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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.

List skin diseases or conditions that are often considered more common in persons with skin of color.

The diseases listed in Table 62-1, while not all-inclusive, represent many skin conditions thought to be seen with higher frequency in blacks. Some diseases, particularly the tropical infections, may be more common in blacks living outside of the United States. The perception of these diseases being more common in blacks may be related purely to this geographic distribution. Furthermore, such entities may be rarely encountered within the United States but are listed here for completeness.

Table 62-1. Dermatologic Conditions More Common in Skin of Color
	Acne keloidalis nuchae Acral lentiginous melanoma Acropustulosis of infancy African histoplasmosis Ainhum Buruli ulcer Chancroid Dermatitis cruris pustulosa et atrophicans Dermatosis papulosa nigra Dissecting cellulitis of the scalp Dracunculiasis (guinea worm) Filariasis Granuloma inguinale Granuloma multiforme Hamartoma moniliformis Infundibulofolliculitis Juxtaclavicular beaded lines Kaposi’s sarcoma (endemic) Keloids Leishmaniasis Leprosy		Lichen nitidus Lichen simplex chronicus Loiasis Madura foot Melanonychia striata Mongolian spots Nevus of Ito Nevus of Ota Onchocerciasis Papular eruption of blacks Pityriasis rotunda Pomade acne Porphyria cutanea tarda (South African Bantus) Pseudofolliculitis barbae Pseudomonas toe web infection Sarcoidosis Sickle cell ulceration Traction alopecia Transient neonatal pustular melanosis Tropical ulcer Trypanosomiasis