UV imaging reveals facial areas that are prone to skin cancer are disproportionately missed during sunscreen application.

Application of sunscreen is a widely used mechanism for protecting skin from the harmful effects of UV light. However, protection can only be achieved through effective application, and areas that are routinely missed are likely at increased risk of UV damage. Here we sought to determine if specific areas of the face are missed during routine sunscreen application, and whether provision of public health information is sufficient to improve coverage. To investigate this, 57 participants were imaged with a UV sensitive camera before and after sunscreen application: first visit; minimal pre-instruction, second visit; provided with a public health information statement. Images were scored using a custom automated image analysis process designed to identify areas of high UV reflectance, i.e. missed during sunscreen application, and analysed for 5% significance. Analyses revealed eyelid and periorbital regions to be disproportionately missed during routine sunscreen application (median 14% missed in eyelid region vs 7% in rest of face, p<0.01). Provision of health information caused a significant improvement in coverage to eyelid areas in general however, the medial canthal area was still frequently missed. These data reveal that a public health announcement-type intervention could be effective at improving coverage of high risk areas of the face, however high risk areas are likely to remain unprotected therefore other mechanisms of sun protection should be widely promoted such as UV blocking sunglasses

Comorbid autoimmune diseases in patients with vitiligo: A cross-sectional study

BACKGROUND: Few large-scale studies have quantified the burden of comorbid autoimmune diseases in patients with vitiligo. OBJECTIVE: We sought to determine the prevalence of comorbid autoimmune diseases in patients with vitiligo. METHODS: We conducted a manual chart review on a cohort of 1873 patients with vitiligo seen between January 2002 and October 2012 at the Henry Ford Health System in Detroit, MI. Patients were excluded if they had fewer than 2 dermatology notes (N = 595) or if they were never given a diagnosis of vitiligo by a dermatologist (N = 180). RESULTS: Of 1098 patients with vitiligo, nearly 20% had at least 1 comorbid autoimmune disease. Compared with the general US population, we found a higher prevalence of thyroid disease (12.9%, P \u3c .001), alopecia areata (3.8%, P \u3c .001), inflammatory bowel disease (0.9%, P = .046), pernicious anemia (0.5%, P = .007), systemic lupus erythematosus (0.3%, P = .048), Guillain-Barre syndrome (0.3%, P \u3c .001), discoid lupus (0.2%, P = .003), linear morphea (0.2%, P \u3c .001), myasthenia gravis (0.2%, P = .002), and Sjögren syndrome (0.2%, P = .011). LIMITATIONS: The study lacked a control group. This was a single-institution study with possible selection bias, and thus the findings may not be representative of the overall population of patients with vitiligo. CONCLUSIONS: We observed a high prevalence of comorbid autoimmune diseases in patients with vitiligo and report several new associations

Comorbid autoimmune diseases in a cohort of patients with vitiligo

Background: Vitiligo has been reported to be associated with autoimmune diseases. However, few large-scale studies have been conducted to quantify the burden of autoimmune disease in patients with vitiligo. Objective: To determine the prevalence of comorbid autoimmune diseases in patients with vitiligo seen at the Henry Ford Hospital Department of Dermatology in Detroit, Michigan, during a period of almost 11 years. Methods: Using the International Classification of Diseases, 9th revision code 709.01, we searched the Henry Ford Health System Medical Record Database to identify 1873 patients with vitiligo seen between January 2002 and November 2012. We manually reviewed all 1873 electronic medical records to validate the diagnosis of vitiligo and collect data. Patients were excluded if they did not have at least 2 dermatology notes (N = 595) and if they were never diagnosed with vitiligo by a dermatologist (N = 180), resulting in a final study population of 1098 patients with vitiligo. As designed a priori, we assessed the prevalence of comorbid autoimmune diseases in these patients. Results: The final study population included 1098 patients with vitiligo. Nearly 20% had at least 1 comorbid autoimmune disease. Compared to the general US population, we found a higher prevalence of thyroid disease (12.9% of those 12 years or older,