Dermatology Weekly

Rosacea in the skin of color population, plus isotretinoin’s links to psychiatric conditions, and the FDA sends fewer warning lettersFailure to recognize rosacea in the skin of color population presents an important gap in dermatology practice. Beginning at 10:06, Dr. Vincent DeLeo talks with Dr. Susan Taylor about how dermatologists can improve diagnosis and treatment of rosacea in this patient population. “I think that rosacea is underrecognized because it’s often confused for other disorders that occur commonly in skin of color populations,” Dr. Taylor explains. She highlights various clinical clues distinguishing rosacea from mimickers such as connective tissue diseases, seborrheic dermatitis, cutaneous sarcoidosis, and acne vulgaris. We also bring you the latest in dermatology news and research: 1. No increased risk of psychiatric problems tied to isotretinoin Arash Mostaghimi, MD, of Brigham and Women's Hospital in Boston discusses the study's findings and their implications. 2. FDA warning letters fall on Trump’s watch The Food and Drug Administration sent out one-third fewer warning letters to marketers of problematic drugs, devices, or food during the Trump administration's first 28 months. Things you will learn in this episode: • Overall, rosacea does not occur as commonly in skin of color patients as in white patients in the United States, but all types of rosacea can be observed in skin of color. • The erythematotelangiectatic and papulopustular subtypes are most common in skin of color populations, with granulomatous rosacea occurring more frequently in black patients. • Rosacea is underrecognized and underdiagnosed in skin of color patients because physicians often don’t appreciate that rosacea can and does occur in these populations. It also can be difficult to identify the erythema that is characteristic of rosacea in skin of color. • Skin of color patients with rosacea often don’t present to dermatology for treatment because they have no awareness of the disease. • Connective tissue diseases such as systemic lupus erythematosus and dermatomyositis can mimic rosacea in patients with skin of color. • Seborrheic dermatitis and rosacea have similar clinical features and can occur concurrently in the same patient. • Biopsy is needed to accurately distinguish between granulomatous rosacea and cutaneous sarcoidosis, as it can be a challenge to make the diagnosis clinically. • Comedones, nodules, cysts, and postinflammatory hyperpigmentation are suggestive of acne vulgaris, as these findings are not observed in rosacea. • Most of the same medications used in white patients with rosacea can be used for skin of color patients. • The most important factor to keep in mind when treating rosacea in skin of color patients is that irritation from topical agents can lead to postinflammatory hyperpigmentation. “I don’t think you can go wrong being cautious and approaching therapy slowly in this patient population,” notes Dr. Taylor. • Daily sunscreen use is important in all skin of color patients, particularly those with rosacea who may have facial skin that is more subject to burning or stinging or those who are photosensitive because of treatment with topical agents. • Ultimately, dermatologists should rely on information garnered from patients when rosacea is suspected in skin of color. “I think the key here is you must think about rosacea when you see a skin of color patient who comes to you and complains of burning, tingling, stinging of the facial skin; sensitivity to products; redness of the skin; papules; and pustules. There are times when as clinicians you may not be able to appreciate the erythema, but rest assured that your patient can tell you if his or her facial skin is red.” Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: Susan C. Taylor, MD (Perelman School of Medicine, University of Pennsylvania, Philadelphia) References: Establishing the Diagnosis of Rosacea in Skin of Color Patients Article PDF Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. You can find more of our podcasts at www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

24M

Skin conditions in U.S. military members, plus sun safety in minorities, and conjunctivitis in atopic dermatitisAre you prepared to treat a U.S. military service member with acne or psoriasis? Civilian specialists are playing a larger role in the care of our military population. Josephine Nguyen, MD, president of the Association of Military Dermatologists, talks with Dr. Kristina Burke to help civilian dermatologists understand the concept of medical readiness. They also discuss skin conditions and treatments that are incompatible with military service and cannot be maintained in a deployed environment. "It’s not [meant] to be discriminatory; but it’s recognizing that, in this unique population, [service members] are going to be put into situations that are totally different than what they would be at home, and they have to be medically ready,” Dr. Burke explains. When treating a service member, you must consider patient satisfaction as well as his/her career and our nation’s security. We also bring you the latest in dermatology news and research: 1. Racial and ethnic minorities often don’t practice sun protective behaviors Cultural beliefs, stigma, and personal preferences may affect behaviors. 2. Patients with atopic dermatitis should routinely be asked about conjunctivitis New onset conjunctivitis always should be referred to an ophthalmologist, especially in more severe cases when patients do not respond to antihistamine or artificial tears. 3. Measles cases have slowed but not stopped The CDC removes California from the list of active measles outbreaks. Things you will learn in this episode: • Military medicine is focused on medical readiness for U.S. military service members to deploy to locations across the globe and perform their duties. Dr. Burke explains medical readiness as "maintaining a person and a unit that is medically able to perform their military functions, both at home and in a deployed environment." • Accession guidelines can disqualify a person from military service if symptomatic. • A diagnosis of psoriasis or eczema is potentially disqualifying. Dr. Burke details why these conditions would be incompatible with military service. The key consideration is what’s going to happen when this patient is deployed and not able to access care. While service members are deployed, there is a lack of appropriate medication, a lack of refrigeration, and intense stress that can exacerbate an underlying condition such as psoriasis. She explains, “Mild cases can explode into severe flares when [service members] are under stress; when they’re in a different environment, an austere environment; and they’re not able to routinely access the care and the normal treatment that they would at home.” • Acne treatment guidelines are the same in active-duty service members, but the therapies are worked around schedules for deployment and field training. For example, isotretinoin is a nondeployable medication — secondary to its side-effect profile, laboratory monitoring, and maintenance of the iPLEDGE system — and may be used when a service member comes home from deployment or is in between deployments. • Unique populations such as aircrew members, special operations, and submariners have more restrictions on medications. For example, a flight crew member on doxycycline for acne will be grounded for a short period of time to monitor for side effects. Spironolactone and minocycline use also grounds aircrew members. “When a pilot takes medication, it can affect his or her spatial orientation,” Dr. Nguyen adds. “You can’t just give them a medication and assume that there will be no side effects.” • Civilian dermatologists with questions about how to treat a service member can consult the Association of Military Dermatologists • and Military Dermatology columns • published in Cutis. Hosts: Elizabeth Mechcatie; Terry Rudd; Josephine Nguyen, MD (Captain James A. Lovell Federal Health Care Center, North Chicago, Ill.) Guest: Kristina R. Burke, MD (Tripler Army Medical Center, Honolulu) Show notes by Melissa Sears, Alicia Sonners, and Elizabeth Mechcatie. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

26M

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