Pigmentation Disorders

MIAMI — A topical tocopheryl phosphate complex effectively reduced problems associated with sensitive skin and shaving-induced irritation in a study of 28 Hispanic, Asian, and other participants.

Tocopheryl phosphate occurs naturally and is found in many animal and plant species, Roger McMullen, Ph.D., said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

The livers of rats, guinea pigs, and chickens, and the adipose tissue of guinea pigs, rats, and humans contain tocopheryl phosphate. It is also found in wheat germ oil, butter, cheddar cheese, olive oil, and chocolate, said Dr. McMullen, a researcher at International Specialty Products in Wayne, N.J.

Researchers studied a lipophilic tocopheryl phosphate complex (Vital ET, International Specialty Products) for relief of sensitive and/or irritated skin since it had demonstrated efficacy in previous studies.

Tocopheryl phosphate inhibited inflammatory and proliferative pathways in previous animal studies.

The substance "also provides protection against oxidative stress, but not through a free radical scavenging mechanism," said Dr. McMullen, who presented findings of the current study on behalf of David J. Moore, Ph.D., a senior science fellow at International Specialty Products.

There are many skin care products on the global market that contain Vital ET, Dr. Moore said in an interview after the meeting.

The researchers assessed the ability of the lipophilic tocopheryl phosphate complex to relieve symptoms of skin sensitive to shaving in Hispanic, Asian, and other study participants.

They applied a balm containing 2% tocopheryl phosphate once daily for 4 weeks. There were 13 men who shaved their faces daily and 15 women who shaved their legs every other day. There were four Hispanic and seven Asian participants.

Erythema, folliculitis, tactile roughness, dryness, skin clarity, and nicks and cuts were clinically graded at baseline. A board-certified dermatologist then rated these parameters at week 2 and week 4. Participants also scored any burning, stinging, itching, or tightness.

"All objective and subjective graded parameters of irritated or sensitive skin were significantly improved compared to baseline. The very significant efficacy for all clinically graded parameters at 2 and 4 weeks … was delivered in a real skin care formulation," Dr. McMullen said at the meeting, which was also sponsored by Howard University.

"We were not surprised, as this was our third clinical study with Vital ET and both previous studies had demonstrated significant efficacy in mitigating skin irritation," Dr. Moore said.

The previous research involved treatment of UV-induced erythema or acne with the product applied in a simple gel formulation, he noted.

In the current study, erythema improved from a mean score of 5 at baseline to a mean of 2 after 2 weeks and a mean of 1 after 4 weeks. These improvements were observed in all study participants, said Dr. McMullen.

Similarly, improvements in skin clarity were observed at 2 weeks and 4 weeks, compared with baseline, in all participants. In addition, "there was a big drop in folliculitis from baseline to 2 weeks," he said.

"We are currently conducting human ex vivo skin studies at ISP Global Skin Research in Nice, France, to further understand the biologic activity of Vital ET in skin," Dr. Moore said. Researchers are assessing its protective effect on Langerhans cells and its role in protecting the skin from glycation stress.

"After this work is complete, we expect to conduct further human clinical studies," he said.

An Asian patient with shaving-induced irritation is shown before using a skin balm containing tocopheryl phosphate complex.

The patient is shown 2 weeks after daily treatment with the skin care formulation. Skin improvements were observed in all study patients. Photos courtesy Dr. David J. Moore

MIAMI — A topical tocopheryl phosphate complex effectively reduced problems associated with sensitive skin and shaving-induced irritation in a study of 28 Hispanic, Asian, and other participants.

Tocopheryl phosphate occurs naturally and is found in many animal and plant species, Roger McMullen, Ph.D., said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

The livers of rats, guinea pigs, and chickens, and the adipose tissue of guinea pigs, rats, and humans contain tocopheryl phosphate. It is also found in wheat germ oil, butter, cheddar cheese, olive oil, and chocolate, said Dr. McMullen, a researcher at International Specialty Products in Wayne, N.J.

Researchers studied a lipophilic tocopheryl phosphate complex (Vital ET, International Specialty Products) for relief of sensitive and/or irritated skin since it had demonstrated efficacy in previous studies.

Tocopheryl phosphate inhibited inflammatory and proliferative pathways in previous animal studies.

The substance "also provides protection against oxidative stress, but not through a free radical scavenging mechanism," said Dr. McMullen, who presented findings of the current study on behalf of David J. Moore, Ph.D., a senior science fellow at International Specialty Products.

There are many skin care products on the global market that contain Vital ET, Dr. Moore said in an interview after the meeting.

The researchers assessed the ability of the lipophilic tocopheryl phosphate complex to relieve symptoms of skin sensitive to shaving in Hispanic, Asian, and other study participants.

They applied a balm containing 2% tocopheryl phosphate once daily for 4 weeks. There were 13 men who shaved their faces daily and 15 women who shaved their legs every other day. There were four Hispanic and seven Asian participants.

Erythema, folliculitis, tactile roughness, dryness, skin clarity, and nicks and cuts were clinically graded at baseline. A board-certified dermatologist then rated these parameters at week 2 and week 4. Participants also scored any burning, stinging, itching, or tightness.

"All objective and subjective graded parameters of irritated or sensitive skin were significantly improved compared to baseline. The very significant efficacy for all clinically graded parameters at 2 and 4 weeks … was delivered in a real skin care formulation," Dr. McMullen said at the meeting, which was also sponsored by Howard University.

"We were not surprised, as this was our third clinical study with Vital ET and both previous studies had demonstrated significant efficacy in mitigating skin irritation," Dr. Moore said.

The previous research involved treatment of UV-induced erythema or acne with the product applied in a simple gel formulation, he noted.

In the current study, erythema improved from a mean score of 5 at baseline to a mean of 2 after 2 weeks and a mean of 1 after 4 weeks. These improvements were observed in all study participants, said Dr. McMullen.

Similarly, improvements in skin clarity were observed at 2 weeks and 4 weeks, compared with baseline, in all participants. In addition, "there was a big drop in folliculitis from baseline to 2 weeks," he said.

"We are currently conducting human ex vivo skin studies at ISP Global Skin Research in Nice, France, to further understand the biologic activity of Vital ET in skin," Dr. Moore said. Researchers are assessing its protective effect on Langerhans cells and its role in protecting the skin from glycation stress.

"After this work is complete, we expect to conduct further human clinical studies," he said.

An Asian patient with shaving-induced irritation is shown before using a skin balm containing tocopheryl phosphate complex.

The patient is shown 2 weeks after daily treatment with the skin care formulation. Skin improvements were observed in all study patients. Photos courtesy Dr. David J. Moore

MIAMI — A topical tocopheryl phosphate complex effectively reduced problems associated with sensitive skin and shaving-induced irritation in a study of 28 Hispanic, Asian, and other participants.

Tocopheryl phosphate occurs naturally and is found in many animal and plant species, Roger McMullen, Ph.D., said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

The livers of rats, guinea pigs, and chickens, and the adipose tissue of guinea pigs, rats, and humans contain tocopheryl phosphate. It is also found in wheat germ oil, butter, cheddar cheese, olive oil, and chocolate, said Dr. McMullen, a researcher at International Specialty Products in Wayne, N.J.

Researchers studied a lipophilic tocopheryl phosphate complex (Vital ET, International Specialty Products) for relief of sensitive and/or irritated skin since it had demonstrated efficacy in previous studies.

Tocopheryl phosphate inhibited inflammatory and proliferative pathways in previous animal studies.

The substance "also provides protection against oxidative stress, but not through a free radical scavenging mechanism," said Dr. McMullen, who presented findings of the current study on behalf of David J. Moore, Ph.D., a senior science fellow at International Specialty Products.

There are many skin care products on the global market that contain Vital ET, Dr. Moore said in an interview after the meeting.

The researchers assessed the ability of the lipophilic tocopheryl phosphate complex to relieve symptoms of skin sensitive to shaving in Hispanic, Asian, and other study participants.

They applied a balm containing 2% tocopheryl phosphate once daily for 4 weeks. There were 13 men who shaved their faces daily and 15 women who shaved their legs every other day. There were four Hispanic and seven Asian participants.

Erythema, folliculitis, tactile roughness, dryness, skin clarity, and nicks and cuts were clinically graded at baseline. A board-certified dermatologist then rated these parameters at week 2 and week 4. Participants also scored any burning, stinging, itching, or tightness.

"All objective and subjective graded parameters of irritated or sensitive skin were significantly improved compared to baseline. The very significant efficacy for all clinically graded parameters at 2 and 4 weeks … was delivered in a real skin care formulation," Dr. McMullen said at the meeting, which was also sponsored by Howard University.

"We were not surprised, as this was our third clinical study with Vital ET and both previous studies had demonstrated significant efficacy in mitigating skin irritation," Dr. Moore said.

The previous research involved treatment of UV-induced erythema or acne with the product applied in a simple gel formulation, he noted.

In the current study, erythema improved from a mean score of 5 at baseline to a mean of 2 after 2 weeks and a mean of 1 after 4 weeks. These improvements were observed in all study participants, said Dr. McMullen.

Similarly, improvements in skin clarity were observed at 2 weeks and 4 weeks, compared with baseline, in all participants. In addition, "there was a big drop in folliculitis from baseline to 2 weeks," he said.

"We are currently conducting human ex vivo skin studies at ISP Global Skin Research in Nice, France, to further understand the biologic activity of Vital ET in skin," Dr. Moore said. Researchers are assessing its protective effect on Langerhans cells and its role in protecting the skin from glycation stress.

"After this work is complete, we expect to conduct further human clinical studies," he said.

An Asian patient with shaving-induced irritation is shown before using a skin balm containing tocopheryl phosphate complex.

The patient is shown 2 weeks after daily treatment with the skin care formulation. Skin improvements were observed in all study patients. Photos courtesy Dr. David J. Moore

MIAMI — Although some skin features vary by ethnicity and with age, researchers found no significant seasonal differences in skin smoothness or dryness between African American, Chinese, white, or Hispanic women. In a second comparison, color heterogeneity and yellowness were the primary skin differences among these ethnic groups.

"There is a paucity of data when it comes to trying to quantify properties of ethnic skin," Felicia Dixon, Ph.D., said at an international symposium sponsored by the L'Oréal Institute for Ethnic Hair and Skin Research.

The investigators studied 214 women aged 18-87 years in the summer of 2004 and again, 6 months later, in the winter of 2005. There were 91 African American, 47 Chinese, 41 white, and 35 Hispanic women.

"There are drastic changes in temperature in Chicago between summer and winter, while humidity is about the same," said Dr. Dixon, a researcher at L'Oréal USA Inc. in Chicago. She presented the results for Stephane Diridollou, Ph.D., also of L'Oréal USA, who was unable to attend the meeting.

The researchers compared skin microrelief, dryness features, mechanical properties, and sebum function between groups. They also looked for differences in the epidermis, subepidermal nonechogenic band, papillary dermis, and dermis.

Microrelief and dryness were measured using a SkinChip sensor (jointly developed by L'Oréal and STMicroelectronics). This device features about 92,000 microsensors in a sensor slightly larger than a penny. The image analysis software quantified skin smoothness and dryness at three sites—the cheek and dorsal and ventral sides of the arm.

The ventral arm sites were smoother than the dorsal sites during both seasons, and the dorsal skin became rougher from summer to winter. "Yes, in winter, there was an increase in dryness of the skin at the three sites. But there were more changes on the dorsal arm and cheek versus the ventral arm, related to exposure to the elements," Dr. Dixon said.

The seasonal differences in dryness were not statistically significant between groups. "All ethnic groups seem to respond the same way," she said at the meeting, which was also sponsored by Howard University.

With aging, white women showed more changes in microrelief, elasticity, and skin structures. These changes were not observed among African American women. "It's not lost on this audience that black women tend to age well, so to speak," Dr. Dixon said. "What was unique for the African American women was the uneven skin tone as a function of age."

In a second comparison, Jean Paul de Rigal, Ph.D., and his associates assessed 387 women for skin color and color heterogeneity. They compared 122 African Americans, 120 Chinese, 81 whites, and 64 Hispanics aged 20-90 years.

Any differences in forehead or cheek color characteristics were detected using standardized whole face images taken with the L'Oréal Chromasphere. The device diffuses light in a spherical manner around the face and allows for precise color measurements without any shadows, said Dr. de Rigal, a research engineer at L'Oréal Inc. in Chevilly-Larue, France.

Skin color heterogeneity was highest among African American and Hispanic women. On the forehead, color heterogeneity decreased from African American to white participants, "with Chinese and Hispanic women in between, and more or less identical," Dr. de Rigal said. For all women, there was lower color heterogeneity on the forehead, compared with the cheeks. Again, African Americans displayed the most color heterogeneity on the cheek area, followed by Hispanics.

The redness component of skin did not vary significantly between groups. The yellow component, however, did vary by ethnicity. Yellowness was higher in Hispanic and Chinese skin, compared with African American and white skin.

MIAMI — Although some skin features vary by ethnicity and with age, researchers found no significant seasonal differences in skin smoothness or dryness between African American, Chinese, white, or Hispanic women. In a second comparison, color heterogeneity and yellowness were the primary skin differences among these ethnic groups.

"There is a paucity of data when it comes to trying to quantify properties of ethnic skin," Felicia Dixon, Ph.D., said at an international symposium sponsored by the L'Oréal Institute for Ethnic Hair and Skin Research.

The investigators studied 214 women aged 18-87 years in the summer of 2004 and again, 6 months later, in the winter of 2005. There were 91 African American, 47 Chinese, 41 white, and 35 Hispanic women.

"There are drastic changes in temperature in Chicago between summer and winter, while humidity is about the same," said Dr. Dixon, a researcher at L'Oréal USA Inc. in Chicago. She presented the results for Stephane Diridollou, Ph.D., also of L'Oréal USA, who was unable to attend the meeting.

The researchers compared skin microrelief, dryness features, mechanical properties, and sebum function between groups. They also looked for differences in the epidermis, subepidermal nonechogenic band, papillary dermis, and dermis.

Microrelief and dryness were measured using a SkinChip sensor (jointly developed by L'Oréal and STMicroelectronics). This device features about 92,000 microsensors in a sensor slightly larger than a penny. The image analysis software quantified skin smoothness and dryness at three sites—the cheek and dorsal and ventral sides of the arm.

The ventral arm sites were smoother than the dorsal sites during both seasons, and the dorsal skin became rougher from summer to winter. "Yes, in winter, there was an increase in dryness of the skin at the three sites. But there were more changes on the dorsal arm and cheek versus the ventral arm, related to exposure to the elements," Dr. Dixon said.

The seasonal differences in dryness were not statistically significant between groups. "All ethnic groups seem to respond the same way," she said at the meeting, which was also sponsored by Howard University.

With aging, white women showed more changes in microrelief, elasticity, and skin structures. These changes were not observed among African American women. "It's not lost on this audience that black women tend to age well, so to speak," Dr. Dixon said. "What was unique for the African American women was the uneven skin tone as a function of age."

In a second comparison, Jean Paul de Rigal, Ph.D., and his associates assessed 387 women for skin color and color heterogeneity. They compared 122 African Americans, 120 Chinese, 81 whites, and 64 Hispanics aged 20-90 years.

Any differences in forehead or cheek color characteristics were detected using standardized whole face images taken with the L'Oréal Chromasphere. The device diffuses light in a spherical manner around the face and allows for precise color measurements without any shadows, said Dr. de Rigal, a research engineer at L'Oréal Inc. in Chevilly-Larue, France.

Skin color heterogeneity was highest among African American and Hispanic women. On the forehead, color heterogeneity decreased from African American to white participants, "with Chinese and Hispanic women in between, and more or less identical," Dr. de Rigal said. For all women, there was lower color heterogeneity on the forehead, compared with the cheeks. Again, African Americans displayed the most color heterogeneity on the cheek area, followed by Hispanics.

The redness component of skin did not vary significantly between groups. The yellow component, however, did vary by ethnicity. Yellowness was higher in Hispanic and Chinese skin, compared with African American and white skin.

MIAMI — Although some skin features vary by ethnicity and with age, researchers found no significant seasonal differences in skin smoothness or dryness between African American, Chinese, white, or Hispanic women. In a second comparison, color heterogeneity and yellowness were the primary skin differences among these ethnic groups.

"There is a paucity of data when it comes to trying to quantify properties of ethnic skin," Felicia Dixon, Ph.D., said at an international symposium sponsored by the L'Oréal Institute for Ethnic Hair and Skin Research.

The investigators studied 214 women aged 18-87 years in the summer of 2004 and again, 6 months later, in the winter of 2005. There were 91 African American, 47 Chinese, 41 white, and 35 Hispanic women.

"There are drastic changes in temperature in Chicago between summer and winter, while humidity is about the same," said Dr. Dixon, a researcher at L'Oréal USA Inc. in Chicago. She presented the results for Stephane Diridollou, Ph.D., also of L'Oréal USA, who was unable to attend the meeting.

The researchers compared skin microrelief, dryness features, mechanical properties, and sebum function between groups. They also looked for differences in the epidermis, subepidermal nonechogenic band, papillary dermis, and dermis.

Microrelief and dryness were measured using a SkinChip sensor (jointly developed by L'Oréal and STMicroelectronics). This device features about 92,000 microsensors in a sensor slightly larger than a penny. The image analysis software quantified skin smoothness and dryness at three sites—the cheek and dorsal and ventral sides of the arm.

The ventral arm sites were smoother than the dorsal sites during both seasons, and the dorsal skin became rougher from summer to winter. "Yes, in winter, there was an increase in dryness of the skin at the three sites. But there were more changes on the dorsal arm and cheek versus the ventral arm, related to exposure to the elements," Dr. Dixon said.

The seasonal differences in dryness were not statistically significant between groups. "All ethnic groups seem to respond the same way," she said at the meeting, which was also sponsored by Howard University.

With aging, white women showed more changes in microrelief, elasticity, and skin structures. These changes were not observed among African American women. "It's not lost on this audience that black women tend to age well, so to speak," Dr. Dixon said. "What was unique for the African American women was the uneven skin tone as a function of age."

In a second comparison, Jean Paul de Rigal, Ph.D., and his associates assessed 387 women for skin color and color heterogeneity. They compared 122 African Americans, 120 Chinese, 81 whites, and 64 Hispanics aged 20-90 years.

Any differences in forehead or cheek color characteristics were detected using standardized whole face images taken with the L'Oréal Chromasphere. The device diffuses light in a spherical manner around the face and allows for precise color measurements without any shadows, said Dr. de Rigal, a research engineer at L'Oréal Inc. in Chevilly-Larue, France.

Skin color heterogeneity was highest among African American and Hispanic women. On the forehead, color heterogeneity decreased from African American to white participants, "with Chinese and Hispanic women in between, and more or less identical," Dr. de Rigal said. For all women, there was lower color heterogeneity on the forehead, compared with the cheeks. Again, African Americans displayed the most color heterogeneity on the cheek area, followed by Hispanics.

The redness component of skin did not vary significantly between groups. The yellow component, however, did vary by ethnicity. Yellowness was higher in Hispanic and Chinese skin, compared with African American and white skin.

BUENOS AIRES — The five most common skin disorders of black patients can be effectively managed by understanding that not all skin types are treated the same, reported Dr. Susan C. Taylor at the at the 21st World Congress of Dermatology.

Acne is the most common dermatologic diagnosis seen in black patients. It is unlikely that racial differences affect the pathophysiology of acne, but histopathologically there may be racial differences in sebaceous gland size and activity, said Dr. Taylor, director of the Skin of Color Center at St. Luke's-Roosevelt Hospital, New York.

Inflammation has been seen in the facial comedones of black women, with marked inflammation observed in papular and pustular lesions, she said. "This probably explains why postinflammatory hyperpigmentation is such a huge problem in the black population with acne."

Hyperpigmentation is one of the primary complaints of black patients who seek treatment for acne. "When we address treatment of acne in this population, it behooves us not only to treat the acne early and aggressively but also to treat the postinflammatory hyperpigmentation," said Dr. Taylor. Aggressive therapy must be balanced with the recognition that some topical therapies may be irritating to the skin, leading to further postinflammatory hyperpigmentation. Additional depigmenting therapy may be needed.

Maintenance therapy is advisable in order to prevent formation of new comedones that would lead to acne and postinflammatory hyperpigmentation. Sunscreens and sun protection are essential. "Many people of African descent do not readily embrace the use of sunscreens," she said. "It is very important for us to educate this particular population about the need for sunscreens, particularly as it relates to the stimulation of melanocytes and the production of melanin and further postinflammatory hyperpigmentation."

Acne treatment should include both topical and systemic therapies. "Keep in mind that many of the topical treatments can be irritating to the skin, thereby increasing inflammation," said Dr. Taylor. Standard topical treatments for acne in black patients include benzoyl peroxide, topical antibiotics, and topical retinoids such as tretinoin, adapalene, and tazarotene. In an 18-week, double-blind, vehicle-controlled study, tazarotene 0.1% cream was found to be well tolerated and effective in the treatment of postinflammatory hyperpigmentation in darker-skinned patients with acne vulgaris (Cutis 2006;77:45-50).

Systemic antibiotics include erythromycin, tetracycline, doxycycline, and minocycline; however, minocycline should be used cautiously, as it may induce hyperpigmentation.

Hormonal treatment with oral contraceptives or spironolactone may be effective in some patients.

Postinflammatory hyperpigmentation is the most common pigmentary disorder and can occur at any site of earlier inflammation. The intensity and duration of the hyperpigmentation appears to be linked to the skin hue, affecting those with darker skin color to a greater extent than those with lighter skin color.

Prevention is the most important factor concerning pigmentary disorders. Spot tests always should be performed before initiating cosmetic procedures such as laser therapy, chemical peels, or microdermabrasion in patients. "You never know when a patient is going to have dyschromia or hyperpigmentation," said Dr. Taylor. Remind patients who are susceptible to pigmentary disorders to use sunscreens regularly. For treatment of pigmentary disorders, 4% hydroquinones remain the gold standard, but retinoids can also be effective. Other agents include azelaic acid, kojic acid, and glycolic acid.

Compared with other racial groups, blacks appear to have higher rates of allergic contact dermatitis to thioureas, p-tert-butyl phenol-formaldehyde resin, cobalt chloride, and paraphenylenediamine, a component of dark hair dye. The higher paraphenylenediamine sensitivity may be related to more extensive exposure through the use of dark hair dyes, said Dr. Taylor.

In the treatment of eczema, "attention to skin care cannot be overemphasized," she said. Emollients and bathing rituals can be helpful in alleviating symptoms. Topical corticosteroids and topical immunomodulators are recommended treatments.

Seborrheic dermatitis is a condition that appears to show no racial predilection, but the incidence is increased in patients with HIV or chronic neurologic conditions. It can affect the scalp, face, ears, and chest, causing scaling and pigmentary abnormalities.

Daily shampooing often is recommended for patients with seborrheic dermatitis. "This is not an option for patients of African descent, because of the structural differences of the hair, particularly the dryness, as well as cultural practices," she said, "most patients of African descent only shampoo once a week or once every other week, so you have to tailor your therapy appropriately."

Dr. Taylor has worked as a clinical investigator, speaker, or consultant for Allergan Inc., Beiersdorf AG, Dermik Laboratories, Galderma Laboratories, Medicis Pharmaceutical Corp., Stiefel Laboratories Inc., and Johnson & Johnson.

BUENOS AIRES — The five most common skin disorders of black patients can be effectively managed by understanding that not all skin types are treated the same, reported Dr. Susan C. Taylor at the at the 21st World Congress of Dermatology.

Acne is the most common dermatologic diagnosis seen in black patients. It is unlikely that racial differences affect the pathophysiology of acne, but histopathologically there may be racial differences in sebaceous gland size and activity, said Dr. Taylor, director of the Skin of Color Center at St. Luke's-Roosevelt Hospital, New York.

Inflammation has been seen in the facial comedones of black women, with marked inflammation observed in papular and pustular lesions, she said. "This probably explains why postinflammatory hyperpigmentation is such a huge problem in the black population with acne."

Hyperpigmentation is one of the primary complaints of black patients who seek treatment for acne. "When we address treatment of acne in this population, it behooves us not only to treat the acne early and aggressively but also to treat the postinflammatory hyperpigmentation," said Dr. Taylor. Aggressive therapy must be balanced with the recognition that some topical therapies may be irritating to the skin, leading to further postinflammatory hyperpigmentation. Additional depigmenting therapy may be needed.

Maintenance therapy is advisable in order to prevent formation of new comedones that would lead to acne and postinflammatory hyperpigmentation. Sunscreens and sun protection are essential. "Many people of African descent do not readily embrace the use of sunscreens," she said. "It is very important for us to educate this particular population about the need for sunscreens, particularly as it relates to the stimulation of melanocytes and the production of melanin and further postinflammatory hyperpigmentation."

Acne treatment should include both topical and systemic therapies. "Keep in mind that many of the topical treatments can be irritating to the skin, thereby increasing inflammation," said Dr. Taylor. Standard topical treatments for acne in black patients include benzoyl peroxide, topical antibiotics, and topical retinoids such as tretinoin, adapalene, and tazarotene. In an 18-week, double-blind, vehicle-controlled study, tazarotene 0.1% cream was found to be well tolerated and effective in the treatment of postinflammatory hyperpigmentation in darker-skinned patients with acne vulgaris (Cutis 2006;77:45-50).

Systemic antibiotics include erythromycin, tetracycline, doxycycline, and minocycline; however, minocycline should be used cautiously, as it may induce hyperpigmentation.

Hormonal treatment with oral contraceptives or spironolactone may be effective in some patients.

Postinflammatory hyperpigmentation is the most common pigmentary disorder and can occur at any site of earlier inflammation. The intensity and duration of the hyperpigmentation appears to be linked to the skin hue, affecting those with darker skin color to a greater extent than those with lighter skin color.

Prevention is the most important factor concerning pigmentary disorders. Spot tests always should be performed before initiating cosmetic procedures such as laser therapy, chemical peels, or microdermabrasion in patients. "You never know when a patient is going to have dyschromia or hyperpigmentation," said Dr. Taylor. Remind patients who are susceptible to pigmentary disorders to use sunscreens regularly. For treatment of pigmentary disorders, 4% hydroquinones remain the gold standard, but retinoids can also be effective. Other agents include azelaic acid, kojic acid, and glycolic acid.

Compared with other racial groups, blacks appear to have higher rates of allergic contact dermatitis to thioureas, p-tert-butyl phenol-formaldehyde resin, cobalt chloride, and paraphenylenediamine, a component of dark hair dye. The higher paraphenylenediamine sensitivity may be related to more extensive exposure through the use of dark hair dyes, said Dr. Taylor.

In the treatment of eczema, "attention to skin care cannot be overemphasized," she said. Emollients and bathing rituals can be helpful in alleviating symptoms. Topical corticosteroids and topical immunomodulators are recommended treatments.

Seborrheic dermatitis is a condition that appears to show no racial predilection, but the incidence is increased in patients with HIV or chronic neurologic conditions. It can affect the scalp, face, ears, and chest, causing scaling and pigmentary abnormalities.

Daily shampooing often is recommended for patients with seborrheic dermatitis. "This is not an option for patients of African descent, because of the structural differences of the hair, particularly the dryness, as well as cultural practices," she said, "most patients of African descent only shampoo once a week or once every other week, so you have to tailor your therapy appropriately."

Dr. Taylor has worked as a clinical investigator, speaker, or consultant for Allergan Inc., Beiersdorf AG, Dermik Laboratories, Galderma Laboratories, Medicis Pharmaceutical Corp., Stiefel Laboratories Inc., and Johnson & Johnson.

BUENOS AIRES — The five most common skin disorders of black patients can be effectively managed by understanding that not all skin types are treated the same, reported Dr. Susan C. Taylor at the at the 21st World Congress of Dermatology.

Acne is the most common dermatologic diagnosis seen in black patients. It is unlikely that racial differences affect the pathophysiology of acne, but histopathologically there may be racial differences in sebaceous gland size and activity, said Dr. Taylor, director of the Skin of Color Center at St. Luke's-Roosevelt Hospital, New York.

Inflammation has been seen in the facial comedones of black women, with marked inflammation observed in papular and pustular lesions, she said. "This probably explains why postinflammatory hyperpigmentation is such a huge problem in the black population with acne."

Hyperpigmentation is one of the primary complaints of black patients who seek treatment for acne. "When we address treatment of acne in this population, it behooves us not only to treat the acne early and aggressively but also to treat the postinflammatory hyperpigmentation," said Dr. Taylor. Aggressive therapy must be balanced with the recognition that some topical therapies may be irritating to the skin, leading to further postinflammatory hyperpigmentation. Additional depigmenting therapy may be needed.

Maintenance therapy is advisable in order to prevent formation of new comedones that would lead to acne and postinflammatory hyperpigmentation. Sunscreens and sun protection are essential. "Many people of African descent do not readily embrace the use of sunscreens," she said. "It is very important for us to educate this particular population about the need for sunscreens, particularly as it relates to the stimulation of melanocytes and the production of melanin and further postinflammatory hyperpigmentation."

Acne treatment should include both topical and systemic therapies. "Keep in mind that many of the topical treatments can be irritating to the skin, thereby increasing inflammation," said Dr. Taylor. Standard topical treatments for acne in black patients include benzoyl peroxide, topical antibiotics, and topical retinoids such as tretinoin, adapalene, and tazarotene. In an 18-week, double-blind, vehicle-controlled study, tazarotene 0.1% cream was found to be well tolerated and effective in the treatment of postinflammatory hyperpigmentation in darker-skinned patients with acne vulgaris (Cutis 2006;77:45-50).

Systemic antibiotics include erythromycin, tetracycline, doxycycline, and minocycline; however, minocycline should be used cautiously, as it may induce hyperpigmentation.

Hormonal treatment with oral contraceptives or spironolactone may be effective in some patients.

Postinflammatory hyperpigmentation is the most common pigmentary disorder and can occur at any site of earlier inflammation. The intensity and duration of the hyperpigmentation appears to be linked to the skin hue, affecting those with darker skin color to a greater extent than those with lighter skin color.

Prevention is the most important factor concerning pigmentary disorders. Spot tests always should be performed before initiating cosmetic procedures such as laser therapy, chemical peels, or microdermabrasion in patients. "You never know when a patient is going to have dyschromia or hyperpigmentation," said Dr. Taylor. Remind patients who are susceptible to pigmentary disorders to use sunscreens regularly. For treatment of pigmentary disorders, 4% hydroquinones remain the gold standard, but retinoids can also be effective. Other agents include azelaic acid, kojic acid, and glycolic acid.

Compared with other racial groups, blacks appear to have higher rates of allergic contact dermatitis to thioureas, p-tert-butyl phenol-formaldehyde resin, cobalt chloride, and paraphenylenediamine, a component of dark hair dye. The higher paraphenylenediamine sensitivity may be related to more extensive exposure through the use of dark hair dyes, said Dr. Taylor.

In the treatment of eczema, "attention to skin care cannot be overemphasized," she said. Emollients and bathing rituals can be helpful in alleviating symptoms. Topical corticosteroids and topical immunomodulators are recommended treatments.

Seborrheic dermatitis is a condition that appears to show no racial predilection, but the incidence is increased in patients with HIV or chronic neurologic conditions. It can affect the scalp, face, ears, and chest, causing scaling and pigmentary abnormalities.

Daily shampooing often is recommended for patients with seborrheic dermatitis. "This is not an option for patients of African descent, because of the structural differences of the hair, particularly the dryness, as well as cultural practices," she said, "most patients of African descent only shampoo once a week or once every other week, so you have to tailor your therapy appropriately."

Dr. Taylor has worked as a clinical investigator, speaker, or consultant for Allergan Inc., Beiersdorf AG, Dermik Laboratories, Galderma Laboratories, Medicis Pharmaceutical Corp., Stiefel Laboratories Inc., and Johnson & Johnson.

MIAMI — Unique structural and functional differences between the skin of black and white patients might help explain differences in the top five dermatology diagnoses for each ethnicity.

"As diversity increases in the U.S., understanding these differences becomes important," said Dr. Amanda B. Sergay, a third-year dermatology resident at St. Luke's-Roosevelt Hospital Center in New York City.

Dr. Sergay and her associates, including principal investigator Dr. Andrew F. Alexis, retrospectively compared the diagnostic codes for 1,074 black and white patient visits treated at the Skin of Color Center at St. Luke's-Roosevelt Hospital Center, New York City, from August 2004 to July 2005. When ethnicity was unclear, the patient's own description was used.

Prior to this study, the most recent survey of cutaneous diseases in black Americans was published more than 2 decades ago (Cutis 1983;32:388-90), Dr. Sergay said during a presentation at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research. "The survey highlights the variability in skin disorders for which individuals of different racial/ethnic groups present to a dermatologist."

Acne vulgaris was the most common diagnosis in both groups (ICD-9 code 706.1). "The pathophysiology of acne is not thought to differ between races or ethnicities," she said at the symposium, which was also sponsored by Howard University.

Acne and dyschromia (code 709.09) are so common that they accounted for almost 50% of black patient visits (Cutis, in press: November 2007). Black patients also were commonly diagnosed with contact dermatitis and other eczema, unspecified cause (code 692.9), alopecia (code 704.0), and seborrheic dermatitis (code 690.1).

After acne vulgaris, the most common diagnoses in white patients were a lesion of unspecified behavior (code 238.2), benign neoplasm of the skin of the trunk (code 216.5), contact dermatitis or other eczema, and psoriasis (696.1).

Dyschromia and alopecia made the top 5 list for black patients but did not appear among the top 10 diagnoses for white patients, Dr. Sergay commented.

The dyschromia diagnoses included postinflammatory hyperpigmentation and melasma. "Postinflammatory hyperpigmentation is a common sequela of cutaneous injury or irritation in skin of color," Dr. Sergay said. Postinflammatory hyperpigmentation can also result from pseudofolliculitis barbae, which is more common among black patients because of structural differences in the hair follicle and shaft compared with white patients.

Fewer elastic fibers in black skin to anchor hair follicles to dermis might partially explain the higher incidence of alopecia among black patients (Dermatol. Clin. 1988;6:271-81). Chemical and physical hair care practices may also contribute. Other possible explanations are the significantly lower total hair density and number of hair follicles among black patients, compared with white patients (Dermatol. Clin. 2003;21:595-600; Arch. Dermatol. 1999;135:656-8).

Racial variations in skin physiology may lead to differences in eczema prevalence, Dr. Sergay said. Black skin, for example, typically features a greater number of stratum corneum layers. "There is no consensus, however, about the propensity to develop eczema and race or ethnicity."

The single-center source of information is a limitation of the study, as well as potential selection bias from participating physicians, Dr. Sergay said. In addition, categorization of patient ethnicity by a physician or assistant is less reliable than self-reporting.

Melasma is one of the dyschromia diagnoses. Dyschromia and acne accounted for almost half of all black patient visits.

Lower total hair density and number of hair follicles might explain the higher incidence of alopecia in black patients. Photos courtesy Dr. Pearl E. Grimes

MIAMI — Unique structural and functional differences between the skin of black and white patients might help explain differences in the top five dermatology diagnoses for each ethnicity.

"As diversity increases in the U.S., understanding these differences becomes important," said Dr. Amanda B. Sergay, a third-year dermatology resident at St. Luke's-Roosevelt Hospital Center in New York City.

Dr. Sergay and her associates, including principal investigator Dr. Andrew F. Alexis, retrospectively compared the diagnostic codes for 1,074 black and white patient visits treated at the Skin of Color Center at St. Luke's-Roosevelt Hospital Center, New York City, from August 2004 to July 2005. When ethnicity was unclear, the patient's own description was used.

Prior to this study, the most recent survey of cutaneous diseases in black Americans was published more than 2 decades ago (Cutis 1983;32:388-90), Dr. Sergay said during a presentation at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research. "The survey highlights the variability in skin disorders for which individuals of different racial/ethnic groups present to a dermatologist."

Acne vulgaris was the most common diagnosis in both groups (ICD-9 code 706.1). "The pathophysiology of acne is not thought to differ between races or ethnicities," she said at the symposium, which was also sponsored by Howard University.

Acne and dyschromia (code 709.09) are so common that they accounted for almost 50% of black patient visits (Cutis, in press: November 2007). Black patients also were commonly diagnosed with contact dermatitis and other eczema, unspecified cause (code 692.9), alopecia (code 704.0), and seborrheic dermatitis (code 690.1).

After acne vulgaris, the most common diagnoses in white patients were a lesion of unspecified behavior (code 238.2), benign neoplasm of the skin of the trunk (code 216.5), contact dermatitis or other eczema, and psoriasis (696.1).

Dyschromia and alopecia made the top 5 list for black patients but did not appear among the top 10 diagnoses for white patients, Dr. Sergay commented.

The dyschromia diagnoses included postinflammatory hyperpigmentation and melasma. "Postinflammatory hyperpigmentation is a common sequela of cutaneous injury or irritation in skin of color," Dr. Sergay said. Postinflammatory hyperpigmentation can also result from pseudofolliculitis barbae, which is more common among black patients because of structural differences in the hair follicle and shaft compared with white patients.

Fewer elastic fibers in black skin to anchor hair follicles to dermis might partially explain the higher incidence of alopecia among black patients (Dermatol. Clin. 1988;6:271-81). Chemical and physical hair care practices may also contribute. Other possible explanations are the significantly lower total hair density and number of hair follicles among black patients, compared with white patients (Dermatol. Clin. 2003;21:595-600; Arch. Dermatol. 1999;135:656-8).

Racial variations in skin physiology may lead to differences in eczema prevalence, Dr. Sergay said. Black skin, for example, typically features a greater number of stratum corneum layers. "There is no consensus, however, about the propensity to develop eczema and race or ethnicity."

The single-center source of information is a limitation of the study, as well as potential selection bias from participating physicians, Dr. Sergay said. In addition, categorization of patient ethnicity by a physician or assistant is less reliable than self-reporting.

Melasma is one of the dyschromia diagnoses. Dyschromia and acne accounted for almost half of all black patient visits.

Lower total hair density and number of hair follicles might explain the higher incidence of alopecia in black patients. Photos courtesy Dr. Pearl E. Grimes

MIAMI — Unique structural and functional differences between the skin of black and white patients might help explain differences in the top five dermatology diagnoses for each ethnicity.

"As diversity increases in the U.S., understanding these differences becomes important," said Dr. Amanda B. Sergay, a third-year dermatology resident at St. Luke's-Roosevelt Hospital Center in New York City.

Dr. Sergay and her associates, including principal investigator Dr. Andrew F. Alexis, retrospectively compared the diagnostic codes for 1,074 black and white patient visits treated at the Skin of Color Center at St. Luke's-Roosevelt Hospital Center, New York City, from August 2004 to July 2005. When ethnicity was unclear, the patient's own description was used.

Prior to this study, the most recent survey of cutaneous diseases in black Americans was published more than 2 decades ago (Cutis 1983;32:388-90), Dr. Sergay said during a presentation at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research. "The survey highlights the variability in skin disorders for which individuals of different racial/ethnic groups present to a dermatologist."

Acne vulgaris was the most common diagnosis in both groups (ICD-9 code 706.1). "The pathophysiology of acne is not thought to differ between races or ethnicities," she said at the symposium, which was also sponsored by Howard University.

Acne and dyschromia (code 709.09) are so common that they accounted for almost 50% of black patient visits (Cutis, in press: November 2007). Black patients also were commonly diagnosed with contact dermatitis and other eczema, unspecified cause (code 692.9), alopecia (code 704.0), and seborrheic dermatitis (code 690.1).

After acne vulgaris, the most common diagnoses in white patients were a lesion of unspecified behavior (code 238.2), benign neoplasm of the skin of the trunk (code 216.5), contact dermatitis or other eczema, and psoriasis (696.1).

Dyschromia and alopecia made the top 5 list for black patients but did not appear among the top 10 diagnoses for white patients, Dr. Sergay commented.

The dyschromia diagnoses included postinflammatory hyperpigmentation and melasma. "Postinflammatory hyperpigmentation is a common sequela of cutaneous injury or irritation in skin of color," Dr. Sergay said. Postinflammatory hyperpigmentation can also result from pseudofolliculitis barbae, which is more common among black patients because of structural differences in the hair follicle and shaft compared with white patients.

Fewer elastic fibers in black skin to anchor hair follicles to dermis might partially explain the higher incidence of alopecia among black patients (Dermatol. Clin. 1988;6:271-81). Chemical and physical hair care practices may also contribute. Other possible explanations are the significantly lower total hair density and number of hair follicles among black patients, compared with white patients (Dermatol. Clin. 2003;21:595-600; Arch. Dermatol. 1999;135:656-8).

Racial variations in skin physiology may lead to differences in eczema prevalence, Dr. Sergay said. Black skin, for example, typically features a greater number of stratum corneum layers. "There is no consensus, however, about the propensity to develop eczema and race or ethnicity."

The single-center source of information is a limitation of the study, as well as potential selection bias from participating physicians, Dr. Sergay said. In addition, categorization of patient ethnicity by a physician or assistant is less reliable than self-reporting.

Melasma is one of the dyschromia diagnoses. Dyschromia and acne accounted for almost half of all black patient visits.

Lower total hair density and number of hair follicles might explain the higher incidence of alopecia in black patients. Photos courtesy Dr. Pearl E. Grimes