THE STUDY OF THE SPECTRUM OF ETHNIC SKIN AND HAIR DISORDERS AND THE COMPOSITION AND USE OF SKIN LIGHTENING PREPARATIONS, TRADITIONAL COSMETICS AND. Mantha Makume for devoting her time to proofreading my manuscripts and for her critical comments on the thesis.
GRANTS SUPPORTING THIS WORK
PERSONAL CONTRIBUTION TO THE WORK DESCRIBED IN THIS DISSERTATION
Identified the cases, performed the skin biopsies, contributed to the discussion and drafting of the manuscript as first author and submitted the paper. Identified the case, performed the skin biopsy, contributed to the discussion and drafting of the manuscript as first author and submitted the paper.
REFERENCING
INTRODUCTION, RESEARCH PAPERS AND DISCUSSION
APPENDICES
INTRODUCTION
THE IMPORTANCE OF SKIN DISORDERS
ETHNODERMATOLOGY
However, in recent years there has been a significant increase in research focused on the study of ethnic skin. As part of this, it is essential that clinicians are familiar with the unique dermatoses most relevant to ethnic communities, as well as the differences in more widespread conditions specific to ethnic skin.
THE SKIN
This is partly due to demographic changes in developed countries resulting from global migration, as well as the increasing wealth of black people, leading to increased demand for health care resources [6, 12]. Therefore, there is an urgent need for large-scale research in ethnodermatology so that this large and overlooked population can receive the benefits of diagnosis, management and community interventions that precisely target the spectrum of disease relevant to them [8, 10].
Fitzpatrick’s classification of skin types
Physical characteristics of ethnic skin
Ethnic skin patients have larger, more dispersed melanosomes compared to smaller and aggregated melanosomes in whites [8, 21]. Ethnic skin has an increased number of macrophages in the papillary dermis and a decreased amount of collagenase.
ETHNODERMATOSES
AIM OF THE STUDY
We have found that this is followed by pigmentary disorders, as described in this thesis. The introduction and background, details of topics and methodology, results, discussion and conclusion are fully reported in the publications that make up the bulk of this thesis.
CHAPTE R 2
Background Accurate knowledge of the prevalence and spectrum of skin diseases in a population allows for effective planning for the provision of dermatology services and. A study of the spectrum of skin disease occurring in a black population in South East London.
CHAPTE R 3
Objectives To examine the skin lightening practices of African and Indian women living in South Africa. An epidemiological survey of the use of skin lightening cosmetics among traders in Lagos, Nigeria.
CHAPTE R 4
Women's perceptions of the benefits and risks of skin lightening creams in two South African communities. We therefore set out to investigate the perceptions of benefits and risks associated with the use of skin-lightening products among black African and Indian women in Durban, South Africa.
CHAPTE R 5
The last paper on skin lightening products on the market in South Africa was published 31 years ago by Findlay and De Beer.10 In this we report the findings of an investigation into the contents of the top 10 top selling skin lightening creams available on the market in Durban, South Africa. Of the 10 best-selling lightening creams, nine (90%) were found to contain banned or illegal compounds.
CHAPTE R 6
TITLE
RUNNING HEAD
KEY WORDS
WORD, TABLE AND FIGURE COUNT
AUTHORS
CORRESPONDING AUTHOR
FUNDING
CONFLICT OF INTEREST
ABSTRACT Background
Objectives
Results
Conclusions
SUMMARY
INTRODUCTION
MATERIALS AND METHODS
Data analysis
RESULTS Demographics
Understanding of sunscreen practice
Cancer awareness
Knowledge index
Prevalence of sun-protective behaviour
Behaviour index
DISCUSSION
Physicians and health care providers should take the lead in implementing early detection and screening measures and in educating the public about the need for these measures. Fewer than 10% of respondents reported that their doctor had ever discussed skin cancer with them or shown them how to examine their skin, and fewer than 10% had ever had a medical skin exam. Our study shows a general lack of knowledge about the risks of sun exposure, the benefits of sun protection, and the steps needed to prevent and detect melanoma.
ACKNOWLEDGEMENTS
We believe that there is a need for major improvements in public education, and for greater emphasis on these measures by health care providers. The results point to the need for targeted and culturally inclusive programs to increase rates of early detection, reduce melanoma incidence and improve skin health more generally.
Did you know that black people can get skin cancer on the palms of the hands, soles of the feet, fingernails and toenails. The horizontal axis shows a scale from 0 (no appropriate answer to any question) to 11 (appropriate answer to all questions). The horizontal axis shows a scale from 0 (no appropriate behavior reflected in any response) to 6 (appropriate behavior reflected in all responses).
CHAPTE R 7
Chemical analysis and in vitro UV-protection characteristics of clays traditionally used for sun
In the case of the red clay, iron oxide was also present, corresponding to the color of the clay. The mass losses between dehydration and dehydroxylation are due to the presence of the iron oxides, especially for the red clay. In the case of the white clay, 50% of the particles (by volume) had a diameter smaller than 12.463mm.
CHAPTE R 8
Author's personal copy
A combined ethyl acetate/methanol extract of the stem bark yielded morelloflavones (1) (20 mg) and morelloflavone-7″-sulfate (2) (20 mg). Morelloflavones (1), morelloflavone-7″-sulfate (2), gutiferone A (3) and sargaol (4) along with ethyl acetate and methanol extracts of Garcinia livingstoneistum bark (crude extracts 39b and 39c, respectively) and fruit peel extract were selected for further in vitro analysis. Morelloflavones, morelloflavone-7″-sulfate and sargaol elicited a dose-dependent effect on cytotoxicity and melanin content (Fig. 4A–C).
CHAPTE R 9
CHAPTER 10
Hair care includes occasional chemical hair relaxers once every 4 months for the past 3 years and mostly natural hair twists. In all seven patients from families 1 and 2, skin histology showed perifollicular and perivascular lymphoid cell infiltration with eccentric thinning of the follicular epithelium with concentric lamellar fibroplasia consistent with CCCA (Fig. 3). a) 92-year-old mother, with clinical and histological features of central centrifugal cicatricial alopecia (CCCA), with no history of chemical or mechanical hair treatment. Figure 3 Histology: ·40 transverse section with features of central centrifugal cicatricial alopecia – eccentric thinning of the follicular epithelium with concentric lamellar fibroplasia (a). a) 35-year-old mother with central centrifugal cicatricial alopecia (CCCA), hair treatment included a combination of chemical relaxers, tight braids with hair extensions and sew-in hair weaves.
CHAPTER 11
Traction alopecia (TA) occurred in most African women, but neither in Indian women nor in African men. None of the PRO assessment tools met the recommended criteria based on the quality checklist. Expression of Snail1 in the fibrotic dermis of postmenopausal frontal fibrosing alopecia: possible involvement of an epithelial-mesenchymal transition and a review of Japanese patients.Br J Dermatol.
CHAPTER 14
A diagnosis of frontal fibrosing alopecia (FFA) was confirmed and the patient was started on hydroxychloroquine 200 mg twice daily for 6 months, topically. 3 Chew A-L, Bashir SJ, Wain ME, et al. Expanding the spectrum of frontal fibrosing alopecia: a unifying concept. Fibrosing alopecia in a patterned distribution: patterned lichen planopilaris or androgenetic alopecia with a lichenoid tissue reaction pattern? Arch Dermatol.
CHAPTER 15
1Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. 2 Department of Dermatology - Department of Medicine, Clinical and Surgical, University of Naples Federico II, Naples, Italy. 4Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
MATERIALS AND METHODS Patients
Statistical methods
RESULTS
Subjective symptoms: the impact of the relevant manifest variables on quality of life as measured by the QLI. Objective symptoms: the impact of the relevant manifest variables on quality of life, as measured by the QLI. Relationships: The impact of the relevant manifest variables on quality of life, as measured by the QLI.
DISCUSSION AND CONCLUSIONS
SUMMARY OF THE STUDIES
Second, we analyzed a local plant extract derived from Garcinia livingstonei, which is traditionally used as a skin lightening agent. We found that CCCA can be inherited as an autosomal dominant genetic disorder that can be exacerbated by different hair care practices. In addition, we found that FFA may be associated with lichen planus pigmentosus, the latter presenting as a precursor to FFA.
The spectrum of skin diseases in a black population in KwaZulu-Natal, South Africa (Chapter 2)
The plant extracts were found to be less toxic than hydroquinone, and they also show potential for further research and development into safer skin lightening agents (Chapter 8). Together, the two studies should provide an accurate assessment of the importance of the various skin diseases in our population.
Skin lightening compounds in KwaZulu-Natal (Chapters 3-5)
Cancer awareness and sunscreen use (Chapter 6)
Ethnopharmacology and indigenous knowledge systems: Use of traditional medicinals for sun-protection and skin-lightening (Chapters 7-8)
Ethnic hair disorders (Chapters 9-15)
Quality of life in African patients with alopecia Chapter 15)
STUDY LIMITATIONS
We were only able to obtain useful data on 10 skin lightening products, and our findings may not be fully representative of the full spectrum of products on the market. This work continues, and we are currently analyzing another 40 products in South Africa to establish a better understanding of the extent of the problem.
GENERAL CONCLUSIONS
Similarly, we have shown that clay products, long used in African society for sun protection, provide a useful level of UVA protection. We have shown that alopecia significantly harms quality of life by lowering self-esteem among black women in South Africa, and it is important that healthcare practitioners are aware of its psychological impact. We have demonstrated a possible genetic link to the etiology of CCCA, provided the first published descriptions of FFA in Africans, and identified a likely association between FFA and LPPigm; this opens the possibility that early detection may be possible and allow the prevention of irreversible scarring alopecia.
IMPLEMENTATION OF RESEARCH FINDINGS Clinical practice
Through laboratory studies of commonly used traditional plants, we isolated a series of compounds from the stem bark and fruit of Garcinia livingstonei, some of which were found to be less toxic and more potent than the standard universally used hydroquinone. We are particularly concerned about the serious gap in knowledge and behavior regarding skin cancer that we have identified among our population. However, it is worrying that the white population, although better informed, exhibits an essentially complacent attitude to sun protection, despite the very high risk of skin cancer to which they are exposed throughout their lives.
Regulation
Current and planned research projects
Ethnopharmacology
Hair
This is a follow-up study on the study conducted in the private sector and is in preparation for publication. This will give a balanced overview of the spectrum of skin conditions seen in KwaZulu-Natal.
Education
Patient education and support
We wrote a chapter on skin and hair care for a children's textbook intended to spark interest in science, technology, engineering and mathematics among primary school children in South African schools. We also approached the producer of the popular TV soap Generations, which is widely watched every weekday by a significant part of the African population, with the suggestion that material raising awareness of the dangers of skin lighteners be included in the script. We have also written articles for popular magazines and participated in podcasts, TV and radio interviews to raise public awareness of the implications of our research findings.
GENERAL CONCLUSIONS: ETHNODERMATOLOGY
The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. An enlightening tour of SA's skin lightening industry; Lichen Planus Pigmentosus and Frontal Fibrosing Alopecia; Use of botanical substances as skin lighteners in SA. 3rd Continental Congress of the International Society of Dermatology (ISD) and 65th National Congress of the Dermatology Society of South Africa (DSSA), Durban, South Africa (2012).
