Vitamin D levels in patients with albinism compared with those in normally pigmented Black patients attending dermatology clinics in the Free State province, South Africa.

BACKGROUND: Associations between vitamin D deficiency and a broad variety of independent diseases, including several bone diseases, various types of cancer, autoimmune diseases, hypertension, and cardiovascular disease, have been suggested. It is therefore important to detect and treat vitamin D deficiency in high-risk groups. Because patients with albinism (PWA) practice a policy of strict sun avoidance, they may be at risk for low levels of vitamin D. OBJECTIVES: This study was conducted in patients attending dermatology clinics in the Free State, South Africa, to determine sun avoidance behavior in the patient population and to compare 25-hydroxyvitamin D (25[OH]D) levels in PWA with those in normally pigmented Black patients attending the same clinics. METHODS: Serum 25(OH)D levels were assessed in 50 PWA and 50 normally pigmented Black control subjects. Questionnaires on sun exposure avoidance behaviors were administered to all participants. RESULTS: The present study showed no statistically significant difference in median 25(OH)D levels between PWA and controls with normally pigmented Black skin. Rather, the study found a tendency for controls to have lower 25(OH)D levels. A total of 53% (n = 53) of all study participants (PWA and controls) had a 25(OH)D level of <20 ng/ml; thus most participants were deficient in vitamin D. Most of the PWA who participated in the study did not adhere to strict sun avoidance behavior. CONCLUSIONS: People with albinism attending dermatology clinics in the Free State, South Africa, need not be viewed as specifically at risk for low vitamin D levels.

A histopathological study of melanocytic and pigmented skin lesions in patients with albinism.

BACKGROUND: Oculocutaneous albinism (OCA) is a group of genetic disorders characterized by diminished pigmentation of the skin, hair and eyes. Individuals with OCA are at increased risk to develop sun-induced skin malignancies. The incidence of malignant melanoma in OCA individuals is, however, very low. The aim of this study was to document pigmented and melanocytic skin lesions occurring in patients with OCA. METHODS: A prospective study was performed. Sixteen patients with OCA presenting at the Oncology and Dermatology Departments at Universitas Academic Hospital Annex in Bloemfontein, South Africa, were included. Selected clinically pigmented and/or melanocytic lesions were biopsied and studied by light microscopy. RESULTS: Twenty-four punch biopsies were taken. Ten dendritic freckles and 10 melanocytic nevi were confirmed histologically. The nevi, which occurred in eight patients, were found on sun-protected skin. All the freckles occurred on sun-exposed skin. Twelve patients had current or previous skin malignancies. No melanomas were present in the study population. Other skin lesions ranged from solar keratoses to squamous cell carcinomas. CONCLUSION: The majority of pigmented lesions were dendritic freckles that occurred on sun-exposed skin. None of the patients had a current or previous diagnosis of malignant melanoma.

Widespread atypical vascular lesions of the skin after whole-body electron beam therapy: expanding the clinical spectrum.

Atypical vascular lesion of the skin is an uncommon usually benign condition, thus far reported almost exclusively from mammary skin after radiotherapy for carcinoma of the breast. Some clinical and histological overlap exists with early angiosarcoma, which can also occur on irradiated skin. The lesions are divided into vascular and lymphatic types, the first representing a higher risk for development of angiosarcoma and the latter being more common. This article reports a rare case of widespread, progressive, vascular-type atypical vascular lesion after repeated whole-body electron beam irradiation administered as treatment for mycosis fungoides.

The rational use of systemic isotretinoin: a call for moderation.

Systemic isotretinoin effectively treats all forms of acne vulgaris. However, it has many side-effects, some potentially serious, that warrant limiting its use to serious cases of acne. Inappropriate use in large numbers of patients puts prescribers at risk of malpractice litigation should serious side-effects occur where safer alternative treatments were available. Doctors also risk losing access to the drug should authorities limit its use to reduce the occurrence of side-effects.

House-dust mite species in Bloemfontein, South Africa.

UNLABELLED: House-dust mites (HDMs) are an important source of allergens that are reputed to act as a trigger for atopic disease. Climatic conditions in parts of South Africa are not suitable for their proliferation, and there is doubt whether they occur on the Highveld. We studied whether HDMs occur in homes in Bloemfontein, Free State. METHODS: Ten houses were sampled over a 1-year period. Dust was collected monthly or quarterly from a mattress, a bedroom floor and the living room floor of each house and examined for the presence of HDMs. Climate data were collected during the same period and a questionnaire was completed by home-owners to gather data on indoor factors that could influence mite proliferation. RESULTS: HDMs were regularly found in 3 houses (30%). Dermatophagoides farinae was the dominant species (97.5%). The highest numbers were found in winter, when climatic conditions were the least favourable. Climatic conditions never met the requirements for active proliferation of the mites. Indoor factors that may have promoted mite proliferation in some houses were artificial heating (especially under-floor heating), en-suite bathrooms and lack of adequate ventilation during the winter months. CONCLUSION: HDMs do occur in central South Africa, owing to a microclimate created indoors. Adequate ventilation, to reduce indoor humidity, should suffice to reduce mite numbers and prevent atopic symptoms induced by them.

Management of atopic dermatitis in adolescents and adults in South Africa.

OBJECTIVE: The guidelines for the management of atopic dermatitis in patients older than 18 years have been developed in an attempt to improve the outcomes of treatment of this condition in South Africa. This condition has a major impact on the quality of life of sufferers and it is expected that these guidelines, if implemented, will play a role in achieving this. RECOMMENDATIONS: All health care workers involved in the management of atopic dermatitis should take note of these guidelines and try to implement them in clinical practice as far as possible. All treatment methods and procedures not substantiated by evidence from the literature should be discontinued and avoided to decrease the financial burden of dermatitis treatment. VALIDATION: These guidelines were developed through general consensus by a group of five South African dermatologists, from evidence based on extensive literature review. Draft documents were made available for comment to the dermatology community as a whole, via the official website of the Dermatological Society of South Africa. They were also presented and discussed at the annual congress of the Dermatological Society of South Africa. All input from these sources, where appropriate, were then incorporated into these guidelines.

Acne guideline 2005 update.

OBJECTIVE: The guidelines on the management of acne vulgaris have been developed in an attempt to improve the outcomes of acne treatment in South Africa. This extremely common condition has a major impact on the quality of life of South African young people and it is expected that if implemented, these guidelines will play a role in improving this situation. RECOMMENDATIONS: All health care workers involved in the management of acne should take note of these guidelines and endeavour to implement them in clinical practice. All treatment methods and procedures not substantiated by evidence from the literature should be discontinued and avoided to decrease the financial burden of acne treatment. VALIDATION: These guidelines were developed through general consensus by a group of about 40 internationally recognised experts in the field of acne treatment (the Global Alliance to Improve Outcomes in Acne, see details below) and further refined for South African circumstances by the majority of South African dermatologists who attended a series of six discussions held in the major centres of South Africa during 2004. GUIDELINE SPONSOR: The meetings of the Global Alliance to Improve Outcomes in Acne as well as the South African discussion meetings were sponsored by Galderma.

Guideline on the management of melanoma.

OBJECTIVE: 1. The Guideline for the Management of Melanoma has been developed in an attempt to improve management through the process of locating the best available evidence on which to base decisions. It is expected to help to improve the quality of care. 2. Melanoma remains a common cancer in South Africa. Despite the achievement of earlier diagnosis, it would appear from current statistics that at least 850 people continue to die of melanoma each year. Many of these deaths occur at a younger age than for other solid tumours, so the number of years of life lost due to melanoma exceeds that of many other cancers. It is seen as imperative to maximise effective management of melanoma. 3. Prevention of melanoma has not yet been achieved, and there are no conclusive data to show that current promotion of sun avoidance has substantially altered its incidence. 4. Early detection is an important factor in melanoma management, with diagnosis based mainly on changes in colour, diameter, elevation and border (irregularity of outline) of a skin lesion, asymmetry of a lesion, or a lesion different from other naevi. People at high risk of melanoma should be offered a surveillance programme. RECOMMENDATIONS: 1. All clinicians should be trained in the recognition of early melanoma. 2. If there is doubt about a lesion, the patient should be referred for specialist opinion (if readily available) or a biopsy should be undertaken. Biopsy of a pigmented lesion should be done only on the basis of suspicion of melanoma. Excision with a 2 mm margin is adequate. 3. Prophylactic excision of benign naevi is not recommended. In general, elective lymph node dissection is not indicated. 4. People with high-risk primary melanoma, lymph node involvement and melanoma in unusual sites (e.g. mucosal and disseminated melanoma) should be managed with support from a melanoma centre. VALIDATION: Melanoma management involves many medical specialties. Guidelines should therefore be developed through a multidisciplinary consensus. The Melanoma Advisory Board consists of a forum of dermatologists, oncologists, plastic surgeons and pathologists.