Skin of Color


Skin of Color, Ethnic Skin, Skin Color, Dermatologic Conditions in Skin of Color, Skin Conditions in Black Patients, Skin Conditions in African American Patients, Skin Conditions in Asian Patients, Skin Conditions in Native American Patients, Skin Conditions in Middle Eastern Patients, Skin Conditions in Hispanic Patients

  • Definitions
  1. Skin of Color
    1. Patients with richly pigmented skin (Fitzpatrick Skin Types 3-6)
    2. Typically in ethnic backgrounds from Africa, Asia, Middle East, Central and South America, as well as native americans
  • Precautions
  • Health Disparities
  1. Most textbook dermatologic condition images and descriptions are on caucasian skin
    1. Adelekun (2021) J Am Acad Dermatol 84(1): 194-6 [PubMed]
  2. Skin Cancers (Melanoma, basal cell and squamous cell cancers) are dianosed at later, more advanced stages in people of color
    1. Culp (2019) Prev Chronic Dis 16: E79 +PMID: 31228233 [PubMed]
  3. Formal dermatologic training is lacking in conditions that affect black skin
    1. Buster (2012) Dermatol Clin 30(1): 53-9 [PubMed]
  • Approach
  • Common skin conditions
  1. See Skin Cancer in Skin of Color
  2. Postinflammatory Hyperpigmentation
    1. Presents at any age in more than 65% of people of color, irregular hyperpigmented patches in regions of prior skin lesions
  3. Acne
    1. Skin of Color is more susceptible to scarring, Keloids and Postinflammatory Hyperpigmentation
    2. Many skin and hair products (e.g. cocoa butter, olive oil) used more commonly in Skin of Color communities exacerbate acne
    3. Start acne Topical Medications at less irritating, lower concentrations and increase slowly to reduce Postinflammatory Hyperpigmentation
      1. Retin A 0.025% cream every other day (instead of 0.05% gel daily)
      2. Benzoyl Peroxide 2.5% (instead of 5-10%)
      3. Azelaic Acid (Azelex, Finacea) may be indicated if Postinflammatory Hyperpigmentation is already present
  • Approach
  • Conditions More Common in Skin of Color
  1. See Hair Disorders in Black Patients
  2. Early Childhood Onset
    1. Atopic Dermatitis (7 to 19% of people of color)
      1. Pruritic Eczematous patches
    2. Traction Alopecia (up to 37%)
      1. Alopecia resulting from hair in tight braids (e.g. corn rows)
      2. Hair Loss is typically symmetrical at the scalp line
  3. Teen Onset
    1. Hidradenitis Suppurativa (up to 4% of people of color)
      1. Nodules and abscesses involving the axillary and inguinal regions
    2. Acanthosis Nigricans (5 to 34% of people of color)
      1. Irregular hyperpigmented patches at the neck, axilla and inguinal region
    3. Dermatosis Papulosa Nigra (33% of people of color)
      1. Hyperpigmented sessile Papules on the face and neck
    4. Keloids (up to 8% of people of color)
      1. Firm, Rubbery skin Nodules form in regions of scar
    5. Pseudofolliculitis Barbae (45 to 85% of people of color)
      1. Hyperpigmented, inflamed firm Papules and Pustules in beard region
  4. Young Adult Onset
    1. Acne Keloidalis Nuchae (up to 13% of people of color)
      1. Keloid Papules and Plaques of the scalp and neck
    2. Melasma (9 to 50% of people of color)
      1. Gray-brown Hyperpigmentation especially on the face, and more prominent in pregnancy
    3. Prurigo Nodularis (up to 9%)
      1. Firm, pruritic Nodules, esp. on the arms and legs, forming in response to scratching