Dark Skin Complexion Research Articles

Navigating Complexities: Vitamin D, Skin Pigmentation, and Race.

Vitamin D plays a critical role in many physiological functions, including calcium metabolism and musculoskeletal health. This commentary aims to explore the intricate relationships among skin complexion, race, and 25-hydroxyvitamin D (25[OH]D) levels, focusing on challenges the Endocrine Society encountered during clinical practice guideline development. Given that increased melanin content reduces 25(OH)D production in the skin in response to UV light, the guideline development panel addressed the potential role for 25(OH)D screening in individuals with dark skin complexion. The panel discovered that no randomized clinical trials have directly assessed vitamin D related patient-important outcomes based on participants' skin pigmentation, although race and ethnicity often served as presumed proxies for skin pigmentation in the literature. In their deliberations, guideline panel members and selected Endocrine Society leaders underscored the critical need to distinguish between skin pigmentation as a biological variable and race and ethnicity as socially determined constructs. This differentiation is vital to maximize scientific rigor and, thus, the validity of resulting recommendations. Lessons learned from the guideline development process emphasize the necessity of clarity when incorporating race and ethnicity into clinical guidelines. Such clarity is an essential step toward improving health outcomes and ensuring equitable healthcare practices.

When Educational Images Don't Reflect the Population: Phlegmasia Cerulea Dolens, a Case Report.

Phlegmasia cerulea dolens (PCD) is an uncommon, potentially life-threatening complication of acute deep venous thromboses that requires a timely diagnosis. The name of the condition, the visual diagnostic criteria, and the preponderance of cases in the literature referencing findings exclusively in patients with lighter skin complexions means that PCD may not be on the differential diagnosis for the patient with more melanated skin who is experiencing this time-sensitive vascular emergency. We describe one case of PCD in a patient with darker skin complexion and the importance of identifying clinical findings, regardless of skin color, given the paucity of reference images for PCD in darker complected patients. Our literature review yielded 60 case reports for PCD. Only two papers included images referencing patients of color. Accurate diagnosis requires recognition of diagnostic findings, which may vary significantly between phenotypically distinct populations. Many pathognomonic physical exam findings rely on descriptors based on presentation in phenotypically white patients.

Diagnostic Value of Dermoscopic Structures in Predicting Superficial Basal Cell Carcinoma in the Skin of Color.

Basal cell carcinoma (BCC) manifests different dermoscopic patterns in individuals with dark skin complexion compared to those with fair skin types. This study aimed to investigate the diagnostic utility of dermoscopy in discerning superficial BCC from other types of BCC, specifically in patients with dark skin complexion. This cross-sectional study focuses on patients diagnosed with BCC who were referred for skin biopsy between July 2020 and September 2022. Initially, the demographic characteristics of patients, clinical attributes of lesions, and pathological sub-types of BCC were documented. Subsequently, videodermoscopy was employed to capture comprehensive views and dermoscopic images of the lesions. Univariate logistic regression analysis was then utilized to assess the reliability of dermoscopic structures in distinguishing superficial BCC from other BCC types. Last, the study evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of dermoscopy in the differentiation of superficial BCC from other BCC sub-types. The study enrolled 49 patients diagnosed with BCC, with a mean age of 66.22 ± 10.41 years. The most prevalent pathological sub-type observed was nodular (53.1%). Dermoscopy exhibited a higher specificity compared to the naked eye in the differentiation of superficial BCC from other types (55% vs. 35%, respectively). Univariate analysis revealed a significant association between spoke-wheel structures and superficial BCC (P = 0.02, odds ratio = 7.2, 95% confidence interval = 1.35-38.32). Dermoscopy exhibited superior specificity compared to the naked eye in differentiating superficial BCC from other BCC types. Notably, the spoke-wheel structure demonstrated the most robust correlation with superficial BCC.

Leveraging machine learning to evaluate factors influencing vitamin D insufficiency in SLE patients: A case study from southern Bangladesh.

Vitamin D insufficiency appears to be prevalent in SLE patients. Multiple factors potentially contribute to lower vitamin D levels, including limited sun exposure, the use of sunscreen, darker skin complexion, aging, obesity, specific medical conditions, and certain medications. The study aims to assess the risk factors associated with low vitamin D levels in SLE patients in the southern part of Bangladesh, a region noted for a high prevalence of SLE. The research additionally investigates the possible correlation between vitamin D and the SLEDAI score, seeking to understand the potential benefits of vitamin D in enhancing disease outcomes for SLE patients. The study incorporates a dataset consisting of 50 patients from the southern part of Bangladesh and evaluates their clinical and demographic data. An initial exploratory data analysis is conducted to gain insights into the data, which includes calculating means and standard deviations, performing correlation analysis, and generating heat maps. Relevant inferential statistical tests, such as the Student's t-test, are also employed. In the machine learning part of the analysis, this study utilizes supervised learning algorithms, specifically Linear Regression (LR) and Random Forest (RF). To optimize the hyperparameters of the RF model and mitigate the risk of overfitting given the small dataset, a 3-Fold cross-validation strategy is implemented. The study also calculates bootstrapped confidence intervals to provide robust uncertainty estimates and further validate the approach. A comprehensive feature importance analysis is carried out using RF feature importance, permutation-based feature importance, and SHAP values. The LR model yields an RMSE of 4.83 (CI: 2.70, 6.76) and MAE of 3.86 (CI: 2.06, 5.86), whereas the RF model achieves better results, with an RMSE of 2.98 (CI: 2.16, 3.76) and MAE of 2.68 (CI: 1.83,3.52). Both models identify Hb, CRP, ESR, and age as significant contributors to vitamin D level predictions. Despite the lack of a significant association between SLEDAI and vitamin D in the statistical analysis, the machine learning models suggest a potential nonlinear dependency of vitamin D on SLEDAI. These findings highlight the importance of these factors in managing vitamin D levels in SLE patients. The study concludes that there is a high prevalence of vitamin D insufficiency in SLE patients. Although a direct linear correlation between the SLEDAI score and vitamin D levels is not observed, machine learning models suggest the possibility of a nonlinear relationship. Furthermore, factors such as Hb, CRP, ESR, and age are identified as more significant in predicting vitamin D levels. Thus, the study suggests that monitoring these factors may be advantageous in managing vitamin D levels in SLE patients. Given the immunological nature of SLE, the potential role of vitamin D in SLE disease activity could be substantial. Therefore, it underscores the need for further large-scale studies to corroborate this hypothesis.

Prevalence of Tooth Shade and its Correlation with Skin Colour- A cross-sectional study

Background: The significance of aesthetics has become a significant concern in recent years. One of the elements that determine one's beauty is the colour of one's teeth. Gender, age, eyes and skin colour as well as other variables have all been found to impact tooth shade in studies. Aim: To find out that how tooth shade relates to the skin colour. Methods: This cross-sectional, analytical research was performed in the Operative Dentistry Department. Over a year, 250 patients between the ages of 18 and 68, of either gender, participated. The complexion of the skin on the face was assessed and split into three skin tone categories (Fair, Medium, and Dark). Results: SPSS version 20.0 was used to analyse the data. There were 162 males and 88 females among the 250 participants. 45.2% of patients was Value 2, which was followed by Value 3 (31.2%), Value 1 (13.2%), and Value 4. (10%). Value 5 had no shadows recorded. The skin tone of the male participants was medium, whereas the skin tone of the female participants was fair. Conclusion: A lower tooth shade value was found in people with fair skin, resulting in teeth that looked darker in colour. A greater tooth shade value was found in those with a darker skin complexion, leading in teeth that seemed lighter in colour. When comparing the tooth colours of men and women, men had a lower shade value while women had a greater shade value. The teeth of the older people were darker in colour because of a significant decrease in lower tooth shade value. Keywords: Skin tone, Shade guide, Tooth colour, gender

Prevalence of vitamin D deficiency among South Indian pregnant women.

ABSTRACTBackground:Deficiency of vitamin D is widespread across the globe. Expectant women are one of the most vulnerable groups for vitamin D deficiency (VDD). Even in South India with abundance of sunlight, pregnant women are believed to be at a high risk of this deficiency. The objectives of this study are to assess the prevalence of VDD in antenatal women, associate it with modifiable risk factors and evaluate its correlation with low birth weight.Methods:This cross-sectional study was conducted in a tertiary care hospital, in Chennai, in 100 pregnant women in their last trimester on the basis of inclusion and exclusion criteria and their vitamin D and calcium levels were assessed. A detailed history regarding physical activity, diet, and sun exposure were collected and results were analyzed.Results:The point prevalence of VDD (serum 25-hydroxyvitamin D (25(OH) D) level <20 ng/mL) among antenatal women in our study is 62%. Univariate analysis revealed that sun exposure and socioeconomic status were the significant factors associated with higher percentage of VDD. Linear regression analysis showed that only sun exposure was a significant predictor for serum 25(OH) D levels. VDD is also associated with increased risk of low-birth-weight babies.Conclusion:VDD is highly prevalent among pregnant women in South India leading to adverse health consequences in the mother and offspring. Less physical activity, decreased sun exposure, darker skin complexion, lower socioeconomic status and lack of awareness are the major risk factors associated with VDD in our study population.

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

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

Pharmacologic manipulation of skin pigmentation.

Skin complexion is among the most recognizable phenotypes between individuals and is mainly determined by the amount and type of melanin pigment deposited in the epidermis. Persons with dark skin complexion have more of a brown/black pigment known as eumelanin in their epidermis whereas those with fair skin complexions have less. Epidermal eumelanin acts as a natural sunblock by preventing incoming UV photons from penetrating into the skin and therefore protects against UV mutagenesis. By understanding the signaling pathways and regulation of pigmentation, strategies can be developed to manipulate skin pigmentation to improve UV resistance and to diminish skin cancer risk.

CAMP-mediated regulation of melanocyte genomic instability: A melanoma-preventive strategy.

Malignant melanoma of the skin is the leading cause of death from skin cancer and ranks fifth in cancer incidence among all cancers in the United States. While melanoma mortality has remained steady for the past several decades, melanoma incidence has been increasing, particularly among fair-skinned individuals. According to the American Cancer Society, nearly 10,000 people in the United States will die from melanoma this year. Individuals with dark skin complexion are protected damage generated by UV-light due to the high content of UV-blocking melanin pigment in their epidermis as well as better capacity for melanocytes to cope with UV damage. There is now ample evidence that suggests that the melanocortin 1 receptor (MC1R) is a major melanoma risk factor. Inherited loss-of-function mutations in MC1R are common in melanoma-prone persons, correlating with a less melanized skin complexion and poorer recovery from mutagenic photodamage. We and others are interested in the MC1R signaling pathway in melanocytes, its mechanisms of enhancing genomic stability and pharmacologic opportunities to reduce melanoma risk based on those insights. In this chapter, we review melanoma risk factors, the MC1R signaling pathway, and the relationship between MC1R signaling and DNA repair.

Vitamin D status and dental caries in healthy Swedish children

BackgroundVitamin D is crucial for mineralized tissue formation and immunological functions. The purpose of this study was to evaluate the association between vitamin D status and dental status in healthy children with vitamin D supplementation in infancy and at 6 years of age.MethodEight-year-old children who had participated in a vitamin D intervention project when they were 6 years old were invited to participate in a dental follow-up study. They had fair or darker skin complexion and represented two geographically distant parts of Sweden. 25-hydroxy vitamin D in serum had been measured at 6 years of age and after a 3-month intervention with 25, 10 or 2 (placebo) μg of vitamin D3 per day. Two years later, caries and enamel defects were scored, self-reported information on e.g., oral behavior, dietary habits and intake of vitamin D supplements was collected, and innate immunity peptide LL37 levels in saliva and cariogenic mutant streptococci in tooth biofilm were analyzed. The outcome variables were caries and tooth enamel defects.ResultsDental status was evaluated in 85 of the 206 children in the basic intervention study. Low vitamin D levels were found in 28% at baseline compared to 11% after the intervention, and 34% reported continued intake of vitamin D supplements. Logistic regression supported a weak inverse association between vitamin D status at 6 years of age and caries 2 years later (odds ratio 0.96; p = 0.024) with minor attenuation after an adjustment for potential confounders. Multivariate projection regression confirmed that insufficient vitamin D levels correlated with caries and higher vitamin D levels correlated with being caries-free. Vitamin D status at 6 years of age was unrelated to enamel defects but was positively associated with saliva LL37 levels.ConclusionAn association between vitamin D status and caries was supported, but it was not completely consistent. Vitamin D status at 6 years of age was unrelated to enamel defects but was positively associated with LL37 expression.Trial registrationThe basic intervention study was registered at ClinicalTrials.gov with register number NCT01741324 (www.clinicaltrials.gov/ct2/show/NCT02347293) on November 26, 2012.

The significance of age group, gender and skin complexion in relation to the clinical distribution of developmental oral mucosal alterations in 5-13 year-old children.

To describe the relationship and impact of age group, gender and skin complexion on the prevalence and clinical distribution of oral mucosal alterations of developmental origin (OMA-DO) among school children aged 5-13 years. A randomized representative national survey of Jordanian school children including all Country geographic areas was performed. Cut-off age that significantly correlated with presence and distribution of OMA-DO was identified (ROC curve). Skin complexion was classified into light/fair, intermediate/tan, dark/brown based on skin complexion index. Chi square test with P value≤0.05 was used for significance of correlations. Two thousand two hundred and fifty one children were clinically examined. The average age that significantly correlated with prevalence and distribution of OMA-DO was 9.9 years. Female gender was significantly correlated with four OMA-DO: leukoedema (L), linea Alba (LA), Fordyce's granules (FG), commissural lip pits (CLP) and wider distribution of racial pigmentations (RP) (P<0.05, χ2 test). Older age group (9.9-13 years) was significantly correlated with 7 OMA-DO: L, LA, FG, frenal tag, CLP, mandibular and maxillary tori (MT) as well as wider clinical distribution of RP, FG, L (P<0.05 χ2 test). Dark skin complexion significantly correlated with 5 OMA-DO: L, LA, FG, RP, MT and wider clinical distribution of RP (P<0.02, χ2 test). Increased prevalence and wider clinical distribution of OMA-DO are significantly associated with older age group of 9.9-13 years, female gender, and dark skin complexion. Oral health care provides are encouraged to be familiar with these correlations. This knowledge is expected to improve OMA-DO diagnosis and clinical management. Continuous education programs in this field are recommended.

Oral pyridoxine can substitute for intravenous pyridoxine in managing patients with severe poisoning with isoniazid and rifampicin fixed dose combination tablets: a case report

BackgroundFixed drug combination of isoniazid and rifampicin is a rare cause of poisoning even in endemic countries for tuberculosis infection. Severe poisoning can cause severe morbidity and mortality if not treated promptly. Though intravenous pyridoxine is the preferred antidote for severe standard isoniazid poisoning it is not freely available even in best of care centers. We describe a case of severe poisoning with fixed drug combination of isoniazid and rifampicin successfully managed with oral pyridoxine at national hospital of Sri Lanka.Case presentationA 22 year old, Sri Lankan female presented to a local hospital 1 h after self-ingestion of 28 tablets of fixed drug combination of isoniazid and rifampicin which contained 4.2 g of standard isoniazid and 7.2 g of rifampicin. One and half hours after ingestion she developed generalized tonic–clonic seizure with loss of consciousness. She was given intravenous diazepam 5 mg immediately and transferred to national hospital of Sri Lanka, for further care. Upon arrival to tertiary care hospital in 3.5 h of poisoning she had persistent vomiting, dizziness and headache. On examination, she was drowsy but arousable, orange–red discoloration of the body was noted even with the dark skin complexion. She also had orange–red colour urine and vomitus. Pulse rate was 104 beats/min, blood pressure 130/80 mmHg, respiratory rate was 20 breaths/min. The arterial blood gas analysis revealed compensated metabolic acidosis and mildly elevated lactic acid level. Considering the clinical presentation with neurological toxicity and the large amount of isoniazid dose ingested, crushed oral tablets of pyridoxine 4.2 g (equal to standard isoniazid dose ingested) administered immediately via a nasogastric tube since intravenous preparation was not available in the hospital. Simultaneously forced diuresis using intravenous 0.9% saline was commenced in order to enhance excretion of toxic metabolites via kidneys. She had no recurrence of seizures but had acute liver injury subsequently which gradually improved with supportive care. Her liver functions found to be completely normal 1 week after the discharge.ConclusionsPoisoning with fixed drug combination of isoniazid and rifampicin tablets is rare but can cause severe morbidity and mortality if not treated promptly. Oral pyridoxine can substitute for intravenous pyridoxine with almost similar efficacy at a low cost in managing patients with acute severe standard isoniazid poisoning in resource poor setting.

Cutaneous T-cell lymphoma in Saudi Arabia: retrospective single-center review.

BACKGROUNDCutaneous T-cell lymphoma (CTCL) is an uncommon disease with various clinical presentations. The hypopigmented type is more common in individuals with a dark skin complexion. Moreover, childhood CTCL is more common in Mediterranean populations in comparison to the West.OBJECTIVETo describe CTCL in the Saudi population.DESIGNA retrospective collection of data on all cases of CTCL from 2010–2016.SETTINGDermatology clinic at a tertiary center in Riyadh, Saudi Arabia.PATIENTS AND METHODSWe collected data on all cases of CTCL diagnosed clinically and confirmed pathologically.MAIN OUTCOME MEASURE(S)The number of cases of CTCL, gender, age at diagnosis and clinical subtypes.RESULTSThe most common presentation among 125 patients was the classic type (patches and plaques) followed by the hypopigmented and poikilodermatous variants. Males were 58% of the population (n=72). The median age at diagnosis was 41 years and the range was 5 to 86 years. Thirteen percent were younger than 20 years of age.CONCLUSIONHypopigmented and poikilodermatous types of CTCL are more common in our population than in the West.LIMITATIONRetrospective, single-center data may not be generalizable since difficult cases are more likely to be referred to a tertiary center.

Relationship of Facial Skin Complexion with Gingiva and Tooth Shade on Smile Attractiveness

Background: A Smile is the most visible record of the dentist care. There are three important factors that play an important role when planning and designing any fixed or removable aesthetic and functional restoration. They include; Facial skin complexion, gingival tissue pigmentation and Tooth shade respectively. Objective: The objective of this study was to determine a relationship of facial skin complexion with the gingiva and tooth shade on smile attractiveness. Methods: This cross-sectional, analytical study was conducted at the Operative Dentistry Department of Altamash Institute of Dental Medicine, Karachi, Pakistan. It included 250 patients from 18-68 years of age of either gender over a period of 1 year from 15th October 2014 to 15th October 2015 respectively. The Facial skin complexion was determined by the Ideal Balance Quick Stick Makeup shade guide manufactured by (Revlon Foundation Makeup Shade Guide, USA) and was divided into three skin tone groups (Fair, Medium and Dark) respectively. The intensity and location of Gingival tissue pigmentation was determined by Dummett-Oral Pigmentation Index (DOPI). Lastly, the shade of middle one-third of labial surface of maxillary teeth was recorded visually with the help of a Vitapan 3D- Master shade Guide (VITA Zahnfabrik, Bad Sackingen, Germany) under a standardized natural day lightening procedure. Results: The data was analyzed by using the SPSS version 20.0 (Statistical Package for Social Sciences for Windows, SPSS Inc. Chicago). Out of 250 participants; 162 were male and 88 were female participants. The most common shade recorded was 2M1 (14.4%) followed by 3M2 (13.6%), 2L1.5 (10.8%) and 2R1.5 (9.6%). Among the males, the most common shade recorded was 3M2 (18.5%) and among the females the most common shade recorded was 2M1 (21.5%). The Value 2 shade was commonly seen in (45.2%), followed by Value 3; (31.2%), Value 1; (13.2%) and Value 4 (10.1%) of patients; However no shade was recorded for Value 5 shade group. The Medium skin complexion was more commonly seen in 60.4% of male participants and a Fair skin complexion was seen in 60.2% of female participants respectively. Conclusion: The prevalence of gingival tissue pigmentation was more found on the attached gingiva and interdental papilla (class II) and more severe in dark-skinned people and lesser in fair-skinned people. People having a fair skin complexion had a lower tooth shade value with the teeth appearing more darker in color whereas, people having a darker skin complexion had a higher tooth shade value with the teeth appearing more lighter in color. The respective male gender had a lower tooth shade value whereas females had a higher tooth shade value. The aging patients had a darker shade of teeth because of a lower tooth shade value respectively.

Index of Suspicion * Case 1: Leg Cramps, Hand Spasms, Diarrhea, and Substantial Weight Loss in a 12 Year Old * Case 2: Hypothermia, Hypoglycemia, and Hyperbilirubinemia in a Neonate * Case 3: Recurrent Fevers, Abdominal Pain, and Cervical Lymphadenopathy in a 7 Year Old

A 12-year-old previously healthy boy presents with leg cramps for 2 weeks and spasms of his hands since yesterday. He also complains of nausea, bloating, epigastric pain, and recurrent watery and loose stools for 1 month. Currently, he is taking lansoprazole for epigastric pain without any relief. He also has a history of involuntary weight loss of 10 lb over 2 months. The family history contains no findings of note. On physical examination, the boy's weight is 36 kg (25th percentile) and height is 140 cm (10th percentile) and he exhibits a positive Trousseau sign and negative Chvostek sign. Remaining physical signs, including on abdominal examination, are normal. Laboratory evaluation shows hypocalcemia (total calcium of 5.3 mg/dL [1.3 mmol/L], ionized calcium of 2 mg/dL [0.5 mmol/L], and corrected calcium of 6.1 mg/dL [1.5 mmol/L]) as well as hypoalbuminemia (3 g/dL [30 g/L]). Serum magnesium measures 1.6 g/dL. CBC shows Hgb of 9.3 g/dL (93 g/L), Hct of 29% (0.29), WBC count of 9.9×103/μL (9.9×109/L), platelet count of 471×103/μL (471×109/L), mean corpuscular volume of 67 fL, and reticulocyte count of 1% (0.01). Results of the iron studies are consistent with iron deficiency anemia, with a serum iron concentration of 6 μg/dL (1.07 μmol/L) (31 to 144 μg/dL [5.5 to 25.8 μmol/L]), transferrin saturation of 3% (0.3), and serum ferritin less than 5 ng/mL (11.23 pmol/L) (21 to 275 ng/mL [47.2 to 617.9 pmol/L]). ESR is 46 mm/h and CRP is 9.5 mg/dL (normal <0.05 mg/dL). His serum 25-hydroxyvitamin D concentration is low at 5.7 ng/mL (14.2 nmol/L) (normal, 32 to 100 ng/mL [79.9 to 249.6 nmol/L]) and serum parathyroid hormone, urine calcium, and creatinine values are within normal limits. His tetany and hypocalcemia resolve with calcium replacement. Additional evaluation leads to the diagnosis. …

Nine-Year Incidence and Risk Factors for Pterygium in the Barbados Eye Studies

To present 9-year incidence data and associated risk factors for pterygium among black participants in the Barbados Eye Studies. Population-based incidence study. A total of 1888 black participants, aged 40 to 84 years, who were free of pterygium at baseline and received an ophthalmologic study examination at the 9-year follow-up. Age and sex-specific 9-year incidence of pterygium is presented. Risk factors were initially identified using Mantel-Haenszel analyses, and significant factors (P<0.10) were subsequently included in multivariate logistic regression models. Odds ratios (OR) and 95% confidence intervals (CI) are provided. Development of pterygium, defined as the presence of a raised fleshy growth that crosses the limbus and encroaches onto the clear cornea. The 9-year incidence of pterygium was 11.6% (95% CI, 10.1-13.1), with no clear pattern with increasing age and no statistically significant differences between genders. Multivariate logistic regression analyses indicated that having a lifetime outdoor job location was positively associated with the development of pterygium (OR = 1.51; 95% CI, 1.05-2.16), whereas darker skin color (OR = 0.67; 95% CI, 0.46-0.97) and use of any prescription lenses (OR = 0.58; 95% CI, 0.42-0.81) were found to be protective factors. The incidence of pterygium was high in this population, for an average of 1.3% per year. Working outdoors increased the risk 1.5-fold, whereas having a darker skin complexion and using eyewear for either reading or distance substantially decreased the risk of developing pterygium. These data suggest that absorption of ultraviolet light plays a role in this condition and that preventive strategies are needed to decrease the burden of pterygium development in this and other populations. The authors have no proprietary or commercial interest in any materials discussed in this article.

P53 codon 72 Pro homozygosity increases the risk of cutaneous melanoma in individuals with dark skin complexion and among noncarriers of melanocortin 1 receptor red hair variants

p53 has a common polymorphism at amino acid 72, encoding either arginine or proline. p53Arg and p53Pro exhibit differences in various biological activities, such as cell-cycle arrest and induction of apoptosis. Numerous epidemiological studies have examined the role of this polymorphism in several human malignancies, including cutaneous cancers, with contradictory results. To investigate the germline frequency of p53 codon 72 polymorphism in malignant melanoma in a Mediterranean population, and to examine possible associations with various clinicopathological factors. In this hospital-based case-control study we used allele-specific polymerase chain reaction for p53 codon 72 genotyping in blood specimens from 107 Greek patients with sporadic cutaneous melanoma and 145 healthy controls. After adjustment for age, sex and phototype the Pro/Pro genotype was associated with increased risk for cutaneous melanoma compared with the Arg/Arg genotype (adjusted odds ratio, OR 3.17, 95% confidence interval, CI 1.03-9.78). This correlation was more pronounced in subjects with phototypes III or IV (adjusted OR 9.56, 95% CI 1.56-58.46), dark skin (adjusted OR 10.96, 95% CI 1.64-73.28), dark eyes (adjusted OR 8.86, 95% CI 1.69-46.52) and dark hair (adjusted OR 3.17, 95% CI 1.01-9.95), and among noncarriers of melanocortin 1 receptor gene (MC1R) red hair polymorphisms (adjusted OR 2.99, 95% CI 1.02-8.78). p53 codon 72 Pro/Pro genotype could be a risk factor for the development of melanoma in the Greek population, especially in subgroups with darker skin pigmentation, as well as among noncarriers of the MC1R red hair polymorphic variants.

Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

Previous studies of vitamin D status in pediatric patients with inflammatory bowel disease have revealed conflicting results. We sought to report (1) the prevalence of vitamin D deficiency (serum 25-hydroxy-vitamin D concentration < or = 15 ng/mL) in a large population with inflammatory bowel disease, (2) factors predisposing to this problem, and (3) its relationship to bone health and serum parathyroid hormone concentration. A total of 130 patients (8-22 years of age) with inflammatory bowel disease, 94 with Crohn disease and 36 with ulcerative colitis, had serum 25-hydroxy-vitamin D, intact parathyroid hormone, and lumbar spine bone mineral density (using dual-energy x-ray absorptiometry) measured at Children's Hospital Boston. The prevalence of vitamin D deficiency was 34.6%. Mean serum 25-hydroxy-vitamin D concentration was similar in patients with Crohn disease and ulcerative colitis, 52.6% lower among patients with dark skin complexion, 33.4% lower during the winter months (December 22 to March 21), and 31.5% higher among patients who were taking vitamin D supplements. Serum 25-hydroxy-vitamin D concentration was positively correlated with weight and BMI z score, disease duration, and serum albumin concentration and negatively correlated with erythrocyte sedimentation rate. Patients with Crohn disease and upper gastrointestinal tract involvement were more likely to be vitamin D deficient than those without it. Serum 25-hydroxy-vitamin concentration was not associated with lumbar spine bone mineral density z score or serum parathyroid hormone concentration. Vitamin D deficiency is highly prevalent among pediatric patients with inflammatory bowel disease. Factors predisposing to the problem include having a dark-skin complexion, winter season, lack of vitamin D supplementation, early stage of disease, more severe disease, and upper gastrointestinal tract involvement in patients with Crohn disease. The long-term significance of hypovitaminosis D for this population is unknown at present and merits additional study.

Optimal management of recalcitrant disorders of hyperpigmentation in dark-skinned patients.

Alterations in skin pigmentation may often have a dramatic expression in individuals with a dark skin complexion and can be a source of significant emotional distress in these individuals. Hyperpigmented disorders such as melanosis (melasma), post-inflammatory hyperpigmentation, drug-induced hyperpigmentation, and erythema dyschromicum perstans tend to have a prolonged course and, in many cases, are refractory to treatment, further contributing to the psychological impairment of the affected patients. Melanosis, is a common form of facial pigmentation attributable to sunlight and hormonal factors. A range of treatment modalities, such as depigmenting agents, topical retinoids, and chemical peels in conjunction with rigorous sun protection, can improve the melanosis but the condition usually recurs. Combination regimens, including frequent applications of superficial- and medium-depth chemical peels, appear to be particularly effective and well tolerated in dark-skinned patients with melanosis. Post-inflammatory hyperpigmentation is the result of excess pigment deposition following an inflammatory skin disorder. Topical tretinoin, hydroquinone, azelaic acid, kojic acid, and glycolic acid peels have been employed with variable degrees of success. Drug-induced pigmentation is a frequent cause of acquired hypermelanosis, its clinical expression depending on the triggering molecule and the underlying pathogenetic mechanism. Identifying and discontinuing the offending agent is the main approach in this condition, although, recent reports have demonstrated the efficacy of Q-switched lasers in accelerating the pigment removal. Erythema dischromicum perstans is a characteristic dermal pigmentation occurring mainly in dark-skinned individuals. Immunomodulating agents, such as clofazimine and dapsone have been shown to lighten this disorder, although, the exact mode of action is not clear.