Pigmentation Disorders

BUENOS AIRES — Cultural sensitivity is essential for dermatologists who work with Hispanic and Latino patients, Dr. David Rodriguez said at the 21st World Congress of Dermatology.

"Many immigrants continue to adhere to their cultural views of health and disease," he said. Failure to understand cultural background leads to miscommunication in the doctor-patient relationship and can result in poor treatment compliance.

Approximately 42 million people in the United States are ethnically identified as Hispanic. The term Hispanic came into widespread use in the United States in the 1970s, when it was first used as a classification in the national census. Hispanic refers to someone of Spanish descent, and in the United States it is a governmental designation of ethnicity. Latino refers to the Latin-based or Romance languages.

"When you say Latino, you would include the people of Portugal and Brazil," said Dr. Rodriguez, a dermatologist in Coral Gables, Fla. "When you say Hispanic, you talk about the people who come from Spain." The terms, however, are often used interchangeably.

The Hispanic population is racially diverse. Hispanics can be white, black, American Indian, or a mixture of racial groups. "The Hispanic population is also culturally diverse. When we look at Hispanics we cannot think of them as just one group," he said. "There are great differences between someone from Argentina, and what he or she does, and someone from El Salvador." Understanding the cultural proclivities for each patient is important.

Cultural differences that might impede care of Hispanic patients include reluctance to question the physician, who may be seen as an authority figure, and hesitation to discuss their disease because of embarrassment. Cultural belief in fatalismo also can impede treatment: Patients might accept their condition as the will of God and feel powerless to change it.

Acne, eczema/contact dermatitis, photoaging, facial melasma, and hyperpigmentation are the major dermatologic conditions seen in Hispanic patients in private clinics. Disorders of pigmentation are especially important to Hispanic patients because they consider them disfiguring.

Conditions like melasma or acne can have a profoundly negative impact on self-esteem, quality of life, and job pros-pects, said Dr. Rodriguez.

Melasma is common in Hispanics, particularly in women. "Hispanics commonly attribute melasma to a sick liver, aging, poor nutrition, or lack of sleep," he said, so patients need to understand the role of UV radiation in triggering or exacerbating the condition.

Special care must be taken in treating acne in Hispanic patients because Fitzpatrick skin types IV-VI are susceptible to hyperpigmentation. Hispanic patients are often unaware that they have acne, but they may be concerned about "dark scars or spots," said Dr. Rodriguez. "We must educate them that they have to stop touching or picking their face."

Like other patient populations, Hispanics have misconceptions about the causes of acne, and may attribute outbreaks of acne to certain foods, sex, or ill health. They need to know that the ointments and oils, especially cocoa butter, in popular Hispanic hair and skin treatments can clog pores and worsen acne, he said.

There is a widespread misconception that individuals with dark pigmented skin cannot get skin cancer, so many Hispanics consider sunscreens necessary only for the beach or the pool and do not understand the importance of using sunscreen on a daily basis. Dr. Rodriguez said he recommends that Hispanic patients be reminded to use sunscreen, particularly in regions of the country, such as South Florida, where incidental sun exposure can be intense.

Ideally, dermatologists who treat Hispanic patients should provide Spanish-language materials in the waiting room and offer bilingual take-home instructions. Practices that treat many Hispanic patients should have a bilingual staff, he said.

BUENOS AIRES — Cultural sensitivity is essential for dermatologists who work with Hispanic and Latino patients, Dr. David Rodriguez said at the 21st World Congress of Dermatology.

"Many immigrants continue to adhere to their cultural views of health and disease," he said. Failure to understand cultural background leads to miscommunication in the doctor-patient relationship and can result in poor treatment compliance.

Approximately 42 million people in the United States are ethnically identified as Hispanic. The term Hispanic came into widespread use in the United States in the 1970s, when it was first used as a classification in the national census. Hispanic refers to someone of Spanish descent, and in the United States it is a governmental designation of ethnicity. Latino refers to the Latin-based or Romance languages.

"When you say Latino, you would include the people of Portugal and Brazil," said Dr. Rodriguez, a dermatologist in Coral Gables, Fla. "When you say Hispanic, you talk about the people who come from Spain." The terms, however, are often used interchangeably.

The Hispanic population is racially diverse. Hispanics can be white, black, American Indian, or a mixture of racial groups. "The Hispanic population is also culturally diverse. When we look at Hispanics we cannot think of them as just one group," he said. "There are great differences between someone from Argentina, and what he or she does, and someone from El Salvador." Understanding the cultural proclivities for each patient is important.

Cultural differences that might impede care of Hispanic patients include reluctance to question the physician, who may be seen as an authority figure, and hesitation to discuss their disease because of embarrassment. Cultural belief in fatalismo also can impede treatment: Patients might accept their condition as the will of God and feel powerless to change it.

Acne, eczema/contact dermatitis, photoaging, facial melasma, and hyperpigmentation are the major dermatologic conditions seen in Hispanic patients in private clinics. Disorders of pigmentation are especially important to Hispanic patients because they consider them disfiguring.

Conditions like melasma or acne can have a profoundly negative impact on self-esteem, quality of life, and job pros-pects, said Dr. Rodriguez.

Melasma is common in Hispanics, particularly in women. "Hispanics commonly attribute melasma to a sick liver, aging, poor nutrition, or lack of sleep," he said, so patients need to understand the role of UV radiation in triggering or exacerbating the condition.

Special care must be taken in treating acne in Hispanic patients because Fitzpatrick skin types IV-VI are susceptible to hyperpigmentation. Hispanic patients are often unaware that they have acne, but they may be concerned about "dark scars or spots," said Dr. Rodriguez. "We must educate them that they have to stop touching or picking their face."

Like other patient populations, Hispanics have misconceptions about the causes of acne, and may attribute outbreaks of acne to certain foods, sex, or ill health. They need to know that the ointments and oils, especially cocoa butter, in popular Hispanic hair and skin treatments can clog pores and worsen acne, he said.

There is a widespread misconception that individuals with dark pigmented skin cannot get skin cancer, so many Hispanics consider sunscreens necessary only for the beach or the pool and do not understand the importance of using sunscreen on a daily basis. Dr. Rodriguez said he recommends that Hispanic patients be reminded to use sunscreen, particularly in regions of the country, such as South Florida, where incidental sun exposure can be intense.

Ideally, dermatologists who treat Hispanic patients should provide Spanish-language materials in the waiting room and offer bilingual take-home instructions. Practices that treat many Hispanic patients should have a bilingual staff, he said.

BUENOS AIRES — Cultural sensitivity is essential for dermatologists who work with Hispanic and Latino patients, Dr. David Rodriguez said at the 21st World Congress of Dermatology.

"Many immigrants continue to adhere to their cultural views of health and disease," he said. Failure to understand cultural background leads to miscommunication in the doctor-patient relationship and can result in poor treatment compliance.

Approximately 42 million people in the United States are ethnically identified as Hispanic. The term Hispanic came into widespread use in the United States in the 1970s, when it was first used as a classification in the national census. Hispanic refers to someone of Spanish descent, and in the United States it is a governmental designation of ethnicity. Latino refers to the Latin-based or Romance languages.

"When you say Latino, you would include the people of Portugal and Brazil," said Dr. Rodriguez, a dermatologist in Coral Gables, Fla. "When you say Hispanic, you talk about the people who come from Spain." The terms, however, are often used interchangeably.

The Hispanic population is racially diverse. Hispanics can be white, black, American Indian, or a mixture of racial groups. "The Hispanic population is also culturally diverse. When we look at Hispanics we cannot think of them as just one group," he said. "There are great differences between someone from Argentina, and what he or she does, and someone from El Salvador." Understanding the cultural proclivities for each patient is important.

Cultural differences that might impede care of Hispanic patients include reluctance to question the physician, who may be seen as an authority figure, and hesitation to discuss their disease because of embarrassment. Cultural belief in fatalismo also can impede treatment: Patients might accept their condition as the will of God and feel powerless to change it.

Acne, eczema/contact dermatitis, photoaging, facial melasma, and hyperpigmentation are the major dermatologic conditions seen in Hispanic patients in private clinics. Disorders of pigmentation are especially important to Hispanic patients because they consider them disfiguring.

Conditions like melasma or acne can have a profoundly negative impact on self-esteem, quality of life, and job pros-pects, said Dr. Rodriguez.

Melasma is common in Hispanics, particularly in women. "Hispanics commonly attribute melasma to a sick liver, aging, poor nutrition, or lack of sleep," he said, so patients need to understand the role of UV radiation in triggering or exacerbating the condition.

Special care must be taken in treating acne in Hispanic patients because Fitzpatrick skin types IV-VI are susceptible to hyperpigmentation. Hispanic patients are often unaware that they have acne, but they may be concerned about "dark scars or spots," said Dr. Rodriguez. "We must educate them that they have to stop touching or picking their face."

Like other patient populations, Hispanics have misconceptions about the causes of acne, and may attribute outbreaks of acne to certain foods, sex, or ill health. They need to know that the ointments and oils, especially cocoa butter, in popular Hispanic hair and skin treatments can clog pores and worsen acne, he said.

There is a widespread misconception that individuals with dark pigmented skin cannot get skin cancer, so many Hispanics consider sunscreens necessary only for the beach or the pool and do not understand the importance of using sunscreen on a daily basis. Dr. Rodriguez said he recommends that Hispanic patients be reminded to use sunscreen, particularly in regions of the country, such as South Florida, where incidental sun exposure can be intense.

Ideally, dermatologists who treat Hispanic patients should provide Spanish-language materials in the waiting room and offer bilingual take-home instructions. Practices that treat many Hispanic patients should have a bilingual staff, he said.

MIAMI — Nearly one-third of women of African descent exercise less because they have concerns about hairstyle management, according to a survey presented at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

"Sweating out their hairstyle and the time to wash, dry, and style their hair were the top two reasons they did not exercise as frequently," Shani F. Smith said. "We believe hair care should be explored as another barrier to exercise in this population."

The obesity epidemic is well known in the U.S. population, and "it is also known that African American women are disproportionately affected," said Ms. Smith, a fourth-year medical student at Wake Forest University, Winston-Salem, N.C. The departments of dermatology and public health collaborated on the survey.

A total of 31% of 103 women indicated they reduced physical activity levels because of concerns over hairstyle management. "They were three times less likely to meet exercise levels [odds ratio, 2.94] if their hairstyle was a concern," Ms. Smith said. Of this group, 88% did not meet physical activity guidelines recommended by the Centers for Disease Control and Prevention or the American College of Sports Medicine.

"Time and motivation are common and ethnically indistinct barriers [to physical activity], but hairstyle management may be a unique barrier for African American women.

Effective physical activity promotion strategies to address this barrier should be utilized," Ms. Smith said at the meeting, which was also sponsored by Howard University.

Half the respondents said they had considered modifying their hairstyle to accommodate exercise, she said. Hair braiding and wearing a ponytail were the leading considerations.

Respondents were aged 21-60 years. Most (72) identified themselves as African American, while 12 were African, 3 were Caribbean or West Indian, and 15 identified themselves as "other black" or of African descent. One person listed multiple ethnic backgrounds, Ms. Smith said.

The women were considered active if they reported 150 minutes of physical activity per week or 30 minutes per day at least 5 days per week. "Although 100% of respondents believe it's important for them and other African American females to exercise, very few are meeting this physical activity cutoff," she pointed out.

"Daily living was the No. 1 reason they engage in physical activity, mostly related to housework or other similar things," said Ms. Smith, who had no relevant conflicts to disclose.

The survey also asked about hair care practices. A total of 42% of the respondents said that they spent more than 1 hour per week on hair care, including regular visits to a salon.

MIAMI — Nearly one-third of women of African descent exercise less because they have concerns about hairstyle management, according to a survey presented at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

"Sweating out their hairstyle and the time to wash, dry, and style their hair were the top two reasons they did not exercise as frequently," Shani F. Smith said. "We believe hair care should be explored as another barrier to exercise in this population."

The obesity epidemic is well known in the U.S. population, and "it is also known that African American women are disproportionately affected," said Ms. Smith, a fourth-year medical student at Wake Forest University, Winston-Salem, N.C. The departments of dermatology and public health collaborated on the survey.

A total of 31% of 103 women indicated they reduced physical activity levels because of concerns over hairstyle management. "They were three times less likely to meet exercise levels [odds ratio, 2.94] if their hairstyle was a concern," Ms. Smith said. Of this group, 88% did not meet physical activity guidelines recommended by the Centers for Disease Control and Prevention or the American College of Sports Medicine.

"Time and motivation are common and ethnically indistinct barriers [to physical activity], but hairstyle management may be a unique barrier for African American women.

Effective physical activity promotion strategies to address this barrier should be utilized," Ms. Smith said at the meeting, which was also sponsored by Howard University.

Half the respondents said they had considered modifying their hairstyle to accommodate exercise, she said. Hair braiding and wearing a ponytail were the leading considerations.

Respondents were aged 21-60 years. Most (72) identified themselves as African American, while 12 were African, 3 were Caribbean or West Indian, and 15 identified themselves as "other black" or of African descent. One person listed multiple ethnic backgrounds, Ms. Smith said.

The women were considered active if they reported 150 minutes of physical activity per week or 30 minutes per day at least 5 days per week. "Although 100% of respondents believe it's important for them and other African American females to exercise, very few are meeting this physical activity cutoff," she pointed out.

"Daily living was the No. 1 reason they engage in physical activity, mostly related to housework or other similar things," said Ms. Smith, who had no relevant conflicts to disclose.

The survey also asked about hair care practices. A total of 42% of the respondents said that they spent more than 1 hour per week on hair care, including regular visits to a salon.

MIAMI — Nearly one-third of women of African descent exercise less because they have concerns about hairstyle management, according to a survey presented at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

"Sweating out their hairstyle and the time to wash, dry, and style their hair were the top two reasons they did not exercise as frequently," Shani F. Smith said. "We believe hair care should be explored as another barrier to exercise in this population."

The obesity epidemic is well known in the U.S. population, and "it is also known that African American women are disproportionately affected," said Ms. Smith, a fourth-year medical student at Wake Forest University, Winston-Salem, N.C. The departments of dermatology and public health collaborated on the survey.

A total of 31% of 103 women indicated they reduced physical activity levels because of concerns over hairstyle management. "They were three times less likely to meet exercise levels [odds ratio, 2.94] if their hairstyle was a concern," Ms. Smith said. Of this group, 88% did not meet physical activity guidelines recommended by the Centers for Disease Control and Prevention or the American College of Sports Medicine.

"Time and motivation are common and ethnically indistinct barriers [to physical activity], but hairstyle management may be a unique barrier for African American women.

Effective physical activity promotion strategies to address this barrier should be utilized," Ms. Smith said at the meeting, which was also sponsored by Howard University.

Half the respondents said they had considered modifying their hairstyle to accommodate exercise, she said. Hair braiding and wearing a ponytail were the leading considerations.

Respondents were aged 21-60 years. Most (72) identified themselves as African American, while 12 were African, 3 were Caribbean or West Indian, and 15 identified themselves as "other black" or of African descent. One person listed multiple ethnic backgrounds, Ms. Smith said.

The women were considered active if they reported 150 minutes of physical activity per week or 30 minutes per day at least 5 days per week. "Although 100% of respondents believe it's important for them and other African American females to exercise, very few are meeting this physical activity cutoff," she pointed out.

"Daily living was the No. 1 reason they engage in physical activity, mostly related to housework or other similar things," said Ms. Smith, who had no relevant conflicts to disclose.

The survey also asked about hair care practices. A total of 42% of the respondents said that they spent more than 1 hour per week on hair care, including regular visits to a salon.

MIAMI — Many black women experience adverse events and dissatisfaction stemming from their hair care practices, but few seek medical advice, results of a survey presented at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research indicate.

"A few years ago, I noticed scalp and hair conditions were a common complaint among black women in my practice," said Dr. Maria C. Rios, a clinical dermatologist in Montevideo, Uruguay.

"Dermatologists need to recognize scalp and hair conditions associated with some procedures used by this ethnic group," she said.

All 42 adult women (aged 18-60 years) surveyed used chemical or physical hair straightening techniques. Hair and scalp disorders occurred in 70% of respondents.

Following a physical examination and clinical photography, each woman completed a brief questionnaire, in which they rated how satisfied they were with the ethnic or natural aspect of their hair, hair care practices, and any clinical presentations related to hairstyle management.

The majority, 37 women, reported dissatisfaction with the ethnic aspect of their hair. A total of 26 reported a history of dermatologic lesions or other scalp/hair conditions.

Twenty women experienced irritant contact dermatitis after use of a chemical relaxer. Nine used a commercial brand and 11 used a product with "banana extract."

Although participants reported excellent hair-straightening results with banana extract, all those who used it experienced stinging, burning, itchiness, flaking, and/or pain, Dr. Rios said at the meeting, which was also sponsored by Howard University.

Seven women reported scarring alopecia; five attributed the condition to chemical use, one to thermal hair treatment, and another to both practices. Three participants reported nonscarring alopecia related to their hair care.

One of the 26 women experienced allergic dermatitis after use of a chemical relaxer and hair dye at almost the same time, Dr. Rios said. A total of six women experienced burns, four from chemicals and two from hair ironing. A total of 16 women reported temporary hair loss and breakage. Interestingly, only four of these women sought medical advice.

MIAMI — Many black women experience adverse events and dissatisfaction stemming from their hair care practices, but few seek medical advice, results of a survey presented at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research indicate.

"A few years ago, I noticed scalp and hair conditions were a common complaint among black women in my practice," said Dr. Maria C. Rios, a clinical dermatologist in Montevideo, Uruguay.

"Dermatologists need to recognize scalp and hair conditions associated with some procedures used by this ethnic group," she said.

All 42 adult women (aged 18-60 years) surveyed used chemical or physical hair straightening techniques. Hair and scalp disorders occurred in 70% of respondents.

Following a physical examination and clinical photography, each woman completed a brief questionnaire, in which they rated how satisfied they were with the ethnic or natural aspect of their hair, hair care practices, and any clinical presentations related to hairstyle management.

The majority, 37 women, reported dissatisfaction with the ethnic aspect of their hair. A total of 26 reported a history of dermatologic lesions or other scalp/hair conditions.

Twenty women experienced irritant contact dermatitis after use of a chemical relaxer. Nine used a commercial brand and 11 used a product with "banana extract."

Although participants reported excellent hair-straightening results with banana extract, all those who used it experienced stinging, burning, itchiness, flaking, and/or pain, Dr. Rios said at the meeting, which was also sponsored by Howard University.

Seven women reported scarring alopecia; five attributed the condition to chemical use, one to thermal hair treatment, and another to both practices. Three participants reported nonscarring alopecia related to their hair care.

One of the 26 women experienced allergic dermatitis after use of a chemical relaxer and hair dye at almost the same time, Dr. Rios said. A total of six women experienced burns, four from chemicals and two from hair ironing. A total of 16 women reported temporary hair loss and breakage. Interestingly, only four of these women sought medical advice.

MIAMI — Many black women experience adverse events and dissatisfaction stemming from their hair care practices, but few seek medical advice, results of a survey presented at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research indicate.

"A few years ago, I noticed scalp and hair conditions were a common complaint among black women in my practice," said Dr. Maria C. Rios, a clinical dermatologist in Montevideo, Uruguay.

"Dermatologists need to recognize scalp and hair conditions associated with some procedures used by this ethnic group," she said.

All 42 adult women (aged 18-60 years) surveyed used chemical or physical hair straightening techniques. Hair and scalp disorders occurred in 70% of respondents.

Following a physical examination and clinical photography, each woman completed a brief questionnaire, in which they rated how satisfied they were with the ethnic or natural aspect of their hair, hair care practices, and any clinical presentations related to hairstyle management.

The majority, 37 women, reported dissatisfaction with the ethnic aspect of their hair. A total of 26 reported a history of dermatologic lesions or other scalp/hair conditions.

Twenty women experienced irritant contact dermatitis after use of a chemical relaxer. Nine used a commercial brand and 11 used a product with "banana extract."

Although participants reported excellent hair-straightening results with banana extract, all those who used it experienced stinging, burning, itchiness, flaking, and/or pain, Dr. Rios said at the meeting, which was also sponsored by Howard University.

Seven women reported scarring alopecia; five attributed the condition to chemical use, one to thermal hair treatment, and another to both practices. Three participants reported nonscarring alopecia related to their hair care.

One of the 26 women experienced allergic dermatitis after use of a chemical relaxer and hair dye at almost the same time, Dr. Rios said. A total of six women experienced burns, four from chemicals and two from hair ironing. A total of 16 women reported temporary hair loss and breakage. Interestingly, only four of these women sought medical advice.

MIAMI — A strong association was found between the use of sewn-in or glued-in weaves by black women and development of central centrifugal cicatricial alopecia in a retrospective survey.

Investigators did not, however, find a strong association with genetics or other hair-grooming practices, such as the use of hot combs or Jheri curling, as other anecdotal evidence has suggested.

"We don't really know what causes central centrifugal cicatricial alopecia [CCCA]," Dr. Raechele Cochran Gathers said during a poster session at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research. "We tell patients that relaxers have been implicated and to limit the amount of heat in pressing or combing."

"The exact etiology is poorly understood and it is likely multifactorial," Dr. Sejal K. Shah, a research fellow at the Skin of Color Center, St. Luke's-Roosevelt Hospital Center in New York City, said during a separate presentation at the meeting. "Most of what we know about CCCA is based on anecdotal evidence."

CCCA is a chronic, progressive, crown- or vertex-centered alopecia that disproportionately affects black women. Most active disease is in the peripheral zone of hair loss, where both clinical and histologic evidence of inflammation is found. And its impact is considerable—CCCA is responsible for more hair loss in African Americans than all other causes of alopecia combined, said Dr. Gathers, a dermatologist at the multicultural dermatology center at Henry Ford Medical Center, Detroit.

"It is a very common and very distressing disease to these patients," session moderator Leonard Sperling said. "It has an emotional and physical toll that I think is underappreciated."

Dr. Sperling is professor and chair of dermatology at Uniformed Services University, Bethesda, Md.

To explore possible etiologies, Dr. Gathers and Dr. Henry W. Lim, chair of dermatology at Henry Ford Medical Center, developed a seven-page, 20-question hair grooming assessment survey. They compared survey responses from 51 women with biopsy-proven CCCA with 50 controls with no history of alopecia. All participants were treated at the medical center between 2000 and 2007.

Almost 50% of women reported onset by age 40, emphasizing a need for early intervention, Dr. Gathers said at the meeting, which was also sponsored by Howard University, Washington. In addition, some patients may be unaware of initial hair loss—21% of women in the survey were first alerted by their stylist.

Use of extensions or artificial hair appears to be associated with CCCA, as does a history of damage from cornrows or braids, Dr. Gathers said. Those in the CCCA group who wore cornrows and braids with added hair were more likely to report a history of damage than those who did not use these hair care options (odds ratio, 2.7). In addition, those in the CCCA group who wore sewn-in weaves were 5.6 times more likely to report tender scalp and 8.1 times more likely to report uncomfortable pulling compared with controls.

Duration and initiation of these hair care practices made a difference. For every 10 years with cornrows or braids, respondents were 1.6 times more likely to have CCCA.

"Interestingly, women who reported that they wore their hair natural before the age of 20 had an 86% decrease in likelihood to develop CCCA," Dr. Gathers said.

There also was no significant correlation with the use of relaxers, curly perms, or history of burns or raw spots after use of relaxers. People with CCCA were not more likely to report an affected mother, grandmother, aunt, or cousin. However, 46% of CCCA group had a sister with hair loss. "It is unlikely that CCCA is genetic, despite this association in sisters," Dr. Gathers said. "It can be an environmental insult, such as sisters using similar grooming practices."

People with CCCA have premature desquamation of the root sheath in affected follicles. Perifollicular fibrosis, inflammation, and thinning of the epithelium at the isthmus are among the consequences. Then the follicle is replaced with a scar, which is the end of that follicle, Dr. Sperling said.

A meeting attendee asked why CCCA occurs predominantly in the center of the scalp.

"It's only a hypothesis, but it may be that sometime during adulthood, the [inner sheath] defect begins to be expressed," Dr. Sperling responded. A differential mode of expression of this defect in different parts of the scalp may be much like balding.

"There is a need for larger population-based studies in different geographic locales," Dr. Gathers said.

"There is a lot left to be done: Define pathogenesis, epidemiology, and the public health impact, and improve treatment on a rational, scientific basis. We also need to increase public awareness about this disease," concluded Dr. Sperling.

MIAMI — A strong association was found between the use of sewn-in or glued-in weaves by black women and development of central centrifugal cicatricial alopecia in a retrospective survey.

Investigators did not, however, find a strong association with genetics or other hair-grooming practices, such as the use of hot combs or Jheri curling, as other anecdotal evidence has suggested.

"We don't really know what causes central centrifugal cicatricial alopecia [CCCA]," Dr. Raechele Cochran Gathers said during a poster session at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research. "We tell patients that relaxers have been implicated and to limit the amount of heat in pressing or combing."

"The exact etiology is poorly understood and it is likely multifactorial," Dr. Sejal K. Shah, a research fellow at the Skin of Color Center, St. Luke's-Roosevelt Hospital Center in New York City, said during a separate presentation at the meeting. "Most of what we know about CCCA is based on anecdotal evidence."

CCCA is a chronic, progressive, crown- or vertex-centered alopecia that disproportionately affects black women. Most active disease is in the peripheral zone of hair loss, where both clinical and histologic evidence of inflammation is found. And its impact is considerable—CCCA is responsible for more hair loss in African Americans than all other causes of alopecia combined, said Dr. Gathers, a dermatologist at the multicultural dermatology center at Henry Ford Medical Center, Detroit.

"It is a very common and very distressing disease to these patients," session moderator Leonard Sperling said. "It has an emotional and physical toll that I think is underappreciated."

Dr. Sperling is professor and chair of dermatology at Uniformed Services University, Bethesda, Md.

To explore possible etiologies, Dr. Gathers and Dr. Henry W. Lim, chair of dermatology at Henry Ford Medical Center, developed a seven-page, 20-question hair grooming assessment survey. They compared survey responses from 51 women with biopsy-proven CCCA with 50 controls with no history of alopecia. All participants were treated at the medical center between 2000 and 2007.

Almost 50% of women reported onset by age 40, emphasizing a need for early intervention, Dr. Gathers said at the meeting, which was also sponsored by Howard University, Washington. In addition, some patients may be unaware of initial hair loss—21% of women in the survey were first alerted by their stylist.

Use of extensions or artificial hair appears to be associated with CCCA, as does a history of damage from cornrows or braids, Dr. Gathers said. Those in the CCCA group who wore cornrows and braids with added hair were more likely to report a history of damage than those who did not use these hair care options (odds ratio, 2.7). In addition, those in the CCCA group who wore sewn-in weaves were 5.6 times more likely to report tender scalp and 8.1 times more likely to report uncomfortable pulling compared with controls.

Duration and initiation of these hair care practices made a difference. For every 10 years with cornrows or braids, respondents were 1.6 times more likely to have CCCA.

"Interestingly, women who reported that they wore their hair natural before the age of 20 had an 86% decrease in likelihood to develop CCCA," Dr. Gathers said.

There also was no significant correlation with the use of relaxers, curly perms, or history of burns or raw spots after use of relaxers. People with CCCA were not more likely to report an affected mother, grandmother, aunt, or cousin. However, 46% of CCCA group had a sister with hair loss. "It is unlikely that CCCA is genetic, despite this association in sisters," Dr. Gathers said. "It can be an environmental insult, such as sisters using similar grooming practices."

People with CCCA have premature desquamation of the root sheath in affected follicles. Perifollicular fibrosis, inflammation, and thinning of the epithelium at the isthmus are among the consequences. Then the follicle is replaced with a scar, which is the end of that follicle, Dr. Sperling said.

A meeting attendee asked why CCCA occurs predominantly in the center of the scalp.

"It's only a hypothesis, but it may be that sometime during adulthood, the [inner sheath] defect begins to be expressed," Dr. Sperling responded. A differential mode of expression of this defect in different parts of the scalp may be much like balding.

"There is a need for larger population-based studies in different geographic locales," Dr. Gathers said.

"There is a lot left to be done: Define pathogenesis, epidemiology, and the public health impact, and improve treatment on a rational, scientific basis. We also need to increase public awareness about this disease," concluded Dr. Sperling.

MIAMI — A strong association was found between the use of sewn-in or glued-in weaves by black women and development of central centrifugal cicatricial alopecia in a retrospective survey.

Investigators did not, however, find a strong association with genetics or other hair-grooming practices, such as the use of hot combs or Jheri curling, as other anecdotal evidence has suggested.

"We don't really know what causes central centrifugal cicatricial alopecia [CCCA]," Dr. Raechele Cochran Gathers said during a poster session at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research. "We tell patients that relaxers have been implicated and to limit the amount of heat in pressing or combing."

"The exact etiology is poorly understood and it is likely multifactorial," Dr. Sejal K. Shah, a research fellow at the Skin of Color Center, St. Luke's-Roosevelt Hospital Center in New York City, said during a separate presentation at the meeting. "Most of what we know about CCCA is based on anecdotal evidence."

CCCA is a chronic, progressive, crown- or vertex-centered alopecia that disproportionately affects black women. Most active disease is in the peripheral zone of hair loss, where both clinical and histologic evidence of inflammation is found. And its impact is considerable—CCCA is responsible for more hair loss in African Americans than all other causes of alopecia combined, said Dr. Gathers, a dermatologist at the multicultural dermatology center at Henry Ford Medical Center, Detroit.

"It is a very common and very distressing disease to these patients," session moderator Leonard Sperling said. "It has an emotional and physical toll that I think is underappreciated."

Dr. Sperling is professor and chair of dermatology at Uniformed Services University, Bethesda, Md.

To explore possible etiologies, Dr. Gathers and Dr. Henry W. Lim, chair of dermatology at Henry Ford Medical Center, developed a seven-page, 20-question hair grooming assessment survey. They compared survey responses from 51 women with biopsy-proven CCCA with 50 controls with no history of alopecia. All participants were treated at the medical center between 2000 and 2007.

Almost 50% of women reported onset by age 40, emphasizing a need for early intervention, Dr. Gathers said at the meeting, which was also sponsored by Howard University, Washington. In addition, some patients may be unaware of initial hair loss—21% of women in the survey were first alerted by their stylist.

Use of extensions or artificial hair appears to be associated with CCCA, as does a history of damage from cornrows or braids, Dr. Gathers said. Those in the CCCA group who wore cornrows and braids with added hair were more likely to report a history of damage than those who did not use these hair care options (odds ratio, 2.7). In addition, those in the CCCA group who wore sewn-in weaves were 5.6 times more likely to report tender scalp and 8.1 times more likely to report uncomfortable pulling compared with controls.

Duration and initiation of these hair care practices made a difference. For every 10 years with cornrows or braids, respondents were 1.6 times more likely to have CCCA.

"Interestingly, women who reported that they wore their hair natural before the age of 20 had an 86% decrease in likelihood to develop CCCA," Dr. Gathers said.

There also was no significant correlation with the use of relaxers, curly perms, or history of burns or raw spots after use of relaxers. People with CCCA were not more likely to report an affected mother, grandmother, aunt, or cousin. However, 46% of CCCA group had a sister with hair loss. "It is unlikely that CCCA is genetic, despite this association in sisters," Dr. Gathers said. "It can be an environmental insult, such as sisters using similar grooming practices."

People with CCCA have premature desquamation of the root sheath in affected follicles. Perifollicular fibrosis, inflammation, and thinning of the epithelium at the isthmus are among the consequences. Then the follicle is replaced with a scar, which is the end of that follicle, Dr. Sperling said.

A meeting attendee asked why CCCA occurs predominantly in the center of the scalp.

"It's only a hypothesis, but it may be that sometime during adulthood, the [inner sheath] defect begins to be expressed," Dr. Sperling responded. A differential mode of expression of this defect in different parts of the scalp may be much like balding.

"There is a need for larger population-based studies in different geographic locales," Dr. Gathers said.

"There is a lot left to be done: Define pathogenesis, epidemiology, and the public health impact, and improve treatment on a rational, scientific basis. We also need to increase public awareness about this disease," concluded Dr. Sperling.

MIAMI — Differences in lip color vary by ethnicity and with aging, according to a study presented at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research.

"We have a large range of skin tones in the world, but we also have a wide range of lip shades," said Diane Baras, an engineer at L'Oreal Inc. in Chevilly-Larue, France.

Ms. Baras and her associates compared 914 women. They measured lip hue (red/orange color), intensity (chroma/color saturation), and lightness among 238 American black, 238 American white, 225 French white, and 213 Japanese women. All participants were adults between the ages of 18 and 65 years.

The researchers also assessed properties of the perioral skin just below the left corner of the mouth. Younger and older participants were compared to determine how aging affects the lip and perioral skin.

Investigators used the L'Oreal Chromasphere diffuse lighting system to quantify color properties, a corneometer to measure dryness of the lips, and front and profile photographs to assess lip height and plumpness.

"There are some ethnic differences, which emphasizes how we need individualized products for different women," Ms. Baras said at the meeting, which was also sponsored by Howard University.

In terms of hue, lips were strongly redder than perioral skin. This was a positive finding, she said, because "a lot of women want to have a high contrast between the vermilion zone" and perioral skin. In contrast, the hue of the skin was more yellow.

There was no significant difference in chroma or color saturation between the lips and perioral skin.

Lightness did vary in the study. The vermilion zones are always darker than the perioral skin, except in African American women, Ms. Baras said.

Capacitance was measured with a corneometer. Capacitance, which reflects the water content in the skin, was significantly stronger in the vermilion zone, compared with the perioral skin. In addition, there was a "big difference" in transepidermal water loss measured with a VapoMeter, she said. The lower lip lost significantly more water than did perioral skin. Interestingly, this water loss did not significantly differ with age, she noted.

Aging did modify other lip and skin properties. The findings were based on comparisons among an equal number of participants in the 18- to 35-year, 36- to 50-year, and 51- to 65-year age ranges.

For example, there was a decrease in lightness with aging. "A lot of older women will say their lips become pale, that there is 'no life' [to their lips] anymore," Ms. Baras said. "We know they are not pale, because they become darker. But the chroma decreases, so there is a loss of radiance."

Age-related morphology changes also were revealed. There was a strong decrease in the height of the mouth—an average of 3 mm—between younger and older white women, and an even more pronounced decrease of 3.5 mm among American black women.

There was a strong decrease in lip plumpness as well. With age, "lips lose some substance, vitality, and some life," Ms. Baras said.

MIAMI — Differences in lip color vary by ethnicity and with aging, according to a study presented at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research.

"We have a large range of skin tones in the world, but we also have a wide range of lip shades," said Diane Baras, an engineer at L'Oreal Inc. in Chevilly-Larue, France.

Ms. Baras and her associates compared 914 women. They measured lip hue (red/orange color), intensity (chroma/color saturation), and lightness among 238 American black, 238 American white, 225 French white, and 213 Japanese women. All participants were adults between the ages of 18 and 65 years.

The researchers also assessed properties of the perioral skin just below the left corner of the mouth. Younger and older participants were compared to determine how aging affects the lip and perioral skin.

Investigators used the L'Oreal Chromasphere diffuse lighting system to quantify color properties, a corneometer to measure dryness of the lips, and front and profile photographs to assess lip height and plumpness.

"There are some ethnic differences, which emphasizes how we need individualized products for different women," Ms. Baras said at the meeting, which was also sponsored by Howard University.

In terms of hue, lips were strongly redder than perioral skin. This was a positive finding, she said, because "a lot of women want to have a high contrast between the vermilion zone" and perioral skin. In contrast, the hue of the skin was more yellow.

There was no significant difference in chroma or color saturation between the lips and perioral skin.

Lightness did vary in the study. The vermilion zones are always darker than the perioral skin, except in African American women, Ms. Baras said.

Capacitance was measured with a corneometer. Capacitance, which reflects the water content in the skin, was significantly stronger in the vermilion zone, compared with the perioral skin. In addition, there was a "big difference" in transepidermal water loss measured with a VapoMeter, she said. The lower lip lost significantly more water than did perioral skin. Interestingly, this water loss did not significantly differ with age, she noted.

Aging did modify other lip and skin properties. The findings were based on comparisons among an equal number of participants in the 18- to 35-year, 36- to 50-year, and 51- to 65-year age ranges.

For example, there was a decrease in lightness with aging. "A lot of older women will say their lips become pale, that there is 'no life' [to their lips] anymore," Ms. Baras said. "We know they are not pale, because they become darker. But the chroma decreases, so there is a loss of radiance."

Age-related morphology changes also were revealed. There was a strong decrease in the height of the mouth—an average of 3 mm—between younger and older white women, and an even more pronounced decrease of 3.5 mm among American black women.

There was a strong decrease in lip plumpness as well. With age, "lips lose some substance, vitality, and some life," Ms. Baras said.

MIAMI — Differences in lip color vary by ethnicity and with aging, according to a study presented at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research.

"We have a large range of skin tones in the world, but we also have a wide range of lip shades," said Diane Baras, an engineer at L'Oreal Inc. in Chevilly-Larue, France.

Ms. Baras and her associates compared 914 women. They measured lip hue (red/orange color), intensity (chroma/color saturation), and lightness among 238 American black, 238 American white, 225 French white, and 213 Japanese women. All participants were adults between the ages of 18 and 65 years.

The researchers also assessed properties of the perioral skin just below the left corner of the mouth. Younger and older participants were compared to determine how aging affects the lip and perioral skin.

Investigators used the L'Oreal Chromasphere diffuse lighting system to quantify color properties, a corneometer to measure dryness of the lips, and front and profile photographs to assess lip height and plumpness.

"There are some ethnic differences, which emphasizes how we need individualized products for different women," Ms. Baras said at the meeting, which was also sponsored by Howard University.

In terms of hue, lips were strongly redder than perioral skin. This was a positive finding, she said, because "a lot of women want to have a high contrast between the vermilion zone" and perioral skin. In contrast, the hue of the skin was more yellow.

There was no significant difference in chroma or color saturation between the lips and perioral skin.

Lightness did vary in the study. The vermilion zones are always darker than the perioral skin, except in African American women, Ms. Baras said.

Capacitance was measured with a corneometer. Capacitance, which reflects the water content in the skin, was significantly stronger in the vermilion zone, compared with the perioral skin. In addition, there was a "big difference" in transepidermal water loss measured with a VapoMeter, she said. The lower lip lost significantly more water than did perioral skin. Interestingly, this water loss did not significantly differ with age, she noted.

Aging did modify other lip and skin properties. The findings were based on comparisons among an equal number of participants in the 18- to 35-year, 36- to 50-year, and 51- to 65-year age ranges.

For example, there was a decrease in lightness with aging. "A lot of older women will say their lips become pale, that there is 'no life' [to their lips] anymore," Ms. Baras said. "We know they are not pale, because they become darker. But the chroma decreases, so there is a loss of radiance."

Age-related morphology changes also were revealed. There was a strong decrease in the height of the mouth—an average of 3 mm—between younger and older white women, and an even more pronounced decrease of 3.5 mm among American black women.

There was a strong decrease in lip plumpness as well. With age, "lips lose some substance, vitality, and some life," Ms. Baras said.