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Context • Pigmented dermatoses are skin diseases characterized by pigmentation changes in the skin’s surface due to abnormal melanocyte production. Photon-skin- rejuvenation technology can be effective for the management of facial pigmented dermatoses. Black Gold Delicate Pulse Light (DPL) Super Photon Skin Rejuvenation therapy is a new technology based on traditional photo rejuvenation. Objective • The study intended to evaluate the therapeutic efficacy of DPL therapy in the management of targeted pigmented skin diseases, such as melasma, solar lentigines, and postinflammatory hyperpigmentation. Design • The research team conducted a prospective cohort study. Setting • The study took place at Department of Dermatology, Affiliated Hospital of Shaoxing University, Shaoxing, China. Participants • Participants were 130 patients with facial pigmented dermatoses treated at the hospital between February 2021 and December 2021. Interventions • The research team assigned participants to one of two groups, with 65 participants in each group: (1) the control group, the intense pulsed light (IPL) group, who received IPL treatment, and (2) the intervention group, the DPL group, who received black gold DPL super photon skin rejuvenation. Both groups received the treatments once a month for 6 months. Outcome Measures • At baseline and postintervention for both groups, the research team: (1) collected 5 ml of fasting venous blood from participants and measured serum concentrations of melatonin (MEL), vascular endothelial growth factor (VEGF) and endothelin-1 (ET- 1) using enzyme-linked immunosorbent assay (ELISA); (2) assessed the degree of reduction of facial pigmentation using the Visia skin test and each participant’s clinical results and calculated total efficacy; and (3) monitored and recorded adverse events. Results • Compared to the IPL group, the DPL group: (1) had greater symptom mitigation of the facial pigmented dermatosis, as evinced by significantly lower serum MEL (P = .001) and ET-1 (P = .020) concentrations and higher VEGF levels (P = .001); (2) for participants with freckles (P = .045), cafe-au-lait spots (P = .021), or post-acne hyperpigmentation (P = .029), had a significantly higher total efficacy; and (3) had a lower incidence of adverse events (P = .041). Conclusions • Black Gold DPL Super Photon Skin Rejuvenation offers a significantly higher safety profile and treatment efficacy for pigmented-skin diseases compared to IPL treatment. These promising results suggest potential for its use in clinical practice, but clinical adoption requires future trials. [ABSTRACT FROM AUTHOR]

Malassezia are yeast species that commonly colonize healthy skin. However, they have been associated with or implicated in the pathogenesis of numerous skin disorders, particularly in the setting of pediatric populations. In this review, we will focus on several Malassezia‐associated skin conditions manifesting in infants, children, and adolescents: pityriasis versicolor, Malassezia folliculitis, infantile and adolescent seborrheic dermatitis, head and neck dermatitis, and neonatal cephalic pustulosis. We examine the literature and provide an overview of these conditions, including clinical presentation in diverse skin colors, diagnosis, risk factors, and treatment and management. Additionally, we summarize and highlight some of the proposed theories on the role of Malassezia spp. in the pathogenesis of these skin conditions. [ABSTRACT FROM AUTHOR]

Acne is a common skin disease associated with a range of sequelae. These include scarring and dyspigmentation, emotional and psychosocial disturbances, and occupational problems, in part because acne often manifests on the face, in addition to other body areas, and is highly visible. Worldwide, the prevalence of acne is estimated at 9.4 percent; it is most common in adolescents but also affects a relatively high proportion of adults. Early studies of acne epidemiology were conducted primarily in the United States and the United Kingdom. In more recent decades, data have been increasing for other areas of the world. There has also been more attention devoted to how acne may present and be managed in individuals with skin of color (i.e., the broad and diverse range of populations that self-identify as belonging to a non-White racial/ethnic group and share characteristics such as higher skin phototypes and propensity toward hyperpigmentation). This review seeks to highlight aspects of acne that may be unique to skin of color. [ABSTRACT FROM AUTHOR]

The diagnosis of basal cell carcinoma (BCC) in dark phototypes can be a challenging task due to the lack of relevant clues and its variable presentation. In this regard, there is growing evidence that dermoscopy may benefit the recognition of BCC even for skin of color (SoC). The objective of this review is to provide an up-to-date overview on clinical and dermoscopic patterns of BCC in SoC, also comparing such findings with those of the main clinical mimickers reported in the literature. A comprehensive search of the literature through the PubMed electronic database was carried out in order to identify papers describing the clinical and dermoscopic features of BCC in dark phototypes (IV–VI). By finding macroscopic clinical presentations of BCCs in SoC patients and any possible clinical mimickers considered in the retrieved papers, we built a differential diagnosis list and analyzed the dermoscopic findings of such conditions to facilitate the diagnosis of BCC. BCC in darker skin may present as pigmented nodular lesions, pigmented patches or plaques, ulcers, erythematous nodular lesions, erythematous plaques or patches, or scar-like lesions, depending on its subtype and body site. The differential diagnosis for BCC in patients with SoC includes squamous cell carcinoma, melanoma, nevi, adnexal tumors and sebaceous keratosis. Additionally, it differs from that of Caucasians, as it also includes lesions less common in fair skin, such as dermatosis papulosa nigra, melanotrichoblastoma, and pigmented dermatofibrosarcoma protuberans, and excludes conditions like actinic keratosis and keratoacanthoma, which rarely appear in darker skin. The resulting differences also include infectious diseases such as deep cutaneous mycosis and inflammatory dermatoses. The most prevalent differentiating dermoscopic feature for BCC includes blue, black and gray dots, though arborizing vessels still remain the predominant BCC feature, even in dark phototypes. Diagnostic approach to BCC in dark-skinned patients varies due to the prevalence of dermoscopy findings associated with hyperpigmented structures. Clinicians should be aware of such points of differentiation for a proper management of this tumor in SoC. [ABSTRACT FROM AUTHOR]

Background: Skin diseases in patients with skin of colour (Fitzpatrick skin types IV to VI) are underrepresented in dermatology training, which may lead to lower quality of care for these patients. To address this underrepresentation in medical education, a newly developed seminar on skin type diversity using an interactive teaching method was implemented in an undergraduate medical curriculum. This study examined the effects of a seminar on the self-assessed competence of medical students in managing skin conditions in patients with skin of colour. Methods: A questionnaire survey was conducted among fourth-year undergraduate medical students at the University of Hamburg (Germany) between October 2023 and February 2024. Students' self-assessed competence was compared before and after the obligatory seminar (pre- and post-design). Results: In total, 158 students participated in the survey. After the seminar, knowledge of the presentation of skin diseases in patients with skin of colour and the associated psychological burden, differences in the incidence of skin diseases in different skin types, and the ability to diagnose skin diseases in darker skin types increased. Most participants stated that they wanted to attend more courses on this topic. Discussion: Appropriate courses for medical students can improve their competence in managing different skin diseases in patients with skin of colour. In the future, more attention should be paid to teaching the diversity of skin types in dermatology education. [ABSTRACT FROM AUTHOR]

Background Cutaneous manifestations of sarcoidosis are seen in around 25% of patients with sarcoidosis and that usually accompanies systemic involvement. Non-caseating granuloma is the classical histopathological picture. Sarcoidosis shares many clinical and histopathological features with many granulomatous diseases. Objective To do full clinical and histopathological evaluation of all cases that were diagnosed with cutaneous sarcoidosis, trying to find clinical limitations and borders between sarcoidosis and other granulomatous mimicking diseases. Methods This is a descriptive study where all patients that were diagnosed with cutaneous sarcoidosis during the period from 2014-2023 were assessed regarding dermographic features, clinical pictures and histopathological examination. An appropriate general physical examination as well as investigative techniques were implemented to detect the presence or absence of systemic involvements. Results This study included 24 patients, whose ages ranged from 27-70 years with a mean of 47.8 years with 16 (66.7%) females and 8 (33.3%) males. All patients had shiny smooth, skin colored or dusky red papules, nodules or plaques but rarely scaly. No obvious systemic involvements were detected by physical examination or investigative techniques. The histopathological assessment showed marked granulomatous reaction consisting of multiple non-caseating non-necrotizing granuloma formations. Conclusion Sarcoidosis is emerging as not a rare cutaneous disease that can mimic and compete with other granulomatous diseases. There is no specific available test for this disease but identifying the full cutaneous and pathological features is mandatory and might lead us to the correct diagnosis, hence it is an exclusion disease. [ABSTRACT FROM AUTHOR]

Topical retinoids continue to be the treatment of choice for healthcare professionals and patients due to their effectiveness in treating several common skincare concerns. In a comprehensive review, Cigdem Kemal Yilmaz discusses the most used topical retinoids: retinyl palmitate, retinol, retinal (retinaldehyde), tretinoin (retinoic acid) and adapalene, and their potential benefits to the skin. This article also addresses the latest EU regulations impacting their use, and the necessity for healthcare professionals to stay informed about advancements and regulatory changes in topical retinoid therapy in order to provide personalised treatment plans for their patients. [ABSTRACT FROM AUTHOR]

Rosacea is a chronic inflammatory skin disease of the central face, affecting 5% of the population. The exact etiology is unknown. A diagnosis is made based on the updated 2017 National Rosacea Society Expert Committee guidelines, including fixed erythema, phymatous changes of skin thickening due to sebaceous gland hyperplasia and fibrosis, papules, pustules, telangiectasia, and flushing. Delays in an accurate diagnosis and treatment may occur in skin of color due to difficulty visualizing erythema and telangiectasia. The daily use of sunscreen, moisturizers, and mild skin cleansers and avoidance of triggers are essential aspects of maintenance treatment. Effective topical treatment options include alpha-adrenergic receptor agonists for flushing and ivermectin, metronidazole, and azelaic acid for papules and pustules. Systemic treatments include nonselective beta blockers for flushing, low-dose doxycycline, and isotretinoin for papules and pustules. Rosacea can significantly affect a patient's emotional health and quality of life. A referral for care is recommended for fixed phymatous changes and ocular rosacea. (Am Fam Physician. 2024; 109(6): 533–542. Copyright © 2024 American Academy of Family Physicians.) Rosacea is a chronic inflammatory skin disease of the central face, affecting 5% of the population. The exact etiology is unknown. A diagnosis is made based on the updated 2017 National Rosacea Society Expert Committee guidelines, including fixed erythema, phymatous changes of skin thickening due to sebaceous gland hyperplasia and fibrosis, papules, pustules, telangiectasia, and flushing. Delays in an accurate diagnosis and treatment may occur in skin of color due to difficulty visualizing erythema and telangiectasia. The daily use of sunscreen, moisturizers, and mild skin cleansers and avoidance of triggers are essential aspects of maintenance treatment. Effective topical treatment options include alpha-adrenergic receptor agonists for flushing and ivermectin, metronidazole, and azelaic acid for papules and pustules. Systemic treatments include nonselective beta blockers for flushing, low-dose doxycycline, and isotretinoin for papules and pustules. Rosacea can significantly affect a patient's emotional health and quality of life. A referral for care is recommended for fixed phymatous changes and ocular rosacea. (Am Fam Physician. 2024;109(6):533-542. Copyright © 2024 American Academy of Family Physicians.) [ABSTRACT FROM AUTHOR]

Background: Dyschromias are the second most commonly diagnosed dermatological entity in patients with skin of color (SOC). People with SOC develop postinflammatory hyperpigmentation (PIH) with a higher frequency and greater severity attributed to the presence of reactive melanocytes. This can have severe repercussions on selfesteem and social/emotional functioning. While there are studies on the impact of post-acne PIH on quality of life (QOL), the assessment of impact of PIH on QOL as a heterogenous group of dermatoses has not been studied previously. Objectives: The aim of this study was to assess the impact of PIH on QOL in patients with SOC using Skindex-16. Materials and Methods: This was a cross-sectional study conducted from October 2019 to September 2021, involving 60 patients with SOC having biopsy-proven PIH. All patients underwent thorough clinical workup, followed by the administration of the Skindex-16 questionnaire. Data were tabulated and analyzed. Results: The mean age was 32.53±11.73 years: 35 (58%) patients were male, and 25 (42%) were females. Most patients presented with PIH secondary to papulosquamous disorders (n=23; 38.34%), followed by acne/acneiform eruptions (n=11; 18.33%). The mean scores for symptoms, emotions, functioning, and total scores were 0.37±0.51, 2.30±1.13, 2.26 ±1.40, and 1.64±0.85, respectively. PIH lesions with simultaneous evolution were associated with higher symptoms subscale scores. A previous tendency of PIH, involvement of exposed sites, higher intensity of PIH, epidermal PIH, and lesions accentuating on Wood's lamp had higher, statistically significant impact on emotions, functioning, and total scores. Conclusion: PIH had significant impact on Quality of Life in patients of Skin-of-Color. Our study was limited by the sample size, and larger, multicentric, population-based studies are recommended. [ABSTRACT FROM AUTHOR]

Background: To determine the composition of skin pigmentation in chronic venous insufficiency (CVI) and other less common vascular conditions of lower limbs. Methods: Forty-five skin biopsies were obtained from 17 patients. Samples were taken from pigmented regions and compared with control non-lesional samples from the same patient. Perl's Prussian Blue was used to identify haemosiderin and Schmorl's for melanin. Results: Seven patients presented with CVI, one with concurrent livedo vasculopathy (LV). One patient had LV only. Two patients had acroangiodermatitis (AAD). Six patients had post-sclerotherapy pigmentation (PSP), one with concurrent post-inflammatory hyperpigmentation (PIH). One patient had PIH only. The predominant pigment in CVI samples was haemosiderin. C5-C6 patients showed increased epidermal melanin. LV, AAD, and PSP samples showed dermal haemosiderin but no increase in epidermal melanin. PIH samples showed prominent epidermal melanin whilst no haemosiderin was detected. Conclusion: The predominant pigment in CVI and other vascular conditions was haemosiderin. Melanin was present in later stages of CVI (C5-C6) and in PIH. [ABSTRACT FROM AUTHOR]

As the US population becomes increasingly diverse, more patients of color seek dermatologic care and often have concerns that are unique to their skin color. Therefore, it is critically important that the knowledge gap in skin of color dermatology be urgently addressed. In addition to addressing the clinical gap in recognizing dermatologic disease in patients of color, the role of dermatopathology in bridging this gap remains unaddressed. Given the impact that skin color can have on the presentation and subsequent management of dermatologic diseases, understanding the current knowledge of the unique structural and histologic characteristics in skin of color may help give us insight on the role skin color should play in histopathologic diagnosis. In this paper, we bring insights into the role dermatopathology plays in addressing our knowledge of cutaneous disease in patients with skin of color. After we highlight issues to consider, we can begin to identify gaps in knowledge that still exist within dermatopathology that need to be addressed to ensure patients of all backgrounds receive equitable dermatologic care. [ABSTRACT FROM AUTHOR]

Research in dermatology education highlights the lack of skin of color (SOC) instruction for medical students, leading to concerning healthcare outcomes. Because of the already limited opportunity for students to have dedicated teaching in pathophysiology, management, and treatment of dermatologic diseases in medical school, we developed an educational module that addresses these gaps. We created a one-hour virtual lecture for medical students focused on common skin diseases tested on the United States Medical Licensing Examination with visual images across all skin types. A questionnaire was administered before and after the educational module to assess outcomes comparing disease identification in lighter (Fitzpatrick scale I-III) versus darker (Fitzpatrick scale IV-VI) skin tones and to determine medical school student attitudes. An analysis of 43 examination scores before, and after attending the educational module determined rosacea, psoriasis, and basal cell carcinoma to be conditions in SOC patients that demonstrated the most significant improvement (47.3%, 54.9%, and 30.8%, respectively). Our results also highlighted worse performance outcomes for diseases in SOC in the pre-examination questionnaire. Thus, our study indicates that a concise education module focused on disease presentations inclusive of all skin types may efficiently increase students' ability to identify diseases commonly misdiagnosed in the clinical setting. [ABSTRACT FROM AUTHOR]

Background/Aim: The aim of the present study was to investigate the prevalence of obesity‐related dermatoses in obese children, and the association between these dermatoses and insulin resistance as well as skin color. Methods: Obese, overweight, and normal weight children according to body mass index who were followed up and treated in the outpatient clinics were included in the study. Dermatological examinations of the participants were performed, and fasting insulin and glucose levels were checked. Results: The obese and overweight children were evaluated as the patient group (70 girls, 41 boys, mean age: 12.37 ± 3.14 years). One hundred one healthy children with normal weight were determined as the control group (59 girls, 42 boys, mean age: 12.15 ± 2.43). The first five common dermatoses in the patient group when compared with the control group were keratosis pilaris (KP), striae distensae, hyperhidrosis, acanthosis nigricans (AN), and plantar hyperkeratosis. The first five dermatoses which were positively correlated with formation and insulin resistance were KP, striae distensae, AN, hyperhidrosis, and plantar hyperkeratosis. According to the Fitzpatrick skin scale, we found that the darker the skin color, the higher the probability of AN and KP (OR, 0.298; 95% CI, 0.106–0.834, p = 0.021; OR, 0.306; 95% CI, 0.117–0.796, p = 0.015, respectively). Conclusion: Some dermatoses associated with obesity and insulin resistance were not found in obese children, or there was no significant association. These results indicate that many skin morbidities may be prevented by preventing and treating obesity and insulin resistance in the early period. [ABSTRACT FROM AUTHOR]

Skin is the largest organ of the human body and participates in the functional activities of the human body all the time. Therefore, human beings have a large risk of getting skin diseases. The diseased skin lesion image shows visually different characteristics from the normal skin image, and sometimes unusual skin color may indicate human viscera or autoimmune issues. However, the current recognition and classification of dermatological conditions still rely on expert visual diagnosis rather than a visual algorithm. This is because there are many kinds of lesion features of skin diseases, and the lesion accounts for a small proportion of the skin image, so it is difficult to learn the required lesion features; meanwhile, some dermatology images have too few samples to deal with the problem of small samples. In view of the above limitations, we propose a model named Lesion Area Aware Shifted windows Transformer for dermatological conditions classification rely on the powerful performance and excellent result of Swin transformer recently proposed. For brief notation, we use its abbreviation later. Our main contributions are as follows. First, we modify the Swin transformer and use it in the automatic classification of dermatological conditions. Using the self‐attention mechanism of the transformer, our method can mine more long‐distance correlations between diseased tissue image features. Using its shifting windows, we can fuse local features and global features, so it is possible to get better classification results with a flexible receptive field. Second, we use a skip connection to grasp and reinforce global features from the previous block and use Swin transformer to extract detailed local features, which will excavate and merge global features and local features further. Third, considering Swin transformer is a lightweight model compared with traditional transformers, our model is compact for deployment and more favorable to resource‐strict medical devices. [ABSTRACT FROM AUTHOR]

As research related to skin of color (SOC) in dermatology continues to grow, it is increasingly important to precisely define terminology. The terms 'SOC', 'race', and 'ethnicity' are frequently used to analyze differences in dermatologic disease onset, severity, and outcomes. These terms are used interchangeably, are ill-defined across research studies, and frequently conflate biologic and socially constructed categories. SOC has been thought to represent differing degrees of pigment or melanin in the skin, however skin pigment is quite variable among races and ethnicities. Furthermore, certain individuals with less skin pigment may socially consider themselves to be SOC, while the inverse is also true. Fitzpatrick skin phototype classifications in SOC dermatology, while commonly used as an objective measure of diversity, also present with numerous limitations and inaccuracies. We seek to highlight strengths and weaknesses of the current terminology used in SOC dermatology and recommend a more holistic understanding of reported differences, including a framework reflective of upstream socioeconomic, environmental, and historical factors that may be most relevant to reported associations. [ABSTRACT FROM AUTHOR]

The main task of creating new digital images of different skin diseases is to increase the resolution of the specific textures and colors of each skin disease. In this paper, the performance of generative adversarial networks has been optimized to generate multicolor and histological color digital images of a variety of skin diseases (melanoma, birthmarks, and basal cell carcinomas). Two architectures for generative adversarial networks were built using two models: the first is a model for generating new images of dermatology through training processes, and the second is a discrimination model whose main task is to identify the generated digital images as either real or fake. The gray wolf swarm algorithm and the whale swarm algorithm were relied on to generate values that improve the performance of GANs and insert them into the generator instead of random values, which in turn worked to reduce the loss values for the generated images. Loss values were adopted as a measure of optimizations for each epoch, and the fastest access time to actual digital images for each skin disease was adopted. Before the optimization operations, 50% accurate images of skin diseases were obtained; after the optimization operations, 98% accurate images of skin diseases were obtained. [ABSTRACT FROM AUTHOR]

Images depicting dark skin tones are significantly underrepresented in the educational materials used to teach primary care physicians and dermatologists to recognize skin diseases. This could contribute to disparities in skin disease diagnosis across different racial groups. Previously, domain experts have manually assessed textbooks to estimate the diversity in skin images. Manual assessment does not scale to many educational materials and introduces human errors. To automate this process, we present the Skin Tone Analysis for Representation in EDucational materials (STAR-ED) framework, which assesses skin tone representation in medical education materials using machine learning. Given a document (e.g., a textbook in.pdf), STAR-ED applies content parsing to extract text, images, and table entities in a structured format. Next, it identifies images containing skin, segments the skin-containing portions of those images, and estimates the skin tone using machine learning. STAR-ED was developed using the Fitzpatrick17k dataset. We then externally tested STAR-ED on four commonly used medical textbooks. Results show strong performance in detecting skin images (0.96 ± 0.02 AUROC and 0.90 ± 0.06 F1 score) and classifying skin tones (0.87 ± 0.01 AUROC and 0.91 ± 0.00 F1 score). STAR-ED quantifies the imbalanced representation of skin tones in four medical textbooks: brown and black skin tones (Fitzpatrick V-VI) images constitute only 10.5% of all skin images. We envision this technology as a tool for medical educators, publishers, and practitioners to assess skin tone diversity in their educational materials. [ABSTRACT FROM AUTHOR]

Human skin pigmentation and melanin synthesis are incredibly variable, and are impacted by genetics, UV exposure, and some drugs. Patients' physical appearance, psychological health, and social functioning are all impacted by a sizable number of skin conditions that cause pigmentary abnormalities. Hyperpigmentation, where pigment appears to overflow, and hypopigmentation, where pigment is reduced, are the two major classifications of skin pigmentation. Albinism, melasma, vitiligo, Addison's disease, and post-inflammatory hyperpigmentation, which can be brought on by eczema, acne vulgaris, and drug interactions, are the most common skin pigmentation disorders in clinical practice. Anti-inflammatory medications, antioxidants, and medications that inhibit tyrosinase, which prevents the production of melanin, are all possible treatments for pigmentation problems. Skin pigmentation can be treated orally and topically with medications, herbal remedies, and cosmetic products, but a doctor should always be consulted before beginning any new medicine or treatment plan. This review article explores the numerous types of pigmentation problems, their causes, and treatments, as well as the 25 plants, 4 marine species, and 17 topical and oral medications now on the market that have been clinically tested to treat skin diseases. [ABSTRACT FROM AUTHOR]

Moisture-associated skin damage (MASD) is a term used to describe skin damage that is caused by prolonged exposure to moisture, such as incontinence-associated dermatitis (IAD), intertriginous dermatitis, periwound moisture-associated dermatitis and peristomal moisture-associated dermatitis. MASD is a hugely prevalent issue in hospitals and long-term care facilities (Voegeli, 2019). Studies have shown that skin tone bias exists in the diagnosis and treatment of MASD, the impact of which this paper discusses as well as how to prevent such bias while assessing and diagnosing MASD. [ABSTRACT FROM AUTHOR]

There is a paucity of literature on pediatric skin conditions in skin of color, of which old epidemiological data are likely to become outdated as the ethnic diversity in developed countries such as Australia continues to grow. We analyzed the prevalence of presenting conditions of pediatric patients with skin of color attending an urban dermatology clinic in Melbourne, Australia over an 18‐month period. The major presenting issues were vitiligo, atopic dermatitis, and acne vulgaris, the majority of which did not significantly differ by ethnicity; however, there was a statistically significantly higher proportion of Chinese and Indian patients presenting with atopic dermatitis. Given the varying presentations of these conditions in skin of color, our findings highlight the importance of increasing education for dermatologists and health personnel in pigmentary disorders and the need for further focused studies comparing the prevalence of skin disease across ethnicities. [ABSTRACT FROM AUTHOR]

Hailey-Hailey disease (HHD) is an autosomal dominant genodermatosis related to mutations of the ATP2C1 gene (encoding a calcium pump of Golgi apparatus).[1] It typically manifests during the second or third decade of life and is clinically characterized by erosions/fissures and scaly/macerated plaques or chronic vegetations mainly involving flexural sites.[1] These clinical manifestations are similar to those of other common intertriginous dermatoses, making the differential diagnosis particularly challenging.[1] This is even more relevant in dark-skinned patients, in which important clinical features (e.g., shade of erythema and sharpness of lesions margins) may be less evident.[2] Over the last few years, dermoscopy has been shown to improve the recognition of several inflammatory dermatoses in both light and dark phototypes.[[3]] However, data on HHD are sparse and limited to single case reports.[[5], [7]] In this multicentric retrospective observational study conducted by the "Imaging in Skin of Color" Task Force of the I International Dermoscopy Society i (IDS), we sought to characterize dermoscopic findings of HHD, as compared to those of the main clinical mimickers. Dermoscopy in general dermatology (non-neoplastic dermatoses) of skin of colour: a comparative retrospective study by the International Dermoscopy Society. Moreover, a possible overlap with flexural lesions of Darier's disease due to histological similarities should be considered, thereby clinical/anamnestic data remain of utmost importance in distinguishing these dermatoses. [Extracted from the article]

Immune-mediated skin diseases have a high prevalence and seriously affect patients' quality of life. Gold compounds have been considered promising therapeutic agents in dermatology, but the high incidence of adverse reactions have limited their clinical application. There is a great need to develop more effective and less toxic gold-based drugs. Gold nanoclusters fabricated by using peptides (pep-AuNCs) have appeared as potential biomedical nanomaterials because of their excellent biocompatibility, ease of fabrication and unique physicochemical properties. Glutathione (GSH) is an endogenous tripeptide and has been used for lightening the skin color. Therefore, we fabricated a well-defined gold nanocluster with GSH as an example to explore the immunomodulatory effect of AuNCs on a TNF-α-treated human keratinocyte cell line (HaCaT) in vitro, the 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced irritant contact dermatitis (ICD) model and the oxazolone (OXA)-induced psoriatic model in vivo. The results indicated that topically applied AuNCs successfully attenuated the severity of ICD and psoriasis-like lesions. In vitro and in vivo, AuNCs effectively inhibited the abnormal activation of the NF-κB pathway and the consequent overexpression of proinflammatory cytokines in keratinocytes. In particular, the transactivation of IL-17A, the most important cytokine in psoriasis pathology, was effectively inhibited by AuNCs treatment. In addition, AuNCs did not show any obvious cytotoxicity in HaCaT cells at doses even up to 100 µM and did not induce any irritation in the healthy skin and major organs, which indicated their favorable biosafety. These results indicate that biocompatible pep-AuNCs might be a promising gold-based nanomedicine for the treatment of inflammatory skin diseases. [ABSTRACT FROM AUTHOR]

Background and Design: Dermatologists have limited experience with dermatological diseases seen in immigrants with Fitzpatrick skin types 5-6 in Turkey, which can cause difficulties in diagnosis. This study aimed to examine the clinical and demographic characteristics of this patient population evaluated in a tertiary health center. Materials and Methods: All patients with Fitzpatrick skin types 5-6 who applied to our dermatology outpatient clinic between June 1, 2018, and July 15, 2021, were included in this single-center, retrospective study. All data were obtained from the electronic database. Results: The study included 65 patients with Fitzpatrick skin types 5-6 from 14 countries. Overall, 37 of the patients were female and 28 were male, and the mean age was 30.7±15.54 years. The patients were most commonly from East Africa (76.9%), and 38 (58.5%) patients were from Somalia. The most common diagnoses were acne (21.5%), infections (20.0%), dermatitis (12.3%), pigmentation disorders (9.2%), and xerosis cutis (9.2%). Biopsy was taken from 6 (9.2%) patients. As regards treatment, only topical treatment was recommended in 55.4%, topical and systemic treatment in 26.1%, systemic treatment in 4.6%, cryotherapy/surgical methods in 6.1%, and further examination in 7.7% of the cases. Conclusion: Acne, dermatitis, pigmentation disorders, and alopecia, which are common diagnoses in our study, are consistent with the diagnoses reported most frequently in patients with Fitzpatrick skin type 5-6. The finding that infections (20.0%) were among the most common diagnoses in our study may be related to the difficult living conditions of this patient population as they are immigrants. Thus, physicians should recognize common dermatological diseases in individuals with Fitzpatrick skin types 5-6. Our results may guide further studies in determining the medical needs of this patient group and planning dermatological care appropriately. [ABSTRACT FROM AUTHOR]

The article presents a study on the determination of the optical parameters of the skin using spatially resolved diffuse reflectance measurements (RDRE). The importance of classifying skin phototypes in dermatology is highlighted, and the need for an objective characterization of these phototypes is mentioned. Additionally, it is mentioned that the optical properties of tissues change depending on their condition, and that knowing these parameters can be useful for diagnosing skin diseases. The article proposes a physical model to obtain the optical parameters of the tissue from RDRE measurements, and describes a measurement system developed to apply this model to real measurements. Experiments were also conducted on subjects with different skin phototypes and on an individual with vitiligo, showing significant differences in the values of the optical parameters among them. [Extracted from the article]

Pigmentation diseases can lead to significant color differences between the affected part and the normal part, resulting in severe psychological and emotional distress among patients. The treatment of pigmentation diseases with good patient compliance is mainly in the form of topical drugs. However, conventional hydroquinone therapy contributes to several pathological conditions, such as erythema, dryness, and skin desquamation, and requires a longer treatment time to show significant results. To address these shortcomings, natural whitening substances represented by kojic acid and arbutin have gradually become the candidate ingredients of traditional local preparations due to their excellent biological safety. This review focuses on several natural whitening substances with potential therapeutic effects in pigmentation disease and their mechanisms, and a thorough discussion has been conducted into the solution methods for the challenges involved in the practical application of natural whitening substances. [ABSTRACT FROM AUTHOR]

Background: Hyperpigmentary disorder is one of the commonest skin concerns in dermatology clinics. The availability of noninvasive instruments provided a convenient, objective, and reproducible methodology for the evaluation of pigmentation and skin color. The aim of this study is to compare CSKIN and VISIA in measuring facial hyperpigmentation, as well as to assess the correlation between the instrumental analyzing and clinical evaluation. Methods: Eighty Chinese patients were enrolled. Images were taken and analyzed by VISIA from Canfield and CSKIN from Yanyun Technology, and the facial hyperpigmentation was graded by three dermatologists. Results: Feature counts within the facial pigmented areas analyzed by VISIA showed positive correlations with brown pixels (r = 0.331, p < 0.05) and brown percent (r = 0.395, p < 0.0001) measured by CSKIN. The parameters measured by CSKIN and VISIA were significantly correlated with visual scores graded by the dermatologists, with VISIA presenting a moderate correlation (r = 0.509, p < 0.001) and CSKIN a slightly stronger correlation with the visual scores (r = 0.653, p < 0.001). Conclusion: CSKIN could serve as an alternative in the assessment and follow‐up of skin disease featuring with facial hyperpigmentation. [ABSTRACT FROM AUTHOR]

Introduction: Vitiligo is a skin disease that is associated with impaired skin immune systems and pigment degradation in skin melanocyte cells. Despite the significant impact of the disease on the quality of life of patients, treatment of the disease using an effective method such as the transplantation of uncultivated melanocytes was considered by researchers around the world. The goal of this research was to use microneedling to transplant epidermal keratinocyte–melanocyte cells suspension for the treatment of vitiligo patients. Methods: In this study, 15 male and female vitiligo in face region patients aged 18–45 years were studied. In this study, melanocyte–keratinocyte cells suspension was sprayed. Patients underwent microneedling treatment after spraying the cells. Before and after transplantation, patients were biometrically examined, and the quantity of pigmentation and changes in the transplanted region were documented. Statistical software was used to examine the results. Results: The color difference between the lesion area and normal skin in one, two, and six months after treatment with cell suspension was significantly reduced compared with before treatment (by 48.95%). Moreover, the amount of melanin was significantly increased 6 months after treatment compared with before treatment (129.8 ± 4.16 vs. 195.2 ± 3.54, p = 0.000). A significant decrease in skin brightness in the skin of the lesion area was observed compared with normal skin, 6 months after treatment compared with before treatment (43.7 ± 1.44 vs. 27.9 ± 1.24, p = 0.000). Conclusion: Epidermal keratinocyte–melanocyte cells suspension in combination with microneedling could be considered as an effective treatment of vitiligo. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of the study is to determine dermoscopic findings of melasma after evaluating them based upon clinical examination and to correlate each clinical picture with dermoscopic findings. Materials and methods: Various patients of melasma from December 2019 to December 2020 were enrolled from outpatient department. Detailed history was taken. The dermoscopic examination and photographic documentation of clinical as well as dermoscopic picture was done and findings were noted. Results: We enrolled 50 patients in study including 80% females and 20% males. Mean age of melasma in our study was 31.28 years. Mostly the patients were farmers and housewives with the most common precipitating factor being sun exposure. Twenty patients on clinical examination along with Wood's lamp showed epidermal pattern, 18 patients showed mixed pattern, and 12 patients had dermal pattern. On dermoscopy, melasma showed perifollicular sparing in all patients (100%), but in 36 patients, along with perifollicular sparing, it also showed perifollicular pigmentation in some areas, granular pattern in 38 patients, globular pattern in 42 patients, blotches in 36 patients, telangiectasias in 30 patients, arcuate pattern in 32 patients, and annular in 12 patients. The frequency of findings was nearly similar in all three three types except for the arcuate pattern. In the dermal pattern, nearly 83% patients (P= 0.1) showed arcuate pattern as compared to 40% (P= 0.004) in epidermal pattern. Limitations: A larger sample size is required. Also, since a few of the patients were already on topical corticosteroids, it may have affected the dermoscopic findings. Conclusion: Dermoscopy is a noninvasive tool that can be used to diagnose and differentiate it from other disorders of hyperpigmentation, but it cannot be used to classify melasma into epidermal, dermal, or mixed pattern. [ABSTRACT FROM AUTHOR]

Dermatological research and education have predominantly focused on lighter skin types in the past, leading to a significant gap in knowledge and understanding of conditions in darker skin types. This has contributed to disparities in the diagnosis and treatment of diseases in patients with skin of color. In the current issue of the Journal, we highlight four papers on the epidemiology and clinics of skin of color patients but also emphasize the importance of education and research in the dermatopathology of SOC patients. [ABSTRACT FROM AUTHOR]

Skin diseases are the most common types of health illness faced by people of different age groups. The identification and classification of skin disease problems relies on highly expert doctors and high level instruments which is a time consuming process. To avoid this delay in diagnosis, an automated system is required to identify and classify this skin disease. This paper proposes a convolutional neural network based intelligent system for multi-class skin disease categorization. Three pre-trained deep learning based convolutional neural network models, VGG16, MobileNet, and Inception V3, are used in this study to classify skin disease images. The Dermoscopic image dataset HAM10000 is used for training, validating, and testing. The proposed system is designed, implemented, and tested to classify skin lesion image into one of seven categories. The implementation result of these models using HAM10000 Dataset is obtain as MobileNet accuracy 85.72%,VGG16 accuracy 73.63% and Inception V3 accuracy 75.80%. [ABSTRACT FROM AUTHOR]

During the last years, computer vision-based diagnosis systems have been widely used in several hospitals and dermatology clinics, aiming mostly at the early detection of malignant melanoma tumor, which is among the most frequent types of skin cancer, versus other types of nonmalignant cutaneous diseases. They grow in melanocytes, the cells responsible for pigmentation. This type of cancer is increasing rapidly and its related mortality rate is increasing more modestly, and inversely proportional to the tumor's thickness. The mortality rate can be decreased by earlier detection of suspicious lesions and better prevention. In this work, we are interested in extracting all specific attributes which can be used for computer-aided diagnosis of melanoma. In the first step of the proposed work, we applied the Dull Razor [Lee T et al., Dullrazor: A software approach to hair removal from images, Cancer Control Research, British Columbia Cancer Agency, Vancouver, Canada, Vol. 21, No. 6, pp. 533–543, 1997] technique to images to reduce the influence of small structures, hairs, bubbles, light reflection. In the second step, a new fuzzy level set algorithm is proposed in order to facilitate the medical image segmentation task. It is able to directly evolve from the initial segmentation proposed that uses a spatial fuzzy clustering approach. The controlling parameters of the level set evolution are also estimated from the results of the fuzzy clustering step. This step is essential to characterize the shape of the lesion and also to locate the tumor to be analyzed. In this paper, we have also treated the necessity to extract all the specific attributes used to develop a characterization methodology that enables specialists to take the best possible diagnosis. For this purpose, our proposal relies largely on visual observation of the tumor while dealing with some characteristics as color, texture or form. The method used in this paper is called ABCD. It requires calculating four factors: Asymmetry (A) , Border (B) , Color (C) , and Diversity (D). Finally, these parameters are used to construct a classification module based on artificial neural network for the recognition of malignant melanoma. [ABSTRACT FROM AUTHOR]

Background: The International Dermoscopy Society (IDS) recently released a set of five basic dermoscopic parameters (vessels, scales, follicular findings, "other structures," and specific clues) encompassing a total of 31 subitems to standardize the use of dermoscopy in non‐neoplastic dermatoses, yet they have been developed taking into account Caucasian/Asian skin, with consequent possible limitations if used in dark skin. Objectives: To validate the abovementioned criteria for the use in dark‐skinned patients (phototypes IV–VI) through an expert consensus. Methods: The two‐round Delphi method was adopted, with an iterative process consisting of two rounds of email questionnaires. Potential panelists were recruited via e‐mail from all over the world based on their expertise on dermoscopy of non‐neoplastic dermatoses in skin of color. Results: Twenty‐two panelists took part in the validation process. All of the five originally proposed parameters and subitems reached agreement during the first round, aside from "follicular red dots." Additionally, during round 1, five new subitems were proposed (perifollicular scales distribution, follicular openings obliteration, broken hairs, eccrine pigmentation, and eccrine ostia obliteration), along with the possibility to change the denomination of parameter 3 (from "follicular findings" to "follicular/eccrine findings") and split it into two subparameters ("follicular findings" and "eccrine findings"). All such proposals reached agreement during the second round and therefore were included in the final list, for a total of 37 items. Conclusions: Although nearly all the dermoscopic criteria originally proposed by the IDS are applicable even to darker phototypes, several additional variables need to be assessed. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate medical student confidence in diagnosing dermatologic diseases in skin of color. Methods: A voluntary supplemental module was implemented as part of the second-year dermatology curriculum at Wayne State University School of Medicine (WSU SOM) in Detroit, Michigan. The goal of the module was to ascertain whether it may increase confidence in students with their approach to diagnosing diseases in darker skin tones. Results: Seventy-seven of 295 students (26%) completed a "Skin of Color" optional module consisting of thirteen cases of common skin pathologies in African American patients. A pre- and post-survey performed to assess students' confidence using a five-point Likert scale. After completing the module, medical students demonstrated a statistically significant increase in confidence in diagnosing skin pathologies in skin of color. Conclusion: Dermatology pre-clinical course work should include supplementary materials to increase student confidence in diagnosing skin diseases in darker skin tones. [ABSTRACT FROM AUTHOR]

Currently, there is a lack of racial/ethnic heterogeneity in research databases, exposing a systematic issue in studies exploring inflammation-mediated diseases, such as hidradenitis suppurativa (HS). HS is a chronic inflammatory skin condition that disrupts normal structure and functioning of terminal hair follicles, resulting in the formation of recurrent abscesses, nodules, and sinus tracts within intertriginous regions. Studies have described higher serum levels of inflammation-mediated C-reactive protein (CRP) in patients with HS, a disease that predominantly affects skin of color (SOC) populations. Herein, we explore the role of CRP levels in the context of HS disease presentation, management, and psychosocial implications in SOC patients to determine existing disparities in research studies. [ABSTRACT FROM AUTHOR]

In the current world, the disorders occurring in dermatological images are among the foremost widespread diseases. Despite being common, its identification is tremendously hard because of the complexities like skin tone and color variation due to the presence of hair regions. Therefore the type of skin disease prediction is not accurately achieved in many pieces of research. To deal with mentioned concerns, a novel optimal probability-based deep neural network is proposed to assist medical professionals in appropriately diagnosing the type of skin disease. Initially, the input dataset is fed into the pre-processing stage, which helps to remove unwanted contents in the image. Afterward, features extracted for all the pre-processed images are subjected to the proposed Optimal Probability-Based Deep Neural Network (OP-DNN) for the training process. This classification algorithm classifies incoming clinical images as different skin diseases with the help of probability values. While learning OP-DNN, it is essential to determine the optimal weight values for reducing the training error. For optimizing weight in OP-DNN structure, an optimization approach is implemented in this research. For that, whale optimization is utilized because it works faster than other methods. The proposed multi-type skin disease prediction model is implemented in MatLab software and achieved 95% of accuracy, 0.97 of specificity, and 0.91 of sensitivity. This exposes the superiority of the proposed multi-type skin disease prediction model using an effective OP-DNN based feature extraction approach to attain a high accuracy rate and also it predict several kinds of skin disease than the previous models, which can protect the patients survives as well as can assist the physicians in making a decision certainly. [ABSTRACT FROM AUTHOR]

The article presents the discussion on improving care for skin of color showing self-reflection on existing biases and expansion of education and experiences. Topics include expanding the understanding of dermatology for all types of races, ethnicities, and pigmentation; and daily maintenance with a gentle cleanser, use of a noncomedogenic moisturizer, and protective sunscreen.

Dermatology for the pediatric skin of color population is the application of dermatology to the genetically diverse and distinctive segment of the pediatric population that includes children of non‐White racial and ethnic groups with increased pigmentation including individuals of Asian, LatinX, African, Native American, Pacific Island descent, Indigenous Peoples, among others, with overlap in particular individuals, and mixtures thereof. Treating children of color is a unique skill set within the field of pediatric dermatology, requiring knowledge and sensitivity. The discipline of pediatric skin of color can be challenging. Difficulty in diagnosis of common conditions stems from underlying pigmentation, variations in common hairstyling practices, and differences in demographics of cutaneous disease, whereas some conditions are more common in children of color, other conditions have nuances in clinical appearance and/or therapeutics with regard to skin color. This article is the first in a series of two articles looking at recently published skin‐related issues of high concern in children of color. Conditions reviewed in Part 1 include (1) hairstyling hair‐related concerns (traction alopecia, central centrifugal cicatricial alopecia, endocrine disruption), (2) autoimmune concerns (cutaneous lupus, vitiligo), and (3) infections (tinea capitis, progressive macular hypomelanosis). [ABSTRACT FROM AUTHOR]

Dermatology for pediatric skin of color is the application of dermatology to the genetically diverse and distinctive segment of the pediatric population that includes children of non‐White racial and ethnic groups with increased pigmentation including individuals of Asian, Hispanic/LatinX, African, Native American, Pacific Island descent, indigenous people among others with overlap in particular individuals, and mixtures thereof. The discipline of pediatric skin of color can be challenging with difficulty in diagnosis of common conditions due to underlying pigmentation, variations in common hair styling practices, and differences in demographics of cutaneous disease. Whereas some conditions are more common in children of color, other conditions have nuances in clinical appearance and therapeutics with regard to skin color. This article, the second of the series, focuses on inflammatory skin disease nuances, melanocytic disorders, and hypopigmented mycosis fungoides. [ABSTRACT FROM AUTHOR]

Melanoma is a lethal skin cancer disease affecting millions of people around the globe and has a high mortality rate. Dermatologists perform the manual inspection through visual analysis of pigmented skin lesions for melanoma identification at the early stage. However, manual inspection for melanoma detection is limited due to variable accuracy and lesser availability of dermatologists. Therefore, there exists an urgent need to develop automated melanoma detection methods that can effectively localize and classify skin lesions. Accurate localization and classification of the melanoma lesions is a challenging task due to the presence of low contrast information between the moles and skin part, the massive color similarity between the infected and non-infected skin portions, presence of noise, hairs, and tiny blood vessels, variations in color, texture, illumination, contrast, blurring, and melanoma size. To address these afore-mentioned challenges, we propose an effective and efficient melanoma detection method. The proposed method consists of three steps: i) image preprocessing, ii) employing Faster Region-based Convolutional Neural Network (Faster-RCNN) for melanoma localization, and iii) application of Support Vector Machine (SVM) for the classification of localized melanoma region into benign and malignant classes. Performance of the proposed method is evaluated on the benchmark ISIC-2016 dataset launched by ISBI challenge-2016 that is diverse in terms of variations in illumination, color, texture, and size of melanoma, and presence of blurring, noise, hairs, and tiny blood vessels, etc. Moreover, we have also performed a cross-dataset validation over the ISIC-2017 dataset to show the efficacy of our method in real-world scenarios. Our experimental results illustrate that the proposed framework is efficient and able to effectively localize and classify the melanoma lesion than state-of-the-art techniques. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Most cutaneous vascular lesions are benign and do not require treatment. Many are referred to specialist dermatologists from primary care. AIM: This study aimed to investigate the characteristics of cutaneous vascular lesions and the reasons for their referral from primary care. METHODS: Lesions diagnosed as cutaneous vascular abnormalities or dermatoses were retrospectively selected from a database of patients attending the Waikato Virtual Lesion Clinic. Demographic data, diagnosis and clinic outcome were recorded for each imaged lesion. Primary care referrals were reviewed to determine the reasons for referral. RESULTS: In total, 229 referrals for vascular lesions were received between January 2010 and February 2019. Patient ages ranged from 6 to 95 years and 64.2% of patients were female. Nearly half the lesions (47.2%) were located on the head and neck; 64.1% had a dermatological diagnosis of a vascular tumour and 18.7% had a malformation. The most common reason for referral was pigmentation (45.7%) and bleeding was least common (8.2%). No diagnosis was given in 34.2% of referrals and less than one-quarter had a correct diagnosis. Malignancy was suspected in 40.2% of referrals; however, the dermatologists found that 95.2% of patients did not require further treatment. Half of excisions (n = 2) were for bleeding and all were histologically benign. DISCUSSION: Diagnostic uncertainty and suspected malignancy commonly result in referral of benign cutaneous vascular lesions to public dermatology services. This study highlights the usefulness of teledermatology in the timely access of specialist input, minimising the need for intervention or excision. [ABSTRACT FROM AUTHOR]

Dermatoscopy is a relevant in vivo diagnostic tool for inflammatory diseases of the skin that aids not only in diagnosis, but also in monitoring the response to treatment. The inflammatory diseases show dermoscopic patterns involving the vessels, scales, follicles, background hue, and special clues. This review aims to provide an overview on the use of dermoscopy in inflammatory dermatoses based on the available literature and the deviation from it in the skin of color (SOC) as there is paucity of literature in dermoscopy of inflammatory disorders in SOC. The dermatoscopic patterns in most of the inflammatory diseases in SOC are similar to that of white skin, with pigmentary changes being the prominent dermoscopic findings while vascular patterns and erythema being less evident. [ABSTRACT FROM AUTHOR]