Roopal Vashi Kundu

Background: Few studies have comprehensively assessed dermatologic conditions in women, particularly among different racial and ethnic groups. Objective: This study characterizes common dermatologic diagnoses in adult women (acne), emphasizing conditions disproportionately affecting women of color (WOC) (hidradenitis suppurativa [HS], hypertrophic scars, and scarring and nonscarring alopecia). Methods: This retrospective cohort study analyzed data from Northwestern Medicine’s Enterprise Data Warehouse, covering 637,124 patient visits from 2018 to 2021. The dataset included 212,223 unique patients, with 398,431 visits by women. Patient demographics (age, race, and ethnicity) and clinical data (diagnoses, treatments) were analyzed using logistic and linear regression. Results: Women accounted for 62.5% of dermatologic visits. Women were significantly more likely than men to present with acne, HS, and scarring and nonscarring alopecia. White women represented 77.4% of women, while WOC (Black, Asian, and Hispanic) comprised 16.3%. Acne was the most common diagnosis among women under 30. WOC were younger on average (44.6 years) compared with white patients (50.9 years) and had higher odds of alopecia, hypertrophic scars, acne, and HS. Cosmetic procedures were less frequent among WOC. Limitations: Findings may have limited generalizability due to being conducted within a single medical system. Conclusion: Women, and specifically WOC, are disproportionately impacted by many common dermatologic conditions. These conditions have significant morbidity, which is heightened by complications like hyperpigmentation and scarring in the skin of the color population. Accurate and timely diagnosis is necessary to improve women’s dermatology outcomes.

Vitiligo is a generally asymptomatic acquired depigmentation disorder, limiting the utility of general dermatology quality of life (QoL) scales that may not adequately reflect the psychosocial burden experienced by patients. The aim of our study was to translate the vitiligo-specific quality-of-life instrument (VitiQoL) with maximum score of 90, into Turkish language, and to culturally adapt and validate it for use in the Turkish population. The VitiQoL was initially cross‑culturally adapted to Turkish through forward‑backward translation. The Turkish version of the VitiQoL together with the dermatology life quality index (DLQI) and the Skindex‑16 scale were applied to Turkish vitiligo patients. A total of 148 consecutive volunteer vitiligo patients were included in the study. The internal consistency of the Turkish version of the VitiQoL was excellent (Cronbach’s alpha = 0.915). Since the Turkish version of the VitiQoL item 13 had a corrected item-total correlation lower than 0.3 (0.264), it was removed from the survey. VitiQoL-TR includes 14 items, with the removal of item 13 (Cronbach’s alpha = 0.922). Exploratory factor analyses revealed two distinct factors within the VitiQoL scale: participation limitation and stigma. Forty-six (31.08%) of the participants completed the VitiQoL-TR twice, 10–14 days apart. The test and retest scores of the VitiQoL-TR had a strong significant correlation (r = 0.883; p < 0.001). The intraclass correlation coefficient was 0.939. There was a strong significant correlation between the VitiQoL-TR score and the Skindex-16 score (r = 0.848; p < 0.001), and a moderate significant correlation with the DLQI score (r = 0.696; p < 0.001) thus confirming the convergent validity. In conclusion, the maximum value of the scale is 84 instead of 90. This should be taken into consideration when conducting international studies and comparing international data. The VitiQoL-TR is a valid and reliable health-related QoL tool for assessing the QoL of Turkish vitiligo patients.

Differences in prevalence of inflammatory skin diseases including atopic dermatitis and psoriasis in African American (AA) versus White Non-Hispanic (WNH) population are well recognized. However, the underlying mechanisms are largely unknown. We previously observed significant differences in healthy AA skin transcriptome with differentially expressed genes (DEG) enriched for inflammation and cornification processes. Here we analyzed proteome in skin biopsies from healthy AA and WNH volunteers using Olink ® Explore Inflammation 384 biomarker panel. Among proteins with higher expression in AA skin were IRAK1, IL1A, IL4, IL22RA1. IL1A binding to IL1R1 receptor is known to result in recruitment of adapter molecules such as IRAK1, and activation of downstream NF-κB and MAPK signaling. We confirmed NF-κB and ERK1/2 activation in AA skin by Western blot analysis of their phosphorylation at specific activating sites. Importantly, we observed similar differences between AA and WNH neonatal foreskin and between AA and WNH 3D skin organoids. Further analysis of DEG promoters by Gene Transcription Regulation Database (GTRD) pointed to NF-κB and AP1 as key transcription factors involved in AA DEG regulation. Overall, proinflammatory signaling in healthy AA skin starting early in childhood may contribute to the increased risk of certain inflammatory skin diseases within the AA population.

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.

Vitiligo is characterized by skin depigmentation, which can lead to profound psychological effects and decreased quality of life, especially for those with skin of color. Individuals with vitiligo may utilize complementary and alternative medicine (CAM) due to limited treatment options with varying efficacy. An anonymous, multiple-choice, cross-sectional questionnaire was distributed to participants with vitiligo in the United States through online forums. Data on disease characteristics, use of prescription medications, use of topical therapies, supplements, and diets, and perceptions of CAM were collected. In total, 625 respondents completed the survey. Overall, 32.5% of participants (203/625) have tried CAM. Commonly reported CAM include supplements of vitamin D (57.7%, 116/203), vitamin B12 (46.3%, 93/203), vitamin C (27.4%, 55/203), topical Nigella sativa oil (26.4%, 53/203), oral omega-3 fatty acids (24.9%, 50/203), folic acid (22.9%, 46/203), and vitamin E (22.9%, 46/203). Frequently cited reasons for CAM use include desire to try “new” (40.4%, 82/203) or “more natural” (26.6%, 54/203) therapies, “frustration with conventional medicine” (24.6%, 50/203), and fear of “adverse side effects of conventional medicine” (23.6%, 48/203). Non-White participants were more likely than their White counterparts to report CAM use and have more positive perceptions of CAM therapies. Less than half (43.3%, 88/203) of CAM users reported that they disclosed their use of CAM with their physician. Dermatologists should be mindful of CAM and ask patients about their use. Further investigation of the role of CAM as adjuvant therapy for vitiligo is warranted to better advise patients.