Prevalence of pigmentary disorders: A cross-sectional study in public hospitals in Durban, South Africa

Usage Frequency and Ecotoxicity of Skin Depigmenting Agents

Background/Objectives: Depigmenting cosmetic products are a fast-growing segment of the health products market, driven by consumer demand to address skin hyperpigmentation. Simultaneously, interest in products with a reduced environmental impact is increasing. However, the potential environmental risks, especially in aquatic ecosystems, of depigmenting products remain unexplored. This study assesses the usage frequency of skin depigmenting agents in cosmetic products and compiles data on the biodegradability and acute aquatic toxicity of the most prevalent compounds. Methods: A market analysis of Portuguese pharmacies and parapharmacies in 2022 identified prevalent depigmenting agents. Scientific evidence on their biodegradability and acute aquatic toxicity was compiled, and when data was unavailable, in silico predictions were conducted. Results: The study identified the ten most-used depigmenting agents in cosmetic products, including hydroxy/keto acids, as well as vitamin C and derivatives, with a usage frequency surpassing 50%. While most were naturally derived and showed low environmental risk, synthetic and highly lipophilic depigmenting agents found in 35 of 70 products (ascorbyl tetraisopalmitate/tetrahexyldecyl ascorbate and resorcinol derivatives) showed a higher potential for environmental hazard. Conclusions: The findings underscore the need for further research on the presence of these cosmetic ingredients in aquatic ecosystems and a reassessment of regulatory frameworks concerning their environmental impact. Mitigation strategies should emphasize biodegradable alternatives, renewable sources, and molecular modifications to reduce toxicity while maintaining depigmenting efficacy and skin safety. This study provides original insights into commonly used depigmenting agents in the health products market and their chemical structures, offering valuable opportunities for innovation in chemical/pharmaceutical industries.

Nevus of Hori in African patients: an entity that is most likely underdiagnosed in clinical practice

Background

Nevus of Hori (HN) has been primarily reported in patients of Eastern Asian descent, with a paucity of data regarding HN occurring in African patients. In this study, we report on South African patients with HN initially thought to have melasma.

Objective

To characterize the histopathological and clinical phenotypes of HN in African patients.

Methods

Retrospective data were collected from patients who met the inclusion criteria. These data entailed the clinical distribution, demographic data, Fitzpatrick skin phototype, and histopathologic features of African patients diagnosed with HN from a single private aesthetic center in Bloemfontein, South Africa.

Results

Thirty patients with an average age of 49 ± 7.37 were included in this analysis. The majority of patients were female (n = 29; 96.67%), and most patients were of Fitzpatrick skin phototype V (n = 22; 73.3%). The most common clinical distribution pattern was bitemporal (76.7%), followed by the zygomatic pattern (20%), mixed type (16.7%), and finally the central forehead pattern (3.3%). Histopathologically, the dendritic cell type of melanocytes was observed in the majority of patients (n = 25; 83.3%), while spindle-shaped cells were observed in few patients (n = 7; 23.33%), and none of the patients had bipolar-type melanocytes.

Limitations

This study has limitations inherent to small sample size and its inability to accurately generalize the findings.

Conclusion

HN can clinically mimic melasma in African patients. The most common clinical presentation was bitemporal. To our knowledge, this study is the largest regarding the clinicopathological profile of HN in African patients and it is likely to be the first to report these compelling findings.

Effectiveness and safety of acupuncture for melasma: A meta-analysis of randomized controlled trials

BACKGROUND

Treating melasma remains challenging. We conducted a meta-analysis to assess the effectiveness and safety of acupuncture as a treatment option.

METHODS

We searched three English and four Chinese databases up to January 2, 2024. The primary outcome was the total effective rate, while secondary outcomes included skin lesion area and color scores, total lesion score, and adverse effects. Study quality was assessed using the risk of bias tool, and data were analyzed with Review Manager 5.4. The GRADE approach evaluated evidence certainty.

RESULTS

This study included 22 studies with 1644 participants. Findings indicate that acupuncture significantly outperforms Western medicine and other treatments (risk ratio [RR] = 1.21, 95 % confidence interval [CI] (1.18, 1.30), P < 0.00001, I² = 34 %). Acupuncture effectively reduces the area of skin lesions (mean difference [MD] = -0.35, 95 % CI (-0.52, -0.19), P < 0.0001, I² = 93 %), lightens color (MD = -0.45, 95 % CI (-0.58, -0.31), P < 0.00001, I² = 89 %), and lowers the total score of skin lesions (MD = -1.00, 95 % CI (-1.29, -0.70), P < 0.00001, I² = 79 %). Adverse reactions were infrequent with acupuncture. The most common needling sites were in the facial lesion area, noted in 17 studies. Sanyinjiao (SP6) was the most frequently used acupoint (n = 8), followed by Hegu (LI4) (n = 7) and Xuehai (SP10) (n = 7). Other commonly used acupoints included Tianshu (ST25), Zusanli (ST36), Taichong (LR3), and Zhongwan (RN12). All secondary outcomes, except for the primary outcome, were rated as very low quality.

CONCLUSION

This review confirms that acupuncture therapy effectively reduces the area and color of melasma lesions and lowers lesion scores. Acupuncture therapy appears to be a safe and effective treatment option for melasma; however, results should be interpreted cautiously due to potential publication and regional biases.

REGISTRATION

CRD42024503394.

Prevalence and burden of vitiligo in Africa, the Middle East and Latin America

Vitiligo is a common chronic autoimmune disorder characterized by skin and hair depigmentation that affects 0.5%-2.0% of the global population. Vitiligo is associated with diminished quality of life (QoL) and psychosocial burden. The burden of vitiligo may vary based on skin tone and cultural differences as well as geographical variations in disease awareness, societal stigma, healthcare systems and treatment options. Data on the burden and management of vitiligo in Africa, the Middle East and Latin America are scarce. Literature searches using terms covering vitiligo in Africa, the Middle East and Latin America were conducted using PubMed to identify relevant publications that focused on disease prevalence and burden, QoL and psychosocial impact and disease management between 2011 and 2021. Most of the reviewed studies were conducted in the Middle East, and most Latin American studies were from Brazil. Most studies involved small patient numbers and may not be generalizable. Reported prevalence of vitiligo ranged from 0.18% to 5.3% in Africa and the Middle East, and from 0.04% to 0.57% in Latin America. In several studies, prevalence was higher among female participants. Generally, non-segmental vitiligo was the dominant clinical variant identified and the age at onset varied widely across studies. Common comorbidities include autoimmune diseases such as Hashimoto's thyroiditis, alopecia areata and diabetes. Few treatment guidelines exist in these regions, with the exceptions of guidelines published by the Brazilian and Argentinian Societies of Dermatology. There is a clear unmet need for large epidemiological studies with uniform methodology to accurately ascertain the true prevalence of vitiligo in Africa, the Middle East and Latin America. Additional data on vitiligo burden and management in Africa and Latin America are also needed, along with local disease management guidelines that consider genetic variation, psychosocial burden and socioeconomic diversity in all 3 regions.

The Effect of Melasma on the Quality of Life in People with Darker Skin Types Living in Durban, South Africa

Melasma is a common skin disorder of acquired hyperpigmentation that appears commonly on the face. Although asymptomatic, melasma causes psychosocial and emotional distress. This study aimed to assess melasma's severity on people with darker skin types, evaluate the effects of melasma on the quality of life (QoL), and establish QoL predictors in affected individuals. This was a cross-sectional analytic study that enrolled 150 patients from three private dermatology clinics in Durban, South Africa who were diagnosed with melasma. The severity of melasma alongside QoL were measured using a melasma area and severity index (MASI) score and melasma quality of life scale (MELASQoL), respectively. The associations among factors and QoL were explored using multivariable methods and stepwise regression analysis. p-values less than 0.05 were considered significant. Enrolled patients were predominantly females (95%), of which 76% were of black African ethnicity, 9% were of Indian ethnicity, and 15% had mixed ancestry, with an average age of 47.30 years. Family history revealed that 61% had no prior melasma cases, while 39% had affected relatives, most commonly mothers (41%). The cheeks were the most common site for melasma. MASI score of Masi (β = 0.209, t = 2.628, p < 0.001), the involvement of cheeks (β = -0.268, t = -3.405, p < 0.001), level of education (β = -0.159, t = -2.029, p = 0.044), and being menopausal (β = -0.161, t = -2.027, p = 0.045) were found to be predictors of QoL. A regression model was created to forecast MELASQoL using these four predictors. This equation's significance lies in its ability to enable the remote assessment of MELASQoL based on these four variables. It offers a valuable tool for researchers and medical professionals to quantitatively and objectively evaluate the impact of melasma on an individual's quality of life.

Topical Hydroquinone for Hyperpigmentation: A Narrative Review

Topical hydroquinone (HQ) has been used for decades to treat disorders of hyperpigmentation such as melasma, post-inflammatory hyperpigmentation, and solar lentigines. Additionally, it has been used as a skin-lightening agent for cosmetic purposes. Multiple studies have shown it to be effective in treating hyperpigmentation, though it is not without side effects. Currently, HQ is not approved for over-the-counter use in the United States. Its use is also banned in other countries, including Japan, Australia, and the European Union. Hyperpigmentation disorders affect individuals worldwide. Patients with these disorders are frequently seen in medical practices. Hyperpigmentation disorders can significantly negatively impact a person's quality of life, and agents that treat hyperpigmentation can improve patient outcomes. A comprehensive literature search was performed on HQ as a treatment for skin hyperpigmentation disorders. A literature review revealed that HQ is an effective compound for treating hyperpigmentation disorders and can be combined with other therapies for enhanced results. Evidence exists to support HQ as a topical therapy for skin hyperpigmentation. HQ is not without side effects and should be prescribed by trained professionals who can educate patients on usage. HQ can be used in pharmaceutical regimens to treat hyperpigmentation disorders.

Melasma in people with darker skin types: a scoping review protocol on prevalence, treatment options for melasma and impact on quality of life

BACKGROUND

Melasma is one of the most encountered dermatoses in dermatology and skin care clinics. It is a challenging chronic, recurrent condition associated with hyperpigmentation. Its aetiology is poorly understood. Melasma affects all races and gender but is more prevalent in women with darker skin types. Being a facial lesion, melasma has a severe impact on quality of life due to its disfigurement. While many modalities of treatment for melasma exists, unfortunately, effectiveness and safety remain a huge concern. Treatment modalities are variable and often unsatisfactory. The objective of this scoping review is to systemically map available evidence from literature regarding melasma on people with darker skin types, garner insight as to how melasma affects the quality of life and begin to investigate and gain understanding on effectiveness of different treatments used for melasma.

METHODS

A scoping review guided by Arksey and O'Malley's framework, the enhancements and recommendations of Levac, Colquhoun and O'Brien, Daudt and associates and the 2015 Johanna Briggs Institute's guidelines will be conducted. Systematic electronic searches of databases and search engines will include Scopus, PubMed, CINAHL Complete, Cochrane, Science Direct, and Web of Science which will be conducted to attain published peer-reviewed articles of all study designs excluding reviews and grey literature. All literature that meets the inclusion criteria, research question and sub-question will be included in this review. All the retrieved literature will be exported to an Endnote X20 library. Quality appraisal of the included articles will be conducted using the mixed methods appraisal tool (MMAT) 2018 version.

DISCUSSION

We anticipate mapping relevant literature on the melasma, investigating the effectiveness of treatment options of melasma as well as evaluating its association with quality of life in people with darker skin types. This study is likely to reveal research gaps, which could guide future implementation research on melasma treatment interventions.

SYSTEMATIC REVIEW REGISTRATION

This protocol has been registered a priori with OSF and is accessible on this link: https://osf.io/ru3jc/ .

Photoprotection for people with skin of colour: needs and strategies

Skin of colour or pigmented skin has unique characteristics: it has a higher eumelanin-to-pheomelanin ratio, more mature melanosomes, an increased amount of melanin distributed in the upper layers of the epidermis, and more efficient DNA repair compared with lighter skin. However, individuals with skin of colour are at a significant risk of skin damage caused by ultraviolet radiation, including the development of photodermatoses and photoageing changes such as uneven skin tone, and are predisposed to pigmentary disorders. In fact, one of the most common conditions leading to dermatology consultations by patients with skin of colour is photoexacerbated pigmentary disorders. Unfortunately, individuals with skin of colour may be less prone to engage in photoprotective measures, including the use of sunscreens. Physicians are also less likely to prescribe sunscreens for them. There is thus a clear need for better education on photodamage and for more efficient and suitable photoprotection in populations with skin of colour. However, this need has thus far only partially been met, and the development of sunscreen products designed to provide optimal photoprotection for people with skin of colour remains a challenge. Targeted sunscreens for individuals with skin of colour require optimal cosmetic appeal (leaving no white residue and not disrupting skin tone). They should include broad-spectrum [ultraviolet (UV)B/UVA] protection with high sun protection factor, as well as protection against long-wave UVA (UVA1) and visible light, as these wavelengths are capable of inducing or augmenting pigmentary disorders. They may also contain depigmenting agents for patients with pigmentary disorders.

Photoprotection according to skin phototype and dermatoses: practical recommendations from an expert panel

Increasing evidence on the impact of the different wavelengths of sunlight on the skin demonstrates the need for tailored recommendations of sunscreen according to skin phototype and dermatoses, which is now possible due to advances in the filters and formulations of sunscreens. A selective literature search was performed by an international expert panel, focusing on the type of sunscreen to recommend for photoaging, skin cancers, photodermatoses, pigmentary disorders and skin inflammatory disorders. Protection against ultraviolet (UV)B is especially important for light skin as there is a high risk of sunburn, DNA damage and skin cancers. Darker skin may be naturally better protected against UVB but is more prone to hyperpigmentation induced by visible light (VL) and UVA. Protection against UVA, VL and infrared A can be helpful for all skin phototypes as they penetrate deeply and cause photoaging. Long‐wave UVA1 plays a critical role in pigmentation, photoaging, skin cancer, DNA damage and photodermatoses. Adapting the formulation and texture of the sunscreen to the type of skin and dermatoses is also essential. Practical recommendations on the type of sunscreen to prescribe are provided to support the clinician in daily practice.