Predicting the evolution of clinical skin aging in a multi-ethnic population: Developing causal Bayesian networks using dermatological expertise.

INTRODUCTION: Software to predict the impact of aging on physical appearance is increasingly popular. But it does not consider the complex interplay of factors that contribute to skin aging. OBJECTIVES: To predict the +15-year progression of clinical signs of skin aging by developing Causal Bayesian Belief Networks (CBBNs) using expert knowledge from dermatologists. MATERIAL AND METHODS: Structures and conditional probability distributions were elicited worldwide from dermatologists with experience of at least 15 years in aesthetics. CBBN models were built for all phototypes and for ages ranging from 18 to 65 years, focusing on wrinkles, pigmentary heterogeneity and facial ptosis. Models were also evaluated by a group of independent dermatologists ensuring the quality of prediction of the cumulative effects of extrinsic and intrinsic skin aging factors, especially the distribution of scores for clinical signs 15 years after the initial assessment. RESULTS: For easiness, only models on African skins are presented in this paper. The forehead wrinkle evolution model has been detailed. Specific atlas and extrinsic factors of facial aging were used for this skin type. But the prediction method has been validated for all phototypes, and for all clinical signs of facial aging. CONCLUSION: This method proposes a skin aging model that predicts the aging process for each clinical sign, considering endogenous and exogenous factors. It simulates aging curves according to lifestyle. It can be used as a preventive tool and could be coupled with a generative AI algorithm to visualize aging and, potentially, other skin conditions, using appropriate images.

Analysis of Three Species of Cassipourea Traditionally Used for Hypermelanosis in Selected Provinces in South Africa.

There is a growing demand and use of herbal cosmetics for skin purposes due to their perceived safety when applied to the skin. Three Cassipourea species commonly known as "ummemezi" are used interchangeably by women in rural areas of Eastern Cape and KwaZulu-Natal provinces to treat hypermelanosis as well as sun protection. We conducted a phytochemical comparison of three Cassipourea species; Cassipourea flanaganii (Schinz) Alston, Cassipourea gummiflua Tul. verticillata (N.E.Br.) J. Lewis and Cassipourea malosana (Baker) Alston by Liquid Chromatography-Mass Spectrometry (LC-MS/MS) analysis in negative mode. The results obtained from the LC-MS/MS yielded a total number of twenty-four compounds of different chemical classes, including fatty acids, steroids, di- and tri-terpenoids, flavonoids, phenolic acids, and eighteen among them were tentatively identified. The LC-MS /MS analysis showed that the three studied Cassipourea extracts contain compounds that have anti-tyrosinase activity and consequently. The presence of these compounds, either in synergy or individually, can be attributed to the anti-tyrosinase effect. Although the traditional names of the species are used interchangeably, they are different, however, they possess similar skin-lightening properties. Despite the recent popularity of modern cosmetic products, plants continue to play an important role in the local cosmetics industry in South Africa's Eastern Cape and KwaZulu-Natal community provinces.

Variant PADI3 in Central Centrifugal Cicatricial Alopecia.

BACKGROUND: Central centrifugal cicatricial alopecia (CCCA) is the most common form of scarring alopecia among women of African ancestry. The disease is occasionally observed to affect women in families in a manner that suggests an autosomal dominant trait and usually manifests clinically after intense hair grooming. We sought to determine whether there exists a genetic basis of CCCA and, if so, what it is. METHODS: We used exome sequencing in a group of women with alopecia (discovery set), compared the results with those in a public repository, and applied other filtering criteria to identify candidate genes. We then performed direct sequencing to identify disease-associated DNA variations and RNA sequencing, protein modeling, immunofluorescence staining, immunoblotting, and an enzymatic assay to evaluate the consequences of potential etiologic mutations. We used a replication set that consisted of women with CCCA to confirm the data obtained with the discovery set. RESULTS: In the discovery set, which included 16 patients, we identified one splice site and three heterozygous missense mutations in PADI3 in 5 patients (31%). (The approximate prevalence of the disease is up to 5.6%.) PADI3 encodes peptidyl arginine deiminase, type III (PADI3), an enzyme that post-translationally modifies other proteins that are essential to hair-shaft formation. All three CCCA-associated missense mutations in PADI3 affect highly conserved residues and are predicted to be pathogenic; protein modeling suggests that they result in protein misfolding. These mutations were found to result in reduced PADI3 expression, abnormal intracellular localization of the protein, and decreased enzymatic activity - findings that support their pathogenicity. Immunofluorescence staining showed decreased expression of PADI3 in biopsy samples of scalp skin obtained from patients with CCCA. We then directly sequenced PADI3 in an additional 42 patients (replication set) and observed genetic variants in 9 of them. A post hoc analysis of the combined data sets showed that the prevalence of PADI3 mutation was higher among patients with CCCA than in a control cohort of women of African ancestry (P = 0.002 by the chi-square test; P = 0.006 by Fisher's exact test; and after adjustment for relatedness of persons, P = 0.03 and P = 0.04, respectively). CONCLUSIONS: Mutations in PADI3, which encodes a protein that is essential to proper hair-shaft formation, were associated with CCCA. (Funded by the Ram Family Foundation and others.).

The Feasibility of an Interdisciplinary Approach on the Management of Psoriasis in South Africa.

CONTEXT: Psoriasis is an immune-mediated, inflammatory skin disease associated with comorbidities such as psoriatic arthritis, depression, obesity, and cardiovascular disease. Due to its visibility, psoriasis can induce stress and have a negative impact on a patient's quality of life. Current medical interventions are often ineffective and costly and are associated with undesirable side effects, thus emphasizing the need for innovative approaches to treatment. OBJECTIVE: The study intended to explore the feasibility of an interdisciplinary approach between dermatologists and somatologists in the holistic management of psoriasis. DESIGN: The research team performed a narrative review by searching for scientific articles in the databases Google Scholar, Scopus, PubMed, and Medline, including relevant observational studies, systematic reviews, randomized controlled trials, and meta-analyses on the diagnosis and management of psoriasis. SETTING: The review took place at Durban University of Technology library, Durban, South Africa. RESULTS: Psoriasis is a huge medical burden. It has a negative psychological impact on quality of life. Patients are not satisfied with the current treatment approach and they prefer alternative therapies. Spa therapy could be used in conjunction with medical therapy for the management of psoriasis. Through water or spa therapy, it has been shown that trace elements in mineral waters are absorbed through the skin and perhaps modulate the immune system. CONCLUSIONS: The current review has provided some practical advice on how to manage psoriasis in a holistic manner. Somatology training institutions should consider incorporating Pso Well training in their program, thereby keeping abreast of new developments associated with psoriasis management. MBCT could be added to the set of holistic interventions for patients suffering from psoriasis, particularly those who suffer from poor psychological well-being. Robust clinical tests should be performed to evaluate the effectiveness of treatments, such as integrative patient management between the two professions.

Synthetic hair extensions causing irritant contact dermatitis in patients with a history of atopy: A report of 10 cases.

BACKGROUND: We present a case series of 10, atopic, African women who developed irritant contact dermatitis (ICD) from synthetic hair extensions. METHODS: Ten consecutive African female patients who presented with a pruritic cutaneous eruption on the neck over a period of 2 years are described. Patients underwent skin patch testing using both standard and hair commercial patch test panels and samples of their own hair extensions. Hair care products were not tested. RESULTS: All 10 patients used synthetic hair extensions. A strong history of atopy was documented for all the patients and examination was significant for eczematous, lichenified plaques at the location of contact with the free end of the hair extension. Patch test results yielded no relevant reactivity and a diagnosis of ICD was made for all patients. The lesions resolved completely on removal of the hair extensions and the use of topical steroids and emollients, dependent on eczema severity. CONCLUSIONS: Artificial hair extensions should be considered as a potential irritant, resulting in ICD. Patients with a history of atopy are at risk of developing ICD from synthetic hair extensions.

Corticosteroid wraps as monotherapy in a child with extensive idiopathic pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis that may present with limited to severe disease, posing a therapeutic challenge. A 7-year-old African female who presented with extensive PG showed a remarkable response to corticosteroid wrap monotherapy.

Effective reduction of post-inflammatory hyperpigmentation with the tyrosinase inhibitor isobutylamido-thiazolyl-resorcinol (Thiamidol).

OBJECTIVE: Post-inflammatory hyperpigmentation (PIH) is a major cosmetic concern especially in individuals with darker skin complexion. Unfortunately, treatment with anti-inflammatory ingredients alone does not prevent the development of hyperpigmented spots. Recently, isobutylamido-thiazolyl-resorcinol (Thiamidol) was described as a very potent inhibitor of human tyrosinase. The objective of this research was to investigate the potential of this compound to prevent PIH induced by epidermal wounding (suction blister) and related to acne. METHODS: Suction blister-induced PIH was treated with a formulation containing Thiamidol or a vehicle for 3 months, and the changes in hyperpigmentation were monitored by spectroscopic measurements. The effect of skin care formulations containing Thiamidol on acne-related PIH was investigated in two studies, a vehicle-controlled, double-blinded, randomized clinical study and a clinical observational study. Both studies had a duration of 3 months and included assessments such as clinical photography, clinical grading and melanin index measurements. RESULTS: Already after 2 weeks of treatment, suction blister sites treated with Thiamidol were significantly lighter than control sites and improved throughout the treatment period. Subjects´ self-grading demonstrated that Thiamidol significantly improved the visibility of acne-induced hyperpigmentation compared to the vehicle treatment. A skin care regimen with Thiamidol significantly improved acne-related PIH over 12 weeks shown by Mexameter measurements, expert grading, self-grading and clinical photography. CONCLUSION: Thiamidol represents a safe and effective ingredient for cosmetic products against post-inflammatory hyperpigmentation.

OBJECTIF: L'hyperpigmentation post-inflammatoire (Post-Inflammatory Hyperpigmentation, PIH) est une préoccupation d'ordre esthétique majeure, en particulier chez les personnes dont le teint est plus foncé. Malheureusement, un traitement par des ingrédients anti-inflammatoires seuls n'empêche pas le développement de taches hyperpigmentées. Récemment, l'isobutylamido-thiazolyl-résorcinol (Thiamidol) a été décrit comme un inhibiteur très puissant de la tyrosinase humaine. L'objectif de cette investigation était d'étudier le potentiel de ce composé pour prévenir la PIH induite par une plaie épidermique (bulle de succion) et liée à l'acné. MÉTHODES: La PIH induite par la bulle de succion a été traitée avec une formulation contenant du Thiamidol ou un véhicule pendant 3 mois et les changements dans l'hyperpigmentation ont été surveillés par le biais de mesures spectroscopiques. L'effet des formulations pour soins de la peau contenant du Thiamidol visant à traiter la PIH liée à l'acné a été étudié au cours de deux études : une étude clinique randomisée, en double aveugle, contrôlée par véhicule et une étude clinique observationnelle. Les deux études avaient une durée de 3 mois et comportaient des évaluations telles que la photographie médicale, l'évaluation par les médecins et les mesures de l'indice de mélanine. RÉSULTATS: Après 2 semaines de traitement seulement, les sites de bulles de succion traités par du Thiamidol étaient significativement plus clairs que les sites-témoins et avaient montré une amélioration tout au long de la période de traitement. L'auto-évaluation des sujets a démontré que le Thiamidol améliorait significativement la visibilité de l'hyperpigmentation induite par l'acné par rapport au traitement par véhicule. Un programme de soins de la peau contenant du Thiamidol a significativement amélioré la PIH liée à l'acné sur 12 semaines, comme l'ont démontré les mesures de Mexameter, l'évaluation par des experts, l'auto-évaluation des sujets et la photographie médicale. CONCLUSION: Le Thiamidol représente un ingrédient sûr et efficace pour les produits cosmétiques contre l'hyperpigmentation post-inflammatoire.

Seborrheic Dermatitis in Skin of Color: Clinical Considerations

Seborrheic dermatitis is a common, relapsing, inflammatory skin condition of unclear etiology. The Malassezia yeast genus are believed to play a role. Seborrheic dermatitis commonly affects areas of the skin with high sebum production, including the scalp, nasolabial folds, glabella, eyebrows, beard, ears, retroauricular skin, sternum, and other skin folds. Seborrheic dermatitis may present differently in individuals with skin of color. Darker-skinned individuals may present with scaly, hypopigmented macules and patches in typical areas of involvement. Arcuate or petal-like patches may be seen, specifically termed petaloid seborrheic dermatitis. Children of color often do not experience the classic "cradle cap" appearance of seborrheic dermatitis, and have erythema, flaking, and hypopigmentation of the affected areas and folds of skin. Seborrheic dermatitis tends to respond well to conventional treatments, although it tends to recur. Skin of color patients may require a modified treatment approach which takes into account differences in hair texture and hair washing frequency. This paper aims to highlight these differences to help reduce disparities in the management of seborrheic dermatitis in patients of color. J Drugs Dermatol. 2019;18(1):24-27.

Colourism: a global adolescent health concern.

PURPOSE OF REVIEW: Colourism, a form of prejudice and discrimination based solely upon skin colour, stands to jeopardize the physical health, wellbeing and life chances of adolescents of colour, globally. RECENT FINDINGS: Research shows that adolescents can experience colourism at school and college, in the criminal justice system, at work and in the media they consume. It is therefore unsurprising that adolescents of colour often express a desire for lighter skin tones and/or are dissatisfied with their skin tone. Although research is scarce, some studies include older adolescents in their samples of skin-lightening product users. This is significant as the evidence is clear that the unmonitored use of skin-lightening products can be harmful to physical and psychological health, with evidence linking skin-lightening use to skin damage, kidney failure and depression. SUMMARY: Although it is evident that colourism is central to the lives of adolescents of colour, more research is needed concerning the use of skin-lightening products among adolescents. Media literacy and critical race theory offer avenues in helping attenuate the harmful impact of colourism for adolescents of colour.

Epidermal barrier function in healthy black South African infants compared with adults.

A cross-sectional observational study of 43 infants and 60 adult women was performed in South Africa to assess skin barrier (SB) function through noninvasive quantification of transepidermal water loss (TEWL) and skin surface hydration (SSH). TEWL and SSH improved with age and in anatomic locations with chronic environmental exposure in keeping with reported trends in other ethnicities.

Central Centrifugal Cicatricial Alopecia: New Insights and a Call for Action.

Central centrifugal cicatricial alopecia (CCCA) is a common and progressive form of lymphocyte predominant scarring alopecia which impacts negatively on the quality of life of those affected. It is seen more commonly in women of African descent with prevalence ranging from 2.7% to 5.7%. Current postulates include genetic inheritance, with traction inducing hairstyling practices and hair chemicals as aggravating factors. Histology reveals a perifollicular lymphocytic inflammation of the lower infundibulum, premature desquamation of the inner root sheath, and fibrous connective tissue. Treatment remains challenging and is directed at suppressing and preventing the inflammation, thus aborting scarring, with surgical intervention reserved for those who have stable disease or absence of histological inflammation. Future research with more patient numbers, focusing on the genetics of CCCA may prove useful in order to fully understand the etiology, thus providing more effective treatments for CCCA.

Central Centrifugal Cicatricial Alopecia in Children: A Case Series and Review of the Literature.

BACKGROUND/OBJECTIVES: Central centrifugal cicatricial alopecia (CCCA) is a form of scarring hair loss most commonly seen in middle-aged African and African American women. It is rarely reported in children. The objective of the current study was to document the presence of CCCA in children and to encourage physicians to recognize early signs of CCCA in children of affected adults. METHODS: Six children presented with biopsy-proven CCCA to the Department of Dermatology at Wake Forest Baptist Health and the Nelson R. Mandela School of Medicine from 2012 to 2015. Demographic characteristics, hair styling history, and family history of CCCA were noted. Examination included complete history, skin and scalp examination, photographs of the scalp, and scalp biopsies. RESULTS: Patient ages ranged from 14 to 19 years (mean age at onset 14 years). Five patients reported scalp symptoms such as tender papules, pruritus, and scaling. Four patients reported appreciable hair loss on the vertex of the scalp. One patient had used chemical relaxers and hair dyes in the past. Five patients had a known family history of CCCA. CONCLUSION: Because CCCA is not typically seen or suspected in children, it is likely to be misdiagnosed or underreported. The findings in these cases add weight to the concept that genetic susceptibility rather than hair care practices may play a significant role in causing CCCA.

HIV infection predisposes skin to toxic epidermal necrolysis via depletion of skin-directed CD4⁺ T cells.

BACKGROUND: A greater incidence of adverse cutaneous drug eruptions, including toxic epidermal necrolysis (TEN), occurs among HIV-infected patients. OBJECTIVE: We sought to determine if immunophenotypical differences exist in the inflammatory infiltrates of TEN lesions from HIV-infected individuals versus noninfected individuals. METHODS: The inflammatory infiltrates in 12 cases of TEN from HIV-positive patients were characterized and compared with the infiltrates present in 12 cases of TEN from HIV-negative patients. RESULTS: TEN infiltrates consisted of CD3, CD4, and CD8 immunoreactive T lymphocytes in both the dermis and epidermis. HIV infection was associated with an 8-fold increase in the ratio of CD8(+) to CD4(+) T cells infiltrating the dermis (P = .006) and a decrease in the number of dermal CD4(+) cells (P = .044). There was also a significant decrease in the ratio of CD25(+) to CD4(+) cells in the epidermis of HIV-infected skin (P = .011). LIMITATIONS: This study is limited by small sample sizes. CONCLUSION: A decrease in the number of skin-directed CD4(+) cells and an increase in the ratio of CD8(+) to CD4(+) cells exists in TEN lesions among HIV-infected individuals and likely contribute to an increased risk of developing drug reactions because of the loss of skin-protective CD4(+)CD25(+) regulatory T cells.

Autosomal dominant inheritance of central centrifugal cicatricial alopecia in black South Africans.

BACKGROUND: Central centrifugal cicatricial alopecia (CCCA) is the commonest type of primary scarring alopecia in women of African descent. Little is currently known about the disease genetics. OBJECTIVE: We sought to investigate patterns of inheritance in CCCA and ascertain the contribution of nongenetic factors such as hair-grooming habits to the pathogenesis of the disease. METHODS: Affected individuals with at least 1 available family member were recruited from 2005 through 2012 inclusive for pedigree analysis. CCCA was diagnosed on clinical and histopathological grounds. RESULTS: Fourteen index African families with 31 immediate family members participated in the initial screening. The female to male ratio was 29:2 with an average age of 50.4 years. All patients displayed histologic features typical for CCCA. Pedigree analysis suggested an autosomal dominant mode of inheritance. Hair-grooming habits were found to markedly influence disease expression. LIMITATIONS: Small number of patients is a limitation. CONCLUSION: CCCA can be inherited in an autosomal dominant fashion, with partial penetrance and a strong modifying effect of hairstyling and gender.

The impact, perceptions and needs of parents of children with epidermolysis bullosa.

BACKGROUND:  Epidermolysis bullosa (EB) is a rare, incurable genodermatosis that presents with blistering and skin fragility. Complications can be localised or generalised, limited to the skin or have systemic effects resulting in death. Caring for a child with this painful condition can have a profound effect on the quality of life of parents and the family. There is currently no published research on the lived experience of parents caring for a child with EB in a resource-limited environment in Africa. METHOD:  This qualitative research used interpretative phenomenological analysis with the aim of understanding the lived experiences of parents caring for children with EB. Semi-structured interviews were conducted with 13 participants between May 2022 and October 2023. Guba's framework of trustworthiness was used to ensure rigour. RESULTS:  Seven experiential themes with associated sub-themes were identified. The themes were (1) grappling with understanding EB, (2) the psychological experience, (3) living with the responsibility, (4) barriers to feeling supported, (5) changing relational dynamics, (6) experience of healthcare professionals and (7) parental needs. CONCLUSION:  Parents caring for children with EB face emotional, physical, psychosocial and financial challenges. Addressing parents' needs and concerns will go a long way in decreasing this burden. A biopsychosocial approach with an awareness of cultural context is essential for family-centred holistic EB care.Contribution: This is the first study in Africa that focussed on the lived experiences of parents caring for a child with EB.

Weekly hair washing: The recommended solution for women with afro-textured hair to alleviate dandruff and scalp discomfort.

Dandruff and scalp discomfort are common concerns for women and men in Africa. Moreover, women with afro-textured hair are prone to scalp discomfort owing to irregular hair washing, frequent use of oil-based products on their scalp, and harsh chemical treatments. Current literature does not, however, provide data on the pathophysiological mechanisms of these conditions in this population. In this study, we investigated the mechanisms behind scalp discomfort and dandruff in women of African descent before and after hair washing. We conducted the in Durban, South Africa, over a 3-week period with 60 women of African descent aged 20-40 years. The respondents were equally divided into a "dandruff" and a "no dandruff" group, based on clinical grading of adherent dandruff by a dermatologist. Malassezia spp. and bacterial loads were quantified by quantitative polymerase chain reaction. Evaluations of scalp condition and sample collection were performed at five time points during the 3 weeks. Data on discomfort symptoms were collected via a self-assessment questionnaire. We observed that the dandruff severity peaked at the end of the first week after hair washing and plateaued from thereon in both groups. Dandruff was associated with higher Malassezia and bacterial load counts and there was a direct correlation between the Malassezia spp. load and dandruff score. Via self-assessment questionnaire responses submitted by participants, we observed that itching was the most pronounced scalp discomfort, compared with the sensation of tingling and burning at baseline, while an improvement of the scalp symptoms of dandruff and itch was observed in both groups after one hair wash. The study also showed that higher colonization with Malassezia spp. and bacteria is associated with dandruff independently of the time point, confirming a scalp microbiome contribution to the dandruff pathophysiology in the study population. The benefits of washing were, however, not sustained after 1 week and we thus recommend weekly hair washing for long-term management of dandruff and scalp itchiness in this population.