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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 is “skin of color”?

There are many ways to subcategorize human beings. Widely recognized racial groups include Africans, African- Americans, Asians, Middle Easterners, Northern Europeans, Native Americans, Pacific Islanders, and Hispanics, to name a few. Even within a racial group gradations exist with regard to skin pigmentation. Simply put, people with “skin of color” have darker skin tones than those of typical white skin. The term may be used also to reference other shared cutaneous characteristics, such as hair color or quality, or a common reaction pattern to skin insults, all of which may be clinically relevant. By 2050, about 54% of the United States population will be composed of people with skin of color. Accordingly, a solid understanding of the myriad differences in diagnosing and treating persons with skin of color is essential to the competent practice of dermatology.

Taylor SC, Cook-Bolden F: Defining skin of color, Cutis 69:435–437, 2002.