Ethnic skin: overview of structure and function

Langerhans' cell density and degree of keratinization in foreskins of Chinese preschool boys and adults

BACKGROUND

Recent epidemiological studies have proposed that male circumcision reduces the relative risk of acquiring HIV-1. Here, we evaluated the density of Langerhans' cell and degree of keratinization in the foreskins of Chinese preschool boys and adults.

METHODS

Sixty preschool boys and 20 healthy men without infectious history following male circumcisions were included. The keratin thickness and Langerhans' cells were quantified by using keratin staining, immunohistochemistry, and image analysis.

RESULTS

The extent of keratinization was much greater in the inner foreskin than in the outer foreskin in adults and boys with infectious history. It was likely to be less keratinized in boys' foreskins compared with those of adults. The density of Langerhans' cells was higher in the outer foreskin than in the inner foreskin of adults and healthy boys. Furthermore, an increased density of Langerhans' cells of inner foreskin was also found in boys with infectious history compared with healthy boys. There was much higher Langerhans' cell density in boys' foreskin compared with those of adults.

CONCLUSIONS

These findings suggest that Chinese men may have a different feature of keratin in the foreskin, and a higher Langerhans' cells density in boys' foreskin may be due to it being less keratinized.

Skin differences, needs, and disorders across global populations

Accurately determining the incidence and prevalence of dermatologic disease in most large populations has been challenging for reasons ranging from the lack of easily quantifiable tests and measures to imprecision around definitions of race, ethnicity, photo skin type, pigmentation, and population groups. Compounding the problems with these categorizations is the fact that skin disease and skin health are affected not just by inherent risk factors but also by habits and environment. Thus, a fundamental question remains as we evaluate the effects of cultural and environmental factors: do genetic factors account for most of the difference that we see in skin types? Is the primary influence the way the skin mediates the environmental insult of UV radiation or how inflammation is handled? Is melanization the primary characteristic that we should measure and consider? This article will provide an introduction to current knowledge and future directions researchers are taking in differentiating both the biological differences of skin and the clinical manifestations of skin disease among the groups described above. This discussion will be followed by a brief overview of cultural practices and environmental factors that are known to have significant impact on skin disease and a summary of the most common conditions that are encountered worldwide.

Percutaneous penetration, melanin activation and toxicity evaluation of a phytotherapic formulation for vitiligo therapeutic

The aim of this work was to apply photoacoustic spectroscopy for the ex vivo determination of the penetration rate of a phytotherapic formulation for vitiligo therapeutic, with or without salicylic acid as the promoter agent. In addition, the compound toxicity and morphophysiology effects were evaluated for different concentrations of salicylic acid. The experiments were performed as a function of the period of time of treatment in a well-controlled group of rabbits. Toxic effects were not observed with any of the tested products. All formulations containing salicylic acid induced cutaneous reaction which was dose dependent. The histological analysis showed that the use of the medication was associated with an increased comedogenic effect in relation to the control group, regardless of salicylic acid concentration. Inflammatory reactions and acanthosis were observed only in the animals treated with formulations containing higher concentrations of salicylic acid, while none of these effects were detected with the use of the formulation containing 2.5% (wt/vol) of salicylic acid. Photoacoustic depth monitoring showed that both formulations, with or without salicylic acid, propagated through the skin up to the melanocytes region, suggesting that the transport of the active agent may occur through the epithelial structure without the need of using queratinolitic substances, which are known to induce side effects in the animals.

Self reported skin morbidity and ethnicity: a population-based study in a Western community

Background

Recent studies have shown ethnic differences concerning cardio-vascular disease, diabetes and mental health. Little is known about ethnic differences in skin morbidity. The purpose of this study was to describe possible ethnic differences in self-reported skin morbidity in a Western urban community.

Methods

The design was cross sectional. 40 888 adults in Oslo, Norway, received a postal questionnaire providing information on socio-demographic factors and self-reported health, including items on skin complaints.

Results

18770 individuals answered the questionnaire. In the sample 84% were from Norway. The largest immigrant group was from Western countries (5%) and the Indian Subcontinent (3%). Itch was the most prevalent reported skin symptom (7%), and was significantly more reported by men from East Asia (18%) and Middle East/North Africa (13%). The same observations were seen for reported dry and sore skin. Hair loss was a dominating complaint for men from the Indian Subcontinent and the Middle East/North Africa (23% and 25%) and for women from the same ethnic groups. Women from Sub-Saharan Africa reported significantly more pimples than in the other groups (17%).

Conclusion

The study showed that there were significant differences in self-reported skin complaints among ethnic groups. Issues concerning the cultural value of some skin symptoms should be examined further.

Determination of age-related changes in structure and function of skin, adipose tissue, and skeletal muscle with computed tomography, magnetic resonance imaging, and positron emission tomography

In this article, we report quantitative preliminary data obtained from retrospective analysis of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) and combined PET-computed tomography (PET/CT) examinations in subjects ages 3 to 84 years pertaining to changes in the metabolism of skin, subcutaneous adipose tissue, visceral adipose tissue, and skeletal muscle with age, as well as age-related changes in skeletal muscle attenuation. We also propose a new method for identifying hypermetabolic brown fat on FDG-PET. Finally, we present a review of the literature regarding reported age-related structural and functional changes that occur in skin, fat, and skeletal muscle. Using FDG-PET, We evaluated 213 subjects for changes in the metabolism of skin, adipose tissue, and skeletal muscle with aging. Thirty-two separate subjects were chosen to measure maximum standardized uptake value (SUV) of hypermetabolic brown fat on dual-time point PET imaging. Finally, 15 subjects evaluated by PET/CT were selected to measure changes in metabolism and attenuation of skeletal muscle, and changes in metabolism of adipose tissue with aging. We found that skin, fat, and skeletal muscle all demonstrate significant (P < 0.05) increases in SUV with increasing age on PET imaging. Dual-time point PET imaging demonstrates increasing FDG uptake of hypermetabolic brown fat in various regions studied. Finally, our PET/CT studies revealed statistically insignificant (P > 0.05) decreases in SUV of adipose tissue with aging and the opposite trend in skeletal muscles (P > 0.05). Skeletal muscle attenuation in the various regions studied was found to significantly decrease with age (P < 0.05). Our study shows notable trends in metabolism and attenuation of skeletal muscle and metabolism of skin and adipose tissue that occur with normal aging. We hope that the methodologies and data we present here will serve as a useful starting point for those interested in conducting future prospective research on age-related changes in these structures.

Ex vivo evaluation of the percutaneous penetration of proanthocyanidin extracts from Guazuma ulmifolia using photoacoustic spectroscopy

In this work photoacoustic spectroscopy has been applied to determine ex vivo the percutaneous penetration of proanthocyanidins present in extracts obtained from Guazuma ulmifolia, in rats. Lotion formulations containing 0.0663 mg of procyanidin B2 day(-1)animal(-1) were topically applied during 7, 10 and 13 days in each group of the animals. After the end of treatment the animals were killed, the skin dissected to remove the basal content, and the measurements were carried out as a function of the period of time of treatment. The results showed that despite the very low concentration of the active principle (procyanidin B2) in the lotion, the photoacoustic method was able to show the presence of optical absorption bands from this substance in the dermis region, evidencing once again that this method may be useful for studies of topically applied formulations of interest in the pharmacokinetic area.

Influence of usage practices, ethnicity and climate on the skin compatibility of sanitary pads

Modern disposable sanitary pads are becoming available worldwide. Regional differences in usage practices, ethnicity, and climate may influence their skin compatibility. Pad usage practices depend on culture, economics, and menstrual physiology. Daily usage is higher in Japan and but lower in Nigeria compared to North America or Western Europe. Evidence for ethnic differences in skin irritant susceptibility is not compelling. Dark skin may be less susceptible to certain irritants than fair skin; the Japanese may experience a higher degree of sensory irritation than Caucasians. Ambient conditions such as high temperature and humidity increase the skin temperature and skin surface moisture under sanitary pads by small but measurable amounts, causing no discernible skin irritation; vapor-permeable pad backings reduce these effects. Cold dry conditions, which can irritate exposed skin, may not affect vulvar skin to the same degree due to its elevated hydration and occlusion. To address the practical significance of these variables, results of prospective clinical trials of sanitary pads performed by industry and academic scientists in North America (Indiana), Mexico, Western Europe (Munich, Athens, Goteborg, Sweden), Eastern Europe (Kiev) and Africa (Abuja, Nigeria) were reviewed. Despite the diverse range of conditions, no significant adverse skin effects were observed with modern pads compared to traditional pad designs. Study participants generally preferred modern pads for performance and comfort.

Disparities in dermatology educational resources

Patients with dark skin can present with morphologic variants, subtle disease presentations, and disease manifestations requiring unique management and therapies. With African Americans, Asians, and Hispanic Americans becoming a significant portion of the population, dermatologists must be able to diagnose and manage skin conditions in people of color. In this study, core dermatology educational sources were examined to determine if they provide dermatologists and trainees with the knowledge base necessary to diagnose and treat skin disease in the ethnic patient. Overall, the coverage of dark skin at national meetings and in photographs in the major dermatology resources is limited and variable. More consistent photographic coverage and textual information describing common and serious skin diseases in people of color should be incorporated into educational resources.

Transcutaneous Pco2 monitoring in critically ill adults: Clinical evaluation of a new sensor*

OBJECTIVE

In critically ill patients, arterial blood gas analysis is the gold standard for evaluating systemic oxygenation and carbon dioxide partial pressure. A new miniaturized carbon dioxide tension Pco2-Spo2 single sensor (TOSCA, Linde Medical Sensors AG, Basel, Switzerland) continuously and noninvasively (transcutaneously) monitors both Paco2 and oxygen saturation by pulse oximetry (Spo2). The present study was designed to investigate the usability and the accuracy of this device in critically ill patients.

DESIGN

Prospective clinical investigation.

SETTING

A 20-bed, university-affiliated, surgical intensive care unit.

PATIENTS

Patients admitted after major surgery, multiple trauma, or septic shock equipped with an arterial catheter.

INTERVENTIONS

The heated (42 degrees C) sensor was fixed at the earlobe using an attachment clip. Transcutaneous Pco2 (TcPco2) measurements were correlated with Paco2 values (measured using a blood gas analyzer). In addition, the differences between Paco2 and TcPco2 values were evaluated using the method of Bland-Altman.

MEASUREMENTS AND MAIN RESULTS

We studied 55 patients, aged 18-80 (mean 57 +/- 15) yrs. A total of 417 paired measurements were compared. Correlation between TcPco2 and Paco2 was r = .86 (p < .01) in the Paco2 range of 24-101 mm Hg. Mean bias (+/-sd) between the two methods of measurement (Bland-Altman analysis) was 1.2 +/- 6.0 mm Hg with TcPco2 slightly overestimating arterial carbon dioxide tension. Nineteen percent of the measured values were outside of the acceptable clinical range of agreement of +/-7.5 mm Hg.

CONCLUSIONS

The present study suggests that Paco2 can be acceptably assessed by measuring TcPco2 using the TOSCA Pco2-Spo2 sensor.

Assessing the role of race in quantitative measures of skin pigmentation and clinical assessments of photosensitivity

BACKGROUND

Given the increasing demographic diversity in the United States, clarifying relationships between race, color, ethnicity, and disease processes is critical.

OBJECTIVES

We sought to examine the correlation between objective measures of skin pigmentation, racial identification, and physician-diagnosed and self-reported skin phototypes.

METHODS

A total of 558 participants (76 nonwhite) were evaluated. A subset underwent spectrometric readings and digital photography of the upper aspect of the inner arm. Self-identified race was compared with 7 measures of pigmentation.

RESULTS

Race correlates best with physician-diagnosed skin phototype (r = 0.55, P < .01), whereas self-reported skin phototype, spectrometry, and colorimetry correlate poorly with race (r = 0.28, < 0.40, and r > -0.31, respectively, P < .01). Associations between race and subjective measures strengthen among patients with darker skin.

CONCLUSION

Objective measures of pigmentation fail to correlate well with race, whereas race correlates moderately with physician-diagnosed skin phototype. Including objective methods of analyzing skin color may reduce subjective influences of race in assessing photosensitivity and potential risk for skin cancer.

Structure and function of ethnic skin and hair

Differences have been found among blacks, whites, Asians, and Hispanics in various areas of skin structure and function. Among them is the stratum corneum lipid (ceramide) content, which is highest in Asians, then Hispanics, then whites, and lowest in blacks. Melanosomal packaging and percutaneous absorption rates for specific compounds also vary among the different races. Reports supporting the occurrence of difference in TEWL, tyrosinase levels, skin elasticity, and water absorption rates between blacks and whites, and reaction to skin irritation have been conflicting. No significant differences in corneocyte size, skin thickness, and skin biomechanics have been reported.