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Special Considerations in Skin of Color

»	What is “skin of color”?
»	What accounts for differences in color between ethnic and racial groups?
»	Do any physiologic differences exist between black skin and that of other racial/ethnic groups?
»	Are the brown streaks on the nails of people with skin of color always a cause for concern?
»	Is pigmentation of the oral mucosa in people with skin of color invariably concerning?
»	Are there other areas of the body where hyperpigmentation represents a normal racial variant?
»	What are Futcher’s lines?
»	What causes postinflammatory hyperpigmentation?
»	What causes postinflammatory hypopigmentation?
»	Is pityriasis alba the same thing as postinflammatory hypopigmentation?
»	Is vitiligo more common in patients with darker skin?
»	Why does tinea versicolor cause hypopigmented spots on dark skin?
»	Why is it more difficult to appreciate erythema in darker skin?
»	Can any other generalizations be made about common cutaneous reaction patterns in skin of color?
»	What is the significance of multiple brown papules often seen on the periorbital area, cheeks, and nose?
»	What is cutaneous sarcoidosis?
»	What are keloids?
»	What are “razor bumps”?
»	How is pseudofolliculitis barbae treated?
»	Are there other racial differences that may affect the treatment of hair or scalp conditions in blacks?
»	Are patients with skin of color particularly susceptible to any life-threatening illnesses?
»	Do any special considerations exist when performing skin surgery on patients with skin of color?
»	Why is skin cancer less common in skin of color?
»	Are there any unique presentations of skin cancer when it does occur in patients with darker skin?
»	List skin diseases or conditions that are often considered more common in persons with skin of color.

Do any physiologic differences exist between black skin and that of other racial/ethnic groups?

Yes. In truth, the color of “black” skin ranges from light brown to very dark brown/black, and it is difficult to generalize given this tremendous variability. Nevertheless, studies have demonstrated that the stratum corneum of most black skin maintains more layers and is more compact and cohesive than white skin. This finding may explain why black skin tends to manifest a decreased susceptibility to cutaneous irritants. One study demonstrated that black skin had a spontaneous desquamation rate 2.5 times that of white skin, and this may explain why some blacks experience a particular type of xerosis commonly referred to as ashy skin. Ashy skin consists of fine white flakes yielding a dry appearance. Other differences in black skin include an increased transepidermal water loss (TEWL), lower pH, and larger mast cell granules compared with white skin.

Black skin also produces less vitamin D3 in response to equivalent sunlight, and this has been postulated to possibly represent the driving evolutionary force in development of paler skin as early humans migrated away from the equator. Conflicting data exist regarding differences in resistance, capacitance, conductance, impedance, and skin microflora.

Jablonski NG, Chaplin G: The evolution of human skin coloration, J Hum Evol 39:57–106, 2000.

Wesley NO, Maibach HI: Racial (ethnic) differences in skin properties: the objective data, Am J Clin Dermatol 4:843–860, 2003.