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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.

Why is skin cancer less common in skin of color?

Ultraviolet (UV) radiation-induced damage to the DNA of cells in the lower epidermis, including keratinocyte stem cells and melanocytes, is prevented to a greater degree in darker skin, suggesting that the pigmented epidermis serves as an efficient UV filter. In addition, UV radiation-induced apoptosis (programmed cell death) is significantly greater in darker skin, indicating that any damaged cells may be removed more efficiently from the epidermis in skin of color. Together, the combination of decreased DNA damage due to ultraviolet radiation and the more efficient removal of damaged cells likely play a critical role in the decreased photocarcinogenesis seen in individuals with skin of color.

Yuji Y, Takahashi K, Zmudska BZ, et al: Human skin responses to UV radiation: pigment in the upper epidermis protects against DNA damage in the lower epidermis and facilitates apoptosis, FASEB J 20:E630–E639, 2006.