Review of treatments for pseudofolliculitis barbae.

Pseudofolliculitis barbae (PFB) is a chronic inflammatory condition characterized by follicular and perifollicular papules and pustules primarily affecting the beard and neck area. PFB is a condition that predominantly affects patients with skin of colour. The objective of this paper is to review the epidemiology, pathogenesis and presentation of PFB, and assess the most recent evidence-based treatment options and recommendations for PFB. This is important to increase the quality of care given to target patient populations and to address the prominent disparity in healthcare management of patients with skin of colour. A literature review was conducted utilizing PubMed and Cochrane Library. The key term 'pseudofolliculitis barbae' was used. Search parameters were set to search from 1987 to the present. Results were further narrowed by limiting the literature review to published observational studies, case studies, case series, randomized control trials and case-control studies. Effective treatment for PFB requires a multifaceted approach that targets various aspects of the pathogenesis. Current treatments include preventive measures, antibiotics, corticosteroids, keratolytics, chemical depilatories and/or laser treatments. Topical therapies are currently the mainstay treatment. However, laser hair removal has become a potential long-term treatment option, and additional studies are warranted to understand its long-term efficacy and permanency.

Ethnic Equity Implications in the Management of Pseudofolliculitis Barbae.

One major issue facing the health care system in the United States is the disparity in health care management of diseases that affect minority patient populations. Pseudofolliculitis barbae (PFB) is very common in Black men. It presents as skin-colored to erythematous, follicular or perifollicular papules and pustules predominantly on the neck and chin. The most definitive treatment for PFB is cessation of close shaving. However, many Black men are forced to comply with "clean-shaven" policies in the workforce. For those who are able to obtain medical waivers, there is significant time and costs associated with this, especially if they must wait to receive this waiver from a dermatologist. If primary care providers are able to identify the disease and spread awareness of its legitimacy, it may be easier for patients to receive the necessary waivers and may encourage employers to reflect on the ethnic equity of this practice. Our professional support can help reduce stigma and lead to improvements in the physical and psychological health of this historically mistreated population.

Prospective Longitudinal Assessment of Health-related Quality of Life in Patients With Brain Metastases Undergoing Radiation Therapy.

OBJECTIVE: We conducted a prospective clinical trial of patients receiving radiation (RT) for brain metastases to identify clinical predictors of pre-RT and post-RT health-related quality of life (hrQoL). MATERIALS AND METHODS: Patients with brain metastases completed overall (European Organisation for Research and Treatment of Cancer QLQ C15-PAL) and brain tumor-specific (QLQ-BN20) hrQoL assessments pre-RT (n=127) and 1 (n=56) and 3 (n=45) months post-RT. Linear and proportional-odds models analyzed patient, disease, and treatment predictors of baseline, 1-, and 3-month hrQoL scores. Generalized estimating equations and repeated measures proportional-odds models assessed predictors of longitudinal hrQoL scores. RESULTS: Most patients underwent stereotactic radiosurgery (SRS) (69.3%) and had non-small-cell lung (36.0%) metastases. Compared with SRS, receipt of whole brain RT was associated with a higher odds of appetite loss (baseline P=0.04, 1 mo P=0.02) and greater motor dysfunction (baseline P=0.01, 1 mo P=0.003, 3 mo P=0.02). Receipt of systemic therapy was associated with better emotional functioning after RT (1 mo P=0.03, 3 mo P=0.01). Compared with patients with breast cancer, patients with melanoma had higher odds of better global hrQoL (P=0.01) and less pain (P=0.048), while patients with lung cancer reported lower physical function (P=0.048) 3 months post-RT. Nonmarried patients had greater odds of higher global hrQoL (1 mo P=0.01), while male patients had lower odds of reporting more hair loss (baseline P=0.03, 3 mo P=0.045). Patients 60 years and above had lower odds of more drowsiness (P=0.04) and pain (P=0.049) over time. CONCLUSIONS: Patients receiving SRS versus whole brain RT and systemic therapy reported better posttreatment hrQoL. In addition, melanoma metastases, nonmarried, male, and older patients with reported better hrQoL in various as well as domains after intracranial RT.

Art in Medical Education: A Review.

BACKGROUND: The use of fine art in medical education has a long history. Numerous studies have investigated the potential benefits of incorporating art in medical education; however, there are gaps in knowledge regarding the efficacy, methodology, and clinical significance of these studies. OBJECTIVE: This scoping review of the literature aims to describe the available literature on the incorporation of art education in medical school and residency. METHODS: PubMed, Google Scholar, and MedEDPortal were queried from their inception dates through December 2019. English-language studies providing a detailed methodology and detailed analysis were included. A total of 37 studies were identified. Upon further screening of the studies' methodologies and results, 16 studies describing art education implemented with medical students and 12 studies describing art education implemented with residents were included for final review. RESULTS: Various methods of art education exist, including Visual Thinking Strategies (VTS), rigorous curricula, and unstructured roundtable discussions with art curators or artistically minded clinicians. Studies range in duration, art media, and type of analysis. CONCLUSIONS: There has been an increasing effort to incorporate fine art education into medical training, primarily to enhance visual perception skills and empathy. Although there is limited research on its efficacy, and wide variations in study methodologies exist, results consistently indicate that participants find the incorporation of art into curricula beneficial. Further research analyzing which methodologies are most likely to yield statistically and clinically significant improvements in visual perception and empathy may lead to increased utilization of this teaching method.

Radiation Dose-Dependent Hippocampal Atrophy Detected With Longitudinal Volumetric Magnetic Resonance Imaging.

PURPOSE: After radiation therapy (RT) to the brain, patients often experience memory impairment, which may be partially mediated by damage to the hippocampus. Hippocampal sparing in RT planning is the subject of recent and ongoing clinical trials. Calculating appropriate hippocampal dose constraints would be improved by efficient in vivo measurements of hippocampal damage. In this study we sought to determine whether brain RT was associated with dose-dependent hippocampal atrophy. METHODS AND MATERIALS: Hippocampal volume was measured with magnetic resonance imaging (MRI) in 52 patients who underwent fractionated, partial brain RT for primary brain tumors. Study patients had high-resolution, 3-dimensional volumetric MRI before and 1 year after RT. Images were processed using software with clearance from the US Food and Drug Administration and Conformité Européene marking for automated measurement of hippocampal volume. Automated results were inspected visually for accuracy. Tumor and surgical changes were censored. Mean hippocampal dose was tested for correlation with hippocampal atrophy 1 year after RT. Average hippocampal volume change was also calculated for hippocampi receiving high (>40 Gy) or low (<10 Gy) mean RT dose. A multivariate analysis was conducted with linear mixed-effects modeling to evaluate other potential predictors of hippocampal volume change, including patient (random effect), age, hemisphere, sex, seizure history, and baseline volume. Statistical significance was evaluated at α = 0.05. RESULTS: Mean hippocampal dose was significantly correlated with hippocampal volume loss (r=-0.24, P=.03). Mean hippocampal volume was significantly reduced 1 year after high-dose RT (mean -6%, P=.009) but not after low-dose RT. In multivariate analysis, both RT dose and patient age were significant predictors of hippocampal atrophy (P<.01). CONCLUSIONS: The hippocampus demonstrates radiation dose-dependent atrophy after treatment for brain tumors. Quantitative MRI is a noninvasive imaging technique capable of measuring radiation effects on intracranial structures. This technique could be investigated as a potential biomarker for development of reliable dose constraints for improved cognitive outcomes.