Ethnic skin disorders overview

Melanometry for objective evaluation of skin pigmentation in pulse oximetry studies

Pulse oximetry enables real-time, noninvasive monitoring of arterial blood oxygen levels. However, results can vary with skin color, thus detecting disparities during clinical validation studies requires an accurate measure of skin pigmentation. Recent clinical studies have used subjective methods such as self-reported color, race/ethnicity to categorize skin. Melanometers based on optical reflectance may offer a more effective, objective approach to assess pigmentation. Here, we review melanometry approaches and assess evidence supporting their use as clinical research tools. We compare performance data, including repeatability, robustness to confounders, and compare devices to each other, to subjective methods, and high-quality references. Finally, we propose best practices for evaluating melanometers and discuss alternate optical approaches that may improve accuracy. Whilst evidence indicates that melanometers can provide superior performance to subjective approaches, we encourage additional research and standardization efforts, as these are needed to ensure consistent and reliable results in clinical studies.

Understanding the perception of sunscreen utility in African Americans

Dyschromia is a top diagnosis among African Americans (AA). Sunscreen is an essential part of its management, but AA have low sunscreen use. We sought to examine the perception of sunscreen utility in dyschromia and photoaging among patients who identify as AA or Black. This cross-sectional study recruited participants from the Case Western Reserve University Academic Dental Clinic. Participants completed an electronic survey that contained questions related to sunscreen use, knowledge of the sun's role in hyperpigmentation and photoaging, and whether sunscreen could be used for hyperpigmentation and photoaging. Of the 151 participants recruited, 63.6% (n = 96) were women and 36.4% (n = 57) were men. Consistent with previous reports, participants had lower sunscreen use (20.5%) than whites (43.5%). The majority of participants (80.1% and 58.3%, respectively) didn't attribute the sun to hyperpigmentation or photoaging. Participants with dark/brown spots were significantly more likely to not attribute the sun to hyperpigmentation than those without spots. (p = 0.003) Limitations for this study include its small sample size, recall and reporter bias, question misinterpretation, and lack of question neutrality. This study highlights the knowledge gap of a major contributing factor to dyschromia which in turn could be leading to their view of the decreased utility of sunscreen.

Transient Postinflammatory Hyperpigmentation Following Eyelid Surgery

PURPOSE

The authors' aim was to describe a rare mild complication of eyelid surgery presenting as transient hyperpigmentation along the suture lines.

METHODS

A retrospective case series of 6 patients experiencing transient hyperpigmentation following eyelid surgery. Each patient underwent either blepharoplasty alone or blepharoplasty with ptosis repair utilizing Müller muscle conjunctival resection. Data including surgery type, hyperpigmentation laterality and location, time to diagnosis, follow-up time, and outcome were assessed.

RESULTS

All 6 patients with hyperpigmentation were females. All patients underwent blepharoplasty, including 1 upper eyelid blepharoplasty and 4 with both upper and lower eyelid blepharoplasty. One patient underwent bilateral upper blepharoplasty with concurrent posterior approach ptosis surgery repair of the left upper eyelid. Hyperpigmentation was bilateral in all 5 blepharoplasty cases and unilateral in the ptosis repair case. Hyperpigmentation included the medial portion of the operated upper eyelid in all cases. Time to diagnosis ranged from 1 to 4 weeks postoperatively, and follow-up time ranged from 3 to 5 months. Management was conservative in all cases. Five patients experienced complete resolution, and 1 patient experienced near-complete resolution on a 3-month follow-up.

CONCLUSIONS

Transient hyperpigmentation is a rare posteyelid surgery complication, generally with an excellent outcome not requiring additional intervention.

Dermatopathology Trends in African Americans: A Retrospective Analysis of Biopsies

ABSTRACT

In a retrospective analysis of biopsies from January 1, 2019 to December 31, 2020, at University Hospitals Cleveland Medical Center, we aimed to determine the frequency of dermatologic conditions biopsied in African Americans (AA). Given that AAs constitute 13.4% of the US population, understanding the skin disease profile within this significant demographic is crucial. From a total of 1701 biopsies collected from 1442 AA patients, benign neoplasms emerged as the most common diagnosis, accounting for 26.7%, predominantly in females. Notably, cutaneous T-cell lymphoma was the most frequently biopsied malignancy, whereas pigmentary disorders were the least common at 1.4%. The study highlighted the higher occurrence of squamous cell carcinoma compared with basal cell carcinoma in AA, contrasting trends in other racial demographics. Moreover, recognizing the unique presentations of skin disorders in different racial backgrounds is essential, especially because disparities have been reported in skin of color training among dermatology residency programs. Understanding these racial differences in skin diseases can assist clinicians in refining their diagnostic approach. Future research could further explore the potential gaps between clinical expectations and histologic findings, improving diagnostic accuracy.

Cosmetovigilance for infrequent allergens in Spain using a national online registry: The example of allergic contact dermatitis caused by phenylethyl resorcinol

BACKGROUND

Monitoring of adverse events induced by cosmetics performed by health authorities, known as cosmetovigilance, has been relied on the collection of case notifications.

OBJECTIVES

We aimed to show how a contact dermatitis registry can contribute to the cosmetovigilance of emerging allergens. We used the example of phenylethyl resorcinol, an infrequent allergen with only 6 previous cases reported in Europe and Japan since 2013.

METHODS

A systematic search in the Spanish Registry of Contact Dermatitis and Cutaneous Allergy (REIDAC) database was performed to identify patients with positive patch test to phenylethyl resorcinol or cosmetics that contains it between June 2018 and January 2023. We collected the main clinical features of these patients and compared them with those of patients recorded in the registry with similar epidemiological features.

RESULTS

Thirteen patients with positive patch test to phenylethyl resorcinol were identified. All the patients were women with a mean age of 42 years (range 32-59) and their lesions were mainly in the face.

CONCLUSION

Assessing the importance of infrequent allergens based solely on a case series is difficult. Multicentre registries facilitate the collection of cases and provide appropriate background information for new allergens.

In Vitro Release of Glycyrrhiza Glabra Extract by a Gel-Based Microneedle Patch for Psoriasis Treatment

Microneedle patches are attractive drug delivery systems that give hope for treating skin disorders. In this study, to first fabricate a chitosan-based low-cost microneedle patch (MNP) using a CO2 laser cutter for in vitro purposes was tried and then the delivery and impact of Glycyrrhiza glabra extract (GgE) on the cell population by this microneedle was evaluated. Microscopic analysis, swelling, penetration, degradation, biocompatibility, and drug delivery were carried out to assess the patch's performance. DAPI staining and acridine orange (AO) staining were performed to evaluate cell numbers. Based on the results, the MNs were conical and sharp enough (diameter: 400-500 μm, height: 700-900 μm). They showed notable swelling (2 folds) during 5 min and good degradability during 30 min, which can be considered a burst release. The MNP showed no cytotoxicity against fibroblast cell line L929. It also demonstrated good potential for GgE delivery. The results from AO and DAPI staining approved the reduction in the cell population after GgE delivery. To sum up, the fabricated MNP can be a useful recommendation for lab-scale studies. In addition, a GgE-loaded MNP can be a good remedy for skin disorders in which cell proliferation needs to be controlled.

Clinical Applications of Sunscreens and Formulation Advancements

Sunscreens cover the big market ratio in terms of cosmetic applications, but the therapeutic necessity of sunscreen still needs to be uncovered in the clinical context. Clinically, sunscreens are being employed more often nowadays as a result of the rising consequences of skin malignancies and the photodamaging effects of UV radiation. Sunscreens are essential to prevent aging by shielding the skin from the harmful effects of ultraviolet (UV) radiation. Over the recent decades, there has been a significant evolution in the usage of sunscreens as photo protectants. The demand for sunscreen formulations will inevitably rise as more people become aware of the protection that sunscreens provide against tanning, photoaging, non-melanoma skin cancers, premalignant skin lesions, and skin melanomas. The novel contemporary formulation techniques are also beneficial in enhancing the product's aesthetic look and quality. Recently, regulatory agencies have also started paying attention to the regulation of the clinical application, efficacy, and safety parameters related to sunscreen. This review underlines the pathophysiological response of UV exposure with the therapeutic applications of sunscreen in various dermatological conditions and the recent formulation advancements in the development of sunscreen.

Racial, Gender, and Size Bias in a Medical Graphical Abstract Gallery: A Content Analysis

Introduction

Graphical abstracts may enhance dissemination of scientific and medical research but are also prone to reductionism and bias. We conducted a systematic content analysis of the Journal of Internal Medicine (JIM) Graphical Abstract Gallery to assess for evidence of bias.

Materials and Methods

We analyzed 140 graphical abstracts published by JIM between February 2019 and May 2020. Using a combination of inductive and deductive approaches, we developed a set of codes and code definitions for thematic, mixed-methods analysis.

Results

We found that JIM graphical abstracts disproportionately emphasized male (59.5%) and light-skinned (91.3%) bodies, stigmatized large body size, and overstated genetic and behavioral causes of disease, even relative to the articles they purportedly represented. Whereas 50.7% of the graphical surface area was coded as representing genetic factors, just 0.4% represented the social environment.

Discussion

Our analysis suggests evidence of bias and reductionism promoting normative white male bodies, linking large bodies with disease and death, conflating race with genetics, and overrepresenting genes while underrepresenting the environment as a driver of health and illness. These findings suggest that uncritical use of graphical abstracts may distort rather than enhance our understanding of disease; harm patients who are minoritized by race, gender, or body size; and direct attention away from dismantling the structural barriers to health equity.

Conclusion

We recommend that journals develop standards for mitigating bias in the publication of graphical abstracts that (1) ensure diverse skin tone and gender representation, (2) mitigate weight bias, (3) avoid racial or ethnic essentialism, and (4) attend to sociostructural contributors to disease.

Consumer Preferences of Topical Vitamin C Products: A Comparative Study

Hyperpigmentation disorders greatly impact the quality of life of many patients. Vitamin C and ascorbic acid derivatives are commonly used as topical agents to reduce the effect of facial dyschromia. The market for vitamin C topicals has greatly increased, but with little oversight, resulting in a wide variety of products with regard to purity and efficacy. In this study, we conducted an analysis of the most highly rated vitamin C-containing compounds on Amazon and Sephora. It was found that consumers for both retailers prioritized efficacy and cosmetic elegance in their rating of products. Additionally, consumers displayed no preference among vitamin C derivatives in the products available to them. This study highlights the diverse vitamin C formulations currently available as well as consumer preferences, emphasizing the importance of fully reviewing all products patients are utilizing to better counsel on treatment regimens.

Evaluation of Antibacterial Mechanism of Action, Tyrosinase Inhibition, and Photocatalytic Degradation Potential of Sericin-Based Gold Nanoparticles

In recent times, numerous natural materials have been used for the fabrication of gold nanoparticles (AuNPs). Natural resources used for the synthesis of AuNPs are more environment friendly than chemical resources. Sericin is a silk protein that is discarded during the degumming process for obtaining silk. The current research used sericin silk protein waste materials as the reducing agent for the manufacture of gold nanoparticles (SGNPs) by a one-pot green synthesis method. Further, the antibacterial effect and antibacterial mechanism of action, tyrosinase inhibition, and photocatalytic degradation potential of these SGNPs were evaluated. The SGNPs displayed positive antibacterial activity (8.45-9.58 mm zone of inhibition at 50 μg/disc) against all six tested foodborne pathogenic bacteria, namely, Enterococcus feacium DB01, Staphylococcus aureus ATCC 13565, Listeria monocytogenes ATCC 33090, Escherichia coli O157:H7 ATCC 23514, Aeromonas hydrophila ATCC 7966, and Pseudomonas aeruginosa ATCC 27583. The SGNPs also exhibited promising tyrosinase inhibition potential, with 32.83% inhibition at 100 μg/mL concentration as compared to 52.4% by Kojic acid, taken as a reference standard compound. The SGNPs also displayed significant photocatalytic degradation effects, with 44.87% methylene blue dye degradation after 5 h of incubation. Moreover, the antibacterial mode of action of the SGNPs was also investigated against E. coli and E. feacium, and the results show that due to the small size of the nanomaterials, they could have adhered to the surface of the bacterial pathogens, and could have released more ions and dispersed in the bacterial cell wall surrounding environment, thereby disrupting the cell membrane and ROS production, and subsequently penetrating the bacterial cells, resulting in lysis or damage to the cell by the process of structural damage to the membrane, oxidative stress, and damage to the DNA and bacterial proteins. The overall outcome of the current investigation concludes the positive effects of the obtained SGNPs and their prospective applications as a natural antibacterial agent in cosmetics, environmental, and foodstuff industries, and for the management of environmental contagion.

Induced pluripotent stem cells reprogramming overcomes technical limitations for highly pigmented adult melanocyte amplification and integration in 3D skin model

Understanding pigmentation regulations taking into account the original skin color type is important to address pigmentary disorders. Biological models including adult melanocytes from different phenotypes allow to perform fine-tuned explorative studies and support discovery of treatments adapted to populations' skin color. However, technical challenges arise when trying to not only isolate but also amplify melanocytes from highly pigmented adult skin. To bypass the initial isolation and growth of cutaneous melanocytes, we harvested and expanded fibroblasts from light and dark skin donors and reprogrammed them into iPSC, which were then differentiated into melanocytes. The resulting melanocyte populations displayed high purity, genomic stability, and strong proliferative capacity, the latter being a critical parameter for dark skin cells. The iPSC-derived melanocyte strains expressed lineage-specific markers and could be successfully integrated into reconstructed skin equivalent models, revealing pigmentation status according to the native phenotype. In both monolayer cultures and 3D skin models, the induced melanocytes demonstrated responsiveness to promelanogenic stimuli. The data demonstrate that the iPSC-derived melanocytes with high proliferative capacity maintain their pigmentation genotype and phenotypic properties up to a proper integration into 3D skin equivalents, even for highly pigmented cells.

Post-Inflammatory Hypopigmentation: Review of the Etiology, Clinical Manifestations, and Treatment Options

Post-inflammatory hypopigmentation is a common acquired pigmentary disorder that is more prominent in skin of color, leading to great cosmetic and psychosocial implications. Often, a diagnosis with a pigmentary disorder can negatively impact an individual's health-related quality of life and may result in stigma. Although most cases of post-inflammatory hypopigmentation resolve spontaneously over time, a systematic diagnostic approach can help with identifying the underlying etiology and informing treatment strategies. It can be due to cutaneous inflammation, sequelae of inflammatory or infectious dermatoses, or dermatologic procedures. Therefore, a thorough understanding of the epidemiology, patient history, physical exam findings, and clinical features of post-inflammatory hypopigmentation phenomenon can explain the primary cause to providers and allow for patient education. It is also important to understand the various therapeutic approaches available and the efficacy of these options, which will inform providers to choose the appropriate therapy for patients. Although algorithms exist for classifying acquired disorders of hypopigmentation, there are no established algorithms for the diagnosis and treatment of post-inflammatory hypopigmentation, which warrants further exploration and discourse.

Design and Characterization of Lipid-Surfactant-Based Systems for Enhancing Topical Anti-Inflammatory Activity of Ursolic Acid

Skin inflammation is a symptom of many skin diseases, such as eczema, psoriasis, and dermatitis, which cause rashes, redness, heat, or blistering. The use of natural products with anti-inflammatory properties has gained importance in treating these symptoms. Ursolic acid (UA), a promising natural compound that is used to treat skin diseases, exhibits low aqueous solubility, resulting in poor absorption and low bioavailability. Designing topical formulations focuses on providing adequate delivery via application to the skin surface. The aim of this study was to formulate and characterize lipid-surfactant-based systems for the delivery of UA. Microemulsions and liquid crystalline systems (LCs) were characterized by polarized light microscopy (PLM), rheology techniques, and textural and bioadhesive assays. PLM supported the self-assembly of these systems and elucidated their formation. Rheologic examination revealed pseudoplastic and thixotropic behavior appropriate, and assays confirmed the ability of these formulations to adhere to the skin. In vivo studies were performed, and inflammation induced by croton oil was assessed for response to microemulsions and LCs. UA anti-inflammatory activities of ~60% and 50% were demonstrated by two microemulsions and 40% and 35% by two LCs, respectively. These data support the continued development of colloidal systems to deliver UA to ameliorate skin inflammation.

Arctigenin-Enriched Burdock Seed Oil (ABSO): A New Skin Brightening Botanical Extract

The Arctium lappa L. plant, commonly known as burdock, has been used therapeutically for hundreds of years. Arctigenin (ATG) is an active ingredient in burdock, albeit at low quantities or mostly in the form of acrtiin (arctigenin-4-glucoside). ATG has been touted for its anti-inflammatory properties in many cell types and disease states; however, its role in skin and melanin production has not been extensively studied. Our aims for this study were to develop a burdock seed extract enriched for ATG that is amenable to quasi-drug development, determine in vitro brightening activity, and evaluate safety and skin brightening efficacy clinically in human subjects. Arctiin and ATG content were measured by high-performance liquid chromatography (HPLC). In vitro studies utilized EpiDermTM tissues for skin irritation test, and MelanoDermTM tissues for melanin reduction capacity. A 45 subject clinical study was performed in adult subjects ranging in age from 30 to 60 years old (mean = 41.9 ± 6.7) to test the safety and skin brightening potential of 1% ABSO lotion. We demonstrate by HPLC that ABSO is a natural extract that contains ~5-times more arctigenin than BSO. Furthermore, ABSO inhibits melanin production better than BSO and retains the same melanin-reducing capacity as synthetic ATG in vitro in MelanoDerm™ 3D skin cultures. ABSO also adheres to quasi-drug criteria according to the Japanese Standards of Quasi-Drug Ingredients as determined by infrared absorption spectrum method, unsaponifiable matter, heavy metal and arsenic content, and acid, saponification, and iodine value methods. Clinical assessment of 1% ABSO lotion shows it is well-tolerated in human skin and demonstrates improved brightness and skin tone evenness. ABSO is a natural arctigenin-enriched burdock seed extract that reduces melanin content in vitro and clinically improves skin brightness.

Decrypting the Potential of Nanotechnology-Based Approaches as Cutting-Edge for Management of Hyperpigmentation Disorder

The abundant synthesis and accretion of melanin inside skin can be caused by activation of melanogenic enzymes or increase in number of melanocytes. Melasma is defined as hyperpigmented bright or dark brown spots which are symmetrically distributed and have serrated and irregular borders. The three general categories of pigmentation pattern include centro facial pattern, malar pattern, and mandibular pattern. Exposure to UV rays, heat, use of cosmetics and photosensitizing drugs, female sex hormonal therapies, aberrant production of melanocyte stimulating hormone, and increasing aesthetic demands are factors which cause the development of melasma disease. This review gives a brief overview regarding the Fitzpatrick skin phototype classification system, life cycle of melanin, mechanism of action of anti-hyperpigmenting drugs, and existing pharmacotherapy strategies for the treatment of melasma. The objectives of this review are focused on role of cutting-edge nanotechnology-based strategies, such as lipid-based nanocarriers, i.e., lipid nanoparticles, microemulsions, nanoemulsions, liposomes, ethosomes, niosomes, transfersomes, aspasomes, invasomes penetration-enhancing vesicles; inorganic nanocarriers, i.e., gold nanoparticles and fullerenes; and polymer-based nanocarriers i.e., polymeric nanoparticles, polymerosomes, and polymeric micelles for the management of hyperpigmentation.

Treatment of hyperpigmentation after burn: A literature review

OBJECTIFY

Skin pigmentation disorders are one of the most frequent sequelae after burn injury. While these conditions often improve over time, some are permanent and cause severe psychological disorders (especially on the face). Given the frequency of these disorders and their benign nature, the scientific community has great difficulty postponing these patient follow-ups. Publications on their management are rare, and there is no consensus on the gold standard treatment for skin dyschromia. Herein, we performed a literature review including the various treatments currently proposed to manage these hyperpigmentations.

METHODS

All reported articles up to February 2021 were reviewed on Pubmed. Studies on the treatment of hyperpigmented scars were included if they were secondary to burn injuries. Excluded articles evaluated transient treatments, such as makeup, and articles on inflammatory hyperpigmentation without etiological details or not secondary to burns.

RESULTS

201 articles were identified, and 13 studies were included. Topical creams used in inflammatory hyperpigmented lesions such as hydroquinone and first-line retinoids are controversial due to their inconstant efficacy. Various types of laser and pulsed light treatments have shown their effectiveness but can also aggravate pigmentation.

CONCLUSION

Dyschromia after burn remains a therapeutic challenge. Hyperpigmentations after burn should be treated on a case-by-case basis, using data from the literature, clinical experience and measuring the risk/benefit ratio.

Photoprotection for Skin of Color

Photoprotection behaviors can mitigate skin damage caused by ultraviolet radiation, and common methods include seeking shade, avoiding sun exposure during peak daylight hours, wearing sun-protective clothing, applying sunscreen, and using sunglasses. While the role of sun protection in preventing sunburns, photoaging, and skin cancer is well established in fair-skinned populations, individuals with skin of color (SOC) are presumed to suffer fewer negative effects from solar radiation. Thus, the importance of photoprotection in this population is understudied and may be underestimated. In SOC populations, sun exposure is known to cause pigmentary disorders, photoaging, and basal cell carcinoma (BCC), highlighting the potential benefits of photoprotection. Although SOC populations tend to practice photoprotection by seeking shade and wearing sun-protective clothing, survey and interview-based studies have consistently found relatively low use of sunscreen among these populations. Common motivators for photoprotection in individuals with SOC include preventing sunburn and pigmentation, with the prevention of skin cancer being a less important reason. As a skin cancer risk behavior, indoor tanning is relatively rare in SOC populations, but its use may increase with acculturation to US norms. While more studies are necessary to clarify whether photoprotection behaviors may decrease skin cancer-related mortality in SOC populations, regular dermatologic care and counseling on photoprotection remain essential in patients with SOC for overall skin health.

Skin diseases in Asian individuals that you do not want to miss: A selection of unique or relatively more common conditions in Asian populations

The Asian population currently constitutes a simple majority of the global population, comprising nearly 60%. The percentage of the US population that identifies as Asian is expected to grow to 41 million by the year 2050, making up an eventual 9% of the US population. As the world and US populations of Asian individuals increase, the demand for dermatologic care from this population will increase, requiring dermatologists to become more familiar with the diagnosis and treatment of Asian-specific skin characteristics and diseases. In this contribution, we review skin conditions specific to or relatively more common in Asian patients to help recognition and management of diseases in an increasing Asian patient population. We discuss prurigo pigmentosa, primary cutaneous plasmacytosis, lipodystrophia centrifugalis abdominalis infantilis, Epstein-Barr viru-positive T- and natural killer-cell lymphoproliferative disorders, acquired bilateral nevus of Ota-like macules, and Behҫet disease.

Transcriptome analysis reveals intrinsic pro-inflammatory signaling in healthy African American skin

Differences in morphology and physiology of darkly pigmented compared to lightly pigmented skin are well recognized. There are also disparities in prevalence and clinical features for many inflammatory skin diseases including atopic dermatitis and psoriasis; however, the underlying mechanisms are largely unknown. We compared the baseline gene expression in full thickness skin biopsies from healthy individuals self-reporting as African American (AA) or White Non-Hispanic (WNH). Extensively validated RNA-Seq analysis identified 570 differentially expressed genes (DEG) in AA skin including immunoglobulins and their receptors such as FCER1G; pro-inflammatory genes such as TNFα, IL-32; EDC (epidermal differentiation cluster) and keratin genes. DEGs were functionally enriched for inflammatory responses, keratinization, cornified envelope formation. RNA-seq analysis of 3D human skin equivalents (HSE) made from AA and WNH primary keratinocytes revealed 360 DEGs (some shared with skin) which were enriched by similar functions. AA HSE appeared more responsive to TNFα pro-inflammatory effects. Finally, AA-specific DEGs in skin and HSE significantly overlapped with molecular signatures of skin in AD and psoriasis patients. Overall, these findings suggest the existence of intrinsic pro-inflammatory circuits in AA keratinocytes/skin that may account for disease disparities and will help to build a foundation for the development of targeted skin disease prevention.

Study of the characteristics of facial skin tone status in 1092 young Chinese females according to the ITA°

BACKGROUND

The ITA° is the gold standard for skin tone classification. Different skin tones are often associated with different skin characteristics and issues. Different skin types are often associated with different skin characteristics and issues in China.

AIMS

To study the population's skin color distribution and accompanying skin problems according to the ITA° classification standard.

METHODS

A total of 1092 women aged 22-42 years were recruited in 7 cities in China. All biophysical parameter measurements (SM, CM, TWEL, pH, R2, GLOSS_DSCT, MEXA, ERYTH, ITA°; 9 indexes total) were quantified with noninvasive instruments. All volunteers provided consent before enrollment.

RESULT

The main skin color categories were light (II), very light (I), intermediate (III), and tan (IV). The results demonstrated that the characteristics of the facial skin based on the ITA° were significantly different among cities and age groups and were associated with different skin issues.

CONCLUSIONS

Lighter skin was associated with worse skin elasticity; intermediate skin was associated with worse skin hydration content and was most prone to being oily; and darker skin was associated with poor barrier function. Established principal component regression (PCR) indicated that pH, gloss GLOSS_DSC, MEXA, ERYTH, TEWL, and SM had significant effects on the ITA°.

Skin-Lightening Products: Consumer Preferences and Costs

Disorders of skin hyperpigmentation have an appreciable impact on quality of life, carrying social and cultural importance that influences widespread consumer demand for cosmetic lightening products. We sought to investigate product factors that may influence consumer preference when choosing an over-the-counter cream for skin-lightening purposes. The keyword "lightening cream" was searched in the "Beauty and Personal Care category" of online retailer Amazon.com. The top fifth percentile of products was determined by filtering the search results for a minimum of four out of five stars from customer reviews, and then further filtered by products with over 100 reviews. Number of reviews, rating, price per unit, vehicle, application instructions, ingredients, and review attributes were evaluated. Over 2,900 products were catalogued as "lightening cream" on Amazon.com. There were 40 products rated >4 stars and >100 reviews, constituting the top 1.34% of entries. Tocopheryl was present in 58% of the top 40 products, ascorbic acid in 40%, and niacinamide in 20%. Notably, 22.5% of the top 40 products contained no known skin-lightening ingredient. There was a moderate positive correlation (R2=0.378) between price and consumer rating, with kojic acid being the most expensive per ounce ($24.89) and salicylic acid being the most highly rated (4.54 stars; $15.00/oz). This study provides insight on the factors influencing the choice, preferences, and satisfaction of consumer that sought Amazon for the purchase of lightening products.

Prevalence of Hypopigmentary Disorders in Primary School Children in Zagazig City, Sharkia Governorate, Egypt

BACKGROUND

Epidemiologic data derived from population-based studies are very important to understand human diseases and their implications. Highlighting skin problems by identifying their incidence and prevalence is vital to direct suitable medical attention toward them.

AIM

The aim of the study was to detect the prevalence and most common causes of hypopigmentation in primary school children in Zagazig City.

METHODS

Cross-sectional study on 185 students selected from two schools. Data were collected by filling a questionnaire, clinical examination, and Wood's light examination to detect hypopigmented skin disorders.

RESULTS

The prevalence of hypopigmentation among studied population was 45.4%; the commonest cause was pityriasis alba 58.3%, followed by pityriasis versicolor 17.9%, postinflammatory hypopigmentation 10.7%, hypopigmented nevus 9.5%, and finally 3.6% vitiligo.

CONCLUSION

Hypopigmented skin disorders are important and easy to diagnosis skin diseases that need medical attention.

Withaferin A-A Promising Phytochemical Compound with Multiple Results in Dermatological Diseases

Withaferin A (WFA) was identified as the most active phytocompound of the plant Withania somnifera (WS) and as having multiple therapeutic/ameliorating properties (anticancer, antiangiogenic, anti-invasive, anti-inflammatory, proapoptotic, etc.) in case of various diseases. In drug chemistry, WFA in silico approaches have identified favorite biological targets, stimulating and accelerating research to evaluate its pharmacological activity—numerous anticancer effects manifested in various organs (breast, pancreas, skin, colon, etc.), antivirals, anti-infective, etc., which are not yet sufficiently explored. This paper is a synthesis of the most relevant specialized papers in the field that are focused on the use of WFA in dermatological diseases, describing its mechanism of action while providing, at the same time, details about the results of its testing in in vitro/in vivo studies.

Melasma: A Condition of Asian Skin

Melasma is a benign yet psychologically debilitating skin condition that is prevalent among women of darker phenotypes, and particularly in Asian women. This potentially preventable condition can lead to skin discoloration that is hard to treat and can frequently recur. This review aims to (1) highlight the pathophysiology of melasma, (2) describe its important risk factors, and (3) identify prevention methods, available treatment options, and potential complications of melasma. By raising awareness of this condition, we hope that physicians and patients will be able to be better informed to discuss screening options and to avoid preventable risk factors, especially in patients who are predisposed to the disease.

Common Dermatologic Procedures and the Associated Complications Unique to Skin of Color

BACKGROUND

The skin of color (SOC) population in the United States continues to grow, and these patients are undergoing various cosmetic and surgical procedures at increasing rates. There is a paucity of data on the potential complications associated with surgical and cosmetic procedures in this patient population.

OBJECTIVE

We aim to educate dermatologic surgeons and clinicians on surgical and cosmetic procedures in patients of color and increase awareness of the potential complications unique to this patient population.

MATERIALS AND METHODS

A thorough PubMed literature search was performed to conduct this review.

RESULTS

There are a number of complications in SOC that require special attention, including keloids, postoperative infections, postinflammatory hyperpigmentation, and hypopigmentation. There are also various precautions to consider when performing cosmetic procedures, such as neurotoxin and filler injections, laser therapy, microneedling, and chemical peels.

CONCLUSION

Dermatologists should be aware of the potential cosmetic and surgical complications of this growing patient population to provide optimal evidence-based medical care.

The role of dermatology in African patients referred for health treatment in a European centre

BACKGROUND

Owing to the migratory movement between African and European countries, we have been seeing an increasing number of dermatoses in patients with darker skin phenotypes in our clinical practice.

AIM

To evaluate the support provided by outpatient dermatology consultations to such patients and to assess the most frequent dermatoses seen in this population.

METHODS

A retrospective 5-year study was conducted in a Portuguese hospital, which is a referral centre to several medical specialities for patients evacuated from Portuguese-speaking African countries, under a specific agreement of international cooperation in health.

RESULTS

In total, 116 patients, with a mean age of 38 years, were evaluated. In total, 47 dermatoses were identified, with the 6 most common being fungal infections (12.1%), eczema (9.5%), dyschromias (8.6%), xerosis (6.9%), acne (6%) and hair disorders (6%).

CONCLUSIONS

This increased knowledge about the most frequent dermatoses in this population, along with their manifestations and the factors that influence them should allow better diagnosis and therapy.

Hydrochlorothiazide use and the risk of skin cancer in patients with hypertensive disorder: a nationwide retrospective cohort study from Korea

BACKGROUND/AIMS

Recent studies have shown a cumulative dose-dependent association between the use of hydrochlorothiazide (HCTZ) and skin cancer, including melanoma and non-melanoma skin cancer (NMSC) in Western Europe. However, whether this pattern is present in East Asia countries is unknown. The aim of this study was to examine the association between HCTZ use and the risk of skin cancer among a cohort of hypertensive patients in South Korea.

METHODS

This was a retrospective, population-based cohort study using the database from the Health Insurance Review and Assessment Service between January 1, 2007 and June 30, 2017 in South Korea. We identified patients diagnosed with melanoma and NMSC in the cohorts of essential hypertensive patients who were treated with HCTZ or antihypertensive agents other than HCTZ. Using Cox proportional hazards regression models, the hazard ratios (HR) for skin cancer associated with HCTZ users were calculated.

RESULTS

The risk of melanoma was significantly lower in HCTZ-users compared with non-HCTZ users (HR, 0.85; 95% confidence interval [CI], 0.75 to 0.97; p = 0.016), and the risk of NMSC was lower in the HCTZ users but no statistically significant association was seen (HR, 0.96; 95% CI, 0.91 to 1.02; p = 0.236). High cumulative doses (≥ 50,000 mg) of HCTZ were associated with decreased risk of both NMSC (HR, 0.20; 95% CI, 0.10 to 0.38; p < 0.001) and melanoma (HR, 0.18; 95% CI, 0.04 to 0.70; p = 0.001), respectively.

CONCLUSION

High cumulative use of HCTZ may have a chemopreventive effect against the development of melanoma and NMSC with clear cumulative dose-response and duration-response relationships in South Korea.

Psoriatic Disease in the US Latino Population: A Comprehensive Review

Current evidence suggests that there are notable differences in the severity of psoriasis between racial and ethnic groups. While the US Latino population is growing rapidly, there is little research on the various factors impacting disease severity in this minority population. This review evaluates the current evidence on psoriasis in Latinos within the US. Psoriasis affects the US Latino population at a lower prevalence, with more severe disease and a greater quality-of-life impact than their White counterparts. In addition, Latinos with psoriasis experience higher rates of comorbidities, such as depression, obesity, and diabetes compared with Whites. There is evidence showing non-inferior or better response to systemic treatments, such as etanercept, secukinumab, and brodalumab, in this population. The combination of barriers to care and lack of involvement in research limit the current understanding of the mechanisms responsible for the pathologic outcomes and the environmental and social disparities observed. Future studies that reflect the growing proportion of minorities in the US may help close these knowledge gaps and improve care.

Melanogenic Difference Consideration in Ethnic Skin Type: A Balance Approach Between Skin Brightening Applications and Beneficial Sun Exposure

Human skin demonstrates a striking variation in tone and color that is evident among multiple demographic populations. Such characteristics are determined predominantly by the expression of the genes controlling the quantity and quality of melanin, which can alter significantly due to the presence of small nucleotide polymorphism affecting various steps of the melanogenesis process and generally linked to the lighter skin phenotypes. Genetically determined, constitutive skin color is additionally complemented by the facultative melanogenesis and tanning responses; with high levels of melanin and melanogenic factors broadly recognized to have a protective effect against the UVR-induced molecular damage in darker skin. Long-term sun exposure, together with a genetic makeup responsible for the ability to tan or the activity of constitutive melanogenic factors, triggers defects in pigmentation across all ethnic skin types. However, sun exposure also has well documented beneficial effects that manifest at both skin homeostasis and the systemic level, such as synthesis of vitamin D, which is thought to be less efficient in the presence of high levels of melanin or potentially linked to the polymorphism in the genes responsible for skin darkening triggered by UVR. In this review, we discuss melanogenesis in a context of constitutive pigmentation, defined by gene polymorphism in ethnic skin types, and facultative pigmentation that is not only associated with the capacity to protect the skin against photo-damage but could also have an impact on vitamin D synthesis through gene polymorphism. Modulating the activities of melanogenic genes, with the focus on the markers specifically altered by polymorphism combined with differential requirements of sun exposure in ethnic skin types, could enhance the applications of already existing skin brightening factors and provide a novel approach toward improved skin tone and health in personalized skincare.

The Surprising Effect of Phenformin on Cutaneous Darkening and Characterization of Its Underlying Mechanism by a Forward Chemical Genetics Approach

Melanin in the epidermis is known to ultimately regulate human skin pigmentation. Recently, we exploited a phenotypic-based screening system composed of ex vivo human skin cultures to search for effective materials to regulate skin pigmentation. Since a previous study reported the potent inhibitory effect of metformin on melanogenesis, we evaluated several biguanide compounds. The unexpected effect of phenformin, once used as an oral anti-diabetic drug, on cutaneous darkening motivated us to investigate its underlying mechanism utilizing a chemical genetics approach, and especially to identify alternatives to phenformin because of its risk of severe lactic acidosis. Chemical pull-down assays with phenformin-immobilized beads were performed on lysates of human epidermal keratinocytes, and subsequent mass spectrometry identified 7-dehydrocholesterol reductase (DHCR7). Consistent with this, AY9944, an inhibitor of DHCR7, was found to decrease autophagic melanosome degradation in keratinocytes and to intensely darken skin in ex vivo cultures, suggesting the involvement of cholesterol biosynthesis in the metabolism of melanosomes. Thus, our results validated the combined utilization of the phenotypic screening system and chemical genetics as a new approach to develop promising materials for brightening/lightening and/or tanning technologies.

Common Skin Disorders in Pediatric Skin of Color

Children with skin of color represent a large proportion of the pediatric population. There are numerous skin conditions that commonly occur in this population, including but not limited to acne, atopic dermatitis, pityriasis alba, tinea versicolor, progressive macular hypomelanosis, traction alopecia, and confluent and reticulated papillomatosis. This article highlights the clinical presentations of these conditions in skin of color and briefly addresses pathophysiology and treatment modalities.

Prevalence of pigmentary disorders: A cross-sectional study in public hospitals in Durban, South Africa

Background

Pigmentary disorders are common in patients with skin of color and one of the top five most common dermatologic diagnoses in individuals of African descent. Little is known about the spectrum of pigmentary disorders in South Africa’s second largest province, KwaZulu Natal.

Objective

This study aimed to determine the profile of pigmentary disorders in patients at five outpatient public hospital skin clinics in Durban, South Africa.

Methods

We collected data related to age, sex, ethnicity, and skin dyspigmentation diagnosis in a cross-sectional descriptive study of all dermatology patients at five public hospitals in Durban, South Africa between January 1 and March 31, 2015. The diagnosis was made on the basis of clinical grounds, supported by relevant laboratory investigations or histopathology where necessary. Only data relating to patients’ first visit were recorded and captured using a Microsoft Excel 2007 spreadsheet.

Results

A total of 304 patients, the majority of whom were African women (n = 230; 75.8%), were included in the study. The three most common pigmentary diagnoses included vitiligo, postinflammatory hyperpigmentation, and melasma.

Conclusion

Dyschromias are the third most common dermatologic diagnosis in Durban, KwaZulu-Natal province, South Africa. The most common subtypes of pigmentary disorders include (in order of frequency) vitiligo, postinflammatory hyperpigmentation, and melasma.

Iatrogenic tattoos after acupuncture: successful outcome after treatment with QS Ruby Laser: A case report and review of literature

Background and Aims

Acupuncture has become a substantial part of medical practice in Switzerland. So far, only few cases of accidental tattoo after acupuncture have been reported, which were all caused by acupuncture needles that had been left in the skin and led to local argyrosis.

Case

We report the case of a 31-year-old female who developed gray-brown macules after acupuncture. Over 5 months, she had received acupuncture on the same spots one to two times per week and the macules had gradually become darker and had increased in size. The needles used were disposable, contained nickel and were not left in the skin for over 30 minutes. The patient was of Fitzpatrick skin phototype II and showed several grayish-brown macules with an average diameter of around 5mm in the region of glabella, nucha and dorsum pedis. We treated the lesions with a quality-switched ruby laser (694 nm) with a fluence between 3 and 5.5 J/cm², a spot size of 4 or 6 mm and in intervals of 8 to 23 weeks up to a complete elimination of the hyperpigmentation within 11 laser sessions.

Conclusion

In synopsis with the anamnesis, the clinical aspect and the therapeutic course, we interpreted the hyperpigmentary spots as a combination of iatrogenic tattooing with nickel and deposition of hemosiderin as well as melanin due to repeated mechanical manipulation and UV exposure of the skin. Furthermore, we hereby show the validity of the quality-switched ruby laser in the removal of accidental hyperpigmentation in skin phototype II.

Transcriptomic Network Interactions in Human Skin Treated with Topical Glucocorticoid Clobetasol Propionate

Glucocorticoids are the most frequently used anti-inflammatory drugs in dermatology. However, the molecular signature of glucocorticoids and their receptor in human skin is largely unknown. Our validated bioinformatics analysis of human skin transcriptome induced by topical glucocorticoid clobetasol propionate (CBP) in healthy volunteers identified numerous unreported glucocorticoid-responsive genes, including over a thousand noncoding RNAs. We observed sexual and racial dimorphism in the CBP response including a shift toward IFN-α/IFN-γ and IL-6/Jak/Signal transducer and activator of transcription (STAT) 3 signaling in female skin; and a larger response to CBP in African-American skin. Weighted gene coexpression network analysis unveiled a dense skin network of 41 transcription factors including circadian Kruppel-like factor 9 (KLF9), and ∼260 of their target genes enriched for functional pathways representative of the entire CBP transcriptome. Using keratinocytes with Kruppel-like factor 9 knockdown, we revealed a feedforward loop in glucocorticoid receptor signaling, previously unreported. Interestingly, many of the CBP-regulated transcription factors were involved in the control of development, metabolism, circadian clock; and 80% of them were associated with skin aging showing similarities between glucocorticoid-treated and aged skin. Overall, these findings indicate that glucocorticoid receptor acts as an important regulator of gene expression in skin-both at the transcriptional and posttranscriptional level-via multiple mechanisms including regulation of noncoding RNAs and multiple core transcription factors.

Dermatologic Conditions in Transgender Populations

Transgender persons receiving gender-affirming hormone therapy and procedures may face specific skin conditions. Skin diseases in transgender patients often are underdiagnosed and underrecognized despite their important impact on quality of life and mental health. This article discusses pathophysiology, diagnosis, and treatment of common skin diseases in the transgender populations. For transmasculine patients, conditions include acne vulgaris and male pattern hair loss. For transfeminine patients, conditions include hirsutism, pseudofolliculitis barbae, and melasma. Postprocedural keloids and other cutaneous complications are discussed. Unique aspects of skin health in transgender persons should be considered in the context of multidisciplinary gender-affirming care.

Clinical and Biological Characterization of Skin Pigmentation Diversity and Its Consequences on UV Impact

Skin color diversity is the most variable and noticeable phenotypic trait in humans resulting from constitutive pigmentation variability. This paper will review the characterization of skin pigmentation diversity with a focus on the most recent data on the genetic basis of skin pigmentation, and the various methodologies for skin color assessment. Then, melanocyte activity and amount, type and distribution of melanins, which are the main drivers for skin pigmentation, are described. Paracrine regulators of melanocyte microenvironment are also discussed. Skin response to sun exposure is also highly dependent on color diversity. Thus, sensitivity to solar wavelengths is examined in terms of acute effects such as sunburn/erythema or induced-pigmentation but also long-term consequences such as skin cancers, photoageing and pigmentary disorders. More pronounced sun-sensitivity in lighter or darker skin types depending on the detrimental effects and involved wavelengths is reviewed.

Postinflammatory Hyperpigmentation: Epidemiology, Clinical Presentation, Pathogenesis and Treatment

Postinflammatory hyperpigmentation (PIH) is a reactive hypermelanosis that develops following cutaneous inflammation. Common causes of PIH include intrinsic skin conditions (e.g., acne and eczema) as well as external insults to the skin, such as burn injuries and dermatologic procedures. PIH more commonly occurs in individuals with darker skin, for whom it is often a source of significant psychological distress. Several therapeutic modalities are available for the treatment of PIH, including topical agents, chemical peels, and energy-based devices. We review the epidemiology, clinical presentation, pathogenesis, and treatment of PIH.

Replenishing Regulatory T Cells to Halt Depigmentation in Vitiligo

Vitiligo is a cutaneous autoimmune disease, especially devastating to patients with darker skin tones because of the contrast between unaffected and lesional skin. We studied immune cells infiltrating vitiligo skin and found very few regulatory T cells (Tregs). Vitiligo was not associated with a reduced frequency or function of circulating Tregs. To manipulate Treg function, we used mouse models expressing melanocyte-reactive TCRs, following changes in pelage color. We also isolated splenocytes to measure Treg function and evaluated cutaneous Treg abundance. Even small numbers of Tregs transferred into depigmenting mice could effectively interfere with depigmentation. The same holds true for treatment with rapamycin, readily translatable for use in human patients; such treatment may be well tolerated. Because vitiligo skin is relatively devoid of cells that produce the chemokine CCL22, whereas circulating Tregs express normal levels of its receptor CCR4, we overexpressed Ccl22 in the skin of vitiligo-prone mice to assess the resulting levels of depigmentation. Markedly reduced depigmentation was accompanied by Treg infiltration to the skin. With several options available to support a healthy balance between Tregs and effector T cells, the next challenge will be to render such treatment antigen specific and avoid general immunosuppression.