Skin Type Research Articles

Comparative study in treatment of acne scars fractional carbon dioxide laser versus micro needling fractional radio frequency - A retrospective study.

Efficacy of fractional carbon dioxide laser and microfractional radiofrequency in treatment of acne scars is well substantiated. The objective of this study was to compare the efficacy and safety of carbon dioxide laser versus microfractional radiofrequency in treatment of acne scars in skin type 3,4. Thirty-two patients of skin types 3-4 with grade 3 and 4 atrophic acne scars, of which 16 were treated with fractional carbon dioxide (CO2) laser and 16 were treated with microfractional radiofrequency were retrospectively analyzed. All patients received either treatment 4 sessions at an interval of 4-6 weeks. Objective assessment was done with qualitative and quantitative Goodman and baron acne scar grading system by assessment of photographs at baseline and 3 months after last session. All the data collected were entered in a Microsoft Excel worksheet and analyzed using R Software R-4.2.1. The study variables acne scar grades were described using frequency with percentage, acne scar scores were described using Mean with Standard deviation, and Median with interquartile range (IQR) (Q1-Q3). Since the data were ordinal, which is non-normal, hence, non-parametric tests are applied. To compare grades between the groups, Mann-Whitney U-test was applied. There was no difference in the last session (after the treatment) between the groups, the Mann- Whitney U-test was 109.5 with P-value of 0.484 >0.05. Therefore, there was no statistically significant difference between the microfractional radiofrequency and carbon dioxide laser group. There were 2 (12.5%) cases reported with post-inflammatory hyperpigmentation in the CO2 laser group and zero cases in the microfractional radiofrequency group.

Nonablative Fractional Diode Laser Resurfacing (1440 nm and 1927 nm) for Photoaged Skin.

Nonablative lasers treat photoaged skin and stimulate new collagen formation while sparing epidermal damage. To evaluate the effectiveness and safety of nonablative fractional diode combination laser skin resurfacing treatment (1440 and 1927 nm) in mild-to-moderate photoaged skin. The entire face was treated with both 1440-nm and 1927-nm wavelengths per treatment, with a total of 4 treatments spaced 1 month apart. Follow-up occurred at 1 and 3 months post-treatment. Outcomes were improvement in the appearance of ≥1 measure of photodamage (rhytides, skin texture, dyschromia/pigment, skin radiance, pore size, and overall appearance) at the 3-month (primary) and 1-month (secondary) follow-up visits. Safety was monitored throughout the study. Participants (N = 28; 89% female; mean age, 40 years) experienced significant mean improvement from baseline in all measures of photodamage with combination laser treatment at 1 and 3 months post-treatment (all p < .001). No serious adverse events occurred. Post-treatment erythema and edema were minimal, and pain levels remained consistent throughout treatment. Most participants (96.4%) considered their overall appearance as improved and expressed satisfaction with treatment outcomes. Nonablative combination laser skin resurfacing treatment was well tolerated and significantly improved measures of photodamage in photoaged skin across diverse skin types.

Mechanisms of Selected Cassipourea Metabolites for Melasma Treatment: Network Pharmacology and Molecular Dynamics Study

Background Melasma is a common dyschromia, mainly found in women with darker skin types. Although asymptomatic, melasma significantly impacts patients’ quality of life. Due to this complex pathogenesis, melasma is difficult to treat. Plant and plant-derived products have been explored as alternatives for the treatment of melasma. Methods This study utilized network pharmacology coupled with molecular docking and molecular dynamics simulations to investigate the molecular mechanisms of three selected Cassipourea metabolites in the treatment of melasma. Results Of the 202 genes obtained from the 14 profiled metabolites, only PTGS2, TYR, ESR2, and ESR1 were common among metabolites and targets implicated in melasma. From this, The gene ontology highlighted the intracellular steroid hormone receptor, signalling pathway, macromolecular complex, and estrogen receptor activity as the top enriched functional annotations, while the KEGG pathway analysis identified five signalling pathways, from which the prolactin signalling pathway, endocrine resistance, and estrogen signalling pathway were implicated in the pathogenesis of melasma. These pathways were further connected by their linkage to ESR2 and ESR1., Of all Cassipourea metabolites and standards, with afzelechin having the highest docking score for both gens. Further binding interaction analysis showed that ESR2-bound tamoxifen had the highest binding free energy of -47.68 kcal/mol, however, among the interacting Cassipourea metabolites, sitosterol-glycoside exhibited the highest negative binding affinity for both ESR2 (-40.50 kcal/mol) and ESR1 (-78.97 kcal/mol) over 150 ns simulation, suggesting its potential as a dual modulator. Altogether, the metabolites presented remarkable binding stability and thermodynamic compactness with the apo-genes. Conclusion The finding that the selected Cassipourea metabolites are associated with the genes and enzymes implicated in melasma pathogenesis, together with their significant binding effects on the enriched genes, suggests their regulatory potential on the profiled targets and, consequently, in the treatment of melasma.

Unmasking Melasma: Confronting the Treatment Challenges

Melasma, also known as chloasma and the “mask of pregnancy”, is a common acquired pigmentary disorder characterized by irregular, hyperpigmented brown-to-grey patches primarily situated on the face. It typically affects women of reproductive age, especially those exhibiting Fitzpatrick skin types III to V. The precise etiopathogenesis of melasma is complex and has not been fully elucidated; however, ultraviolet radiation, hormonal factors, and genetic predispositions significantly contribute to the melanin production increase associated with this condition. Due to the multifactorial aetiology, resistance to various therapeutic options, and high recurrence rate, treating melasma is challenging. Hydroquinone has long been considered a gold standard in melasma treatment due to its ability to inhibit tyrosinase; however, it has faced scrutiny after concerns about its adverse effects. Current treatment strategies include various topical and systemic therapies, procedural interventions, as well as combinations of these methods. For optimal results, both photoprotection and a treatment plan that targets different pathogenic mechanisms should be used. Additionally, treatment should be tailored to patient characteristics, such as skin type, the severity of the condition, and compliance. This review summarises current treatment options, focusing on long-term therapy and the latest advancements in managing this challenging condition.

Niacinamide and sea daffodils-based bright healthy radiance product range for dark spots: a survey of Indian dermatologists' views and patient insights

Background: Niacinamide has demonstrated its ability to treat dark spots in various studies. The present study evaluated the perspectives and experiences of healthcare professionals (HCPs) and patients with the niacinamide and sea daffodils-based bright healthy radiance product range for dark spots. Methods: This study was part of a survey series focusing on various dermatology products across India. The study involved over 1000 registered HCPs including dermatologists, pediatricians, and cosmetologists nationwide. A total of 203 HCPs participated in the survey on the niacinamide and sea daffodils-based product range. A well-structured questionnaire with 15 questions was used to collect the data and the responses were recorded by the HCPs. Results: Out of the total of 1086 individuals who participated in the survey, majority were females (774, 71.2%). Most HCPs reported that nearly 15-30% of their patients present with dark spots. A vast majority of individuals reported extreme satisfaction with the use of niacinamide and sea daffodils-based bright healthy radiance product range (493, 45.5%) and rated its effectiveness as excellent (511, 47.2%). HCPs reported that most patients showed major improvement in skin brightness (529, 48.7%), while the rest of them (418, 38.4%; 137, 12.6%) experienced good and satisfactory improvement respectively. Importantly, an even skin tone was achieved in most of the patients (492, 45.8%) after the application of the product range. Conclusions: A personalized approach of using niacinamide and sea daffodil-based products according to the patient's skin types and skin conditions is essential to remove blemishes and dark spots and improve skin brightness.

Laser hair removal complications and the associated risk factors at a tertiary dermatology center: a case-control study.

Laser hair removal (LHR) has been established as a safe and efficient method for eliminating unwanted hair. This study aimed to investigate the frequency of LHR complications and assess the contributing factors. During one year, 16,900 patients undergoing LHR therapy were evaluated for complications. For each case, two external controls were selected (matched based on age, sex, Fitzpatrick skin type (FST) III-IV, and the treated anatomical region). To assess the impact of anatomical region on complication occurrence, each patient was used as their internal control if another area was treated during the same session. GEE analysis was used for statistical analysis.The incidence of LHR complications was calculated to be 0.69%. The most common complications were petechia, purpura, and ecchymosis (31.66%) followed by pigmentation changes (20.0%). LHR complications were most commonly observed in the lower limbs (32.0%), face and neck (23.3%), and genitalia and thighs (22.3%), respectively. Possible risk factors were younger age (OR = 0.74, P-value ≤ 0.001), operating LHR in the head and neck (OR = 5.8, P-value = 0.022), utilization of the alexandrite laser (OR = 2.32, P-value = 0.011), and fluence in the Alexandrite laser (OR = 3.47, P-value = 0.003).Overall,the results of this study indicate that LHR is generally a safe method for removing unwanted hair. However, factors such as younger age, treatment of the facial area, and use of the alexandrite laser especially with higher fluence levels in patients with FST III-IV were identified as potential risk factors.

Hyaluronic Acid Filler VYC-25L for Jawline Restoration Yields High Satisfaction, Improved Jawline Measurements, and Sustained Effectiveness Across Skin Types, Age, and Gender for up to 12 Months.

A randomized study was previously reported to demonstrate the safety and efficacy of hyaluronic acid filler VYC-25L for restoring jawline definition. Evaluate patient-reported outcomes (PROs), objective changes in jawline profile, and safety and effectiveness measures by Fitzpatrick Skin Phototype (FST), gender, and age following VYC-25L treatment. Adults were randomized to receive VYC-25L (n=157) or no treatment (control; n=49) for 6 months. PROs were assessed by FACE-Q Satisfaction with Lower Face and Jawline, FACE-Q Appraisal of Lines: Marionette, and participant satisfaction with treatment questionnaires. Changes in jawline profile linear depth and volume were calculated using 3D digital image analysis. Responder rates, PROs, and injection site responses (ISRs) were assessed by FST, gender, and age. At month 6, >70% of treated participants responded "somewhat/very satisfied" to FACE-Q Satisfaction with Lower Face and Jawline questions, and ≥78% of treated participants responded "satisfied/definitely satisfied" with treatment overall. For participants treated in the marionette lines, the FACE-Q Appraisal of Lines: Marionette questionnaire mean score improved by 32.6 (baseline to month 6). Mean change in linear depth in the prejowl sulcus in the treatment vs control groups was 4.6 mm vs 2.5 mm, respectively, and for jawline volume was 6.0 cc and -2.6 cc, respectively, (baseline to month 6). Subanalyses showed similar outcomes by FST, gender, and age except for a numerically higher ISR incidence in females vs males. Treatment with VYC-25L to improve jawline definition yielded high patient satisfaction, objective improvements in jawline profile, and comparable effectiveness across various demographics.

Standardized pilonidal protocol as rescue therapy for excision-refractory pilonidal disease.

Severe pilonidal diseases have refractory symptoms despite multiple surgeries and optimal therapy remains unclear. We hypothesized that standardized minimally invasive protocol could be an effective rescue treatment. We prospectively collected data from symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic 2019-2023. We treated these patients with standardized protocol incorporating local wound care, regular manual/laser epilation, and selective debridement/pit trephination. We treated 34 refractory patients (23 males) with median follow-up 405days. Median age of first symptoms was 17.1years; presentation to our clinic 20.0years. Prior to our clinic, 27 received one surgery (cleft lift-2, excision no closure-1, excision primary closure-18, wound vac after excision-3, excision flap closure-3); 7 had two surgeries (excision without closure + cleft lift-1, primary closure after excision twice-3, flap closure after excision twice-2, excision primary closure + excision without closure-1). We treated all patients with regular epilation ± local wound care. 14 (41%) underwent trephination ± debridement. All patients achieved complete resolution after median 52days. Five (14.7%) recurred and were treated with trephination + debridement-2 or wound care alone-3. Symptom length had no correlation with resolution time, skin type, hair amount. Standardized minimally invasive protocol requiring only selective surgical intervention can treat refractory pilonidal disease with low recurrence rate.

Removal of black tattoos by Picosecond Q-switched Nd-YAG laser in the middle eastern skin type IV: prospective study

Tattoo removal is considered a challenging field in cosmetic dermatology. Picosecond Q-switched Nd-YAG lasers targeting unique chromophores effectively manage this condition without serious complications. To evaluate the efficacy and safety of Picosecond Q-switched Nd-YAG laser in the treatment of black tattoos in the skin of middle eastern mostly skin type IV. The study was carried out on 20 patients with skin type IV the most common in middle eastern area with professional black tattoos. They were treated by Picosecond Nd-YAG laser (2 sessions 8 weeks apart). The percentage of improvement ranged from 20.0 to 95.0 (with a mean of 61 ± 24.6). 8 patients (40%) showed excellent improvement, 4 patients (20%) showed marked improvement, 4 patients (20%) showed moderate improvement, and 4 patients (20%) showed mild improvement. No severe side effects were detected. Picosecond Nd-YAG laser was an effective and safe technique in the treatment of professional black tattoos; with only 2 sessions most patients reached excellent to moderate response with minimal side effects.

Pengaruh Perbedaan Jenis Kulit Kopi dan Penambahan Daun Rosemary (Rosmarinus officinalis) terhadap Karakteristik Cascara Celup

The objectives of this study are: (1) to determine the effect of coffee skin type with the addition of rosemary leaf powder on the characteristics of cascara dip; (2) to know the formulation of the type of coffee skin with the addition of rosemary leaf powder that produces the most preferred cascara dip for the panelists. The latest in this study is an innovation to eliminate the taste of cascara with rosemary leaf powder, as well as practical and contemporary presentation in the form of dip cascara. The research will use 2 factors. The first factor is type coffee skin (A) with 3 levels, namely A1= arabica coffee skin, A2= robusta coffee skin, and A3 = arabica and robusta coffee skin blend with a 1:1 ratio. The second factor is the addition of rosemary leaf powder by weight of cascara with 3 levels, namely B1= 2%, B2= 4%, and B3= 6%. The results of the study showed that: (1) The type of coffee skin with the addition of rosemary leaves had an effect on the tannin content, taste, and color of the cascara dip. But it has no effect on antioxidant levels, caffeine levels, total acidity, total color difference, and aroma. (2) Cascara dip made from arabica coffee bark with the addition of 2% rosemary leaves (A1B1) is a cascara that consumers prefer (somewhat like) has an antioxidant level of A1B1 37.397%, caffeine 0.97%, tannins 0.0080, total acid 0.109, total color difference 29.173, moisture content 5.57% and ash content 1.815%.

The Influence of Inclusive Brand Image in Indonesian Cosmetic Products on Customer Loyalty

In recent years, cosmetic brands in Indonesia have shifted their marketing strategies to emphasize inclusivity, aiming to foster stronger customer loyalty. This shift includes the portrayal of diverse beauty standards and the inclusion of a wide range of skin tones and types in their product lines. Prior studies have demonstrated that an inclusive brand image significantly boosts brand trust and customer satisfaction. The research investigates the influence of an inclusive brand image in Indonesia’s cosmetic products on customer loyalty, focusing specifically on Generation Z consumers. By employing a quantitative research methodology, data was collected using online surveys distributed to 201 respondents aged 12-27 years. The study aims to explore the relationship between inclusive brand image and brand trust, customer satisfaction, and loyalty within the context of the Indonesian cosmetics market. Data analysis was conducted using descriptive statistics and PLS-SEM. The findings indicate that an inclusive brand image positively influences brand trust and customer satisfaction, which subsequently strengthen customer loyalty. Findings from this research are anticipated to provide insights that can help local cosmetic brands enhance their inclusive marketing strategies, thereby fostering a sense of acceptance and belonging among their diverse customer base and driving customer loyalty.

Effects of a skin type diversity seminar on undergraduate medical students’ self-assessed competence in managing skin diseases in patients with skin of color

BackgroundSkin diseases in patients with skin of colour (Fitzpatrick skin types IV to VI) are underrepresented in dermatology training, which may lead to lower quality of care for these patients. To address this underrepresentation in medical education, a newly developed seminar on skin type diversity using an interactive teaching method was implemented in an undergraduate medical curriculum. This study examined the effects of a seminar on the self-assessed competence of medical students in managing skin conditions in patients with skin of colour.MethodsA questionnaire survey was conducted among fourth-year undergraduate medical students at the University of Hamburg (Germany) between October 2023 and February 2024. Students’ self-assessed competence was compared before and after the obligatory seminar (pre- and post-design).ResultsIn total, 158 students participated in the survey. After the seminar, knowledge of the presentation of skin diseases in patients with skin of colour and the associated psychological burden, differences in the incidence of skin diseases in different skin types, and the ability to diagnose skin diseases in darker skin types increased. Most participants stated that they wanted to attend more courses on this topic.DiscussionAppropriate courses for medical students can improve their competence in managing different skin diseases in patients with skin of colour. In the future, more attention should be paid to teaching the diversity of skin types in dermatology education.

Epidemiology and Risk Factors of Actinic Keratosis. What is New for The Management for Sun-Damaged Skin.

Actinic keratosis (AK) is considered a chronic skin disease mostly caused by long-term exposure to UV radiation and other risk factors such as immunosuppression, leading to an individual susceptibility for skin cancer manifestation. The treatment of AK is laborious and costly, and the incidence of skin cancer is forecasted to double until the year 2030 in an aging society.Risk factors in AK for malignant transformation in cutaneous squamous cell carcinoma (cSCC) are not fully understood, but studies suggest that histological features, such as atypia in the basal epidermal third and basal proliferation (PRO score) in AK play a pivotal role for development of malignancy. As the clinical appearance of AK does not correlate with the risk for malignancy, guidelines suggest treating every single AK lesion upon diagnosis. Skin imaging techniques, such as line-field confocal optical coherence tomography (LC-OCT) can help to provide an individual holistic follow-up for AK lesions by non-invasive visualization of atypia and basal proliferation. A follow-up for patients with AK may be critical for treatment success in terms of strengthening therapy adherence. When AK presents therapy refractory, cSCC manifests in nearly 30% of the cases after several years. Patients with AK suffering from field cancerization and immunosuppression are susceptible for a severe course of disease including metastasis and high mortality rates. Those vulnerable subgroups benefit from close skin cancer screening, early adequate treatment and chemoprevention, such as niacinamide or acitretin. Skin cancer prevention is substantial. Primary prevention should include chemical and physical UV-light protection and avoidance of indoor tanning. Secondary prevention is essential in high-risk populations, such as fair skin type elderly men and STORs. Tertiary prevention should comprise adequate treatment strategies to prevent therapy resistance, reoccurrence and cSCC, especially when field cancerization and immunosuppression are present.

Adjunctive treatment of atopic dermatitis with novel at-home handheld narrow-band UVB phototherapy.

While conventional in-office phototherapy has long been utilized as a successful treatment for atopic dermatitis (AD), it is associated with potential barriers including inconvenience, poor adherence, time and financial expense. In this retrospective study, we examine the efficacy, adherence, and patient-satisfaction of using adjunctive at-home, self-administered phototherapy utilizing a novel handheld narrow-band ultraviolet B (NB-UVB) device for the treatment of refractory mild to severe AD. Included AD patients were initially trained on proper use of the device. These patients treated involved areas three times per week for a period of 12weeks. Phototherapy dosing protocol was based on skin type. The cohort included 52 patients, who were aged 20-69 and represented all skin types. They were initially categorized by disease involvement as mild, moderate, and severe. Patients were also queried to self-score their disease severity and level of satisfaction. Compared to baseline, at 12weeks, 48% percent of patients indicated that at least one site was Clear/Almost Clear, 38% stated that more than 50% of body locations were Clear/Almost Clear, and 28% reported that 100% (all) treated sites were Clear/Almost Clear. After using at-home hand-held NB-UVB for the study duration, 67% (35/52) of patients experienced disease improvement. Mean overall satisfaction was extremely high at 4.43 on a 5-point scale. Skin type, age, gender, and disease severity at inception did not significantly affect patient satisfaction scores. Overall adherence rate among participants across all groups was 73%. In this small retrospective study, at-home handheld NB-UVB phototherapy was found to be an effective, well-tolerated, adjunctive treatment method for patients with refractory AD, which was associated with a high level of patient satisfaction and adherence.

The Impact of Cashew Nut (Anacardium occidentale) Testa Tannin Feeding Ratio on the Chemical and Mechanical Characteristics of Leather Tanned from Cowhide, Goatskin and Sheepskin

In recent years, there has been a growing interest in exploring natural alternatives to synthetic tannins, driven by concerns over sustainability and environmental impact. Natural tannins offer several advantages, including biodegradability, renewability, and lower environmental impact compared to synthetic chemicals. Among the natural tannins under investigation, cashew nut testa tannin has emerged as a promising candidate due to its abundance, renewability, and potential benefits in leather tanning applications. This research investigated the impact of varying feeding ratios of cashew nut testa tannin on the chemical and mechanical characteristics of leather tanned from cowhide, goatskin, and sheepskin. The objective was to determine how different concentrations of cashew nut testa tannin influence the quality and performance of the leather. Leather samples were prepared using different feeding ratios of cashew nut testa tannin and subjected to a series of chemical and mechanical tests. The results indicated that the absorption of tannin and the resultant chemical stability varied with the type of hide or skin, with each exhibiting unique optimal ratios for tannin uptake. Higher tannin ratios generally improved the tensile and tear strength of the leather across all types, with significant enhancements noted in goatskin and sheepskin. However, an increase in tannin ratio reduced the flexibility of cowhide, while goatskin and sheepskin maintained adequate flexibility. The study demonstrates that cashew nut testa tannin is an effective and sustainable tanning agent, capable of producing quality leather. The findings suggest that the leather industry can utilize cashew nut testa tannin to enhance leather properties, with potential customization of tannin feeding ratios to meet specific performance requirements. Further research is recommended to explore long-term durability and economic viability on a commercial scale. This study contributes to the development of eco-friendly tanning practices and provides insights into optimizing the use of cashew nut testa tannin for various types of leather.

Formulation and Evaluation of Herbal Soap Containing Ocimum tenuiflorum (Tulsi) for Enhanced Skin Health

This study aimed to develop and evaluate a herbal soap formulation containing Ocimum tenuiflorum (Tulsi) and other natural ingredients to promote skin health. The soap was prepared using the double boiling method, incorporating Tulsi powder, turmeric, aloe vera gel, almond oil, rose water, and lavender essential oil into a glycerin soap base. The formulation process and ingredient selection were based on the therapeutic properties of each component, with a focus on antibacterial, anti-inflammatory, and moisturizing effects. The resulting soap was subjected to various evaluation parameters, including organoleptic properties, physical characteristics such as foam retention, foamability, and pH, as well as skin sensitivity and irritation tests. The herbal soap demonstrated favorable characteristics in terms of appearance, odor, and skin compatibility. Its natural composition offers potential advantages over conventional soaps, including the absence of harsh chemicals and the presence of active phytochemicals that may benefit skin health. This study contributes to the growing body of research on natural cosmetic formulations and highlights the potential of herbal ingredients in personal care products. Further research, including clinical trials, is recommended to fully elucidate the efficacy and long-term benefits of this herbal soap formulation for various skin types and conditions

Epidermal and dermal hydration in relation to skin color parameters.

Our goal was to investigate linkages between skin color parameters and skin hydration. Since most prior studies focused on stratum corneum hydration, we focused on epidermal and dermal hydration in relation to skin color parameters in both sexes. Thirty adults (16 female) with an age±SD of 24.3±0.6 years participated. Three sites on both volar forearms were evaluated for melanin index (MI), erythema index (EI), Individual Typology Angle (ITA), tissue dielectric constant (TDC) values to depths of 0.5mm (TDC0.5) and 2.5mm (TDC2.5), and Fitzpatrick skin type (FST). MI and EI were highly correlated (r=0.800, p<0.001) with maximum differences in MI and ITA along the arm of 3% and 6.3% with no difference between arms. Male MI was greater than females (p<0.01). Male TDC2.5 was 36.1±5.4 and correlated with EI (r=0.231, p=0.035). Contrastingly, female TDC25 was 28.5±3.6 with no correlation with EI but was correlated with MI (r=-0.301, p=0.003). These differential patterns held true for TDC0.5. For both sexes, FST and ITA were highly correlated (r=-0.756, p<0.001). The findings revealed several correlations between skin color parameters and hydration that differed between males in females in some cases. The observed correlations may indicate that melanin may differentially impact water-holding capacity between sexes and provides a future research target. Further, these initial findings also may hold significance for dermatological assessments and the customization of skincare treatments tailored to individual skin types and demographics.

Permanent Indian ink tattoos for breast cancer radiotherapy: A United Kingdom study of the emotional impact on patients following radiotherapy

IntroductionPost-operative radiotherapy for early breast cancer is recommended for over 30,000 people every year in the United Kingdom. The majority of these patients will be advised to have radiotherapy alignment tattoos; permanent skin marks applied with Indian ink and a lancing needle, black/green/blue in colour and approximately 2 mm in diameter. The tattoos assist the therapeutic radiographers to position the patient accurately and reproducibly for each treatment fraction. The aim of this study was to investigate the emotional impact of radiotherapy tattoos on people following breast cancer radiotherapy. MethodsAn electronic questionnaire was distributed by the charitable organisation, Breast Cancer Now, to their members who had undergone radiotherapy for early breast cancer. Based on the responses to the open and closed questions, an overall impact score was assigned to each respondent, and representative quotes extracted to contextualise the themes identified. Statistical tests were performed to evaluate the relationship between overall impact scores and several variables such as age at the time of radiotherapy, skin type, and age at the time of completing the questionnaire. Results204 people responded to the questionnaire. 100% had permanent Indian ink tattoos during breast cancer radiotherapy. 95% could still see the midline tattoo. 22 subthemes were identified; 4 positive, 4 neutral and 14 negative. Radiotherapy tattoos served as a constant negative reminder for 27% and affected clothing choices in 14% of respondents. 11% described feelings of ‘hating’ them. 6% were assigned positive overall impact scores, 43% neutral, and 51% had negative overall impact scores. The black/green/blue ink pigment used was commonly described as unnatural; contributing strongly to the negative appearance of the tattoos. ConclusionPermanent Indian ink tattoos have a negative impact on emotional well-being in the months and years following radiotherapy for early breast cancer for many people. In contrast, a very small minority feel positively about the tattoos. Implications for practiceOur findings are unlikely to be unique to this diagnostic cohort and supports the need to offer alternatives that are less-impactful to the recipient, accessible for people of all skin colours, and fit-for-purpose in terms of radiotherapy set-up. Acknowledgement of the significant negative impact and collaboration between industry, healthcare professionals and patient representatives is key to identifying and implementing suitable alternatives as standard of care.

Wound-healing properties of Stryphnodendron adstringens (barbatimão) in skin and mucosa injuries: a scoping review protocol.

This review will map the literature on the types of research and methods used to investigate the wound-healing properties of Stryphnodendron adstringens ( barbatimão ) in skin and mucosa injuries. Barbatimão is a Brazilian native plant and its wound-healing properties have been described in literature since the colonial period. It is one of the 71 plants included in the Brazilian health system's national list of medicinal plants of interest. However, existing literature reviews on the subject are limited, not comprehensive, lack a search strategy, and lack peer review. This scoping review will include all types of published and unpublished sources that investigate the wound-healing properties of barbatimão to treat any type of skin or mucosa injury in humans, animals, or in vitro, in any context. A scoping review will be conducted following JBI methodology. The main databases to be searched will include Embase (EBSCOhost), CINAHL (EBSCOhost), Scopus, PubMed (EBSCOhost), ScienceDirect, Lilacs, SciELO, CUIDEN, MOSAICO, Web of Science, Epistemonikos, and Google Scholar. Unpublished studies will also be considered. Two independent reviewers will examine titles and abstracts and select and read full-text sources for possible inclusion. Subsequently, the reviewers will extract and synthesize the data, which will be presented as a map, diagram, or table, according to the review objectives. Open Science Framework osf.io/w57m4.

External validation of a predictive model for aged-related skin tears in Fitzpatrick skin types I-IV cohort.

Older Australians are at increased risk of skin tears with the risk not always recognised or the injury able to be prevented. This study externally validated Rayner et al. (2019) Skin Tear Risk Prediction Model in an independent aged cohort with a Fitzpatrick skin types I-IV from across multiple residential-care sites, over a 6-month period. A total of 362 individuals aged between 65 and 102.5 years completed the study. In all, 165-residents sustained one or more skin tears. Logistic regression analysis was conducted of the five variables (gender, previous history of skin tears, previous history of falls, purpura and solar elastosis) identified in the skin tear model. The skin tear model provided 'good' to nearly 'very good discrimination' for correctly classifying residents at-risk or not-at-risk (area under the curve of 0.799 [95% confidence interval, CI: 0.75-0.84]). The skin tear model correctly predicted 75.8% (sensitivity) of participants with skin tears and 71.6% (specificity) of residents without skin tears. The model demonstrated it could work as a screening tool to identify older individuals at risk of skin tears and would benefit clinical practice as it was easy to use, was reproducible, and had good accuracy across aged-care residents with a Fitzpatrick skin type I-IV.