Publications by authors named "Valerie D Callender"

54 Publications

Central Centrifugal Cicatricial Alopecia: Challenges and Treatments.

Dermatol Clin 2021 Jul 15;39(3):389-405. Epub 2021 May 15.

Callender Dermatology and Cosmetic Center, 12200 Annapolis Road, Suite 315, Glenn Dale, MD 20769, USA.

Central centrifugal cicatricial alopecia (CCCA) is the most common form of primary scarring alopecia diagnosed in women of African descent. Although the etiology was originally attributed exclusively to hairstyling practices common among women of African descent, more recent research on CCCA supports the concept that there are several contributing factors, including variants in gene expression, hair grooming practices that increase fragility on the hair follicle, and associations with other systemic conditions. Treatment of CCCA involves a combination of patient counseling and education on alternative hairstyles, medical therapies, and procedural methods when necessary.
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http://dx.doi.org/10.1016/j.det.2021.03.004DOI Listing
July 2021

The art of prevention: It's too tight-Loosen up and let your hair down.

Int J Womens Dermatol 2021 Mar 29;7(2):174-179. Epub 2021 Jan 29.

Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia, United States.

Traction alopecia is prevalent in patients of color. Its significance in clinical practice may be underemphasized due to the transient nature of the condition; however, it has the potential to become permanent and cause significant psychosocial distress. Understanding of afro-textured hair and cultural practices, as well as early recognition and treatment, provides an opportunity to prevent permanent traction alopecia and long-term sequelae.
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http://dx.doi.org/10.1016/j.ijwd.2021.01.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072502PMC
March 2021

Turning the Tide: How the Women's Dermatologic Society Leads in Diversifying Dermatology.

Int J Womens Dermatol 2021 Mar 25;7(2):135-136. Epub 2020 Dec 25.

Department of Dermatology, University of California at San Francisco, San Francisco, CA, United States.

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http://dx.doi.org/10.1016/j.ijwd.2020.12.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072496PMC
March 2021

Skin cancer in women of color: Epidemiology, pathogenesis and clinical manifestations.

Int J Womens Dermatol 2021 Mar 2;7(2):127-134. Epub 2021 Feb 2.

Callender Dermatology and Cosmetic Center, Glenn Dale, MD, United States.

Malignant melanoma and nonmelanoma skin cancers (NMSC), which include basal cell carcinoma and squamous cell carcinoma, account for 40% of all neoplasms in white patients, making these cancers the most common malignancy in the United States. Given the large number of NMSC cases in white patients, there is a correspondingly large body of literature addressing various aspects of epidemiology, pathogenesis, and treatment. The incidence of both malignant melanoma and NMSC is well established and remains significantly lower in patients with skin of color (SoC) when compared with white patients. Although there is a lower incidence of skin cancer in SoC, there is often a poorer prognosis among this group. There is even more limited data focusing on women of color, making an accurate determination of incidence and mortality difficult. This gender disparity causes decreased skin cancer awareness and index of suspicion among patients and providers, hindering appropriate evaluation and care. Therefore, there is a need for an increased understanding of skin cancer in women of color. In the traditional sense, SoC refers to people of African, Asian, Native American, Middle Eastern, and Hispanic backgrounds. Patients in these ethnic groups have richly pigmented skin that is usually categorized as Fitzpatrick types III through VI and thus have notable differences in skin disease and presentation compared with fair-skinned individuals. We present this review of skin cancer in women of color to give a reasonably comprehensive representation of the literature to advance our understanding and knowledge in this unique population.
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http://dx.doi.org/10.1016/j.ijwd.2021.01.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072498PMC
March 2021

Safety and Efficacy of Clobetasol Propionate 0.05% Emollient Foam for the Treatment of Central Centrifugal Cicatricial Alopecia.

J Drugs Dermatol 2020 Jul;19(7):719-724

Background: There is currently an unmet need for the treatment of women with central centrifugal cicatricial alopecia (CCCA). Objective: To evaluate the safety and efficacy of Clobetasol propionate 0.05% emollient foam for the treatment of women with CCCA. Methods: Adult women of African descent that presented with clinical evidence of early CCCA were enrolled (N=30). Clobetasol propionate 0.05% emollient foam was applied daily in an open-label fashion. Safety and efficacy assessments were performed at weeks 2, 6, 12, and 14. Results: Subjects achieved substantial improvements in pruritus, pain, tenderness, erythema and scaling. Scalp biopsies revealed considerable improvements in severe inflammation and perifollicular edema. Overall, clobetasol propionate 0.05% emollient foam was well-tolerated. Limitations: This was a nonrandomized, open-label study. Enrollment was limited to subjects with clinically mild CCCA. Conclusion: Subjects with CCCA that applied topical clobetasol propionate 0.05% emollient foam to their scalp daily demonstrated continuous clinical improvement throughout the 14-week study. ClinicalTrials.gov Identifier: NCT01111981 J Drugs Dermatol. 2020;19(7): doi:10.36849/JDD.2020.5201.
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http://dx.doi.org/10.36849/JDD.2020.5201DOI Listing
July 2020

Biotin Alone or a Science-Driven Nutraceutical Multi-Targeted Approach?

J Drugs Dermatol 2019 09;18(9):952-953

It is with great fervor that I revisit the article published in Journal of Drugs in Dermatology by Soleymani et al, titled “The Infatuation With Biotin Supplementation: Is There Truth Behind Its Rising Popularity? A Comparative Analysis of Clinical Efficacy versus Social Popularity.”1 First, I’d like to thank the authors for raising awareness of the overuse of biotin for hair loss and reminding us of the struggle we are faced with daily when debunking quick-fix myths propagated by media infatuation.
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September 2019

Therapeutic Insights in Melasma and Hyperpigmentation Management

J Drugs Dermatol 2019 Aug;18(8):718-729

Melasma and postinflammatory hyperpigmentation (PIH) are the most common forms of dyschromia in patients with skin of color. Both are associated with a high psychological burden of disease. To exacerbate this burden, the need for treatment is chronic, and the results are often suboptimal in the eyes of the patient. Successful treatment is therefore contingent upon a correct diagnosis, patient education, and a carefully considered therapeutic approach. The latter is often multimodal in its design, incorporating sun protection, topical and systemic medications, and in some cases, procedural intervention. Although topical hydroquinone is a mainstay of treatment for melasma and PIH, there are alternatives that have emerged as of late that have shown varying degrees of promise, both in terms of safety and efficacy. In this article, we review the epidemiological, clinical, and histologic features of melasma and postinflammatory hyperpigmentation, and discuss important considerations for both established and emerging treatments for these vexingly common and difficult to treat conditions.
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August 2019

Myths and Knowledge Gaps in the Aesthetic Treatment of Patients With Skin of Color

J Drugs Dermatol 2019 Jul;18(7):616-622

Background: Misperceptions about facial aesthetic treatments in individuals with skin of color (SOC) may influence treatment selection. Objective: We aimed to identify knowledge gaps and myths concerning facial aesthetic treatment in individuals with SOC. Methods: A PubMed search identified articles concerning patients with SOC receiving facial aesthetic treatments. The experience of experts in aesthetic treatment of patients with SOC was also considered. Results: Knowledge gaps included not seeking injectable filler treatment of lips, risk of developing keloids with injectable filler treatment, risk of hyperpigmentation precluding surgical procedures and nonsurgical injectable filler treatment, melasma being a minor cosmetic concern with limited treatments, and racial/ethnic groups being homogeneous with respect to facial characteristics and aesthetic concerns. Dispelled myths included perceptions that: individuals with SOC do not need sunscreen; dermal fillers and neuromodulators are not necessary or useful for patients with darker skin; laser treatments cannot be used on darker skin; facial products are unnecessary; and only medical providers with SOC can understand how to treat patients with SOC. Conclusions: Knowledge gaps and myths concerning facial aesthetic treatment in individuals with SOC exist. These patients may undergo various facial aesthetic procedures safely and effectively, as long as nuances in treatment approaches are recognized. J Drugs Dermatol. 2019;18(7):616-622.
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July 2019

Efficacy and Safety of Crisaborole Ointment, 2%, for the Treatment of Mild-to-Moderate Atopic Dermatitis Across Racial and Ethnic Groups.

Am J Clin Dermatol 2019 Oct;20(5):711-723

Pfizer Inc., New York, NY, USA.

Background: Atopic dermatitis is highly prevalent in black/African American, Asian, and Hispanic patients, making assessment of these populations in clinical trials important. Crisaborole ointment, 2%, is a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild-to-moderate atopic dermatitis. In two pivotal phase III clinical trials in patients aged ≥ 2 years, crisaborole was superior to vehicle in reducing global disease severity. The most common treatment-related adverse event was application site pain.

Objective: The objective of this study was to investigate the efficacy and safety of crisaborole according to patient race and ethnicity.

Methods: A pooled post hoc analysis by race and ethnicity of the two pivotal trials and a safety extension trial was performed. Race included white or nonwhite (encompassing Asian/native Hawaiian/other Pacific Islander, black/African American, and other/American Indian/Alaskan native); ethnicity included Hispanic/Latino or not Hispanic/Latino.

Results: In white, nonwhite, Hispanic/Latino, and not Hispanic/Latino groups at day 29, more crisaborole- than vehicle-treated patients achieved improvements in global disease severity [Investigator's Static Global Assessment of clear/almost clear with a ≥ 2-grade improvement (white: 33.5% vs. 22.3%, nominal p < 0.001; nonwhite: 30.0% vs. 21.3%, nominal p < 0.05; Hispanic/Latino: 35.4% vs. 18.2%, nominal p < 0.01; not Hispanic/Latino: 31.3% vs. 22.8%, nominal p < 0.01)]. Crisaborole treatment also improved atopic dermatitis signs/symptoms and quality of life. Frequency of crisaborole-related adverse events was 7.1-8.5% in the pivotal trials.

Conclusion: Across races and ethnicities, crisaborole demonstrated efficacy for the treatment of mild-to-moderate atopic dermatitis, with a low frequency of treatment-related adverse events.
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http://dx.doi.org/10.1007/s40257-019-00450-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764931PMC
October 2019

A Double-Blind, Placebo-Controlled, Phase 3b Study of ATX-101 for Reduction of Mild or Extreme Submental Fat.

Dermatol Surg 2019 12;45(12):1531-1541

Allergan plc, Irvine, California.

Background: ATX-101 (deoxycholic acid injection) is approved for reduction of moderate or severe submental fat (SMF).

Objective: To evaluate the efficacy and safety of ATX-101 in subjects with mild or extreme SMF.

Patients And Methods: Adults with mild or extreme SMF (based on clinician assessment) were randomized to receive ≤6 treatments with ATX-101 or placebo. Efficacy end points, evaluated at 12 weeks after last treatment, included percentage of subjects who achieved ≥1-grade improvement in SMF from baseline based on both clinician and patient assessment (composite CR-1/PR-1 response) as well as multiple subject-reported outcomes. Safety end points included change in skin laxity and incidence of adverse events.

Results: Overall, 61.3% of ATX-101-treated subjects versus 6.7% of placebo-treated subjects with mild SMF and 89.3% versus 13.3% of subjects, respectively, with extreme SMF achieved a composite CR-1/PR-1 response (p < .001 for both). ATX-101-treated subjects also reported higher levels of satisfaction and greater reductions in the psychological impact of SMF versus placebo-treated subjects regardless of baseline SMF severity. Skin laxity was unchanged or improved in most of the subjects. Adverse events were mainly mild/moderate, transient, and associated with the injection site.

Conclusion: ATX-101 was efficacious and well tolerated for reduction of mild or extreme SMF.
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http://dx.doi.org/10.1097/DSS.0000000000001850DOI Listing
December 2019

Final Data from the Condition of Submental Fullness and Treatment Outcomes Registry (CONTOUR)

J Drugs Dermatol 2019 01;18(1):40-48

Perceptions of attractiveness can be negatively affected by submental fullness. Patients seeking to improve their submental contour have a variety of treatment options including surgical procedures, energy-based devices, and injectable treatment. The Condition of Submental Fullness and Treatment Outcomes Registry (CONTOUR) was designed to provide insights into the treatment of submental fat (SMF) in clinical practice. CONTOUR was a prospective observational study that enrolled 1029 adults at 91 sites in the United States and Canada. Patients were followed until treatment completion, discontinuation, or 1 year elapsed from enrollment without treatment. Final data from CONTOUR are reported here. Of the 676 patients who underwent treatment, 570 were treated with ATX-101 (deoxycholic acid injection), 77 with energy-based devices, 23 with surgical liposuction, 5 with laser liposuction, and 9 with other treatments. The majority of treated patients were facial aesthetic treatment naive. A markedly greater percentage of patients with mild or moderate SMF at baseline received treatment with ATX-101 or energy-based devices, whereas the majority of patients undergoing liposuction had severe or extreme SMF. Physicians most frequently cited a preference for a noninvasive/minimally invasive procedure as the reason for choosing either ATX-101 or energy-based devices. The majority of patients were at least partially satisfied with results, regardless of the chosen treatment. Data from CONTOUR indicate that cost is the most important factor in a patient’s decision to undergo treatment, that choice of treatment method is most influenced by SMF severity and preference for nonsurgical versus surgical intervention, and that the availability of noninvasive/minimally invasive options has made SMF treatment an attractive first procedure for patients who have not undergone previous facial aesthetic treatments. ClinicalTrials.gov identifier: NCT02438813. J Drugs Dermatol. 2019;18(1):40-48.
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January 2019

Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: Review and clinical practice experience.

J Am Acad Dermatol 2019 Jun 19;80(6):1722-1729.e7. Epub 2018 Sep 19.

Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Rosacea has been reported less frequently among individuals with skin of color than in those with white skin, but rosacea is not a rare disease in this population. In fact, rosacea might be underreported and underdiagnosed in populations with skin of color because of the difficulty of discerning erythema and telangiectasia in dark skin. The susceptibility of persons with highly pigmented skin to dermatologic conditions like rosacea, whose triggers include sun exposure, is probably underestimated. Many people with skin of color who have rosacea might experience delayed diagnosis, leading to inappropriate or inadequate treatment; greater morbidity; and uncontrolled, progressive disease with disfiguring manifestations, including phymatous rosacea. In this article, we review the epidemiology of rosacea in skin of color and highlight variations in the clinical presentation of rosacea across the diverse spectrum of patient populations affected. We present strategies to aid in the timely diagnosis and effective treatment of rosacea in patients with skin of color, with an aim of promoting increased awareness of rosacea in these patients and reducing disparities in the management of their disease.
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http://dx.doi.org/10.1016/j.jaad.2018.08.049DOI Listing
June 2019

Efficacy, Safety, and Tolerability of Topical Dapsone Gel, 7.5% for Treatment of Acne Vulgaris by Fitzpatrick Skin Phototype.

J Drugs Dermatol 2018 Feb;17(2):160-167

Background: Acne vulgaris (acne) is prevalent in individuals with skin of color, often with more frequent sequelae than in patients with lighter skin color. It is important to determine if there are also differences in response to medications.

Objective: This study evaluated the efficacy and tolerability of once-daily dapsone gel, 7.5% in patients with acne, stratified by Fitzpatrick skin phototype.

Methods: Data were pooled from 2 identically designed, phase 3, randomized, double-blind, vehicle-controlled studies in patients aged 12 years and older with moderate acne. Patients applied dapsone gel, 7.5% or vehicle once daily for 12 weeks. Efficacy was evaluated using the Global Acne Assessment Score (GAAS), lesion counts, and Acne Symptom and Impact Scale (ASIS); adverse events (AEs) and tolerability were also assessed.

Results: This analysis included 2216 patients with skin phototypes I-III and 2111 with types IV-VI. Dapsone gel, 7.5% significantly improved acne severity versus vehicle in both skin phototype subgroups, as determined by the percentage of patients with at least a 1-grade improvement in GAAS and mean change from baseline in GAAS (both, P less than .0001) at week 12 versus baseline. Dapsone gel, 7.5% significantly reduced inflammatory, comedonal, and total lesions in skin phototypes I-III (P less than .001) and IV-VI (P less than equal to .01) versus vehicle. Improvements in inflammatory lesions occurred first, with generally similar patterns of improvement seen over time in GAAS, comedonal lesions, and ASIS domains. The incidence of AEs was similar in both skin phototype subgroups and between study medications. Local scaling, erythema, stinging/burning, and dryness were rated "none" by most patients in both treatment groups and skin phototype subgroups.

Conclusion: Once-daily dapsone gel, 7.5% was effective, safe, and well tolerated in patients with all skin phototypes who were treated for moderate acne. J Drugs Dermatol. 2018;17(2):160-167.
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February 2018

Approach to treatment of medical and cosmetic facial concerns in skin of color patients.

Cutis 2017 Dec;100(6):375-380

Department of Dermatology, University of Pennsylvania, Philadelphia, USA.

Facial concerns in skin of color (SOC) patients vary and can be a source of emotional and psychological distress. This article discusses 4 common facial concerns in SOC patients: acne, rosacea, facial hyperpigmentation, and cosmetic enhancement. Treatment recommendations are provided as well as management pearls.
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December 2017

Physician-Industry Collaboration: Organizational Considerations for the Future of Innovation and Growth in Dermatology.

Int J Womens Dermatol 2017 Dec 1;3(4):239-243. Epub 2017 Dec 1.

Harvard Medical School, Boston, MA, USA.

The U.S. medical environment continues to evolve with issues from Privacy to EMR, Insurance regulations, Physician Access and Healthcare Reform, and MACRA (Medicare Access and CHIP Reauthorization Act) on the discussion table. Not since the advent of Medicare and Medicaid in the mid 1960's, have we seen such widespread changes in the medical healthcare environment (Centers for Medicare and Medicaid Services). Physicians, industry, patients and consumers are affected by the changes. These four groups have historically worked as separate entities, but are now key stakeholders in the future of dermatology. As stakeholders collaborating in building a future together, the dermatologists/physicians will help to ensure and preserve the quality of patient care and best patient outcomes. In 2 Executive Forum meetings February 21-23, 2014 and June 3-4, 2016 the leaders from the Women's Dermatologic Society and Industry, explored several important areas, six of which will be reviewed in this article 1) A five-year outlook of Dermatology and Medicine; 2) The New Practice Environment; 3) Access of Industry to Dermatologists and Trainees; 4) Doing Things Differently; and 5) Female Leadership 6) Unmet Needs. The collaborative group explored solutions for our specialty and the patients we serve.
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http://dx.doi.org/10.1016/j.ijwd.2017.10.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5715232PMC
December 2017

New Insight Into the Pathophysiology of Hair Loss Trigger a Paradigm Shift in the Treatment Approach.

J Drugs Dermatol 2017 Nov;16(11):s135-s140

Hair loss affects millions of men and women of all ages and ethnicities, impacting appearance, social interactions, and psycho-emotional well-being. Although a number of options are available, they are limited, carry a potential risk of side effects, and none have proven to be comprehensive for treatment of hair loss. Across the spectrum of hair loss disorders, there has long been a segmentation into distinct mechanisms, driving the main trend in current therapeutics to focus on targeting single molecules or pathways. However, research points to similar dysregulation of intrinsic signaling pathways within follicle physiology that span the hair loss disorder spectrum - with a common inflammatory component identified in most hair loss pathogenesis, including that of androgenetic alopecia (AGA).

J Drugs Dermatol. 2017;16(11 Suppl):s135-140.

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November 2017

Commentary on Considerations When Treating Cosmetic Concerns in Men of Color.

Dermatol Surg 2017 11;43 Suppl 2:S151-S152

Department of Dermatology, Howard University College of Medicine, Washington, DC.

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http://dx.doi.org/10.1097/DSS.0000000000001380DOI Listing
November 2017

Central Centrifugal Cicatricial Alopecia: New Insights and a Call for Action.

J Investig Dermatol Symp Proc 2017 10;18(2):S54-S56

Department of Dermatology, Wake Forest Baptist Health Medical Center, Winston-Salem, North Carolina, USA.

Central centrifugal cicatricial alopecia (CCCA) is a common and progressive form of lymphocyte predominant scarring alopecia which impacts negatively on the quality of life of those affected. It is seen more commonly in women of African descent with prevalence ranging from 2.7% to 5.7%. Current postulates include genetic inheritance, with traction inducing hairstyling practices and hair chemicals as aggravating factors. Histology reveals a perifollicular lymphocytic inflammation of the lower infundibulum, premature desquamation of the inner root sheath, and fibrous connective tissue. Treatment remains challenging and is directed at suppressing and preventing the inflammation, thus aborting scarring, with surgical intervention reserved for those who have stable disease or absence of histological inflammation. Future research with more patient numbers, focusing on the genetics of CCCA may prove useful in order to fully understand the etiology, thus providing more effective treatments for CCCA.
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http://dx.doi.org/10.1016/j.jisp.2017.01.004DOI Listing
October 2017

Updates in the understanding and treatments of skin & hair disorders in women of color.

Int J Womens Dermatol 2017 Mar 16;3(1 Suppl):S21-S37. Epub 2017 Feb 16.

Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia.

Skin of color comprises a diverse and expanding population of individuals. In particular, women of color represent an increasing subset of patients who frequently seek dermatologic care. Acne, melasma, and alopecia are among the most common skin disorders seen in this patient population. Understanding the differences in the basic science of skin and hair is imperative in addressing their unique needs. Despite the paucity of conclusive data on racial and ethnic differences in skin of color, certain biologic differences do exist, which affect the disease presentations of several cutaneous disorders in pigmented skin. While the overall pathogenesis and treatments for acne in women of color are similar to Caucasian men and women, individuals with darker skin types present more frequently with dyschromias from acne, which can be difficult to manage. Melasma is an acquired pigmentary disorder seen commonly in women with darker skin types and is strongly associated with ultraviolet (UV) radiation, genetic factors, and hormonal influences. Lastly, certain hair care practices and hairstyles are unique among women of African descent, which may contribute to specific types of hair loss seen in this population, such as traction alopecia, trichorrhexis nodosa and central centrifugal cicatricial alopecia (CCCA).
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http://dx.doi.org/10.1016/j.ijwd.2017.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419061PMC
March 2017

Physician-Industry Collaboration: Organizational Considerations for the Future of Innovation and Growth in Dermatology.

Int J Womens Dermatol 2016 Jun 22;2(2):60-61. Epub 2016 Jun 22.

Harvard Medical School, Boston, MA, USA.

The U.S. medical environment continues to evolve with issues from Privacy to EMR, Insurance regulations, Physician Access and Healthcare Reform, and MACRA (Medicare Access and CHIP Reauthorization Act) on the discussion table. Not since the advent of Medicare and Medicaid in the mid 1960's, have we seen such widespread changes in the medical healthcare environment (Centers for Medicare and Medicaid Services). Physicians, industry, patients and consumers are affected by the changes. These four groups have historically worked as separate entities, but are now key stakeholders in the future of dermatology. As stakeholders collaborating in building a future together, the dermatologists/physicians will help to ensure and preserve the quality of patient care and best patient outcomes. In the Executive Forum, leaders from the Women's Dermatologic Society and Industry, explored five important areas: 1) A five-year outlook of Dermatology and Medicine; 2) Access of Industry to Dermatologists and Trainees; 3) The New Practice Environment; 4) Doing Things Differently; and 5) Unmet Specialty Needs. The collaborative group explored solutions for our specialty and the patients we serve.
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http://dx.doi.org/10.1016/j.ijwd.2016.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412093PMC
June 2016

Diagnostic Clues to Frontal Fibrosing Alopecia in Patients of African Descent.

J Clin Aesthet Dermatol 2016 Apr 1;9(4):45-51. Epub 2016 Apr 1.

Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Frontal fibrosing alopecia has previously been reported as rare among patients of African descent. The authors present 18 cases of frontal fibrosing alopecia affecting African American patients and review all published cases of frontal fibrosing alopecia involving patients of African descent. Since 2010, there have been 66 published cases of frontal fibrosing alopecia among patients of African descent; 59 women, five men, and two cases of unknown gender. Frontal fibrosing alopecia is not uncommon among patients of African descent. In this study, the authors find that female African American patients may have fewer symptoms and unique clinical presentations. Frontal fibrosing alopecia is an entity that can be seen in patients with many different ethnic backgrounds, often with varying presentations. The diagnosis of frontal fibrosing alopecia must be considered in any patient of African descent who presents with frontotemporal alopecia. In the authors' patient population, there was a younger age of presentation. The presence of perifollicular hyperpigmentation along the hairline and concomitant facial hyperpigmentation may aid in making the diagnosis and distinguishing this entity from traction alopecia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898584PMC
April 2016

The Efficacy and Safety of Topical Dapsone Gel, 5% for the Treatment of Acne Vulgaris in Adult Females With Skin of Color.

J Drugs Dermatol 2016 Feb;15(2):197-204

Background: Topical dapsone gel, 5% is approved for treatment of acne vulgaris but has not been studied specifically in women with skin of color (SOC; Fitzpatrick skin types IV, V, or VI).

Objective: Evaluate safety and efficacy of dapsone gel, 5% applied topically twice daily for 12 weeks in women with SOC.

Methods: Females with SOC aged 18 years and older with facial acne participated in a multicenter, open-label, single-group, 12-week pilot study of twice-daily monotherapy with dapsone gel, 5%. The investigator-rated 5-point Global Acne Assessment Score (GAAS) was used to assess efficacy. The impact of acne on subjects was assessed using the validated Acne Symptom and Impact Scale (ASIS).

Results: The study enrolled and treated 68 women with SOC and facial acne. GAAS decreased significantly from baseline to week 12 (mean, -1.2 [95% CI, -1.4, -1.0]; P<.001), a 39.0% improvement. Overall, 42.9% of subjects were responders based on a GAAS of 0 or 1 at week 12. Subjects also experienced significant reductions in mean total lesions (52% decrease), inflammatory lesions (65%), and comedo counts (41%; all P<.001). Dapsone gel, 5% monotherapy was associated with significant improvement in subject-assessed acne signs (P<.001) and impact on quality of life (QOL; P<.001), based on ASIS. Dapsone gel, 5% used twice daily was well tolerated, with no treatment-related adverse events. The local dermal tolerability scores tended to remain stable or decrease from baseline to week 12.

Conclusions: Monotherapy with dapsone gel, 5% administered twice daily was safe and effective for treatment of facial acne in women with SOC. Significant improvement in overall acne severity and both inflammatory lesions and comedones was observed. Further, study subjects reported considerable improvement in both acne signs and impact on QOL.
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February 2016

REFINE-1, a Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase 3 Trial With ATX-101, an Injectable Drug for Submental Fat Reduction.

Dermatol Surg 2016 Jan;42(1):38-49

*Dermatology Division, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; †Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada; ‡Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; §Department ofDermatology, Howard University College of Medicine, Washington, DC; ‖Kythera Biopharmaceuticals, Inc., Westlake Village, California (now an affiliate of Allergan plc, Irvine, California); ¶Evidence Scientific Solutions, Philadelphia, Pennsylvania.

Background: ATX-101, an injectable form of deoxycholic acid, is approved in the United States and Canada for submental fat (SMF) reduction.

Objective: To report results of REFINE-1, a randomized, double-blind, placebo-controlled, Phase 3 trial investigating the efficacy and safety of ATX-101.

Methods: Subjects dissatisfied with their moderate or severe SMF received ATX-101 (2 mg/cm) or placebo. Coprimary outcome measures were composite ≥1-grade and ≥2-grade improvements in clinician-assessed and subject-assessed SMF severity using validated scales at 12 weeks after last treatment. Magnetic resonance imaging (MRI) provided an objective measure of submental volume reduction. Patient-reported outcomes were assessed.

Results: Among 256 ATX-101-treated and 250 placebo-treated subjects, a ≥1-grade composite response was achieved in 70.0% and 18.6%, and a ≥2-grade composite response in 13.4% and 0%, respectively (p < .001 for both). The proportion of MRI responders was more than 8 times higher with ATX-101 than placebo (46.3% vs 5.3%; p < .001). ATX-101-treated subjects reported improvement in the psychological impact of SMF and satisfaction with treatment (p < .001 for all assessments vs placebo). Of note, 55% and 75% of ATX-101-treated subjects reported 1-grade improvement in clinician-assessed SMF after 2 and 4 treatments, respectively. Adverse events (primarily localized to the injection site) were mostly mild or moderate, and transient. Marginal mandibular nerve paresis reported in 4.3% of ATX-101-treated subjects (1.0% of all ATX-101 treatment sessions) was mostly mild, transient, and resolved without sequelae.

Conclusion: ATX-101 is a safe and efficacious, first-in-class, injectable drug for SMF reduction.
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http://dx.doi.org/10.1097/DSS.0000000000000578DOI Listing
January 2016

Updates in the understanding and treatments of skin & hair disorders in women of color.

Int J Womens Dermatol 2015 Jun 27;1(2):59-75. Epub 2015 May 27.

Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia.

Skin of color comprises a diverse and expanding population of individuals. In particular, women of color represent an increasing subset of patients who frequently seek dermatologic care. Acne, melasma, and alopecia are among the most common skin disorders seen in this patient population. Understanding the differences in the basic science of skin and hair is imperative in addressing their unique needs. Despite the paucity of conclusive data on racial and ethnic differences in skin of color, certain biologic differences do exist, which affect the disease presentations of several cutaneous disorders in pigmented skin. While the overall pathogenesis and treatments for acne in women of color are similar to Caucasian men and women, individuals with darker skin types present more frequently with dyschromias from acne, which can be difficult to manage. Melasma is an acquired pigmentary disorder seen commonly in women with darker skin types and is strongly associated with ultraviolet (UV) radiation, genetic factors, and hormonal influences. Lastly, certain hair care practices and hairstyles are unique among women of African descent, which may contribute to specific types of hair loss seen in this population, such as traction alopecia, trichorrhexis nodosa and central centrifugal cicatricial alopecia (CCCA).
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http://dx.doi.org/10.1016/j.ijwd.2015.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418751PMC
June 2015

Hair transplantation in the surgical treatment of central centrifugal cicatricial alopecia.

Dermatol Surg 2014 Oct;40(10):1125-31

*Callender Dermatology and Cosmetic Center, Glenn Dale, Maryland; †Department of Dermatology, Howard University College of Medicine, Washington, D.C.

Background: Central centrifugal cicatricial alopecia (CCCA) is a progressive primary scarring alopecia that occurs mainly on the vertex of the scalp and expands centrifugally. To date, there is a paucity of published prospective studies reporting successful surgical therapy for CCCA.

Objective: To evaluate the efficacy of hair transplantation using the round (punch) grafting technique in African American women with CCCA.

Materials And Methods: We describe 2 African American female patients with CCCA who had endured nearly 5 to 6 years of progressive hair loss on the crown of the scalp. After a scalp biopsy and hair transplant test session, both patients underwent hair transplantation with the use of round grafts. Digital photographs were obtained before and after hair transplantation to determine the hair growth success and response rates.

Results: Hair growth was visibly observed at the recipient sites in both patients beginning between 4 to 5 months post-test session. No postoperative scarring in the recipient or donor areas of the scalp were noted in either patient.

Conclusion: Hair transplantation is a safe well-tolerated procedure to improve hair loss in African American women with end-stage CCCA who histologically display a lack of inflammation on scalp biopsy.
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http://dx.doi.org/10.1097/DSS.0000000000000127DOI Listing
October 2014

Racial differences in clinical characteristics, perceptions and behaviors, and psychosocial impact of adult female acne.

J Clin Aesthet Dermatol 2014 Jul;7(7):19-31

Society Hill Dermatology, Philadelphia, Pennsylvania.

Objective: Limited data are available on racial differences in clinical characteristics and burden in adult female acne. The objective was to describe racial differences in clinical characteristics, psychosocial impact, perceptions, behaviors, and treatment satisfaction in facial adult female acne.

Design: Cross-sectional, web-based survey.

Setting: Diverse sample of United States women.

Participants: Women between the ages of 25 and 45 years with facial acne (≥25 visible lesions).

Measurements: Outcomes included sociodemographic characteristics, psychosocial impacts, perceptions, behaviors, and treatment satisfaction. Racial differences were evaluated using descriptive statistics and t-test/chi-square analyses.

Results: 208 females participated (mean age 35±6 years); 51.4 percent were White/Caucasian and 48.6 percent were non-White/Caucasian women [Black/African American (n=51); Hispanic/Latina (n=23); Asian (n=16); Other (n=ll)]. Age of acne onset (mean 14.8±5 vs. 17.0±8 years, p<0.05) and acne concern occurred earlier (16.6±7 vs. 19.3±9 years, p<0.05) in White/Caucasian than non-White/Caucasian subjects. Facial acne primarily presented on chin (28.0%) and cheeks (30.8%) for White/Caucasian women versus cheeks (58.4%) for non-White/Caucasian women. Non-White/Caucasian women experienced more postinflammatory hyperpigmentation than White/Caucasian women (p<0.0001). Facial acne negatively affected quality of life (QoL) in both groups, and most participants (>70%) reported some depression/anxiety symptoms. More White/Caucasian than non-White/Caucasian women were troubled by facial acne (88.8% vs. 76.2%, p<0.05). Lesion clearance was most important to White/Caucasian women (57.9 vs. non-White/Caucasian 31.7%, p<0.001); non-White/Caucasian females focused on postinflammatory hyperpigmentation clearance (41.6% vs. Caucasian 8.4%, p<0.0001).

Conclusion: RESULTS highlight racial differences in participant-reported clinical characteristics, attitudes, behaviors, and treatment satisfaction. These findings may inform clinicians about racial differences in facial adult female acne and guide treatment recommendations toward improving care.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106354PMC
July 2014

Advances and challenges in hair restoration of curly Afrocentric hair.

Dermatol Clin 2014 Apr;32(2):163-71

Howard University College of Medicine, 520 West Street Northwest, Washington, DC 20059, USA; Callender Dermatology & Cosmetic Center, 12200 Annapolis Road, Suite 315, Glenn Dale, MD 20769, USA. Electronic address:

Although the biochemical composition of hair is similar among racial and ethnic groups, the hair structure between them varies, and individuals with curly hair pose specific challenges and special considerations when a surgical option for alopecia is considered. Hair restoration in this population should therefore be approached with knowledge on the clinical characteristics of curly hair, hair grooming techniques that may influence the management, unique indications for the procedure, surgical instrumentation used, and the complications that may arise.
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http://dx.doi.org/10.1016/j.det.2013.12.004DOI Listing
April 2014

Understanding the burden of adult female acne.

J Clin Aesthet Dermatol 2014 Feb;7(2):22-30

Callender Dermatology and Cosmetic Center, Glenn Dale, Maryland.

Objective: Typically regarded as an adolescent condition, acne among adult females is also prevalent. Limited data are available on the clinical characteristics and burden of adult female acne. The study objective was to describe clinical characteristics and psychosocial impact of acne in adult women.

Design: Cross-sectional, web-based survey.

Setting: Data were collected from a diverse sample of United States females.

Participants: Women ages 25 to 45 years with facial acne (≥25 visible lesions).

Measurements: Outcomes included sociodemographic and clinical characteristics, perceptions, coping behaviors, psychosocial impact of acne (health-related quality of life using acne-specific Quality of Life questionnaire and psychological status using Patient Health Questionnaire), and work/productivity.

Results: A total of 208 women completed the survey (mean age 35±6 years), comprising White/Caucasian (51.4%), Black/African American (24.5%), Hispanic/Latino (11.1%), Asian (7.7%), and Other (5.3%). Facial acne presented most prominently on cheeks, chin, and forehead and was characterized by erythema, postinflammatory hyperpigmentation, and scarring. Average age of adult onset was 25±6 years, and one-third (33.7%) were diagnosed with acne as an adult. The majority (80.3%) had 25 to 49 visible facial lesions. Acne was perceived as troublesome and impacted self-confidence. Makeup was frequently used to conceal acne. Facial acne negatively affected health-related quality of life, was associated with mild/moderate symptoms of depression and/or anxiety, and impacted ability to concentrate on work or school.

Conclusion: RESULTS highlight the multifaceted impact of acne and provide evidence that adult female acne is under-recognized and burdensome.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935648PMC
February 2014