Dark-skinned Individuals Research Articles

Hypopigmented mycosis fungoides in Egyptian patients

Hypopigmented mycosis fungoides (HMF) is uncommon clinical variant that was commonly observed in dark-skinned individuals. We described the clinical characteristics, pathological features, immunohistochemical profile and prognosis of HMF in Egyptian patients. During the period from January 2004 to December 2011, we were able to diagnose and follow up 27 patients with HMF. The study included 18 males (66.7%) and 9 females (33.3%) with a mean age of 35.39 ±13.13 years. The duration ranged from 1 to 6 years with a mean of 3.26 ±1.7 years. The majority of patients were skin type IV (63%) and presented with multiple (88.9%), asymptomatic (74.1%), ill-defined (70.4%) and non-scaly (77.8%) lesions distributed on the trunk (81.5%). Histologically, epidermotropic lymphocytes were observed in 100%, basal alignment of lymphocytes in 81.5%, Pautrier's microabscesses in 29% and folliculotropism in 18.5%. Immunostaining showed predominance of epidermal CD8+ cells in 51.9% while in 29.6% CD4+ cells were predominant. Phototherapy was effective in 86.7% of patients with success rate 66.7% of narrow band (NB) ultraviolet-B and 80% of psoralen ultraviolet-A. HMF among Egyptians could be classified as non-aggressive epidermotropic cytotoxic CD8+ variant. It is common among middle age males with skin type IV and mostly well respond to phototherapy.

Clinicopathological correlation of acquired hypopigmentary disorders

Acquired hypopigmentary disorders comprise a significant group of disorders that affect Indians and Asians. The pigment disturbance in darker skin individuals can be very distressing to the patient and the family. These disorders cover a wide array of pathologies including infections, autoimmune processes, lymphoproliferative disorders, and sclerosing diseases. Histological diagnosis is particularly important because treatments for these diseases are varied and specific. This review will focus on histopathological diagnosis based on clinicopathological correlation for commonly encountered disorders such as leprosy, vitiligo, lichen sclerosus, pityriasis alba (PA), and pityriasis versicolor (PV). Atypical or uncommon clinical presentation of classic diseases such as hypopigmented mycosis fungoides (HMF) and hypopigmented sarcoidosis are also included.

Cutaneous Pigmentation in Health and Disease: Novel and Well-Established Players

Cutaneous pigment formation and aberration in disease are addressed. Dynoodt et al. (this issue) present data on a specific micro RNA that downregulates proteins involved in melanogenesis and melanosome movement. Kim et al. (this issue) present data showing that Wnt signaling is involved in the pathogenesis of melasma. Both articles enhance our understanding of cutaneous pigmentation and point to targets in the development of novel therapeutic modalities.

A focused review on acne‐induced and aesthetic procedure‐related postinflammatory hyperpigmentation in Asians

Postinflammatory hyperpigmentation (PIH) is a common consequence following cutaneous inflammation in dark-skinned individuals with Fitzpatrick skin phototypes (SPTs) III-VI. The exact pathogenesis of this condition is unknown, but is believed to be an integral part of the normal response of the skin to inflammatory stimuli. PIH can last from months to years and may significantly impair quality of life of affected individuals. The primary treatment of PIH is prevention and treatment of the underlying inflammatory condition. In addition to prevention, there are a variety of medication and procedures used to treat PIH. Although topical skin-depigmenting agents remain the treatment of choice for PIH, lasers and light sources may be an effective adjunctive therapy or alternative for treatment failures. When treating PIH, any treatment options selected should be optimized and utilized carefully because the treatments itself may worsen the PIH.

The Case Files

The Case Files

Anogenital Lesions: Kaposi's Sarcoma and Its Mimicks

Kaposi's sarcoma (KS) is a low-grade vascular neoplasm associated with human herpes virus-8 (HHV-8) infection, and, in the epidemic form, with the human immunodeficiency virus (HIV). Although HHV-8 is present in all body fluids and is sexually transmitted, there are surprisingly few reports of anogenital KS. Clinically, especially in HIV/KS endemic areas, dark stained skin patches or nodules are prone to misdiagnosis, especially in dark-skinned individuals. Therefore, a biopsy is recommended. The histologic appearance spans a broad spectrum of KS and non-KS lesions; therefore, the final diagnosis should be confirmed by HHV-8 immunohistochemistry. We report a series of 36 anogenital biopsies from a group of 16 documented HIV-positive patients; in 20 the HIV serostatus was unknown. There were ten KS (five in HIV-positive patients), and 26 non-KS (11 in HIV-positive subjects) lesions. In the era of HIV/AIDS, anogenital lesions may be the first manifestation of KS in immunocompromised individuals and should be biopsied. The histological diagnosis should be confirmed by HHV-8 immunohistochemistry.

Vitamin D Deficiency/Insufficiency and Challenges in Developing Global Vitamin D Fortification and Supplementation Policy in Adults

This review summarizes studies discussing vitamin D status in adults and reveals that vitamin D deficiency/insufficiency is highly prevalent in adults and that current fortification and supplementation policies are inadequate. Studies suggest a crucial role for adequate vitamin D status in various health conditions including bone metabolism, cancer, cardiovascular diseases, and allergies. However, relatively little is known about poor vitamin D status and unmet needs in adults. This report aims to highlight the contribution of epidemiologic studies (through the identification of health effects and societal burden) to the development of vitamin D fortification and supplementation policies and reveal unmet global challenges in adults. In order to assess worldwide vitamin D status in adults, the search strategy combined the medical literature database MEDLINE (using PubMed) for the time period between January 1, 1980 and February 28, 2011, using the key words "vitamin D" "deficiency" and "insufficiency", and included articles in which access to full text was possible and in which healthy adults were assessed according to one of four commonly used vitamin D threshold classifications. This report reveals that vitamin D deficiency occurs in 4.10 % [95 % CI (confidence interval), 3.93 %, 4.27 %] to 55.05 % (54.07 %, 56.03 %) of adults, while insufficiency occurs in 26.07 % (24.82 %, 27.33 %) to 78.50 % (77.85 %, 79.16 %), depending on the classification used. However, lack of overlap in CIs and high value of I2 statistics indicate considerable heterogeneity between studies. Further, certain populations (i. e. dark-skinned individuals, immigrants, and pregnant women) may be at higher risk for poor vitamin D status. Current policies for vitamin D supplementation and fortification are inadequate and new guidelines are required to improve vitamin D status in adults.

Exogenous ochronosis: a review for clinicians

Exogenous ochronosis has been described as a complication associated with the use of hydroquinone for skin lightening in dark-skinned individuals, but is now also increasingly recognized as a possible complication of hydroquinone use for treatment of pigmentary disorders such as melasma in fairer-skinned individuals. Diagnosis of this condition is difficult in early cases. Dermoscopy and reflectance confocal microscopy have been put forward as possible diagnostic aids. It is important that clinicians are aware of this complication of hydroquinone therapy. In this article, we briefly discuss the clinical findings, pitfalls in diagnosis, etiopathogenesis and possible treatment options of this difficult-to-treat condition.

25-Hydroxyvitamin D levels in African-American and Caucasian/Hispanic subjects with cutaneous lupus erythematosus

Because exposure to ultraviolet radiation accounts for a significant portion of endogenous vitamin D production, subjects with cutaneous lupus (CLE) who practise sun-protective measures are at risk for vitamin D insufficiency. Previous studies have shown light-skinned subjects with CLE to have lower serum 25-hydroxy (25-OH) vitamin D levels than normal controls. To assess the status of vitamin D insufficiency in dark-skinned individuals with CLE. We performed a cross-sectional study comparing serum 25-OH vitamin D levels in 25 African-American (AA) subjects with CLE and 26 normal AA subjects matched by age, sex and season in Dallas, Texas. A questionnaire on demographics, medical history and lifestyle habits was administered to determine factors potentially affecting vitamin D levels. Findings were contrasted to a similar comparison in 26 Caucasian and Hispanic (C/H) subjects with CLE and 24 normal C/H subjects matched by age, sex and season. We found similar mean±SD 25-OH vitamin D levels in AA subjects with CLE (52·0±18·5nmolL(-1) ) and normal AA subjects (54·8±21·2 nmolL(-1) ) (P=0·62). Almost half of AA subjects in both groups were vitamin D insufficient. A larger difference in 25-OH vitamin D levels was found between C/H subjects with CLE (59·4±21·0nmolL(-1) ) and normal C/H subjects (70·5±27·4nmolL(-1) ) (P=0·12). Two-way anova demonstrated that skin colour (AA vs. C/H) had a significant effect on 25-OH vitamin D levels (P=0·008), although CLE status (CLE vs. normal) did not (P=0·13). Providers are encouraged to address vitamin D insufficiency concerns in all dark-skinned individuals. Future studies should stratify subjects by skin colour in determining differences between subjects with CLE and normal controls.

Vitamin D in the New Millennium

The incidence of vitamin D deficiency is rising worldwide, yet in the vast majority of patients, the condition remains undiagnosed and untreated. Current evidence overwhelmingly indicates that supplemental doses greater than 800IU/day have beneficial effects on the musculoskeletal system, improving skeletal homeostasis, thus leading to fewer falls and fractures. Evidence is also accumulating on the beneficial effects of vitamin D on extraskeletal systems, such as improving immune health, autoimmune disorders, cancer, neuromodulation, diabetes, and metabolic syndrome. The cause-effect relationship of vitamin D deficiency with increasing incidences of nonskeletal disorders is being investigated. Published reports support the definition of sufficiency, serum levels of 25-hydroxyvitamin D [25(OH)D] greater than 30ng/mL (75nmol/L). To achieve this, most people need vitamin D supplementation ranging from 600 to 2000IU/day; consumption up to of 5000 international units (IU) per day of vitamin D is reported as safe. Although light-skinned individuals need 1000IU/day of vitamin D, elderly and dark-skinned individuals are likely to need approximately 2000IU/day to maintain serum 25(OH)D levels greater than 30ng/mL. Other vulnerable patients, such as the obese, those who have undergone bariatric surgery, and those with gastrointestinal malabsorption syndromes, may require higher doses of vitamin D to maintain normal serum levels and be healthy.

Zidovudine-induced nail pigmentation in a 12-year-old boy

Zidovudine is an important component of first-line antiretroviral treatment (ART) regimens used to manage pediatric HIV. Nail pigmentation with zidovudine is a well-documented occurrence in adults, especially dark-skinned individuals. But it has so far not been reported in children. Here, we report a pediatric case of zidovudine-induced nail pigmentation. A 12-year-old boy receiving ART with zidovudine, lamivudine, and nevirapine presented to dermatology OPD with complaint of diffuse bluish-brown discoloration of all fingernails. The pigmentation was noticed by the patient after 3 months of initiating zidovudine-based regimen. It first appeared in thumb nails, gradually involved all fingernails, and increased in intensity over time. Though harmless and reversible, psychological aspects of this noticeable side effect may hamper adherence to therapy and may lead to unnecessary investigations and treatment for misdiagnosis such as cyanosis or melanoma.

Skin Malignancies

Skin Malignancies Skin malignancies are among the most common form of cancer. Dark-skinned individuals of African descent are far less likely than fair-skinned individuals to develop skin cancer. Significant differences in the pattern of skin malignancy have also been observed in different regions of the world. The pattern of skin cancer in sub-Saharan Africa shows a sharp contrast to that seen in Caucasians populations. Effective policies on public education and implementation of preventive and therapeutic strategies should be developed based on evidence of research in various regions and not on adapted models as risk factors vary among Caucasians in Europe, North America, and Australia compared to the darkly pigmented in Africa.

Vitamin D: an essential component for skeletal health

Vitamin D deficiency is increasing worldwide. Ultraviolet rays are supposed to provide humans over 80% of our vitamin D requirement; the rest is received through diet and supplements. In addition to enhancing calcium absorption from the intestine and mineralization of the osteoid tissue, vitamin D has many other physiological effects, including neuromodulation, improving muscle strength and coordination, insulin release, immunity and prevention of infections, and curtailing cancer. Whether the increased incidence of vitamin D deficiency is related to increased incidences of nonskeletal disorders remains to be determined. Serum levels of 25-hydroxyvitamin [25(OH)D] above 30 ng/mL indicate vitamin D sufficiency. An additional 1,000 IU of vitamin D/day is sufficient for most lighter-skinned individuals, whereas an extra 2,000 IU/day is needed by the elderly and dark-skinned individuals to maintain normal 25(OH)D levels. Additional research is needed to clarify the relationship between vitamin D and the nonskeletal systems, nonclassic functions, and targets of vitamin D.

The determinants of periorbital skin ageing in participants of a melanoma case–control study in the U.K.

BackgroundSkin ageing is said to be caused by multiple factors. The relationship with sun exposure is of particular interest because the detrimental cutaneous effects of the sun may be a strong motivator to sun protection. We report a study of skin ageing in participants of an epidemiological study of melanoma.ObjectivesTo determine the predictors of periorbital cutaneous ageing and whether it could be used as an objective marker of sun exposure.MethodsPhotographs of the periorbital skin in 1341 participants were graded for wrinkles, degree of vascularity and blotchy pigmentation and the resultant data assessed in relation to reported sun exposure, sunscreen use, body mass index (BMI), smoking and the melanocortin 1 receptor (MC1R) gene status. Data were analysed using proportional odds regression.ResultsWrinkling was associated with age and heavy smoking. Use of higher sun-protection factor sunscreen was protective (P=0·01). Age, male sex, MC1R variants (‘r’, P=0·01; ‘R’, P=0·02), higher reported daily sun exposure (P=0·02), increased BMI (P=0·01) and smoking (P=0·02) were risk factors for hypervascularity. Blotchy pigmentation was associated with age, male sex, higher education and higher weekday sun exposure (P=0·03). More frequent sunscreen use (P=0·02) and MC1R variants (‘r’, P=0·03; ‘R’, P=0·001) were protective.ConclusionsPeriorbital wrinkling is a poor biomarker of reported sun exposure. Vascularity is a better biomarker as is blotchy pigmentation, the latter in darker-skinned individuals. In summary, male sex, sun exposure, smoking, obesity and MC1R variants were associated with measures of cutaneous ageing. Sunscreen use showed some evidence of being protective.

Brighten up: Smiles facilitate perceptual judgment of facial lightness

The metaphoric expression ‘bright smile’ may reflect the actual judgment of facial lightness under varying emotional expressions. The present research examined whether people in fact judge smiling faces as perceptually brighter than frowning faces. Four studies demonstrated that participants believed smiling faces were brighter compared to frowning faces in a binary choice task and in an absolute judgment task. The results suggest that emotional expressions (i.e., smiles and frowns) can bias judgments of facial brightness in ways consistent with the metaphor. Among other implications, such results suggest that stereotypes about darker-skinned individuals may be attenuated by smiles.

Assessment of bruise age on dark-skinned individuals using tristimulus colorimetry

Studies on the ageing of bruises have been reported on Caucasians or individuals of fair ethnicity. This study focuses on bruise changes in dark-skinned individuals using tristimulus colorimetry for forensic analysis in such individuals. Eighteen subjects of South Indian or Sri-Lankan ethnicity were recruited. Subjects were bruised using a vacuum pump and then daily colour measurements were taken of the bruise using a tristimulus colorimeter. The L*a*b* readings were recorded of a control area and of the bruise until it disappeared. Two Caucasians were used for comparison. This study showed that, using colorimetry, bruises on dark-skinned individuals can be measured and analysed even if the bruises are unclear visually. As the bruise is beneath the skin, the colour difference ΔL*, Δa* and Δb* were calculated. All values showed a trend, indicating that the L*a*b* measuring technique is a reliable method to analyse bruises on dark-skinned individuals. Comparisons of Asian subjects and Caucasian subjects were performed. The largest difference was seen in the b* value. Statistical analysis showed that ΔL* colour difference was the most consistent (95% CI -4.05 to -2.49) showing a significant difference between days 1-4 and 5-8. Objective assessment of bruises on dark-skinned individuals using the L*a*b* method of measuring gave reproducible results. Furthermore, the study showed that the yellowing of a bruise cannot be seen or measured with a tristimulus colorimeter on dark-skinned individuals due to the pigmentation of the skin. With further studies and more subjects, the age of bruises could potentially be assessed for use in forensic analysis.

Patient knowledge and attitudes on laser hair removal: a survey in people of color

It is now widely accepted that dark-complexioned skin individuals can be safely treated with laser hair removal (LHR). However, some people are still concerned about the side effects or have been told that hair removal laser is not possible in darkly pigmented skin. To measure the knowledge and attitudes of African Americans about LHR and assess the need for additional education focusing on LHR. A cross-sectional survey with questionnaire was administered to African American subjects between the ages of 21-70 years. Questions comprised attitudes and knowledge about LHR. Demographic characteristics, attitudes, and knowledge were assessed by descriptive statistics. Results were considered statistically significant if P <0.05. The survey was completed by 221 African American subjects. There were only 122 subjects (55.2%) who knew that dark-skinned individuals can be treated with LHR. Only 44.3% of subjects believed that dark-skinned people are more prone to develop hyperpigmentation from LHR. Female subjects and subjects with higher educational background have a higher tendency to consider LHR as a treatment choice (P < 0.05). This study shows that many African Americans still have negative attitudes and lack knowledge about LHR. The results of this study provide information that can lead to better informed dermatology providers who can then better educate patients of color regarding LHR knowledge.

INHIBITION OF MELANOGENIC ACTIVITY BY GELATIN AND POLYPEPTIDES FROM PACIFIC COD SKIN IN B16 MELANOMA CELLS

ABSTRACT Gelatin extracted from Pacific cod skin was hydrolysed with serials of protease. Then, the effects of gelatin and polypeptides on melanogenesis and antioxidant were assessed using B16 melanoma cell and reactive oxygen species scavenging ability. Polypeptides showed better scavenging properties on superoxide anions and hydroxyl radical in vitro than gelatin. PEP1 (2–6 kDa) exhibited the highest inhibition of melanogenesis and tyrosinase activity without affecting cell growth. PEP1 (100 µg/mL) significantly reduced the melanin content to 60.5% of control and tyrosinase activity to 51.7% of control, respectively (P < 0.01). In addition, the cyclic AMP levels was decreased evidently, and intracellular GSH/GSSG ratio were enhanced remarkably in a dose-dependent manner treated by PEP1, which expected to play a crucial role in the regulation of melanogenesis. Treatment with PEP1 at 100 µg/mL, GSH levels increased 16.6-fold and GSSG contents were reduced to 38.8% of control. Therefore, PEP1 can be used as a potential antimelanogenesis substance. PRACTICAL APPLICATIONS Gelatin is an important functional biopolymer that has a very broad application in many industrial fields, such as food, cosmetics, materials, pharmacy and photography. Although the properties of gelatin from fish skin are different from those from mammals and avian species, fish skin gelatin has the advantages of utilizing highly abundant fish offal, and avoiding bovine spongiform encephalopathy concerns. Protease hydrolysis of gelatin has been shown to produce biologically active peptides that inhibited angiotensin I converting enzyme and linoleic acid peroxidation. Recently, we confirmed that gelatin hydrolysates exhibited better scavenging properties and inhibition of melanogenic activity. Presently, a global market demand has developed for skin-lightening agents as “vanity” cosmeceutical products, because lighter skin color is preferred by some dark-skinned individuals in many countries and races. Thus, it appears that gelatin hydrolysate could be an economical source of antioxidant and antimelanogenesis peptides that may be produced in large quantities at relatively low cost.

Comparison of Secondary Intention Healing and Full-Thickness Skin Graft After Excision of Acral Lentiginous Melanoma on Foot

Melanoma in dark-skinned individuals often develops in an acral lentiginous fashion on the foot. After wide excision, substantial defects usually develop and they may endure insufficient vascular flow. In addition, the final scar must withstand the mechanical stress of daily walking. Various repair methods are used to repair these defects, but secondary intention healing has not been evaluated in the repair of wounds of the foot. To compare the functional and cosmetic results of secondary intention healing and full-thickness skin graft after wide excision of melanoma on the foot. Retrospective review of 25 patients who were treated using excision for melanoma on the foot. The defects of 13 patients were healed by secondary intention (secondary intention healing group; SIHG), and those of 12 patients were repaired by full-thickness skin graft (skin graft group; SGG). The SGG showed more rapid healing than the SIHG, but the SIHG showed better functional and cosmetic outcomes at complete re-epithelialization than the SGG as evaluated by patients and independent physicians. Secondary intention healing after excision of melanoma from the foot is a therapeutic option with acceptable functional and cosmetic outcomes.

Long-pulsed Nd:YAG laser-assisted hair removal in Fitzpatrick skin types IV–VI

Unwanted hair is a common problem for which a variety of laser treatments is available. Laser treatment in dark-skinned individuals carries a higher risk of complications like hyperpigmentation and burn. The objective of this study was to evaluate efficacy and safety profile of laser-assisted hair removal in individuals with Fitzpatrick type IV-VI skin using long-pulsed Nd:YAG laser. Retrospective data was collected from 150 individuals with Fitzpatrick type IV-VI skin who underwent laser-assisted hair removal. This included area treated, fluence, number of treatments, and outcome. Data was also gathered on patient satisfaction and complications. The most common phototype was type IV (94%). The most frequently treated area was the face (84.7%) followed by the underarms and legs. Among the facial areas, the chin was the most frequently treated area followed by the upper lip and jaw line. The mean number of treatments was 8.9 (range 4-22). The maximum fluence averaged 26.8 Joules/cm(2) and was significantly higher for facial hair. Of the patients, 78.7% felt that their treatment was good or satisfactory. Mean hair reduction was 54.3%. Satisfaction from the treatment was significantly higher in individuals undergoing treatment of non-facial areas. Subsequent hair growth was slower and finer in 79.3% of the patients. There were no complications in 86% of the patients. All the complications were transient, with hyperpigmentation being the most frequent complication. Our results show that laser hair removal using the long-pulsed Nd:YAG laser is safe and effective in dark-skinned individuals with satisfactory results in most patients.