Ebook Treatment for skin color: Part 1

Treatments

FOR

SKIN OF Color


Acquisitions Editor: Claire Bonnett/Russell Gabbedy
Development Editor: Nani Clansey
Editorial Assistant: Poppy Garraway
Project Manager: Beula Christopher
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Illustration Manager: Bruce Hogarth
Illustrator: Gillian Richards
Marketing Manager: Richard Jones


Treatments

for

Skinof Color
Susan C Taylor

Raechele Cochran Gathers

MD

Assistant Clinical Professor of Dermatology
College of Physicians and Surgeons

Columbia University
Society Hill Dermatology
Phildelphia, PA, USA

Sonia Badreshia-Bansal

Clinical Instructor
Department of Dermatology
University of California San Francisco
Elite MD, Inc
Advanced Dermatology, Laser, and Plastic Surgery Institute
Danville, CA, USA

Valerie D Callender

Senior Staff Physician
Henry Ford Hospital
Multicultural Dermatology Center
Detroit, MI, USA

David A Rodriguez
MD

MD

MD

Voluntary Associate Professor
Dermatology and Cutaneous Surgery
University of Miami

Medical Director
Dermatology Associates and Research
Coral Gables, FL, USA

MD

Associate Professor of Dermatology
Howard University College of Medicine
Washington DC, USA
Callender Skin and Laser Center
Glenn Dale, MD, USA

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Notices
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British Library Cataloguing in Publication Data
Treatments for skin of color.
â•… 1.╇ Skin – Diseases – Treatment.â•… 2.╇ Pigmentation disorders – Treatment.â•… 3.╇ Human skin color.
â•… I. Taylor, Susan C.
â•… 616.5′0089 – dc22
â•… ISBN-13: 9781437708592
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Contents

PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
LIST OF CONTRIBUTORS . . . . . . . . . . . . . . . . . . . . . . . xiii
EVIDENCE LEVELS . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . xvii

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix

Part 1. Medical Dermatology . . . . . . . . . . . . . . . . . . . . . .

1

╇ 1. Acneiform Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Sonia Badreshia-Bansal and Vivek Bansal
Acne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acne vulgaris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pomade acne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Steroid acne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pediatric perspectives: Infantile acne Candrice R Heath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pediatric perspectives: Neonatal acne (acne neonatorum) Candrice R Heath . . . . . . . . . . . . . . . . . . . .
Acne rosacea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hidradenitis suppurativa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Perioral dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. 3
. 3
12
13
13
14
14
19
21

╇ 2. Bullous and Pustular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Janelle Vega and David A Rodriguez
Bullosis diabeticorum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bullous pemphigoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Impetigo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Infantile acropustulosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pemphigus foliaceus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pemphigus vulgaris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25
26
29
32
33
35

v

Contents

╇ 3. Collagen Vascular Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Sumayah J Taliaferro, Erica Chon Davis and Valerie D Callender
Dermatomyositis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Livedoid vasculopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lupus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chronic cutaneous lupus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subacute cutaneous lupus erythematosus (SCLE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Systemic lupus erythematosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Scleroderma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Localized scleroderma (morphea) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Systemic sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

39
44
47
47
52
53
58
58
61

╇ 4. Eczematous Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Sonia Badreshia-Bansal
Allergic contact dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Atopic dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dyshidrotic eczema/Pomphylox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Irritant contact dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lichen simplex chronicus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nummular dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

69
74
81
84
87
90

╇ 5. Granulomatous Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Sonia Badreshia-Bansal
Granuloma annulare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Localized granuloma annulare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Generalized granuloma annulare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sarcoidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

93
93
95
97

╇ 6. Hypersensitivity and Allergic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Ninad Pendharkar, Sonia Badreshia-Bansal, Janelle Vega, and David A Rodriguez
Arthropod bites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fixed drug eruption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Erythema multiforme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Erythema nodosum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Exfoliative dermatitis/Erythroderma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Polymorphous light eruption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Urticaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

101
102
104
108
111
113
115

╇ 7. Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Rashmi Sarkar, Vivek Nair, Surabhi Sinha, Vijay K Garg and David A Rodriguez
Candidiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Oral candidiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Candidal intertrigo/Cutaneous candidiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cellulitis and Erysipelas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chancroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

vi

119
119
120
121
123


Contents

Chlamydia trachomatis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Donovanosis (Granuloma inguinale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Exanthems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Folliculitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Furunculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Human papilloma virus (HPV) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lymphogranuloma venereum (LGV) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pityriasis versicolor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tinea capitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tinea corporis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tinea unguium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

125
126
128
130
131
133
135
137
139
142
145
146

╇ 8. Lichenoid Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Sonia Badreshia-Bansal
Lichen amyloidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lichen nitidus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lichen planus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cutaneous lichen planus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mucosal involvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lichen sclerosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pediatric perspectives: Lichen sclerosus et atrophicus Candrice R Heath . . . . . . . . . . . . . . . . . . . . . . .
Lichen striatus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

149
152
154
155
156
158
160
161

╇ 9. Papulosquamous Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Sonia Badreshia-Bansal
Parapsoriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pityriasis rosea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Plaque psoriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pediatric perspectives: Psoriasis Candrice R Heath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Seborrheic dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Facial seborrheic dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Scalp seborrheic dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

163
166
168
174

177
177
179

Part 2. Pigmentary Disorders . . . . . . . . . . . . . . . . . . . . .

181

10. Hyperpigmented Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
David A Rodriguez
Acanthosis nigricans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Benign melanonychia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Confluent and reticulated papillomatosis of Gougerot and Carteaud (CRPGC) . . . . . . . . . . . . . . . . . . . . . .
Drug-induced pigmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Erythema dyschromicum perstans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Exogenous ochronosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gingival hyperpigmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

183
185
187
189
191
192
194

vii


Contents

Melasma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mongolian spots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nevus of Ota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pigmentary demarcation lines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Post-inflammatory hyperpigmentation (PIH) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Solar lentigines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pediatric perspectives: Transient neonatal pustular melanosis Candrice R Heath . . . . . . . . . . . . . . . . . . .

195
199
201
203
204
207
209

11. Hypopigmented Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
David A Rodriguez
Hypomelanosis of Ito . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hypopigmented cutaneous T-cell lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hypopigmented sarcoidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pityriasis alba . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Vitiligo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pediatric perspectives: Vitiligo Candrice R Heath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

211
212
215
216
217

221

Part 3. Follicular Disorders and Alopecias . . . . . . . . .

225

12. Alopecias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Raechele Cochran Gathers
Alopecia areata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Alopecia mucinosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Central centrifugal cicatricial alopecia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dissecting cellulitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Discoid lupus erythematosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Traction alopecia Crystal Y Pourciau . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Traumatic alopecia: chemical, heat and mechanical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trichotillomania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

227
232
234
236
239
242
244
246

13. Follicular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Raechele Cochran Gathers
Acne keloidalis nuchae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Folliculitis decalvans Crystal Y Pourciau . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

Pseudofolliculitis barbae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254

Part 4. Tumors Benign and Malignant . . . . . . . . . . . . .

257

14. Benign Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Erica Mailler-Savage, Matthew Joseph Turner, David Robert Crowe, Erica Chon Davis and Hugh Morris Gloster Jr
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Acrochordon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260

viii


Contents
Dermatofibroma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dermatosis papulosa nigra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Epidermal nevus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Congenital melanocytic nevus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dysplastic nevus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Epidermoid cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Keloid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

260
261
263
264
265
266
267

15. Malignant Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Erica Mailler-Savage, Matthew Joseph Turner, David Robert Crowe, Erica Chon Davis and Hugh Morris Gloster Jr
Basal cell carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Cutaneous T-cell lymphoma (CTCL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Dermatofibrosarcoma protuberans (DFSP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276
Malignant melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Squamous cell carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279

Part 5. Cosmetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

287

16. Cosmetic Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Valerie D Callender and Erica Chon Davis
Hair cosmetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Shampoos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hair moisturizers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chemical processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hair dyes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Glossary of terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Camouflage techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skin cosmetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skin lightening agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Photoprotection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Camouflage techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

289
289
292

293
294
296
301
301
301
306
306

17. Cosmetic Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Valerie D Callender, Vic A Narurkar and Erica Chon Davis
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Botulinum neurotoxin-A (BoNT-A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chemical peels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fillers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hair transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lasers, light sources and other devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

309
311
315
321
326
332

ix


Contents

Part 6. Complementary and Alternative Medicine . .

349

18. An Overview of Complementary and Alternative Medicine . . . . . . . . . . . . . . 351
Janet L Nelson and Sonia Badreshia-Bansal
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Alopecia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Eczema / Atopic dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Psoriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375

x

351
357
361
364
368


Preface
There are many complexities associated with selection of
appropriate treatment for cutaneous diseases. These complexities increase when selecting treatment for patients with skin of
color due to structural and functional differences in their skin
and hair as well as differing adverse event profiles. Treatment
for Skin of Color is an important resource that will allow the
practicing clinician to quickly identify evidence-based treatment options for their skin of color patients. The scope of the
book is extensive beginning with medical dermatology followed by follicular disorders, tumors, cosmetics and concluding with alternative medicine. Each therapy covered has been

assigned an evidence level from A (the strongest scientific
evidence) to E (anecdotal case reports) reflecting the amount
of published evidence available to support its use.
The truly outstanding authors of Treatment for Skin of Color,
to whom I am indebted, were chosen for this project based

upon the strength of their clinical skills, and their ability to
educate and present information in an organized, succinct and
easily absorbable manner. The work of Drs. Rodriguez, Gathers,
Badreshia-Bansal, and Callender with diverse patient populations coupled with their clinical research experience have
allowed us to produce a unique resource.
When a question or therapeutic dilemma arises in a teaching clinic or private office setting, Treatment for Skin of Color is
a quick reference for either the dermatology resident or the
more experienced clinician. Additionally, by providing extensive references, it provides the first step for a seamless in-depth
look into topics of interest.
Susan C Taylor, MD

xi


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List of Contributors

Sonia Badreshia-Bansal MD

Raechele Cochran Gathers MD

Clinical Instructor

Department of Dermatology
University of California San Francisco
Elite MD, Inc
Advanced Dermatology, Laser, and Plastic Surgery Institute
Danville, CA, USA

Senior Staff Physician
Henry Ford Hospital
Multicultural Dermatology Center
Detroit, MI, USA

Vivek Bansal MD

Professor of Dermatology
Director of Dermatologic Surgery and Mohs Surgery
University of Cincinnati
Cincinnati, OH, USA

Medical Director of Plastic Surgery
Elite MD, Inc
Advanced Dermatology, Laser, and Plastic Surgery Institute
Danville, CA, USA

Valerie D Callender MD
Associate Professor of Dermatology
Howard University College of Medicine
Washington DC, USA
Callender Skin and Laser Center
Glenn Dale, MD, USA

David Robert Crowe MD
Dermatology Resident
Department of Dermatology
University of Cincinnati
Cincinnati, OH, USA

Erica Chon Davis MD
Dermatology Research Fellow
Callender Skin and Laser Center
Glenn Dale, MD, USA

Hugh Morris Gloster Jr MD

Candrice R Heath MD
Physician
Children’s Healthcare of Atlanta
Atlanta, GA, USA

Erica Mailler-Savage MD
Clinical Instructor
Dermatology Department
University of Cincinnati
Cincinnati, OH, USA

Vivek Nair MD
Senior Resident
Department of Dermatology
Maulana Azad Medical College
New Delhi, India

Vijay K Garg MD MNAMS

Vic A Narurkar MD FAAD

Professor and Head of Department
Department of Dermatology
Maulana Azad Medical College
New Delhi, India

Chairman
Department of Dermatology
California Pacific Medical Center
San Fransisco, CA, USA

xiii


List of Contributors
Janet L Nelson MS Lac

Surabhi Sinha MD MNAMS DNB

Practitioner of Asian Medicine
Elite MD, Inc
Advanced Dermatology, Laser, and Plastic Surgery Institute
Danville, CA, USA

Senior Resident
Department of Dermatology
Maulana Azad Medical College

New Delhi, India

Ninad Pendharkar MD

Sumayah J Taliaferro MD

Dermatology Resident
Penn State, College of Medicine
Department of Dermatology
Milton S. Hershey Medical Center
Hershey, PA, USA

Dermatologist
Private Practice
Metro Atlanta Dermatology
Atlanta, GA, USA

Crystal Y Pourciau MD MPH
Resident Physician
Department of Dermatology
Henry Ford Hospital
Detroit, MI, USA

David A Rodriguez MD
Clinical Assistant Professor
University of Miami School of Medicine
Dermatology and Cutaneous Surgery
Miami, FL, USA

Rashmi Sarkar MD MNAMS

Associate Professor
Department of Dermatology
Maulana Azad Medical College
New Delhi, India

xiv

Matthew Joseph Turner MD PhD
Dermatology Resident
Department of Dermatology
University of Cincinnati
Cincinnati, OH, USA

Janelle Vega MD
Dermatology Resident
University of Miami Miller School of Medicine
Miami, FL, USA


Evidence Levels
Each therapy covered has been assigned a letter from A (most
evidence) to E (least evidence) signifying the amount of published evidence available to support its use. The following
table shows the criteria used in making this classification.
A DOUBLE-BLIND STUDY
At least one prospective randomized, double-blind,
controlled trial without major design flaws (in the
author’s view)
B CLINICAL TRIAL ≥ 20 SUBJECTS

C CLINICAL TRIAL < 20 SUBJECTS

Small trials with fewer than 20 subjects with significant
design limitations, very large numbers of case reports
(at least 20 cases in the literature), retrospective analyses
of data
D SERIES ≥ 5 SUBJECTS
Series of patients reported to respond (at least 5 cases in
the literature)
E ANECDOTAL CASE REPORTS

Prospective clinical trials with 20 or more subjects; trials
lacking adequate controls or another key facet of design,
which would normally be considered desirable (in the
author’s opinion)

Individual case reports amounting to published experience
of less than 5 cases

xv


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Acknowledgements
Each of us had the invaluable opportunity to collaborate with
extraordinary colleagues on various chapters of this book. We
thank them for their expertise and commitment to making this
book a success.
We also thank Claire Bonnett of Elsevier Publishing who
guided this project from the very beginning and Nani Clansey

and Beula Christopher for their assistance in completing this
extensive project.
Drs. Taylor, Badreshia-Bansal,
Callender, Gathers, and Rodriguez

xvii


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Introduction
Each day in dermatology practices and clinics throughout the
United States, we find ourselves increasingly challenged as we
attempt to select the most appropriate treatments for our skin
of color patients. Our challenges are two-fold. First, in the
United States, the number of individuals with skin of color
has increased significantly and continues to do so. Those who
were previously considered in the minority, by the year 2056
will become the majority of US citizens. Thus, we are increasingly encountering skin of color patients including those
with more complicated and difficult to treat dermatologic
disorders. Secondly, differences in the skin and hair of individuals with skin of color have important implications regarding treatment selection, success and sequelae. Treatment for
Skin of Color is designed to assist and guide clinicians in the
selection of the best therapeutic options for their skin of color
patients, assess the likelihood of success, and educate regarding common and unexpected adverse events.
Who is the patient that we are primarily addressing in Treatment for Skin of Color? For the purposes of this book, we are
defining skin of color patients as those who have Fitzpatrick
Skin Phototypes IV through VI (Table 1). Thus, we are concentrating on individuals with darker skin hues including patients
with light brown, brown and black skin tones as compared to

patients with white skin tones.
Additionally, individuals of several racial and ethnic groups
are highly represented in the group of patients with darker skin
hues including those of Southeast and South Asian, Latino or
Hispanic, African, and Native American descent. Although
there is clearly variability in skin hue amongst individuals of
these racial and ethnic groups, many have darker skin hues.
Why is it important to distinguish skin of color patients
from others when considering treatment options? Fundamental structural and functional differences exist between individuals with skin of color and those with white skin tones.
These differences may have a direct effect upon a clinician’s
selection of appropriate treatment as well as for the rate of
success of the treatment and occurrence of adverse effects. Key
differences involve melanin content and pigmentation, fibrosis and scarring, and tightly coiled hair and follicular disorders,
to name just a few. For example, facial seborrheic dermatitis is
a common cutaneous disorder in individuals of all skin types.
However, because of the lability of melanocytes in individuals
with darker skin tones, post-inflammatory hypopigmentation

is often the presenting complaint in skin of color seborrheic
dermatitis patients. In this patient population, treatment considerations will include agents that simultaneously treat the
seborrheic dermatitis as well as the post-inflammatory hypopigmentation such as lower potency corticosteroids or topical
immune modulators. Additionally, patients should be counseled that the pigmentary alteration is temporary and does not
represent the more serious disorder, vitiligo. Furthermore, for
patients with concomitant scalp seborrheic dermatitis, daily
shampooing is often not the most appropriate treatment given
the tightly coiled hair with low water content and increased
fragility of this population. Rather, the addition of daily topical
treatment agents coupled with once weekly shampooing often
yields appropriate treatment results and avoids potential
adverse events.

Often, adverse event profiles are different in skin of color
patients. Consequently, the selection of treatment may vary. As
an example, a disorder in which liquid nitrogen is an accepted
treatment for white skin hues may not be the appropriate
treatment for skin of color patients due to the sequelae of
hypopigmentation or depigmentation. Additionally, cosmetic
procedures, such as laser hair removal may need to be performed with a lower fluence or a particular laser may be
required given the propensity of skin of color toward laser
induced hyperpigmentation.
Some disorders may occur at increased frequency or even
exclusively in skin of color patient populations. An important
example is central centrifugal cicatricial alopecia (CCCA).
Whereas alopecia areata is covered in general treatment books,
central centrifugal cicatricial alopecia is usually not included.
CCCA appears to be responsible for more cases of scarring
alopecia in African American women as compared to all other
forms of scarring alopecia combined. For this disorder, understanding treatment selection, success and sequelae is critically
important. Treatment for Skin of Color will provide insight into
these types of disorders.
Likewise, there are differences in the occurrence of sys�
temic disorders in certain skin of color populations. Hyper�
tension and diabetes affect individuals of African and Latino
descent disproportionately as compared to those of Caucasian
descent. One would expect increased dermatologic disorders
related to these disorders. Examples would include dis�
orders such as drug-induced eruptions which may present

xix

Introduction

Table 1╇ Fitzpatrick Skin Phototypes and Corresponding Color Hues
Type

Description

Type I

Always burns, never tans (white skin tones)

Type II

Always burns, minimal tan (white skin tones)

Type III

Burns minimally, tans moderately and gradually (white
skin tones)

Type IV

Burns minimally, tans well (light brown skin tones)

Type V

Rarely burns, tans deeply (brown skin tones)

Type VI

Never burns, tans deeply (dark brown/black skin tones)

differently in skin of color patients, such as photodistributed
hyperpigmentation.
Finally, the definition of treatment success may vary with
skin of color patients as compared to those of Caucasian
descent. Skin of color patients may view acne as unsuccessfully
treated if post-inflammatory hyperpigmentation (PIH) remains
after papules, pustules and comedones have resolved. Therefore, treatment of PIH is as important as treatment of the acne
in skin of color populations. Either the selection of topical
agents that can simultaneously address acne and PIH, or the
simultaneous use of acne and PIH agents are required in this
population.

How should you use this book?
Treatment for Skin of Color is a great resource that should not
be read once and then filed away in a bookcase. Rather, it
should be kept near you in your practice or clinic to be referred
to on a daily basis. It will provide you with the most up to
date treatment recommendations and you will find that it will
be particularly helpful as you navigate treatment dilemmas.
In addition, under each disease, you will find two invaluable
sections: Commonly Encountered Pitfalls in Skin of Color and
Special Management and Counseling Considerations. These sections provide diagnostic pearls, examples of potential hindrances to achieving treatment goals and how to avoid them,
and effective ways to counsel your skin of color patient.

Organization of the book
Treatment for Skin of Color is organized into six easy to use
sections. Pediatric perspectives on treatment have been added
at the end of certain sections.

• Medical dermatology
• Pigmentary disorders

xx

•
•
•
•

Follicular disorders including alopecia
Tumors benign and malignant
Cosmetics
Alternative medicine.

In each section, treatment will be outlined specifically with
your skin of color patients in mind. Additionally, each treatment will be evaluated and assessed based upon the current
evidence available in the literature. The evidence level scale
utilized in this book is one that you may be familiar with as
it encompasses five grades, A through E.
A Double blind, control trial
B Clinical trial involving more than 20 subjects
C Clinical trial involving fewer than 20 subjects
D Case series involving more than 5 subjects
E Anecdotal case reports involving fewer than 5 subjects.
As you will see, there is a relative paucity of data for the treatment of certain diseases that occur in your skin of color
patients. In recent years, the FDA has required populations of
diverse subjects in pivotal trials for new drugs and devices.
Existing clinical trials or case series that include skin of color
patients, when available, have been cited for each treatment.

Nevertheless, there are many disorders in which there are no
clinical trials or case reports that include skin of color subjects.
In these instances, we rely on anecdotal case reports, the experience of skin of color experts or experience with non-skin of
color patients.
Unlike other books that provide a guide to treatment, we
thought it important to include a section on complementary
and alternative medicine (CAM) because of its importance to
many skin of color populations. Even if you do not suggest or
prescribe to these particular treatments, the CAM section in
this book will provide a firm foundation for you to understand
the fundamentals of these treatments. As you will learn in this
chapter, Americans spend $34 billion dollars annually on
complementary and alternative medicine. CAM’s use by adults
with dermatologic disorders in the US has been estimated at
between 50% and 62%. It has been estimated that in skin of
color patients, 50% of Native Americans, 40% of Asians, 25%
of Blacks and 25% of Hispanics utilize some form of CAM.
This section will provide insight and guide you as to treatments that your patients may already be participating in.
We trust that you will find Treatment for Skin of Color a valuable and trusted resource. The treatment sections offer firstline, second-line and third-line recommendations which will
provide the entire scope of available therapeutic options. We
trust that Treatment for Skin of Color will allow you to select the
most effective and safest treatments for your skin of color
patients.
Susan C Taylor, MD


PART 1

Medical Dermatology

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Part 1

Medical Dermatology

Acneiform Disorders
Sonia Badreshia-Bansal and Vivek Bansal

Acne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Acne vulgaris . . . . . . . . . . . . . . . . . . . . . . . . 3
Pomade acne . . . . . . . . . . . . . . . . . . . . . . . 12
Steroid acne . . . . . . . . . . . å°“. . . . . . . . . . . . å°“. 13
Pediatric perspectives: Infantile acne . . . . . . . . . . . 13
Pediatric perspectives: Neonatal acne
(acne neonatorum) . . . . . . . . . . . .å°“ . . . . . . . . . 14
Acne rosacea . . . . . . . . . . . . . . . . . . . . . . . . 14
Hidradenitis suppurativa . . . . . . . . . . . . . . . . . . 19
Perioral dermatitis . . . . . . . . . . . . . . . . . . . . . 21

Acne
Acne vulgaris
Acne vulgaris is a multifactorial disorder of the pilosebaceous
unit.1–4 The pathogenesis involves a complex interaction of
multiple internal and external factors. The four main factors
that cause acne include excess sebum from increased androgenic hormonal stimulation (especially at adrenarche), follicular epidermal hyperkeratosis with subsequent plugging of
the follicle, elevated P. acnes population, and subsequent
inflammation.1–4 Medications that can precipitate acneiform

lesions include corticosteroids, lithium, some antiepileptics,
and iodides.5 Genetic factors may also play a role.6
Acne vulgaris is a common skin disease that affects over
85% of people at some time point. It is also an extremely
©2011 Elsevier Ltd, Inc, BV

1â•…

common dermatological problem among ethnic patients and
is found predominantly during adolescence.7 Acne may be
present in the first few weeks and months of life while a
newborn is still under the influence of maternal hormones
and when the androgen-producing portion of the adrenal
gland is disproportionately large.8 Neonatal acne resolves
spontaneously. Adolescent acne commonly begins prior to the
onset of puberty, when the adrenal gland begins to produce
and release higher levels of the androgen hormone. However,
acne is not limited to adolescence – 12% of women and 5%
of men at 25 years of age have acne. By 45 years of age 5% of
both men and women are still affected.7
The diagnosis of acne is primarily clinical and may be characterized by comedones, papules, pustules, nodules and cysts.
Acne vulgaris affects areas of the skin more densely populated
with sebaceous follicles, including the face, upper chest, and
back. A severe inflammatory variant of acne, acne fulminans,
can be associated with fever, arthritis, and additional systemic
symptoms. Darker skin types represent a particular clinical
challenge for dermatologists treating acne due to the higher
risk of post-inflammatory hyperpigmentation (PIH), hypertrophic scarring, and keloids (Fig. 1.1). Additionally, acne
lesions may lead to permanent scarring. Although the overall
prognosis is good, acne can result in long-lasting psychosocial

impairment and physical scarring.
The differential diagnosis of acne is extensive. During the
neonatal period, it includes transient sebaceous hyperplasia,
miliaria, and Candida. In adolescence and adulthood, appendageal tumors such as trichoepithelioma, trichodiscomas, cysts,
steatocystoma multiplex, and eruptive vellus hair cysts should
be considered in the differential diagnosis. Bacterial folliculitis, pseudomonas folliculitis (if on the lower trunk), rosacea,
pseudofolliculitis barbae, acne keloidalis nuchae, perioral

3


Part 1

Medical Dermatology

Figure 1.1:╇ This African-American patient presents with active acne and PIH.

dermatitis (if previously treated with topical corticosteroids),
and steroid acne (if treated with oral corticosteroids) may also
be considered. Cultures of skin lesions to rule out Gramnegative folliculitis are necessary when acne is unresponsive
to treatment or when improvement is not maintained with
treatment.
As with all patients, therapy should be directed toward the
known patho�genic factors. The grade and the severity of the
acne determines which of the following treatments is most
appropriate (Fig. 1.2). When using a topical or systemic antibiotic, a benzoyl peroxide should be utilized in conjunction
to reduce the emergence of bacterial resistance. The patient’s
skin color, skin type, and propensity for PIH can influence
choice of formulation of a topical regimen. The ideal acne
treatment for ethnic skin would specifically target the inflammatory process as well as the resulting hyperpigmentation.

There are several components to the treatment of mild acne
including topical retinoids, antibiotics and benzoyl peroxide.
Topical retinoids, including tretinoin, adaalene and tazarotene, are comedolytic, normalize follicular hyperkeratinization, and are anti-inflammatory.9–11 Retinoids may enhance the
penetration of other topical products and medications.12 They
are known to thin the stratum corneum, cause irritation, and
increase the risk of sunburn.13 Therefore, the use of sunscreen
is essential. Short contact method and gradual titration may
be attempted to increase tolerance and minimize contact irritant dermatitis.14 Although topical retinoids may result in
improvement of PIH, the potential for irritation may provoke
further PIH. Each retinoid has unique characteristics. For
example, the synthetic retinoid, adapalene is light stable and
resistant to oxidation by benzoyl peroxide.15 Finally, retinoids
are known teratogens and contraceptive counseling must be
provided to women of childbearing age.
Benzoyl peroxide is an important bacteriostatic agent that
exerts its affect through the interaction of oxidized intermediates with elements of bacterial cells. It decreases inflammatory
damage by inhibiting the release of reactive oxygen species
from polymorphonuclear leukocytes.16 However, the risk of
irritation with subsequent PIH may occur. Benzoyl peroxide is
most effective when used in a combination as resistance to this
agent has not been reported.17–18

4

Topical antibiotics are helpful in controlling P. acnes colonization and its pro-inflammatory mediators. The development of resistance is significant when antibiotics are used as
monotherapy, and greatly lowered when used in combination
treatment with benzoyl peroxide. Clindamycin inhibits
bacterial protein synthesis by binding to the 50S ribosomal
subunits, causing inhibition of peptide-bond formation.19
Clindamycin suppresses the complement-derived chemotaxis

of polymorphonuclear leukocytes in vitro, thereby reducing
the potential for inflammation.20 Azelaic acid is a naturally
occurring dicarboxylic acid which inhibits growth of P. acnes,
alters hyperkeratinization and may help to lighten PIH.21
Sodium sulfacetamide is a generally well tolerated topical antibiotic that restricts P. acnes growth.22 It is available in a 10%
lotion in combination with 5% sulfur with tinted formulations available. Salicylic acids are widely used over-the-counter
products for their comedolytic and mild anti-inflammatory
ability.
Moderate to severe inflammatory acne unresponsive to a
topical combination regimen will require systemic treatment.
First-line antibiotic therapy with tetracycline or its derivatives
doxycycline and minocycline, suppress growth of P. acnes and
are anti-inflammatory. At this time, minocycline is felt to have
less antibiotic resistance but increased side effects including
nausea, vomiting, esophagitis, yeast infection, and sun sensitivity compared to tetracycline.23,24 In addition, minocycline
crosses the blood–brain barrier and increases susceptibility to
pseudotumor cerebri and also can cause a serum sicknesslike reaction, drug-induced lupus, or blue-black pigmentation.23,24 Erythromycin has the greatest amount of resistance.25
Other antibiotics reportedly useful include trimethoprimsulfamethoxazole, and azithromycin. Hormonal therapies
may be effective in the treatment of acne. When hyperandrogenism is suspected, especially in a female patient with dysmennorhea or hirsutism, a hormonal evaluation including
total and free testosterone and DHEA sulfate should be
performed. Oral contraceptive agents have been shown to
be effective in decreasing circulating free testosterone while
spironolactone binds the androgen receptor and reduces
androgen production.26 Side effects with spironolactone
include breast tenderness, dysmennorhea, and abnormalities
in blood pressure.
Severe, scarring acne is best treated with the oral retinoid,
13-cis-retinoic acid. Isotretinoin normalizes follicular hyper�
keratinization and causes sebaceous gland atrophy, thus
reducing sebum production and producing an unfavorable

environment for P. acnes.9 In patients with marked inflammatory acne, lower starting doses may be indicated to prevent the
induction of severe flares during the first month of treatment.28
In cases of acne fulminans or initial retinoid induced flares,
prednisone may decrease the severity of the flare and sub�
sequent exuberant granulation tissue formation. Potential
adverse events are numerous and may include generalized
xerosis, eczematous dermatitis, and elevated triglycerides,
decreased night vision, arthralgias, myalgias, headache,
depression, skeletal hyperkeratosis, elevations in liver function
tests or an abnormal blood count. Teratogenicity is among the