A primer to natural hair care practices in black patients.

Natural hairstyles have increased in popularity in the United States among individuals of African and Afro-Caribbean descent. Dermatologists should be aware of general principles of natural hair care in this patient population, including basic hair care terminology, types of natural hairstyles, methods of washing, and product selection. A basic knowledge of natural hair care practices in black patients will assist dermatologists in the management and treatment of many conditions associated with traumatic hairstyling in this patient population.

Pubic lice: an endangered species?

UNLABELLED: The incidence of pubic lice infestations is estimated to be between 1.3% and 4.6%, with an average incidence of 2% worldwide. It is also estimated that 70% to 80% of adults now remove pubic hair in part or entirety, using a variety of methods. It is hypothesized that the destruction of this pubic hair habitat may account for the falling incidence of pubic lice and may possibly lead to its eradication or atypical presentation. AIM: To report the changing incidence of pubic lice infestation from our unit over the last 10 years and assess its association, if any, with pubic hair removal of any kind. METHODS: Assessment of medical records and questionnaires were used to identify the incidence of hair removal and pubic lice infestation over a 10-year period. Data were anonymized and analyzed to identify any correlation. RESULTS: A significant and strong correlation between the falling incidence of pubic lice infections and increase in pubic hair removal was observed, with a Pearson correlation r value of 0.9686 (95% confidence intervals, 0.88-0.992). The P value is less than 0.0001. CONCLUSIONS: The increased incidence of hair removal may lead to atypical patterns of pubic lice infestations or its complete eradication as the natural habitat of this parasite is destroyed.

Three cases of liver toxicity with a dietary supplement intended to stop hair loss.

Liver toxicity associated with herbal remedies and dietary supplements is an increasing concern. Several toxic hepatitis cases have been reported in the literature in association with products intended for weight loss where green tea extracts are an ingredient.Three hepatotoxicity cases are reported below in association with the use of Inneov masa capilar®, a dietary supplement intended to stop hair loss whose primary component is green tea catechins. In all of them, other potential causes of acute hepatitis were ruled out.We highlight the importance of awareness regarding these substances at history taking in order to identify and report hepatic adverse reactions secondary to apparently safe herbs as described in the present manuscript.

Shave frequency and regimen variation effects on the management of pseudofolliculitis barbae.

BACKGROUND: Pseudofolliculitis barbae (PFB) is an inflammatory condition of the face with a clinical presentation of papules in the beard area with occasional pustules or hypertrophic scarring, all of which develop in response to shaving. Prevalent in African American men, a limited amount of data have been published on the shave outcomes as they relate to clinically measurable responses and patient satisfaction scoring. The primary purpose of this study is to evaluate the impact of a daily shaving regimen and advanced shaving products on exacerbation of lesions and symptoms in patients with PFB. METHODS: Ninety African American men were randomized to 1 of 3 treatment groups shaving 2 to 3 times per week with standard products (control group), shaving daily with standard products (daily standard group) or shaving daily with advanced products (daily advanced). The number of pustules, papules, ingrown hairs, and investigator's assessment of severity and subjective symptoms of itching and burning/stinging were assessed at baseline, week 6, and week 12. The response to treatment was also assessed by the investigator and the subject at weeks 6 and 12. Secondary measures including questionnaires regarding baseline shave practices were also correlated with outcomes variables. RESULTS: There were no significant differences noted between the 3 groups for papule (P=.32) or pustule (P=.46) count for the 12-week study. However, there was a significant mean papule reduction from baseline detected for both the control and daily advanced groups. In addition, compared to baseline, there was a significant reduction in ingrown hairs for the control group, and a directional reduction in ingrown hairs for the daily advanced group. There were significant group differences between the control group and both daily shaving groups, with the control group seeing significantly fewer ingrown hairs (P=.005 for control vs daily standard group and P=.04 for control vs daily advanced group). There were no significant group differences among the 3 groups for investigator-graded severity (P=.43) and response to treatment (P=.51). There was a significant perceived improvement in the response to treatment (P=.007) and itching (P=.002) for the daily advanced group vs the control group.

Premature hair graying.

Hair pigmentation and graying are important topics for the understanding of the physiology of aging; the differentiation of stem cells; and the mechanisms underlying disease processes such as progeroid syndromes, vitiligo, and hypothyroidism. Although hair graying, or canities, is a common process occurring in people as they age, an unknown percentage of individuals experience premature graying from familial inheritance or pathologic conditions. We review the physiology of hair pigmentation and the mechanism underlying physiologic graying, and we explore the etiology of pathologic causes of premature graying, pathologies associated with premature graying, and the limited available treatment options for hair graying.

Pitfalls of mapping a large Turkish consanguineous family with vertical monilethrix inheritance.

Monilethrix, a rare autosomal dominant disease characterized by hair fragility and follicular hyperkeratosis, is caused by mutations in three type II hair cortex keratins. The human keratin family comprises 54 members, 28 type I and 26 type II. The phenotype shows variable penetrance and results in hair fragility and patchy dystrophic alopecia. In our study, Monilethrix was diagnosed on the basis of clinical characteristics and microscopic examination in a family with 11 affected members. Haplotype analysis was performed by three Simple Tandem Repeat markers (STR) and KRT86 gene was sequenced for the identification of the disease causing mutation. In the results of this, autosomal dominant mutation (E402K) in exon 7 of KRT86 gene was identified as a cause of Moniltherix in the large family from Turkey.

Azithromycin prevents recurrence of severe trichiasis following trichiasis surgery: STAR trial.

PURPOSE: Trichiasis, the potentially visually disabling result of chronic trachoma, is a leading cause of blindness world wide. Surgery can repair trichiasis, but recurrence of severe trichiasis (lashes touching the cornea) following surgery is likely to have immediate vision threatening consequences. Azithromycin use post-surgery appeared to be beneficial against recurrences but there were a mix of severe, moderate, and mild trichiasis; the specific effect on prevention of severe, vision-threatening recurrence is unknown. This randomized, clinical trial determined if treating trichiasis surgical patients with oral azithromycin compared to usual care (topical tetracycline) resulted in a reduction in severe recurrence of trichiasis to one year. METHODS: In a rural, trachoma hyperendemic district in Ethiopia, 1452 trichiasis patients age 18 or older presenting for surgery were randomly allocated to azithromycin, single 1 gram dose, versus topical tetracycline twice per day for six weeks. The outcome was recurrent severe trichiasis, defined as lashes touching the cornea, or more than 5 lashes touching the globe, to one year. RESULTS: Patients randomized to receive azithromycin had significantly fewer severe recurrences, 4.2/100 person years overall, compared to those randomized to topical tetracycline, 7.9/100 person years (p < 0.01). CONCLUSIONS: A single dose of azithromycin has been shown to reduce severe post-surgical trichiasis recurrence rates to one year and should become standard post surgical treatment.

Single-dose azithromycin prevents trichiasis recurrence following surgery: randomized trial in Ethiopia.

BACKGROUND: Trichiasis recurrence following surgery is a serious problem for trachoma programs. OBJECTIVE: To determine if postoperative treatment with azithromycin compared with topical tetracycline reduces recurrence up to 1 year, and if azithromycin treatment of household members provides additional benefit compared with treating only the surgical patient. DESIGN: A randomized, single-masked, clinical trial was conducted in Ethiopia. A total of 1452 patients with trichiasis were randomized 1:1:1 to the following 3 arms: single-dose (1 g) oral azithromycin alone, single-dose azithromycin for household members (20 mg/kg up to 1 g) plus the patient, or topical tetracycline (twice per day for 6 weeks). MAIN OUTCOME MEASURES: Trichiasis recurrence within 1 year following surgery. RESULTS: The combined azithromycin groups had significantly fewer recurrences, 6.9 of 100 person-years overall, compared with topical tetracycline, 10.3 of 100 person-years (P = .047). There was no additional reduction in the arm that also treated household members, 8.1 of 100 person-years, compared with treating the surgical patients alone, 5.8 of 100 person-years (P = .19). CONCLUSIONS: In trachoma-endemic areas, a single dose of azithromycin reduced postoperative trichiasis recurrence rates by one third compared with topical tetracycline. Application to Clinical Practice In countries where azithromycin is part of the Trachoma Control Program, patients with trachomatous trichiasis should be treated postoperatively to prevent recurrence.

Prevention of dermatologic side effects of bimatoprost 0.03% topical therapy.

PURPOSE: To investigate the efficacy of reducing the drop-skin contact to prevent dermatologic side effects of bimatoprost 0.03% topical therapy. DESIGN: Prospective, randomized, single-blinded, internally controlled study. METHODS: Enrolled subjects started bimatoprost 0.03% therapy once at night in both eyes and were instructed to wipe selectively only one eye (eye 1) with an adsorbent pad during and after drops administration for four months. The fellow eye acted as the internal control. Eyelash growth, regional skin hypertrichosis, and pigmentation on the periocular skin were assessed at baseline and during the four months of follow-up. RESULTS: A lower incidence of eyelash growth and skin pigmentation in the inferonasal pericanthal region were observed in eye 1. The incidence of pigmentation in the inferotemporal skin region and skin hypertrichosis were similar in the two eyes. CONCLUSION: The reduction of the drop-skin contact affects the regional incidence and the extent of dermatologic skin changes that are related to bimatoprost 0.03% topical therapy.

Impact of oral azithromycin on recurrence of trachomatous trichiasis in Nepal over 1 year.

BACKGROUND: Recently, a significant association between Chlamydia trachomatis infection and postoperative trachomatous trichiasis (TT) recurrence was shown. The current study evaluated whether azithromycin treatment at the time of surgery could reduce recurrence. METHODS: As part of Nepal's national trachoma control programme, patients received azithromycin (53 patients) or placebo (56 patients) at surgery. Conjunctivae were graded for trachoma and swabbed to detect chlamydiae preoperatively and postoperatively up to 12 months. Logistic regression was performed for associations of treatment option with recurrence, infection, and active trachoma (by eye and by patient). RESULTS: TT recurrence was 28.9% at 12 months. Recurrence was significantly lower for those with major TT at baseline in the azithromycin group at 12 months (p = 0.03); incident recurrence was also significantly lower at 6 months (OR, 0.056; 95% CI, 0 to 0.423; p = 0.004). There was a trend for increased recurrence among those with minor TT at baseline and for reduction of active trachoma and infection in the azithromycin group but not the placebo group. CONCLUSION: These data suggest that azithromycin treatment at the time of surgery may be warranted for patients with major TT. However, treatment should be investigated further for minor TT, for efficacy at subsequent time intervals and in other trachoma endemic settings.

A randomised controlled trial of azithromycin following surgery for trachomatous trichiasis in the Gambia.

BACKGROUND/AIM: Trachomatous trichiasis frequently returns following surgery. Several factors may promote recurrence: preoperative disease severity, surgeon ability, surgical procedure, healing responses, and infection. This study investigates whether enhanced control of infection, both of Chlamydia trachomatis and other bacteria, with azithromycin can improve surgical outcome in a trachoma control programme. METHODS: Individuals with trachomatous trichiasis were examined and operated. After surgery patients were randomised to the azithromycin or control group. The azithromycin group and children in their household were given a dose of azithromycin. Antibiotic treatment was repeated at 6 months. All patients were reassessed at 6 months and 12 months. Samples were collected for C trachomatis polymerase chain reaction and general microbiology at each examination. RESULTS: 451 patients were enrolled. 426 (94%) were reassessed at 1 year, of whom 176 (41.3%) had one or more lashes touching the eye and 84 (19.7%) had five or more lashes. There was no difference in trichiasis recurrence between the azithromycin and control group. Recurrent trichiasis was significantly associated with more severe preoperative trichiasis, bacterial infection, and severe conjunctival inflammation at 12 months. Significant variability in outcome was found between surgeons. Visual acuity and symptoms significantly improved following surgery. CONCLUSION: In this setting, with a low prevalence of active trachoma, azithromycin did not improve the outcome of trichiasis surgery conducted by a trachoma control programme. Audit of trichiasis surgery should be routine.

Cost-effectiveness of trachoma control in seven world regions.

BACKGROUND/AIMS: The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and antibiotics in trachoma-endemic areas in seven world regions. METHODS: A population model was applied to follow the lifelong impact on individuals receiving trachoma control. Intervention costs and effectiveness estimates were based on a combination of primary data collection and literature review. RESULTS: Providing trichiasis surgery to 80% of those who need it would avert over 11 million DALYs per year globally, with cost effectiveness ranging from I$13 to I$78 per DALY averted across regions. Mass antibiotic treatment of all children using azythromycin at prevailing market prices would avert more than 4 million DALYs per year globally with cost-effectiveness ranging between I$9,000 and I$65,000 per DALY averted. The intervention is only cost-effective if azythromycin is donated or becomes available at reduced prices. Mass treatment of all children with tetracycline and targeted treatment with azythromycin are not cost-effective. CONCLUSIONS: As individual components of the SAFE strategy, trichiasis surgery for trachoma is a cost-effective way of restoring sight in all epidemiological sub-regions considered, as is the use of azythromycin, if donated or at reduced prices. Large study uncertainties do not change study conclusions. The results should be interpreted in the context of the overall SAFE strategy to address issues of sustainability.

Advice on hair and scalp care during cranial radiotherapy: a prospective randomized trial.

BACKGROUND: The advice on hair washing during brain irradiation is aimed at minimizing radiation induced skin toxicity. We performed a prospective randomized trial to assess the effect of advice on scalp care on the local skin reaction in patients undergoing cranial radiotherapy. METHODS: One hundred and nine patients undergoing cranial radiotherapy were randomized into two groups. Patients in group 1 were advised not to wash hair during treatment and patients in group 2 to maintain normal pattern of hair washing. They were assessed weekly over a period of 10 weeks from the start of treatment. Symptoms of pain and itching were recorded using a modified RTOG/EORTC acute skin reaction scoring system and skin reaction was assessed clinically using erythema/desquamation score. The frequency of hair washing and the distress of changing the practice of normal hygiene were recorded on a diary card. Skin reaction scores were compared as a summary measure using area under the curve per week (AUC/week) and median scores, and the differences between groups were assessed by means of the t-test. RESULTS: One hundred and nine patients commencing cranial radiotherapy according to standard protocol were randomized into the trial (group 1, 55 patients; group 2, 54 patients). Patients asked to restrict hair washing, washed at a lower average frequency. There were no significant differences between scores of skin reaction in the two groups for each of the variables measured. CONCLUSIONS: The practice of normal hair washing is not associated with increased severity of adverse skin reaction. As a request to change the pattern of normal hygiene may cause distress, the current advice should be to maintain normal hair washing during cranial radiotherapy.

Hospital hairdresser as a potential source of cross-infection with MRSA.

Following medical staff concerns about patients screening positive for methicillin-resistant Staphylococcus aureus (MRSA) from the hairline site only, it was suggested that the hospital hairdresser could be a possible source for cross-contamination. Analysis of her procedures and decontamination practices confirmed her to be a potential source. Swabbing of her equipment after a day's session with her normal cleansing practice revealed the presence of MRSA, confirmed by phage typing as an epidemic strain within the hospital. This provided putative evidence for a vehicle of transmission. A review of advice for hairdressers in hospitals was obtained from the literature and via a telephone survey of infection control nurses in London. A composite policy was produced for hairdressers attending MRSA-positive patients in hospital to minimize this potential risk.

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.