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Abeck F, Heinen I, Sommer R, Blome C, Härter M, Augustin M, Schneider SW, Hansen-Abeck I, Booken N. Effects of a skin type diversity seminar on undergraduate medical students' self-assessed competence in managing skin diseases in patients with skin of color. BMC MEDICAL EDUCATION 2024; 24:848. [PMID: 39112981 PMCID: PMC11308697 DOI: 10.1186/s12909-024-05828-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Skin diseases in patients with skin of colour (Fitzpatrick skin types IV to VI) are underrepresented in dermatology training, which may lead to lower quality of care for these patients. To address this underrepresentation in medical education, a newly developed seminar on skin type diversity using an interactive teaching method was implemented in an undergraduate medical curriculum. This study examined the effects of a seminar on the self-assessed competence of medical students in managing skin conditions in patients with skin of colour. METHODS A questionnaire survey was conducted among fourth-year undergraduate medical students at the University of Hamburg (Germany) between October 2023 and February 2024. Students' self-assessed competence was compared before and after the obligatory seminar (pre- and post-design). RESULTS In total, 158 students participated in the survey. After the seminar, knowledge of the presentation of skin diseases in patients with skin of colour and the associated psychological burden, differences in the incidence of skin diseases in different skin types, and the ability to diagnose skin diseases in darker skin types increased. Most participants stated that they wanted to attend more courses on this topic. DISCUSSION Appropriate courses for medical students can improve their competence in managing different skin diseases in patients with skin of colour. In the future, more attention should be paid to teaching the diversity of skin types in dermatology education.
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Affiliation(s)
- Finn Abeck
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Ines Heinen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inga Hansen-Abeck
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Booken
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Plec EMRL, Bacelete VSB, Santos MAR, Gama ACC. Laryngeal photobiomodulation: application sites, interferences from body mass index and skin phototype. Codas 2024; 36:e20230333. [PMID: 39109706 DOI: 10.1590/2317-1782/20242023333en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/22/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE Establish points on the neck, correspondent to the laryngeal topography, where to apply Low Level Light therapy (LLLT), to evaluate the incidence of light through variables such as skin phototype and body mass index (BMI). METHODS This is a cross-sectional, analytical, observational study, carried out with 15 vocally healthy women, between 18 and 50 years of age, who were divided into three groups, according to BMI and skin phototype. Six anatomical reference points were established to locate the larynx and its musculature, with visual monitoring by videonasolaryngoscopy, to assess light reach (present/absent) and degree of illumination (from very weak to very strong) in the larynx during the LASER application at doses of 3J, 6J and 9J. A flexible endoscope was used for visual monitoring during the LASER application, and subsequent image analysis. RESULTS The light reached the larynx at doses of 3J, 6J and 9J, in the anterior commissure of the vocal folds, membranous (thyroarytenoid muscle) and cartilaginous portions of the vocal fold and the cricothyroid muscle. The degree of LASER light illumination decreased in overweight and obese participants and increased in moderate brown and dark brown skin phototypes. CONCLUSION Data suggest that the LLLT penetrates differently according to skin phototype and BMI, being more evident in individuals with Fitzpatrick IV and V phototypes and less evident with higher BMI levels. The evidence that the LASER light reaches the larynx in specific anatomical points provides direction for the standardization of its use in voice practice.
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Affiliation(s)
- Elisa Meiti Ribeiro Lin Plec
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| | - Viviane Souza Bicalho Bacelete
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| | - Marco Aurélio Rocha Santos
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| | - Ana Cristina Côrtes Gama
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
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Lua BL, Robic J. Yellowness in skin complexion: Analysis of self-perception of women in China evaluated against clinical parameters of yellowness. Skin Res Technol 2024; 30:e13831. [PMID: 39104132 DOI: 10.1111/srt.13831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/04/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Skin "yellowness" is an abstract and subjective term, without a definitive measurement protocol. Objectives were to analyze Chinese women's self-perception of skin yellowness and associated parameters and identify objective clinical measurements that correlate with these perceptions. METHODS Following focus group discussions, criteria for skin yellowness were defined, and validated by volunteer rankings of facial images. A typology study of 185 women was performed. Participants were grouped into yellow (Color Uniformity, Brightness and Transparency (CUBT) yellow scale grade > 3, chromameter b* value > 16) and non-yellow (CUBT yellow scale grade < 2, b* value < 14) groups. Participants self-evaluated their skin on yellowness, transparency, skin uniformity, dullness, radiance, oiliness, and texture. Expert assessments were performed to grade sebaceous pores, ocular area pigmentation, pigmentary spots and CUBT scores. Instrumental analysis of the skin was employed using corneometer, sebumeter, mexameter chromameter, and AGE reader. RESULTS Women in the yellow group self-evaluated their skin as significantly duller, less uniform, and less radiant than women in the non-yellow group (P ≤ 0.05). Higher levels of ocular area pigmentation and lower facial skin uniformity and brightness (P < 0.001) were observed in women with yellow skin. CUBT expert grading showed lower pink skin color, but significantly higher beige, yellow, and olive pigmentation (P ≤ 0.05) in women in the yellow skin group. Melanin and b* values were significantly higher in women with yellow skin while L value was significantly lower. CONCLUSION Self-perceived skin yellowness in Chinese women correlates to chromameter and mexameter measurements, as well as expert evaluation of ocular pigmentation and CUBT parameters.
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Affiliation(s)
- Bee Leng Lua
- Research & Development, Groupe Clarins, Singapore, Singapore
| | - Julie Robic
- Research & Development, Laboratoires Clarins, Pontoise, France
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Abstract
The classification of an individual's skin type is important because it helps dermatologists and aesthetic clinicians select the most effective methods for treating the skin. To select suitable cosmetic products and procedures that help ensure healthy and beautiful skin, clinicians must consider the patient's skin type. An individualized classification of skin types allows the clinician to develop personalized skin care recommendations that consider an individual's genetic and physiological characteristics. In the fields of dermatology and aesthetics, the classification of skin types is the basis for scientific research. Skin type classification systems are additionally important for both dermatologists and aesthetic practitioners because they influence the selection of cosmetic products, procedures, and treatments. The purpose of this paper was to provide a detailed review and evaluation of the relevance, suitability, and benefits of the new ABCD Classification of Skin Types, to compare it with other systems for classifying skin types, and to identify parameters for its improvement.
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Affiliation(s)
- Oksana Pashkovska
- Oksana Pashkovska, MD, is a Dermatologist at the Face Zone Clinic for Aesthetic Medicine in Kiev, Ukraine. Dr. Pashkovska has a keen interest in the classification of skin types, particularly in dermatology and cosmetology. Her research focuses on evaluating the ABCD classification system that she developed, comparing it with previous systems, and exploring its advantages for personalized skincare
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5
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Gupta AS, Massaro M, Bunya VY. Intense pulsed light treatment for the management of meibomian gland dysfunction. Curr Opin Ophthalmol 2024; 35:322-328. [PMID: 38813738 DOI: 10.1097/icu.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE OF REVIEW Meibomian gland dysfunction (MGD) is one of the most common disorders encountered by ophthalmologists, and its management can prove challenging for both clinicians and patients. Intense pulsed light (IPL), which has been historically used in the field of dermatology, has emerged as a tool to help improve meibomian gland function. The goal of this review is to assess the clinical efficacy, utility, and safety of IPL for the treatment of MGD. RECENT FINDINGS In recent randomized controlled trials, IPL has been shown to improve meibomian gland function, and subsequently tear film quality and dry eye symptoms. The mechanism of action still remains unclear. Recent literature suggests that IPL may also be used in conjunction with other therapies, such as meibomian gland expression, low-level light therapy, and thermal pulsation. Careful attention should be placed on each patient's Fitzpatrick skin type, as well as protecting the ocular structures to reduce the risk of adverse effects. Cost, accessibility, as well as a limited duration of efficacy may be drawbacks. SUMMARY There is significant evidence supporting that IPL may be used as a potential well tolerated and effective treatment for MGD, though there are certain caveats regarding its long-term efficacy, accessibility, and cost.
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Affiliation(s)
- Angela Satya Gupta
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Skiba MB, Miller D, Stratton DB, Hall CA, McKenna S, Blair CK, Demark-Wahnefried W. Adaptation and study protocol for harvest for health together Arizona: A mentored community garden intervention for survivors of cancer. Contemp Clin Trials Commun 2024; 39:101290. [PMID: 38595771 PMCID: PMC11002544 DOI: 10.1016/j.conctc.2024.101290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/16/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Background Current health behavior recommendations for skin cancer prevention, treatment, and survivorship are the same for survivors of other cancers; they include eating a healthy diet, being physically active, maintaining a healthy weight, and minimizing ultraviolet (U.V.) exposure. Few interventions exist to support health behaviors beyond U.V. exposure. We adapted Harvest for Health, a home-based mentored gardening intervention for cancer survivors, for implementation in Arizona as a community-based intervention. Methods Stakeholder-informed adaptations for Harvest for Health Together Arizona (H4H2-AZ) included updating intervention materials to be relevant to the arid desert environment, emphasizing the importance of sun safety in cancer survivorship, and shifting from a home-based to a community-based delivery model. Participants will be enrolled in cohorts aligned with growing seasons (e.g., spring, monsoon, fall) and matched to an individual 30 ft2 community garden plot for two growing seasons (6 months). Original intervention components retained are: 1) Master Gardeners deliver the intervention providing one-to-one mentorship and 2) gardening materials and supplies provided. This pilot six-month single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer as primary outcomes. Secondary outcomes are to explore the effects on cancer preventive health behaviors and health-related quality of life. Discussion This pilot single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer. If successful, the intervention could be widely implemented throughout existing Master Gardener programs and community garden networks for survivors of other cancers. Trial registration ClinicalTrials.gov identifier: NCT05648604. Trial registered on December 13, 2022.
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Affiliation(s)
- Meghan B. Skiba
- Advanced Nursing Practice and Science Division, College of Nursing, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Dylan Miller
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Epidemiology, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Delaney B. Stratton
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Dermatology, Banner University Health, Tucson, AZ, USA
| | - Caitlyn A. Hall
- W.A. Franke Honors College, University of Arizona, Tucson, AZ, USA
- Department of Biosystems Engineering, College of Agricultural and Life Sciences, University of Arizona, Tucson, AZ, USA
| | - Sharon McKenna
- Melanoma Task Force, Arizona Department of Health Services, Phoenix, AZ, USA
| | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
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Nadir U, Yi MD, Koza E, Shi VJ, Dave L, Hisham FI, Maisel-Campbell A, Lin KA, Ibrahim SA, Kang BY, Anvery N, Dirr MA, Christensen RE, Riley JM, Kundu RV, Aylward JL, Bari O, Bhatti H, Bolotin D, Cherpelis BS, Cohen JL, Condon S, Farhang S, Firoz B, Garrett AB, Geronemus RG, Golda NJ, Humphreys TR, Hurst EA, Jacobson OH, Jiang SB, Karia PS, Kimyai-Asadi A, Kouba DJ, Council ML, Le M, MacFarlane DF, Maher IA, Miller SJ, Moioli EK, Morrow M, Neckman J, Peterson SR, Poblete-Lopez C, Prather CL, Ranario JS, Rubin AG, Swanson AM, Urban C, Xu YG, Pearlman R, Cahn BA, Yoo S, Harikumar V, Weil A, Schaeffer M, Iyengar S, Poon E, Alam M. Outcomes of cutaneous surgery for nonmelanoma skin cancer in patients with different Fitzpatrick skin types: A nationwide, multicenter, prospective study. J Am Acad Dermatol 2024; 90:1243-1245. [PMID: 38296200 DOI: 10.1016/j.jaad.2023.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 02/23/2024]
Affiliation(s)
- Umer Nadir
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Michael D Yi
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Eric Koza
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Victoria J Shi
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Loma Dave
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | | | - Amanda Maisel-Campbell
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois; Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Katherine A Lin
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Noor Anvery
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - McKenzie A Dirr
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | | | - Julia M Riley
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Roopal V Kundu
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Juliet L Aylward
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Omar Bari
- Mohs and Dermatologic Surgery Center, University of California, San Diego, San Diego, California; Division of Dermatology, University of California, Los Angeles, Los Angeles, California
| | - Hamza Bhatti
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey; The Skin Institute of South Florida, Coral Springs, Florida
| | - Diana Bolotin
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Basil S Cherpelis
- Department of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine, Tampa, Florida
| | - Joel L Cohen
- AboutSkin Dermatology, Denver, Colorado; Department of Dermatology, University of California, Irvine, Irvine, California
| | - Sean Condon
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio; The Center For Dermatology Care, Thousand Oaks, California
| | - Sheila Farhang
- Department of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine, Tampa, Florida; Avant Dermatology and Aesthetics, Tucson, Arizona
| | - Bahar Firoz
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | | | - Roy G Geronemus
- Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York; Laser and Skin Surgery Center of New York, New York, New York
| | - Nicholas J Golda
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri
| | - Tatyana R Humphreys
- Main Line Center for Skin Surgery, Bala Cynwyd, Pennsylvania; Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eva A Hurst
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Distinctive Dermatology, Fairview Heights, Illinois
| | - Oren H Jacobson
- Revere Health Central Utah Mohs, Provo, Utah; St. George's University School of Medicine, Grenada, West Indies
| | - Shang Brian Jiang
- Mohs and Dermatologic Surgery Center, University of California, San Diego, San Diego, California
| | - Pritesh S Karia
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - David J Kouba
- Wayne State University School of Medicine, Detroit, Michigan; Toledo Clinic Facial Plastics and Dermatology, Toledo, Ohio
| | - Martha Laurin Council
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Marilyn Le
- Main Line Center for Skin Surgery, Bala Cynwyd, Pennsylvania
| | | | - Ian A Maher
- Department of Dermatology, Saint Louis University, St. Louis, Missouri; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | | | - Eduardo K Moioli
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Meghan Morrow
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Julia Neckman
- Laser and Skin Surgery Center of New York, New York, New York; MetroDerm, Atlanta, Georgia
| | - Samuel R Peterson
- Revere Health Central Utah Mohs, Provo, Utah; ERderm, Newport Beach, California
| | | | | | | | - Ashley G Rubin
- Mohs and Dermatologic Surgery Center, University of California, San Diego, San Diego, California; Bernardo Dermatology Medical Group, Poway, California
| | - Andrew M Swanson
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christopher Urban
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Carolina Mountain Dermatology, Arden, North Carolina
| | - Yaohui Gloria Xu
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ross Pearlman
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Brian A Cahn
- University of Illinois Chicago, Chicago, Illinois
| | - Simon Yoo
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Vishnu Harikumar
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Alexandra Weil
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Schaeffer
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Sanjana Iyengar
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois.
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Gantz HY, Zameza PA, Zaino M, Parraga SP, Duong JQ, Taylor SL, Feldman SR. Validity of facial skin analysis pore detection: A comparative analysis. J Cosmet Dermatol 2024. [PMID: 38822560 DOI: 10.1111/jocd.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/02/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Reliable, objective measures to assess facial characteristics would aid in the assessment of many dermatological treatments. Previous work utilized an iOS application-based artificial intelligence (AI) tool compared to the "gold standard" computer-based and a physician assessment on five skin metrics (British Journal of Dermatology, 2013, 169, 474). The AI tool had superior agreement for all skin metrics except pores and subsequently underwent an algorithm update for its pore detection system. AIMS This comparative analysis assessed the performance of the updated AI tool's pore scores across all Fitzpatrick skin phototypes to determine whether the AI tool more accurately represents a dermatologist's assessment of pores. PATIENTS/METHODS Frontal facing photographs in uniform lighting conditions were taken of each participant. Percentile scores were generated by each of the four self-learning models of the updated AI tool. The pore percentile scores generated by the original and updated AI tool were used to rate "worse" pores among participant pairs. These ratings were compared to pore assessments performed by a "gold-standard" device and a board-certified dermatologist. RESULTS Compared to the original pore detection tool and the computer-based program, models A and D had the highest concordance with the physician's pore assessments for Fitzpatrick skin phototypes III-IV and V-VI, respectively. CONCLUSIONS The AI tool's pores detection update was successful in its ability to accurately detect pores on all Fitzpatrick skin types, improving on the performance of the AI prior to the update. Responsibly developed AI tools that can accurately and reliably detect skin metrics across diverse Fitzpatrick skin types can facilitate dermatologic evaluation, individualize treatment, and determine treatment response.
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Affiliation(s)
- Hannah Y Gantz
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Priscila Arellano Zameza
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mallory Zaino
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Shirley P Parraga
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jessica Q Duong
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sarah L Taylor
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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9
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Hafez SY, Alraddadi EA, Ramadan M, Alsalamah F, Alghumuy R, Aljuhani FF. Assessment of prevalence of sunscreen use and related practices among people living in Saudi Arabia: A cross-sectional survey-based study. J Cosmet Dermatol 2024; 23:1718-1725. [PMID: 38234195 DOI: 10.1111/jocd.16191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND The use of sunscreen significantly reduces the risk of skin cancer and helps maintain skin health; however, improper use can decrease its effectiveness. This study aimed to investigate the prevalence and factors associated with sunscreen use in Saudi Arabia as well as identifying areas of weakness in sunscreen practices. METHODS A cross-sectional survey-based study was conducted with a diverse population sample in Saudi Arabia. Participants were asked about their sunscreen usage habits, motivations, and knowledge of proper application techniques. Demographic information, including age, gender, and skin type, were also collected. RESULTS A total of 2321 individuals participated in the study. More than two-thirds of the participants reported using sunscreen either always, regularly, or often, primarily to maintain a light skin color and prevent skin cancer. Factors associated with sunscreen use included younger age (18-40 years old), female gender, history of sunburn, and fair skin. Despite the majority reporting healthy sun exposure habits, several shortcomings were identified in sunscreen practices, including incorrect application and suboptimal reapplication frequency. CONCLUSION While sunscreen use is common among the study population, there is a need for improved education on proper application techniques. National awareness campaigns, especially those utilizing popular social media and digital platforms in Saudi Arabia, should focus on disseminating accurate sunscreen use guidelines to maximize sun protection and skin health.
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Affiliation(s)
- Salwa Y Hafez
- College of Nursing, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Eman A Alraddadi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Majed Ramadan
- Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
- Population Health Department, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Faris Alsalamah
- Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Raghad Alghumuy
- College of Nursing, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Faisal F Aljuhani
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Collage of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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10
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Tári V, Janka EA, Emri G, Nemes B, Remenyik É, Gellén E. Effect of education on sun-safe behaviour in kidney transplant recipients. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12966. [PMID: 38616381 DOI: 10.1111/phpp.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/10/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Organ transplant recipients (OTR) are more likely to develop skin cancer than the general population. One of the main components of the exposome that triggers the development of skin tumours is solar ultraviolet (UV) radiation. To reduce the incidence of harmful consequences of sun exposure, sun protection education is needed for patients taking long-term immunosuppressive drugs. METHODS In a previous study, we assessed the sun-safe behaviour of 221 OTR using a questionnaire before and after transplantation and personally educated the patients about proper sun protection. After the education, there were no further reminder presentations. Presently, the sun protection and sun seeking habits of the available 176 of these patients were questioned to assess the long-term effect of the previous sun protection education. RESULTS Two-four years after the education, more patients wore hats and protected their skin with long-sleeved clothing than before the education. In terms of sun seeking habits, both occupational and recreational sun exposure decreased significantly. Significantly fewer people went on holiday after transplantation, but those who went on holiday spent significantly less time in the sun. CONCLUSION The long-term positive effects of education can be seen both in the patients' sun protection and in their sun seeking habits. However, the long-term goal is to maintain these results and thereby reduce the likelihood of skin tumours and consequently the associated tumour death.
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Affiliation(s)
- Vanessza Tári
- Department of Dermatology, MTA Centre of Excellence, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Eszter Anna Janka
- Department of Dermatology, MTA Centre of Excellence, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- ELKH-DE Allergology Research Group, Debrecen, Hungary
| | - Gabriella Emri
- Department of Dermatology, MTA Centre of Excellence, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- ELKH-DE Allergology Research Group, Debrecen, Hungary
| | - Balázs Nemes
- Department of Transplantation, Institute of Surgery, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Éva Remenyik
- Department of Dermatology, MTA Centre of Excellence, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- ELKH-DE Allergology Research Group, Debrecen, Hungary
| | - Emese Gellén
- Department of Dermatology, MTA Centre of Excellence, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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11
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Brar KK. Let us not conflate burn risk and race onto patients with atopic dermatitis. Ann Allergy Asthma Immunol 2024; 132:555-556. [PMID: 38702103 DOI: 10.1016/j.anai.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Kanwaljit K Brar
- Division of Pediatric Allergy & Immunology, Department of Pediatrics, New York University Langone Health Center, New York, New York; Associate Professor, NYU Grossman School of Medicine, New York, New York.
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12
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Klonoff DC, Aaron RE, Tian T, DuNova AY, Pandey A, Rhee C, Fleming GA, Sacks DB, Pop-Busui R, Kerr D. Advanced Glycation Endproducts: A Marker of Long-term Exposure to Glycemia. J Diabetes Sci Technol 2024:19322968241240436. [PMID: 38525944 DOI: 10.1177/19322968241240436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
This article examines the importance of advanced glycation endproducts (AGEs) and summarizes the structure of AGEs, pathological changes associated with AGEs, the contribution of AGEs to metabolic memory, and the value of AGEs as a predictor of diabetic complications and cardiovascular disease in people with and without diabetes. As a practical focus, skin autofluorescence (SAF) is examined as an attractive approach for estimating AGE burden. The measurement of AGEs may be of significant value to specific individuals and groups, including Black and Hispanic/Latino Americans, as they appear to have higher concentrations of hemoglobin A1c (HbA1c) than would be predicted by other metrics of mean glycemia. We hypothesize that if the amount of glycation of HbA1c is greater than expected from measured glucose levels, and if AGEs are accumulating, then this accumulation of AGEs might account for the increased rate of complications of diabetes in populations with high rates of vascular disease and other complications. Thus, identifying and modifying the burden of AGEs based on measurement of AGEs by SAF may turn out to be a worthwhile metric to determine individuals who are at high risk for the complications of diabetes as well as others without diabetes at risk of vascular disease. We conclude that available evidence supports SAF as both a clinical measurement and as a means of evaluating interventions aimed at reducing the risks of vascular disease and diabetic complications.
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Affiliation(s)
- David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | | | - Tiffany Tian
- Diabetes Technology Society, Burlingame, CA, USA
| | | | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Connie Rhee
- VA Greater Los Angeles Healthcare System, UCLA, Los Angeles, CA, USA
| | | | | | | | - David Kerr
- Sutter Health Center for Health Systems Research, Santa Barbara, CA, USA
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13
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Tang X, Yang T, Yu D, Xiong H, Zhang S. Current insights and future perspectives of ultraviolet radiation (UV) exposure: Friends and foes to the skin and beyond the skin. ENVIRONMENT INTERNATIONAL 2024; 185:108535. [PMID: 38428192 DOI: 10.1016/j.envint.2024.108535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/25/2024] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
Ultraviolet (UV) radiation is ubiquitous in the environment, which has been classified as an established human carcinogen. As the largest and outermost organ of the body, direct exposure of skin to sunlight or UV radiation can result in sunburn, inflammation, photo-immunosuppression, photoaging and even skin cancers. To date, there are tactics to protect the skin by preventing UV radiation and reducing the amount of UV radiation to the skin. Nevertheless, deciphering the essential regulatory mechanisms may pave the way for therapeutic interventions against UV-induced skin disorders. Additionally, UV light is considered beneficial for specific skin-related conditions in medical UV therapy. Recent evidence indicates that the biological effects of UV exposure extend beyond the skin and include the treatment of inflammatory diseases, solid tumors and certain abnormal behaviors. This review mainly focuses on the effects of UV on the skin. Moreover, novel findings of the biological effects of UV in other organs and systems are also summarized. Nevertheless, the mechanisms through which UV affects the human organism remain to be fully elucidated to achieve a more comprehensive understanding of its biological effects.
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Affiliation(s)
- Xiaoyou Tang
- Medical College of Tibet University, Lasa 850000, China; Laboratory of Radiation Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Tingyi Yang
- Laboratory of Radiation Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Daojiang Yu
- Laboratory of Radiation Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China; The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu 610051, China
| | - Hai Xiong
- Medical College of Tibet University, Lasa 850000, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China.
| | - Shuyu Zhang
- Medical College of Tibet University, Lasa 850000, China; Laboratory of Radiation Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China; The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu 610051, China; NHC Key Laboratory of Nuclear Technology Medical Transformation (Mianyang Central Hospital), Mianyang 621099, China.
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14
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Rahimi M, Rossi A, Son T, Dadzie AK, Ebrahimi B, Abtahi M, Heiferman MJ, Yao X. Multispectral Fundus Photography of Choroidal Nevi With Trans-Palpebral Illumination. Transl Vis Sci Technol 2024; 13:25. [PMID: 38546980 PMCID: PMC10981443 DOI: 10.1167/tvst.13.3.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/23/2024] [Indexed: 04/01/2024] Open
Abstract
Purpose The purpose of this study was to investigate the spectral characteristics of choroidal nevi and assess the feasibility of quantifying the basal diameter of choroidal nevi using multispectral fundus images captured with trans-palpebral illumination. Methods The study used a widefield fundus camera with multispectral (625 nm, 780 nm, 850 nm, and 970 nm) trans-palpebral illumination to examine eight subjects diagnosed with choroidal nevi. Geometric features of nevi, including border clarity, overlying drusen, and lesion basal diameter, were characterized. Clinical imagers, including scanning laser ophthalmoscopy (SLO), autofluorescence (AF), and optical coherence tomography (OCT), were utilized for comparative assessment. Results Fundus images depicted nevi as dark regions with high contrast against the background. Near-infrared (NIR) fundus images provided enhanced visibility of lesion borders compared to visible fundus images and SLO images. Lesion-background contrast measurements revealed 635 nm SLO at 11% and 625 nm fundus at 42%. Significantly enhanced contrasts were observed in NIR fundus images at 780 nm (73%), 850 nm (63%), and 970 nm (67%). For quantifying the diameter of nevi, NIR fundus images at 780 nm and 850 nm yielded a deviation of less than 10% when compared to OCT measurements. Conclusions NIR fundus photography with trans-palpebral illumination enhances nevi visibility and boundary definition compared to SLO. Agreement in diameter measurements with OCT validates the accuracy and reliability of this method for choroidal nevi assessment. Translational Relevance Multispectral fundus imaging with trans-palpebral illumination improves choroidal nevi visibility and accurately measures basal diameter, promising to enhance clinical practices in screening, diagnosis, and monitoring of choroidal nevi.
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Affiliation(s)
- Mojtaba Rahimi
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, USA
| | - Alfa Rossi
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, USA
| | - Taeyoon Son
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, USA
| | - Albert K. Dadzie
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, USA
| | - Behrouz Ebrahimi
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, USA
| | - Mansour Abtahi
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, USA
| | - Michael J. Heiferman
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, , USA
| | - Xincheng Yao
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, , USA
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15
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Williams S, McDonald KA, Beach RA. Same But Different: An 18-Month Cross-Sectional Study of Cosmetic Procedures in Patients With Skin Phototype I-III Versus IV-VI in Toronto, Canada. Dermatol Surg 2024; 50:272-276. [PMID: 38113172 DOI: 10.1097/dss.0000000000004034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Patients with darker skin phototypes self-report less facial aging than their lighter-skinned counterparts. However, the association of skin phototype with the type of cosmetic procedures received, is yet to be established in a Canadian context. OBJECTIVE To compare the pattern of nonsurgical cosmetic procedures performed on people with different Fitzpatrick SPTs. MATERIALS AND METHODS Cross-sectional study of patient encounters from October 2020-April 2022. Charts and photographs were reviewed and analyzed for age, sex, SPT, and procedure type. Participants were stratified by SPT into 2 cohorts: SPT I-III and SPT IV-VI. SPTs were collapsed into groups based on definitions of "skin of color" (SPT IV-VI) in previous literature. RESULTS We analyzed 350 patients with mean age 43.4, of whom 320 (91%) were female and 30 (9%) were male. The SPT I-III cohort was older (mean age 45 vs 38.5 years, p < .0001) and more frequently underwent neuromodulator injection. The SPT IV-VI cohort more frequently underwent microneedling, platelet-rich plasma, or electrodessication. CONCLUSION There are distinct patterns of cosmetic procedures performed. The SPT I-III cohort more commonly received procedures to manage facial aging. The SPT IV-VI cohort was younger and more commonly underwent procedures to manage hyperpigmentation.
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Affiliation(s)
- Stephen Williams
- Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Renée A Beach
- DermAtelier on Avenue-Medical & Cosmetic Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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16
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Ráčková L, Pompa T, Zlámal F, Barták M, Nývlt D, Bienertová-Vašků J. Physiological evidence of stress reduction during a summer Antarctic expedition with a significant influence of previous experience and vigor. Sci Rep 2024; 14:3981. [PMID: 38368474 PMCID: PMC10874375 DOI: 10.1038/s41598-024-54203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/09/2024] [Indexed: 02/19/2024] Open
Abstract
Antarctica provides a unique environment for studying human adaptability, characterized by controlled conditions, limited sensory stimulation, and significant challenges in logistics and communication. This longitudinal study investigates the relationship between stress indicators, with a specific focus on mean sleep heart rate, during a COVID-19 quarantine and subsequent 83 days long summer Antarctic expedition at the J. G. Mendel Czech Antarctic Station. Our novel approach includes daily recordings of sleep heart rate and weekly assessments of emotions, stress, and sleep quality. Associations between variables were analyzed using the generalized least squares method, providing unique insights into nuances of adaptation. The results support previous findings by providing empirical evidence on the stress reducing effect of Antarctic summer expedition and highlight the importance of previous experience and positive emotions, with the novel contribution of utilizing physiological data in addition to psychological measures. High-frequency sampling and combination of psychological and physiological data addresses a crucial gap in the research of stress. This study contributes valuable knowledge to the field of psychophysiology and has implications for expedition planners, research organizations, teams in action settings, pandemic prevention protocols, global crises, and long-duration spaceflight missions. Comprehensive insights promote the well-being and success of individuals in extreme conditions.
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Affiliation(s)
- Lucie Ráčková
- RECETOX, Faculty of Sciences, Masaryk University, Brno, Czech Republic
| | - Tomáš Pompa
- Department of Physical Activities and Health Sciences - Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Filip Zlámal
- Department of Physical Activities and Health Sciences - Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Miloš Barták
- Department of Experimental Biology, Masaryk University, Brno, Czech Republic
| | - Daniel Nývlt
- Polar-Geo-Lab, Department of Geography, Masaryk University, Brno, Czech Republic
| | - Julie Bienertová-Vašků
- RECETOX, Faculty of Sciences, Masaryk University, Brno, Czech Republic.
- Department of Physical Activities and Health Sciences - Faculty of Sports Studies, Masaryk University, Brno, Czech Republic.
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17
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Harvey VM, Alexis A, Okeke CAV, McKinley-Grant L, Taylor SC, Desai SR, Jaleel T, Heath CR, Kang S, Vashi N, Lester J, Vasquez R, Rodrigues M, Elbuluk N, Hamzavi I, Kwatra SG, Sundaram H, Cobb C, Brown SG, Kohli I, Callender VD. Integrating skin color assessments into clinical practice and research: A review of current approaches. J Am Acad Dermatol 2024:S0190-9622(24)00215-9. [PMID: 38342247 DOI: 10.1016/j.jaad.2024.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/13/2024]
Abstract
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.
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Affiliation(s)
- Valerie M Harvey
- Director, Hampton Roads Center for Dermatology, Newport News, Virginia; President, Skin of Color Society, Newport News, Virginia.
| | - Andrew Alexis
- Clinical Dermatology, Weill Cornell Medical College, New York, New York
| | - Chidubem A V Okeke
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Lynn McKinley-Grant
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Seemal R Desai
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Innovative Dermatology, Dallas, Texas
| | - Tarannum Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Candrice R Heath
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Neelam Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Jenna Lester
- Department of Dermatology, School of Medicine, University of California, San Francisco, California
| | | | - Michelle Rodrigues
- Department of Dermatology, Royal Children's Hospital, Victoria, Australia
| | - Nada Elbuluk
- Department of Dermatology, Keck Medicine, University of Southern California, Los Angeles, California
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hema Sundaram
- Private Practice, Rockville, Maryland; Private Practice, Fairfax, Virginia; Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Caryn Cobb
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Stafford G Brown
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia
| | - Indermeet Kohli
- The Henry W Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; Department of Physics and Astronomy, Wayne State University, Detroit, Michigan
| | - Valerie D Callender
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
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18
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Khanna AK, Beard J, Lamminmäki S, Närväinen J, Antaki N, Yapici HO. Assessment of skin pigmentation-related bias in pulse oximetry readings among adults. J Clin Monit Comput 2024; 38:113-120. [PMID: 37882880 PMCID: PMC10879215 DOI: 10.1007/s10877-023-01095-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Recent reports that pulse oximeters may overestimate oxygen saturation in individuals with darker skin pigmentation have prompted concerns from regulatory authorities regarding racial bias. We investigated the performance of TruSignal SpO2 sensors (GE Healthcare, Helsinki, Finland) in adults with varying skin pigmentation. METHODS A retrospective study was conducted using a set of pooled assessments of SpO2/SaO2 measurements from nine studies to assess bias, accuracy (Arms), and precision of TruSignal sensors in healthy adults under induced hypoxia. Subgroup analyses were performed based on oxygen saturation levels (band 1, ≥ 70 and ≤ 80%; band 2, > 80 and ≤ 90%; band 3, > 90 and ≤ 100%). RESULTS Of the 10,800 data points from 131 individuals, 8,202 (75.9%) and 2,598 (24.1%) were assigned to the light and dark pigment groups, respectively. Bias was 0.14% overall and less than 1% across oxygenation bands. The difference in bias between dark and light pigment groups was statistically significant at the low oxygenation band with SpO2 ≥ 70 and ≤ 80% (+ 0.58% and + 0.30% respectively; p = 0.0035). Throughout the saturation range, Arms was 1.64% in the light and 1.71% in the dark pigment group, within device specifications and regulatory requirements. Oxygenation was the dominating factor in stepwise ANOVA modeling. The mixed model also showed that bias was strongly affected by the oxygenation range. CONCLUSION TruSignal sensors demonstrated higher bias at lower oxygen saturation, with less than 0.5% difference between pigment groups. These findings raise new questions, such as ways to improve pulse oximetry measurements during challenging clinical conditions, including low perfusion.
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Affiliation(s)
- Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
- Outcomes Research Consortium, Cleveland, OH, USA.
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
| | - John Beard
- GE HealthCare - Patient Care Solutions, Milwaukee, WI, USA
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Poorzargar K, Pham C, Panesar D, Riazi S, Lee K, Parotto M, Chung F. Video plethysmography for contactless measurement of respiratory rate in surgical patients. J Clin Monit Comput 2024; 38:47-55. [PMID: 37698697 DOI: 10.1007/s10877-023-01064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/24/2023] [Indexed: 09/13/2023]
Abstract
The accurate recording of respiratory rate (RR) without contact is important for patient care. The current methods for RR measurement such as capnography, pneumography, and plethysmography require patient contact, are cumbersome, or not accurate for widespread clinical use. Video Plethysmography (VPPG) is a novel automated technology that measures RR using a facial video without contact. The objective of our study was to determine whether VPPG can feasibly and accurately measure RR without contact in surgical patients at a clinical setting. After research ethics approval, 216 patients undergoing ambulatory surgery consented to the study. Patients had a 1.5 min video of their faces taken via an iPad preoperatively, which was analyzed using VPPG to obtain RR information. The RR prediction by VPPG was compared to 60-s manual counting of breathing by research assistants. We found that VPPG predicted RR with 88.8% accuracy and a bias of 1.40 ± 1.96 breaths per minute. A significant and high correlation (0.87) was observed between VPPG-predicted and manually recorded RR. These results did not change with the ethnicity of patients. The success rate of the VPPG technology was 99.1%. Contactless RR monitoring of surgical patients at a hospital setting using VPPG is accurate and feasible, making this technology an attractive alternative to the current approaches to RR monitoring. Future developments should focus on improving reliability of the technology.
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Affiliation(s)
- Khashayar Poorzargar
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Chi Pham
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Darshan Panesar
- Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Sheila Riazi
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kang Lee
- Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Matteo Parotto
- Department of Anesthesia and Pain Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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20
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Giuliano KK, Bilkovski RN, Beard J, Lamminmäki S. Comparative analysis of signal accuracy of three SpO 2 monitors during motion and low perfusion conditions. J Clin Monit Comput 2023; 37:1451-1461. [PMID: 37266709 PMCID: PMC10651546 DOI: 10.1007/s10877-023-01029-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/04/2023] [Indexed: 06/03/2023]
Abstract
To compare pulse oximetry performance during simulated conditions of motion and low perfusion in three commercially available devices: GE HealthCare CARESCAPE ONE TruSignal SpO2 Parameter, Masimo RADICAL-7 and Medtronic Nellcor PM1000N. After IRB approval, 28 healthy adult volunteers were randomly assigned to the motion group (N = 14) or low perfusion (N = 14) group. Pulse oximeters were placed on the test and control hands using random assignment of digits 2-5. Each subject served as their own control through the series of repeated pair-wise measurements. Reference co-oximetry oxyhemoglobin (SaO2) measurements from the radial artery were also obtained in the motion group. SpO2 readings were compared between the test and control hands in both groups and to SaO2 measurements in the motion group. Accuracy was assessed through testing of accuracy root-mean squared (ARMS) and mean bias. In the simulated motion test group the overall Accuracy Root Mean Square (ARMS) versus SaO2 was 1.88 (GE), 1.79 (Masimo) and 2.40 (Nellcor), with overall mean bias of - 0.21 (Masimo), 0.45 (GE), and 0.78 (Nellcor). In the motion hand, ARMS versus SaO2 was 2.45 (GE), 3.19 (Masimo) and 4.15 (Nellcor), with overall mean bias of - 0.75 (Masimo), - 0.01 (GE), and 0.04 (Nellcor). In the low perfusion test group, ARMS versus the control hand SpO2 for low PI was 3.24 (GE), 3.48 (Nellcor) and 4.76 (Masimo), with overall bias measurements of - 0.53 (Nellcor), 0.96 (GE) and 1.76 (Masimo). Experimental results for all tested devices met pulse oximetry regulatory and testing standards requirements. Overall, SpO2 device performance across the three devices in this study was similar under both motion and low perfusion conditions. SpO2 measurement accuracy degraded for all three devices during motion as compared to non-motion. Accuracy also degraded during normal to low, very low, or ultra low perfusion and was more pronounced compared to the changes observed during simulated motion. While some statistically significant differences in individual measurements were found, the clinical relevance of these differences requires further study.
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Affiliation(s)
- Karen K Giuliano
- Elaine Marieb Center for Nursing and Engineering Innovation, University of Massachusetts Amherst, Institute of Applied Life Sciences and Elaine Marieb College of Nursing, 240 Thatcher Road, Amherst, MA, 01003, USA.
| | - Robert N Bilkovski
- RNB Ventures Consulting Inc., 12191 W. Linebaugh Avenue, Unit 687, Tampa, FL, 33626, USA
| | - John Beard
- Patient Care Solutions, GE HealthCare, 8200 W. Tower Ave, 53223, Milwaukee, WI, USA
| | - Sakari Lamminmäki
- Patient Care Solutions, GE HealthCare, Teollisuuskatu 29, 00510, Helsinki, Finland
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Carter BM, Newberry D, Leonard C. Color Does Matter: Nursing Assessment of Varying Skin Tones/Pigmentation. Adv Neonatal Care 2023; 23:525-531. [PMID: 37820356 DOI: 10.1097/anc.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND The observation of color is an integral part of the nursing assessment. However, the current understanding of individual skin qualities and pigmentation has not yet been integrated thoroughly into foundational assessment courses, clinical education, simulation, and textbooks. EVIDENCE ACQUISITION Literature is scarce regarding racial groups, skin color, and physical assessment for patients across the lifespan, but even more so for the neonatal population. Historically, many nursing textbooks did not provide visual pictures or observational assessment strategies for the assessment of the Black, Indigenous, and people of color (BIPOC) population. This is improving in some nursing textbooks; however, the descriptors of and visual differences and anticipated assessment findings for the BIPOC population are not comprehensive. RESULTS Evidence-based assessment findings, which may occur in newborns with varying skin tones/pigmentations, are presented. IMPLICATIONS FOR PRACTICE AND RESEARCH The most essential step to having an accurate assessment is acknowledging the importance of color awareness. Color blindness, while thought to support inclusivity, only contributes to exclusion of one of the most important components of a person's being-their color.
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Affiliation(s)
- Brigit M Carter
- American Association of Colleges of Nursing, Washington, District of Columbia (Dr Carter); and Duke University School of Nursing, Durham, North Carolina (Drs Newberry and Leonard)
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22
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Ward MP, Malloy JS, Kannmacher C, Steinhubl SR. Educating the healthcare workforce of the future: lessons learned from the development and implementation of a 'Wearables in Healthcare' course. NPJ Digit Med 2023; 6:214. [PMID: 37990139 PMCID: PMC10663572 DOI: 10.1038/s41746-023-00964-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/05/2023] [Indexed: 11/23/2023] Open
Abstract
Digital health technologies will play an ever-increasing role in the future of healthcare. It is crucial that the people who will help make that transformation possible have the evidence-based and hands-on training necessary to address the many challenges ahead. To better prepare the future health workforce with the knowledge necessary to support the re-engineering of healthcare in an equitable, person-centric manner, we developed an experiential learning course-Wearables in Healthcare-for advanced undergraduate and graduate university students. Here we describe the components of that course and the lessons learned to help guide others interested in developing similar courses.
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Affiliation(s)
- Matthew P Ward
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
- Div. of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - J Scott Malloy
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Chris Kannmacher
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Steven R Steinhubl
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
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Kottler D, Dupechez L, Martin Silva N, Boutemy J, Dumont A, Maigné G, Aouba A, Dompmartin A. Efficacy, tolerance and acceptability of pulsed dye laser on facial and neckline telangiectasias in systemic scleroderma: a prospective open-label monocentric study in 21 patients. J COSMET LASER THER 2023; 25:77-85. [PMID: 38373440 DOI: 10.1080/14764172.2024.2313472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 01/29/2024] [Indexed: 02/21/2024]
Abstract
Facial and neckline telangiectasias have an underestimated yet important impact on quality of life of patients with systemic scleroderma (SSc). This monocentric, prospective, open-label, intra-patient comparative study was conducted in 21 consecutive patients with SSc. Patients underwent 4 sessions of PDL 8 weeks apart. A final quadruple assessment was performed by several raters 2 months after the last session, based on the following criteria: change in telangiectasia number; subjective improvement score (LINKERT scale); impact on the quality of life (QoL; SKINDEX score); visual analog pain scale; adverse effects (AEs), including treatment discontinuation for PDL-induced purpura and patient satisfaction. The mean telangiectasia number decreased by 5 (32%) at the end of the protocol. Eighteen patients (85.7%) reported an improvement or a strong improvement, versus 73.81% for the expert committee. Immediate session pain (mean = 3.4/10) was slightly less than overall pain (mean = 4.6/10). Ten patients (47%) experienced at least one AE (oozing/crusts, edema, epidermal blistering), including PDL-induced purpura in 3 patients (14%). AEs were mostly transient (<1 week) and mild (CTCAE grade 1). All QoL parameters improved after treatment, and 85% of patients were satisfied.
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Affiliation(s)
- D Kottler
- Department of Dermatology, Caen, France
| | | | - N Martin Silva
- Department of Internal Medicine, CHU de Caen Normandie, Caen, France
| | - J Boutemy
- Department of Internal Medicine, CHU de Caen Normandie, Caen, France
| | - A Dumont
- Department of Internal Medicine, CHU de Caen Normandie, Caen, France
| | - G Maigné
- Department of Internal Medicine, CHU de Caen Normandie, Caen, France
| | - A Aouba
- Department of Internal Medicine, CHU de Caen Normandie, Caen, France
| | - A Dompmartin
- Department of Internal Medicine, CHU de Caen Normandie, Caen, France
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Rau A, Kerr H. Can ChatGPT be my Dermatologist? Arch Dermatol Res 2023; 316:2. [PMID: 37971538 DOI: 10.1007/s00403-023-02762-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/04/2023] [Accepted: 09/16/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Akash Rau
- Michigan State University College of Human Medicine, 15 Michigan St NE, Grand Rapids, MI, 49503, USA.
| | - Holly Kerr
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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Zhao Y, Amorrortu RP, Stewart SC, Ghia KM, Williams VL, Sondak VK, Tsai KY, Pinilla-Ibarz J, Chavez JC, Rollison DE. Melanoma and CLL co-occurrence and survival: role of KC history. BMC Cancer 2023; 23:1084. [PMID: 37946198 PMCID: PMC10636833 DOI: 10.1186/s12885-023-11573-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Survival following melanoma and chronic lymphocytic leukemia (CLL) have both been individually associated with previous history of non-melanoma skin cancers (specifically keratinocyte carcinomas [KC]). Furthermore, melanoma and CLL have been reported to occur within the same patients. The survival experience of patients with both cancers is understudied, and the role of history of KC is unknown. Additional research is needed to tease apart the independent associations between KC and CLL survival, KC and melanoma survival, and the co-occurrence of all three cancers. METHODS A retrospective cohort study was conducted among patients who were diagnosed with melanoma and/or CLL at a comprehensive cancer center between 2008 and 2020. Multivariable Cox regression models were used to examine the association between history of KC and survival following melanoma and/or CLL with careful consideration of calendar year of diagnosis, treatment regimens and other risk factors. A nested case-control study comparing patients with both CLL and melanoma to those with only CLL or only melanoma was conducted to compare blood parameters across the three groups. RESULTS A time-dependent association was observed between history of KC and favorable melanoma survival within 4 years following diagnosis and poorer survival post 7 years after melanoma diagnosis. History of KC was not significantly associated with survival following the diagnosis of CLL, after adjustment for clinical factors including historical/concurrent melanoma. Patients with co-occurring melanoma and CLL tended to be diagnosed with melanoma first and had elevated blood parameters including white blood cell and lymphocyte counts as compared with patients who were diagnosed with only melanoma. CONCLUSIONS History of KC was an independent predictor of survival following melanoma but not of CLL. Additional studies are needed to determine if blood parameters obtained at the time of melanoma diagnosis could be used as a cost-effective way to identify those at high risk of asymptomatic CLL for the promotion of earlier CLL diagnosis.
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Affiliation(s)
- Yayi Zhao
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Sandra C Stewart
- Department of Cancer Registry, Moffitt Cancer Center, Tampa, FL, USA
| | - Kavita M Ghia
- Collaborative Data Services Core, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Kenneth Y Tsai
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Dana E Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA.
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Pusey-Reid E, Quinn LW, Wong J, Wucherpfennig A. Representation of dark skin tones in foundational nursing textbooks: An image analysis. NURSE EDUCATION TODAY 2023; 130:105927. [PMID: 37556863 DOI: 10.1016/j.nedt.2023.105927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/11/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE This study aimed to analyze and quantify the representation of dark skin tones (DST) images/graphics across fifteen foundational and clinical nursing textbooks to understand the degree of portrayed diversity in current nursing texts. BACKGROUND The United States (U.S.) population is becoming more ethnically and racially diverse. There is a scarcity of nursing literature, studies, and educational materials on the assessment and early recognition of common skin assessment in patients with dark skin tones (DST). The underrepresentation of people with DST images in didactic material suggests that omissions of these images in educational resources may introduce bias in health care provider education and practice. METHODS Fifteen popular foundational and clinical nursing textbooks were selected and analyzed. All the photo images and drawn graphics in these textbooks were coded according to Fitzpatrick's skin phototype (FSP) scale, which categorizes skin tone as (a) "Light" or Fitzpatrick scale I or II, (b) "Medium" or Fitzpatrick scale III or IV, and (c) "Dark" or Fitzpatrick scale V or VI. The training was provided for data collectors before analysis to ascertain good inter-rater reliability (Cohen's kappa = 0.960 for light skin tone, Cohen's kappa = 0.899 for medium skin tone, and Cohen's kappa = 0.913 for dark skin tone). RESULTS Analysis of 14,192 photo images and drawn graphics depicting skin tone was completed across 15 foundational and clinical nursing textbooks. 12.3 % of photo images and 2.4 % of drawn graphics depicted dark skin tones, compared to 60.9 % of photo images and 82.8 % of drawn graphics that displayed light skin tones in these textbooks. CONCLUSIONS Nursing textbooks overrepresent light skin tones and underrepresent dark skin tones. While the approximate racial distribution of the U.S. population is 59.3 % non-Hispanic-White, 13.6 % Black/African American, and 26.6 % Person of Color, the images and graphics of skin tones represented 68 % light, 15 % medium, and 9.4 % dark. RELEVANCE TO CLINICAL PRACTICE All healthcare providers are expected and required to deliver competent clinical care to an increasingly diverse population. For teaching-learning, more visual representations of DST and comparative images between what to expect in dark, medium, and light skin tones can help improve knowledge deficits and increase health equity.
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Affiliation(s)
- Eleonor Pusey-Reid
- MGH Institute of Health Professions, School of Nursing, Charlestown Navy Yard, 36 1st Avenue, Boston, MA 02129, United States of America.
| | - Lisa W Quinn
- MGH Institute of Health Professions, School of Nursing, Charlestown Navy Yard, 36 1st Avenue, Boston, MA 02129, United States of America.
| | - John Wong
- MGH Institute of Health Professions, School of Nursing and Department of Occupational Therapy, Charlestown Navy Yard, 36 1st Avenue, Boston, MA 02129, United States of America.
| | - Andrea Wucherpfennig
- MGH Institute of Health Professions, School of Nursing, Charlestown Navy Yard, 36 1st Avenue, Boston, MA 02129, United States of America.
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Nouri N, Iravani P, Abtahi‐Naeini B. Sun protection behaviors among children aged 6-18 years old, the role of socioeconomic factors: A cross-sectional study. Health Sci Rep 2023; 6:e1727. [PMID: 38028698 PMCID: PMC10663172 DOI: 10.1002/hsr2.1727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/18/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Aims Evaluation of sun protection behavior and related factors in children aged between 6 and 18 years in Isfahan, Iran. Methods This cross-sectional study was conducted at outpatient pediatric clinics affiliated with Isfahan University of Medical Sciences, Isfahan, Iran during the summer of 2021. A checklist was designed, and the interviewer used that to gather the required information including children's demographic characteristics, families' socioeconomic data, and sun-protective behaviors in children. Results The mean ± standard deviation (SD) age of children was 10.54 ± 3.61. Among the study population, 63.7% of children were male. The most common skin phototypes were II and III (33.5% each). 83.8% of children used at least one method of sun protection (94.5% of girls, 77.6% of boys, p < 0.001). Wearing long-sleeved clothes was the most frequent UV-protection method (48%), while sunscreen application was the least prevalent method (28.1%). Sun protection behaviors were more frequent among urban children (86.7%, p = 0.009) and children with wealthy families (94%, p = 0.035). Sun protection methods were used by most of the children whose mothers applied sunscreen on a daily basis (90.2%, p = 0.002) and all of the children whose mothers held a master's degree or above (100%, p = 0.004). Conclusion Children's sun protection behavior is directly associated with demographic characteristics, families' socioeconomic level and maternal usage of sun protection measures. It is necessary to provide information and education about sun protection methods and the risks of excessive sun exposure to families and children, as well as facilitate their access to these.
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Affiliation(s)
- Nikta Nouri
- School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Parisa Iravani
- Pediatrics Department, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Bahareh Abtahi‐Naeini
- Pediatric Dermatology Division of Pediatric Department, Imam Hossein Children's HospitalIsfahan University of Medical SciencesIsfahanIran
- Skin Diseases and Leishmaniasis Research CenterIsfahan University of Medical SciencesIsfahanIran
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Salle R, Tubach F, Arlegui H, Curmin R, Viguier M, Beylot-Barry M, Dupuy A, Beneton N, Joly P, De Rycke Y, Jullien D, Mahé E, Paul C, Richard MA, Bachelez H, Zago M, Chosidow O, Sbidian É. Clinical features, therapeutic choice and response by phototype in psoriasis: analysis of the French PsoBioTeq cohort. Clin Exp Dermatol 2023; 48:1238-1246. [PMID: 37409606 DOI: 10.1093/ced/llad233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Little is known about phototype and the response to systemic treatment in psoriasis. OBJECTIVES To assess the characteristics of psoriasis, the therapeutic choice and its efficacy according to phototype. METHODS We included patients from the PsoBioTeq cohort initiating a first biologic. Patients were classified according to their phototype. The evaluation included disease characteristics, choice of the initial biologic and therapeutic response at 12 months based on 90% improvement from baseline in Psoriasis Area and Severity Index (PASI 90) and Dermatology Life Quality Index (DLQI) 0/1. RESULTS Of the 1400 patients included, 423 (30.2%), 904 (64.6%) and 73 (5.2%) were in the phototype I-II, III-IV and V-VI groups, respectively. The V-VI group had a higher initial DLQI, and more frequently initiated ustekinumab. Patients in the V-VI group maintained the initial biologic prescribed as did the other phototype groups, even though the proportion of patients reaching PASI 90 and DLQI 0/1 at 12 months was lower in this group than the other groups. CONCLUSIONS Patient phototype seems associated with quality of life and choice of the initial biologic in psoriasis. The phototype V-VI group less frequently switched treatments than did the other groups when the response was not efficient.
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Affiliation(s)
- Romain Salle
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Hugo Arlegui
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Raphaëlle Curmin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Manuelle Viguier
- Department of Dermatology and Venereology, Hôpital Robert Debré, Centre Hospitalier Universitaire (CHU) de Reims, Reims, France
| | - Marie Beylot-Barry
- Department of Dermatology, Hôpital Saint-André CHU de Bordeaux; and Bordeaux Institute of Oncology, INSERM U1312, Team 05, Université de Bordeaux, Bordeaux, France
| | - Alain Dupuy
- Department of Dermatology, CHU de Rennes; Pharmacoepidemiology and Health Services Research, Université de Rennes; and EHESP French School of Public Health, Rennes, France
| | | | - Pascal Joly
- Department of Dermatology, Rouen University Hospital, INSERM U1234, CHU Rouen Normandie, Rouen, France
| | - Yann De Rycke
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Denis Jullien
- Department of Dermatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Mahé
- Department of Dermatology, Hôpital Victor Dupouy, Argenteuil, France
| | - Carle Paul
- Department of Dermatology, INSERM Infinity U1291, Paul Sabatier University, Toulouse, France
| | | | - Hervé Bachelez
- Department of Dermatology, Hôpital Saint-Louis, AP-HP; Université Paris Diderot/Université Paris Cité; and INSERM UMR1163, Institut Imagine, Paris, France
| | - Marilyn Zago
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Olivier Chosidow
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Facial Dermatosis Clinic, Hôpital Universitaire Pitié-Salpêtrière, Paris, France; and Université Paris-Est Créteil (UPEC), Créteil, France
| | - Émilie Sbidian
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Clinical Investigation Centre, Hôpital Henri Mondor, Créteil, France
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Salminen AT, Manga P, Camacho L. Race, pigmentation, and the human skin barrier-considerations for dermal absorption studies. FRONTIERS IN TOXICOLOGY 2023; 5:1271833. [PMID: 37886124 PMCID: PMC10598584 DOI: 10.3389/ftox.2023.1271833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
A functional human skin barrier is critical in limiting harmful exposure to environmental agents and regulating the absorption of intentionally applied topical drug and cosmetic products. Inherent differences in the skin barrier between consumers due to extrinsic and intrinsic factors are an important consideration in the safety assessment of dermatological products. Race is a concept often used to describe a group of people who share distinct physical characteristics. The observed predisposition of specific racial groups to certain skin pathologies highlights the potential differences in skin physiology between these groups. In the context of the human skin barrier, however, the current data correlating function to race often conflict, likely as a consequence of the range of experimental approaches and controls used in the existing works. To date, a variety of methods have been developed for evaluating compound permeation through the human skin, both in vivo and in vitro. Additionally, great strides have been made in the development of reconstructed human pigmented skin models, with the flexibility to incorporate melanocytes from donors of different race and pigmentation levels. Together, the advances in the production of reconstructed human skin models and the increased adoption of in vitro methodologies show potential to aid in the standardization of dermal absorption studies for discerning racial- and skin pigmentation-dependent differences in the human skin barrier. This review analyzes the existing data on skin permeation, focusing on its interaction with race and skin pigmentation, and highlights the tools and research opportunities to better represent the diversity of the human populations in dermal absorption assessments.
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Affiliation(s)
- Alec T Salminen
- U.S. Food and Drug Administration, National Center for Toxicological Research, Jefferson, AR, United States
| | - Prashiela Manga
- U.S. Food and Drug Administration, Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, College Park, MD, United States
| | - Luísa Camacho
- U.S. Food and Drug Administration, National Center for Toxicological Research, Jefferson, AR, United States
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Okeke CAV, Tran J, Wright I, Okoye GA, Burgess CM, Byrd AS. Skin tone representation in dermatologic direct-to-consumer advertisements: a cross-sectional analysis and call to action. Int J Womens Dermatol 2023; 9:e101. [PMID: 37860124 PMCID: PMC10584291 DOI: 10.1097/jw9.0000000000000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/06/2023] [Indexed: 10/21/2023] Open
Abstract
Background Direct-to-consumer advertisements (DTCAs) in medical marketing serve as a prominent modality to deliver information to an increasingly diverse audience of consumers and increase prescription sales. In dermatology, advertisements have the potential to shape the public's opinions, aid in the understanding of skin conditions, and raise awareness of available treatments. Objective To investigate and characterize the representation of skin tones in DTCAs. Methods Nielsen ratings were utilized to identify the networks most watched by Black viewers in 2022. Programming on NBCUniversal, ABC, CBS, and FOX that aired in the District of Columbia, suburban Maryland, and Northern Virginia from June 2022 to July 2022 was reviewed for DTCAs. DTCAs were then analyzed to determine the skin tones of models and skin conditions depicted on models with darkly pigmented skin. Results Of the 106 DTCAs related to dermatologic conditions, there were 13 unique advertisements featuring 32 unique models. Four advertisements depicted the skin condition on darkly pigmented skin tones. Using the Monk Skin Tone (MST) scale to assess the 32 unique individuals, only 25% (n = 8) were rated at an MST 7 or above, and 6.25% (n = 2) were rated at an MST 10. Limitations This study has the limitation of only sampling DTCAs from Washington, District of Columbia which does not fully represent all dermatology-related DTCAs in the United States. Conclusion Results of this content analysis demonstrate that the number of persons of color within dermatologic DTCAs is 23%, whereas there are 13.6% Black individuals in the 2021 US census. This suggests that DTCAs are becoming more diverse since 2018. However, findings also show that the vast majority of DTCAs do not include models with darkly pigmented skin, and there remains a lack of advertisements depicting skin disease among people of color. Given the role of DTCAs in informing and aiding patients' requests for prescription drugs, representation of all skin tones is essential for this communication to be effective, especially in the field of dermatology.
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Affiliation(s)
- Chidubem A. V. Okeke
- Department of Dermatology, Howard University College of Medicine, Washington, DC
| | - Joseph Tran
- Howard University College of Medicine, Washington, DC
| | | | - Ginette A. Okoye
- Department of Dermatology, Howard University College of Medicine, Washington, DC
| | | | - Angel S. Byrd
- Department of Dermatology, Howard University College of Medicine, Washington, DC
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Sonenblum SE, Patel R, Phrasavath S, Xu S, Bates-Jensen BM. Using Technology to Detect Erythema Across Skin Tones. Adv Skin Wound Care 2023; 36:524-533. [PMID: 37729162 PMCID: PMC10545068 DOI: 10.1097/asw.0000000000000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To examine the effectiveness of the ColorMeter DSM III (ColorMeter; Cortex Technology) at grouping individuals by skin tone and measuring erythema/skin discoloration after erythema induction across skin tones. METHODS This pre/post experimental study induced erythema on a convenience sample of 61 healthy adults. Skin tone at baseline was measured using the ColorMeter, Munsell Soil Color Chart 5YR (Munsell), and Pantone SkinTone Guide (Pantone) and compared with the Eumelanin Human Skin Colour Scale (Eumelanin Scale) groupings. Erythema and melanin values on the arm immediately and after recovery time were compared with baseline values. Melanin was measured at five body regions on the face and arm. RESULTS Participants were predominantly women (64% [n = 39] women, 36% [n = 22] men) and young (mean, 28.8 ± 14.3 years); 5% (n = 3) were Hispanic, 26% (n = 16) Asian, 29% (n = 18) Black, 38% (n = 23) White, and 7% (n = 4) identified with more than one race. ColorMeter lightness (L*) and melanin measures were strongly correlated with both Munsell and Pantone values. Munsell skin tone groups were not aligned with Eumelanin Scale groupings. Most participants were in the Eumelanin intermediate-low group, and this changed depending on which body location melanin value was used. The change in erythema from baseline did not differ significantly across skin tone groups at the ulnar head, but on the forearm at the delayed time point, significant differences existed between light and both medium and dark skin tone groups (P = .001; 95% CI, 0.04-0.37). CONCLUSIONS The ColorMeter provides an effective objective measure of skin tone and erythema/discoloration across various skin tones and may improve on current standards for detection. The proposed Eumelanin Scale-Modified provides additional sensitivity for persons with medium skin tones.
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Affiliation(s)
- Sharon Eve Sonenblum
- Sharon Eve Sonenblum, PhD, is Principal Research Scientist, George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA. Rahee Patel, DPT, Sarah Phrasavath, DPT, and Sharon Xu, DPT, are Student Researchers, Emory University, Atlanta. Barbara M. Bates-Jensen, PhD, RN, FAAN, is Professor of Nursing and Medicine, University of California, Los Angeles
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Jansen FM, den Broeder N, Lubeek SFK, Savelkoul EHJ, Marcus CM, Hoentjen F, van Dop WA. Cumulative thiopurine dosing and keratinocyte skin cancer in inflammatory bowel disease: a case-control study. Eur J Gastroenterol Hepatol 2023; 35:1123-1130. [PMID: 37665613 DOI: 10.1097/meg.0000000000002617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND AIM Patients with inflammatory bowel disease (IBD) treated with thiopurines are at increased risk of keratinocyte skin cancer (KSC). Most international guidelines recommend yearly dermatological screening of thiopurine-treated patients. Whether the association between the development of KSC and the use of thiopurines is dose-dependent remains unclear. The aim of this study was to investigate the association between the cumulative thiopurine dose and KSC development in patients with IBD which can be helpful to assist in further skin cancer risk stratification and personalization of screening recommendations in patients with IBD. METHODS We performed a single-center case-control study, including patients with IBD with and without a history of KSC (cases and controls, respectively). The primary outcome was the association of cumulative azathioprine, mercaptopurine and thioguanine dose with KSC development. Univariable and multivariable logistic regression analyses were performed, the latter corrected for age and smoking, known risk factors of KSC. RESULTS We included 50 cases and 150 controls, predominantly white population. Age and current azathioprine use were univariably significantly associated with KSC development. In multivariable logistic regression analyses, age at inclusion remained significantly associated. Cumulative doses of thiopurines (separate or combined) or duration of thiopurine use did not impact KSC risk, also after correcting for age and smoking. CONCLUSION Cumulative thiopurine dose and duration did not show an association with KSC development. Future KSC risk stratification, based on all available KSC risk factors, may aid in selecting individuals who can benefit most from dermatologic screening programs.
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Affiliation(s)
- Fenna M Jansen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Radboud Institute for Molecular Life Sciences
| | - Nathan den Broeder
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Radboud Institute for Molecular Life Sciences
| | - Satish F K Lubeek
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Edo H J Savelkoul
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Radboud Institute for Molecular Life Sciences
| | - Carlijne M Marcus
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Radboud Institute for Molecular Life Sciences
| | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Radboud Institute for Molecular Life Sciences
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Willemijn A van Dop
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Radboud Institute for Molecular Life Sciences
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Rizzo J, Min M, Adnan S, Afzal N, Maloh J, Chambers CJ, Fam V, Sivamani RK. Soy Protein Containing Isoflavones Improves Facial Signs of Photoaging and Skin Hydration in Postmenopausal Women: Results of a Prospective Randomized Double-Blind Controlled Trial. Nutrients 2023; 15:4113. [PMID: 37836398 PMCID: PMC10574417 DOI: 10.3390/nu15194113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Preliminary findings from multiple studies indicate that dietary intake of soy-derived isoflavones exert beneficial effects on the skin including defense against oxidant damage, stimulation of collagen synthesis, and increased hydration. This study aims to investigate how oral supplementation of a soy protein isolate with added isoflavones (SPII) affects components of photoaging such as facial wrinkles and dyspigmentation, and skin biophysical measures such as skin hydration and sebum excretion in postmenopausal women. This 6-month prospective, randomized double-blind controlled study was conducted on 44 postmenopausal women with Fitzpatrick skin types I, II, and III who were randomized to receive either casein protein or SPII. A high-resolution facial photography system was used to measure wrinkle severity and pigmentation at 0, 8, 16, and 24 weeks. Skin biophysical measurements included skin hydration and sebum production. The average wrinkle severity was decreased in the SPII intervention group at week 16 and week 24 by 5.9% and 7.1%, respectively, compared to the baseline. Compared to the casein group, average wrinkle severity was significantly decreased at week 16 (p < 0.05) and week 24 (p < 0.0001). Facial pigment intensity was decreased by -2.5% (p < 0.05) at week 24, whereas there was no significant change in the casein group. Compared to baseline, skin hydration in the SPII group was significantly increased by 39% and 68% on the left and right cheeks (p < 0.05), respectively, at 24 weeks. There were no significant differences in sebum production. Dietary soy protein supplementation with isoflavones may improve skin photoaging, including wrinkles and dyspigmentation, and increase skin hydration in postmenopausal women with Fitzpatrick skin types I, II, and III.
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Affiliation(s)
- Julianne Rizzo
- Integrative Skin Science and Research, Sacramento, CA 95815, USA
- School of Medicine, University of California-Davis, Sacramento, CA 95817, USA
| | - Mildred Min
- Integrative Skin Science and Research, Sacramento, CA 95815, USA
- Zen Dermatology, Sacramento, CA 95819, USA
| | - Sarah Adnan
- Integrative Skin Science and Research, Sacramento, CA 95815, USA
| | - Nasima Afzal
- Integrative Skin Science and Research, Sacramento, CA 95815, USA
| | - Jessica Maloh
- Integrative Skin Science and Research, Sacramento, CA 95815, USA
| | - Cindy J. Chambers
- Integrative Skin Science and Research, Sacramento, CA 95815, USA
- Zen Dermatology, Sacramento, CA 95819, USA
- Pacific Skin Institute, Sacramento, CA 95815, USA
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA
| | - Vivien Fam
- Integrative Skin Science and Research, Sacramento, CA 95815, USA
| | - Raja K. Sivamani
- Integrative Skin Science and Research, Sacramento, CA 95815, USA
- Zen Dermatology, Sacramento, CA 95819, USA
- Pacific Skin Institute, Sacramento, CA 95815, USA
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA
- Department of Dermatology, University of California-Davis, Sacramento, CA 95616, USA
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Raphelson JR, Ahmed IM, Ancoli-Israel S, Ojile J, Pearson S, Bennett N, Uhles ML, Rohrscheib C, Malhotra A. Evaluation of a novel device to assess obstructive sleep apnea and body position. J Clin Sleep Med 2023; 19:1643-1649. [PMID: 37140998 PMCID: PMC10476032 DOI: 10.5664/jcsm.10644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea is a prevalent disease with well-known complications when left untreated. Advances in sleep-disordered breathing diagnosis may increase detection and appropriate treatment. The Wesper device is a recently developed portable system with specialized wearable patches that can measure respiratory effort, derived airflow, estimated air pressure, and body position. This study sought to compare the diagnostic ability of the novel Wesper device with the gold standard of polysomnography. METHODS Patients enrolled in the study underwent simultaneous polysomnography and Wesper device testing in a sleep laboratory setting. Data were collected and scored by readers blinded to all patient information, and the primary reader was blinded to testing method. The accuracy of the Wesper device was determined by calculation of the Pearson correlation and Bland-Altman limits of agreement of apnea-hypopnea indices between testing methods. Adverse events were also recorded. RESULTS A total of 53 patients were enrolled in the study and 45 patients were included in the final analysis. Pearson correlation between polysomnography and Wesper device apnea-hypopnea index determinations was 0.951, which met the primary endpoint goal (P = .0003). The Bland-Altman 95% limits of agreement were -8.05 and 6.38, which also met the endpoint goal (P < .001). There were no adverse events or serious adverse events noted. CONCLUSIONS The Wesper device compares favorably with gold-standard polysomnography. Given the lack of safety concerns, we advocate for further study regarding its utility in diagnosis and management of sleep apnea in the future. CITATION Raphelson JR, Ahmed IM, Ancoli-Israel S, et al. Evaluation of a novel device to assess obstructive sleep apnea and body position. J Clin Sleep Med. 2023;19(9):1643-1649.
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Affiliation(s)
- Janna Rae Raphelson
- Division of Pulmonary, Critical Care, Sleep Medicine & Physiology, University of California San Diego, La Jolla, California
| | - Imran M. Ahmed
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Joseph Ojile
- Saint Louis University Hospital, Saint Louis University School of Medicine, St. Louis, Missouri
- Clayton Sleep Institute, St. Louis, Missouri
| | | | | | | | | | - Atul Malhotra
- Division of Pulmonary, Critical Care, Sleep Medicine & Physiology, University of California San Diego, La Jolla, California
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35
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Vroom IR, Hulshof MA, Schelhaas W, Koning SN, Sanavro SM, van der Worp H, Jansen DEMC, Blanker MH. Differences and similarities in teledermatological primary care case histories between people with different skin tones. Br J Dermatol 2023; 189:348-349. [PMID: 37210217 DOI: 10.1093/bjd/ljad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/16/2023] [Accepted: 05/20/2023] [Indexed: 05/22/2023]
Abstract
Evaluation of teleconsultations on the Prisma platform revealed differences in the type of questions posted by Dutch general practitioners and advice received from dermatologists regarding people with skin of colour (SOC) and those with white skin. A survey of users of this interdisciplinary platform confirmed low competence in recognizing and treating problems in people with SOC, and a need for additional education to provide care for people with SOC identified.
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Affiliation(s)
- Iris R Vroom
- Department of Primary and Long-Term Care, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Maaike A Hulshof
- Department of Primary and Long-Term Care, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Willeke Schelhaas
- Department of Primary and Long-Term Care, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Steven N Koning
- Department of Primary and Long-Term Care, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Sanne M Sanavro
- Department of Primary and Long-Term Care, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Henk van der Worp
- Department of Primary and Long-Term Care, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Daniëlle E M C Jansen
- Department of Primary and Long-Term Care, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Marco H Blanker
- Department of Primary and Long-Term Care, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Silveira TMD, Kroyzanovski M, Purim KSM, Ramos Júnior O, Skare T, Nisihara R. Prevalence of skin lesions in a sample of Brazilian patients with inflammatory bowel disease. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230165. [PMID: 37585986 PMCID: PMC10427176 DOI: 10.1590/1806-9282.20230165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/27/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Inflammatory bowel diseases may have extra intestinal manifestations such as those affecting the skin. This study aimed to study skin manifestations in a cohort of Brazilian patients with inflammatory bowel diseases. METHODS Epidemiological and clinical data were obtained through a cross-sectional study of 70 inflammatory bowel diseases patients and a control group comprising 50 healthy individuals. All patients were subjected to dermatological examination and photography of skin lesions. RESULTS Out of the 70 inflammatory bowel diseases patients, 50 had ulcerative colitis and 20 had Crohn's disease. Skin lesions occurred in 95.7% of the inflammatory bowel diseases patients and in 88% of individuals in the control group (p=0.001). Alopecia (p<0.0001), xerosis (p=0.03), striae (p=0.02), and acne (p=0.04) were more common in inflammatory bowel diseases patients than in the control group. Alopecia was more frequent in females (p=0.01) than in males. Two male patients, one with ulcerative colitis and the other with Crohn's disease, had pyoderma gangrenosum. Erythema nodosum was not observed in both groups. CONCLUSION There was a high prevalence of skin lesions in the Brazilian inflammatory bowel diseases patients. Additionally, alopecia, xerosis, striae, and acne were more common in patients with inflammatory bowel diseases than in those in the control group.
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Affiliation(s)
| | | | | | - Odery Ramos Júnior
- Mackenzie Evangelical School of Medicine - Curitiba (PR), Brazil
- Universidade Federal do Paraná, Departamento de Medicina Interna - Curitiba (PR), Brazil
| | - Thelma Skare
- Mackenzie Evangelical School of Medicine - Curitiba (PR), Brazil
| | - Renato Nisihara
- Mackenzie Evangelical School of Medicine - Curitiba (PR), Brazil
- Universidade Positivo, Departmento de Medicina - Curitiba (PR), Brazil
- Universidade Federal do Paraná, Departamento de Medicina Interna - Curitiba (PR), Brazil
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Miller IJ, Stapelberg M, Rosic N, Hudson J, Coxon P, Furness J, Walsh J, Climstein M. Implementation of artificial intelligence for the detection of cutaneous melanoma within a primary care setting: prevalence and types of skin cancer in outdoor enthusiasts. PeerJ 2023; 11:e15737. [PMID: 37576493 PMCID: PMC10416769 DOI: 10.7717/peerj.15737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/20/2023] [Indexed: 08/15/2023] Open
Abstract
Background There is enthusiasm for implementing artificial intelligence (AI) to assist clinicians detect skin cancer. Performance metrics of AI from dermoscopic images have been promising, with studies documenting sensitivity and specificity values equal to or superior to specialists for the detection of malignant melanomas (MM). Early detection rates would particularly benefit Australia, which has the worlds highest incidence of MM per capita. The detection of skin cancer may be delayed due to late screening or the inherent difficulty in diagnosing early skin cancers which often have a paucity of clinical features and may blend into sun damaged skin. Individuals who participate in outdoor sports and recreation experience high levels of intermittent ultraviolet radiation (UVR), which is associated with the development of skin cancer, including MM. This research aimed to assess the prevalence of skin cancer in individuals who regularly participate in activities outdoors and to report the performance parameters of a commercially available AI-powered software to assess the predictive risk of MM development. Methods Cross-sectional study design incorporating a survey, total body skin cancer screening and AI-embedded software capable of predictive scoring of queried MM. Results A total of 423 participants consisting of surfers (n = 108), swimmers (n = 60) and walkers/runners (n = 255) participated. Point prevalence for MM was highest for surfers (6.48%), followed by walkers/runners (4.3%) and swimmers (3.33%) respectively. When compared to the general Australian population, surfers had the highest odds ratio (OR) for MM (OR 119.8), followed by walkers/runners (OR 79.74), and swimmers (OR 61.61) rounded out the populations. Surfers and swimmers reported comparatively lower lifetime hours of sun exposure (5,594 and 5,686, respectively) but more significant amounts of activity within peak ultraviolet index compared with walkers/runners (9,554 h). A total of 48 suspicious pigmented lesions made up of histopathology-confirmed MM (n = 15) and benign lesions (n = 33) were identified. The performance of the AI from this clinical population was found to have a sensitivity of 53.33%, specificity of 54.44% and accuracy of 54.17%. Conclusions Rates of both keratinocyte carcinomas and MM were notably higher in aquatic and land-based enthusiasts compared to the general Australian population. These findings further highlight the clinical importance of sun-safe protection measures and regular skin screening in individuals who spend significant time outdoors. The use of AI in the early identification of MM is promising. However, the lower-than-expected performance metrics of the AI software used in this study indicated reservations should be held before recommending this particular version of this AI software as a reliable adjunct for clinicians in skin imaging diagnostics in patients with potentially sun damaged skin.
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Affiliation(s)
- Ian J. Miller
- Aquatic Based Research, Southern Cross University, Bilinga, Queensland, Australia
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
| | - Michael Stapelberg
- Aquatic Based Research, Southern Cross University, Bilinga, Queensland, Australia
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
- Specialist Suite, John Flynn Hospital, Tugun, Queensland, Australia
| | - Nedeljka Rosic
- Aquatic Based Research, Southern Cross University, Bilinga, Queensland, Australia
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
| | - Jeremy Hudson
- Aquatic Based Research, Southern Cross University, Bilinga, Queensland, Australia
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
- North Queensland Skin Centre, Townsville, Queensland, Australia
| | - Paul Coxon
- North Queensland Skin Centre, Townsville, Queensland, Australia
| | - James Furness
- Water Based Research Unit, Bond University, Robina, Queensland, Australia
| | - Joe Walsh
- Sport Science Institute, Sydney, NSW, Australia
- AI Consulting Group, Sydney, NSW, Australia
| | - Mike Climstein
- Aquatic Based Research, Southern Cross University, Bilinga, Queensland, Australia
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
- Water Based Research Unit, Bond University, Robina, Queensland, Australia
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, University of Sydney, Sydney, NSW, Australia
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38
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Shafique DA, Weiss AN, McCann SE. Sun-Induced Rash in a 6-year-old Girl. Pediatr Rev 2023; 44:466-469. [PMID: 37525306 DOI: 10.1542/pir.2021-005359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
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Davis CM, Flohr C, Gupta MR, Koplin JJ. Managing Atopic Dermatitis in Patients With Skin of Color. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1376-1383. [PMID: 37001639 DOI: 10.1016/j.jaip.2023.03.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
Managing atopic dermatitis (AD) in patients with skin of color presents unique challenges for the clinician. There is increasing evidence that AD has higher prevalence, persistence, and severity among skin of color populations. This is likely to be partly related to differences in living conditions and exposure to irritants and allergens, among other factors. Assessment of AD severity in patients with darker skin can be challenging, in particular the assessment of erythema, leading to the potential for underscoring AD severity. Variations in disease have also been described, with the potential for a greater risk of inflammation-induced nodularity and hyper- or hypopigmentation. Management challenges include variable adherence to treatment, potential disparities in access to health care, and differences in the metabolism of cyclosporine. Optimal management of AD in patients with skin of color requires a tailored approach. Here, we review approaches to diagnosing AD, evaluating extent and severity with subjective and objective measures, considering treatment options for patients with skin of color, and highlighting areas for improvement in AD care for skin of color populations.
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Affiliation(s)
- Carla M Davis
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
| | - Carsten Flohr
- St. John's Institute of Dermatology, King's College London, and Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Meera R Gupta
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Jennifer J Koplin
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
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40
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Huang J, Zhang L, Shi L, Wu M, Lv T, Zhang Y, Lai Y, Tu Q, Wang X, Wang H. An epidemiological study on skin tumors of the elderly in a community in Shanghai, China. Sci Rep 2023; 13:4441. [PMID: 36932111 PMCID: PMC10023674 DOI: 10.1038/s41598-023-29012-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 01/30/2023] [Indexed: 03/19/2023] Open
Abstract
The morbidity of skin tumors (ST) in China is a great concern as the population ages. No epidemiological survey on ST in elderly communities in China has been reported. A questionnaire survey was conducted among the residents over 60 years old in a community in Shanghai, China from May 1, 2011 to November 30, 2011. The prevalence of cutaneous tumors and associated factors were analyzed. Among 2038 valid cases, a total of 78 (3.8%, 95% CI 3.0-4.7) skin cancers (SC) were confirmed. According to the final multivariate regression analysis, age, gender and previous occupation were the significantly influential factors for SC. Actinic keratosis (AK) accounted for the largest proportion (63, 3.1%) in SC. The head and neck was the physiological site with the highest incidence of SC (64, 82.1%), and AK was the most common (55, 87.3%) in head and neck SC. The common concomitant diseases of SC were hypertension (26, 33.3%) and diabetes mellitus (9, 11.5%). Seborrheic keratosis (SK) was the most common benign skin tumor with a prevalence of 100%. Men and women developed SK in significantly different parts of the body (P < 0.0001). The incidence of ST in the elderly population in Shanghai community increased with age. ST preferred to occur in the head and neck, which might be attributed to excessive ultraviolet (UV) exposure in these areas. Therefore, early diagnosis and sun-protection education are essential interventions for ST in the elderly.
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Affiliation(s)
- Jianhua Huang
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Linglin Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Shi
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Minfeng Wu
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Ting Lv
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Yunfeng Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yongxian Lai
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qingfeng Tu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Hongwei Wang
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China.
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41
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Francis KF. Assessment and Identification of Skin Disorders in Skin of Color: An Integrative Review. J Wound Ostomy Continence Nurs 2023; 50:107-114. [PMID: 36867032 DOI: 10.1097/won.0000000000000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Skin assessment in patients with dark skin tones (DST) continues to be a challenge for many healthcare providers (HCP) because the visual cues are not always readily identified. For example, identification of early signs of pressure injury when subtle skin color changes are missed has the potential to cause harm and contribute to healthcare disparities. Appropriate wound management can begin only when the wound is correctly identified. For HCPs to identify early signs of skin conditions in DST patients, they must be provided education and effective tools enabling them to identify clinically relevant signs of skin damage in all patients. This article reviews basic anatomy of the skin; it focuses on differences seen in DST and reviews assessment strategies to assist the HCP to identify skin changes and conditions.
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Affiliation(s)
- Kathleen F Francis
- Kathleen F. Francis, DNP, RN, FNP-BC, CWOCN, Wound Ostomy Service, NYU Langone Hospital Brooklyn, Brooklyn, New York
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42
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Jacobs JW, Abels E. The potential for unnecessary medical interventions due to inaccurate pulse oximetry measurements. Heart Lung 2023; 58:238-239. [PMID: 36192240 DOI: 10.1016/j.hrtlng.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, 55 Park Street, New Haven, CT 06511, United States.
| | - Elizabeth Abels
- Department of Laboratory Medicine, Yale School of Medicine, 55 Park Street, New Haven, CT 06511, United States
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Weiler HA, Sarafin K, Martineau C, Daoust JL, Esslinger K, Greene-Finestone LS, Loukine L, Dorais V. Vitamin D Status of People 3 to 79 Years of Age from the Canadian Health Measures Survey 2012-2019. J Nutr 2023; 153:1150-1161. [PMID: 36848989 DOI: 10.1016/j.tjnut.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Vitamin D is recognized in bone health and the prevention of rickets and osteomalacia. OBJECTIVE This study aimed to assess vitamin D status of people in Canada and to identify factors associated with vitamin D inadequacy and deficiency. METHODS Serum 25-hydroxyvitamin D (25(OH)D) from the Canadian Health Measures Survey (cycles 3-6, n = 21,770, 3-79 y) were evaluated for geometric means and proportions <40 (inadequate) and <30 (risk of deficiency) nmol/L. Factors associated with inadequacy or deficiency were tested using logistic regression. RESULTS Mean serum 25(OH)D was 57.9 (95% CI: 55.4, 60.5) nmol/L; the prevalence of inadequacy was 19.0% (95% CI: 15.7, 22.3) and risk of deficiency was 8.4% (95% CI: 6.5, 10.3). Prominent dietary factors associated with inadequacy in adults included: not consuming fish compared with ≥1/wk (adjusted ORadj: 1.60; 95% CI: 1.21, 2.11), none compared with ≥1/d for cow's milk (ORadj: 1.41; 95% CI: 1.02, 1.94) or margarine (ORadj: 1.42; 95% CI: 1.08, 1.88); or nonuser compared with user of vitamin D supplements (ORadj: 5.21; 95% CI: 3.88, 7.01). Notable demographic factors included: younger adults compared with 71 to 79 y (19-30 y ORadj: 2.33; 95% CI: 1.66, 3.29); BMI ≥30 compared with <25 kg/m2 (ORadj: 2.30; 95% CI: 1.79, 2.95); lower household income quartile 1 compared with 4 (ORadj: 1.46; 95% CI: 1.00, 2.15); and self-reported Black (ORadj: 8.06; 95% CI: 4.71, 13.81), East/Southeast Asian (ORadj: 3.83; 95% CI: 2.14, 6.85), Middle Eastern (ORadj: 4.57; 95% CI: 3.02, 6.92), and South Asian (ORadj: 4.63; 95% CI: 2.62, 8.19) race compared with White. Similar factors were observed in children and for deficiency. CONCLUSIONS Most people in Canada have adequate vitamin D status; nonetheless, racialized groups have an elevated prevalence of inadequacy. Further research is required to evaluate if current strategies to improve vitamin D status, including increasing vitamin D in fortified foods and supplements, and dietary guidance to include a source of vitamin D every day help to reduce health inequality in Canada.
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Affiliation(s)
- Hope A Weiler
- Nutrition Research Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada.
| | - Kurtis Sarafin
- Nutrition Research Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Chantal Martineau
- Nutrition Regulations and Standards Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Janice L Daoust
- Nutrition Regulations and Standards Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Krista Esslinger
- Office of Nutrition Policy and Promotion, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | | | - Lidia Loukine
- Bureau of Food Surveillance and Science Integration, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Veronique Dorais
- Bureau of Food Surveillance and Science Integration, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
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Consumer Behavior, Skin Phototype, Sunscreens, and Tools for Photoprotection: A Review. COSMETICS 2023. [DOI: 10.3390/cosmetics10020039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Sunscreens and photoprotection tools along with consumer habits and behaviors, can mitigate the skin damage caused by excessive solar radiation. For example, protecting oneself in the shade, avoiding inadequate sun exposure at times of higher incidence of UVB radiation (between 10:00 a.m. and 4:00 p.m.), wearing clothes with sun protection factors, applying sunscreens at the correct amounts and intervals, and wearing glasses with anti-UVA and UVB lenses are effective measures for protecting an individual. Therefore, the objective of this review was to highlight the importance of photoprotection for all skin phototypes, as skin cancer is a worldwide public health problem. In this review of the scientific literature on the Scopus platform between 2015 and 2022, we addressed the most common behaviors among different individuals and their phototypes, the importance of clarifying population habits against solar radiation, and the use of sunscreens and photoprotection tools to provide advice on healthy and safe sun exposure.
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Moss WD, King BW, Memmott S, Pires G, Rosales M, Kwok A, Tenzel P. An Evaluation of Racial Disparities in Online Marketing of Academic Plastic Surgery Practices. Ann Plast Surg 2023; 90:114-117. [PMID: 35502937 DOI: 10.1097/sap.0000000000003212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Racial disparities in plastic surgery limit health care accessibility and quality. The aim of this study is to determine if racial disparities exist within patient-targeted advertising materials on academic plastic surgery practice (APSP) Web sites and if disparities are more pronounced in specific categories within plastic surgery. METHODS Throughout May 2021, 3 independent reviewers analyzed the Web sites for APSPs and identified all photos, videos, and graphics with visible skin. For each image, the Fitzpatrick skin tone scale was used to classify the skin tone as "White" (I-III) or "non-White" (IV-VI). The images were further categorized based on the type of procedure depicted. Comparisons were made to publish US census data using χ 2 tests and linear mixed effects models. RESULTS In total, 4615 images were analyzed from 100 APSP Web sites. Seven hundred eighty (16.9%) portrayed non-White skin tone, which was significantly less than expected based on US census data (23.7% non-White race) ( P < 0.001). Online representation had the starkest disparity in hand surgery (8.65% non-White) and adult craniofacial (9.74% non-White). The only categories that showed no significant difference between representation and demographics included implant-based breast reconstruction ( P = 0.32) and pediatric craniofacial ( P = 0.93). Overall, the marketing materials demonstrated significantly lower representation of non-White skin compared with the census demographics by an absolute difference of -4.71% ( P < 0.001). CONCLUSIONS Non-White patients are significantly underrepresented in advertising materials published by APSPs, indicating systemic racial biases. Patient-targeted advertising can be improved to promote equality in representation for patients seeking plastic and reconstructive surgery.
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Affiliation(s)
- Whitney D Moss
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine
| | | | | | - Giovanna Pires
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine
| | - Megan Rosales
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Alvin Kwok
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine
| | - Paul Tenzel
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine
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Newman DM. Racial Differences in Detection of Fever Using Temporal vs Oral Temperature Measurements. JAMA 2023; 329:342. [PMID: 36692570 DOI: 10.1001/jama.2022.21349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- David M Newman
- United Memorial Medical Center Family Medicine Residency, Batavia, New York
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47
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Chen CP, Wang HC. Yellow Hands and Feet in a 14-month-old Girl. Pediatr Rev 2022; 43:e24-e27. [PMID: 36045155 DOI: 10.1542/pir.2021-005153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Cathy P Chen
- Pediatric Residency Program and.,Rady Children's Hospital-San Diego, San Diego, CA
| | - Helen C Wang
- Department of Pediatrics, University of California, San Diego, School of Medicine, San Diego, CA
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Flores-Bozo LR, Méndez-Flores S, Olvera-Rodríguez V, Echevarría-Keel J, Esquivel-Pedraza L, Rangel-Cordero A, Belaunzarán-Zamudio PF, Domínguez-Cherit JG. Nail Changes in People Living with Human Immunodeficiency Virus: Observational and Cross-Sectional Study in a Third-Level Hospital. Skin Appendage Disord 2022; 8:368-375. [PMID: 36161090 PMCID: PMC9485993 DOI: 10.1159/000524257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/12/2022] [Indexed: 09/03/2023] Open
Abstract
Introduction Nail changes in people living with human immunodeficiency virus (HIV) have been scarcely reported. The aim of this study was to establish the frequency and characteristics of nail alterations observed in adults with HIV infection in a third-level hospital in Mexico. Method Observational and cross-sectional study carried out in 205 patients receiving care at the HIV/AIDS Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) in Mexico City. We performed a nail and iconographic assessment of both hands and toenails. We collected information of demographic and clinical variables, as well as drugs use, and antiretroviral treatment used by the participants through a questionnaire and from medical records. We performed direct cytological examinations and nail mycological cultures in participants with symptoms of onychomycosis. Results The participants were predominantly male patients (91.2%), with a mean age of 41 (range 21-78) years, under antiretroviral therapy (91.2%), with a suppressed viral load (78.5%) and mean CD4+ lymphocyte count of 379.5 (range 20-1,162) cells/μL. Fitzpatrick's IV phototype was prevailing in the studied population (70%). Nail changes were documented in 72.2% of the patients; being pigmentary changes (37.1%) and trauma (30.7%) the most frequent. Onychomycosis was observed in 26.3%; with total dystrophic onychomycosis as the most frequent clinical variant (68.5%). We obtained fungal isolates in 59.3% of participants and Candida parapsilosis was the most frequent of these (37.5%). Conclusions We observed a high prevalence of nail changes with very diverse etiology, as well as a variety of nondermatophytic yeasts and molds isolates associated with cases with onychomycosis. These findings reinforce and confirm the need for routine nail examination and stress the importance of medical personnel working with people living with HIV to have broad knowledge of nail pathology.
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Affiliation(s)
- Luis R. Flores-Bozo
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | - Silvia Méndez-Flores
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | - Valeria Olvera-Rodríguez
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | - Josune Echevarría-Keel
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | - Lilly Esquivel-Pedraza
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | - Andrea Rangel-Cordero
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | - Pablo F. Belaunzarán-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | - Judith G. Domínguez-Cherit
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
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Clinical Efficacy and Safety of Pulsed Dye Laser Combined with Pingyangmycin on Hyperplastic Scar after Acne. Mediators Inflamm 2022; 2022:3305107. [PMID: 36072572 PMCID: PMC9441375 DOI: 10.1155/2022/3305107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/18/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background Acne is the most common chronic inflammatory disease of hair follicles and sebaceous glands in dermatology. Hyperplastic scar (HS), a very common sequelae of acne, is also the most common scar type in clinical practice. Objective This research analyzed the clinical effectiveness and safety of pulsed dye laser (PDL) combined with pingyangmycin (PI) in the treatment of post-acne HS. Methods One hundred and nine patients with post-acne HS admitted in June 2020 were selected and divided into a research group (n = 52) and a control group (n = 57) according to the difference in treatment methods. The efficacy, incidence of adverse reactions, skin repair, treatment comfort, and satisfaction were compared between groups. Results The total effective rate was higher in the research group compared with the control group. No statistical difference was observed between groups in the incidence of adverse reactions. The research group showed better scar repair, skin improvement, and granulation tissue maturity than the control group. And compared with the control group, the growth factor of the research group was lower, while the treatment comfort and satisfaction, psychological state, and prognosis quality of life were higher. The two groups showed no notable difference in the recurrence rate. Conclusions PDL combined with PI can effectively improve the clinical efficacy, scar repair effect, overall skin status, and treatment experience of patients and boost the psychological state and prognostic quality of life of patients, which has great clinical application prospect for the treatment of HS.
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Yuan N, Feldman AT, Chin P, Zaliznyak M, Rabizadeh S, Garcia MM. Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria. Sex Med 2022; 10:100545. [PMID: 35914381 PMCID: PMC9537259 DOI: 10.1016/j.esxm.2022.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Permanent genital hair removal is required before gender-affirming vaginoplasty to prevent hair-related complications. No previous studies have directly compared the relative efficacy, costs, and patient experiences with laser hair removal (LHR) vs electrolysis treatments. Food and Drug Administration (FDA) oversight of medical devices is poorly understood and commonly misrepresented, adversely affecting patient care. Aim This study compares treatment outcomes of electrolysis and LHR for genital hair removal and investigates FDA regulation of electrolysis and LHR devices. Methods Penile-inversion vaginoplasty and shallow-depth vaginoplasty patients completed surveys about their preoperative hair removal, including procedure type, number/frequency of sessions, cost, and discomfort. Publicly available FDA-review documents and databases were reviewed. Main Outcomes Measure Compared to electrolysis, LHR was associated with greater efficiency, decreased cost, decreased pain, and improved patient satisfaction. Results Of 52 total (44 full-depth and 8 shallow-depth) vaginoplasty patients, 22 of 52 underwent electrolysis only, 15 of 52 underwent laser only, and 15 of 52 used both techniques. Compared to patients that underwent LHR only, patients that underwent only electrolysis required a significantly greater number of treatment sessions (mean 24.3 electrolysis vs 8.1 LHR sessions, P < .01) and more frequent sessions (every 2.4 weeks for electrolysis vs 5.3 weeks for LHR, P < .01) to complete treatment (defined as absence of re-growth over 2 months). Electrolysis sessions were significantly longer than LHR sessions (152 minutes vs 26 minutes, P < .01). Total treatment costs for electrolysis ($5,161) were significantly greater than for laser ($981, P < .01). Electrolysis was associated with greater pain and significantly increased need for pretreatment analgesia, which further contributed to higher net costs for treatment with electrolysis vs laser. Many LHR and electrolysis devices have been FDA-cleared for safety, but the FDA does not assess or compare clinical efficacy or efficiency. Clinical Implications For patients with dark-pigmented hair, providers should consider LHR as the first-line treatment option for preoperative hair removal before gender-affirming vaginoplasty. Strength and Limitations This is the first study to compare electrolysis and LHR for genital hair removal. The discussion addresses FDA review/oversight of devices, which is commonly misrepresented. Limitations include the survey format for data collection. Conclusion When compared with electrolysis, LHR showed greater treatment efficiency (shorter and fewer treatment sessions to complete treatment), less pain, greater tolerability, and lower total cost. Our data suggests that, for patients with dark genital hair, providers should consider recommending laser as the first-line treatment for permanent genital hair removal before vaginoplasty. Yuan N, Feldman A, Chin P, et al. Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria. Sex Med 2022;10:100545.
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Affiliation(s)
- Nance Yuan
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexandra Terris Feldman
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Patrick Chin
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Susan Rabizadeh
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maurice M Garcia
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Urology, University of California San Francisco, San Francisco, CA, USA; Department of Anatomy, University of California San Francisco, San Francisco, CA, USA.
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