Amy J. McMichael

Development and validation of a health-related quality of life instrument for women with melasma.

Background  Melasma can have significant emotional and psychological effects on those affected with the condition. In the past, the impact of melasma on health‐related quality of life (HRQoL) has been assessed using general measures of skin disease that equally weigh both the physical and psychosocial distress arising from the presence of a dermatological condition.

Medical and surgical therapies for alopecias in black women

ABSTRACT:  Hair loss is a common problem that challenges the patient and clinician with a host of cosmetic, psychological and medical issues. Alopecia occurs in both men and women, and in all racial and ethnic populations, but the etiology varies considerably from group to group. In black women, many forms of alopecia are associated with hair‐care practices (e.g., traction alopecia, trichorrhexis nodosa, and central centrifugal cicatricial alopecia). The use of thermal or chemical hair straightening, and hair braiding or weaving are examples of styling techniques that place African American women at high risk for various “traumatic” alopecias. Although the exact cause of these alopecias is unknown, a multifactorial etiology including both genetic and environmental factors is suspected. A careful history and physical examination, together with an acute sensitivity to the patients perceptions (e.g., self‐esteem and social problems), are critical in determining the best therapy course. Therapeutic options for these patients range from alteration of current hair grooming practices or products, to use of specific medical treatments, to hair replacement surgery. Since early intervention is often a key to preventing irreversible alopecia, the purpose of the present article is to educate the dermatologist on all aspects of therapy for hair loss in black women—including not only a discussion of the main medical and surgical therapies but also an overview of ethnic hair cosmetics, specific suggestions for alterations of hair‐care practices, and recommendations for patient education and compliance.

Correlates of health-related quality of life in women with severe facial blemishes.

Background  Facial appearance plays a large role in self‐perception and interaction with others. Visible facial skin lesions are a common condition.

Melasma and its impact on health-related quality of life in Hispanic women

Objectives: Melasma poses a substantial emotional and psychosocial burden on patients. Even though melasma is prevalent in Hispanic women, its impact on health‐related quality of life (HRQOL) has been under‐reported. The purpose of this review is to evaluate the impact of melasma on the HRQOL of Hispanic women. Methods: An extensive literature review of articles published in English and Spanish over the last 15 years (1991–2006) was conducted. The search terms used to obtain relevant information were ‘melasma’, ‘women’, ‘health‐related quality of life’, HRQOL’, ‘treatment’, ‘Hispanic’, and ‘Latino’. Specific issues covered include HRQOL issues in melasma, instruments used and treatment modalities available for melasma. Results: The literature search revealed that melasma has a deleterious impact on the HRQOL. It severely affects social life, emotional well‐being, physical health and money matters in Hispanic women. Conclusion: Patient education, awareness and counseling are needed to improve HRQOL outcomes.

Characteristics of office-based visits for skin cancer. Dermatologists have more experience than other physicians in managing malignant and premalignant skin conditions.

BACKGROUND. Actinic keratoses and skin cancer constitute a major public health problem for predisposed individuals. objective. The purpose of this paper is to determine the characteristics of office‐based visits for actinic keratoses and skin cancer in the United States. METHODS. The National Ambulatory Medical Care Survey provided data on office‐based physician visits for actinic keratoses and skin cancer in 1993 and 1994. RESULTS. There were 3.7 million visits per year for actinic keratoses, 3.1 million visits per year for nonmelanoma skin cancer (NMSC), and 430,000 visits per year for melanoma. Excisions and destructions of lesions accounted for 90%, 67%, and 62% of procedures for actinic keratoses, NMSC, and melanoma, respectively. Dermatologists (683), plastic surgeons (37), and general and family physicians (11) managed more visits per physician per year than other specialists. CONCLUSION. Dermatologists have significantly more experience managing skin cancer than do other physicians.

Tobacco smoking contributes little to facial wrinkling.

The potential detrimental effects of tobacco smoking have been widely cited. Tobacco smoking has been linked with facial wrinkling, but some previous studies have failed to take into account a number of potential confounders or were unblinded and thus subjective to bias.

Long-term efficacy and safety of tretinoin emollient cream 0.05% in the treatment of photodamaged facial skin : A two-year, randomized, placebo-controlled trial

AbstractBackground: Long-term (>1 year) placebo-controlled studies of tretinoin in the treatment of photodamaged skin have not been conducted. Recently, we conducted a 2-year placebo-controlled study of tretinoin emollient cream 0.05%, including histopathologic assessment of safety and analysis of markers of collagen deposition. Objective: The objective of the study was to determine the long-term safety and efficacy of tretinoin emollient cream 0.05% in the treatment of moderate to severe facial photodamage. Methods: A total of 204 subjects were treated with tretinoin or placebo (vehicle emollient cream) applied to the entire face once a day for up to 2 years. Clinical and histologic effects were assessed at regularly scheduled clinic visits. Results: Treatment with tretinoin resulted in significantly greater improvement relative to placebo in clinical signs of photodamage (fine and coarse wrinkling, mottled hyperpigmentation, lentigines, and sallowness), overall photodamage severity, and investigator’s global assessment of clinical response (p < 0.05). Histologic evaluation showed no increase in keratinocytic or melanocytic atypia, dermal elastosis, or untoward effects on stratum corneum following treatment with tretinoin compared with placebo. Immunohistochemistry studies, conducted at three study centers, showed a significant increase relative to placebo in facial procollagen 1C terminal, a marker for procollagen synthesis, at month 12 (p = 0.0074). Conclusion: Long-term treatment with tretinoin emollient cream 0.05% is safe and effective in subjects with moderate to severe facial photodamage.

Hair and scalp disorders in ethnic populations

Treating scalp and hair disorders is challenging because of the emotional nature of hair loss and because of unknown pathogenesis. Treating African American patients can add an extra layer of complexity to this treatment if the dermatologist is not familiar with hair care practices. Only the dermatologist who strives to understand hair care practices, the common disease entities of the hair and scalp in African Americans, and the disturbance in quality of life from alopecia will effectively approach treatment in these patients.

Central scalp alopecia photographic scale in African American women.

ABSTRACT:  Central centrifugal cicatricial alopecia (CCCA) is a common but poorly understood cause of hair loss in African American women. A photographic scale was developed that captures the pattern and severity of the central hair loss seen with CCCA in order to help identify this problem in the general community and to potentially correlate clinical data with hair loss. The utility and reproducibility of this photographic scale was determined in a group of 150 African American women gathered for a health and beauty day who were evaluated by both four investigators experienced in the diagnosis of hair disorders and by the subjects themselves.

Are there racial and sex differences in the use of oral isotretinoin for acne management in the United States

BACKGROUND Treatment of various diseases has been noted to vary by patient demographics. There is reason to suspect that there may be sex and racial differences in the treatment of severe acne. OBJECTIVE We sought to determine if treatment of severe acne with oral isotretinoin varied with patient sex, race, or both. METHODS We analyzed the demographics of patients with acne and patients using oral isotretinoin, minocycline, and tetracycline recorded in the 1990 to 1997 National Ambulatory Medical Care Survey. RESULTS There were 35 million visits to physicians for the treatment of acne between 1990 and 1997, and isotretinoin was prescribed at 5.8 million (17%) of these visits. Per capita visit rates for acne among whites was 2.3 times that of blacks, and whites were 1.8 times more likely to receive isotretinoin at acne visits. Per capita, women had 1.4 times as many visits for acne as men, but men were 1.7 times more likely than women to receive isotretinoin at an acne visit. Dermatologists managed 83% of all isotretinoin visits. Dermatologists accounted for 100% of isotretinoin visits for which pregnancy prevention education and counseling was reported. CONCLUSIONS Patients who are black receive less oral isotretinoin than those who are white, and the expense of isotretinoin appears to be one factor in this difference. Women are less likely than men to receive isotretinoin at acne visits. Expense does not appear to be a factor in this difference. Dermatologists have more experience than nondermatologists managing acne, prescribing isotretinoin, and counseling women treated with isotretinoin concerning pregnancy prevention. Pregnancy prevention is an essential component of isotretinoin use in women that must not be ignored.