Therapeutic and Diagnostic Pearls for Treating Patients of Color, with Andrew Alexis, MD, MPH

At the American Academy of Dermatology (AAD) Annual Meeting, Andrew F. Alexis, MD, MPH, spoke in a talk called ‘Melasma in Skin of Color’ and another talk titled ‘Therapeutic and Diagnostic Pearls.’

These talks covered procedural management and new trends for melasma and clinical pearls for treating patients with skin of color, respectively. Alexis is known for his work as a professor of clinical dermatology and as the vice-chair for diversity and inclusion at Weill Cornell Medicine. He first spoke about advice on methods for addressing melasma.

“So in terms of the ‘tried and true’ options, I covered chemical peels and in particular superficial peeling agents, including glycolic acid, Jessner's peel, and low concentration TCA,” Alexis explained. “Out of those options, the body of evidence and also clinical experience does favor glycolic acid as a first-line peeling agent. One has to use more caution with TCA, which, although effective, does have a more narrow margin of safety concerning pigmentary complications.”

Alexis also highlighted the use of topical tranexamic acid for melasma, done in conjunction with a procedure such as micro-needling to enhance efficacy. Alexis also talked about a laser procedure done in his own practice which is the 1927 nanometer fractional laser coupled with topical therapy, which he says have both demonstrated safe and effective outcomes for melasma patients.

“Shifting into the more evolving, newer approaches to melasma there, there is some emerging data on using PRP, or platelet rich plasma, as a potential therapy for melasma,” Alexis said. “In 1 comparative study, split-face, hydroquinone was used for the full face, but 1 half of the face got PRP…the PRP side did demonstrate some degree of increased efficacy.”

Lastly, Alexis discussed his clinical pearls-related talk, highlighting clinical pearls for dermatologists treating those with skin of color.

“I used a case-based approach and started with 1 very common scenario, which is patients come in with a chronic inflammatory skin disorder…like atopic dermatitis and psoriasis, and the other component to their concern, which is the pigmentary changes,” Alexis said. “So in addition to the erythema, the scaling, and the elevation of the lesions, there's also this dispigmentation that patients with skin of color are very much affected by.”

Alexis had demonstrated that, using long-term control of the underlying inflammatory condition with biologics, there was improvement in pigmentary changes as well as the other, more well-known issues with such conditions.

“I used examples of secukinumab, guselkumab for psoriasis, I used examples of dupilumab, tralokinumab, lebrikizumab in atopic dermatitis, even the oral JAK-inhibitor abrocitinib in atopic dermatitis,” Alexis said. “I was showing a bunch of different examples of targeted and long-term longitudinal therapy for the underlying inflammatory condition, demonstrating not only the improvement in the scaling, the elevation, the erythema, but also the pigmentary change.”

Alexis added that the key element of looking at both changes in primary features as well as pigmentary changes, a longer timeframe must be expected.

To find out more from Alexis’s talks at AAD, view the full video interview posted above. For more from the conference itself, view our latest conference coverage.

The quotes used in this summary were edited for clarity. Examples of Alexis's disclosures include the following: Consultant (Fees/Honoraria): AbbVie, Amgen, Boehringer Ingelheim, Canfield Scientific, Eli Lilly, Janssen, Janssen Scientific Affairs, LEO Pharma, L'Oréal USA, Pfizer, Symrise; Other (Equipment/Financial Benefit): Aerolase (Equipment), Elsevier, Medscape, Springer Science & Business Media, UpToDate, Wiley-Blackwell.