Chemical peeling of the dark skinned patient Fitzpatrick Type V + VI

There are fundamental, histological and physiological differences in the dark skinned patient which, to a large extent, determine the variation in response to and the indications for chemical peeling. This study is designed to assess the incidence of complications after superficial, medium and deep chemical peeling of dark skinned patients, using 70 percent glycolic acid (superficial) 70 percent glycolic acid with 35 percent trichloroacetic acid (TCA) (medium) and 70 percent glycolic acid with 50 percent TCA (deep). Clinical, glycolic acid with TCA was safe and effective in peeling the dark skin. It was very satisfactory in 62.4 percent, satisfactory in 34 percent and unsatisfactory in 1.2 percent. The incidence of complications was: hyperpigmentation, 6.6 percent; erythema, 1.8 percent; scarring, 0.4 percent; milia, 0.2 percent; and poor physician/patient relationship 0.2 percent. The risk complications in peeling the dark skinned patient can be decreased if segmental medium and deep peels are done and if melanocytic activity is monitored before and after peeling. The destroyed stratum corneum immediately after peeling allows deeper penetration of tyrosinase inhibitor with better resolution of hyperpigmentation.(AU)

The African Caribbean eye survey: risk factors for glaucoma in a sample of African Caribbean people living in London

The purpose of the study was to estimate the prevalence of and risk factors for chronic glaucoma in a sample of African Caribbean people over 35 years of age living in the London Borough of Haringey. A cross-sectional voluntary sample of persons were subjected to detailed ophthalmic assessment including automated tangent screen suprathreshold visual field testing, applanation tonometry and stereoscopic disc evaluation in 50 community-based survey clinics over an 8 month period. Cases and suspects were referred to Moorfields Eye Hospital for more detailed assessment and confirmation of the diagnosis. Of 873 eligible persons examined (out of a total of 1022), 32 definite cases of glaucoma were identified, a prevalence of 3.9 percent; 42 percent of these had been previously diagnosed. Approximately 10 percent of the sample required further assessment and follow-up when ocular hypertensives and glaucoma suspects were included. An age-standardised comparison with the findings of the Roscommon survey revealed a relative risk for glaucoma for Haringey blacks compared with Irish whites of 3.7. Significant risk factors for glaucoma included age, African birthplace and darker skin colour. Neither diabetes nor hypertension reached significance. Despite the lack of a population base, this study provides strong evidence that the 4 times greater risk of glaucoma estimated for American blacks compared with whites applies equally to the United Kingdom population. Community-based facilities are required to raise awareness of the risk among this ethnic minority in this country and case-finding resources should be provided to meet local needs (Summary)

Skin colorimetry in Belize I. conversion formulae

Comparisons between skin colorimetry reports have been hampered by the common use of two different types of portable reflectometers, which sample reflectance at different wavelengths. In an attempt to provide direct comparability between the two machines, multiple linear regression equations were derived from reflectance spectrophotometry readings on 308 Black Caribs and 175 Creoles in Belize, Central America, using both machines. Cross validation tests show the coefficients presented are applicable to independent data sets and generally applicable to other heavily pigmented populations. Comparisons with previous published conversion formulae, which were from very small samples using simple linear regression, show a definite improvement in predictive accuracy when using multple regression equations based on a large sample.