Angela Carter and Transformations

When asked in an interview whether "we tell stories to try to come to terms with the world, to harmonize our lives with reality" (4), Joseph Campbell replied, "I think so, yes" (4). We often use stories to define the world around us--to make it available to us and render it understandable. In many ways we come to know the world through the stories we know from childhood and as we get older we often sort out the world in the stories we learn to tell about ourselves. And in a fashion similar to the way we tell, read, or listen to stories, we also develop stories in which we recognize ourselves. We place the things around us and our experiences into a kind of self-narrative so as to be able to derive meaning from them. We set up stories of self which encompass everything from our goals and dreams to our psyche and sexuality: such stories encompass our lives as individuals, as members of a family, and as members of a community. We place ourselves in the world in terms of certain self-narratives that we learn to develop. Parallel to the traditional stories we have come to know, each of us has his/her own self-evolving story through which we identities maintain self

Trends in Cancers of the Skin: Insights from a Three-year Observational Cohort in Manhattan Beach, California.

BACKGROUND: There exists significant heterogeneity in the presentation of common skin cancers such as cutaneous melanoma (CM), cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC). Meaningful differences are often observed among the trio concerning age, sex, site at presentation and laterality. OBJECTIVE: In this paper, we endeavor to elucidate such heterogeneity, reaffirm burgeoning trends in skin cancer incidence, and offer new insights in the presentation of common skin cancers. RESULTS: While agreement with current consensus was achieved with regard to various aspects of sex, age, and site-specific findings, several novel results emerged: (1) the percentage of subjects presenting with CM was demonstrably higher than population averages would estimate; (2) melanoma exhibited a pronounced right-side bias; (3) cSCC was not head and neck preferring as other reviews have documented (4) cSCC exhibited greater female bias. CONCLUSION: In this study, we documented insights from 663 cases (397 unique subjects) across a range of factors including age, laterality, site of presentation, and sex specific differences in incidence. The results of our analysis generally accord well with previous findings, replicating several of the most prominent results

Treatment-Refractory Central Centrifugal Cicatricial Alopecia Responsive to a Novel Botanical Treatment.

PURPOSE: Central centrifugal cicatricial alopecia (CCCA) is the most common cause of scarring alopecia in women of African descent. However, current treatments for CCCA, such as immunosuppressants and immunomodulatory pharmaceutical agents, have suboptimal efficacy and undesirable side effects. This case series reports the therapeutic effect of a new botanical formulation (Dr. UGro Gashee) in four patients with histologically supported diagnoses of CCCA. The formulations contain at least three phytoactive ingredients that affect multiple targets in the cascade of pathophysiologic events contributing to CCCA. Possible mechanisms of action include anti-inflammatory effects, inhibiting proinflammatory cytokines, and the net antifibrotic effect of inhibiting transforming growth factor-beta while upregulating AMP-activated protein kinase and peroxisome proliferator-associated receptor-gamma activity. PATIENTS AND METHODS: Four African American women with treatment-refractory CCCA were treated with a new topical botanical formula (cosmeceutical) alone or in combination with its oral formulation (nutraceutical) for 8 weeks to 1 year. The cosmeceutical and nutraceutical treatments contain similar phytoactive ingredient profiles. Treatment outcomes were collected using documented patient reports and images and by direct observation. RESULTS: In all patients, scalp pruritus cessation occurred within 2 weeks of treatment, and significant hair regrowth was observed within 2 months. All patients reported a high satisfaction level without adverse effects. CONCLUSION: Patients with treatment-refractory CCCA responded to the novel botanical treatment reported in this study. Further evaluations in a controlled trial with more patients are warranted

Unveiling a Shared Precursor Condition for Acne Keloidalis Nuchae and Primary Cicatricial Alopecias.

PURPOSE: Small observational studies suggest subclinical disease occurrence in the normal-appearing scalp zones of several primary cicatricial alopecias. To aid patient management, we began routinely evaluating the entire scalp of patients with acne keloidalis nuchae (AKN), including trichoscopy-guided biopsies. PATIENTS AND METHODS: This retrospective study evaluated 41 patients sequentially presenting with AKN at a single clinic between June and December 2022. Primary lesions and normal-appearing scalp in the superior parietal scalp at least 5 cm away from AKN-affected zones were clinically evaluated, and areas showing perifollicular erythema or scales/casts on trichoscopy were biopsied and histologically analyzed. RESULTS: Forty-one men with AKN, including 20 men of African descent, 17 Hispanic, and 4 European-descended Whites, were evaluated. All patients, including 22% with associated folliculitis decalvans, showed scalp-wide trichoscopy signs of perifollicular erythema or scaling in normal-appearing scalp areas. All patients showed histologic evidence of perifollicular infundibulo-isthmic lymphocytoplasmic infiltrates and fibrosis (PIILIF), with 96% showing Vellus or miniaturized hair absence. PIILIF was often clinically mistaken for seborrheic dermatitis (44-51%). All White patients had mild papular acne keloidalis nuchae lesions mistaken for seborrheic dermatitis. CONCLUSION: PIILIF may be a precursor to a wide spectrum of primary cicatricial alopecias, including AKN and folliculitis decalvans. This finding carries implications for the early diagnosis and management of AKN and other primary cicatricial alopecias

Refractory Folliculitis Decalvans Treatment Success with a Novel Surgical Excision Approach Using Guarded High-Tension Sutures.

PURPOSE: Folliculitis decalvans (FD) is a difficult-to-treat, localized scarring alopecia characterized by an expanding area of chronically inflamed purulent plaques or masses. Current treatment modalities vary and often result in only temporary remission. There are no reports of surgical therapies for FD. Here, we describe FD treatment using surgical excision and second-intention healing aided by guarded high-tension sutures. METHODS: Five patients (one woman and four men) with histologically confirmed FD were treated by surgical lesion excision. All wounds were allowed to heal via second-intention. Guarded high-tension sutures were employed to minimize tissue tears while aiding and guiding wound contraction. RESULTS: All wounds healed with a 47-83% spatial contraction of the maximum wound diameters. Three patients healed entirely by second-intention, while two required a minor skin graft to close the wound completely. No disease recurrence was noted at 10-24 months. CONCLUSION: Surgical excision with second-intention healing aided by guarded high-tension sutures effectively treated small and extensive FD lesions with no recurrence at long-term follow-up. To our knowledge, this is the first report of successful surgical treatment of FD

Acne Keloidalis Nuchae is Associated with Cutis Verticis Gyrata

Sanusi Umar,1– 3 Jenna J Lullo,2 Marissa J Carter,4 Paul K Shitabata,2,5 Delphine J Lee1,2 1Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; 2Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA; 3Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA; 4Strategic Solutions, Inc., Bozeman, MT, USA; 5Dermatopathology Institute, Torrance, CA, USACorrespondence: Sanusi Umar, Dr. U Hair and Skin Clinic, 2121 N. Sepulveda Avenue, Suite 200, Manhattan Beach, CA, 90266, USA, Tel +1-310 318-1500, Fax +1-310 318-1590, Email [email protected]: Both acne keloidalis nuchae (AKN) and cutis verticis gyrata (CVG) are scalp conditions predominantly affecting men. Both are characterized by dermal thickening and fibroblast hyperactivity. AKN typically occurs in the nuchal area, often involving the naturally occurring folds in the occipital region. The aim of this study was to determine the relationship between excessive scalp folding (CVG) and AKN.Patients and methods: A total of 108 patients with AKN seen over 11 years from July 2009 and November 2020 were retrospectively evaluated. Patients with AKN concomitant with CVG were selected for analysis.Results: Seven of the 108 AKN patients had scalp-wide (widespread) AKN lesions, including 4 with CVG. In 3 of the 4 patients with concomitant AKN and CVG, the AKN was widespread, and its onset had preceded CVG by 1– 2 years. In the fourth CVG patient, AKN lesions were confined to the nuchal area, and the CVG preceded AKN onset by several years. All patients were male, with a mean age of 35.8 years (overall) and 38.0 years (CVG group).Conclusion: We describe a previously unreported relationship between widespread AKN and CVG, with the development of AKN preceding CVG formation.Keywords: transforming growth factor, cicatricial alopecia, fibroblasts, syndromi

Lichen Planopilaris Responsive to a Novel Phytoactive Botanical Treatment: A Case Series.

INTRODUCTION: Lichen planopilaris (LPP) is characterized by chronic scarring alopecia that is progressive and typically refractory to therapy. Current drug treatments are suboptimal and not applicable for long-term use because of the high potential for adverse effects, warranting safer and more effective treatment alternatives. METHODS: Based on our previous success in treating a patient with central centrifugal cicatricial alopecia using a topical botanical formulation (Gashee), we reviewed records of four patients with biopsy-proven LPP treated with the topical formulation alone or in combination with its oral preparation. Three patients had failed previous treatment with intralesional steroid injections, topical minoxidil, tacrolimus, and clobetasol. Physical examination and photographic documentation were also used as outcome measures. Treatment duration with the botanical formulations ranged from 6 weeks to 9.5 months. RESULTS: All patients showed overall improvement in surrogate indicators of LPP activity as evidenced by the disappearance of symptoms (pruritus, tenderness, scalp irritation, and hair shedding), improvement in hair growth, and reduction in redness. All reported a high satisfaction level and no adverse effects. CONCLUSIONS: Patients with treatment-refractory LPP responded to a novel botanical treatment. To the best of our knowledge, this is the first published report of LPP responding to a plant-based natural treatment. Further evaluation of this treatment in a controlled trial with a larger number of patients is warranted

Acne Keloidalis Nuchae is Associated with Cutis Verticis Gyrata.

PURPOSE: Both acne keloidalis nuchae (AKN) and cutis verticis gyrata (CVG) are scalp conditions predominantly affecting men. Both are characterized by dermal thickening and fibroblast hyperactivity. AKN typically occurs in the nuchal area, often involving the naturally occurring folds in the occipital region. The aim of this study was to determine the relationship between excessive scalp folding (CVG) and AKN. PATIENTS AND METHODS: A total of 108 patients with AKN seen over 11 years from July 2009 and November 2020 were retrospectively evaluated. Patients with AKN concomitant with CVG were selected for analysis. RESULTS: Seven of the 108 AKN patients had scalp-wide (widespread) AKN lesions, including 4 with CVG. In 3 of the 4 patients with concomitant AKN and CVG, the AKN was widespread, and its onset had preceded CVG by 1-2 years. In the fourth CVG patient, AKN lesions were confined to the nuchal area, and the CVG preceded AKN onset by several years. All patients were male, with a mean age of 35.8 years (overall) and 38.0 years (CVG group). CONCLUSION: We describe a previously unreported relationship between widespread AKN and CVG, with the development of AKN preceding CVG formation

Keloidal Atypical Fibroxanthoma: Case and Review of the Literature

Keloidal atypical fibroxanthoma (KAF) has recently been categorized as a variant of atypical fibroxanthoma. This paper will emphasize the importance of including KAF in both clinical and histological differential diagnosis of benign and malignant lesions which exhibit keloidal collagen and will also review the current literature on epidemiology, pathogenesis, histology, immunochemistry and treatments