Nonhlanhla P. Khumalo

Hairdressing and the prevalence of scalp disease in African adults

Background  Anecdotal reports suggest that certain scalp disorders are common in Africans and may be associated with hairstyles.

Guidelines for the management of bullous pemphigoid

Summary These guidelines have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence‐based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines and a brief overview of epidemiological aspects, diagnosis and investigation. The guidelines reflect data available from Medline, Embase, the Cochrane library, literature searches and the experience of the authors of managing patients with bullous pemphigoid in special and general clinics for over 10 years. However, caution should be exercised in interpreting the data obtained from the literature because only six randomized controlled trials are available involving small groups of patients.

Life‐threatening infantile haemangioma: a dramatic response to propranolol

tion therapy was increased (41.7% fi 85.7%). Furthermore, survival rate was increased after melanoma multidisciplinary clinic, although there was no statistical meaning (Fig. 1b). In conclusion, cutaneous melanoma showed similar features with other reports in Asians, and we could observe some changes, perhaps reflecting recent westernization of the Korean life style. Centralized, coordinated, multidisciplinary program can provide more proper and diverse care to melanoma patients.

Hairdressing is associated with scalp disease in African schoolchildren

Background  Anecdotal reports suggest that certain disorders are common in African hair and may be associated with hairstyles.

Determinants of marginal traction alopecia in African girls and women

BACKGROUND Our recent population studies reported a prevalence of traction alopecia (TA) of 17.1% in African schoolgirls (6-21 years) and of 31.7% in women (18-86 years). More schoolgirls had chemically treated hair than women and disease presence was associated with hairstyles. The aim of this study was to investigate determinants of TA presence and severity in girls and women using data from both studies. METHODS Clinical assessment and a Marginal TA Severity score were used for diagnosis and disease severity, respectively. The data used included 574 schoolgirls and 604 women. The first analysis was multiple logistic regression for disease presence. Exploratory associations for disease severity were assessed using the Spearman rank correlation test. Adults were defined as age 18 years or older, irrespective of study. RESULTS The odds ratio for TA was higher in adults than in children (<18 years) (1.87 [P < .001, 95% confidence interval 1.28-2.72]) and was higher with braiding-related than chemical-related symptoms. The highest risk of TA, compared with natural hair, occurred when traction was added to relaxed hair (odds ratio 3.47 [P < .001, 95% confidence interval 1.94-6.20]). Only 18.9% of patients with TA had never had symptoms related to hairdressing. TA severity was associated with age group, current hairstyle, and hairdressing symptoms. Participants with severe disease were too few to estimate determinants. LIMITATIONS There is a need for the validation of the Marginal TA Severity score with larger numbers and for future studies to include more participants with severe disease. CONCLUSIONS Our findings suggest that avoiding both hairdressing symptoms and the addition of traction, especially to chemically processed hair, may reduce the risk of developing TA.

Food allergy in South African children with atopic dermatitis

The prevalence of food allergy in South Africa is unknown, but previously thought to be rare in black South Africans. This study aimed to determine the prevalence of, and risk factors for, IgE‐mediated food allergy in South African children with atopic dermatitis (AD).

Apparent fragility of African hair is unrelated to the cystine‐rich protein distribution: a cytochemical electron microscopic study

Abstract:  A feature of black African hair is an apparent increased fragility of the hair shaft compared to other ethnic groups (as measured by the tensile force needed to break the hair fibre). This has certain similarities to that reported for trichorrhexis nodosa (weathering secondary to physical damage) and trichothiodystrophy [a genetic disorder associated with reduced cystine (sulphur)‐rich proteins and increased fragility]. In the present study, the distribution of the cystine‐rich proteins in the hair of black Africans was compared to that of Caucasian and Asian volunteers, plus patients with trichorrhexis nodosa and trichothiodystrophy, using transmission electron microscopy and specific silver stains. It was found that the silver staining pattern of the hair shafts of black Africans was similar to that observed for Caucasians, Asians and also patients with trichorrhexis nodosa. The cuticular cells exhibited an electron dense A layer and exocuticle, and in the cortex the microfibrils forming the macrofibres were outlined by electron‐dense material. This contrasts with the abnormal distribution of the cystine‐rich proteins seen in trichothiodystrophy. This study is the first formal comparison of the cystine‐rich proteins in the various racial groups and shows that there is no abnormality in their distribution in black African hair shafts compared to the other ethnic groups. Therefore, the excessive structural damage observed in the African hair shafts is consistent with physical trauma (resulting from grooming) rather than an inherent weakness due to any structural abnormality.

Mutations in FAM111B Cause Hereditary Fibrosing Poikiloderma with Tendon Contracture, Myopathy, and Pulmonary Fibrosis

Congenital poikiloderma is characterized by a combination of mottled pigmentation, telangiectasia, and epidermal atrophy in the first few months of life. We have previously described a South African European-descent family affected by a rare autosomal-dominant form of hereditary fibrosing poikiloderma accompanied by tendon contracture, myopathy, and pulmonary fibrosis. Here, we report the identification of causative mutations in FAM111B by whole-exome sequencing. In total, three FAM111B missense mutations were identified in five kindreds of different ethnic backgrounds. The mutation segregated with the disease in one large pedigree, and mutations were de novo in two other pedigrees. All three mutations were absent from public databases and were not observed on Sanger sequencing of 388 ethnically matched control subjects. The three single-nucleotide mutations code for amino acid changes that are clustered within a putative trypsin-like cysteine/serine peptidase domain of FAM111B. These findings provide evidence of the involvement of FAM111B in congenital poikiloderma and multisystem fibrosis.

Elevated formaldehyde concentration in “Brazilian keratin type” hair-straightening products: A cross-sectional study

BACKGROUND Brazilian keratin treatment (BKT) and similar straightening products fix and retain a straight shape even when the hair is wet. Unacceptably high concentrations of formaldehyde have been reported in such products. OBJECTIVE We sought to measure the formaldehyde concentration in all BKT brands marketed in South Africa in 2012. METHODS We quantified formaldehyde by high-performance liquid chromatography with ultraviolet light detection after derivatization with dinitrophenylhydrazine. All components of 7 identified commercial brands were each tested 3 times. RESULTS The maximum safe concentration of formaldehyde set by the US Cosmetic Ingredient Review Expert Panel is less than 0.2%. Of the 7 commercial BKT brands, 6 had formaldehyde levels that ranged from 0.96% to 1.4%, ie, 5 times higher than the recommended level; these included 5 brands labeled formaldehyde-free. LIMITATIONS The study is limited by not including all internationally available BKT products. CONCLUSIONS Formaldehyde concentrations in BKT products may exceed recommended levels and serve as a health hazard. Industry monitoring is needed to improve compliance and protection of hairdressers and consumers.

Management of Bullous Pemphigoid

In 1953, Lever differentiated bullous pemphigoid from autoimmune pemphigus. The natural course of bullous pemphigoid is relatively benign, with a disease-related mortality rate of 24% compared with around 70% in pemphigus. In spite of the introduction of systemic corticosteroids, the mortality rates in bullous pemphigoid have generally not improved and vary between 0% and 40%. Higher doses of systemic corticosteroids seem to be associated with higher mortality rates, which led to the addition of corticosteroid-sparing agents to the treatment of bullous pemphigoid. However, many of these modalities are also accompanied by severe adverse effects and have not led to a significant decrease in the mortality rate. In recent years, there has been a move toward less toxic treatment options for a disease that is usually self-limited.A systematic review of the literature found that treatment with lower doses of systemic corticosteroids and potent topical corticosteroids is effective and accompanied by less serious adverse effects, including death. No benefit of the addition of plasmapheresis or azathioprine to systemic corticosteroids has been shown. The treatment of bullous pemphigoid with tetracyclines and niacinamide (nicotinamide) is effective and accompanied by less serious adverse effects. However, more randomized controlled trials are needed to confirm these results and to determine the best treatment for bullous pemphigoid.