Dark Skin Type Research Articles

Psoriasiform dermatitis in a person of colour with chronic hepatitis B

AbstractA 43‐year‐old patient from Liberia presented with itching scaly plaques, impaired quality of life persisting for 9 months and intermittent joint pain in the knees. Personal and family history was unremarkable. Coexisting diagnoses included type 1 diabetes mellitus and liver cirrhosis due to chronic hepatitis B and D. The patient reported ongoing use of Tenofovir, Propranolol, Glargine and Aspart. Clinical examination showed disseminated brownish, partly confluent hyperkeratotic plaques distributed throughout the integument in a Fitzpatrick skin type V. A skin biopsy revealed histologically a psoriasiform dermatitis. Laboratory findings included lymphocytopenia and elevated liver values. Hepatitis B serology confirmed chronic hepatitis B. Considering the clinical and histopathological findings Psoriasis vulgaris was diagnosed and psoriatic arthritis was ruled out by a rheumatologist. After consulting with the hepatologist, systemic therapy with Apremilast was initiated. Despite an initial positive response, gastrointestinal side effects led to a switch to therapy with Tildrakizumab, with regular monitoring of transaminases and HBV DNA. Despite an initial positive treatment response, a secondary loss of efficacy occurred prompting a switch to Risankizumab. Psoriasis is a chronic inflammatory systemic disease significantly impacting quality of life, necessitating optimal long‐term management. In this case, therapy with Apremilast and biologic therapy targeting IL‐23 blockade, even with concurrent hepatitis B, was well tolerated and effective. However, the evidence on the safety of modern psoriasis therapies in known chronic infections remains limited. Noteworthy in this case report is the patient's dark skin type. Diagnosing inflammatory dermatoses in People of Colour is challenging due to less visible erythema and other clinical nuances, exacerbating the already poorer healthcare for People of Colour. This case aims to raise awareness about the need for increased representation of People of Colour in education, presentations and clinical trials to ensure better care for this patient population.

Hydrochlorothiazide increases risk of nonmelanoma skin cancer in an elderly Japanese cohort with hypertension: The Shizuoka study

Hydrochlorothiazide (HCT), a widely used hypertensive drug, has photocarcinogenic potential, leading to concerns about the development of nonmelanoma skin cancers (SCs) after intake. Despite substantial numbers of observational studies, the results remain inconsistent especially among Asian countries. To assess the incidence of nonmelanoma SCs in hypertensive Japanese HCT users compared with nonusers. A population-based, cohort nested, propensity score-matched study was conducted using the Shizuoka Kokuho database. All participants were patients aged ≥60years. Hazard ratios for SC incidence were calculated in the matched cohorts using the propensity scores of potential confounders, sex, age category, comorbidities, and administration of methotrexate, cyclosporin, and statins. The risk of SC was higher in HCT users than in nonusers (hazard ratio, 1.58; 95% confidence interval, 1.04-2.40), with preferential sun-exposed location and a tendency to develop squamous cell carcinoma, but not basal cell carcinoma or Bowen disease. No additional information was available from other than medical records. The data were confined to a Japanese population. HCT use increases the risk of SC in Japanese patients with hypertension and a dark skin type, highlighting the increased risk of SC among HCT users in the aging society worldwide.

Increasing Amount of Hair Reduction using Laser Correlates with Lower Probability of Recurrence in Patients with Pilonidal Disease

BackgroundHair at the gluteal cleft plays a key role in the development and recurrence of pilonidal disease (PD). We hypothesized that more hair reduction achieved using laser could correlate with lower chance of PD recurrence. MethodsPD patients who underwent laser epilation (LE) were categorized by Fitzpatrick skin type, hair color, and hair thickness. Photos taken at LE sessions were compared to determine hair reduction amount. LE sessions completed prior to the recurrences were recorded. Groups were compared using multivariate T-test. Results198 PD patients had mean age 18.1 ± 3.6 years. 21, 156, and 21 patients had skin types 1/2, 3/4, and 5/6, respectively. 47 patients had light- and 151 had dark-colored hair. 29 patients had fine hair, 129 medium, and 40 thick. Median follow-up was 217 days. 95%, 70%, 40%, and 19% of patients reached 20%, 50%, 75%, and 90% hair reduction after mean LE sessions of 2.6, 4.3, 6.6, 7.8 sessions, respectively. To reach 75% hair reduction, patients require a mean of 4.8–6.8 LE sessions, depending on different skin/hair characteristics. PD recurrence rate was 6%. Probability of recurrence after 20%, 50%, 75% hair reduction was decreased by 50%, 78%, 100%, respectively. Dark hair and skin type 5/6 were associated with higher recurrence rates. ConclusionPatients with dark-color and thick hair require more LE sessions to achieve certain degree of hair reduction. Patients with dark hair and skin type 5/6 were more likely to recur; more hair reduction correlated with lower chance of recurrence. Level of EvidenceLevel IV.

Children with atopic eczema experiencing increased disease severity in the pollen season more often have hay fever at a young age and a dark skin type.

Children with atopic eczema are known to experience seasonal variations in disease severity, with winter being the season in which severity generally increases. There is a lack of knowledge about the subgroup of children that experiences increased severity in spring and summer months. We aimed to investigate which phenotype characteristics best describe children flaring in the pollen season. A retrospective database analysis was conducted, including 110 children with difficult‐to‐treat atopic eczema aged 0–17 years. Relevant outcome parameters were extracted from medical records. In our population, 36% (n = 40/110) of children reported flares of atopic eczema in the pollen season. These children were more often sensitized to one or more types of pollen (73% [n = 29/40] vs. 28% [n = 10/36], p < 0.0001) and had more patient‐reported hay fever (70% [n = 28/40] vs. 19% [n = 7/36], p < 0.0001), compared with children who do not flare in the pollen season. Moreover, children flaring in the pollen season more often had a dark skin type (78% [n = 31/40] vs. 44% [n = 16/36], p = 0.003). Based on stepwise multivariable analyses, children flaring in the pollen season were characterized by the combination of younger age, hay fever, and dark skin type (C‐statistic: 0.86). In conclusion, patient‐reported flares in spring and summer are experienced by one‐third of children with difficult‐to‐treat atopic eczema. This phenotype can be characterized as young children having hay fever and a dark skin type and can be identified based on clinical parameters alone without the need to perform immunoglobulin E blood testing or skin prick tests.

Angiomas at the university hospital of Yalgado Ouedraogo in Ouagadougou, Burkina Faso: Epidemiological and clinical profile.

Angiomas are vascular abnormalities that affect less than 1% of the world's population. Data on these disorders in Africa are limited. The purpose of our work was to study the epidemiological and clinical aspects of angiomas in the Dermatology-Venerology Department of the University Hospital of Yalgado Ouedraogo in Ouagadougou (Burkina Faso) to contribute to improving knowledge of this group of pathologies in our region. This cross-sectional descriptive, retrospective, and prospective study covers cases from 1998 through 2014. We identified 61 patients with angioma, 67.2% of them younger than 30 months. The sex ratio was 0.56. Vascular tumors (hemangiomas) accounted for 43 cases (70.5%) and vascular malformations 18 (29.5%). Lesions appeared between 0 and 15 days of life in 57.4% of cases. Their size ranged from 1 to 3 cm in 49.2% of cases. They were most frequently located on the head (49.2%). The most frequent clinical forms were cutaneous hemangiomas (tuberous) (36 cases), followed by the nevus flammeus (8 cases), and mixed hemangiomas (7 cases). Only one complex forms was observed: one case of Klippel-Trenaunay syndrome. Superficial vascular abnormalities are rare in our dark skin type context including infantile hemangiomas. The clinical peculiarities of the angiomas observed in this African series in Ouagadougou seem quite similar to the characteristics described in European and American series.

Hair removal treatment using 1,064 nm long-pulsed Nd:YAG laser in auricular post reconstruction of microtia patient: two case reports

Microtia is a congenital anomaly of the external and middle ear with various degrees of severity. The hair growth on the reconstructed auricle causes aesthetic problems. We describe two cases about the successful epilation of unwanted hair in postauricular reconstruction of microtia patients using 1,064 nm long-pulsed neodymium: ytrium-alumunium-garnet (LP Nd:YAG) laser in Fitzpatrick skin type IV patients, using 6x6 mm tip, 35 J/cm2 fluence, 10 ms pulse, and 1 Hz frequency with burnt of hair as an endpoint. On the follow up day 11 of case one and day 7 of case two, the hair reductions on treated auricles were 46% and 58%, respectively, with no adverse effects. Minimal 6 repeated sessions are recommended for optimal result. In these case reports, LP Nd:YAG laser treatment is considered effective for the unwanted hair growth on the reconstructed auricle in dark skin type patients with minimal risk of adverse effect.

Clinical and dermoscopic (in vivo and ex vivo) predictors of recurrent nevi.

Recurrent nevi occur following removal of melanocytic nevi mainly after shaving excision. Due to its differential diagnosis with melanoma, its recognition can be challenging. To evaluate clinical and dermoscopic predictors of recurrent nevi. Clinical data on 224 melanocytic nevi were collected, together with dermoscopic images. Shave biopsy was performed and the underside of the surgical specimen was examined using ex vivo dermoscopy. A total of 195 lesions were followed for six months. Recurrent nevi were observed in 59 lesions. The occurrence of recurrent nevi was inversely associated with increased patient age. Darker skin phototypes and the compound nevus type were more associated with recurrence. Regarding dermoscopic features, the presence of dark brown colour, multiple colours, dots, terminal hair, and an annular-distributed pigmentation around adnexal structures were associated with recurrent nevi. Ex vivo dermoscopy showed that visible hyperpigmentation on the underside of the surgical specimen was correlated with recurrence. Multivariable analysis showed that annular hyperpigmentation and age were the most relevant predictors of recurrence. Individuals with dark skin type and young adults are at increased risk of recurrent nevi. Dermoscopy of the primary lesion and the underside of the surgical specimen are helpful in predicting recurrence after shave biopsy.

Fractional Carbon Dioxide Laser: Optimizing Treatment Outcomes for Pigmented Atrophic Acne Scars in Skin of Color.

Dark skin type has high propensity to acne scarring and is often complicated by persistent erythema or pigmentation at the base. Fractional lasers are available for the longest period and are able to improve most atrophic acne scars. Often pigmented scar bases and dark skin types limit the use of aggressive laser parameters. Long pulse mode is preferred over short pulse to prevent epidermal damage; low fluence is chosen versus high fluence and low density versus high density. Repeated treatments are needed to minimize complications and optimize results; all these must be achieved through a controlled stage of inflammation. Interventional priming with chemical peels and laser toning before ablative fractional carbon dioxide laser helps to reduce photodamage, recent tan, and pigment at scar base, thus minimizing the risk of post-inflammatory hyperpigmentation. Multiple recent literature evidence validates the combinations to optimize outcomes in atrophic acne scars as discussed in this review article.

The association between skin auto-fluorescence of palmoplantar sites and microvascular complications in Asian patients with type 2 diabetes mellitus

Skin auto-fluorescence (SAF) has generated broad interest about the prospects for non-invasive advanced glycation end product assessment and its direct interplay with the development of microvascular complications, but clinical application of the existing SAF measuring of non-palmoplantar sites in non-Caucasian subjects with dark skin type is still controversial. Here, we tested the diabetic complication screening performance of a novel SAF measuring system in Asian type 2 diabetes mellitus (T2DM) subjects. A total of 166 Korean patients with T2DM were enrolled in this study and palmoplantar SAF was measured by a newly developed transmission-geometry noninvasive optical system. We found that transmitted SAF values of palmoplantar sites, 1st dorsal interossei muscles of the hand, in a complication group were significantly higher than in a non-complication group while no differences were observed between the two groups in reflected SAF of non-palmoplantar sites. The transmitted SAF values of palmoplantar sites were dramatically increased in subjects with multiple complications and were tightly correlated with the duration of microvascular complications. In conclusion, the SAF measurement in the palmoplantar sites with a non-invasive transmission-geometry optical system provided better microvascular complication screening performance compared to the SAF measurement of non-palmoplantar sites specifically in Asian T2DM subjects.

Development and validation of a patient-reported outcome measure in vitiligo: The Self Assessment Vitiligo Extent Score (SA-VES)

The Vitiligo Extent Score (VES) has recently been introduced as a physicians' score for the clinical assessment of the extent of vitiligo, but a good patient self-assessment score is lacking. The objective is to develop and validate a simplified version of the VES as a patient-reported outcome measure (PROM). After extensive pilot testing, patients were asked to score their vitiligo extent twice with an interval of 2 weeks using the Self Assessment Vitiligo Extent Score (SA-VES). The scores were compared with the physicians' evaluation (VES). The SA-VES demonstrated very good test-retest reliability (intraclass correlation = 0.948, 95% confidence interval [CI]: 0.911-0.970) that was not affected by age, skin type, or vitiligo distribution pattern. According to patients, this evaluation method was easy to use (22% very easy; 49% easy; 29% normal) and required <5 minutes in the majority of patients (73%, <5 minutes; 24%, 5-10 minutes; 2%, 10-15 minutes). Comparison of the SA-VES and the VES demonstrated excellent correlation (r = 0.986, P <.001). Few patients had a dark skin type. The results demonstrate excellent reliability of the SA-VES and excellent correlation with its investigator-reported counterpart (VES). This patient-oriented evaluation method provides a useful tool for the assessment of vitiligo extent.

Relationship between skin color and skin response to ultraviolet light

Relationship between skin color and skin response to ultraviolet light

Acral Amelanotic Verrucous Melanoma: Dermoscopic Findings

Acral melanoma is a rare but distinctive subtype of melanoma. It is frequently found in the nonwhite population with dark skin type (Fitzpatrick V and VI). Acral melanoma is the most common type of all cutaneous melanomas (B70%) in these patients. In the white population, its prevalence is 4.5% to 7% of all melanomas. The diagnosis is often delayed, and misdiagnosis is common because its clinical presentation is frequently unusual and there is a higher rate of amelanosis than in other melanoma subtypes. When melanoma is poorly pigmented, there are many conditions in the differential diagnosis such as warts, hemorrhage, ulcers, callous, tinea pedis, and other skin tumors such as squamous cell carcinoma and adnexal tumors.

Influence of UV exposure on DNA damage in Chinese skin

Influence of UV exposure on DNA damage in Chinese skin

Friction melanosis: a clinical, histologic, and ultrastructural study in Jordanian patients.

Friction melanosis (FM) is an acquired pigmentary disorder mainly affecting young people. The primary skin regions affected are located over the osseous prominences, especially the clavicular zone and upper back. Our purpose in this study was to report the clinical spectrum, histologic findings, and ultrastructural features of FM in Jordanian patients. Thirteen patients with FM (10 women and three men) were studied. The patients were seen at Princess Basma Teaching Hospital in north Jordan between 1999 and 2001. Eleven patients presented with asymptomatic, diffuse, brownish patches and two presented with mottled patches on the skin over the trunk bones and limbs. All had a history of rubbing their skin repeatedly with scrub pads (loofah) or bathroom towels. Ten of the 13 cases were studied histologically. Skin biopsies from four patients were examined ultrastructurally. Both histologic and electron microscopic examination of the biopsies from our patients showed a marked increase in melanin and melanin incontinence, with a lack of amyloid in the upper dermis. FM is infrequently seen in north Jordan. We believe that repeated frictional trauma from clothing or scrub pads against the skin overlying the bony protuberances is fundamental in its pathogenesis. Other factors, such as scrub pads made of rough material (loofah), dark skin type, and individual variability, may also play a role in the pathogenesis. We advise patients not to use rough scrub pads during bathing, to avoid rubbing the skin overlying the bony prominences, to avoid rubbing vigorously, and to use a soft cotton pad instead.

800 nanometer diode laser hair removal in African American patients: a clinical and histologic study.

Although numerous lasers are available for laser assisted hair removal, their use in individuals with a dark skin type presents many challenges due to competition from epidermal melanin. Our aim was to evaluate two 800 nm diode lasers (Lightsheer) with 30 msec and 100 msec pulse durations in the treatment of African American patients with skin types V and VI. Histologic studies, efficacy and side effects were examined in an effort to optimize laser hair removal procedures in this patient population. Facial, neck and axillary areas were treated using 800 nm diode lasers at 30 and 100 msec pulse durations with fluences between 15 J/cm2 and 40 J/cm2. Both lasers could be used safely in skin type V and VI African American patients. Longer pulse durations enabled the delivery of higher fluences with minor and acceptable postoperative complication profiles. The Lightsheer diode laser (Coherent Medical, Santa Clara, CA, USA) operating at 30 msec and 100 msec can be safely used in hair removal procedures in African American patients.

Cysteine-dependent 5-S-cysteinyldopa formation and its regulation by glutathione in normal epidermal melanocytes.

Recent evidence suggests that the melanogenesis intermediate 5-S-cysteinyldopa (5-S-CD) could display antioxidative activity. In the present study, the synthesis of 5-S-CD was examined in human epidermal melanocytes isolated from dark skin type VI (MT) and from white skin type III (GT). The MT melanocytes showed the higher melanin content and dopa oxidase activity. In addition, they produced eumelanin as shown by their ultrastructure, and the solubility and UV/visible absorption of the isolated pigment. Both MT and GT cells showed high levels of 5-S-CD (5.5-6.9 nmol/mg protein). 5-S-CD was also detected in culture supernatants from MT cells; the secretion rate was estimated to be 2.5 nmol/mg protein per 24 h. The role of cysteine and glutathione in 5-S-CD formation was investigated by exposing the melanocytes to the gamma-glutamylcysteine synthetase inhibitor L-buthionine sulfoximine (BSO). A strong reduction in glutathione levels (4-8% of the untreated controls) associated with an increase in cysteine levels (152-154%) was observed. In addition, BSO induced a moderate increase in the cellular levels of 5-S-CD (114-129%) and a decrease in dopa oxidase activity (75-83%). Our results indicate that the direct addition of cysteine to dopaquinone is the main source of 5-S-CD in human epidermal melanocytes. It is proposed that the synthesis of 5-S-CD is a mechanism regulating dopaquinone levels during pigment formation and/or a defence mechanism against oxidative stress.