Integrating skin color assessments into clinical practice and research: A review of current approaches.

Skin color classification can have importance in skin health, pigmentary disorders, and oncologic condition assessments. It is also critical for evaluating disease course and response to a variety of therapeutic interventions and aids in accurate classification of participants in clinical research studies. A panel of dermatologists conducted a literature review to assess the strengths and limitations of existing classification scales, as well as to compare their preferences and utilities. We identified 17 skin classification systems utilized in dermatologic settings. These systems include a range of parameters such as UV light reactivity, race, ethnicity, and degree of pigmentation. The Fitzpatrick skin type classification is most widely used and validated. However it has numerous limitations including its conflation with race, ethnicity, and skin color. There is a lack of validation data available for the remaining scales. There are significant deficiencies in current skin classification instruments. Consensus-based initiatives to drive the development of validated and reliable tools are critically needed.

Quality of Life in Patients with Acquired Dermal Macular Hyperpigmentation: A Systematic Review.

Acquired dermal macular hypergpigmentation (ADMH) encompasses conditions including lichen planus pigmentosus, erythema dyschromicum perstans, ashy dermatosis, Riehl's melanosis and pigmented contact dermatitis. This group of cosmetically distressing pigmentary disorders pose a therapeutic challenge, yet there have been no systematic reviews published that describe their quality of life (QOL) impact. An electronic database search of PubMed, EMBASE, PsycINFO and Cochrane library was performed in December 2022, to search for articles published from inception until 15/12/2022. Articles were included if they fulfilled the following criteria: (1) primary clinical publication; (2) reports QOL in patients with ADMH; and (3) available in full-text. Overall, the review highlighted a considerable gap in the literature concerning the impact of ADMH on QOL. Seven studies fulfilling the inclusion criteria were included, with a total of 259 patients. All seven studies reported an impaired QOL in patients with ADMH. The currently available literature on this topic indicate that ADMH has a significant adverse impact on QOL, likely to a greater degree than melasma, and to a similar or lesser degree than vitiligo. Five of seven studies reported the QOL impairment for patients with ADMH based on the Dermatology Life Quality Index (DLQI); these studies consistently found a mean DLQI score reflective of a moderate effect on patient's QOL. Clinicians must be aware of, and should seek to address the significant, yet often overlooked, psychosocial burden associated with ADMH when taking a holistic approach to management.

Dermoscopy in vitiligo, diagnostic clues and markers of disease activity: a review of the literature.

Dermoscopy is a noninvasive, efficient and inexpensive tool used to aid diagnosis of skin conditions such as vitiligo. Furthermore, it aids in tracking patient progress, treatment response and disease activity. Vitiligo can be diagnosed on dermoscopy by the presence of white structureless areas signifying hypopigmentation with a typical glowing appearance. Other typical features are perilesional and perifollicular hyperpigmentation, pigmentation networks and leucotrichia. In total, 15 studies were reviewed to determine the dermoscopic signs of the three main stages of disease activity: active, stable and repigmenting vitiligo. Features that differentiate active, stable and repigmenting vitiligo are reviewed and discussed in this article. Notably, there is a conflict in the literature between various dermoscopic features and which type of vitiligo they are truly indicative of. However, dermoscopy can be coupled with other clinical, biological and physiological markers to strengthen diagnostic accuracy.

Do siblings influence one another? Unpacking processes that occur during sibling conflict.

This study examined the extent to which 205 sibling dyads influenced each other during conflict. Data were collected between 2013 to 2015. The sample included 5.9% Black, 15.1% South Asian, 15.1% East Asian, and 63.8% White children. Older siblings were between 7-13 years old (Female = 109) and younger siblings were 5-9 years old (Female = 99). Siblings' conflict resolution was analyzed using dynamic structural equation modeling. Modeling fluctuations in moment-to-moment data (20-s intervals) allowed for a close approximation of causal influence. Older and younger siblings were found to influence one another. Younger sisters were more constructive than younger brothers, especially in sister-sister dyads. Sibling age gap predicted inertia in older siblings. Socialization processes within sibling relationships are discussed.

Review of dermoscopic features in hypopigmentary disorders.

Dermoscopy has seen increased utilisation in the diagnosis of hypopigmentary disorders. As a quick and effective adjunct to the clinician's toolbox, dermoscopy offers the opportunity to differentiate between hypopigmentary lesions that ostensibly present with clinically similar morphology on the macroscopic scale. The focus of this article is to review the various dermoscopic signs and patterns that have been elucidated for these disorders.

Atopic dermatitis in skin of colour. Part 2: considerations in clinical presentation and treatment options.

Recent advances in atopic dermatitis (AD) present the condition as a heterogeneous disease of distinct endotypes across ethnic groups. AD in people with skin of colour may appear psoriasiform, lichenoid, scaly or papular, with a violaceous colour and there is a higher prevalence of post-inflammatory dyspigmentation compared with affected individuals of White ethnicity. These differences in clinical presentation may limit the use of AD assessment tools in people with skin of colour, leading to the potential for misdiagnosis and underestimation of severity, particularly in relation to assessment of erythema. Recent targeted therapies for AD have been studied in multiple ethnic groups; however, ethnicity-based subgroup analysis is often not performed. Further research is required to understand whether treatment responses or safety may differ among ethnic groups.

Atopic dermatitis in skin of colour. Part 1: new discoveries in epidemiology and pathogenesis.

Atopic dermatitis (AD) is a global condition that has a rising prevalence in developing countries such as those within South-east Asia and Latin America. Recent research represents the condition as a heterogeneous disease of distinct endotypes among different ethnic groups. Variation between ethnic groups in physiological measures such as transepidermal water loss, ceramide/+, skin sensitivity, alongside pathological barrier and immune system dysfunction processes, may ultimately lead to the distinct phenotypes seen clinically. AD in patients of White ethnicities is typified by filaggrin dysfunction, more T helper (Th)1 and less Th17 involvement, with less epidermal thickness compared with patients of Black or Asian ethnicities. AD in patients of Black ethnic groups is Th2/Th22-skewed, with robust IgE expression, and less Th1 and Th17 involvement than patients of Asian or White ethnicities. AD across South Asian and East Asian populations is characterized by Th17/Th22 upregulation. Differences also exist in how AD psychosocially has an impact on individuals of different ethnic groups.

Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the international Vitiligo Task Force-Part 2: Specific treatment recommendations.

BACKGROUND: The treatment of vitiligo can be challenging. Up-to-date agreed consensus recommendations on the use of topical and systemic therapies to facilitate the clinical management of vitiligo are currently lacking. OBJECTIVES: To develop internationally agreed-upon expert-based recommendations for the treatment of vitiligo. METHODS: In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in different online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence for different topics included in the algorithms. A survey was then given to a core group of eight experts to resolve the remaining issues. Subsequently, the recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS: The recommendations provided summarize the latest evidence regarding the use of topical therapies (steroids, calcineurin inhibitors and Jak-inhibitors) and systemic therapies, including steroids and other systemic immunomodulating or antioxidant agents. The different modalities of phototherapies (NB-UVB, photochemotherapy, excimer devices and home phototherapy), which are often combined with other therapies, are also summarized. Interventional approaches as well as depigmentation strategies are presented for specific indications. Finally, the status of innovative and targeted therapies under development is discussed. CONCLUSIONS: This international consensus statement culminated in expert-based clinical practice recommendations for the treatment of vitiligo. The development of new therapies is ongoing in vitiligo, and this will likely improve the future management of vitiligo, a disease that still has many unmet needs.

Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the International Vitiligo Task Force Part 1: towards a new management algorithm.

BACKGROUND: The treatment of vitiligo can be challenging and depends on several factors such as the subtype, disease activity, vitiligo extent, and treatment goals. Vitiligo usually requires a long-term approach. To improve the management of vitiligo worldwide, a clear and up-to-date guide based on international consensus with uniform stepwise recommendations is needed. OBJECTIVES: To reach an international consensus on the nomenclature and to develop a management algorithm for the diagnosis, assessment, and treatment of vitiligo. METHODS: In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence of topics included in the algorithms. A survey was utilized to resolve remaining issues among a core group of eight experts. Subsequently, the unanimous recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS: The algorithms highlight the importance of shared decision-making. Dermatologists are encouraged to provide patients with detailed explanations of the prognosis and expected therapeutic outcomes based on clinical examination. The treatment goal should be discussed and clearly emphasized to patients given the different approaches for disease stabilization and repigmentation. The evaluation of disease activity remains a cornerstone in the tailor-made approach to vitiligo patients. CONCLUSIONS: These new treatment algorithms are intended to guide clinical decision-making in clinical practice. Promising novel therapies for vitiligo are on the horizon, further highlighting the need for reliable outcome measurement instruments and greater emphasis on shared decision-making.

Best practices are never best: Evaluating primate conservation education programs (PCEPs) with a decolonial perspective.

Who do we aim to educate with primate conservation education programs (PCEPs)? In a commentary published in a recent AJP, Annette Lanjouw suggested that many efforts to "educate" habitat-country communities can be neocolonial in their approaches. Forest destruction and habitat loss are a result of global consumption and expansion. We therefore need to approach conservation education from many angles including local stakeholders, policy makers, government officials, and the humans living in industrialized nations who are major consumers of the items that shrink primate habitats. In this review, we investigate PCEPs to determine if the conservation education goals, education methods, and assessment processes are proceeding within a neocolonial context. We reviewed the last 20 years of primate conservation literature and looked for publications that were focused on education programs. We found that in 50 of 52 publications published between 2001 and 2021, the education programs take place in habitat-country local communities. We also reviewed primate field researcher and field site websites, and in most cases, education programs were also focused on educating local communities living near or in nonhuman primate habitats. Exceptions were student clubs, zoo programs, and a high school outreach program. Many PCEP providers presented a list of "lessons learned" and we compiled their wisdom in combination with our experience to provide a framework for moving forward. We conclude that as conservation primatologists, we must think beyond our field sites to create opportunities for educational outreach. We can reach global consumers by linking to zoos, television/motion picture, print media, social media, and working with schools on curricula. Primatologists can engage our undergraduates to establish clubs and create meaningful assignments that reach beyond the classroom. We encourage primatologists from the Global North to consider their positionality and the history of conservation exclusion in their attempts to conserve primates.

A cross-sectional study of pediatric dermatoses in a specialized pigment and skin-of-color center in Australia.

There is a paucity of literature on pediatric skin conditions in skin of color, of which old epidemiological data are likely to become outdated as the ethnic diversity in developed countries such as Australia continues to grow. We analyzed the prevalence of presenting conditions of pediatric patients with skin of color attending an urban dermatology clinic in Melbourne, Australia over an 18-month period. The major presenting issues were vitiligo, atopic dermatitis, and acne vulgaris, the majority of which did not significantly differ by ethnicity; however, there was a statistically significantly higher proportion of Chinese and Indian patients presenting with atopic dermatitis. Given the varying presentations of these conditions in skin of color, our findings highlight the importance of increasing education for dermatologists and health personnel in pigmentary disorders and the need for further focused studies comparing the prevalence of skin disease across ethnicities.

Do Mothers or Children Lead the Dance? Disentangling Individual and Influence Effects During Conflict.

Are mother-child conflict discussions shaped by time-varying, reciprocal influences, even after accounting for stable contributions from each individual? Mothers were filmed discussing a conflict for 5 min, separately with their younger (ages 5-9, N = 217) and older (ages 7-13, N = 220) children. Each person's conflict constructiveness was coded in 20-s intervals and data were analyzed using dynamic structural equation modeling, which separates individual and influence effects. Children influenced their mothers' behavior under certain conditions, with evidence for developmental differences in the magnitude and direction of influence, whereas mothers did not influence their children under any circumstance. Results are discussed in the context of child effects on parent behavior and changes in parenting across middle childhood.

Paternal Sensitivity and Children's Cognitive and Socioemotional Outcomes: A Meta-Analytic Review.

In a series of meta-analyses, paternal sensitivity was associated with children's (age range: 7 months-9 years) overall cognitive functioning (N = 3,193; k = 23; r = .19), including language skills (k = 9; r = .21), cognitive ability (k = 9; r = .18), and executive function (k = 8; r = .19). Paternal sensitivity was not associated with children's overall socioemotional functioning (N = 2,924; k = 24; r = -.03) or internalizing problems, but it was associated with children's emotion regulation (k = 7; r = .22) and externalizing problems (k = 19; r = -.08). In the broad cognitive functioning, executive function, broad socioemotional functioning, and externalizing problems meta-analyses, child age was a significant moderator.

Effect of oral tranexamic acid on erythema index in patients with melasma.

Melasma is a common disorder of hyperpigmentation that presents a therapeutic challenge for clinical dermatologists. The pathogenesis is complex, but previous studies have demonstrated vascular proliferation is a key factor in the development of the classic hyperpigmented patches. Studies have revealed reduction of erythema by oral tranexamic acid; however, there has been no direct comparison to placebo. This 24-week randomised placebo-controlled trial demonstrates oral tranexamic acid may improve erythema in melasma. This mechanism of action may be the reason for the success of tranexamic acid in complex and difficult to treat melasma.

Evaluation of the efficacy of cysteamine cream compared to hydroquinone in the treatment of melasma: A randomised, double-blinded trial.

BACKGROUND/OBJECTIVE: Melasma is a commonly acquired disorder of hyperpigmentation that often poses a therapeutic challenge for dermatologists. Recently, cysteamine cream has shown promising results compared to placebo. This study aims to determine the efficacy of cysteamine cream compared to hydroquinone cream in the treatment of melasma. METHODS: A randomised, double-blinded, single-centre trial was conducted in Victoria, Australia. 20 recruited participants were given either cysteamine cream or hydroquinone cream for 16 weeks. The primary outcome measure was a change in the modified Melasma Area and Severity Index (mMASI). Quality of life at baseline and week 16 as well as standard digital photography at each follow-up visit was assessed as secondary outcome measures. RESULTS: At week 16, 14 participants completed the study with 5 participants in the cysteamine group and 9 patients in the hydroquinone group. In the intention to treat analysis, there was a 1.52 ± 0.69 (21.3%) reduction in mMASI for the cysteamine group and a 2.96 ± 1.15 (32%) reduction in the hydroquinone group. The difference between groups was not statistically significant (P = 0.3). Hydroquinone cream was generally better tolerated that cysteamine cream. CONCLUSION: Our study suggests that topical cysteamine may have comparable efficacy to topical hydroquinone. Cysteamine thus provides a possible alternative to patients and clinicians who wish to avoid or rotate off topical hydroquinone. While side effects were more common for participants using cysteamine compared with hydroquinone, these were mild and reversible. Larger studies comparing cysteamine and hydroquinone are required to support these findings.

What are friends for? The impact of friendship on communicative efficiency and cortisol response during collaborative problem solving among younger and older women.

Conversation is a skilled activity that depends on cognitive and social processes, both of which develop through adulthood. We examined the effects of age and partner familiarity on communicative efficiency and cortisol reactivity. Younger and older women interacted with familiar or unfamiliar partners in a dyadic collaborative conversation task (N = 8 in each group). Regardless of age, referential expressions among familiar and unfamiliar partners became more efficient over time, and cortisol concentrations were lower for speakers interacting with familiar partners. These findings suggest that communicative effectiveness is largely preserved with age, as is the stress-buffering effect of a familiar partner.

Network analysis as a tool to understand social development in spider monkeys.

The emerging field of network science has demonstrated that an individual's connectedness within their social network has cascading effects to other dimensions of life. Like humans, spider monkeys live in societies with high fission-fusion dynamics, and are remarkably social. Social network analysis (SNA) is a powerful tool for quantifying connections that may vary as a function of initiating or receiving social behaviors, which has been described as shifting social roles. In primatology, the SNA literature is dominated by work in catarrhines, and has yet to be applied to the study of development in a platyrrhine model. Here, SNA was utilized in combination with R-Index social role calculation to characterize social interaction patterns in juvenile and adult Colombian spider monkeys (Ateles fusciceps rufiventris). Connections were examined across five behaviors: embrace, face-embrace, grooming, agonism, and tail-wrapping from 186 hr of observation and four network metrics. Mann-Whitney U tests were utilized to determine differences between adult and juvenile social network patterns for each behavior. Face-embrace emerged as the behavior with different network patterns for adults and juveniles for every network metric. With regard to social role, juveniles were receivers, not initiators, for embrace, face-embrace, and grooming (ps < .05). Network and social role differences are discussed in light of social development and aspects of the different behaviors.

From maternal tending to adolescent befriending: The adolescent transition of social support.

Attachment theory holds that parental relationships have lifelong effects on offspring social lives. The tend-and-befriend hypothesis posits that female friendships among humans evolved as part of a primate-wide coping mechanism to mediate stress by relying on social support. Here we bridge developmental and evolutionary frameworks to examine adolescent girls' perception of their reliance on female friendship for social support, how perceptions of parental relationships affect peer relationships, and the extent to which parent and peer relationships buffer depressive symptoms. We predict perceived maternal relationship quality will be positively associated with close female friendships, and maternal relationships, paternal relationships, and female friendship will buffer depressive symptoms. Participants were adolescent girls from a summer science camp (N = 95). Participants filled out demographic information, social network surveys, the Parent-Adolescent Communication Scale, and the Center for Epidemiology Depression Scale. Data was analyzed with Pearson's correlations, t tests, and path analysis. Adolescent girls with few female friends, compared with girls who had more than two very close female friends, experienced more depressive symptoms (t = 3.382, p = .001, D = 0.784). Adolescent girls with few female friends experienced more depressive symptoms compared to girls with two or more very close female friends (t = 3.382, p = .001, D = 0.784). Stronger maternal and paternal relationships were associated with having more female friends (maternal: t = -3.213, p = .003, D = 0.837; paternal: t = -2.432; p = .017). In the path analysis model, only maternal relationship quality significantly predicted female friendship category (ß = .33, CR = 2.770, p < .006). Furthermore, participants with two or more very close female friends and higher paternal relationship quality had significantly fewer depressive symptoms (friends; ß = -.19, CR = -2.112, p = .035; paternal: ß = -.33, CR = -3.220, p < .001), and older participants had more depressive symptoms (ß = .17, CR = -1.931, p = .036). These results provide additional support for the tend-and-befriend hypothesis, suggesting that maternal tending sets the stage for close female friendships.

Design and Development of Magnetostrictive Actuators and Sensors for Structural Health Monitoring.

Carbon Fibre Reinforced Polymer composite (CFRP) is widely used in the aerospace industry, but is prone to delamination, which is a major causes of failure. Structural Health Monitoring (SHM) systems need to be developed to determine the damage occurring within it. Our motivation is to design cost-effective new sensors and a data acquisition system for magnetostrictive structural health monitoring of aerospace composites using a simple RLC circuit. The developed system is tested on magnetostrictive FeSiB and CoSiB actuator ribbons using a bending rig. Our results show detectable sensitivity of inductors as low as 0.6 µH for a bending rig radii between 600 to 300 mm (equivalent to 0.8 to 1.7 mStrain), which show a strain sensitivity resolution of 0.01 µStrain (surface area: ~36 mm2). This value is at the detectability limit of our fabricated system. The best resolution (1.86 µStrain) was obtained from a 70-turn copper (~64 µH) wire inductor (surface area: ~400 mm2) that was paired with a FeSiB actuator.

The A allele of the UCP2 -866G/A polymorphism changes UCP2 promoter activity in HUVECs treated with high glucose.

The mitochondrial uncoupling protein 2 (UCP2) decreases reactive oxygen species (ROS) formation by mitochondria. Our group previously showed that the UCP2 -866A allele was associated with risk of diabetic retinopathy (DR), which is caused by hyperglycemia-induced oxidative stress. To date, it is still unclear if the -866A allele directly affects UCP2 expression in endothelial cells. Thus, we investigated the effect of the A allele on UCP2 promoter activity in HUVECs treated with high glucose (HG) or hydrogen peroxide (H2O2). To quantify UCP2 promoter activity, HUVECs were transfected with pGL3 plasmids containing the UCP2 promoter and the firefly luciferase coding sequence. Experimental groups were: (1) pGL3-866G-transfected cells and (2) pGL3-866A cells, both under normal (4 mM) or HG (25 mM) concentrations for 24 h and 48 h or incubated with H2O2 (0.1 mM) for 1 h. UCP2 promoter activity was monitored by Luminescent Dual-luciferase Assay. HG induced an upregulation of UCP2 promoter activity in PGL3-866G cells after 24 h of treatment (P = 0.027), but not after 48 h. Compared to pGL3-866G cells, pGL3-866A cells seems to have reduced UCP2 promoter activity following 24 h and 48 h of normal glucose treatment (P = 0.087 and P = 0.022). After HG treatment, pGL3-866A cells had more marked UCP2 downregulation (24 h: - 3.2-folds, P < 0.001; and 48 h: - 2.5-folds, P < 0.001 vs. G cells). Both pGL3-866G and pGL3-866A cells treated with H2O2 showed a ≅ 4-fold increase in UCP2 promoter activity (both P < 0.001). The -866A allele modifies UCP2 promoter activity in HUVECs under HG treatment but not in the H2O2 condition.