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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 accounts for differences in color between ethnic and racial groups?

Although the number of melanocytes varies within anatomic regions of the body, interestingly, among different races and ethnicities, the actual number of melanocytes in the skin does not vary with skin color. Instead, among variations, it is the amount and distribution of melanin produced that changes. In mammals, two types of melanin are produced by melanocytes, eumelanin and pheomelanin. Eumelanin is a tyrosine-derived, dark brown or black pigment. Pheomelanin, derived from a biochemical shunt in the normal melanin production pathway, has a yellow to red-brown hue. Pheomelanin is the predominant pigment produced by those with freckles and red hair. It is also increased in Asian skin, and in women when compared to men. Melanin is packaged in melanosomes, which are membrane-bound vesicles containing a unique scaffolding of matrix proteins. Melanosomes within keratinocytes of white skin are distributed as membrane-bound clusters. In black skin, melanosomes tend to be larger and more diffusely located in the cell. Therefore, the quantity and composition of melanin, as well as melanosome size and distribution, vary considerably within the epidermis, both with ethnicity and with chronic sun exposure, yielding various degrees and hues of pigmentation.

Thong HY, Jee SH, Sun CC, Boissy RE: The patterns of melanosome distribution in keratinocytes of human skin as one determining factor of skin colour, Br J Dermatol 149:498–505, 2003.