Structural and molecular characteristics of weight-bearing volar skin can be reconstituted by micro skin tissue column grafting.

For patients with lower limb amputations, prostheses are immensely helpful for mobility and the ability to perform job-related or recreational activities. However, the skin covering the amputation stump is typically transposed from adjacent areas of the leg and lacks the weight-bearing capacity that is only found in the specialized skin covering the palms and soles (a.k.a. volar skin). As a result, the skin tissue in direct contact with the prosthesis frequently breaks down, leading to the development of painful sores and other complications that limit, and often preclude, the use of prostheses. Transplanting volar skin onto amputation stumps could be a solution to these problems, but traditional skin transplantation techniques cause substantial morbidity at the donor site, such as pain and scarring, which are especially problematic for volar skin given the critical functional importance of the volar skin areas. We previously developed the technology to collect and engraft full-thickness skin tissue while avoiding long-term donor site morbidity, by harvesting the skin in the form of small (~0.5 mm diameter) cores that we termed "micro skin tissue columns" (MSTCs), so that each donor wound is small enough to heal quickly and without clinically appreciable scarring or other long-term abnormalities. The goal of this study was to establish whether a similar approach could be used to confer the structural and molecular characteristics of volar skin ectopically to other skin areas. In a human-to-mouse xenograft model, we show the long-term persistence of various human plantar MSTC-derived cell types in the murine recipient. Then in an autologous porcine model, we harvested MSTCs from the bottom of the foot and transplanted them onto excision wounds on the animals' trunks. The healing processes at both the donor and graft sites were monitored over 8 weeks, and tissue samples were taken to verify volar-specific characteristics by histology and immunohistochemistry. The volar donor sites were well-tolerated, healed rapidly, and showed no signs of scarring or any other long-term defects. The graft sites were able to maintain volar-specific histologic features and expression of characteristics protein markers, up to the 8-week duration of this study. These results suggest that MSTC grafting could be a practical approach to obtain autologous donor volar skin tissue, confer volar skin characteristics ectopically to nonvolar skin areas, improve the load-bearing capacity of amputation stump skin, and ultimately enhance mobility and quality-of-life for lower limb amputees.

Injection of oral medication into the skin confirmed by infrared spectroscopy.

"Skin popping" refers to the practice of injecting drugs, most commonly heroin, subcutaneously or into granulation tissue. Pharmaceutical tablets meant for oral consumption are modified into solutions for injection. Excipients-inactive substances that serve as vehicles for medication-are often not filtered out before injection and result in abscess formation, granulomatous inflammation, and scarring. Common excipients used in the production of pharmaceutical tablets include starch, microcrystalline cellulose, magnesium stearate, silica, and polyvinylpyrrolidone (PVP). Identification of these exogenous materials is valuable in confirming the diagnosis of skin popping, especially when patients may not be forthcoming about their drug use. We present a case of subcutaneous oral medication injection in which PVP and cellulose were identified by Fourier transform infrared spectroscopy. Considering the variable cutaneous manifestations of injection drug abuse, recognition of histopathologic and chemical characteristics of exogenous material from oral medications is helpful for diagnosis and intervention.

Hair growth-promoting effect of Geranium sibiricum extract in human dermal papilla cells and C57BL/6 mice.

BACKGROUND: Geranium sibiricum L. has been used as a medicinal plant to treat diarrhea, bacterial infection, and cancer in Bulgaria, Peru, and Korea. However, its hair growth-promoting effect was not investigated so far. This study examined the effects of Geranium sibiricum L. extract (GSE) on hair growth, using in vitro and in vivo models. METHODS: Antioxidant, proliferation and migration assay of GSE was performed with human dermal papilla cells (hDPCs). Hair-growth promoting effect was measured in animal model. Relative expression of interleukin-1, vascular endothelial growth factor, hepatocyte growth factor, and transforming growth factor beta 1 was determined by real time RT-PCR. Expression of Ki-67 and stem cell factor were analyzed by immunohistochemistry. RESULTS: GSE treatment proliferated and migrated human dermal papilla cells (hDPCs) more than treatment of 10 µM minoxidil. GSE significantly stimulated the expression of Ki-67 protein and the mRNA levels of hepatocyte growth factor and vascular endothelial growth factor in hDPCs. Topical application of 1,000 ppm GSE for 3 weeks promoted more significant hair growth on shaved C57BL/6 mice than did 5% minoxidil. The histological morphology of hair follicles demonstrated an active anagen phase with the induction of stem cell factor. GSE treatment significantly reduced the number of mast cells and the expression of transforming growth factor beta 1 in mouse skin tissues. CONCLUSIONS: These results demonstrated that GSE promotes hair growth in vitro and in vivo by regulating growth factors and the cellular response.

Development of Light-Scribing Process Using L-Ascorbic Acid for Graphene Micro-Supercapacitor.

The rapid development of smart technologies is accelerating the growing demand for microscale energy storage devices. This work reports a facile and practical approach to fabricating interdigitated graphene micro-patterns through the LSC process accompanied by the l-ascorbic acid (L-AA) and preheating treatment. Our work offered a higher degree of GO reduction than the conventional microfabrication. It significantly shortened the overall processing time to obtain the micro-patterns with improved electrical and electrochemical performances. The interdigitated MSC composed of 16 electrodes exhibited a high capacitance of 14.1 F/cm3, energy density of 1.78 mWh/cm3, and power density of 69.9 mW/cm3. Furthermore, the fabricated MSC device demonstrated excellent cycling stability of 88.2% after 10,000 GCD cycles and a high rate capability of 81.1% at a current density of 1.00 A/cm3. The fabrication process provides an effective means for producing high-performance MSCs for miniaturized electronic devices.

Reappraising the Use of Systemic Immunomodulators for Psoriasis and Eczema in the Military.

INTRODUCTION: Psoriasis and atopic dermatitis are chronic, immune-mediated skin disorders that are disqualifying for entrance into the military. Both conditions can cause difficulty wearing body armor and other protective equipment when poorly controlled, limiting a service member's ability to train and deploy worldwide. In addition, these conditions may be exacerbated by military service because of increased exposure to austere environments, extreme temperatures, stress, skin injury, bug bites, and vaccinations Service members have limited treatment options because of restrictions on systemic medications that can be used while deployed. Newer systemic medications-in particular, biologics and oral immunomodulators-have evolved to be both extremely effective and safe. We review more recent treatment options for psoriasis and atopic dermatitis in the context of DoD's regulations guiding entry and retention of personnel with psoriasis and eczema and make recommendations regarding updating DoD policy for systemic treatment options. MATERIALS AND METHODS: A literature search was performed using PubMed, Embase, and Ovid with the last search done in the fall of 2023 from all years to date. These articles were further screened based on inclusion and exclusion criteria. In total, 25 articles were included in this review. An Internet search was also performed on the DoD's regulations guiding entry and retention of personnel with psoriasis and eczema. In addition, we examined medical requirements for deployment to the U.S. Central Command and U.S. European Command. RESULTS: Currently, U.S. Central Command and U.S. European Command do not allow the use of medications with special storage and handling requirements on deployments. Newer biologics are safe and efficacious but require refrigeration, although other immunomodulators like deucravacitinib and apremilast are oral pills and do not have cold-storage requirements. However, the use of biologics in austere environments may be feasible because of increased intervals between dosing and the ability to store refrigerated medical supplies in most deployed environments. For military service members with psoriasis, risankizumab and deucravacitinib are excellent options given their favorable safety and efficacy profiles. Of the biologics available for atopic dermatitis, dupilumab is the safest and effective systemic medication available. The Janus kinase inhibitors have also demonstrated excellent efficacy in treating atopic dermatitis, but more safety data are needed because of potential adverse events to include heart-related events, blood clots, and cancers. CONCLUSIONS: Systemic treatments have evolved to become highly specific for both eczema and psoriasis. These newer biologics and immunomodulators may be compatible with use in the deployed setting, especially those that have long dosing intervals and proven efficacy and safety. Of the biologics, dupilumab and risankizumab offer the best efficacy, safety, and dosing intervals for atopic dermatitis and psoriasis, respectively. Deucravcitinib is a recently FDA-approved oral immunomodulator for psoriasis that has an excellent safety profile and efficacy. Allowing the use of these medications on deployments will enable more people with moderate to severe psoriasis and eczema to join and remain in the military while receiving effective treatment.

A Review of JAK Inhibitors for Treatment of Alopecia Areata in the Military Health Care System.

INTRODUCTION: Alopecia areata (AA) is a disease that manifests as patchy hair loss on the scalp and other parts of the body; severe disease may result in disfigurement, functional impairment, and significant psychological distress. This condition is understood to be caused by autoimmunity to the hair follicle and subsequent arrest of hair growth. New medications, baricitinib and ritlecitinib, belong to the Janus kinase (JAK) inhibitor family and are among the first FDA-approved treatments for severe AA. In this manuscript, we aim to answer the question: What treatment options exist for AA in the military health care system (MHS)? In doing so, we review the pathogenesis, physical and psychosocial impact of AA, conventional treatment of AA, and the efficacy and safety of baricitinib and ritlecitinib. METHODS: A literature search was performed using PubMed, Embase, and Ovid for the history and pathogenesis of AA, psychosocial impact of disease, functional impairments, and current treatments. Keywords "alopecia areata," "current therapy for alopecia areata," "pathogenesis alopecia areata," "baricitinib," "ritlecitinib," "JAK inhibitor alopecia," "JAK inhibitor safety," "baricitinib efficacy," "alopecia eyelash," "alopecia nails," and "psychosocial impact of alopecia" were used for the search. The TRICARE manual was searched for guidelines applicable to the treatment of AA, DoD Instruction 6130.03 Volume 2 for medical standards for military service, and the U.S. Central Command Modification 15 for fitness of deployment to Central Command area of operations. RESULTS: Traditional treatments such as intralesional steroids may be effective for some patients, but difficulty lies in controlling extensive or refractory disease. Janus kinase inhibitors, baricitinib and ritlecitinib, are found effective at improving severe refractory disease; baricitinib induced hair regrowth in 32.6% more patients than placebo, and ritlecitinib was found to be superior to placebo by at least 24%. Currently, there is no coverage for therapeutic treatment of hair growth in the MHS. Additionally, military members are disqualified for continued service if they require immunomodulator medications such as baricitinib and ritlecitinib. Those on immunomodulators are unable to deploy worldwide. CONCLUSIONS: Baricitinib and ritlecitinib are effective treatments for widespread, progressive, and refractory AA. Although JAK inhibitors demonstrate improved effectiveness compared to non-immunomodulator treatments, their use in the MHS for this purpose is limited.

Stoichiometric Study on Ion Composition of a Precursor in Chemical Bottom-Up Synthesis for Peroxo-Titanate.

Layered alkali titanates of the lepidocrocite type are gaining enormous interest in various fields owing to their unique properties. These materials are mainly synthesized through a hydrothermal alkali treatment. However, this method uses a highly concentrated alkali solution, which has high environmental impacts and is therefore unsuitable for mass synthesis. Herein, we propose an efficient method for the large-scale synthesis of layered sodium titanate structures (Na2-x H x Ti2O5) using a recently reported bottom-up chemical process. The effects of the Na:Ti molar ratio in the peroxo-titanium complex ion precursor on the products are investigated through stoichiometric calculations for a molar ratio range of 10:1-1:1. The optimal ratio for the complete ionization of TiH2 (which is the starting material) to form the peroxo-titanium complex ion is found to be 1.1:1. The amount of alkali raw material required is 99.6% lower than that required in the traditional hydrothermal method. The crystal structures and morphologies of the samples are almost identical regardless of the Na:Ti molar ratio. The precursor-derived peroxo bonds narrow the energy band gaps of the layered titanates even when the amount of titanium ions dissolved in the precursor increases. The proposed method is not only an efficient synthetic route for mass production but also has potential applications in the development of photofunctional materials.

Effects of Cation Exchange in Rhodamine B Photocatalytic Degradation Using Peroxo-Titanate Nanotubes.

Lepidocrocite-type layered sodium titanate (NaxH2-xTi2O5) is widely used in environmental remediation because of its large specific surface area, formed by anisotropic crystal growth, and its ability to store and exchange cations between layers. Additionally, peroxo-titanate nanotubes (PTNTs), which are tubular titanates with peroxy groups, exhibit visible-light absorption capabilities, rendering them suitable for photocatalytic applications under visible light irradiation. However, because of cation exchange reactions, the Na+ concentration and pH of the solution can fluctuate under aqueous conditions, affecting the photocatalytic performance of the PTNTs. Herein, we evaluated the impact of cation exchange reactions on the photocatalytic degradation of Rhodamine B (Rh B) by PTNTs at controlled Na+ ratios. The observed pH of Rh B solutions increases due to the cation exchange reaction with Na+ and H3O+, leading to the formation of zwitter-ionic Rh B molecules, eventually weakening their adsorption and photodegradation performance. Moreover, the results indicate that inhibiting the pH increase of the Rh B solution can prevent the weakening of both the adsorption and photodegradation performance of PTNTs. This study highlights the significance of regulating the sodium ion content in layered titanate materials, emphasizing their importance in optimizing these materials' photocatalytic efficacy for environmental purification applications.

Impact of Hydrocolloid Dressing and Moisturizing Cream as Facial Skin Protectants Among Health Care Workers.

INTRODUCTION: During the novel coronavirus disease 2019 pandemic, health care workers experienced facial problems from prolonged use of N95 masks, including skin irritation, pigmentation changes, and contact dermatitis. We assessed the use of hydrocolloid dressing versus dimethicone cream to prevent skin breakdown among military health care workers while wearing an N95. MATERIALS AND METHODS: Participants were recruited using convenience and snowball sampling in this nonblinded, randomized, cross-over study with 2 active treatments, hydrocolloid dressing and dimethicone cream, across 3 time points. The skin was assessed using photographs and subepidermal moisture scanner (SEM). N95 seal integrity was assessed using qualitative fit test. Institutional review board approval was obtained from the Madigan Army Medical Center Institutional Review Board. RESULTS: Among the 73 participants, wearing an N95 alone versus with dimethicone cream or hydrocolloid dressing caused more adverse skin reactions. There were no significant differences in qualitative fit test failure rate between groups. Participants experienced minimal to no dizziness, loss of energy/tiredness/fatigue, claustrophobia, shortness of breath, difficulty breathing, and dry or itchy eyes. For all interventions, wearing an N95 did not interfere with participants' concentration, verbal communication, hearing, vision, and, importantly, delivery of care. CONCLUSIONS: Using a skin protectant with an N95 may prevent adverse skin reactions while preserving health care workers' ability to safely and competently care for patients in routine and pandemic conditions.

Porous Lithium Disilicate Glass-Ceramics Prepared by Cold Sintering Process Associated with Post-Annealing Technique.

Using melt-derived LD glass powders and 5-20 M NaOH solutions, porous lithium disilicate (Li2Si2O5, LD) glass-ceramics were prepared by the cold sintering process (CSP) associated with the post-annealing technique. In this novel technique, H2O vapor originating from condensation reactions between residual Si-OH groups in cold-sintered LD glasses played the role of a foaming agent. With the increasing concentration of NaOH solutions, many more residual Si-OH groups appeared, and then rising trends in number as well as size were found for spherical pores formed in the resultant porous LD glass-ceramics. Correspondingly, the total porosities and average pore sizes varied from 25.6 ± 1.3% to 48.6 ± 1.9% and from 1.89 ± 0.68 µm to 13.40 ± 10.27 µm, respectively. Meanwhile, both the volume fractions and average aspect ratios of precipitated LD crystals within their pore walls presented progressively increasing tendencies, ranging from 55.75% to 76.85% and from 4.18 to 6.53, respectively. Young's modulus and the hardness of pore walls for resultant porous LD glass-ceramics presented remarkable enhancement from 56.9 ± 2.5 GPa to 79.1 ± 2.1 GPa and from 4.6 ± 0.9 GPa to 8.1 ± 0.8 GPa, whereas their biaxial flexural strengths dropped from 152.0 ± 6.8 MPa to 77.4 ± 5.4 MPa. Using H2O vapor as a foaming agent, this work reveals that CSP associated with the post-annealing technique is a feasible and eco-friendly methodology by which to prepare porous glass-ceramics.

Plantar Skin Exhibits Altered Physiology, Constitutive Activation of Wound-Associated Phenotypes, and Inherently Delayed Healing.

Wound research has typically been performed without regard for where the wounds are located on the body, despite well-known heterogeneities in physical and biological properties between different skin areas. The skin covering the palms and soles is highly specialized, and plantar ulcers are one of the most challenging and costly wound types to manage. Using primarily the porcine model, we show that plantar skin is molecularly and functionally more distinct from nonplantar skin than previously recognized, with unique gene and protein expression profiles, broad alterations in cellular functions, constitutive activation of many wound-associated phenotypes, and inherently delayed healing. This unusual physiology is likely to play a significant but underappreciated role in the pathogenesis of plantar ulcers as well as the last 25+ years of futility in therapy development efforts. By revealing this critical yet unrecognized pitfall, we hope to contribute to the development of more effective therapies for these devastating nonhealing wounds.

Graphene/polyaniline/poly(4-styrenesulfonate) hybrid film with uniform surface resistance and its flexible dipole tag antenna application.

A graphene/polyaniline/poly(4-styrenesulfonate) (G/PANI/PSS)-based conducting paste is successfully fabricated by introducing a PANI/PSS nanofiller into a multilayer graphene matrix by mechanical blending. As a compatibilizer, the PSS binder increases the dispersibility, interfacial interactions, and mechanical interlocking between the multilayer graphene matrix and PANI, thereby allowing surface resistance with narrow distribution. High concentrations of this PSS binder, obtained using ex situ polymerization, further improve the adhesion of the hybrid film to a flexible substrate. The minimum surface resistance of the screen-printed G/PANI/PSS hybrid film is approximately 10 Ω sq(-1) for a 70 µm uniform thickness. When bent to angles of -30°, the flexible hybrid film exhibits an approximately 6% decrease in surface resistance. The surface resistance after 500 bending cycles increases by only 10 Ω sq(-1) , which is 14 times that of smaller, graphene-based thin films. The micropatterned, screen-printed G/PANI/PSS hybrid film is evaluated as a practical dipole tag antenna. High-resolution patterns are formed in the hybrid film by the inherently high surface tension and the properties of grains within the domain-based structure. The G/PANI/PSS-based dipole tag antenna has a bandwidth of 28.7 MHz, a high transmitted power efficiency of 98.5%, and a recognition distance of 0.42 m at a mean frequency of 910 MHz. These characteristics indicate that the G/PANI/PSS-based dipole tag antenna could be used as a signal-receiving apparatus, much like a radio-frequency identification tag, for detecting nearby objects.

The Effects of Polyaniline Nanofibers and Graphene Flakes on the Electrical Properties and Mechanical Properties of ABS-like Resin Composites Obtained by DLP 3D Printing.

Three-dimensional printing is regarded as a future-oriented additive manufacturing technology that is making significant contributions to the field of polymer processing. Among the 3D printing methods, the DLP (digital light processing) technique has attracted great interest because it requires a short printing time and enables high-quality printing through selective light curing of polymeric materials. In this study, we report a fabrication method for ABS-like resin composites containing polyaniline (PANI) nanofibers and graphene flakes suitable for DLP 3D printing. As-prepared ABS-like resin composite inks employing PANI nanofibers and graphene flakes as co-fillers were successfully printed, obtaining highly conductive and mechanically robust products with the desired shapes and different sizes through DLP 3D printing. The sheet resistance of the 3D-printed composites was reduced from 2.50 × 1015 ohm/sq (sheet resistance of pristine ABS-like resin) to 1.61 × 106 ohm/sq by adding 3.0 wt.% of PANI nanofibers and 1.5 wt.% of graphene flakes. Furthermore, the AP3.0G1.5 sample (the 3D-printed composite containing 3.0 wt.% of PANI nanofibers and 1.5 wt.% of graphene flakes) exhibited 2.63 times (22.23 MPa) higher tensile strength, 1.47 times (553.8 MPa) higher Young's modulus, and 5.07 times (25.83%) higher elongation at break values compared to the pristine ABS-like resin with a tensile strength of 8.46 MPa, a Young's modulus of 376.6 MPa, and an elongation at break of 5.09%. Our work suggests the potential use of highly conductive and mechanically robust ABS-like resin composites in the 3D printing industry. This article not only provides optimized DLP 3D printing conditions for the ABS-like resin, which has both the advantages of the ABS resin and the advantages of a thermoplastic elastomer (TPE), but also presents the effective manufacturing process of ABS-like resin composites with significantly improved conductivity and mechanical properties.

Treatment and Current Policies on Pseudofolliculitis Barbae in the US Military.

Pseudofolliculitis barbae (PFB), or ingrown hairs, is a common skin condition of the face and neck caused by shaving in predisposed individuals who have naturally curly hair. It uniquely affects a disproportionate number of US service members with African ancestry who must abide by strict uniform grooming standards across the entire military. The main rationale behind this policy is that a beard can prevent a proper seal when using breathing protection devices such as gas masks or N95 respirators. Against the backdrop of the COVID-19 pandemic and ever-looming overseas conflicts, dermatologists who treat service members should be aware of the separate yet related guidelines to treat PFB that each military branch follows. Herein, we review the treatments and current policies on PFB in the US Military.

Topical eflornithine hydrochloride improves the effectiveness of standard laser hair removal for treating pseudofolliculitis barbae: a randomized, double-blinded, placebo-controlled trial.

BACKGROUND: Pseudofolliculitis barbae (PFB) significantly impacts the military population, especially deployed personnel. OBJECTIVE: This study was designed to determine whether the addition of topical eflornithine to hair laser treatment would improve efficacy in treating PFB. METHODS: This was a randomized, double-blinded, placebo-controlled, paired (right and left neck) comparison study examining a combination of eflornithine and hair laser versus placebo and hair laser for the treatment of PFB. In all, 27 male patients with clinical PFB were treated with a long-pulsed neodymium:yttrium-aluminum-garnet laser with an energy fluence of 25 to 30 J/cm(2), a pulse duration of 20 to 30 milliseconds, and a 10-mm spot size to the entire bearded neck region. The laser treatment was performed every 4 weeks for a total of 16 weeks. Between laser treatments, patients applied eflornithine and placebo creams twice daily to opposite sides of the bearded neck region. The number of hairs and inflammatory papules were counted bilaterally at each visit. RESULTS: The eflornithine side had a statistically significant decrease in the number of hairs and inflammatory papules compared with the placebo side. At 16 weeks, the eflornithine side had a median hair reduction of 99.5% from baseline (range 48.5%-100.0%), whereas the placebo side had an 85.0% median hair reduction from baseline (range 50.5%-94.5%), P less than .001. LIMITATIONS: Patients were not followed up beyond 16 weeks. CONCLUSION: The addition of topical eflornithine to hair laser treatment decreased hairs and inflammatory papules faster when compared with hair laser therapy alone in the treatment of PFB.

We Can Do Better at Protecting Our Service Members From Skin Cancer.

Skin cancer rates have been steadily increasing among the American public for decades, but multiple studies have demonstrated that the U.S. military suffers from higher rates of skin cancer than the general public. As with so many aspects of health, simple preventive measures made early on can dramatically improve long-term health outcomes. Ample research has demonstrated that ultraviolet protection reduces skin damage and cancer rates. Although further research is needed to fully understand current barriers to soldiers' use of sun protection, we recommend a variety of simple measures the U.S. military can implement to reduce skin cancer risk for our soldiers. Early education and intervention to reduce skin cancer risk and promote sun-protective strategies is critical. These include improving sun protection offered by uniform items, such as increasing the availability of the sun hat, using eye protection with tinted inserts, and testing and publicizing the ultraviolet protection level of uniform items. We also recommend increasing sunscreen access for soldiers. Options to do so include issuing soldiers small portable packets or bottles of sunscreen to carry on their person, incorporating small packets of sunscreen in MREs, and issuing sunscreen to commands to distribute before field exercises. Unit and medical leadership should encourage the use of sunscreen and sun-protective strategies when possible; leadership engagement is critical to overcoming current behavioral barriers to change. Finally, we recommend that units attempt to reduce sun exposure during training by encouraging soldiers to seek shade and avoiding outdoor training in the middle of the day.

Developing and Measuring Effectiveness of a Distance Learning Dermatology Course: A Prospective Observational Study.

As a response to the COVID-19 pandemic, many institutions transitioned to online learning or participation in telehealth as a substitute for clinical rotations. The Uniformed Services University of the Health Sciences (Bethesda, Maryland) relied heavily on e-learning during this time as an alternative means for meeting educational objectives. We report the positive results of a prospective study evaluating short-term information recall and comprehension as well as students' confidence in their ability to apply course objectives over 3 months of an online distance learning (DL) dermatology course.

Military Grooming Standards and Black Hairstyling Practices.

INTRODUCTION: Throughout history, armies of the world have codified grooming standards for their members. In the USA, the Department of Defense (DoD) provides overall guidance for grooming standards and each uniformed military service develops, promulgates, and enforces its own grooming standards. The specific details of each service's grooming standards are revised regularly to conform to contemporaneous notions of professionalism and operational necessity. In light of growing recognition of and respect for the diversity of people serving in the military, specific language used to describe certain hairstyles and hair textures as well as associated grooming policies have gained attention. Efforts have been made to modify the policy and language to be more inclusive, especially of minority groups with physiologic and cultural differences that influence grooming practices. Initial efforts in the DoD toward this endeavor were made possible with advocacy from members of the Congressional Black Caucus. MATERIALS AND METHODS: We obtained service-specific documents, current and former, from the Army, Navy, Air Force, and Marine Corps that regulate the grooming standards for military personnel. We then examined the documents for text that addressed hair and hairstyles, specifically noting language describing and regulations regarding traditionally Black or African American hairstyles (i.e., afros, dreadlocks/locks/locs, braids, twists, etc.) for female and male soldiers. We also examined recently introduced legislation which seeks to end discrimination based on a person's hair texture or hairstyle, "Creating a Respectful and Open World for Natural Hair Act," abbreviated as the CROWN Act in the context of current grooming standards. RESULTS: Our examination of the grooming regulations of four branches of the U.S. Military shows recent modifications of the language governing female hairstyles, particularly natural hairstyles seen among African American women, such as cornrows, braids, and locs (or locks). Changes made to grooming standards demonstrate a shift in language used to describe natural hairstyles. Words with negative connotations (i.e., "matted," "unkempt," and "dreadlock") have been removed. These have been replaced with more descriptive language that provides a more objective definition of certain hairstyles. While these hairstyles have some level of regulation as to exact dimensions and styling rules to fit with the goal of uniformity in appearance and do not extend to male service members, recent updates in grooming standards have expanded to be inclusive of these natural hairstyles. Recent changes in language and policy in the military have been noted as positive examples in the CROWN Act. CONCLUSIONS: The DoD has recognized that former grooming standards, specifically regarding hair and hairstyles, may have introduced inequities in the treatment of military personnel. The DoD and its component military services have long been engaged in programs to ensure equal protections among its workforces. The re-examination and clarification of grooming standards related to hair and hairstyles is another effort to ensure equity and inclusion. The military services are working with great sincerity to implement policies that promote inclusiveness broadly. Steps to remove discrimination on the basis of hair and hairstyle can make the overall work environment more inclusive for people of color. Passage of a federal CROWN Act will promote similar or parallel changes for federal employees outside the military services.