 Hi I'm Meredith Mar at the University of Maryland Medical Center. Today we're discussing common skin care concerns and conditions in women of color with dermatologist Dr. Marsha Driscoll. Thanks for being here today Dr. Driscoll. It's a pleasure to be here and be with you today. And thanks to all of you for watching. We invite you to leave your questions for Dr. Driscoll in the comment section below and be sure to like this video to let us know you're tuning in. Dr. Driscoll what are the most common skin concerns you see in your practice for those patients with darker skin tone? So right now I chose three main concerns I have you know common problems that women of color may experience. But there are many more. But I'm going to focus on three today. And the first one is a mouthful. It's called hydrodinitis aperitiva. And I'm going to from here on mention this or refer to this as HS. It's easier to that way. And Meredith can also say HS and you all understand. And just really quickly I'll elaborate later. This is a condition where especially in women of color they may develop boils in the underarm area and the abdomen, breast in the genital area and the buttocks that often drain a kind of odor, you know, odorous material is very disturbing physically and psychologically. That's my passion right now. But that's just one of many problems that we see in women of color. A second very common problem is problems with pigment or extra color dark spots on the skin, especially on the face. And so I'm going to refer to that as pigmentary disorders or more specifically, there's one called melasma. The third area I'll just briefly go over that's a very, very common problem is hair loss. And I'm going to address one that causes scarring, meaning that the hair follicle is destroyed and hair cannot be grown back. And this is called another mouthful, central, centrifugal, secretarial alopecia. So we're going to call that CCCA. So those are the three main disorders we're going to talk about today. Let's jump to the pigmentation disorder that you mentioned second. And then we'll get into the other two. How does that condition develop? And I guess how do you diagnose it as well? So there's a variety of reasons why women of color can see maybe dark patches on the face. One very common scenario would be a young woman or an older woman comes in with acne and an acne bump may go away, but then it leaves behind a very disturbing dark spot. And that can be more disturbing than the acne itself sometimes because many of these spots may develop. And the women are wondering how can I get rid of these dark spots and stop them from coming? Other reasons why a woman of color may have a pigmentary disorder is taking combination oral contraceptive pills or other types of contraception that has hormones. Having a baby, a woman may develop something called mask of pregnancy, having a certain inflammatory disorder like lupus, or even taking a medication that makes you more sensitive to sun may cause some dark spots on the face. And this is very disturbing for women of color and how to address this darkening and how can how can I get rid of it basically? So what treatment options are there for women experiencing this condition? So in the case of acne, which is the most common scenario, the first goal is we want to stop the acne from coming because it's the acne really that's going the acne process affects the it sort of causes a disruption in the pigment cells. And in women of color or patients of color, they have more pigment, more melanin packed into their pigment cells, melanocytes, than patients that have lighter skins. They have a lot of pigment packed into that cell. So that cell is damaged, that pigment is released and can deposit in the skin, and therefore will cause more darkening of the skin than we may see in a patient of lighter skin tone. And so the first step is we need to have a skin specialist treat the acne. Once that's under control, and then the pigment is the major problem, there are certain medications we can prescribe. And also over the counter products like sunscreen that patients of color may not typically think about that this is an important part of therapy, but sunscreen can also be an important therapeutic measure in this in this condition. We did have a question in advance from one of our consumers on Facebook, who asked, I have developed patches of dark skin on my chin. Sometimes it flakes and it is I'm also looking for a sunscreen that doesn't make me look like a ghost. So going back to that sunscreen question, what do you suggest that patients look for or avoid in a sunscreen? So dermatologists like to recommend the sunscreens that have the broadest coverage of the ultraviolet spectrum of all the air. It's not worth going into a lot of detail, but just to say we want to have a good sunblock that blocks out the majority of the light, the ultraviolet light and visible light that we're exposed to that can cause darkening of the skin. And I agree with you many of the best sunblocks that are called physical sunblockers that are ones use in babies. They often have the powder pink cap on them, and they have zinc oxide or and or titanium dioxide. When you put them on, you can look very white. And one of my kids that I looked like a snowman once when I had this all over my body when I was going swimming. And it's true they can look very white. There are some there are some sunscreens that contain a tint and it's iron oxide. And that may be more pleasing to a lot of patients and it enhances the spectrum of the block because it also blocks out the visible light as well. So a tinted sunscreen goes on kind of a, you know, it often is pleasing in appearance that almost looks like a makeup. And so that may be an alternative. I didn't want to go into specific brands, but maybe that can be a specific question I answer in chat, you know, privately. But there are sunscreens that are that contain a tint. Typically, they have iron oxide in them that may not look so white. And there are also certain brands that they've kind of made the molecules of sunscreen really small, they call it micronized, that it may maybe not look quite as white. So it is hard sort of hit and miss sometimes of trying a sunscreen. And dermatologists will say the best sunscreen is the one that you will wear. Because I can recommend a lot of sunscreens. But if you're not going to use it, then it's not really very useful. So you have to use it. And I can be, I don't want to give specific brands here, but we can, I can certainly put out a list of sunscreens that have tint that may be more pleasing, cosmetically. Switching gears to alopecia, the hair loss condition that you mentioned early on, what causes that in women of color in particular, and how can we prevent it from happening? Well, a long time ago, they used to call this entity CCCA, they used to call it hot comb alopecia, because it was stopped at these flat irons or I guess in the olden days of my days, maybe when I was young, they would call them hot combs or but that's not true. That's not what this is due to at all. There's a significant genetic component is not one's fault that one develops this type of hair loss. I just want to say briefly that it starts in the central part of the scalp, and that it tends to spread outward. And it can eventually if not treated become scarring. And that's a really important and devastating part of this problem is that you may not be able to regrow hair. So a genetic component is is definitely a big part of this. But I also do want to mention that certain hairstyles that may pull the hair very tightly, like even extensions that are commonly used or certain hairstyles that may pull on the hair follicle may contribute, but I may not be the main factor, but maybe a contributing factor. So it's important to have if one is to have braids or dreads or you know, a type of hairstyle, in particular, you just don't want to be tightly pulling on the hair. So that may be a component, but genetics seem to play a primary role. What are the treatment options for helping stimulate that new hair growth for patients with this type of alopecia? So if there's already some scarring that's occurred, we may not be able to get those damaged hair follicles to regrow hair. But what we can do is stop the process of scarring. And we do that by using anti inflammation medications, because we know that inflammation plays a role in this. And so there are medications that can be put on the scalp directly. Or sometimes this sounds scary, but it really isn't injecting medications in the scalp. And even something that's over the counter medication, that seems to lengthen the growing phase of the hair cycle, that may also help. So seeing your skin doctor, we can offer therapies, we may not be able to do much for the hairs that are permanently lost that are those that where they're scarring, but we can help prevent the worsening of the condition. So seeing the skin specialist early is really important. And there are therapies, and there are more therapies being that are in research currently. But we have some standard therapies, and we have more therapies to come. And are all of these treatment options covered by insurance? Not all. But I would say that the majority of our patients are fortunate that we will look, we can look into that for the patient, or the patient can call the insurance company themselves. But many of them are covered. Some of the newer therapies that are not as well established, I think I can, you know, maybe mentioned might have heard of PRP, or, which is plasma enriched platelets, you know, there are, there are certain therapies that are experimental, those are not covered by insurance, but the ones that are more, there are more established are typically going to be covered. And if they're not, we often can help the patients get prescription medications at a reduced price. So we're often, we're always trying to be the patient advocate. And even if the insurance doesn't cover it, maybe we can find a way to obtain that medication that is a prescription at a reduced cost through certain programs. Lastly, of the three conditions you mentioned at the start of the Facebook live hydrodinitis tuberitiva. So during the month of June, there's a special awareness of this condition. Can you describe what it is exactly and what makes women of color have a higher propensity to develop it? So as I mentioned earlier on, this is a very physically and emotionally disturbing condition because patients get painful red boils that often first start at puberty. So they start can start very early in life. And they typically affect skin fold areas. And so under the arms, under the breasts, and then in the genital area, the infer women, they can suffer that as well. And in the buttock area, and then also sometimes in the abdomen and skin folds. And so they start out as these painful boils. And if not treated, they can cause they can result in some drainage that is very disturbing to the patient. Some patients even have to resort to having a lot of dressings or even diapers to to take up this drainage which is very disturbing. There can eventually be scarring of the of the areas and then distortion or disfigurement of the genitalia, for example. So this is a progressive disease that is thought to have multiple factors involved in its cause. One is genetic. And that may explain why black women, or at least African American women may be more predisposed as a genetic component hormonal and that we know that three to four times as many women compared to men develop HS. So there's a hormonal component. There's an inflammatory component, we know that certain factors, certain proteins released in the body cause inflammation that contribute to this condition. And fourthly, we think bacteria play a role, we're not exactly sure. But we know that sometimes antibacterial agents or antibiotics are used in this condition and may help. So it's multifactorial, why are women of color more often affected? It's probably both hormonal and genetic. So if a patient presents to you with this condition, maybe they had been previously diagnosed and maybe they haven't. What can they expect out of visit with you to go over the condition, how they can prevent it from further developing? Also, you know, as you're saying, there's a psychological, emotional component to it too. How do you help these women come to terms with this condition and also, you know, feel better about themselves with it? So one huge part of HS I haven't really discussed is that HS can be associated with a variety of we call them comorbidities, other problems. One of them can be depression, anxiety. And I happen to be in a wonderful institution called the University of Maryland. And the University of Maryland has specialists in many areas. For example, women with HS may have obesity, they may have diabetes, they may develop high hypertension, high hyperlipidemia or high cholesterol and high fats in the blood, they may have significant pain, they may have depression and anxiety. And I my role as part of the HS clinic is to make sure my patients have all the resources so that if they need to be referred to pain management, we have some wonderful doctors in pain management that can deal with their pain. If they need help with their diabetes, I can refer them to someone that will help them in that area. Smoking is the strongest link. Interestingly, we don't even know why. But smoking is one of the strongest links to hydrodinitis. But we don't really know why, you know, that why smoking adversely affects or predisposes to hydrodinitis, we can plug you in with someone that, you know, does a smoking cessation program. So we're fortunate enough at University of Maryland to help you with finding the right medical care. So in a clinic visit with me, I may ask, do you have a primary care physician? Because some patients don't. And I think that that's, you know, a key person in coordinating care. And so that I try to, I say plug in, but try to refer you to the right doctors that can help with all these problems. I have to sometimes push the patients and say, do you need to help with pain? Because I'm not the pain specialist. I can find you someone that can, because I am in this wonderful place that has all these amazing people, amazing physicians, and physician extenders that can help you with this problem with these problems. What's the biggest myth or misconception about HS or any of the conditions that we discussed today? I think one, one comment or question that comes up on the internet a lot is, is this related to poor hygiene? And it is not at all. So I think that's one myth. So HS is not related to poor hygiene. And I also feel that patients, you know, if they are overweight, you know, they wonder again, if they're to blame for this. And I think it's a myth that they're not to blame for this. There are many components, like I said, genetic that play a role in this. So I also think it's a myth that, you know, it's if someone, another physician may tell you, it's just boils. It may not just be just boils. I mean, this is a progressive disease. There's not a cure for it just to kind of emphasize that, but it can be controlled, especially if caught early. So a myth may be that if someone tells you, well, it's just a boil, you know, and someone can have one boil and it may just be that one time I never develop it again. And that may not be something to worry about. But when someone has recurrent boils and skin folds, it should not be, you know, blown off, so to speak, it needs to be addressed if it's a persistent, recurrent problem. So a myth is, it's just boils and, you know, doesn't have implications for other parts of your life. As we know, this has been an under investigated problem. And I think that it's why I'm so passionate about it is that I think that in general, you know, not to say physicians, but maybe the medical community for a long time, maybe has not been aware of this condition, and maybe has not taken as seriously as we need to take it. Is there anything else you think our viewers should know that we haven't already covered today? I think that if you have any of the conditions that we talked about, or other issues, the dermatologist is, you know, if you have skin issues, it's often best to see a skin specialist. Because really, we're going to be the ones that have the most knowledge. In medical school, most physicians do not get in their training a lot of dermatology. I have to say that University of Maryland is having a new curriculum starting in the fall. I'll be teaching a lot more dermatology. But let's just put for right now, most doctors don't really have a lot of training in dermatology. It's not their fault. They just didn't have it. And so you need to see a skin specialist to get some of these issues diagnosed appropriately and treated promptly. Because as I've explained, with several, at least with the hair loss and with, you know, with HS, sometimes these conditions can be progressive and result in severe consequences if not diagnosed early. So I guess my main message is that if you have a skin problem, try to see a skin specialist so we can appropriately diagnose and treat. Before we wrap up here, speaking of seeing a skin specialist, what are some things that patients should consider when choosing a dermatologist, you know, to make them not feel judged or uncomfortable, you know, it's the kind of an intimate appointment you would have with a physician that may be different than seeing, let's say, you know, an ophthalmologist or orthopedic doc. So what are some things that a patient should consider when choosing their own dermatologist? So dermatologists are actually the skin is that we like to joke, the skin is the largest organ in the body. And it is, I mean, that's it's true. And as part of our job, we frequently do head to toe exams, looking at one's whole body for looking at skin doing our skin cancer screening. So patients should not be embarrassed. For example, many patients to HS are embarrassed to take off their clothes. And but we as dermatologists see, you know, all the skin, like all all day long, we're doing a skin cancer screening, so you should not be fearful about us examining you. Because we that's our job is to look at every part of the skin. And that means putting a gown on and looking at someone heads to toe. And so that's what we that's our job. And so we're used to having patients, you're taking off their clothes to be examined thoroughly. So I don't want we don't want anyone to feel that that's a problem with HS or any other skin problem that we're going to look at your skin. And we want you to feel comfortable because we feel comfortable doing this all day long. So I hope that makes any one feel more reassured that this is part of what the skin doctor does. And we, and again, the skin is the largest organ in the body. So we're used to looking at patients head to toe and to feel comfortable. How do you choose a skin specialist? Well, I'm going to be a little bit biased here and say that the University of Maryland is a good place to come. We have excellent doctors. But certainly, if that's not accessible, the most accessible, you know, organization to seek out. That's we understand that. But certainly, we would like, because the University of Maryland does try to take care of our community. We try to serve our community. And I have to put in a plug to say that we take most insurances. And so we try to be accessible to almost everyone. So I don't know if Meredith that answers the question, but I think that, you know, I'm a little bit biased, of course, but I think the University of Maryland be a great place to start. And because we do accept most insurances at Department of Thermatology. We have just one appointment line. And that is 667 214 1171. And that's University of Maryland Department of Thermatology. We have two sites where we practice. And the first site is 419 West Redwood Street. And we're in Suite 160. And also sometimes we see patients in Suite 260. But the main professional building, there are many other physicians in that building is 419 West Redwood Street in Baltimore. And then our second location is 5890 Waterloo Road in Columbia, Maryland. But it's the same phone number for both locations.