Damian McNamara

FORT LAUDERDALE, FLA. – The first 5-year follow-up study of pain and function after total knee replacement reveals a discrepancy between patients' expectations and their actual ability to engage in sports and recreational activities postoperatively, according to a presentation at the World Congress on Osteoarthritis.

Although patients have realistic expectations about their ability to perform activities of daily life after knee surgery, many are disappointed with their diminished capacity for recreational activities or sports at the 5-year mark, said Dr. Anna K. Nilsdotter, a researcher at Halmstad (Sweden) Central Hospital.

Researchers typically follow patients for just 12 months and record only the number of prosthesis failures. However, Dr. Nilsdotter said, “The best result for patients is after 1 year. Then it declines.

“I have done the same thing in hip replacement after 8 years with the same result,” she added. “Patients report maximum effect at 1 year.” Dr. Nilsdotter and her associates assessed 102 patients with primary osteoarthritis prior to total knee replacement and at 6 months, 1 year, and 5 years after surgery to determine their pain, function, and satisfaction. Using the Short Form-36 health survey and the Knee Injury and Osteoarthritis Outcome Score (KOOS), they evaluated pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life domains. The researchers also asked additional questions about physical activity levels, expectations, and satisfaction.

At baseline, the mean age of participants was 71 years, 62% were women, and 6% had bilateral operations. A total of 21% of patients had a history of surgery on their contralateral knee.

Nine patients died before the 5-year follow-up. Of the remaining patients, 61% reported improved function in activities of daily living. For example, patients rated their ability to walk on a scale of 1 to 6, ranging from a need for crutches to walking indoors and up to unlimited walking on uneven terrain. “As many as 39% of these patients expected unlimited walking ability on uneven ground postoperatively,” Dr. Nilsdotter said. Patients reported their best walking ability at 1 year–28% could walk on uneven ground, whereas at 5 years, 21% could do so.

A total of 96% of patients expected their daily activity levels to be “better or much better,” and 72% expected those same results for their ability to engage in sports and recreation, Dr. Nilsdotter said at the meeting, sponsored by the Osteoarthritis Research Society International. “Patients' expectations were generally higher than their postoperative abilities,” Dr. Nilsdotter noted.

The greatest disparity between expectations and abilities was seen in postoperative functionality for sports and recreation. For example, 41% expected to be able to dance or golf, but at 5 years only 14% reported being able to do so, she said.

Most patients, 93%, were generally satisfied with results at 5 years postoperatively, but only 33% were totally or quite satisfied with their level of ability for sports or recreation.

FORT LAUDERDALE, FLA. – The first 5-year follow-up study of pain and function after total knee replacement reveals a discrepancy between patients' expectations and their actual ability to engage in sports and recreational activities postoperatively, according to a presentation at the World Congress on Osteoarthritis.

Although patients have realistic expectations about their ability to perform activities of daily life after knee surgery, many are disappointed with their diminished capacity for recreational activities or sports at the 5-year mark, said Dr. Anna K. Nilsdotter, a researcher at Halmstad (Sweden) Central Hospital.

Researchers typically follow patients for just 12 months and record only the number of prosthesis failures. However, Dr. Nilsdotter said, “The best result for patients is after 1 year. Then it declines.

“I have done the same thing in hip replacement after 8 years with the same result,” she added. “Patients report maximum effect at 1 year.” Dr. Nilsdotter and her associates assessed 102 patients with primary osteoarthritis prior to total knee replacement and at 6 months, 1 year, and 5 years after surgery to determine their pain, function, and satisfaction. Using the Short Form-36 health survey and the Knee Injury and Osteoarthritis Outcome Score (KOOS), they evaluated pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life domains. The researchers also asked additional questions about physical activity levels, expectations, and satisfaction.

At baseline, the mean age of participants was 71 years, 62% were women, and 6% had bilateral operations. A total of 21% of patients had a history of surgery on their contralateral knee.

Nine patients died before the 5-year follow-up. Of the remaining patients, 61% reported improved function in activities of daily living. For example, patients rated their ability to walk on a scale of 1 to 6, ranging from a need for crutches to walking indoors and up to unlimited walking on uneven terrain. “As many as 39% of these patients expected unlimited walking ability on uneven ground postoperatively,” Dr. Nilsdotter said. Patients reported their best walking ability at 1 year–28% could walk on uneven ground, whereas at 5 years, 21% could do so.

A total of 96% of patients expected their daily activity levels to be “better or much better,” and 72% expected those same results for their ability to engage in sports and recreation, Dr. Nilsdotter said at the meeting, sponsored by the Osteoarthritis Research Society International. “Patients' expectations were generally higher than their postoperative abilities,” Dr. Nilsdotter noted.

The greatest disparity between expectations and abilities was seen in postoperative functionality for sports and recreation. For example, 41% expected to be able to dance or golf, but at 5 years only 14% reported being able to do so, she said.

Most patients, 93%, were generally satisfied with results at 5 years postoperatively, but only 33% were totally or quite satisfied with their level of ability for sports or recreation.

FORT LAUDERDALE, FLA. – The first 5-year follow-up study of pain and function after total knee replacement reveals a discrepancy between patients' expectations and their actual ability to engage in sports and recreational activities postoperatively, according to a presentation at the World Congress on Osteoarthritis.

Although patients have realistic expectations about their ability to perform activities of daily life after knee surgery, many are disappointed with their diminished capacity for recreational activities or sports at the 5-year mark, said Dr. Anna K. Nilsdotter, a researcher at Halmstad (Sweden) Central Hospital.

Researchers typically follow patients for just 12 months and record only the number of prosthesis failures. However, Dr. Nilsdotter said, “The best result for patients is after 1 year. Then it declines.

“I have done the same thing in hip replacement after 8 years with the same result,” she added. “Patients report maximum effect at 1 year.” Dr. Nilsdotter and her associates assessed 102 patients with primary osteoarthritis prior to total knee replacement and at 6 months, 1 year, and 5 years after surgery to determine their pain, function, and satisfaction. Using the Short Form-36 health survey and the Knee Injury and Osteoarthritis Outcome Score (KOOS), they evaluated pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life domains. The researchers also asked additional questions about physical activity levels, expectations, and satisfaction.

At baseline, the mean age of participants was 71 years, 62% were women, and 6% had bilateral operations. A total of 21% of patients had a history of surgery on their contralateral knee.

Nine patients died before the 5-year follow-up. Of the remaining patients, 61% reported improved function in activities of daily living. For example, patients rated their ability to walk on a scale of 1 to 6, ranging from a need for crutches to walking indoors and up to unlimited walking on uneven terrain. “As many as 39% of these patients expected unlimited walking ability on uneven ground postoperatively,” Dr. Nilsdotter said. Patients reported their best walking ability at 1 year–28% could walk on uneven ground, whereas at 5 years, 21% could do so.

A total of 96% of patients expected their daily activity levels to be “better or much better,” and 72% expected those same results for their ability to engage in sports and recreation, Dr. Nilsdotter said at the meeting, sponsored by the Osteoarthritis Research Society International. “Patients' expectations were generally higher than their postoperative abilities,” Dr. Nilsdotter noted.

The greatest disparity between expectations and abilities was seen in postoperative functionality for sports and recreation. For example, 41% expected to be able to dance or golf, but at 5 years only 14% reported being able to do so, she said.

Most patients, 93%, were generally satisfied with results at 5 years postoperatively, but only 33% were totally or quite satisfied with their level of ability for sports or recreation.

FORT LAUDERDALE, FLA. – A new 11-item measure of osteoarthritis pain developed with patient input was validated in a study of 100 people with x-ray-confirmed hip or knee osteoarthritis.

Investigators hope to improve on traditional assessments done with the pain subscale of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC). “We realize it is not getting at the pain of osteoarthritis. It is only five questions relating to pain, and three of them have to do with pain during specific activities,” Dr. Gillian Hawker said in an interview during a poster session at the World Congress of Osteoarthritis.

The Measure of Intermittent and Constant Osteoarthritis Pain “will be much more precise. It really gets at the minutiae of living with pain,” said Dr. Hawker of the department of medicine, Women's College Hospital, Toronto.

Development of this new instrument began with a request from the U.S. Food and Drug Administration. The agency was seeking a good outcome measure for studies to indicate when nonpharmacologic therapy has failed and drug treatment is warranted, said Dr. Hawker, who also is director of the institution's osteoporosis research program and the Canadian osteoarthritis research program.

In clinical settings, physicians can use the measure to monitor response to different therapies–“a tool for the family doc to see if self-management or NSAIDs are making a difference.”

The instrument was developed with patient input. People with osteoarthritis are able to discern two types of pain clearly–intermittent vs. constant pain–according to the focus groups.

“In the beginning, there is intermittent pain. Then it progresses to background pain combined with acute episodes.” Although both types of pain were important to patients, “it was this unpredictable, short-lived pain that curtailed activities,” Dr. Hawker said at the meeting, which was sponsored by the Osteoarthritis Research Society International (OARSI).

For this reason, Dr. Hawker and her associates developed the questionnaire to address both types of pain. “We put it into our osteoarthritis cohort in Toronto, and it looked pretty good.”

The researchers then tested the reliability and validity of the instrument with a telephone survey of 18 people with hip osteoarthritis and 82 with knee osteoarthritis. Researchers also asked three global hip/knee questions, and administered the WOMAC pain subscale, the symptoms subscales of both the Hip Disability and Osteoarthritis Outcome Score (HOOS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). This preliminary psychometric testing supports the validity and reliability of the Measure of Intermittent and Constant Osteoarthritis Pain, Dr. Hawker said. There was no correlation, however, with the limitation dimension of the Late Life Function and Disability Instrument.

Dr. Hawker and her associates plan to determine the cutoff values for pain and function leading to joint replacement.

The instrument will be online at www.oarsi.org[email protected]

FORT LAUDERDALE, FLA. – A new 11-item measure of osteoarthritis pain developed with patient input was validated in a study of 100 people with x-ray-confirmed hip or knee osteoarthritis.

Investigators hope to improve on traditional assessments done with the pain subscale of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC). “We realize it is not getting at the pain of osteoarthritis. It is only five questions relating to pain, and three of them have to do with pain during specific activities,” Dr. Gillian Hawker said in an interview during a poster session at the World Congress of Osteoarthritis.

The Measure of Intermittent and Constant Osteoarthritis Pain “will be much more precise. It really gets at the minutiae of living with pain,” said Dr. Hawker of the department of medicine, Women's College Hospital, Toronto.

Development of this new instrument began with a request from the U.S. Food and Drug Administration. The agency was seeking a good outcome measure for studies to indicate when nonpharmacologic therapy has failed and drug treatment is warranted, said Dr. Hawker, who also is director of the institution's osteoporosis research program and the Canadian osteoarthritis research program.

In clinical settings, physicians can use the measure to monitor response to different therapies–“a tool for the family doc to see if self-management or NSAIDs are making a difference.”

The instrument was developed with patient input. People with osteoarthritis are able to discern two types of pain clearly–intermittent vs. constant pain–according to the focus groups.

“In the beginning, there is intermittent pain. Then it progresses to background pain combined with acute episodes.” Although both types of pain were important to patients, “it was this unpredictable, short-lived pain that curtailed activities,” Dr. Hawker said at the meeting, which was sponsored by the Osteoarthritis Research Society International (OARSI).

For this reason, Dr. Hawker and her associates developed the questionnaire to address both types of pain. “We put it into our osteoarthritis cohort in Toronto, and it looked pretty good.”

The researchers then tested the reliability and validity of the instrument with a telephone survey of 18 people with hip osteoarthritis and 82 with knee osteoarthritis. Researchers also asked three global hip/knee questions, and administered the WOMAC pain subscale, the symptoms subscales of both the Hip Disability and Osteoarthritis Outcome Score (HOOS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). This preliminary psychometric testing supports the validity and reliability of the Measure of Intermittent and Constant Osteoarthritis Pain, Dr. Hawker said. There was no correlation, however, with the limitation dimension of the Late Life Function and Disability Instrument.

Dr. Hawker and her associates plan to determine the cutoff values for pain and function leading to joint replacement.

The instrument will be online at www.oarsi.org[email protected]

FORT LAUDERDALE, FLA. – A new 11-item measure of osteoarthritis pain developed with patient input was validated in a study of 100 people with x-ray-confirmed hip or knee osteoarthritis.

Investigators hope to improve on traditional assessments done with the pain subscale of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC). “We realize it is not getting at the pain of osteoarthritis. It is only five questions relating to pain, and three of them have to do with pain during specific activities,” Dr. Gillian Hawker said in an interview during a poster session at the World Congress of Osteoarthritis.

The Measure of Intermittent and Constant Osteoarthritis Pain “will be much more precise. It really gets at the minutiae of living with pain,” said Dr. Hawker of the department of medicine, Women's College Hospital, Toronto.

Development of this new instrument began with a request from the U.S. Food and Drug Administration. The agency was seeking a good outcome measure for studies to indicate when nonpharmacologic therapy has failed and drug treatment is warranted, said Dr. Hawker, who also is director of the institution's osteoporosis research program and the Canadian osteoarthritis research program.

In clinical settings, physicians can use the measure to monitor response to different therapies–“a tool for the family doc to see if self-management or NSAIDs are making a difference.”

The instrument was developed with patient input. People with osteoarthritis are able to discern two types of pain clearly–intermittent vs. constant pain–according to the focus groups.

“In the beginning, there is intermittent pain. Then it progresses to background pain combined with acute episodes.” Although both types of pain were important to patients, “it was this unpredictable, short-lived pain that curtailed activities,” Dr. Hawker said at the meeting, which was sponsored by the Osteoarthritis Research Society International (OARSI).

For this reason, Dr. Hawker and her associates developed the questionnaire to address both types of pain. “We put it into our osteoarthritis cohort in Toronto, and it looked pretty good.”

The researchers then tested the reliability and validity of the instrument with a telephone survey of 18 people with hip osteoarthritis and 82 with knee osteoarthritis. Researchers also asked three global hip/knee questions, and administered the WOMAC pain subscale, the symptoms subscales of both the Hip Disability and Osteoarthritis Outcome Score (HOOS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). This preliminary psychometric testing supports the validity and reliability of the Measure of Intermittent and Constant Osteoarthritis Pain, Dr. Hawker said. There was no correlation, however, with the limitation dimension of the Late Life Function and Disability Instrument.

Dr. Hawker and her associates plan to determine the cutoff values for pain and function leading to joint replacement.

The instrument will be online at www.oarsi.org[email protected]

HOLLYWOOD, FLA. — Symptom and quality-of-life improvements were noted at 3-year follow-up by most of the women who received a midurethral sling to treat stress urinary incontinence.

Dr. John B. Gebhart reported the findings of the single-surgeon case series study at the annual meeting of the American Urogynecologic Society. Follow-up data were available for 75 of 113 patients who received the Uretex Urethral Support device, which was introduced in 2001 by CR Bard Inc. The company provided a research grant for the study.

Dr. Gebhart, a urogynecologist and reconstructive pelvic surgeon, and a member of the obstetrics and gynecology faculty at the Mayo Clinic, Rochester, Minn., initiated the study in 2002. He or his surgery fellow implanted the Uretex device in 113 women with stress urinary incontinence. Some of these patients also presented with pelvic organ prolapse or mixed incontinence with a predominant stress component; 16 of the 75 women (21%) had undergone prior surgery for incontinence and 43 patients (57%) had undergone prior surgery for pelvic organ prolapse. Patients' mean age at follow-up was 63 years, mean body mass index was 30 kg/m

At baseline and follow-up, researchers assessed history, performed a physical examination, and measured quality of life using the validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). Median scores on quality-of-life measures had significantly improved at follow-up compared with baseline, Dr. Gebhart said.

Also, all 75 women passed a cough stress test at a comfortably full bladder; 65 had no leakage during a leak point pressure test at 300 mL; and 62 participants had a negative 1-hour pad test.

HOLLYWOOD, FLA. — Symptom and quality-of-life improvements were noted at 3-year follow-up by most of the women who received a midurethral sling to treat stress urinary incontinence.

Dr. John B. Gebhart reported the findings of the single-surgeon case series study at the annual meeting of the American Urogynecologic Society. Follow-up data were available for 75 of 113 patients who received the Uretex Urethral Support device, which was introduced in 2001 by CR Bard Inc. The company provided a research grant for the study.

Dr. Gebhart, a urogynecologist and reconstructive pelvic surgeon, and a member of the obstetrics and gynecology faculty at the Mayo Clinic, Rochester, Minn., initiated the study in 2002. He or his surgery fellow implanted the Uretex device in 113 women with stress urinary incontinence. Some of these patients also presented with pelvic organ prolapse or mixed incontinence with a predominant stress component; 16 of the 75 women (21%) had undergone prior surgery for incontinence and 43 patients (57%) had undergone prior surgery for pelvic organ prolapse. Patients' mean age at follow-up was 63 years, mean body mass index was 30 kg/m

At baseline and follow-up, researchers assessed history, performed a physical examination, and measured quality of life using the validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). Median scores on quality-of-life measures had significantly improved at follow-up compared with baseline, Dr. Gebhart said.

Also, all 75 women passed a cough stress test at a comfortably full bladder; 65 had no leakage during a leak point pressure test at 300 mL; and 62 participants had a negative 1-hour pad test.

HOLLYWOOD, FLA. — Symptom and quality-of-life improvements were noted at 3-year follow-up by most of the women who received a midurethral sling to treat stress urinary incontinence.

Dr. John B. Gebhart reported the findings of the single-surgeon case series study at the annual meeting of the American Urogynecologic Society. Follow-up data were available for 75 of 113 patients who received the Uretex Urethral Support device, which was introduced in 2001 by CR Bard Inc. The company provided a research grant for the study.

Dr. Gebhart, a urogynecologist and reconstructive pelvic surgeon, and a member of the obstetrics and gynecology faculty at the Mayo Clinic, Rochester, Minn., initiated the study in 2002. He or his surgery fellow implanted the Uretex device in 113 women with stress urinary incontinence. Some of these patients also presented with pelvic organ prolapse or mixed incontinence with a predominant stress component; 16 of the 75 women (21%) had undergone prior surgery for incontinence and 43 patients (57%) had undergone prior surgery for pelvic organ prolapse. Patients' mean age at follow-up was 63 years, mean body mass index was 30 kg/m

At baseline and follow-up, researchers assessed history, performed a physical examination, and measured quality of life using the validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). Median scores on quality-of-life measures had significantly improved at follow-up compared with baseline, Dr. Gebhart said.

Also, all 75 women passed a cough stress test at a comfortably full bladder; 65 had no leakage during a leak point pressure test at 300 mL; and 62 participants had a negative 1-hour pad test.

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. Physicians “need to recognize scalp and hair conditions associated with some procedures used by this ethnic group.”

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, noting 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 great hair straightening results with banana extract, all 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. Physicians “need to recognize scalp and hair conditions associated with some procedures used by this ethnic group.”

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, noting 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 great hair straightening results with banana extract, all 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. Physicians “need to recognize scalp and hair conditions associated with some procedures used by this ethnic group.”

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, noting 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 great hair straightening results with banana extract, all 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 — Unique structural and functional differences between the skin of black and white patients might help explain differences in the top five dermatology diagnoses for each ethnicity, according to study data presented at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research.

Prior to this study, the most recent survey of cutaneous diseases in black Americans was published more than 2 decades ago (Cutis 1983;32:388–90), said Dr. Amanda B. Sergay, a third-year dermatology resident at St. Luke's-Roosevelt Hospital Center in New York City.

Dr. Sergay and her associates, including principal investigator Dr. Andrew F. Alexis, retrospectively compared the diagnostic codes for 1,074 black and white patient visits treated at the Skin of Color Center at St. Luke's-Roosevelt Hospital Center, New York City, from August 2004 to July 2005. When ethnicity was unclear, the patient's own description was used.

Acne vulgaris was the most common diagnosis in both groups (ICD-9 code 706.1). “The pathophysiology of acne is not thought to differ between races or ethnicities,” she said at the symposium, which was also sponsored by Howard University.

Acne and dyschromia (code 709.09) are so common that they accounted for almost 50% of black patient visits (Cutis, in press: November 2007). Black patients also were commonly diagnosed with contact dermatitis and other eczema, unspecified cause (code 692.9), alopecia (code 704.0), and seborrheic dermatitis (code 690.1).

After acne vulgaris, the most common diagnoses in white patients were a lesion of unspecified behavior (code 238.2), benign neoplasm of the skin of the trunk (code 216.5), contact dermatitis or other eczema, and psoriasis (696.1).

In black patients, dyschromia and alopecia made the top-5 list, but they were not among the top 10 diagnoses for white patients, Dr. Sergay said. The dyschromia diagnoses included postinflammatory hyperpigmentation and melasma.

“Postinflammatory hyperpigmentation is a common sequela of cutaneous injury or irritation in skin of color,” Dr. Sergay said. It can also result from pseudofolliculitis barbae, which is more common in black than in white patients because of structural differences in the hair follicle and shaft.

The higher incidence of alopecia in black patients could be partially explained by the fact that there are fewer elastic fibers in black skin to anchor hair follicles to the dermis (Dermatol. Clin. 1988;6:271–81). Chemical and physical hair care practices may also contribute to alopecia, as could the significantly lower total hair density and number of hair follicles in black patients, compared with whites (Dermatol. Clin. 2003;21:595–600; Arch. Dermatol. 1999;135:656–8).

Racial variations in skin physiology may also lead to differences in eczema prevalence, Dr. Sergay said.

The single-center source of information was a limitation of the study, as was potential selection bias from participating physicians, she said, adding that categorization of patient ethnicity by a physician or assistant is less reliable than self-reporting.

Melasma, a skin pigmentation disorder, manifests as dark spots on the face.

Blacks' skin physiology and hair-care practices make them prone to alopecia. Photos courtesy Dr. Pearl E. Grimes

MIAMI — Unique structural and functional differences between the skin of black and white patients might help explain differences in the top five dermatology diagnoses for each ethnicity, according to study data presented at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research.

Prior to this study, the most recent survey of cutaneous diseases in black Americans was published more than 2 decades ago (Cutis 1983;32:388–90), said Dr. Amanda B. Sergay, a third-year dermatology resident at St. Luke's-Roosevelt Hospital Center in New York City.

Dr. Sergay and her associates, including principal investigator Dr. Andrew F. Alexis, retrospectively compared the diagnostic codes for 1,074 black and white patient visits treated at the Skin of Color Center at St. Luke's-Roosevelt Hospital Center, New York City, from August 2004 to July 2005. When ethnicity was unclear, the patient's own description was used.

Acne vulgaris was the most common diagnosis in both groups (ICD-9 code 706.1). “The pathophysiology of acne is not thought to differ between races or ethnicities,” she said at the symposium, which was also sponsored by Howard University.

Acne and dyschromia (code 709.09) are so common that they accounted for almost 50% of black patient visits (Cutis, in press: November 2007). Black patients also were commonly diagnosed with contact dermatitis and other eczema, unspecified cause (code 692.9), alopecia (code 704.0), and seborrheic dermatitis (code 690.1).

After acne vulgaris, the most common diagnoses in white patients were a lesion of unspecified behavior (code 238.2), benign neoplasm of the skin of the trunk (code 216.5), contact dermatitis or other eczema, and psoriasis (696.1).

In black patients, dyschromia and alopecia made the top-5 list, but they were not among the top 10 diagnoses for white patients, Dr. Sergay said. The dyschromia diagnoses included postinflammatory hyperpigmentation and melasma.

“Postinflammatory hyperpigmentation is a common sequela of cutaneous injury or irritation in skin of color,” Dr. Sergay said. It can also result from pseudofolliculitis barbae, which is more common in black than in white patients because of structural differences in the hair follicle and shaft.

The higher incidence of alopecia in black patients could be partially explained by the fact that there are fewer elastic fibers in black skin to anchor hair follicles to the dermis (Dermatol. Clin. 1988;6:271–81). Chemical and physical hair care practices may also contribute to alopecia, as could the significantly lower total hair density and number of hair follicles in black patients, compared with whites (Dermatol. Clin. 2003;21:595–600; Arch. Dermatol. 1999;135:656–8).

Racial variations in skin physiology may also lead to differences in eczema prevalence, Dr. Sergay said.

The single-center source of information was a limitation of the study, as was potential selection bias from participating physicians, she said, adding that categorization of patient ethnicity by a physician or assistant is less reliable than self-reporting.

Melasma, a skin pigmentation disorder, manifests as dark spots on the face.

Blacks' skin physiology and hair-care practices make them prone to alopecia. Photos courtesy Dr. Pearl E. Grimes

MIAMI — Unique structural and functional differences between the skin of black and white patients might help explain differences in the top five dermatology diagnoses for each ethnicity, according to study data presented at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research.

Prior to this study, the most recent survey of cutaneous diseases in black Americans was published more than 2 decades ago (Cutis 1983;32:388–90), said Dr. Amanda B. Sergay, a third-year dermatology resident at St. Luke's-Roosevelt Hospital Center in New York City.

Dr. Sergay and her associates, including principal investigator Dr. Andrew F. Alexis, retrospectively compared the diagnostic codes for 1,074 black and white patient visits treated at the Skin of Color Center at St. Luke's-Roosevelt Hospital Center, New York City, from August 2004 to July 2005. When ethnicity was unclear, the patient's own description was used.

Acne vulgaris was the most common diagnosis in both groups (ICD-9 code 706.1). “The pathophysiology of acne is not thought to differ between races or ethnicities,” she said at the symposium, which was also sponsored by Howard University.

Acne and dyschromia (code 709.09) are so common that they accounted for almost 50% of black patient visits (Cutis, in press: November 2007). Black patients also were commonly diagnosed with contact dermatitis and other eczema, unspecified cause (code 692.9), alopecia (code 704.0), and seborrheic dermatitis (code 690.1).

After acne vulgaris, the most common diagnoses in white patients were a lesion of unspecified behavior (code 238.2), benign neoplasm of the skin of the trunk (code 216.5), contact dermatitis or other eczema, and psoriasis (696.1).

In black patients, dyschromia and alopecia made the top-5 list, but they were not among the top 10 diagnoses for white patients, Dr. Sergay said. The dyschromia diagnoses included postinflammatory hyperpigmentation and melasma.

“Postinflammatory hyperpigmentation is a common sequela of cutaneous injury or irritation in skin of color,” Dr. Sergay said. It can also result from pseudofolliculitis barbae, which is more common in black than in white patients because of structural differences in the hair follicle and shaft.

The higher incidence of alopecia in black patients could be partially explained by the fact that there are fewer elastic fibers in black skin to anchor hair follicles to the dermis (Dermatol. Clin. 1988;6:271–81). Chemical and physical hair care practices may also contribute to alopecia, as could the significantly lower total hair density and number of hair follicles in black patients, compared with whites (Dermatol. Clin. 2003;21:595–600; Arch. Dermatol. 1999;135:656–8).

Racial variations in skin physiology may also lead to differences in eczema prevalence, Dr. Sergay said.

The single-center source of information was a limitation of the study, as was potential selection bias from participating physicians, she said, adding that categorization of patient ethnicity by a physician or assistant is less reliable than self-reporting.

Melasma, a skin pigmentation disorder, manifests as dark spots on the face.

Blacks' skin physiology and hair-care practices make them prone to alopecia. Photos courtesy Dr. Pearl E. Grimes

MIAMI BEACH – Mild traumatic brain injury can be controversial in both clinical and legal contexts. A conflict arises when patients report disability but neurologic exams appear normal.

“There can be a mismatch between mild injury, a normal exam, and multiple symptoms that lead to an evaluation for legal or insurance reasons. A comprehensive neuropsychiatric evaluation is needed and provides critical data,” Dr. Jacob C. Holzer said at the annual meeting of the American Academy of Psychiatry and the Law.

“Maybe the patient had an evaluation right before or right after the injury. The outcome needs to make sense and match with functioning in the real world,” said Dr. Holzer of the division of psychiatry and medicine at Massachusetts General Hospital, Boston.

In acute traumatic brain injury (TBI), there can be loss of consciousness, confusion, and amnesia. Frontal and anterior temporal regions are most vulnerable to injury. Chronic TBI generally features psychiatric and neurologic symptoms, seizures, and concussion syndrome.

With mild TBI, however, consciousness may or may not be disrupted. Most cases of mild injury resolve within weeks to months, although some endure. Patients with mild injury tend to score in the 13–15 range on the Glasgow Coma Scale. “The prognosis tends to be pretty good when you look at specific goals, such as motor functioning. The enduring picture is that cognitive deficits tend to be long lasting,” Dr. Holzer said.

Symptoms of acute mild TBI cluster in cognitive, somatic, and psychiatric areas. Cognitive effects include impairments in memory, attention, concentration, and speed of information processing. Somatic symptoms can include headache, dizziness, nausea, fatigue, and poor sleep quality. Psychiatric effects include depression, which is very common, and anxiety.

“Imaging studies and neurodiagnostic tests may or may not help” with diagnosis and management of a patient with mild TBI, Dr. Holzer noted. He suggested using structural or functional imaging as one component of a comprehensive evaluation.

For a long time, the literature comprised primarily animal studies, but newer imaging studies in humans are supplanting these previous findings. “It's really interesting looking at athletes who have injuries–studies have found statistically significant differences between groups,” he said. Electrophysiologic studies demonstrate consistent changes among athletes, and neuropsychiatric assessment can demonstrate differences in simple and complex attention areas.

“That is not to say everything is positive,” Dr. Holzer said. Some negative studies indicate that there are no significant differences between athletes and nonathletes.

“This is a hot area in the news, looking at high school sports, including adolescents who get repeated concussions,” said Dr. Holzer, who indicated that he had no relevant financial relationship pertaining to the context of his presentation.

Technology may lend insight. Researchers developed a group of sensors that go inside a football helmet and alert a coach on the sidelines when forces are great enough to cause a concussion (Head Impact Telemetry System, Simbex LLC). The sensors are used by several high school and college football teams such as Virginia Tech, Blacksburg, the University of North Carolina at Chapel Hill, and Dartmouth, Hanover, N.H.

MIAMI BEACH – Mild traumatic brain injury can be controversial in both clinical and legal contexts. A conflict arises when patients report disability but neurologic exams appear normal.

“There can be a mismatch between mild injury, a normal exam, and multiple symptoms that lead to an evaluation for legal or insurance reasons. A comprehensive neuropsychiatric evaluation is needed and provides critical data,” Dr. Jacob C. Holzer said at the annual meeting of the American Academy of Psychiatry and the Law.

“Maybe the patient had an evaluation right before or right after the injury. The outcome needs to make sense and match with functioning in the real world,” said Dr. Holzer of the division of psychiatry and medicine at Massachusetts General Hospital, Boston.

In acute traumatic brain injury (TBI), there can be loss of consciousness, confusion, and amnesia. Frontal and anterior temporal regions are most vulnerable to injury. Chronic TBI generally features psychiatric and neurologic symptoms, seizures, and concussion syndrome.

With mild TBI, however, consciousness may or may not be disrupted. Most cases of mild injury resolve within weeks to months, although some endure. Patients with mild injury tend to score in the 13–15 range on the Glasgow Coma Scale. “The prognosis tends to be pretty good when you look at specific goals, such as motor functioning. The enduring picture is that cognitive deficits tend to be long lasting,” Dr. Holzer said.

Symptoms of acute mild TBI cluster in cognitive, somatic, and psychiatric areas. Cognitive effects include impairments in memory, attention, concentration, and speed of information processing. Somatic symptoms can include headache, dizziness, nausea, fatigue, and poor sleep quality. Psychiatric effects include depression, which is very common, and anxiety.

“Imaging studies and neurodiagnostic tests may or may not help” with diagnosis and management of a patient with mild TBI, Dr. Holzer noted. He suggested using structural or functional imaging as one component of a comprehensive evaluation.

For a long time, the literature comprised primarily animal studies, but newer imaging studies in humans are supplanting these previous findings. “It's really interesting looking at athletes who have injuries–studies have found statistically significant differences between groups,” he said. Electrophysiologic studies demonstrate consistent changes among athletes, and neuropsychiatric assessment can demonstrate differences in simple and complex attention areas.

“That is not to say everything is positive,” Dr. Holzer said. Some negative studies indicate that there are no significant differences between athletes and nonathletes.

“This is a hot area in the news, looking at high school sports, including adolescents who get repeated concussions,” said Dr. Holzer, who indicated that he had no relevant financial relationship pertaining to the context of his presentation.

Technology may lend insight. Researchers developed a group of sensors that go inside a football helmet and alert a coach on the sidelines when forces are great enough to cause a concussion (Head Impact Telemetry System, Simbex LLC). The sensors are used by several high school and college football teams such as Virginia Tech, Blacksburg, the University of North Carolina at Chapel Hill, and Dartmouth, Hanover, N.H.

MIAMI BEACH – Mild traumatic brain injury can be controversial in both clinical and legal contexts. A conflict arises when patients report disability but neurologic exams appear normal.

“There can be a mismatch between mild injury, a normal exam, and multiple symptoms that lead to an evaluation for legal or insurance reasons. A comprehensive neuropsychiatric evaluation is needed and provides critical data,” Dr. Jacob C. Holzer said at the annual meeting of the American Academy of Psychiatry and the Law.

“Maybe the patient had an evaluation right before or right after the injury. The outcome needs to make sense and match with functioning in the real world,” said Dr. Holzer of the division of psychiatry and medicine at Massachusetts General Hospital, Boston.

In acute traumatic brain injury (TBI), there can be loss of consciousness, confusion, and amnesia. Frontal and anterior temporal regions are most vulnerable to injury. Chronic TBI generally features psychiatric and neurologic symptoms, seizures, and concussion syndrome.

With mild TBI, however, consciousness may or may not be disrupted. Most cases of mild injury resolve within weeks to months, although some endure. Patients with mild injury tend to score in the 13–15 range on the Glasgow Coma Scale. “The prognosis tends to be pretty good when you look at specific goals, such as motor functioning. The enduring picture is that cognitive deficits tend to be long lasting,” Dr. Holzer said.

Symptoms of acute mild TBI cluster in cognitive, somatic, and psychiatric areas. Cognitive effects include impairments in memory, attention, concentration, and speed of information processing. Somatic symptoms can include headache, dizziness, nausea, fatigue, and poor sleep quality. Psychiatric effects include depression, which is very common, and anxiety.

“Imaging studies and neurodiagnostic tests may or may not help” with diagnosis and management of a patient with mild TBI, Dr. Holzer noted. He suggested using structural or functional imaging as one component of a comprehensive evaluation.

For a long time, the literature comprised primarily animal studies, but newer imaging studies in humans are supplanting these previous findings. “It's really interesting looking at athletes who have injuries–studies have found statistically significant differences between groups,” he said. Electrophysiologic studies demonstrate consistent changes among athletes, and neuropsychiatric assessment can demonstrate differences in simple and complex attention areas.

“That is not to say everything is positive,” Dr. Holzer said. Some negative studies indicate that there are no significant differences between athletes and nonathletes.

“This is a hot area in the news, looking at high school sports, including adolescents who get repeated concussions,” said Dr. Holzer, who indicated that he had no relevant financial relationship pertaining to the context of his presentation.

Technology may lend insight. Researchers developed a group of sensors that go inside a football helmet and alert a coach on the sidelines when forces are great enough to cause a concussion (Head Impact Telemetry System, Simbex LLC). The sensors are used by several high school and college football teams such as Virginia Tech, Blacksburg, the University of North Carolina at Chapel Hill, and Dartmouth, Hanover, N.H.

MIAMI – Compared with gamma-glutamyl-transferase measures, a new test that uses a combination of 27 blood chemistry values identifies twice as many men and 50% more women who heavily consume alcohol.

The finding of a study presented at the annual meeting of the American Society of Addiction Medicine “holds a lot of promise for reducing problem drinking, in a primary care practice, in a nonjudgmental way,” according to Jim Harasymiw, Psy.D.

The test “can be part of an early intervention and prevention model to handle these issues,” he said in an interview about his poster presentation at the meeting.

The new test determines the likelihood of heavy drinking in the previous 4–6 weeks, based on standard blood laboratory values, said Dr. Harasymiw, director of research at Alcohol Detection Services in Big Bend, Wisc.

The Early Detection of Alcohol Consumption (EDAC) test uses an algorithm that includes 27 blood chemistry levels, including monocytes, high-density lipoprotein, albumin, bilirubin, hematocrit, and liver enzymes. Dr. Harasymiw disclosed that he developed and is part owner of the EDAC test.

Test interpretation is done at a central site. Dr. Harasymiw and his colleagues plan to launch a Web site soon featuring the software for the algorithm. For a fee, physicians can enter the blood values for a particular patient and get results online.

The cutoff values for heavy drinking, compared with light drinking, are expressed as a percentage match with values from more than 1,700 individuals in a database. Heavy drinkers in the database reported more than five drinks (over 2.5 ounces of alcohol total) per day for men and more than four drinks (over 2 ounces of alcohol total) per day for women.

Dr. Harasymiw and his associates used the EDAC and the well-established gamma-glutamyl-transferase (GGT) liver enzyme test to assess 1,022 men (618 heavy drinkers and 404 light drinkers) and 583 women (228 heavy drinkers and 355 light drinkers). The mean age was 38 years. The participants were recruited from detoxification centers, hospitals, outpatient clinics, recovering alcoholic groups, Mormon churches, colleges, and professional associations.

“Guidelines say physicians should be screening for alcohol problems in their practices,” Dr. Harasymiw said. “We have tried to get physicians to use questionnaires for many years, but it doesn't fit into their office practice, and some answers are subjective.” Because the EDAC is based on routine blood values, it is more objective and “gives a physician something they are comfortable talking about.” With the results of the EDAC test, you can tell a patient, “You are drinking to a point that is causing biologic changes in your body,” he added.

In specific populations, such as drunk drivers convicted for the third time, it becomes a diagnostic test, he said. “We tested this [EDAC test] in a number of different settings, and it worked as well or better than anything else out there.”

The sensitivity of the EDAC among men was 65%, compared with 30% for the GGT. Sensitivity among women was 34% for the EDAC and 23% for the GGT. Specificity was 89% among men for the EDAC and 92% with the GGT. Among women, the specificity of the EDAC was 98%, compared with 94% for the GGT.

If a prevalence of 15% is assumed in the general population, for example, the EDAC has a 51% positive predictive value, compared with 40% for the GGT, among men. The difference is even greater among women–a positive predictive value of 75% for the EDAC, compared with 41% for the GGT.

Some recent changes in CPT codes increase the likelihood of reimbursement for the EDAC test, Dr. Harasymiw said. “As of January 2007, there is a CPT code for brief screening and office intervention. We did not have this before.” This also is a CPT code for a brief pathology consult that might be applicable, he added.

MIAMI – Compared with gamma-glutamyl-transferase measures, a new test that uses a combination of 27 blood chemistry values identifies twice as many men and 50% more women who heavily consume alcohol.

The finding of a study presented at the annual meeting of the American Society of Addiction Medicine “holds a lot of promise for reducing problem drinking, in a primary care practice, in a nonjudgmental way,” according to Jim Harasymiw, Psy.D.

The test “can be part of an early intervention and prevention model to handle these issues,” he said in an interview about his poster presentation at the meeting.

The new test determines the likelihood of heavy drinking in the previous 4–6 weeks, based on standard blood laboratory values, said Dr. Harasymiw, director of research at Alcohol Detection Services in Big Bend, Wisc.

The Early Detection of Alcohol Consumption (EDAC) test uses an algorithm that includes 27 blood chemistry levels, including monocytes, high-density lipoprotein, albumin, bilirubin, hematocrit, and liver enzymes. Dr. Harasymiw disclosed that he developed and is part owner of the EDAC test.

Test interpretation is done at a central site. Dr. Harasymiw and his colleagues plan to launch a Web site soon featuring the software for the algorithm. For a fee, physicians can enter the blood values for a particular patient and get results online.

The cutoff values for heavy drinking, compared with light drinking, are expressed as a percentage match with values from more than 1,700 individuals in a database. Heavy drinkers in the database reported more than five drinks (over 2.5 ounces of alcohol total) per day for men and more than four drinks (over 2 ounces of alcohol total) per day for women.

Dr. Harasymiw and his associates used the EDAC and the well-established gamma-glutamyl-transferase (GGT) liver enzyme test to assess 1,022 men (618 heavy drinkers and 404 light drinkers) and 583 women (228 heavy drinkers and 355 light drinkers). The mean age was 38 years. The participants were recruited from detoxification centers, hospitals, outpatient clinics, recovering alcoholic groups, Mormon churches, colleges, and professional associations.

“Guidelines say physicians should be screening for alcohol problems in their practices,” Dr. Harasymiw said. “We have tried to get physicians to use questionnaires for many years, but it doesn't fit into their office practice, and some answers are subjective.” Because the EDAC is based on routine blood values, it is more objective and “gives a physician something they are comfortable talking about.” With the results of the EDAC test, you can tell a patient, “You are drinking to a point that is causing biologic changes in your body,” he added.

In specific populations, such as drunk drivers convicted for the third time, it becomes a diagnostic test, he said. “We tested this [EDAC test] in a number of different settings, and it worked as well or better than anything else out there.”

The sensitivity of the EDAC among men was 65%, compared with 30% for the GGT. Sensitivity among women was 34% for the EDAC and 23% for the GGT. Specificity was 89% among men for the EDAC and 92% with the GGT. Among women, the specificity of the EDAC was 98%, compared with 94% for the GGT.

If a prevalence of 15% is assumed in the general population, for example, the EDAC has a 51% positive predictive value, compared with 40% for the GGT, among men. The difference is even greater among women–a positive predictive value of 75% for the EDAC, compared with 41% for the GGT.

Some recent changes in CPT codes increase the likelihood of reimbursement for the EDAC test, Dr. Harasymiw said. “As of January 2007, there is a CPT code for brief screening and office intervention. We did not have this before.” This also is a CPT code for a brief pathology consult that might be applicable, he added.

MIAMI – Compared with gamma-glutamyl-transferase measures, a new test that uses a combination of 27 blood chemistry values identifies twice as many men and 50% more women who heavily consume alcohol.

The finding of a study presented at the annual meeting of the American Society of Addiction Medicine “holds a lot of promise for reducing problem drinking, in a primary care practice, in a nonjudgmental way,” according to Jim Harasymiw, Psy.D.

The test “can be part of an early intervention and prevention model to handle these issues,” he said in an interview about his poster presentation at the meeting.

The new test determines the likelihood of heavy drinking in the previous 4–6 weeks, based on standard blood laboratory values, said Dr. Harasymiw, director of research at Alcohol Detection Services in Big Bend, Wisc.

The Early Detection of Alcohol Consumption (EDAC) test uses an algorithm that includes 27 blood chemistry levels, including monocytes, high-density lipoprotein, albumin, bilirubin, hematocrit, and liver enzymes. Dr. Harasymiw disclosed that he developed and is part owner of the EDAC test.

Test interpretation is done at a central site. Dr. Harasymiw and his colleagues plan to launch a Web site soon featuring the software for the algorithm. For a fee, physicians can enter the blood values for a particular patient and get results online.

The cutoff values for heavy drinking, compared with light drinking, are expressed as a percentage match with values from more than 1,700 individuals in a database. Heavy drinkers in the database reported more than five drinks (over 2.5 ounces of alcohol total) per day for men and more than four drinks (over 2 ounces of alcohol total) per day for women.

Dr. Harasymiw and his associates used the EDAC and the well-established gamma-glutamyl-transferase (GGT) liver enzyme test to assess 1,022 men (618 heavy drinkers and 404 light drinkers) and 583 women (228 heavy drinkers and 355 light drinkers). The mean age was 38 years. The participants were recruited from detoxification centers, hospitals, outpatient clinics, recovering alcoholic groups, Mormon churches, colleges, and professional associations.

“Guidelines say physicians should be screening for alcohol problems in their practices,” Dr. Harasymiw said. “We have tried to get physicians to use questionnaires for many years, but it doesn't fit into their office practice, and some answers are subjective.” Because the EDAC is based on routine blood values, it is more objective and “gives a physician something they are comfortable talking about.” With the results of the EDAC test, you can tell a patient, “You are drinking to a point that is causing biologic changes in your body,” he added.

In specific populations, such as drunk drivers convicted for the third time, it becomes a diagnostic test, he said. “We tested this [EDAC test] in a number of different settings, and it worked as well or better than anything else out there.”

The sensitivity of the EDAC among men was 65%, compared with 30% for the GGT. Sensitivity among women was 34% for the EDAC and 23% for the GGT. Specificity was 89% among men for the EDAC and 92% with the GGT. Among women, the specificity of the EDAC was 98%, compared with 94% for the GGT.

If a prevalence of 15% is assumed in the general population, for example, the EDAC has a 51% positive predictive value, compared with 40% for the GGT, among men. The difference is even greater among women–a positive predictive value of 75% for the EDAC, compared with 41% for the GGT.

Some recent changes in CPT codes increase the likelihood of reimbursement for the EDAC test, Dr. Harasymiw said. “As of January 2007, there is a CPT code for brief screening and office intervention. We did not have this before.” This also is a CPT code for a brief pathology consult that might be applicable, he added.

MIAMI BEACH — Only six states have mandatory reporting laws, so most physicians can be in a quandary when a patient is alcohol dependent and works where impairment could threaten public safety, according to a poster presented at the annual meeting of the American Academy of Psychiatry and the Law.

When a patient with a 30-year history of alcohol dependence was admitted in ketoacidosis to the Cleveland Clinic's internal medicine service, the psychiatry service was asked to assess any legal or ethical obligations to report the condition of the patient, a commercial bus driver, to his employer.

“Initially, my legal department told me not to report him. Then I got three different answers,” said Dr. Mia Zaharna, chief resident of general adult psychiatry at the Cleveland Clinic. Liability issues, confidentiality concerns, and a fear patients will lose their jobs are possible reasons for a lack of definitive guidance, Dr. Zaharna said.

She and her associates checked Ohio statutes and federal law for definitive guidance, but found none. Next, they sought guidelines from the American Psychiatric Association, the American Medical Association, and the American Society of Addiction Medicine (ASAM). “I was surprised how vague it all seems to be. The APA, AMA, and [ASAM] have some recommendations for talking with patients about not drinking and driving, but when it comes to telling physicians what to do [about duty to report impairment], it's all over the place.”

According to an ASAM public policy statement, it is appropriate to report a substance-dependent patient to authorities when the patient “is considered … to pose an immediate threat to public safety” as in the case of “acute incapacitation by substances” (J. Addict. Dis. 2000;19:125–7).

With more severe cases of impairment, disclosure of confidential patient information is permitted or even obligatory, according to the 1976 California Supreme Court decision in Tarasoff v. Regents of the University of California. The majority opinion stated that mental health professionals have a duty to protect a third party when a patient is threatening to do them bodily harm. The duty can include notifying police and the intended victim and/or taking other reasonable steps to protect the threatened individual.

When a potential threat is less clear, however, physicians must weigh the likelihood of harm to third parties against risks to the patient. Assess how functionally impaired the patient is likely to be while on the job, Dr. Zaharna suggested.

More precise guidance on this issue would reduce confusion for physicians. The six states with mandatory reporting laws are California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania. “It's up in the air in the other states,” she said.

In the case of the bus driver, “we ended up informing this patient about the risks—health risks and driving risks—associated with his alcohol use, but we did not report him to his employer or to the [Bureau of Motor Vehicles] at the advice of our legal department,” she said.

MIAMI BEACH — Only six states have mandatory reporting laws, so most physicians can be in a quandary when a patient is alcohol dependent and works where impairment could threaten public safety, according to a poster presented at the annual meeting of the American Academy of Psychiatry and the Law.

When a patient with a 30-year history of alcohol dependence was admitted in ketoacidosis to the Cleveland Clinic's internal medicine service, the psychiatry service was asked to assess any legal or ethical obligations to report the condition of the patient, a commercial bus driver, to his employer.

“Initially, my legal department told me not to report him. Then I got three different answers,” said Dr. Mia Zaharna, chief resident of general adult psychiatry at the Cleveland Clinic. Liability issues, confidentiality concerns, and a fear patients will lose their jobs are possible reasons for a lack of definitive guidance, Dr. Zaharna said.

She and her associates checked Ohio statutes and federal law for definitive guidance, but found none. Next, they sought guidelines from the American Psychiatric Association, the American Medical Association, and the American Society of Addiction Medicine (ASAM). “I was surprised how vague it all seems to be. The APA, AMA, and [ASAM] have some recommendations for talking with patients about not drinking and driving, but when it comes to telling physicians what to do [about duty to report impairment], it's all over the place.”

According to an ASAM public policy statement, it is appropriate to report a substance-dependent patient to authorities when the patient “is considered … to pose an immediate threat to public safety” as in the case of “acute incapacitation by substances” (J. Addict. Dis. 2000;19:125–7).

With more severe cases of impairment, disclosure of confidential patient information is permitted or even obligatory, according to the 1976 California Supreme Court decision in Tarasoff v. Regents of the University of California. The majority opinion stated that mental health professionals have a duty to protect a third party when a patient is threatening to do them bodily harm. The duty can include notifying police and the intended victim and/or taking other reasonable steps to protect the threatened individual.

When a potential threat is less clear, however, physicians must weigh the likelihood of harm to third parties against risks to the patient. Assess how functionally impaired the patient is likely to be while on the job, Dr. Zaharna suggested.

More precise guidance on this issue would reduce confusion for physicians. The six states with mandatory reporting laws are California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania. “It's up in the air in the other states,” she said.

In the case of the bus driver, “we ended up informing this patient about the risks—health risks and driving risks—associated with his alcohol use, but we did not report him to his employer or to the [Bureau of Motor Vehicles] at the advice of our legal department,” she said.

MIAMI BEACH — Only six states have mandatory reporting laws, so most physicians can be in a quandary when a patient is alcohol dependent and works where impairment could threaten public safety, according to a poster presented at the annual meeting of the American Academy of Psychiatry and the Law.

When a patient with a 30-year history of alcohol dependence was admitted in ketoacidosis to the Cleveland Clinic's internal medicine service, the psychiatry service was asked to assess any legal or ethical obligations to report the condition of the patient, a commercial bus driver, to his employer.

“Initially, my legal department told me not to report him. Then I got three different answers,” said Dr. Mia Zaharna, chief resident of general adult psychiatry at the Cleveland Clinic. Liability issues, confidentiality concerns, and a fear patients will lose their jobs are possible reasons for a lack of definitive guidance, Dr. Zaharna said.

She and her associates checked Ohio statutes and federal law for definitive guidance, but found none. Next, they sought guidelines from the American Psychiatric Association, the American Medical Association, and the American Society of Addiction Medicine (ASAM). “I was surprised how vague it all seems to be. The APA, AMA, and [ASAM] have some recommendations for talking with patients about not drinking and driving, but when it comes to telling physicians what to do [about duty to report impairment], it's all over the place.”

According to an ASAM public policy statement, it is appropriate to report a substance-dependent patient to authorities when the patient “is considered … to pose an immediate threat to public safety” as in the case of “acute incapacitation by substances” (J. Addict. Dis. 2000;19:125–7).

With more severe cases of impairment, disclosure of confidential patient information is permitted or even obligatory, according to the 1976 California Supreme Court decision in Tarasoff v. Regents of the University of California. The majority opinion stated that mental health professionals have a duty to protect a third party when a patient is threatening to do them bodily harm. The duty can include notifying police and the intended victim and/or taking other reasonable steps to protect the threatened individual.

When a potential threat is less clear, however, physicians must weigh the likelihood of harm to third parties against risks to the patient. Assess how functionally impaired the patient is likely to be while on the job, Dr. Zaharna suggested.

More precise guidance on this issue would reduce confusion for physicians. The six states with mandatory reporting laws are California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania. “It's up in the air in the other states,” she said.

In the case of the bus driver, “we ended up informing this patient about the risks—health risks and driving risks—associated with his alcohol use, but we did not report him to his employer or to the [Bureau of Motor Vehicles] at the advice of our legal department,” she said.

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.