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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.

 
 
 

What are Futcher’s lines?


Futcher’s (Voigt’s) line of the upper arm.  (Courtesy of James E. Fitzpatrick, MD.)
Fig. 62.1 Futcher’s (Voigt’s) line of the upper arm. (Courtesy of James E. Fitzpatrick, MD.)
Futcher’s lines, also known as Voigt’s lines or Futcher-Voigtlines or Ito’s lines, are areas of abrupt demarcation between lighter and darker pigmented skin. Common locations include the anterior arms, the sternum, and the posterior thighs and legs (Fig. 62-1). There appears to be no appreciable difference in melanin concentration between the adjacent darker and lighter areas when examined by light microscopy. The distribution and symmetry of the lines allows differentiation from other diagnoses, such as hypomelanosis of Ito, incontinentia pigmenti, linear epidermal nevus, or lichen striatus. Interestingly, drug eruptions have, on occasion, affected preferentially the skin on one side of the line, suggesting the skin in these areas has slightly different embryologic origin, at least with regard to a susceptibility to metabolic insult.

James WD, Carter JM, Rodman OG: Pigmentary demarcation lines: a population survey, J Am Acad Dermatol 16:584–590, 1987.

Shelley ED, Shelley WB, Pansky B: The drug line: the clinical expression of the pigmentary Voigt-Futcher line in turn derived from the embryonic ventral axial line, J Am Acad Dermatol 40:736–740, 1999.