Diseases in Skin of Color
People of different ethnic and cultural backgrounds have their own patterns of disease and reaction of the skin and its appendages. This is mainly due to variations in pigmentation, physiological differences in skin, hair follicles, and hair shafts, as we
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Introduction
People from different ethnic and cultural backgrounds have their own patterns of disease and types of reaction in the skin organ and its attachments. This is mainly because of variations of pigmentation and physiological differences in skin, hair follicles, and hair shafts as well as culturally bound characteristics. Doctors who predominantly care for White patients may have difficulties in correctly classifying physiological variants in dark-skinned patients. This is partly due to the fact that the usual color characterization of some pathological phenomena is appropriate for White skin but not for other skin types. In addition, distribution patterns and morphology of a number of dermatoses vary. Some diseases occur exclusively or predominantly in Blacks (e.g., dermatosis papulosa nigra), Asians (e.g., Kimura disease), or South Americans (e.g., actinic prurigo). Dark-skinned people usually suffer more from changes associated with hypopigmentation because they are more conspicuous than on white skin and can thus lead to stigmatization. In general, illness experience varies: pain, itch, or the need for treatment at all can be perceived very differently. Finally, it should be borne in mind that the prevalence and incidence of some diseases also correlate significantly with factors such as social and financial status and occupation. Quality, accessibility, and affordability of medical care continue to have a modifying effect. In many countries, especially in the developing world, one speaks of a “dermatology of poverty.” In summary, non-White skin has the following characteristics: • Wider range of pigmentation variants • Conspicuous hypopigmentation with associated social stigma C. Bendick (*) Cologne, Germany e-mail: [email protected] © Springer-Verlag GmbH Germany, part of Springer Nature 2020 G. Plewig et al. (eds.), Braun-Falco´s Dermatology, https://doi.org/10.1007/978-3-662-58713-3_88-1
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Tendency to post-inflammatory hyperpigmentation Tendency to develop hypertrophic scars and keloids Higher incidence of inflammatory follicular skin changes Different appearance of inflammatory dermatoses, since color variations common on White skin are often shifted and other distribution patterns may occur.
Cultural phenomena manifest themselves, among other things, in: • Beauty ideals (e.g., acne and melasma after application of topical glucocorticoids for skin bleaching) • Hair styles (e.g., alopecia by traction) • Behavioral patterns (e.g., hyperkeratosis of lateral ankles due to sitting on the floor) • Traditional therapies (e.g., hematomas after application of cupping glasses) • An often unregulated pharmacy system with the free sale of all preparations and the associated more frequent occurrence of undesirable effects and resistances. Skin of color occurs in: • • • • • • •
Africans (sub-Saharan) African-Americans and people of the Caribbean Native Americans and Australian Aborigines Eskimos (Inuit, Yupik, Inupiat, Inuvialuit, and Kalaallit) Central and South Americans Central, South, East, and
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