Pearls to treat dermatological conditions of colored skin
Dermatological conditions appear differently in patients with colored skin than in white patients, which are commonly used as illustrative examples for a variety of skin problems. During her session at the 2021 American Academy of Pediatrics National Virtual Conference and Exhibition, Candrice R. Heath, MD, FAAP, FAAP, assistant professor of dermatology at the Lewis Katz School of Medicine in Philadelphia, Pa., Shared insights clinical pearls to take care of colored skin.
She opened the session with the case of a 14-year-old patient who presented with dark spots on her face that have worsened over the past 3 years. A diagnosis of acne and post-inflammatory hyperpigmentation was made and a treatment plan was developed to address both issues, with an emphasis on acne. Heath noted that the clinician may be happy with the treatment plan, but the patient was likely in the parking lot feeling like the appointment was a waste of time when he only wanted something to treat the spots brunettes. When faced with hyperpigmentation, clinicians should acknowledge that they see the problem and explain how the treatment plan will treat it, such as retinoid in this case. For patients prescribed a retinoid, clinicians should encourage the use of moisturizers and insist that only a pea-sized amount should be used. Due to the irritation retinoids can cause, there is a good chance that there will not be 100% adhesion. However, physicians should discuss with patients and caregivers the daily questions “did you use your retinoid medication today?” Can ensure that the application occurs at a rate that shows the benefits.
Atopic dermatitis and forms of eczema are conditions that can appear differently on colored skin and some forms can also be more common. The erythema may not be noticeable. Heath said that a “close your eyes and use touch” approach can help pinpoint the site of flare-ups, especially with follicular eczema, which looks like goosebumps and occurs more frequently in black children than black children. others. Eczema herpeticum is another form that is often found in young children between the ages of 3 and 4 and is more common in non-white children, especially children of Asian descent. It is also more common among children from higher income households. Additionally, black and Hispanic children are more likely to have persistent atopic dermatitis as well as disease resistant to treatment. Because of this resistance to treatment, it is important to use a broad approach to treatment ranging from soaking and smearing to phototherapy to systemic drugs like dupilumab.
Heath recalled that tinea capitis can present in a variety of ways, including diffuse dander, ring plaque, blackhead, and inflammation. To determine whether to wait for the culture to return, she recalled a study that showed how certain signs of the disease, including alopecia, scaling, and occipital lymphadenopathy, can be fairly certain indicators of the disease. When using microsize griseofulvin (125 mg / 5 ml), she recommended treating at 20-25 mg / kg / day for 12 weeks. With terbinafine (250 mg tablet), it is a quarter of a tablet per day for children between 10 and 20 kg; half a tablet per day for children from 20 to 40 kg; and the whole tablet per day for children over 40 kg.
When examining the scalp, clinicians should demonstrate cultural humility and sensitivity. Keep in mind the ‘wash day’ ritual that many black children with tightly curly hair undergo, which is time consuming and involves removing the previous style, washing the hair twice, conditioning it, detangling it. with a large wide tooth comb while the conditioner is on the hair, rinse, detangle more intensively, then the final styling. When prescribing a scalp topical, it is important to discuss its place in this process. Heath closed his session by pointing out that tightly coiled hair is a big deal because it is an intersection of culture and the relationship between child and barber.
1. Heath C. Dermatologic disorders in pediatric patients with colored skin. American Academy of Pediatrics National Conference and Exhibition 2021; virtual. Accessed October 9, 2021.