Clinical factors and hair care practices influencing outcomes in central centrifugal cicatricial alopecia.

Central centrifugal cicatricial alopecia (CCCA) is the most common form of primary scarring alopecia in women of African descent, negatively impacting their quality of life. Treatment is often challenging, and we usually direct therapy to suppress and prevent the inflammation. However, factors affecting clinical outcomes are still unknown. To characterize medical features, concurrent medical conditions, hair care practices, and treatments used for patients with CCCA and assess their relationship with treatment outcomes. We analyzed data from a retrospective chart review of 100 patients diagnosed with CCCA who received treatment for at least one year. Treatment outcomes were compared with patient characteristics to determine any relationships. P-values were calculated using logistic regression and univariate analysis with 95% CI P < 0.05 was considered significant. After one year of treatment, 50% of patients were stable, 36% improved, and 14% worsened. Patients without a history of thyroid disease (P = 0.0422), using metformin for diabetes control (P = 0.0255), using hooded dryers (P = 0.0062), wearing natural hairstyles (P = 0.0103), and having no other physical signs besides cicatricial alopecia (P = 0.0228), had higher odds of improvement after treatment. Patients with scaling (P = 0.0095) or pustules (P = 0.0325) had higher odds of worsening. Patients with a history of thyroid disease (P = 0.0188), not using hooded dryers (0.0438), or not wearing natural hairstyles (P = 0.0098) had higher odds of remaining stable. Clinical characteristics, concurrent medical conditions, and hair care practices may affect clinical outcomes after treatment. With this information, providers can adjust proper therapies and evaluations for patients with Central centrifugal cicatricial alopecia.

A Polygenic Risk Score for Predicting Racial and Genetic Susceptibility to Prurigo Nodularis.

Prurigo nodularis (PN) is an understudied inflammatory skin disease characterized by pruritic, hyperkeratotic nodules. Identifying the genetic factors underlying PN could help to better understand its etiology and guide the development of therapies. In this study, we developed a polygenic risk score that predicts a diagnosis of PN (OR = 1.41, P = 1.6 × 10-5) in two independent and continentally distinct populations. We also performed GWASs, which uncovered genetic variants associated with PN, including one near PLCB4 (rs6039266: OR = 3.15, P = 4.8 × 10-8) and others near TXNRD1 (rs34217906: OR = 1.71, P = 6.4 × 10-7; rs7134193: OR = 1.57, P = 1.1 × 10-6). Finally, we discovered that Black patients have over a two-times greater genetic risk of developing PN (OR = 2.63, P = 7.8 × 10-4). Combining the polygenic risk score and self-reported race together was significantly predictive of PN (OR = 1.32, P = 4.7 × 10-3). Strikingly, this association was more significant with race than after adjusting for genetic ancestry. Because race is a sociocultural construct and not a genetically bound category, our findings suggest that genetics, environmental influence, and social determinants of health likely affect the development of PN and may contribute to clinically observed racial disparities.

Skin diseases in indigenous population: retrospective epidemiological study at Xingu Indigenous Park (XIP) and review of the literature.

BACKGROUND: Skin diseases among indigenous populations have been poorly described in the literature. Risk factors linked to habits, cultural practices, genetics, and environmental characteristics can influence the frequency and clinical presentation of these diseases. METHODS: This was a cross-sectional study conducted through a review of dermatological medical records. Data were obtained over three visits to Xingu Indigenous Park (XIP). Main dermatoses were compared by gender, age, ethnicity, and village. Diseases were classified into four groups: infectious, inflammatory, neoplastic, and other. RESULTS: Of the 398 patients included in the study, 54.2% were female. The participants ranged in age from 1 to 75 years (median, 10 years). The predominant ethnic group was Caiabi (49.7%), followed by Ikpeng (14.3%) and Kamaiurá (10.0%). The primary village studied was Diauarum, followed by Moigú and Morena. Infectious dermatoses were the most frequent (43.8%), followed by inflammatory (33.7%), neoplastic (15.5%), and other skin diseases (7.0%). Infectious diseases were predominant in Caiabi and Kamaiurá Indians, whereas inflammatory skin diseases were more frequent in Ikpeng and Juruna populations. We also observed a high frequency of malignancy in the Ikpeng and Trumai ethnic groups. Infectious skin diseases, except for fungal infections, were frequent in younger age groups. This trend was not replicated for neoplastic skin diseases. Uncommon dermatoses such as Heck's disease, lichen striatus, and aquagenic urticaria were also observed. Jorge Lobo's disease was not included in this analysis. CONCLUSION: Improved knowledge of the distribution of common dermatoses among different ethnic groups and villages in XIP will aid in the prevention of skin infections and skin cancer. This improved knowledge will also allow the development of skin disease guidelines that can help local indigenous health professionals.

Topical corticosteroids minimise the risk of postinflammatory hyper-pigmentation after ablative fractional CO2 laser resurfacing in Asians.

Postinflammatory hyperpigmentation (PIH) is the most common adverse effect of laser treatment in dark-skinned individuals. Little is known whether PIH can be prevented or minimised. The objective of this study was to investigate the effect of short-term application of topical corticosteroids on the incidence of PIH after ablative fractional resurfacing in Asians. Forty subjects with skin phototype IV and atrophic acne scars were treated with a fractional CO2 laser on both sides of the face. Post-operatively, clobetasol propionate 0.05% ointment was applied to one randomly selected side of the face for the first 2 days, followed by an application of petrolatum jelly for the rest of the week (petrolatum was applied to the other side for 7 days). Assessments on the clinical outcome, the wound healing process and the occurrence of PIH were obtained once weekly for the first month and at 2 and 3 months post-treatment. The side of the face treated with petrolatum alone had significantly (p < 0.001) higher incidence of PIH (75%) after laser irradiation than the side of the face treated with topical corticosteroids and petrolatum (40%). The PIH occurring on the petrolatum-treated sides had significantly higher intensity (p < 0.001) and was spread over a significantly larger area (p < 0.001), compared with the corticosteroid- and petrolatum-treated sides. In conclusion, a short-term application of topical corticosteroids postoperatively is associated with a decreased risk of PIH after ablative fractional resurfacing.

The impact of human immunodeficiency virus-related diseases on pigmented skin types.

Infection with human immunodeficiency virus (HIV) remains a significant problem globally. Early diagnosis and treatment with antiretroviral drugs has considerably improved health outcomes and decreased disease-related morbidity. HIV infection is associated with a wide range of skin disorders enabling dermatologists to diagnose HIV as well as associated opportunistic infections early in the course of disease. Despite concerted efforts by international health organizations to limit disease incidence, the prevalence of HIV infection remains high and is highest in sub-Saharan Africa. The diagnosis of HIV-related skin diseases is challenging as immunosuppression often results in atypical disease presentation. In addition, the clinical presentation will vary in pigmented skin types. The aim of this article is to describe disease variation in pigmented skin types.

Manchineel dermatitis in North American students in the Caribbean.

We report an outbreak of Manchineel dermatitis and ophthalmitis in four students from North America who visited the island of Bequia, West Indies. The exposure resulted from taking shelter during a rain storm under a Manchineel tree. Manchineel exposure and ingestion can lead to severe and even fatal disease.

Granulomatous pigmented purpura: report of a case and review of the literature.

The pigmented purpuric dermatoses (PPD) are a group of diseases characterized by petechiae and bronze discoloration of the skin on the lower extremities. Histopathologically, extravasation of erythrocytes with hemosiderin deposition, a perivascular lymphocytic infiltrate centered on the superficial capillaries and endothelial cell swelling are seen. The granulomatous variant of PPD (GPPD) was described in 1996 and only 10 cases have been reported since in the literature, almost exclusively in patients of East Asian descent only involving the extremities. We present a case of GPPD in a Caucasian, North American Ashkenazi Jewish woman involving the thighs, back, forearms and wrists with concomitant non-granulomatous PPD of the shins. She presented with an asymptomatic, spreading, cayenne pepper-like rash. This rash intermittently involved the lower extremities and back for 15 years, but now involves the thighs with accompanying pink papules on the back, wrists and forearms. Histopathology of the thigh and back lesions revealed superficial lichenoid granulomatous dermatitis with palisading lymphocytes and focal interface changes. Extravasated erythrocytes were seen, but vasculitis was absent. No lymphocytic atypicality was noted and T-cell gene rearrangement studies were non-clonal. This is the second reported case of GPPD in a non-Asian patient and the first case involving sites other than the extremities.

[Nutritional status of adopted Chinese girls in Spain]. / El estado nutricional de niñas chinas adoptadas en España.

INTRODUCTION: Given the increasing number of adoptions from China in countries such as Spain, a study was designed to know and assess the nutritional profile at arrival and its likely implication in global health status, growth, and development of adopted Chinese girls. PATIENTS AND METHODS: Eighty-five Chinese girls adopted in Spain during the 2002-2003 period and ages ranging 7-33 months of life were studied at the Social Pediatrics Unit of the "Niño Jesús" Hospital, Madrid. Datas regarding institution of origin, nutritional parameters (anthropometrical and biochemical), presence of associated diseases, and developmental retardations (psychomotor/bone age) were gathered. RESULTS: Waterlow's nutritional index showed a malnourishment rate of 11% based on Chinese reference tables, as compared to 58% based on Spanish tables, of which 82% was acute malnourishment. When comparing the efficacy of both nutritional assessment methods proposed by Waterlow and Gomez, there were no differences in detection of malnourishment in spite of the fact that the latter author gives priority to the weight/age index as a nutritional indicator at ages lower than 2 years. Eighteen percent of the girls were considered at (height/age < p10) of suffering chronic malnourishment, but this was only confirmed in 67% of the group according to Waterlow's criteria. Among assessed plasma parameters, decreased prealbumin, lymphocytes, iron, and transferrin stand out. The predominant pathological findings were thalassemia, dermatitis, psychomotor retardation, and ferropenic anemia. CONCLUSIONS: These results make us believe in a possible improvement in the conditions at Chinese orphanages. The low age at the time of adoption may justify the low incidence of chronic nutritional deficiencies. As a whole, anthropometrical / nutritional impairments found may be related with the consequences of carelessness and vulnerability of the adoption process. In any case, early diagnosis and implementation of appropriate therapy as soon as possible, as it is being done, is essential to provide appropriate growth and development of these girls.

Association between personal exposure to volatile organic compounds and asthma among US adult population.

OBJECTIVES: There is growing concern about adverse respiratory health effects from exposure to indoor air pollution. The purpose of this study was to analyze association between exposure to volatile organic compounds (VOC) and asthma in adults. METHODS: This study utilized passive personal exposure data on ten VOC collected as part of the National Health and Nutrition Examination Survey (NHANES) 1999-2000. A total of 550 subjects who were of non-Hispanic whites, Mexican-Americans, or non-Hispanic Blacks race/ethnicity were included in this analysis. The primary outcome variable was physician-diagnosed asthma and the secondary outcome variable was presence of wheezing in the previous 12 months among those without physician-diagnosed asthma. Exploratory factor analysis was used to generate factor scores to group VOCs, which were included as indicator variables in the analyses. Associations between exposure to VOCs, physician-diagnosed asthma, and wheezing in the previous 12 months were evaluated using multiple logistic regression analyses. Odds ratios are for 1-U increase in level of exposure. RESULTS: Seven of the ten VOC variables loaded on two factors, "aromatic compounds" and "chlorinated hydrocarbons." The geometric mean concentration of VOCs varied from as low as 0.03 microg/m3 for trichloroethene to as high as 14.33 microg/m3 for toluene. Mexican-Americans had the highest personal exposures to benzene (geometric mean=2.38 microg/m3) as compared to non-Hispanic whites (geometric mean=1.15 microg/m3) and non-Hispanic Blacks (geometric mean=1.07 microg/m3). The odds of physician-diagnosed asthma were significantly higher among those exposed to aromatic compounds (Adjusted OR=1.63, 95% CI: 1.17-2.27). Among those subjects never diagnosed by a physician to have asthma, a significantly increased odds of one to two wheezing attacks were observed for aromatic compounds (Adjusted OR=1.68, 95% CI: 1.08-2.61) and chlorinated hydrocarbons (Adjusted OR=1.50, 95% CI: 1.01-2.23) as compared to no wheezing. No association with three wheezing attacks or more was observed in the study. CONCLUSION: In this cross-sectional study of a representative sample of the US population, environmental exposures to VOCs, especially aromatic compounds, were associated with adverse respiratory effects.

A survey of skin disease and skin-related issues in Arab Americans.

BACKGROUND: There is a paucity of knowledge relating to dermatologic conditions in Arab Americans. OBJECTIVE: To assess common skin diseases and concerns and to evaluate access to dermatologic care and perception of skin in Arab Americans. METHODS: Arab Americans from 3 Southeast Michigan locations (community health center [n = 207], mosque [n = 95], and church [n = 99]) completed a survey questionnaire. RESULTS: The most common self-reported skin conditions were acne, eczema/dermatitis, warts, fungal skin infections, and melasma. The most pressing skin concerns were uneven skin tone, skin discoloration, dry skin, acne, and facial hair. Significant associations exist between socioeconomic status and having seen a dermatologist. Attitudes surrounding skin perception were related to the number of years of residence in the United States. LIMITATIONS: The skin condition data were gathered from a self-reported survey. CONCLUSIONS: Skin conditions and other related issues that affect Arab Americans are similar to those which affect other skin-of-color populations.

[Neuromyelopathy in the population of Noir-marron of Saint-Laurent du Maroni in French Guiana]. / Neuromyélopathies dans la population de Noirs marrons de Saint-Laurent du Maroni en Guyane française.

The neurological observations have been reported at André Bouron Hospital of Saint-Laurent du Maroni and at General Hospital of Cayenne during a period of 5 years. All patients belonged to the "Noir Marron" ethnic group and lived in the area of Saint-Laurent. There were six women and four men, aged 15-35 years. Neurological symptoms were isolated or associated to other organ failure. Neurological manifestations included retrobulbar optic neuropathy, spastic paraparesis, sensitive ataxia and cerebellar ataxia, psychiatric symptoms were observed. Other organs affected were cardiovascular, digestive, cutaneous or endocrinologic (thyroid). Diet consist mainly in cassava. Thiamin deficiency has been observed several times. Improvement of neurological deficits following thiamin administration points towards Thiamin as an etiological factor. Ethnological specificity of Saint-Laurent area may explain that such neurological manifestation have not been observed in the rest of the department.