Ethnopharmacological survey of home remedies used for treatment of hair and scalp and their methods of preparation in the West Bank-Palestine.

BACKGROUND: Natural products have many uses and purposes, including those linked to pharmaceutics and cosmetics. The aim of this study was to investigate the use of natural remedies for the treatment of hair and scalp disorders in the West Bank, Palestine. METHODS: An ethnopharmacological survey of herbal remedies and other natural products used in cosmetics and cosmeceuticals was carried out in the West Bank, Palestine. A questionnaire was distributed to 267 herbalists, traditional healers, hairdressers and rural dwellers. Collected information included: the names of plants and other natural products, the parts used, hair conditions, diseases and problems for which these products were used and also their methods of preparation. To identify the most important species used, the factor of informant's consensus (Fic), fidelity level (Fl) and the use-value (UV) were calculated. RESULTS: Collected data showed that 41 plants are utilized for the treatment of hair and scalp disorders, belonging to 27 families; among them Lamiaceae and Rosaceae, which were the most commonly used. Plant oils and their fruits are the most commonly used parts. Hair loss, dandruff, split hair endings and lice treatment, are reported as the most treated disorders. The number of plant species used consisted of 19, 14, 13, and again 13 with a factor of informant's consensus (Fic) for these disorders corresponding to 0.93, 0.94, 0.95 and 0.92, respectively. Fl was 100% for many plants; the highest UV value (0.84) was registered for Lawsonia inermis, which belongs to the Lythraceae family. CONCLUSIONS: This study showed that many natural remedies are still used in Palestine for the treatment of scalp and hair disorders as well as for cosmeceutical purposes. This study is of great importance as it allows us to have a greater perspective on our folkloric use of these natural products. A combined scientific effort between informants and the scientific community, working in this field, may help in the discovery of new cosmetics, cosmeceutical and nutraceutical products.

Ethnic skin: Kids are not just little people.

There are numerous skin conditions that occur commonly in children with ethnic skin, including vitiligo, progressive macular hypomelanosis, pityriasis alba, acne keloidalis nuchae, pseudofolliculitis barbae, and keloids. Though these conditions occur in both children and adults, children may have different patterns of clinical presentation and response to therapy. In caring for such patients, important treatment considerations include side effects of systemic medications and tolerability of invasive procedures. Quality of life is an important measure and should not be compromised by either the skin disease or its treatment.

Pseudofolliculitis barbae: understanding the condition and the role of facial grooming.

Pseudofolliculitis barbae (PFB) is an inflammatory condition of the beard area, with a high prevalence in men of subequatorial African ancestry and, to a much lesser extent, Indo-Europeans. But it can affect both men and women of all ethnicities. Invariably reported as being associated with shaving, recent evidence suggests a strong genetic component in patients with persistent PFB. There is a lack of robust clinical evidence to support recommendations to avoid or curtail shaving or to shave with a single-blade razor. There is recent clinical evidence that PFB is not exacerbated by daily shaving with a multiblade razor as part of a regimen. Further, there is preliminary evidence that a daily shaving regimen, which includes pre-shave hydration and post-shave moisturization, may be beneficial. To develop evidence-based initial management strategies for PFB, there is a requirement for more randomized blinded clinical trials comparing the use of multi- and single-edge razors, different shaving techniques, shaving frequencies and pre- and post-shaving cosmetic products.

Ethnic hair disorders.

The management of hair and scalp conditions is difficult in any patient, especially given the emotional and psychological implications of hair loss. This undertaking becomes even more challenging in the ethnic patient. Differences in hair care practices, hair shaft morphology, and follicular architecture add complexity to the task. It is imperative that the physician be knowledgeable about these practices and the phenotypic differences seen in ethnic hair in order to appropriately diagnose and treat these patients. In this chapter, we will discuss cultural practices and morphologic differences and explain how these relate to the specific disorders seen in ethnic populations. We will also review the most prominent of the ethnic hair conditions including acquired trichorrhexis nodosa, traction alopecia, central centrifugal cicatricial alopecia, pseudofolliculitis barbae, dissecting cellulitis, and acne keloidalis nuchae.

The spectrum of skin diseases in a black population in Durban, KwaZulu-Natal, South Africa.

BACKGROUND: Precise knowledge of the prevalence and spectrum of skin diseases in a population allows for effective planning for provision of dermatology services and distribution of resources. There are no published data on the epidemiology of skin disorders in Durban, KwaZulu-Natal. OBJECTIVE: We investigated the prevalence of skin diseases in black African patients attending a predominantly black private healthcare facility and profiled the patients. METHODS: Clinical charts of all black African patients seen between January 2003 and December 2010 in a private practice in Durban were reviewed. The diseases seen were described and the prevalence calculated. RESULTS: A total of 6664 patient charts were reviewed. The five most common conditions were acne, eczemas, dyschromias, infections, and hair disorders. These data agree with reports from other parts of the world. LIMITATIONS: Selection bias was presented by a single private practice, thus data may not be fully representative of our population. CONCLUSION: Acne, eczemas, dyschromias, infections, and hair disorders are, in that order, the five most common disorders encountered.

A review of hair care products for black individuals.

Physicians should be prepared to provide professional guidance to black individuals with both chemically treated and natural (ie, nonchemically treated) hair. Patients may seek advice from physicians if they decide to discontinue use of chemical relaxers or if they have sustained damage such as chemical burns, breakage, or hair loss from the misuse of various hair care products. Properly advising this patient population requires a basic understanding of hair morphology in black individuals as well as the unique characteristics of this hair type and the products used to address its needs. Although some products may promote healing properties, misusing or overusing them may cause adverse effects. This article will provide clinicians with a basic understanding of chemically treated and natural hair in black individuals. We also discuss hair care products that are ideal for this patient population and the potential adverse effects based on their chemical formulations.

A systematic approach to Afro-textured hair disorders: dermatoscopy and when to biopsy.

Trichoscopy facilitates the diagnosis of various hair and scalp disorders and is often useful in predicting the disease course. However, to date, few studies describe the dermoscopic findings unique to Afro-textured hair. This article reviews what is currently known regarding trichoscopy and discusses its usefulness in this population.

Folliculitis keloidalis nuchae and pseudofolliculitis barbae: are prevention and effective treatment within reach?

Pseudofolliculitis barbae and folliculitis keloidalis nuchae are chronic follicular disorders disproportionately affecting men of African ancestry. This article explores the etiology, pathogenesis, treatment, and prevention strategies of these conditions. Effective treatment and prevention of these disorders involves pharmacologic and procedural interventions as well as behavioral modifications.

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.

Hair and scalp disorders in women of African descent: an overview.

We present an overview of hair and scalp disorders in women of African descent, discussing the biological features of afro-textured hair, as well as hair-grooming practices in this cohort and their association with specific hair and scalp disorders. A practical approach to diagnosing and managing common hair and scalp disorders in this cohort is also presented.

Pigmented pilomatricoma: an underrecognized variant.

The presence of melanin pigment and/or melanocytes in pilomatricoma has been rarely documented. In this study, we analyzed the incidence and clinicopathological features of pigmented pilomatricoma. Fifty-seven consecutive pilomatricoma cases from 53 Japanese patients were examined in this study. In fourteen cases (24.6%), pigmentation was observed in pilomatricoma. This variant equally affected in males and females, and the common locations were the upper arm and face. Proliferation of dendritic melanocytes was observed within basaloid cell nests in all cases, and melanin pigment was also present within the cytoplasm of the basaloid cells in 11 cases. Melanin pigment was also present in the shadow cells in 7 cases. The incidence of pigmented pilomatricoma as documented in previous reports is approximately 10%. However, our analysis revealed that pigmented pilomatricoma was found in 24.6% of Japanese cases of pilomatricoma, thus, this variant is not uncommon and may be under-recognized.

Dermatologic conditions in skin of color: part II. Disorders occurring predominately in skin of color.

Several skin conditions are more common in persons with skin of color, including dermatosis papulosa nigra, pseudofolliculitis barbae, acne keloidalis nuchae, and keloids. Dermatosis papulosa nigra is a common benign condition characterized by skin lesions that do not require treatment, although several options are available for removal to address cosmetic concerns. Pseudofolliculitis barbae occurs as a result of hair removal. Altering shaving techniques helps prevent lesions from recurring. In acne keloidalis nuchae, keloidal lesions are found on the occipital scalp and posterior neck. Early treatment with steroids, antibiotics, and retinoids prevents progression. A key part of the management of keloids is prevention. First-line medical therapy includes intralesional steroid injections. The distinct structure of the hair follicle in blacks results in hair care practices that can lead to common scalp disorders. For example, chemical relaxers decrease the strength of hair and may cause breakage. Better patient education, with early diagnosis and treatment, often leads to better outcomes.

Hair and scalp disorders in ethnic populations.

Human hair has been classified into 3 major groups, as determined by ethnic origin. In these populations, significant structural and biochemical variations of the hair follicle and shaft are seen, as well as unique hair grooming practices. These structural variations of the hair are closely linked to the common disorders of the hair and scalp, such as acquired trichorrhexis nodosa, seborrheic dermatitis, traction alopecia, central centrifugal cicatricial alopecia, dissecting cellulitis, frontal fibrosing alopecia, and pseudofolliculitis barbae.

Diseases that turn African hair silky.

BACKGROUND: African hair in its natural state poses tenacious grooming challenges; consequently a large portion of the African cosmetic industry is focused on means to relax the tight curls of African hair to make the hair more manageable. In malnourished and hypoproteinemic states, African hair straightens in an uncomplimentary manner. Recently, we observed that in certain diseases African hair changes to a desirable silky wavy texture. METHOD: To identify the diseases that turn African hair silky and their parameters we examined 5612 dermatology patients at a tertiary hospital in Nigeria. We then studied the clinical and basic laboratory parameters of those patients whose diseases were accompanied by the silky hair change. RESULT: Silky hair change similar to the hair of the African neonatal child was observed in five diseases, namely AIDS, rheumatoid arthritis, systemic lupus erythematosus, pulmonary tuberculosis with cachexia, and Behçet's disease. CONCLUSION: Our study identified retrogression of African hair to the neonatal structure in five diseases. Anemia of chronic illness, high erythrocyte sedimentation rate, and mild hypocalcemia were significant laboratory parameters. This is an important observation, which should excite and advance research into the nature and structure of African hair. The causes of structural hair changes should include these five diseases.

Pili annulati--what about racial distribution?

Pili annulati is a rare hair shaft abnormality and, as far as we know, there are no published data on pili annulati's racial distribution. To our knowledge, this is the first case reported in an African-American patient.

Hair care practices and their association with scalp and hair disorders in African American girls.

BACKGROUND: Few studies have extensively examined the prevalence of hair care practices and their association with scalp and hair conditions in African American girls. OBJECTIVES: We sought to determine the prevalence of hair care practices and their association with traction alopecia, seborrheic dermatitis (SD), and tinea capitis (TC). METHODS: A questionnaire was administered to caregivers of African American girls aged 1 to 15 years. Multivariate analyses were performed to determine the association of hair care practices with reported disorders. RESULTS: A total of 201 surveys were completed from dermatology (n = 98) and nondermatology (n = 103) clinics. Mean patient age was 9.8 ± 4.4 years. Essentially all respondents reported use of hair oils/grease (99%). Ponytails, braids, and cornrows were worn by 81%, 67%, and 49% of girls, respectively, within the past 12 months. In all, 61% reported hair washing every 2 weeks; 80% used hot combs; and 42% used chemical relaxers. Cornrows were significantly related to traction alopecia among respondents from nondermatology clinics only: adjusted odds ratio = 5.79 (95% CI 1.35-24.8, P = .018). Hair extensions and infrequent hair oil use were significantly related to SD: adjusted odds ratio = 2.37 (95% CI 1.03-5.47, P = .04) and 3.69 (95% CI 1.07-12.7, P = .039), respectively. No significant associations were observed for TC. LIMITATIONS: Small sample size and disorders reported by caregivers were limitations. CONCLUSIONS: Certain hair care practices were strongly associated with development of traction alopecia and SD. No association was found between hair washing frequency and SD or TC, or between hair grease use and TC. These results can be used to inform practitioners, advise parents, and adapt treatment regimens to accommodate cultural preferences.

[Pseudofolliculitis barbae]. / Pseudofoliculitis de la barba.

Pseudofolliculitis barbae is a chronic, irritating, and potentially disfiguring condition that develops as a result of attempts to eliminate hair from the beard area, usually by shaving. It is difficult to determine the incidence of the disorder, but some studies report that it affects up to 1 of every 5 caucasian individuals and that it is much more common in black persons. Clinically it is characterized by the appearance of inflammatory papules and pustules. Once pseudofolliculitis has become established, treatment consists of avoiding shaving and the use of medical treatment similar to that used in acne. However, the long-term result is much more dependent on prevention through a correct shaving technique. In severe cases or when a definitive solution is sought, the treatment of choice is photodepilation.

Surgical correction of epiblepharon using thermal cauterization of the orbital septum and lash-rotating sutures.

BACKGROUND: Epiblepharon is a congenital eyelid anomaly frequently encountered in Asian infants and children. The purpose of this study was to describe the surgical technique of epiblepharon correction by applying both lash-rotating sutures in the inferior tarsus and the subcutaneous tissue of the upper skin flap and thermal cauterization in the septum. METHODS: A retrospective, interventional study was performed on 75 patients who underwent surgical correction of epiblepharon between August 2006 and July 2007 by 1 surgeon. The upper skin incisional line was just below the eyelash line, and the delineated ellipse extended from just lateral to the punctum to the site of lash inversion. Dissection was carried out between the tarsal plate and orbital septum and the skin-pretarsal and preseptal orbicularis oculi muscle flap, thus exposing the tarsal plate and orbital septum. Thermal cauterization was applied to the orbital septum to create a cicatricial barrier adhesion between the preseptal orbicularis oculi muscle and the septum to minimize vertical overriding of the orbicularis oculi muscle. Three to 4 interrupted sutures were placed in the inferior tarsus and the subcutaneous tissue of the upper skin flap to rotate the direction of the lashes. The small amount of pretarsal orbicularis oculi muscle and redundant skin overlying the lower lid margin were removed. RESULTS: A total of 150 eyes (75 patients) were followed for 24.1 weeks (range, 4-12 months). Patients ranged in age from 2 to 13 years (median age, 7.3 years). All patients were diagnosed with bilateral epiblepharon, and surgery was performed on both eyelids. After a mean follow-up period of 14.1 weeks, no patients had recurrence, and all patients had good cosmetic results. Symptoms disappeared in all patients. There were no cases of lid retraction, wound dehiscence, or ectropion. CONCLUSIONS: Thermal cauterization of the orbital septum and lash-rotating sutures were very useful and effective for treating epiblepharon.

Healthy hair: what is it?

Shiny hair with a smooth texture and clean-cut ends or tapered tips is generally perceived to be healthy. Hair texture and shine relate to hair surface properties, whereas the integrity of hair ends relates to the hair cortex. Hair can be straight, wavy or curly, blonde, black, brown, red, gray white, and its natural variations are important to our identity. Manipulation of the normal structure of the hair shaft is epidemic and dictated by culture, fashion, and above all, celebrity. Although cosmetic procedures are intrinsically safe, there is potential for damage to the hair. Loss of lustre, frizz, split ends, and other hair problems are particularly prevalent among people who repeatedly alter the natural style of their hair or among people with hair that is intrinsically weak. This may be due to individual or racial variation or less commonly an inherited structural abnormality in hair fiber formation. Hair health is also affected by common afflictions of the scalp as well as age-related phenomena such as graying and androgenetic alopecia. Hair products that improve the structural integrity of hair fibers and increase tensile strength are available, as are products that increase hair volume, reduce frizz, improve hair manageability, and stimulate new hair growth.