The Eumelanin Human Skin Colour Scale: a proof-of-concept study.

BACKGROUND: At present there is no standard nomenclature for describing the diversity of human constitutive skin colour. OBJECTIVES: To develop a standard nomenclature to describe human constitutive skin colour. METHODS: Monthly focus group discussions were carried out among a multidisciplinary group of specialists over a 7-month period. Topics covered were (i) limitations and unmet needs of current nomenclature(s) pertaining to human cutaneous diversity, (ii) practical considerations about the function and role of any proposed nomenclature pertaining to human cutaneous diversity, (iii) review of the cellular basis and current molecular genetic understanding of variation in human skin pigmentation and (iv) in vivo methods to evaluate human skin pigmentation. In addition, a preliminary review of the published literature was undertaken to collate data on published skin reflectance measurements, notably melanin index values for well-referenced human populations. RESULTS: We developed a five-point scale to describe the full spectrum of human constitutive skin colour, termed the Eumelanin Human Skin Colour Scale. The nomenclature of the scale uses eumelanin, the dominant chromophore of human skin, as a central descriptive word. The categories of the scale (nomenclature and melanin index values) are eumelanin low (EML), < 25; eumelanin intermediate low (EMIL), 25 to < 50; eumelanin intermediate (EMI), 50 to < 75; eumelanin intermediate high (EMIH), 75 to < 100; and eumelanin high (EH), ≥ 100. CONCLUSIONS: The Eumelanin Human Skin Colour Scale enables the complete range of human constitutive skin colour to be described in an objective, equitable and understandable manner. In future, this scale can be used as the basis for developing other scales that address the specific functional aspects of human skin, such as response to ultraviolet radiation.

UK ethnic minority healthcare workers' perspectives on COVID-19 vaccine hesitancy in the UK ethnic minority community: A qualitative study.

Background: The experiences of UK ethnic minority (UKEM) healthcare workers are crucial to ameliorating the disproportionate COVID-19 infection rate and outcomes in the UKEM community. We conducted a qualitative study on UKEM healthcare workers' perspectives on COVID-19 vaccine hesitancy (CVH) in the UKEM community. Methods: Participants were 15 UKEM healthcare workers (11 females; age range: 26-58 [43.3 ± 9.4] years). Data were collected using individual and joint interviews, and a focus group, and analyzed using thematic analysis. Results: We generated three themes: heterogeneity (two subthemes), mistrust (six subthemes), and mitigating (six subthemes). Therein, participants distinguished CVH in the UKEM community in educational attainment and ethnicity. They pointed to the role of mistrust in CVH in the UKEM community. They opined that the mistrust underlying CVH in the UKEM community is rooted in history and religion, conspiracy theories, the speedy development and novelty of the vaccines, post-vaccination complications/side effects, false positive test results, and social media and social support/influence. Participants recommended that interventions targeted at mitigating CVH in the UKEM community need to, in a non-judgmental way, tackle dis/misinformation and provide education, and incorporate UKEM healthcare worker endorsement. They also suggested such interventions be community-oriented, enhance the convenience of vaccination centers and the possibility of vaccine choice, and appreciate that overcoming CVH and accepting vaccination is a gradual process involving personal assessment of risks and benefits. Conclusion: CVH in the UKEM community is a multifaceted phenomenon requiring multicomponent interventions.

Molecular diagnostics-an emerging frontier in dermatopathology.

Advances made within the field of genomics and proteomics have facilitated the emergence of a new era of molecular diagnostics. However, ongoing rapid developments in molecular methodology ensure that this remains a complex field, accessible primarily to scientists who routinely utilize these techniques. For this reason, in this article we provide a concise overview of established and emerging molecular methods and discuss their role as diagnostic adjuncts in Dermatopathology. Important nonmolecular techniques that are used in conjunction with molecular methods are also highlighted.

The global prevalence and correlates of skin bleaching: a meta-analysis and meta-regression analysis.

PURPOSE: To estimate and investigate the global lifetime prevalence and correlates of skin bleaching. METHODS: A meta-analysis and meta-regression analysis was performed based on a systematic and comprehensive literature search conducted in Google Scholar, ISI Web of Science, ProQuest, PsycNET, PubMed, and other relevant websites and reference lists. A total of 68 studies (67,665 participants) providing original data on the lifetime prevalence of skin bleaching were included. Publication bias was corrected using the trim and fill procedure. RESULTS: The pooled (imputed) lifetime prevalence of skin bleaching was 27.7% (95% CI: 19.6-37.5, I2  = 99.6, P < 0.01). The highest significant prevalences were associated with: males (28.0%), topical corticosteroid use (51.8%), Africa (27.1%), persons aged ≤30 years (55.9%), individuals with only primary school education (31.6%), urban or semiurban residents (74.9%), patients (21.3%), data from 2010-2017 (26.8%), dermatological evaluation and testing-based assessment (24.9%), random sampling methods (29.2%), and moderate quality studies (32.3%). The proportion of females in study samples was significantly related to skin bleaching prevalence. CONCLUSION: Despite some limitations, our results indicate that the practice of skin bleaching is a serious global public health issue that should be addressed through appropriate public health interventions.

Adverse cutaneous reactions to soft tissue fillers--a review of the histological features.

The enhanced use of exogenous substances for cosmetic and reconstructive procedures is paralleled by an increase in reports of cutaneous adverse reactions to several of these agents. Recognition of the histological features of these reactions is of importance to both dermatologists and dermatopathologists but is not always easy for several reasons. First, cost-related issues are resulting in an increasing number of these procedures being performed overseas. Thus, patients are often unsure about the exact product used. Compounding this is the fact that practitioners who perform these procedures are not forthright in divulging this information, given that improper substances may be admixed in the filler injected. Furthermore, cutaneous reactions may occur at sites distant from injected sites, secondary to migration of the filler substance and a lapse of months to years may occur prior to the development of a cutaneous reaction. Thus, a causal relationship between the procedure and the reaction is often not made. We present an overview of the histological features of adverse reactions to currently available soft tissue fillers, both in the United States and overseas, in an attempt to enhance awareness of the diversity of these reactions.

Incidental microscopic foci of nevic aggregates in skin.

Microscopic foci of nevic aggregates have been described in normal lymph nodes, where they may pose diagnostic challenges to pathologists. In the course of our practice, we have observed a similar phenomenon in cutaneous tissue. For this reason, we performed a retrospective study of cutaneous excisions over a 1-year period to better characterize this observation. We reviewed 2482 pathology reports of cutaneous excisions, of which 0.8% were associated with such microscopic foci of incidental nevic aggregates. Incidental nevic aggregates were typically dermal in nature and found commonly in excisions from the head and neck region. They were clinically unapparent, with a maximum mean horizontal and vertical diameter of 0.86 mm (0.3-1.5 mm) by 0.46 mm (0.1-1.3 mm). The nevic aggregates were separate and located in normal skin, away from any associated tumors or scar tissue. Although their etiology remains unknown, we hypothesize a derivation from dermal melanocytes, in keeping with the Hochsteigerung theory of nevogenesis. The purpose of this study is to draw attention to the existence of incidental cutaneous nevic aggregates, thereby alerting pathologists and dermatopathologists to their potential as a diagnostic pitfall, especially in the setting of concurrent primary cutaneous malignant melanoma or melanoma in situ.

Adams-Oliver syndrome with widespread CMTC and fatal pulmonary vascular disease.

We report a neonate with cutis marmorata telangiectatica congenita and clinical features of Adams-Oliver syndrome in association with severe pulmonary vascular disease. We provide an overview of cutis marmorata telangiectatica congenita, distinguishing it from cutis marmorata, a common and benign physiologic cutaneous disorder seen in neonates. We highlight the need for thorough medical evaluation in cutis marmorata telangiectatica congenita to exclude associated congenital anomalies.

Headache in a young woman: leptomeningeal metastasis as the first presentation of underlying breast malignancy.

A 37-year-old woman presented with a 2-week history of persistent headache in an occipitotemporal distribution. The patient had experienced prior headaches and migraines, but this presentation was characterised by its intensity and duration. There was associated dizziness and blurring of vision in episodes occurring up to 4-5 times per day. Whole body cross-sectional CT imaging and MRI of neuronal axes were normal. Cerebrospinal fluid cytology demonstrated large abnormal pleomorphic cells expressing the tumour marker CA125. Positron emission tomography-fluorodeoxyglucose revealed bilateral axillary and cervical lymphadenopathy as well as increased uptake in the lateral regions of both breasts. These results correlated with MRI breast and mammography findings. Axillary lymph node biopsy showed poorly differentiated adenocarcinoma making the diagnosis of breast malignancy, the most likely primary site of metastatic leptomeningeal disease. In the 6-week interval between initial presentation and diagnosis, the patient deteriorated significantly with the new onset of facial nerve palsy and partial seizures. The treatment intent was palliative, focusing on symptom control with systemic chemotherapy and whole brain radiotherapy.

Inflammation and coronary calcification in renal patients--factors that may explain increased cardiovascular risk, and poorer results of coronary interventions?

Cardiovascular disease (CVD) is one of the major causes of mortality in patients with renal diseases, with increased odds ratio of mortality with risk factors as diverse as cholesterol, vascular stiffness, chronic inflammation and hyperhomocysteinemia. Several factors have been incriminated to explain the increase in coronary vascular calcification (CVC) in this particular population. Increased duration of dialysis, dyslipidemia, altered calcium-phosphorus metabolism, and chronic inflammation have all been associated with increased CVC. We present here four case reports illustrating the differences in the pathophysiology, therapy and prognosis of calcific coronary heart disease seen in uremic patients.

Laser capture microdissection: methods and applications.

Laser microdissection is a nonmolecular, minimally disruptive method to obtain cytologically and/or phenotypically defined cells or groups of cells from heterogeneous tissues. It is a versatile technology and allows the preparation of homogenous isolates of specific subpopulations of cells from which RNA/DNA or protein can be extracted for RT-polymerase chain reaction (PCR), quantitative PCR, Western blot analyses, and mass spectrophotometry.

Benign cephalic histiocytosis in a British-African child.

A 14-month-old British-African child presented with an asymptomatic eruption localized to her face and upper limbs. At the age of 17 months the eruption had started to spontaneously regress. Histologic examination of a biopsy specimen from a papular lesion on the arm showed a histiocytic infiltrate in the superficial dermis. Immunohistochemical studies showed negative staining for the Langerhans cell markers, CD1a and S-100 protein, while staining for the macrophage/histiocytic markers, CD68 and factor XIIIa, were positive. The clinical and histologic features in this patient are consistent with the rare, non-Langerhans, histiocytic disorder known as benign cephalic histiocytosis. As far as we are aware, this represents the first published occurrence in a child of African origin, emphasizing the widespread nature of this condition.