Shaving Waivers in the United States Air Force and Their Impact on Promotions of Black/African-American Members.

INTRODUCTION: Regulations of the United States Air Force (USAF) prohibit male members from growing beards. Shaving waivers can be issued to airmen who are not able to shave due to various medical conditions such as pseudofolliculitis barbae, a condition that predominantly affects Blacks/African-Americans. Beard growth has been anecdotally associated with a negative impact on career progression. This study sought to establish if shaving waivers are associated with delays in promotion and, if present, if this association leads to racial bias. MATERIALS AND METHODS: An online survey that collected information relating to shaving waivers and demographic data was emailed to all air force male members at 12 randomly selected air force bases. Generalized linear models were conducted to test the waiver group difference in promotion time controlling for rank and the covariates of race/ethnicity, level of education, professional military education completion, and disciplinary action. RESULTS: A total of 51,703 survey invitations were emailed to members, and 10,383 complete responses were received (20.08% response rate). The demographics of the study cohort closely matched that of the USAF. Shaving waivers were associated with a longer time to promotion (P = .0003). The interaction between race and waiver status was not significant, indicating that shaving waivers are associated with a similarly longer time to promotion in individuals of all races. However, 64.18% of those in the waiver group were Black/African-American despite only being 12.85% of the study cohort. CONCLUSIONS: This study found an association between shaving waivers and delayed promotions. The majority of the waiver group was Black/African-American, which may lead to a racially discriminatory effect of the male grooming standards of the USAF.

Mycobacterium abscessus infection following home dermabrasion.

With an ever-increasing prevalence of cosmetic treatments, there also have been increasing rates of skin and soft tissue infections due to cosmetic procedures and other popular procedures such as acupuncture. We report a case of a 32-year-old woman who presented with a tender lump on the face of 6 weeks' duration that developed acutely after using an at-home microdermabrasion device. She was eventually diagnosed with a skin infection due to Mycobacterium abscessus, which is part of a more specific group known as rapidly growing nontuberculous mycobacteria. Due to multidrug resistance, treatment of the solitary lesion required combination intravenous (IV) antibiotic therapy for more than 2 months. This report considers the significance of these infections within the context of cosmetic procedures that are generally considered to be minimally invasive.

Atopic Dermatitis and Implications for Military Service.

INTRODUCTION: Atopic dermatitis is a common condition in the general population. Historically, it has been a disqualifying condition for military service despite its relatively high prevalence and low severity. As the barriers to service in the military decrease for individuals with atopic dermatitis, it is important to be aware of potential complications of this condition and their military implications. MATERIALS AND METHODS: A literature search for topics relating to atopic dermatitis was performed utilizing PubMed. An internet search of the military regulations regarding this condition was also performed. Additionally, an independent request was made by the authors of this paper to the Armed Forces Health Surveillance Branch to look at evacuations given a specific diagnosis of atopic dermatitis at the time of evacuation from January 2003 to December 2006. The data obtained from this request were compared to data available in publications relating to this topic covering the same time period. RESULTS: There are many complications of atopic dermatitis that are relevant to military service including the propensity to flare in harsh conditions, ocular complications, and risk of secondary infections. Despite this, there were fewer than expected reported casualties secondary to atopic dermatitis suggesting the possibility that screening against this condition prevents non-battle injuries during deployment. CONCLUSIONS: Atopic dermatitis is a very common disease that has the potential to complicate military service in many ways but the reported rates of these complications are actually very low. This is either because there is already an intervention in place or these complications are less common than theoretically anticipated. This is relevant because as it becomes easier to obtain waivers for a history of this condition there will be more individuals with atopic dermatitis in the military.

Diffuse Urticarial Reaction Associated with Titanium Dioxide Following Laser Tattoo Removal Treatments.

IMPORTANCE: Local and generalized allergic reactions following laser tattoo removal have been documented, but are rare. To our knowledge, this is the fourth documented case of widespread urticarial eruptions following laser tattoo removal treatment. Unlike previously documented cases, this patient's reaction was found to be associated with titanium dioxide within the tattoo and her symptoms were recalcitrant to medical therapy. OBSERVATIONS: A 46-year-old female experienced diffuse urticarial plaques, erythema, and pruritis following multiple laser tattoo removal treatments with an Nd:YAG laser. The systemic allergic reaction was recalcitrant to increasing doses of antihistamines and corticosteroids. The tattoo was finally surgically excised. The excised tissue was analyzed by scanning electron microscopy and energy-dispersive X-ray analysis and contained high levels of titanium dioxide. Two weeks following the excision, and without the use of medical therapy, the patient had complete resolution of her generalized urticaria. CONCLUSIONS: Ours is the first documented case of a diffuse urticarial reaction following laser tattoo removal treatments that shows a strong association to titanium dioxide within the tattoo pigment. Herein, we describe a novel surgical approach to treat recalcitrant generalized allergic reaction to tattoo pigment.

Use of the frozen section 'jelly-roll' technique to aid in the diagnosis of bullous congenital ichthyosiform erythroderma (epidermolytic hyperkeratosis).

Frozen section is a valuable tool that is often underutilized in the setting of in-patient dermatology. Traditionally, frozen section has been used in dermatology to diagnose toxic epidermal necrolysis, with some additional utility in staphylococcal scalded skin syndrome in the new born period. We report a newborn female with ruptured bullae on the face, chest, back and extremities with a clinical differential diagnosis that included staphylococcal scalded skin, bullous congenital ichthyosiform erythroderma/epidermolytic hyperkeratosis and epidermolysis bullosa. A thin detached skin sample ('jelly-roll') taken from a ruptured bulla on the abdomen was prepared for frozen section analysis. Characteristic findings of epidermolytic hyperkeratosis were seen which included hyperkeratosis with granular layer degeneration, vacuolization and eosinophilic globules. The 'jelly-roll' technique can be used for quick diagnosis with minimal trauma to the patient. Epidermolytic hyperkeratosis was subsequently confirmed by a biopsy fixed in formalin and by genetic testing. A novel missense mutation in KRT1 (I479N) was identified. Herein, we discuss the use of the frozen section 'jelly roll' technique for rapid diagnosis in a case of bullous congenital ichthyosis erythroderma/epidermolytic hyperkeratosis.

Allergic contact dermatitis to 2-octyl cyanoacrylate.

Cyanoacrylates are widely used as topical skin adhesives in emergency departments, clinics, and operating rooms. We report 4 patients who developed allergic contact dermatitis (ACD) following postsurgical closure with 2-octyl cyanoacrylate. These patients were challenged with a novel method of use testing to confirm sensitivity to 2-octyl cyanoacrylate. The popularity of skin adhesives makes this emerging allergen worthy of examination. It is possible that cyanoacrylate allergy currently is underrecognized.

Carcinomatous meningitis secondary to transitional cell bladder cancer.

We report a patient with carcinomatous meningitis secondary to known transitional cell carcinoma of the bladder. The patient presented with multiple focal neurological signs and symptoms. Diagnosis was suggested by magnetic resonance imaging and confirmed by analysis of the cerebrospinal fluid. He received whole brain radiotherapy despite a poor prognosis. To our knowledge, this is only the fifth reported case of neoplastic meningitis due to bladder cancer with confirmatory imaging and cytology and only the fourth reported case that presented with cranial nerve involvement.