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South Asians (SAs) are among the fastest growing populations in the USA. Colorism — the system of inequality that views lighter skin as more advantageous in society — is prevalent in SA culture. This study evaluates motivations of sun protection use, attitudes of colorism, and skin lightening (SL) practices among SA Americans. Two-hundred-four participants recruited from online forums and ResearchMatch completed a questionnaire. Over half (111/204) reported use of sunscreen, of which 39.6% (44/111) reported daily or frequent use. Nearly half of respondents (98/204) believed that they are not at risk for skin cancer, with 37.7% (77/204) reporting minimal knowledge of skin cancers and only 4.9% (10/204) receiving a total body skin exam. One-third (65/204) reported being more concerned about prevention of tanning than skin cancer. In total, 38.2% (78/204) of respondents reported use of SL products, of which 33.3% (26/78) reported hydroquinone-based products and 26.9% (21/78) were unaware of the ingredients in their SL product. Only 16.7% (13/78) consulted a medical professional before using SL products. While many agreed that SA culture places high importance on light skin with regards to beauty standards (82.3%, 168/204), less noted that lighter skin is more beautiful (37.0%, 74/204). SL users more strongly agreed with colorism attitudes than non-users. Limitations include a small sample size with younger participants. Dermatologists must be mindful of the cultural motivations for skin tone preferences, sun protection habits, and SL behaviors and provide culturally relevant education on sunscreen, skin cancer, and risks of SL for the SA community.

IMPORTANCE: The availability and quality of skin and hair care for black patients in the United States has been a subject of growing interest in dermatology. There is limited understanding of the perceptions of black patients about the care they receive from dermatologists and the factors affecting their care satisfaction. OBJECTIVE: To elucidate black patients’ perceptions of their dermatology experience in and outside of a skin of color clinic (SOCC). DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study involving a survey and focus groups was conducted including adult black patients treated in an SOCC. Recruitment was conducted April through June 2015 through clinic-posted flyers. Participants engaged in 1 of 4 focus groups on July 14, 15, 29, or 30, 2015, and completed a survey. Data were analyzed March 2016 through June 2017. MAIN OUTCOMES AND MEASURES: Planned outcomes of the focus groups were black patients’ inductively generated themes on their perspectives and experiences in dermatology clinics. Planned outcomes of the survey were patients’ ratings of SOCC and non-SOCC dermatologists in terms of interaction style, cultural awareness, and treatment satisfaction. Importance of patient-dermatologist racial concordance was a planned outcome in both measures. Given lack of existing prior research, no specific hypotheses were generated. RESULTS: Of the 19 adult black patients who participated in the study, 18 (95%) were women, and the mean (SD) age was 50.0 (14.2) years. All patients reported positive experiences in the SOCC. Compared with non-SOCC dermatology treatment experiences, patients reported higher levels of overall satisfaction with SOCC dermatologists (t13 = 2.85; P = .01). Patients perceived that SOCC dermatologists were better trained to care for black patients (t13 = 4.42; P = .001); showed patients greater respect and dignity (t13 = 3.37; P = .005), as well as understanding (t13 = 2.56, P = .02); and were more trustworthy (t13 = 3.47; P = .004). The majority of the comments in the focus groups (n = 207) described 2 themes: dermatologists’ interaction style (62/207; 30.0%) and knowledge about black skin and hair (42/207; 20.3%). Other themes were partnering with patients on outcomes (17/207; 8.2%), shared life experiences (14/207; 6.8%), and economic sensitivity (7/207; 3.4%). These themes accounted for a large part of the participants’ discussion. Of all respondents, 71% (12/17) stated that they would prefer a black (or race concordant) dermatologist; this included 91% (10/11) of the race-concordant group and 33% (2/6) of the race-discordant group. CONCLUSIONS AND RELEVANCE: Participants reported that the SOCC dermatologists provided unique and uniformly beneficial care to black patients. Care satisfaction appeared most related to dermatologists’ interpersonal style and specialized knowledge in care of black skin and hair. Findings suggest that black patients’ dermatologic care satisfaction would increase if dermatologists underwent enhanced residency training in skin of color, cultural competency, cost-conscious care, and empathic communication skills, and if there were greater dermatology workforce diversity.

IMPORTANCE: Sunscreen use is a modifiable behavior that can help reduce the risk for skin cancer, prevent sunburns, mitigate photoaging, and treat photosensitive dermatoses. A better understanding of consumer sunscreen preferences would inform dermatologists in their own recommendations. OBJECTIVE: To determine the characteristics and the most commonly cited positive and negative features of highly rated sunscreens described by consumers. DESIGN, SETTING, AND PARTICIPANTS: The top 1 percentile of sunscreen products on Amazon.com as of December 2015 was selected according to average consumer review (≥4 stars) and the highest number of consumer reviews. Descriptive data for each product were collected from the product page and manufacturer claims. The top 5 “most helpful” reviews (positive and critical) were analyzed and coded by a consensus qualitative coding scheme, which included positive and negative descriptors in 6 major categories according to consumer comments: affordability, cosmetic elegance, separate ratings, product ingredients, product performance, and skin compatibility. MAIN OUTCOMES AND MEASURES: The Kruskal-Wallis test was performed to determine whether characteristics of each product (eg, American Academy of Dermatology [AAD] criteria, sun protection factor [SPF], or vehicle) could be used to predict price per ounce. The number (percentage) of comments categorized by major themes and subthemes was determined. Illustrative consumer comments were also collected. RESULTS: There were 6500 products categorized as sunscreens in the Amazon.com, online catalog. Of the 65 products evaluated, the median price per ounce was $3.32 (range, $0.68-$23.47). Of products, 40% (26 of 65) did not adhere to AAD guidelines (broad spectrum, SPF ≥30, and water resistant) for sunscreens. Vehicles, fulfillment of AAD criteria, and sunscreen type predicted a higher price per ounce. Cosmetic elegance was the most cited positive feature (198 of 325 [61%] comments) followed by product performance (146 of 325 [45%] comments) and skin type compatibility (78 of 325 [24%] comments). CONCLUSIONS AND RELEVANCE: In this cohort of highly rated sunscreen products, a significant proportion did not adhere to AAD guidelines, mostly attributable to a lack of water resistance. The most striking variation in this cohort was price, which varied by more than 3000%. Dermatologists should balance the importance of cosmetic elegance, cost, and AAD guidelines for sun protection in making their recommendations to consumers.

Keloids are benign, fibroproliferative dermal tumors that typically form due to abnormal wound healing. Current standard of care is generally ineffective and does not prevent recurrence. To characterize keloid scars and better understand the mechanism of their formation, we performed transcriptomic profiling of keloid biopsies from a total of 25 subjects of diverse racial and ethnic origins, 15 of whom provided a paired non-lesional sample, a longitudinal sample, or both. The transcriptomic signature of non-lesional skin biopsies from keloid subjects resembled control skin at baseline, but after dermal trauma shifted to closely match that of keloid skin. Peripheral keloid skin and re-biopsied surrounding normal skin both showed upregulation of epithelial mesenchymal transition markers, extracellular matrix organization, and collagen genes. These keloid signatures strongly overlapped those from healthy wound healing studies, usually with greater perturbations, reinforcing our understanding of keloids as dysregulated and exuberant wound healing. In addition, 219 genes uniquely regulated in keloids, but not in normal injured or uninjured skin, were also identified. This study provides insights into mature and developing keloid signatures that can act as a basis for further validation and target identification in the search for transformative keloid treatments.

IMPORTANCE Determining Fitzpatrick skin phototypes (FST) allows physicians to assess a person’s risk of developing sunburn and, by extension, the need for sun protection to prevent the development of skin cancer. Reflectance spectrophotometry objectively measures the melanin index and can assist in determining the accuracy of self-report of FST compared with dermatologist-determined FST. OBJECTIVES To assess whether self-reported or dermatologist-determined FST is more accurate in identifying a participant’s FST for FST I through VI and to assess the relevance of the burning and tanning measures for a range of skin types among ethnically diverse participants. DESIGN AND SETTING A convenience sample of participants in an observational study from June 2, 2010, through December 15, 2010, at an ambulatory academic dermatologic practice and employee health center in an urban city. PARTICIPANTS Participants, staff, and students of Northwestern University, who self-identified as being non-Hispanic white, Hispanic or Latino, Asian or Pacific Islander, or black. MAIN OUTCOMES AND MEASURES Melanin index as measured with reflectance spectrophotometry compared with dermatologist- and participant-determined FST. RESULTS Forty-two percent (114 of 270) of the participants’ responses to the burning and tanning questions could not be classified using standard FST definitions. The spectrophotometry measurements for dermatologist-determined FST were significantly different for FST III and IV (P < .001) and FST IV and V (P < .001). The spectrophotometry measurements for participant-determined FST were significantly different for FST III and IV (P < .001) but not for FST IV and V (P = .90). Participant responses to burning and the dermatologist-determined FST were significantly correlated (Spearman ρ, 0.764; P < .001). Participant responses to tanning and the dermatologist-determined FST were not significantly correlated (Spearman ρ, 0.089; P = .15). Spectrophotometry measurements assessing FST were statistically significantly different for FST III through VI (P < .001). CONCLUSIONS AND RELEVANCE Dermatologist-determined FST is more accurate than self-report for FST III through VI. Rephrasing the questions using specific descriptors that have meaning to people with skin of color, such as skin irritation, tenderness, itching, or skin becoming darker, may allow physicians to more accurately assign a skin phototype and, by inference, assess the risk of these participants developing skin cancer. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01124513

Since extracutaneous melanocytes in the eye may also be affected in vitiligo, a systematic review was conducted to explore the ocular manifestations of vitiligo. Studies point to a higher risk of ocular findings in periorbital vitiligo. Dry eye disease is the most reported ocular abnormality in vitiligo. Additionally, several small studies have found potential links to uveitis and glaucoma. Various other chorioretinal pigmentary changes are also reported, but without accompanying functional consequences or changes in vision. Although there is a need for larger studies to further elucidate these associations, dermatologists should be aware of potential ocular comorbidities in vitiligo and refer to ophthalmology accordingly., (© 2023 the International Society of Dermatology.)