Black is beautiful: Looking at skin concerns of patients of color

July 1, 2008

When treating patients of color, dermatologists need to be aware of unique concerns and make an earlier diagnosis of serious problems, such as cancer, an expert says.

Key Points

"We are so diversified as patients with skin of color that it is hard to group us into a stereotype, because blacks are a mixture of every ethnicity in the world. We are different combinations of black, white, Latin, Spanish, Indian ... and not one of us is the same," Dr. Battle tells Dermatology Times.

"Each of these combinations would make skin react differently, so we have to get beyond one type of skin color," he says.

"Probably, the No. 1 concern of people of color is dark spots," Dr. Battle says.

Melasma has a higher incidence in people of color. However, the opposite trouble, vitiligo or light patches, occurs as often among Caucasian patients.

"But it seems more obvious in black patients, because of the contrast in color," Dr. Battle says.

Dermatosis papulosa nigra (DPN), or small dark facial moles, as well as hypertrophic and keloid scarring are also more common.

Dr. Battle says he believes the rate of eczema is similar among all skin colors, but rashes hyperpigment in blacks, leading to long-standing discoloration as secondary PIH.

According to researchers at Harvard Medical School, the incidence of eczema is growing, possibly by 20 percent in children.

"One study showed that, compared with their white counterparts, children born to black and Asian mothers had an adjusted odds ratio of 2.4 and 2.6 for developing atopic dermatitis in the first six months of life.

In this study, no increased risk for developing eczema has been seen among Hispanic infants; however, an increased risk was also seen in Asian and black populations in Australia, they say.

Treatments for PIH and melasma are similar, relying on topical agents, exfoliation and, more recently, Nd:YAG and other lasers.

Hair issues

Curly hair structure often leads to folliculitis or inflammation of the hair follicle itself and, again, hyperpigmentation.

Folliculitis is most common in the beard area, but it occurs in areas throughout the body, and may also result in perifolliculitis surrounding the hair follicle. Women may experience it under their arms, along bikini lines or the legs. Anywhere that is shaven closely is at risk.

The result is also PIH, "so ingrown hair is a major issue," Dr. Battle says.

Teaching patients to shave meticulously with the grain of the face, or using razors that avoid cutting the hair so closely, may help with folliculitis.

Dr. Battle says laser treatments are the gold standard. For women, permanent hair removal may be ideal, but men may consider other alternatives if they wish to grow a beard later in life.

There appears to be no greater incidence of balding among blacks than Caucasians, although cultural differences in hairstyle may cause a form of hair loss. Traction alopecia is common among patients who pull their hair tightly into fine braids or "cornrows."

Although traction alopecia is evident when there is too much stress on the hair in any patient, Dr. Battle says, if hair loss persists after allowing the injury to recover, corticoid or intravenous steroids may be effective. Hair transplantation is a last-resort treatment.