Is beauty worth the risk? Self-confidence is the key motivating factor driving tanning bed use among undergraduate students at South Dakota universities.

Background: Exposure to ultraviolet radiation is a leading risk factor for developing all types of skin cancer. In the United States, an estimated 7.8 million young adults engage in indoor tanning. Objective: Here, it is hypothesized that certain populations of students at undergraduate universities, namely sorority members, have a greater frequency of tanning bed usage than other groups of students and that regardless of sorority status, the most important motivating factor will be the intent to enhance one's appearance. Methods: Undergraduate students at 2 state-funded universities were recruited for participation in this institutional review board-exempt survey via distribution to e-mail addresses and social media accounts affiliated with student organizations/clubs. Results: Among all respondents, the most common motivating factors for tanning bed use were the perception of improved self-appearance and boosted self-confidence. Female sorority members were more likely to use tanning beds and also more likely to report being motivated by enhanced appearance and self-confidence, than their female counterparts who were not sorority members. Limitations: The sample size (n = 321) and population of this study allows data to only be generalizable to surrounding states with similar demographics. The findings of this study are subject to recall bias as the data is self-reported. Conclusion: Tanning bed use remains a popular practice among young people. Understanding motivations for tanning bed use among populations at increased risk of partaking in this behavior allows for educating these groups on the risks associated with ultraviolet radiation exposure. It is crucial that providers continue to promote skin health and take steps to dissuade detrimental practices and possible habit-forming behaviors at the individual and state levels.

A meta-analysis of the incidence of acne vulgaris in patients treated with GLP-1 agonists.

Background: With the emerging popularity of GLP-1 receptor agonists, patients are noticing acne vulgaris side effects that are seemingly related to the concurrent treatment with the drug. Due to the correspondence between these drugs' relatively recent emergence in the U.S. market and their high demand, it is important to investigate what is currently known in the literature so that patients can be properly informed. Objective: The aim of this study is to investigate the relationship, or lack thereof, between glucagon like peptide 1 (GLP-1) receptor agonist usage and acne-related side effects in patients. Methods: A web-based analysis of 6 GLP-1 receptor agonists (3 with a once-weekly dosing schedule, and 3 with a once-daily dosing schedule) was conducted on PubMed online database. Boolean criteria were used to narrow the search. Included in the meta-analysis were 45 research articles that fulfilled the search criteria. Results: The results of the search showed that from the following long-acting GLP-1 receptor agonists, dulaglutide, exenatide extended release, and semaglutide (Wegovy), no conclusive acne side effects were reported. In addition, the results also showed that from the following short-acting GLP-1 receptor agonists, liraglutide, lixisenatide, and semaglutide (Rybelsus), no conclusive acne side effects were reported. Limitations: Limitations of this study include a limited amount of literature regarding the relationship between GLP-1 agonists and acne vulgaris. Conclusion: It is unlikely that GLP-1 agonists themselves are directly responsible for the acne that some patients may develop during treatment. Rather, it is more probable that the weight loss yielded by treatment with these drugs may induce intrinsic physiologic and hormonal changes that induce or exacerbate acne vulgaris in such patients.

A cross-sectional review of contact allergens in popular self-tanning products.

Background: In recent years, self-tanners have become a well-liked alternative to sun tanning and tanning bed usage, as strikingly similar results can be achieved without the harmful side effects of ultraviolet exposure. Objective: The aim of this study is to investigate the presence and prevalence of potential allergens in the most popular self-tanning products. Methods: Five major retailers in the United States were evaluated, from which 17 different brands and 44 unique self-tanning products were analyzed. The ingredients in each self-tanning product were compared with 80 and 36 notable contact allergens taken from the North American Contact Dermatitis Group and Food and Drug Administration-approved T.R.U.E (Thin-Layer Rapid Use Epicutaneous Patch Test), respectively. Results: We found that contact allergens are frequently present in self-tanning products; allergens especially common are propylene glycol, linalool, polysorbate, d-limonene, benzyl alcohol, tocopherol (vitamin E), fragrances, and other scented botanicals. On average, each self-tanner we analyzed contained 11.86 allergens. Limitations: The limitation is that commercial names could not be eliminated from the analysis, introducing potential bias. Conclusion: While self-tanning products are a safer alternative to tanning bed use or sunbathing, consumers and clinicians alike must be aware that they may cause an allergic reaction of the skin for some users.

Management of tinea capitis in infants and children in the United States: A national survey of pediatric dermatologists.

This study aimed to evaluate the current management of tinea capitis in the United States, specifically focusing on patients aged 0-2 months, 2 months to 2 years, and 2 years to 18 years. An online survey, distributed through the Pediatric Dermatology Research Alliance and the Society of Pediatric Dermatology, revealed the following preferences: fluconazole for those under 2 months, griseofulvin for those aged 2 months to 2 years, and terbinafine for those aged 2 years and older. There exists inter-provider variation in tinea capitis treatment regimens within the pediatric dermatology community.

The Relationship of Modified Rankin Score and Risk Factors with Stroke Mortality in the South Dakota Native American Population: A Descriptive Study.

OBJECTIVE: To describe the impact of multiple risk factors on stroke outcomes among Native Americans in South Dakota. METHODS: This is a retrospective chart review of 189 Native American patients treated for stroke in South Dakota between Jan. 1, 2016, to May 1, 2021 at a single hospital system. RESULTS: Risk factor prevalence in the population: hypertension (76.1%), smoking (74.2%), diabetes mellitus (56.8%), dyslipidemia (55.4%), alcohol use (43.7%), cardiac or vascular disease (39.7%), stroke history (26.4%), and atrial fibrillation (13.3%). There was no significant difference between admission and 90-day post-discharge modified Rankin scale scores in all patients. Five risk factors were significantly associated with death: older age, hemorrhagic stroke, female sex, atrial fibrillation, and cardiac/vascular disease. CONCLUSION: These results align with previous studies that concluded many stroke risk factors are more prevalent among Native Americans in comparison to other racial/ethnic groups. Therefore, it remains an imperative public health initiative that efforts be made to improve preventative measures which address comorbid conditions and behaviors in Native American populations to reduce risk for stroke with subsequent related disability or death.

The Relationship of Modified Rankin Score and Risk Factors with Stroke Mortality in the South Dakota American Indian Population: A Descriptive Study.

INTRODUCTION: To describe the impact of multiple risk factors on stroke outcomes among American Indians in South Dakota. METHODS: This is a retrospective chart review of 189 American Indian patients treated for stroke in South Dakota between Jan 1, 2016, to May 1, 2021, at a single hospital system. RESULTS: Risk factor prevalence in the population: hypertension (76.1%), smoking (74.2%), diabetes mellitus (56.8%), dyslipidemia (55.4%), alcohol use (43.7%), cardiac or vascular disease (39.7%), stroke history (26.4%), and atrial fibrillation (13.3%). There was no significant difference between admission and 90-day post-discharge modified Rankin scale scores in all patients. Five risk factors were significantly associated with death: older age, hemorrhagic stroke, female sex, atrial fibrillation, and cardiac/vascular disease. CONCLUSIONS: These results align with previous studies that concluded many stroke risk factors are more prevalent among American Indians in comparison to other racial/ethnic groups. Therefore, it remains an imperative public health initiative that efforts be made to improve preventative measures which address comorbid conditions and behaviors in American Indian populations to reduce risk for stroke with subsequent related disability or death.

Surveying Motivations to Use Tanning Beds Among Undergraduate Students at South Dakota Universities.

BACKGROUND: Exposure to UV radiation is one of the biggest risk factors for developing all types of skin cancer. It is estimated that in the United States, 7.8 million young adults engage in indoor tanning. It is hypothesized that certain populations of students at undergraduate universities, such as sorority participants, have greater frequency of tanning bed usage than other populations and that regardless of sorority status, the most important motivating factor will be the intent to enhance one's appearance. METHODS: This study was granted exemption from the USD Institutional Review Board (IRB). Study participants were recruited through survey distribution to email addresses affiliated with undergraduate student organizations/clubs. Inclusion criteria were undergraduate student status at The University of South Dakota (USD) or South Dakota State University (SDSU), and age 18+. Survey development included interviews of dermatologists and public health professionals. Qualtrics database was used for both anonymous data collection and storage. RESULTS: Overall, 95 of 321 participants identified as being in a sorority. When asked to identify motivations for tanning bed use, the 3 highest ranked responses of participants in a sorority were: "I think I look better when I am tan", "I tan to look better for special events", and "I have more self-confidence when I am tan" with 56.47%, 48.65%, and 60.71% of participants answering, "strongly agree", respectively. There were 147 participants that identified as not being in a sorority. The 3 highest ranked responses for motivations for indoor tanning use were the same as those in a sorority with 40.82%, 26.00%, and 40.15% of participants answering "strongly agree" to the above options, respectively. CONCLUSION: The data does support the hypothesis that the most important motivating factor for young adults to use tanning beds is one's appearance. Understanding motivations for tanning bed use among at risk populations such as undergraduate students or more specifically, those participating in sororities, allows opportunity for education on the risks associated with UV radiation exposure.

Identifying the Use of Tanning Beds Among Undergraduate Students at South Dakota Universities and the Role of Providers: A Survey Analysis.

INTRODUCTION: Tanning bed use is common among young adults in the United States, and it contributes to over 400,000 cases of skin cancer annually. Many college students acknowledge the risk of skin cancer with tanning bed use, but this is not always a deterrent to the behavior. This study assesses the trends regarding tanning bed usage among university students and analyzes the role that primary care providers (PCPs) and dermatologists could play in reducing participation in this risky habit. METHODS: This study used a digital survey to assess the tanning bed usage trends and other aspects of skin health among undergraduate students at South Dakota universities. The survey was developed through interviews with dermatologists and public health professionals affiliated with the University of South Dakota. RESULTS: 321 students responded to the survey; 80% identified as female, 86% as Caucasian, and 93% were from the Midwest. 41% of respondents reported having previously used tanning beds. 46% of respondents reported never having seen a dermatologist for a skin check, and 42% indicated that their PCP does not perform a skin check during routine visits. When asked how a provider might influence participants to reconsider the use of tanning beds, responses included being presented statistics related to skin cancer and visualization of physical damage resulting from exposure to ultraviolet light. CONCLUSION: This study aims to better understand the prevalence of tanning bed usage among students at South Dakota universities. It also sought to better understand how providers can intervene to help reduce participation in this behavior. Given the risk associated with tanning bed exposure, our findings suggest that many students may be at increased risk of skin cancer from this behavior alone. This should encourage PCPs to consider incorporating skin checks into their examinations and provide preventative counseling recommendations to this population.

Rural Residency Status in South Dakotans is Not Associated With More Advanced Stage Melanoma at Time of Diagnosis.

INTRODUCTION: Previous studies have established that geographic location strongly influences health literacy, access to care, and health outcomes across all disease types. There are many well-understood risk factors for the development of melanoma, and likewise various markers of disease severity. However, few studies have been conducted to determine what role locality and access to dermatological care play in both the incidence and severity of melanoma, particularly in South Dakotans. Here, it is hypothesized that living in rural regions with less access to care increases the risk for more advanced stage melanoma at time of diagnosis. METHODS: A retrospective chart review of the electronic medical records of patients with a diagnosis of melanoma from a Midwest dermatology practice in South Dakota was performed. The authors examined patients' rural vs. urban status, disease predictors, and markers of disease severity. Multivariate and descriptive statistical analysis were utilized. RESULTS: There were 148 unique cases identified. The average age was 62.32 (SD=16.69, min=25, max=98); 53.4% were male (n=79); 99.3% were Caucasian. Among them, 35 (23.6%) had a personal history of non-melanoma skin cancer (NMSC), 9 (6.1%) had a personal history of melanoma, and 20 (13.5%) had a family history of melanoma. Most cases (75.7%) had at least one documented visit to a primary care physician (PCP) within a year of melanoma diagnosis. When comparing geographic distance to the Breslow depth at time of biopsy, a significant negative relationship (p=0.009) resulted. However, when eliminating 3 outliers (Breslow depths of 22.2mm, 19.0 mm, and 15.0mm), this relationship was no longer significant (p=0.141). No significant findings resulted when comparing geographic distance to provider site for wide lesion excision (WLE) to post-WLE Breslow depth (p=0.778), pathological stage (p=0.079), +/- sentinel lymph node biopsy (p=0.299), or +/- chemotherapy/radiation (p=0.191). When comparing disease predictors to severity markers of disease, the only significant finding was between personal history of melanoma and post-WLE Breslow depth (p=0.026). Those without a personal history of melanoma had greater (3.08 vs 1.68) post-WLE Breslow depth. CONCLUSIONS: Prior studies indicate increased distance to a dermatologist and decreased density of dermatologists represent significant associations with Breslow depth and mortality. In contrast, the present data did not appear to indicate a significant difference in melanoma detection or outcomes based on geographic parameters. However, it does support that the density of dermatologists is a more appropriate proxy for melanoma outcomes than is PCP density. The lack of impact based on rural vs. urban status may suggest the current literature is not applicable to all states or populations or that some disparities in access to dermatologists and melanoma treatment may be overcome by factors not investigated presently (e.g. AI, tele-dermatology). Other limitations include analyzing patients within a single health system and a sample population consisting primarily of persons located in the Sioux Falls metropolitan area. With rural South Dakotans representing a significant portion of the population, this state presents an opportunity to identify disparities in access and treatment based on population and community resources.

Statin Induced Immune Mediated Necrotizing Myopathy: More Than Just Sore Muscles.

Statin drugs are commonly used to decrease levels of triglycerides and cholesterol. Common side effects of this medication class are generally mild and include headache, nausea, diarrhea, and myalgia. Rarely, statins have been associated with autoimmune disease resulting in a potentially serious inflammatory myopathy known as statininduced immune-mediated necrotizing myopathy (IMNM). Here, we describe a case of statin-induced IMNM in a 66-year-old man placed on atorvastatin several months prior to CABG surgery. We review the relevant laboratory results, imaging, immunologic, histopathologic findings and treatment strategy of this important disorder.

Less Common Focal Neuropathies: A Brief Review.

Focal peripheral neuropathies (FPN) will be encountered by clinical practitioners in all disciplines. While bedside exam skills are greatly beneficial in the diagnostic approach, new options are improving diagnostic accuracy. A variety of management options are available to assist patients with these diverse disorders. Ten less common focal neuropathies are featured in this review.

Mucocutaneous manifestations of congenital syphilis in the neonate: A review of a surging disease.

Syphilis is an infection caused by Treponema pallidum. It is most commonly acquired through sexual transmission, although it can also be transmitted vertically across the placenta, resulting in congenital syphilis. Even with improved public health measures, testing, and treatment capabilities, primary, secondary, and congenital syphilis have all surged since 2012. Given this marked increase in both incidence and prevalence, here we present a comprehensive review of the clinical presentation, treatment, and management of congenital syphilis, with particular consideration given to the mucocutaneous manifestations of the disease in neonates.

A cross-sectional study of contact allergens in feminine hygiene wipes: a possible cause of vulvar contact dermatitis.

Feminine hygiene wipes marketed toward women for maintaining freshness and cleanliness of the vulva and perineum are abundant both in-store and online. Many of these products boast being "fragrance free," "gentle," and "for sensitive skin," which is attractive to consumers. However, these claims do not necessarily mean they are free of potential allergens. Objective: The present study aims to investigate the presence and prevalence of potential allergens in the most used feminine hygiene wipes. Methods: An internet-based search was performed to identify best-selling name brand and generic feminine hygiene wipes. Each unique wipe was analyzed and compared to the North American Contact Dermatitis Group 80 allergens. Results: We found contact allergens are frequently present in feminine hygiene wipes, most commonly fragrances, other scented botanicals in the form of essences, oils, and fruit juices, and vitamin E (tocopherol). All wipes analyzed in this study contained potential allergens. Limitations: The inability to eliminate commercial names from analysis could have introduced bias. Conclusions: Vaginal and vulvar epithelia are highly susceptible to contact allergens, often found in products marketed for feminine hygiene and cleanliness. Providers should caution patients against trusting product labeling claims to avoid incidental contact allergy and encourage simply cleansing the vulva with water.