trends in demographics and treatment for dyschromia

P6813The relationship between dermatologic diagnoses and consumer self-categorization of facial pigmentation

Zachary Schendel, PhD, Unilever R&D, Trumbull, CT, United States; AmirAshkenazi, PhD, Unilever R&D, Trumbull, CT, United States; Edwin Covell, MS,Unilever R&D, Trumbull, CT, United States; Jaime O’Leary, Unilever R&D,Trumbull, CT, United States; Jessica Chamberland, PhD, Unilever R&D,Trumbull, CT, United States; Meggie Luo, PhD, Unilever R&D, Shanghai, China;Stacy Hawkins, PhD, Unilever R&D, Trumbull, CT, United States

When consumers purchase a face care product or visit a dermatologist to exploretheir options in reducing the appearance of unwanted facial pigmentation, theycome into the experience with unique outcome expectations. Individuals can varywidely in these expectations and knowledge depending on factors like age, severity,face care understanding, etc. Many times, consumer expectations and producteffects do not match. The products or treatments they seek are often developedbased on dermatologic or biologic classifications that might be unclear to theconsumer. For example, consumers who purchase products with claims of ‘‘moreeven tone’’ or ‘‘dark spot correction’’ might not be the best candidates for thoseproducts based on a dermatologic assessment. The current research is designed toexplore this potential disconnect, because there is limited reported informationavailable on the relationship between dermatologic classification and consumerperception of facial pigmentation. 78 healthy Chinese women in China providedinformed consent to participate in this IRB-approved facial pigmentation study. Aproprietary software program was developed where subjects grouped facialpigmentation based on perceived similarity or difference. Each participant beganby choosing 1 pigmented lesion followed bymarking each additional lesion that theyconsidered to be in the same kind of pigmented spot category. This process wasrepeated until every pigmented lesion was placed into a category, no matter howsmall or large that category was. Each consumer-classified pigmented lesion wasthen diagnosed by a dermatologist. Image analyses were performed on each lesion,and a psychographic/demographic profile was completed by each participant.Results indicated that there was a minimal relationship between dermatologicdiagnoses and consumer classification. While dermatologists followed strict medicalguidelines, consumers tended to self-cluster pigmentation based primarily on visualproperties: on average, pigmentation of a common contrast and common size weretypically grouped together regardless of their biologic origin. Consumers also usedfewer categories than dermatologists, used different strategies for categorization atthe individual level, and changed categorization behaviors depending on otherfactors like age and current face care behaviors. The work highlights the importanceof consumer education and communication strategies to effectively bridge the gap.

AB190

ponsored by Unilever R&D.

P6854Time sequential changes of melanocytes and melanogenic factors in laser-induced postinflammatory hyperpigmentation

Hyo Sang Song, MD, Department of Dermatology, Ajou University School ofMedicine, Suwon, South Korea; Hee Young Kang, MD, PhD, Department ofDermatology, Ajou University School of Medicine, Suwon, South Korea

Postinflammatory pigmentary changes are frequently encountered problems oflaser treatment. However, the underlyingmechanisms and pathogenesis are not wellunderstood. To elucidate how melanocyte-specific proteins and melanogenicfactors are regulated by laser treatment, time-sequential immunohistochemicalstudies were performed with Q-switched Alexandrite laser irradiated skin.Immediate postlaser irradiation, epidermal and dermal edema were observed.Three days postirradiation extracellular melanin were detected in epidermal layers.Remaining melanocytes after laser irradiation were visible and seemed to beactivated 7 days after irradiation. Increased epidermal pigmentation was observed inthe skin 21 days after irradiation. There was increased expression of someinflammatory cytokines, including TNF-a and a-MSH, whereas decreased expres-sion of those such as HSP-70 in course of the time, suggesting that they may beresponsible for the induction of postinflammatory hyperpigmentation followinglaser treatment.

cial support: None identified.

J AM ACAD DERMATOL

P6640Trends in demographics and treatment for dyschromia

Stephie Kang, DO, Wake Forest School of Medicine, Winston-Salem, NC, UnitedStates; Scott Davis, Wake Forest School of Medicine, Winston-Salem, NC, UnitedStates; Steven Feldman, MD, PhD, Wake Forest School of Medicine, Winston-Salem, NC, United States

Background: Dyschromia, including vitiligo and other hyper- and hypopigmenta-tion, is a common skin disorder with significant impact on quality of life. It is one ofthe 10 most common skin disorders for some demographic groups.

Purpose: To determine the demographics, main treatments used, and trends overtime in demographics and treatment of dyschromia.

Methods: We searched the 1993-2010 National Ambulatory Medical Care Survey(NAMCS) for visits associated with a diagnosis of dyschromia (ICD-9 codes 709.00,709.01, or 709.09). The demographics and leading treatments were tabulated, andtrends over time were assessed by linear regression.

Results: There were about 13.4 million visits for dyschromia over the 18-year period.Patient demographics for dyschromia visits were 70% females, and 74% whites, 10%African Americans, 6% Asians, and 8% Hispanics. Patients were most often in their40s or 50s. Dermatologists managed 77% of visits. The average age increased overtime, and percentage of patients whowere African American also increased. Leadingtreatments included hydroquinone, tretinoin, sunscreen, andfluocinolone/hydroquinone/tretinoin.

Limitations: Data are based on number of ambulatory care visits, which does notallow direct estimation of prevalence.

Conclusions: Dyschromia is most common among middle-aged women, especiallythose of color, and may be undertreated. It is important for physicians to recognizethe quality of life impact of dyschromia and prescribe appropriate treatment.

r for Dermatology Research is supported by an unrestricted edum Galderma Laboratories, L.P.

The Cente cationalgrant fro

P6224Vitiligo extent and distribution are associated with significant quality oflife impairment

Jonathan Silverberg, MD, PhD, private practice, New York, NY, United States;Nanette Silverberg, MD, private practice, New York, NY, United States

Vitiligo is a disorder characterized by autoimmune destruction of pigment and canbe a significant cause of morbidity. We sought to determine whether vitiligo extent,distribution and duration are associated with impairment of specific aspects ofquality of life (QOL). A prospective questionnaire-based study of 1541 adult subjectswith vitiligo was performed using questions regarding body surface area (BSA),distribution and duration of vitiligo, associated symptoms and QOL using theDermatology Life Quality Index (DLQI). Vitiligo negatively impacted upon numer-ous aspects and total score of the DLQI (mean 6 SD, 5.9 6 5.5). DLQI scores invitiligo were associated with BSA [25% (ordinal logistic regression; adjusted OR(aOR): 2.17, CI95: 1.71-2.75; P\.0001) and number of body parts affected withvitiligo (P # .009), but not laterality (P ¼ .06) or duration of disease (P $ .54).Itching and/ or burning skin occur in a sizeable percentage of vitiligo patients(35.1%) and are predicted by BSA[25% (aOR: 1.59, CI95: 1.26-2.01; P\.0001).Sexual dysfunction occurred in 18% of patients and was predicted by BSA[25%(aOR: 1.94, CI95: 1.44-2.61; P\.0001) and vitiligo lesions in the genital area (OR:1.82, CI95: 1.30-2.53; P ¼ .0005). In conclusion, vitiligo extent is associated withincreased QOL impairment, including itch and sexual dysfunction. Moreover,different distributions of vitiligo lesions are associated with different aspects ofQOL impairment. These results highlight the importance of incorporating screeningquestions for QOL into the assessment of vitiligo patients and early referral forpsychological intervention if needed.

cial support: None identified.

APRIL 2013