). All patients initiated systemic therapy within 12 months prior to or at enrollment or had moderate-to-severe AD (vIGA-AD® ≥ 3 and Eczema Area and Severity Index [EASI] ≥ 12) at enrollment. Patients were categorized into five mutually exclusive racial/ethnic groups: non-Hispanic White, Black, Asian, Other/Multiracial, and Hispanic (any race). Patient, clinical, and treatment characteristics were captured at enrollment. Differences in means or proportions of characteristics among racial/ethnic groups were descriptively summarized using effect sizes. Adjusted prevalence ratios and mean differences were estimated (White race/ethnicity group as the reference category) with 95% confidence intervals (CI). RESULTS Among 1288 patients, 64% (n = 822) were White, 13% (n = 167) Black, 10% (n = 129) Asian, 8% (n = 97) Hispanic, and 6% (n = 73) Other/Multiracial. In adjusted analyses, statistically more severe EASI lichenification was noted among Black compared with White patients at the head and neck (mean difference, 0.21, [95% CI 0.06, 0.36]; p = 0.01), trunk (0.32, [0.17, 0.47]; p < 0.001), upper extremities (0.27, [0.09, 0.44]; p = 0.008), and lower extremities (0.39, [0.21, 0.57]; p < 0.001). Statistically more severe EASI lichenification was observed among Asian vs White patients in certain areas (mean difference, head and neck, 0.22 [0.04, 0.39], p = 0.01; trunk, 0.25 [0.07, 0.43], p < 0.001; lower extremities, 0.22 [0.01, 0.43], p < 0.001) and SCORing for AD lichenification (mean difference: 0.34 [0.15, 0.52]; p < 0.001). Significantly higher mean pruritus over the past 7 days for Black (mean difference: 0.63 [0.01, 1.26] and Hispanic patients (0.60 [0.11, 1.09]; p = 0.03) vs White patients was observed. Among AD clinical features, the prevalence of facial erythema was significantly lower among Black compared with White patients (prevalence ratio = 0.38, [0.22, 0.67]; p = 0.007). CONCLUSION Racial/ethnic differences exist in sociodemographic, clinical and treatment characteristics, disease severity, and PROs among real-world AD patients who are candidates for systemic therapy. Recognizing these variations may be of critical importance for dermatologists for the design and delivery of targeted/personalized medicine approaches.
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Affiliation(s)
- Jonathan I Silverberg
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Vivian Y Shi
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Evangeline Pierce
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA.
| | | | | | | | - Maria J Rueda
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
| | - Amber R Atwater
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
| | - Eric Simpson
- Oregon Health and Science University, Portland, OR, USA
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Mosca S, Morrone A. Human Skin Pigmentation: From a Biological Feature to a Social Determinant. Healthcare (Basel) 2023; 11:2091. [PMID: 37510532 PMCID: PMC10379278 DOI: 10.3390/healthcare11142091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Skin pigmentation is the most variable human characteristic that can be observed and has been used throughout history to classify humans into distinct groups. Many factors influence skin colour, but the melanin pigment is considered the most important because its type and quantity can determine variations in pigmentation shades. The evolution of skin pigmentation started around 1.6-2 million years ago. As a result of migratory phenomena to places with less ultraviolet radiation (UVR) and other seasonal regimes, the selection of depigmented skin and different tanning capabilities occurred over time. Thus, genetic adaptation to new environmental conditions gradually led to changes in skin pigmentation. Despite the biological importance of pigmentation, variation in skin colour has led to social and health inequalities. Since Linnaeus, skin colour classifications have been used to describe different human groups, encouraging the misuse of a biological characteristic. This review examines the characterisation of pigmentation and its evolution through history and society. The unequal perception of pigmentation diversity has led to an incomplete state of dermatological training and issues in medical approach in dermatology. The consciousness of all these aspects increases the need to address and overcome dermatologic and social health disparities related to skin pigmentation.
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Affiliation(s)
- Sarah Mosca
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy
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Chatrath S, Bradley L, Kentosh J. Dermatologic conditions in skin of color compared to white patients: similarities, differences, and special considerations. Arch Dermatol Res 2023; 315:1089-1097. [PMID: 36450934 DOI: 10.1007/s00403-022-02493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
The US population is becoming increasingly diverse, yet patients of color remain underrepresented in dermatology. The lack of diverse images in dermatologic learning materials can lead to discomfort in treating patients of color, delayed, and missed diagnoses. In this review, we compare and contrast the clinical presentation, management, and special considerations of common skin conditions between patients of color and white patients as well as provide a visual representation of these differences.
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Affiliation(s)
- Sheena Chatrath
- University of Illinois College of Medicine, Peoria, IL, USA.
| | - Laurence Bradley
- Department of Dermatology, University of Illinois College of Medicine Peoria, Peoria, IL, USA
| | - Joshua Kentosh
- Department of Dermatology, University of Illinois College of Medicine Peoria, Peoria, IL, USA
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Ceresnie MS, Gonzalez S, Hamzavi IH. Diagnosing Disorders of Hypopigmentation and Depigmentation in Patients with Skin of Color. Dermatol Clin 2023; 41:407-416. [PMID: 37236710 DOI: 10.1016/j.det.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Skin hypopigmentation and depigmentation disorders are a top concern for patients with skin of color seeking care from a dermatologist. The visual contrast between involved and uninvolved skin in these disorders makes them particularly burdensome for patients with skin of color. These disorders may have a wide differential of diagnosis, as patients with skin of color may present differently or more frequently than White patients for certain conditions. Clues from a comprehensive history and physical examination with standard lighting and a Wood's light are essential for clinching the diagnosis, although a biopsy may be warranted in special cases.
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Affiliation(s)
- Marissa S Ceresnie
- Department of Dermatology, Multicultural Clinic, Henry Ford Health, 3031 West Grand Boulevard, Suite 700, Detroit, MI 48202, USA
| | - Sarah Gonzalez
- Wayne State University College of Medicine, 540 East Canfield Avenue, Detroit, MI 48201, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Multicultural Clinic, Henry Ford Health, 3031 West Grand Boulevard, Suite 700, Detroit, MI 48202, USA.
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