Many advances have been made in the last 10 years in dermatology. Here are just a few (there are hundreds more) that have changed the way we treat pigment problems and dermatology issues in skin of colour in the last decade:

1. Vitiligo – a shift in perspective and better treatment plans for patients.

Dermatologists now recognise that vitiligo is not just a cosmetic disease. Many are now aware that we can get pigment back in many cases.

We now know that vitiligo is an autoimmune condition, just like type 1 diabetes. In this condition, the immune system attacks the pigment cells (melanocytes) in the skin. It affects about 1-2% of the population. The majority of people will get their first spot before their 30th birthday.

The propagation of knowledge via scientific research papers has (hopefully) changed the way dermatologists around the world diagnose and treat vitiligo. Here is a link to paper one and two published in the middle of 2017 that changed dermatology practice for vitiligo on a global scale.

In the next decade we will be talking about various targeted immunologic treatments for vitiligo and possibly even moving closer to a cure. Chroma Dermatology will continue to be involved in education, research and treatment advances in vitiligo as we welcome a new decade. Learn more about vitiligo here.

2. Melanoma – it’s deadly serious type of skin cancer but we are marching toward a world without melanoma

Australia has one of the highest rates of melanoma in the world, with one Australian dying from melanoma every five hours. More than 14,000 Australians are likely to have been diagnosed with melanoma in 2019.

We now have targeted immunotherapy available to patients with advanced melanoma and have found that vitiligo and melanoma are almost ‘genetically opposite.’ We are looking forward to collaborating with our melanoma research colleagues in Melbourne in 2020 to discover how we can move closer to a cure for vitiligo and melanoma.

3. Melasma – tranexamic acid, considered a game changer.

Melasma is a chronic condition that causes brown spots to develop on the face. It is seen mainly in those with skin of colour. It can be notoriously difficult to treat and cannot be cured. Many patients spend a lot of time and money on expensive treatments that don’t work and can even make the condition worse. 

Our Asian colleagues published (in English) medical research on tranexamic acid in 2011. Tranexamic acid was first presented by Dr. Rodrigues as a treatment option melasma at a dermatology conference in Melbourne in 2013.  The research only hit the USA in 2018. Tranexamic acid and is now seen as a ‘game changer’ for the treatment of melasma.

In the next decade, our advancing knowledge about melasma will definitely mean new treatments will be available to dermatologists. Chroma Dermatology have been involved in key research projects for tranexamic acid with our international research collaborators and we are now wrapping up a study examining a new topical cream. As experts in pigmentary disorders, we look forward to publishing our data in 2020 on the new topical agent and have no doubt that we will find better ways of diagnosing and managing melasma. Learn more about melasma here.

4. Hidradenitis Suppurativa can now be treated with a biologic agent.

Hidradenitis suppurativa (HS) is a condition where pimples and boils appear in the armpits and groin. It can cause pain, oozing, swelling and can limit movement due to scar tissue. In the last decade, research has shown those with skin type 6 (African skin) have larger and more productive apocrine glands which results in more severe disease.

We now have a targeted biologic therapy for patients suffering with severe HS called adalimumab (an anti-TNF drug) used for various types of autoimmune conditions. To learn more about HS, click here.

5. Psoriasis – can now be a thing of the past 

Psoriasis is a chronic skin condition that causes redness, scale and itching. It causes embarrassment and has been shown to affect everything from work and relationships to employment opportunities. It may be associated with psoriatic arthritis (joint pain) and other autoimmune and cardiovascular conditions like diabetes and high blood pressure. Treating psoriasis can lower the risk of these cardiovascular diseases, so it is more than skin deep.

Because it is hard to see “red” in dark skin, psoriasis is often under-diagnosed and under-treated in those that have pigmented skin types. One research paper showed Asians had the highest percentage of body surface area (BSA) affected at 41%, and Caucasians had the lowest at 28%.

More targeted biologic treatments (injectable treatments) that help clear chronic plaque psoriasis have become available in the last decade through the Australian PBS (Medicare). Having biologic medication to treat this condition has literally been life saving for millions of people around the world. While it is not a cure, in some cases, in as little as 16 weeks, the skin clears and patients can live normal lives. Of course, certain medications need to have been tried and documented as ineffective before Medicare will subsidise these expensive treatments. Read more about biologic therapy for psoriasis here.

6. Central Centrifugal Cicatricial Alopecia (CCCA) – gene testing has finally provided some answers

CCCA is a type of hair loss that is common in women of African descent. It occurs mainly on the crown of the scalp and progresses slowly. Sometimes patients describe pain and itch. Through genetic testing in February 2019, researchers found that a mutation in the PADI3 gene was associated with the development of CCCA. PADI3 is an essential part of the hair shaft.

A decade ago, we thought that this was due to the use of hair straighteners. Today, genetic testing has given us some of the answers dermatologists and patients have been looking for for generations.

7. Hyperhidrosis – we can stop sweating with injectable treatment

2-5% of the population suffer with excessive sweating. Injectable treatments are now available through the PBS to literally stop the sweating. Although the injectable medicine has been used for excessive sweating for over a decade, it was not a subsidised treatment until 2011. Many patients could simply not afford treatment in the past.

As one of the first authorised injectors in Australia, Dr. Rodrigues recalls the hundreds of patients that have benefited from this treatment since it was listed on the PBS in 2011. “So many patients cannot believe how quick, easy and effective the treatment is …it boosts their confidence and enjoyment of life itself.” The picture here shows what the armpit looks like just after treatment (these little spots settle within an hour or two).

To read more about hyperhidrosis, click here.

Wrap-up

There are many more advances that have been made in the area of skin of colour and pigment disorders over the last decade but research in this area is still lagging behind. We hope that Chroma Dermatology can continue to research and innovate in this area of dermatology so that we can better diagnose and manage patients with Indian skin, Chinese skin, African skin, Hispanic and middle eastern skin and all those with pigmented and ethnic/mix-ethnic skin types.

What does the future hold?
We have no doubt that reflections from the next decade will be all about genetic testing, advancements in biotechnology and artificial intelligence as well as breakthroughs in the laser and light technology we use. The possibilities are endless, it is up to us to make it happen.

The information contained in this blog post is intended as a guide only and should not substitute seeking medical attention. Please see your healthcare provider for more information on suitability of products, treatments or procedures.