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Chapter 9. Racial Considerations: Skin of Color

Kavitha K. Reddy; Yolanda M. Lenzy; Katherine L. Brown; Barbara A. Gilchrest

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    AMA Citation
    Reddy KK, Lenzy YM, Brown KL, Gilchrest BA. Reddy K.K., Lenzy Y.M., Brown K.L., Gilchrest B.A. Reddy, Kavitha K., et al.Chapter 9. Racial Considerations: Skin of Color. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Goldsmith L.A., Katz S.I., Gilchrest B.A., Paller A.S., Leffell D.J., Wolff K Eds. Lowell A. Goldsmith, et al.eds. Fitzpatrick's Dermatology in General Medicine, 8e New York, NY: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138702. Accessed January 16, 2019.
    MLA Citation
    Reddy KK, Lenzy YM, Brown KL, Gilchrest BA. Reddy K.K., Lenzy Y.M., Brown K.L., Gilchrest B.A. Reddy, Kavitha K., et al.. "Chapter 9. Racial Considerations: Skin of Color." Fitzpatrick's Dermatology in General Medicine, 8e Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Goldsmith L.A., Katz S.I., Gilchrest B.A., Paller A.S., Leffell D.J., Wolff K Eds. Lowell A. Goldsmith, et al. New York, NY: McGraw-Hill, 2012, http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138702.

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Skin of Color at a Glance
  • Race and ethnicity are closely related but distinct factors that may influence skin disease prevalence or presentation.
  • The Fitzpatrick skin phototype classification was developed to convey risk of photodamage in white skin and is often less useful in describing skin of color.
  • The complex polygenic basis for variation in human skin, hair, and eye color has been partially elucidated.
  • The structure and function of skin of color is similar or identical to that of white (Caucasian) skin, other than differences related to pigmentation.
  • Differences in the character of hair among whites, Asians, and Africans relate to shape of the hair follicle and thickness of the cuticle layer.
  • African hair displays low tensile strength and easy breakage. This fragility may be compounded by chemical or heat application, apparently predisposing to several types of alopecia.
  • Postinflammatory hyper- or hypopigmentation is often prominent and long lasting in skin of color; preventive and therapeutic measures should be considered in the plan of care.

In the United States and worldwide, myriad cutaneous phenotypes characterize mankind. Most striking is the range of skin and hair color (Fig. 9-1). The Census Bureau estimates that half of the US population will be of non-European descent by the year 2050.1 There are currently more than 95 million persons in the United States2 and billions of individuals worldwide categorized as having “skin of color.” There has been increasing awareness of racial and ethnic influences (see Table 9-1) on skin biology and on diagnosis and treatment of skin disease.

Figure 9-1
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A spectrum of human pigmentary variation observed among Boston medical trainees. (Photograph by Michael Krathen, MD.)

Table 9-1 Race versus Ethnicity
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Table 9-1 Race versus Ethnicity

Term

Derivation

Current Usage or Implication

Race

< Latin, root

A population distinguished as a more or less distinct group by genetically transmitted physical characteristics; originally geographically segregated

Groups increasingly blurred by interracial offspring

Determined at conception, immutable

May influence disease predilection/susceptibility

Ethnicity

< Greek, race or distinct population with its own customs

A social construct in which a group of individuals shares a language, cultural practices, or customs

Self-assigned and somewhat mutable

Often but not always associated with race

May influence treatment choices and exposure to disease-promoting or disease-preventing factors

Stein J, Urdang L, eds.: Derivations from the Random House Dictionary of the English Language. New York, Random House, 1967. Usage or implication is the authors’ distillation of a large and contradictory literature.3–5

The literature regarding “skin of color” primarily focuses on promoting awareness of normal and abnormal skin conditions in a patient regardless of skin phenotype. It seeks to identify risks and benefits of treatments in diverse skin types, to develop effective treatments for common dermatoses in skin of color, recognizing the importance of individualized therapy, and to avoid ...

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