Coconut, Castor, and Argan Oil for Hair in Skin of Color Patients: A Systematic Review.

Coconut, castor, and argan oils are popular commercial hair oils culturally rooted in current and historical Indian and African heritages. Dermatologists treating hair and scalp conditions often face challenging patient questions of whether over-the-counter hair oils should be used. This is particularly challenging given the deeply rooted cultural practices of some skin of color patients. As a result, many dermatologists recommend patients to continue using hair oils not based on clinical efficacy but rather lack of foreseeable side effects. We analyzed the literature to investigate claims to substantiate whether these hair oils can improve hair growth, hair quality, and treat infestation clinically. Based on 22 articles that met inclusion criteria, coconut oil has been shown to treat both brittle hair and hair infestation clinically, with limited evidence regarding its impact on hair growth. There is weaker evidence for castor oil improving hair quality by increasing hair luster, and no strong evidence supporting its use for hair growth or treatment of infestation. Argan oil does not have any significant evidence supporting its use to improve hair growth, quality, or treatment of infestation. J Drugs Dermatol. 2022;21(7):751-757. doi:10.36849/JDD.6972.

SKIN FEATURES IMPORTANT FOR THE OCCURRENCE OF CONTACT DERMATITIS IN HEALTHCARE WORKERS.

The occurrence of skin lesions in healthcare workers is associated with a negative impact on important skin functions, including protection from mechanical injuries, sunlight, dehydration, and penetration of chemical substances or pathogenic microorganisms. In healthcare professionals, the most common occupational skin disease is contact dermatitis (CD), either irritant (ICD) or allergic (ACD), and typically on the hands. ICD accounts for about 80% of occupational CD, making it the most frequent cause. According to the literature, CD frequency is higher among healthcare professionals than other occupations, with critical occupational risk factors including contact with irritants and allergens at the workplace. Furthermore, ICD is a multifactorial disorder influenced by many constituent and environmental factors. Constituent factors include age, gender, body location, atopy, and genetic factors, while environmental factors include temperature, airflow, humidity, and occlusion. Commonly encountered irritants are water, detergents and surfactants, solvents, oxidizing agents, acids, and alkalis; however, use of protective gloves or equipment, hand-washing habits, use of cleansers and creams, active inflammatory skin diseases, and daily activities are also important for ICD onset. Additionally, ICD is known to predispose to ACD. Important risk factors for ACD development include occupation, age, history of atopic dermatitis, genetics, female gender, and fair skin phototype. In summary, numerous skin features and other occupation-related factors contribute to CD among healthcare practitioners. Given the high level of exposure to contact irritants/allergens in the healthcare setting, implementation of preventive measures is crucial for a safer work environment.

A case of oral foreign-body granuloma due to diatoms.

Diatoms are photosynthetic algae with a siliceous exoskeleton. Diatoms are utilized by a wide array of industries for applications such as filtration and pest control. Unsubstantiated claims have also propelled their societal reach to trendy oral and topical uses. This case highlights a rare case of an oral granuloma secondary to diatoms. An 80-year-old woman presented with a mobile, firm, asymptomatic submucosal mass on her lower left mandibular vestibular mucosa. Histopathology showed a non-caseating granulomatous reaction to diatoms. Her only verified contact with a diatomaceous earth product was a dental impression using alginate after upper front teeth trauma 5 months before. Although there have been several cases of allergic contact dermatitis attributed to diatoms, there are no reported cases of diatom-induced granuloma formation found in the literature. There are, however, ample data on granulomas initiated by silica. Given the silica-based composition of diatoms, and the broad use of diatoms in industry and alternative medicine, it is unclear why diatom-induced granulomas are not more widely described. This report may alert clinicians to the existence of diatom granulomas and incline them to tailor their history to cover questions about possible exposure when evaluating patients presenting with a localized oral lesion.

Understanding State Regulation of Biosimilars and Effect on Prescribers.

Biologics are a mainstay of treatment for many dermatologic conditions, however the high costs can be prohibitive for many patients. A growing market of biosimilar drugs is emerging with the hope of providing patients access to more affordable medications. While the FDA has created an abbreviated licensure pathway for these drugs, states are still in the process of creating regulations regarding their substitution for reference biologics. This article looks to raise awareness of the current federal regulations and the differences among state regulations regarding the use of biosimilars. Fifty percent of states have passed legislation regarding procedures for substitution of biosimilars in the pharmacy. All states require biosimilars to have FDA-approved "interchangeable" status, however states vary on other requirements such as: prescriber and patient notification, pharmaceutical record keeping, publicly-accessible list of interchangeable products, and cost regulations. Some of the issues surrounding biosimilar regulation include difficulty obtaining interchangeability status from the FDA, resistance to the physician notification requirement, and concern for traceability of adverse reactions. Physicians must be aware of current federal and state regulations regarding biosimilars and help inform policy makers of the potential benefits and shortcoming of biosimilar legislation.

J Drugs Dermatol. 2017;16(10):995-1000.

Ergonomics in Dermatologic Laser Procedures.

Due to working in static positions and use of repetitive movements over long periods of time, dermatologists are at increased risk of work-related musculoskeletal injury. Historically, studies on procedural ergonomics have focused on dermatologic surgery, however, laser procedures can also have a significant cumulative effect on physician posture. Here, we aim to highlight ergonomic challenges specific to dermatologic laser procedures and suggest areas of improvement in operating room organization, patient positioning, physician mechanics, and instrumentation. For the operating room, it is beneficial to store several devices in the same room, have central placement of electrical outlets, and to position the devices on the same side of the bed as the laser operator. When considering patient positioning, a Trendelenburg bed position can be helpful for vascular lesions on the head, and frequent repositioning of the patient can prevent uncomfortable bending of the operator and laser arm for circumferential lesions. Physicians should maintain a working position with a neutral spine and wrist position, moving the patient and bed as needed to reduce muscle tension. Lastly, laser instrumentation in the future could be improved upon with lightweight consoles and hand pieces, long multi-articulated device arms, and lightweight laser goggles with adjustable head straps. With the use of organizational, ergonomic positioning, and teamwork strategies, we can reduce the risk of musculoskeletal injury for our laser operators.

Clinical Significance of Mottling Rashes in Diving Decompression Sickness.

INTRODUCTION: Decompression sickness (DCS) is a medical condition caused by outgassing of dissolved nitrogen following rapid ascent by divers and aviators. Cutaneous DCS, historically termed cutis marmorata (CM), presents as a predominantly truncal reticular violaceous-to-dusky eruption. The prevailing theories for its pathogenesis include: localized cutaneous outgassing, paradoxical embolism across a right-to-left shunt (RLS), and brainstem emboli disrupting autonomic control of cutaneous microcirculation.METHODS: We conducted a systematic review of reports of cutaneous DCS to investigate relationships among CM, RLS, and neurological sequelae to better elucidate the mechanism of CM. A literature search examining reports of cutaneous DCS yielded 31 eligible studies, comprising a pooled total of 128 patients.RESULTS: Of the patients with documented workup, 84% showed evidence of RLS with CM. Subsequently 18 patients underwent percutaneous closure of intracardiac RLS with no recurrence of DCS. Of the patients with documented neurological evaluations, 57% experienced both CM and neurological DCS manifestations. The coexistence of RLS and neurological symptoms with CM was noted in numerous cases; exact percentages of overlap cannot be stated due to data unavailability.DISCUSSION: Our results indicating the striking coexistence of RLS and neurological sequelae in CM patients is supportive of the paradoxical embolism theory of pathogenesis. The frequent coincidence of CM with RLS and neurological symptoms raises concern that CM may signify vulnerability to devastating systemic gas emboli. CM has historically been considered trivial and self-limiting; however, our results support reappraisal of its clinical significance and potential reclassification to the more severe subtype.Breen ID, Stepanek J, Marks L, Yale K, Mesinkovska N, Swanson D. Clinical significance of mottling rashes in diving decompression sickness. Aerosp Med Hum Perform. 2024; 95(9):695-702.

Combination of Microfocused Ultrasound with Visualization and Dilute Calcium Hydroxylapatite Filler for Moderate to Severe Knee Skin Laxity.

Background: Microfocused ultrasound with visualization (MFU-V) and calcium hydroxylapatite (CaHA) filler are modalities for improving skin laxity. Their use in combination on body sites other than the face is expanding. Objective: To investigate the effectiveness and safety of combination MFU-V and dilute CaHA (dCaHA) for lower anterior thigh and knee laxity over 12 and 24 weeks. Methods: Twenty women (40-71 years) with moderate to severe laxity of the anterior thigh and knee were enrolled in this split-body trial. Subjects received dual-depth (3.0mm, 1.5mm) or triple-depth MFU-V (4.5mm, 3.0mm, 1.5mm) to the inferior anterior thigh (127-381 lines) along with dCaHA (1:1 normal saline) injection (0.5-3mL). Clinical effectiveness was monitored using photography, qualitative clinician and subject assessments, and quantitative analysis of skin topography by three-dimensional imaging and dermal thickness by optical coherence tomography. Results: At 12 and 24 weeks, the treated thigh and knee experienced significant improvement in qualitative clinician scales (p<0.01), with subjective improvement on photography and subject-reported assessments; no significant changes were noted by quantitative measures. Adverse events were reported in 68 percent of patients, including mild bruising (n=12) and swelling (n=10). Conclusion: Combining MFU-V and dCaHA is safe and results in clinical improvement of anterior thigh and knee laxity.

Commonly Associated Disorders with Complete Scalp Alopecia in Early Childhood: A Review.

Complete scalp hair loss can be a source of distress for affected children and their families. In addition to infectious and trauma-related causes of hair loss, infants and children may present with total scalp alopecia arising from a range of genetic predispositions. Our objective with this review was to identify the common genetic conditions in children with complete scalp alopecia. The PubMed Database was reviewed for all articles from 1962 to 2019 containing the search terms related to genetic alopecia. The conditions with at least five reported cases in the literature were considered for the inclusion. All clinical trials, retrospective studies, and cases on human subjects and written in English were included. Six genetic conditions related to complete scalp alopecia were included in this review. The most common genetic conditions associated with total scalp hair loss include: alopecia totalis/Alopecia universalis (AU), atrichia with papular lesions, AU congenita, hereditary Vitamin D-resistant rickets type IIA, alopecia with mental retardation, and pure hair and nail ectodermal dysplasia. In children presenting with total scalp hair loss, a myriad of genetic and environmental factors may be the underlying cause. Increased awareness of potential genetic conditions associated with total scalp hair loss may assist in diagnosis, with improved the prognosis for the children.

Electrocardiogram Findings in Patients with Alopecia Areata.

INTRODUCTION: While autoimmune comorbidities are common in alopecia areata, little is known about comorbid cardiovascular disease. The purpose of this study was to evaluate the incidence of bradyarrhythmia in patients with alopecia areata. METHODS: Retrospective review of electrocardiograms of 124 patients with [Formula: see text] 50% scalp hair loss (severe alopecia areata) was conducted and compared to National Health and Nutrition Examination Survey (NHANES) data. RESULTS: The prevalence of bradycardia in females with alopecia areata was 24.3% (95% CI, 14.5-34.1%) and in those age 40 years or older was 40.8% (95% CI, 22.2-53.5%) compared to 19.5% in the NHANES III population. The prevalence of bradycardia in males with alopecia areata was 36.0% (95% CI, 22.7-49.3%) and in those age 40 years or older was 50.0% (95% CI, 21.7-78.3%) compared to 26.9% in the NHANES III population. CONCLUSION: The potential association between bradycardia and alopecia areata merits further investigation.

Medication-Induced Repigmentation of Gray Hair: A Systematic Review.

Hair graying is a common sign of aging resulting from complex regulation of melanogenesis. Currently, there is no medical treatment available for hair repigmentation. In this article we review the literature on medication-induced hair repigmentation, discuss the potential mechanisms of action, and review the quality of the literary data. To date, there have been 27 studies discussing medication-induced gray hair repigmentation, including 6 articles on gray hair repigmentation as a primary objective, notably with psoralen treatment or vitamin supplementation, and 21 reports on medication-induced gray hair repigmentation as an incidental finding. Medications noted in the literature include anti-inflammatory medications (thalidomide, lenalidomide, adalimumab, acitretin, etretinate, prednisone, cyclosporin, cisplatinum, interferon-α, and psoralen), stimulators of melanogenesis (latanoprost, erlotinib, imatinib, tamoxifen, and levodopa), vitamins (calcium pantothenate and para-amino benzoic acid), a medication that accumulates in tissues (clofazimine), and a medication with an undetermined mechanism (captopril). Diffuse repigmentation of gray hair can be induced by certain medications that inhibit inflammation or stimulate melanogenesis. There is also low-quality evidence that some vitamin B complex supplementation can promote gray hair darkening. While these compounds are not currently indicated for the treatment of gray hair, their mechanisms shed light on targets for future medications for hair repigmentation.

Genital Allergic Contact Dermatitis.

Genital allergic contact dermatitis (ACD) is an uncommon disorder, yet it severely impairs the quality of life for both men and women. Because of cultural taboos, many patients self-treat and delay proper diagnosis before presenting to a provider. Diagnosis is further confounded by irritant contact dermatitis and other genital dermatoses, which can predispose to skin barrier dysfunction and allergen penetration. Genital ACD can present acutely with erythematous erosions and pruritus or chronically with lichenification. Patch testing helps determine the diagnosis and provide relief for the patient. Topical medications, including local anesthetics and corticosteroids, are the most common genital allergens. Other typical allergens include fragrances, preservatives, adhesives, dyes, and rubber products. Less commonly considered allergens include herbs, spices, and topical vehicle components. Here, we review the most common allergens for both men and women, discuss important patch-testing panels, and recommend safe products for patients with genital ACD.