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People of African, Asian, Latin and Native American backgrounds know that their skin, hair and nails are subject to conditions that do not affect lighter skinned people. “While most of these are not serious, they may be disturbing, troubling or unsightly,” says Joshua Fox, MD, a leading dermatologist, founder of Advanced Dermatology and an official spokesperson for the American Academy of Dermatology and the American Society of Dermatologic Surgery.

“Fortunately, your dermatologist is well acquainted with these conditions and can help people with dark skin to diagnose and treat their concerns early and quickly,” says Dr. Fox. He offers the following listing of the top skin conditions faced by people of color and how it differs from lighter-skinned individuals.

1. Acne – Many dark skinned women suffer from acne vulgaris, sometimes combined with hyper pigmentation, or skin darkening in spots or patches, which occurs in response to the outbreak of acne. Unlike fairer-skinned individuals, the discoloration plays an integral role in treatment. Surprisingly, these patients are more bothered by the discoloration than the acne itself. Treatments may include topical skin lightening creams for dark spots, sunscreen and topical, prescription acne medications.

2. Dermatosis Papulosa Nigra – These brown or black raised spots, which commonly affect African American women and people of Asian descent, may look like moles or flattened warts. They are always benign, never lead to skin cancer and are not harmful. However, some people do have them removed for cosmetic reasons. Typically, up to 50 percent of Dermatosis Papulosa Nigra patients have a family history of the condition, and up to 35 percent of adult blacks in the United States have it. They are easily removed with minimal to no marks.

3. Eczema – Very common among those with brown skin, eczema is an itchy, irritating rash that can occur in skin of any type or color. However, according to the National Eczema Society, it is found twice as often in black skin. When it does occur, differences in the structure of black from Caucasian skin can cause related problems including excessive pigmentation and a thickening of the skin that can also cause changes in skin color. “Because eczema is harder to identify in dark skin, and is often confused with psoriasis or fungal infections, getting the right diagnosis and treatment can be difficult,” Dr. Fox says. “Once the correct diagnosis has been made, topical medicines are quite helpful.”

4. Keloids – Scar tissue caused by abnormal healing of the skin occurs frequently in individuals with brown skin. Any time dark skin is injured, the risk of keloids is dramatically increased. According to Skin & Aging magazine, up to 16% of black and Asian people suffer from keloids. Keloids can develop immediately following an injury or take a long time to grow. Sometimes they itch, are painful and burning or feel tender to the touch. Treatments include cortisone and other injections, radiation therapy, pressure dressings, silicone gel applications and several types of lasers are extremely helpful. Keloids can also be removed via traditional or laser surgery.

5. Traction Alopecia – This hair loss condition is caused by damage to the hair follicle from constant pulling or tension over a long period of time. It is most common in African Americans who braid their hair tightly, but can also be caused by over processing of the hair through dyes, bleaches or straighteners. According to the National Institutes of Health, some 17% of African-American schoolgirls (6-21 years) and more than 30% of women (18-86 years) suffer from traction alopecia. While this condition can be reversed if diagnosed early, it can lead to permanent hair loss if it is undetected for a long period. These people – mainly women – should change to looser, gentler hair styles and should see a dermatologist. Unfortunately, no medical treatment is available to reverse late-stage traction alopecia; hair grafts, transplants or wigs have been identified as the only practical solution.

6. Melanoma — Those with brown skin often have a false sense of security when it comes to skin cancer. “While increased skin pigmentation offers some protection against the sun’s harmful UV rays,” Dr. Fox says, “melanoma can and does occur,” unlike in the lighter-skinned individual, it occurs especially on the palms, soles, fingers and toes, nails and mucous membranes (such as the mouth or nose). “A new dark mark or a mark that changes in size, shape or color in these areas should be seen by a dermatologist immediately. Even people with dark skin should always use a sunscreen when spending extensive time in the sun,” he says.

7. Pigmentation – Women with brown skin, particularly those of African and Latino descent, have a high incidence of hypertension, diabetes and heart disease and thus take medications for those medical problems. These, as well as other commonly used medications (LIST MEDICATIONS THAT CAN CAUSE PROBLEMS) can cause various types of allergic reactions that frequently lead to hyperpigmentation, or dark patches. While the dark spots can fade over time, women should seek treatment early. Procedures such as chemical peels and skin bleaching, designed to lighten the darkened areas, can help, as can diligent use of sunscreen. The new Fraxel™ is the first laser approved for treatment of melasma – a type of pigmentation disorder of the face.

8. Vitiligo – Skin gets its color from pigment cells. When those cells are damaged or destroyed, they no longer produce pigment, causing white or colorless spots to appear. The spots can grow larger over time and eventually blend together so that large portions of the skin have no color at all. While no one knows why this occurs, many suspect it is related to problems within the autoimmune system. Vitiligo also may be hereditary. While people of any skin color can develop Vitiligo, it is most obvious and therefore debilitating on dark skin. One common treatment is PUVA — a repigmentation therapy involving the drug psoralen combined with exposure to UV light. A simpler, newer and equally efficacious treatment is narrowband UVB light treatment. The newest laser treatment though is that of the Excimer laser 308nm which markedly shortens the number to treatments and spares unwanted streaks. This process help increase the amount of pigment cells at the skin’s surface. Other treatments include prescription-strength corticosteroid cream, light/laser treatments and, in rare instances, skin grafting.

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  • Filed under: Skin Care
  • YAG for Face Cancer

    A very important study was recently published in European Journal of Dermatology. A group of Russian researchers reported the results of the use of Neodymium laser radiation (Nd:YAG 1064 nm) for the treatment of facial carcinoma. They followed the treatment of 2,837 patients with 3,001 histologically confirmed facial skin carcinoma lesions of stages T1-2N0M0: 2,743 primary basal cell carcinomas (BCC), 172 recurrent limited basal cell carcinomas (RLBCC), and 86 primary squamous cells carcinomas (SCC).

    (more…)

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  • Filed under: LT | skin cancer
  • Nd:YAG Laser Treatment of Warts

    Warts are ugly but they are common, and there are many ways and means to remove them. I prefer to use a YAG laser to remove warts.

    Surprisingly, this simple technique is not very common among dermatologists who typically freeze warts with nitrogen. That is painful and not very effective as in many cases more than one treatment is required.

    Digging into the body of research on the subject I found a report on a study published in September 2009 by the Korean Academy of Medical Sciences.

    This study was designed to evaluate the efficacy of long-pulsed Nd:YAG laser in the treatment of warts. Over the course of 1 yr, 369 patients with recalcitrant or untreated warts were exposed to a long-pulsed Nd:YAG laser. The following parameters were used:

    • spot size: 5 mm;
    • pulse duration: 20 msec;
    • fluence: 200 J/cm2.

    (more…)

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  • Filed under: LT | other laser therapy
  • blotchy skin with spots

    Treatment of pigmentation is a complex subject. Determining the type of lesion will help to establish which laser or light device to use and what parameters to set.

    Hyperpigmentation is a broad descriptive term, offering us little information about etiology or pathophysiology of the lesion. Dividing this expansive category into primary versus secondary helps with treatment decision-making and predicting outcome.

    Moreover, hyperpigmentation can stem from epidermal, dermal or a combination of these locations. Discrete lesions, such as lentigines, ephelides (primarily epidermal lesions) and nevus of Ito or Ota and decorative tattoos (primarily dermal lesions), show the most favorable response to laser and light-based therapies.

    Postinflammatory hyperpigmentation would be the main component of the secondary hyperpigmentations. Melasma can also be considered in this category, as it generally behaves similarly to postinflammatory hyperpigmentation after laser treatments, showing the most unpredictable response to laser and light-based therapies.

    Primary pigmented lesions are generally easier to treat than secondary lesions. For localized lesions on the trunk and face, the Q-switched lasers are very successful at removing pigmentation. These include Q-switched ruby (694 nm), Q-switched alexandrite (755 nm) and Q-switched Nd:YAG (both 1,064 nm and 532 nm). For darker skin types, choose the longer-wavelength Q-switched lasers, as their emissions have less absorption by melanin and hence less competition/absorption from normally pigmented skin.

    To learn more about the use of IPLs, long-pulsed dye laser (LPDL) and Q-switched lasers for the treatment of solar lentigines, photoaging and flat seborrheic keratosis read The right tool: Lesion type determines which laser, light device is best choice, opinions of Joely Kaufman, M.D., assistant professor of clinical dermatology at the University of Miami Miller School of Medicine and director of lasers for the University of Miami Cosmetic Group, and Vic Narurkar, M.D., the chair of dermatology at California Pacific Medical Center and director and founder, Bay Area Laser Institute, and associate clinical professor of dermatology at University of California Davis School Of Medicine.

    Just like Dr. Kaufman and Dr. Narurkar, I believe that there is a potential of further development of “do it at home” lasers:

    “It remains to be seen what type of contribution the at-home devices will play in the treatment of pigmentation. The newer devices coming to the market look very promising as both preventive and adjuvant therapeutic options.”

    Laser lasers and light-based devices for home use cannot be considered as a replacement of medical office treatment, but some of the products in the laser industry pipeline can be used as ancillary tools to enhance the effectiveness of a medical treatment plan.

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  • Filed under: LT | pigmented lesions
  • Using Laser to Remove Cyst

    Several subscribers have asked us how lasers can be used to remove a cyst.

    A sebaceous cyst is a benign lesion of the skin, which looks like a closed sac or cyst below the surface of the skin that has a lining that resembles the uppermost part of a hair follicle that is filled with a fatty white, semi-solid material called sebum. Sebum is produced by sebaceous glands of the epidermis. More about Sebaceous Cyst.

    Traditional techniques to remove cyst are:

    1. conventional wide excision (can remove the cyst completely but with a potentially big scar),
    2. minimal excision (similar to the punch technique, which can achieve minimal scarring but carries a risk of recurrence), and
    3. punch biopsy excision (high risk of recurrence).

    For large cysts or cysts located in areas of thick skin, the cyst wall is more friable or not easy to squeeze. Complete cyst removal with a better cosmetic appearance in these cases is more difficult to achieve.

    A new procedure for treating a Sebaceous Cyst was recently published by study group from China.

    Chinese physicians have documented a what seems to be a very effective treatment protocol. They use laser punches to prepare the cyst for the removal of the content with a minimal excision.

    The new method with two steps is proposed:

    • A CO2 laser is used to make a small hole for removal of the cyst content;
    • then the cyst wall is removed entirely with a minimal excision about 1 month later.

    The method offers a good alternative for eradication of uninfected cysts with only a small scar, especially large cysts or cysts located in areas of thick skin or cosmetic concern. Images and more detailed description of the laser cyst removal procedure.

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  • Filed under: LT | other laser therapy
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