Patient populations are comprised of diverse ethnicities.The US Census Bureau projects people of color will account for half of the US population by 2050. This group includes Blacks, Asians, Latinos and other ethnicities.1 For clinicians, this is an important factor to keep in mind when considering differential diagnoses for many skin conditions. Skin type and hair texture affect management of both skin and hair disorders. This article focuses on 5 conditions affecting Blacks and other ethnicities with a predisposition for tightly curled hair. This hair type has an intrinsic fragility due to its shape, decreased density and tendency towards coiling and creating knots, which often results in hair loss and breakage.
Seborrheic Dermatitis
Seborrheic dermatitis is a chronic form of eczema that usually involves areas of the face and scalp. Its exact etiology is unknown but genetic, nutritional, hormonal and other environmental factors have been associated with this condition.
For mild seborrhea, antidandruff shampoos are widely used as the first-line treatment,2,3 while for moderate-to-severe cases the use of topical corticosteroids or tacrolimus is preferred. In the Black population, daily washing and drying of their hair can take hours, which leads to added damage to the hair shaft. Therefore, a once-weekly washing regimen with alternating antidandruff shampoos combined with a moisturizing conditioner is recommended.4
(See this related article on seborrheic dermatitis).
Tinea Capitis
Tinea capitis has become the leading dermatophyte infection in childhood and is prevalent in the Black population.5,6 Trichophyton and Microsporum are the responsible dermatophytes that attack the hair shaft. Diagnosis with potassium hydroxide prep and fungal cultures remains the gold standard.
Tinea capitis presentation can range from asymptomatic carriage to inflammatory disease with scaling and broken hairs to scattered patches of hair loss.7,8
Early initiation of antifungal therapy is crucial to avoid severe inflammation resulting in permanent hair loss.9,10
Traction Alopecia
Traction alopecia is a common form of hair loss seen in Black women of all ages resulting from tight braiding and hairstyles (Figure 1).11
Figure 1. Traction alopecia is a non-scarring alopecia due to prolonged tension exerted on the hair.
Photo courtesy: Heather Woolery-Llyod
The typical areas of involvement are the frontal and temporal hairlines. The presentation ranges from thinning hair, folliculitis with scattered broken hairs to follicular hyperkeratosis resulting in hair loss.
Treatment is aimed at educating patients to discontinue hair care practices that put tension on the hair. Local low-dose corticosteroid injections may help in extensive disease.
Pseudofolliculitis Barbae
Pseudofolliculitis barbae is an inflammatory condition commonly seen in Blacks. The usual presentation is erythematous and pruritic acneiform papules over the follicles with hyperpigmentation (Figure 2). This occurs due to the coiled nature of the hair growth, which enters the skin and produces a foreign-body inflammatory reaction.12
Figure 2. Pseudofolliculitis barbae is an inflammatory condition commonly seen in Blacks that typically presents as erythematous
and pruritic acneiform papules over the follicles with hyperpigmentation. Photos courtesy: Heather Woolery-Lloyd, MD,
and Fran Cook-Bolden, MD
Avoidance of shaving or cutting the hair with electric clippers to a minimum length of 1 mm is recommended.13,14
Reducing the inflammation with mild-to-medium-potency topical corticosteroids combined with benzoyl peroxide or with topical antibiotics may offer some relief. However, laser hair removal remains the most effective treatment as it completely removes the causative factor.
Acne Keloidalis Nuchae
Acne keloidalis nuchae is another condition seen in Black men resulting from the curvature of the hairs and follicles (Figure 3). It is similar in presentation to pseudofolliculitis barbae, but involves the back of the neck and occipital scalp. Subcutaneous abscesses and draining sinuses with scarring alopecia may develop if left untreated.
Intralesional steroid injections along with topical or oral antibiotics are used to reduce inflammation. Excision and carbon dioxide laser are best for severe involvement.11,12,15
Figure 3. Acne keloidalis nuchae is another condition seen in Black men resulting from the curvature of the hairs and follicles. Photo courtesy: Omar Torres, MD
Conclusion
Individuals of African descent and others have innate hair fragility due to the degree of curl and overall decreased hair density. Furthermore, cultural practices of hairstyling can cause excessive stress on fragile hairs that can lead to temporary and permanent alopecia.
Our recommendations are focused on changing one’s technique to include low-tension manipulation, appropriate washing frequency and a proper moisturization regimen that will allow the hair to flourish and stay healthy. We recommend once-weekly straightening and washing of hair in women with chemically treated hair. Daily maintenance with a light moisturizer is recommended to maintain a proper moisture balance.
It is important for clinicians to be aware of cultural and ethnic practices that affect the diagnosis and treatment plan. Considering patients ethnicity is an important component in individualizing patient care when managing skin and hair disorders. We encourage more research on skin and hair disorders in this population to optimize treatment options.
Dr. Dorizas is with Sadick Dermatology in New York, NY.
Dr. Henry is with Sadick Dermatology in New York, NY.
Dr. Nassar is with Sadick Dermatology, in New York, NY.
Dr. Sadick is with Sadick Dermatology, in New York, NY. He is also clinical professor in the Department of Dermatology at Weill Medical College of Cornell University in New York, NY.
Disclosures: The authors report no relevant financial disclosures.
Side bar:
Skin Considerations for People of Color
Although people of color have a lower risk of developing skin cancer than Caucasians, skin cancer is often diagnosed at a more advanced stage in people of color, thus making it more difficult to treat.
A study “Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public,” published in the Journal of the American Academy of Dermatology,1 provides recommendations for the prevention and early detection of skin cancer in people of color based on a comprehensive review of available data.
The 5-year survival rate for Blacks and Latinos diagnosed with melanoma is lower than Caucasians, likely due to the fact that it is often more advanced when diagnosed. For example, the 5-year survival rate for Black Americans is 73% compared to 91% in Caucasians.
Tips for Patients
“Many people of color mistakenly believe that they are not at risk, but skin cancer is color blind,” says Henry W. Lim, MD, FAAD, C.S. Livingood Chair and chairman of the department of dermatology at Henry Ford Hospital in Detroit, MI. “Skin cancer can look and develop differently in individuals with skin of color than it does in individuals with lighter skin.” In fact, when skin cancer is diagnosed in people of color, it is often found in areas of the skin that are not typically exposed to the sun. Specifically, the bottom of the foot is where 30% to 40% of melanomas are diagnosed in people of color. Nearly 8% of melanomas in Asian Americans occur in the mouth. Squamous cell carcinoma — the most commonly diagnosed skin cancer in Blacks — often develops on the buttocks, hip, legs and feet.
Dr. Lim recommends that patients with skin of color should be advised to check their skin monthly and make an appointment with their dermatologist if anything suspicious is noted. He also recommend that patients:
• Pay special attention to the palms of the hands, soles of the feet, the fingernails, toenails, mouth, groin and buttocks.
• Look for any spots or lesions that are changing, itching, or bleeding or any ulcers or wounds that will not heal.
Unprotected exposure to ultraviolet rays has been identified as a risk factor for skin cancer in people of color. Basal cell carcinoma, the most commonly diagnosed skin in cancer in Asian Americans and Latinos, is most frequently found on sun-exposed areas of the skin, such as the head and neck. Skin of color patients also can be reminded to:
• Seek shade whenever possible.
• Wear sun-protective clothing, including a wide-brimmed hat and sunglasses.
• Avoid tanning beds.
• Apply sunscreen with a sun protection factor of at least 30 to all exposed areas of the skin 15 to 30 minutes before going outdoors. When outdoors, reapply sunscreen every 2 hours, and after swimming or sweating.
• Take a vitamin D supplement because they are at a higher risk of vitamin D deficiency, especially individuals with darker skin.
Reference for sidebar article
1. Agbai ON, Buster K, Sanchez M, et al. Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4): 748-762.
References for main article
1. US Census Bureau. https://www.census.gov/population/projections/files/usinterimproj/natprojtab01a.pdf. Accessed April 16, 2014.
2. McMichael AJ. Hair and scalp disorders in ethnic populations. Dermatol Clin. 2003;21(4):629-644.
3. Del Rosso JQ. Adult seborrheic dermatitis: a status report on practical topical management. J Clin Aesthet Dermatol. 2011;4(5):32-38.
4. Halder RM. Hair and scalp disorders in blacks. Cutis. 1983;32(4):378-380.
5. Lobato MN, Vugia DJ, Freiden IJ. Tinea capitis in California children: a population-based study of a growing epidemic. Pediatrics. 1997;99(4):551-554.
6. Suh DC, Friedlander SF, Raut M, et al. Tinea capitis in the United States: Diagnosis, treatment, and costs. J Am Acad Dermatol. 2006;55(6):1111-1112.
7. Alvarez MS, Silverberg NB. Tinea capitis. Cutis. 2006;78(3):189-196.
8. Trovato MJ, Schwartz RA, Janniger CK. Tinea capitis: current concepts in clinical practice. Cutis. 2006;77(2):93-99.
9. Roberts BJ, Friedlander SF. Tinea capitis: a treatment update. Pediatr Ann. 2005;34(3):191-200.
10. Gonzalez U, Seaton T, Bergus G, Jacobson J, Martinzes-Monzon C. Systemic antifungal therapy for tinea capitis in children. Cochrane Database Syst Rev. 2007;4:CD004685.
11. Bolduc C, Shapiro J. Hair care products: waving, straightening, conditioning, and coloring. Clin Dermatol. 2001;19(4):431-436.
12. Quarles FN, Brody H, Johnson BA, et al. Pseudofolliculitis barbae. Dermatol Ther. 2007;20(3):133-136.
13. Brown LA. Pathogenesis and treatment of pseudofolliculitis barbae. Cutis. 1983;32(4):373-375.
14. Bridgeman-Shah S. The medical and surgical therapy of pseudofolliculitis barbae. Dermatol Ther. 2004;17(2):158-163.
15. Winter H, Schissel D, Parry DA, et al. An unusual Ala12Thr polymorphism in the 1A alpha-helical segment of the companion layer-specific keratin K6hf: evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae. J Invest Dermatol. 2004;122(3):652-657.
Patient populations are comprised of diverse ethnicities.The US Census Bureau projects people of color will account for half of the US population by 2050. This group includes Blacks, Asians, Latinos and other ethnicities.1 For clinicians, this is an important factor to keep in mind when considering differential diagnoses for many skin conditions. Skin type and hair texture affect management of both skin and hair disorders. This article focuses on 5 conditions affecting Blacks and other ethnicities with a predisposition for tightly curled hair. This hair type has an intrinsic fragility due to its shape, decreased density and tendency towards coiling and creating knots, which often results in hair loss and breakage.
Seborrheic Dermatitis
Seborrheic dermatitis is a chronic form of eczema that usually involves areas of the face and scalp. Its exact etiology is unknown but genetic, nutritional, hormonal and other environmental factors have been associated with this condition.
For mild seborrhea, antidandruff shampoos are widely used as the first-line treatment,2,3 while for moderate-to-severe cases the use of topical corticosteroids or tacrolimus is preferred. In the Black population, daily washing and drying of their hair can take hours, which leads to added damage to the hair shaft. Therefore, a once-weekly washing regimen with alternating antidandruff shampoos combined with a moisturizing conditioner is recommended.4
(See this related article on seborrheic dermatitis).
Tinea Capitis
Tinea capitis has become the leading dermatophyte infection in childhood and is prevalent in the Black population.5,6 Trichophyton and Microsporum are the responsible dermatophytes that attack the hair shaft. Diagnosis with potassium hydroxide prep and fungal cultures remains the gold standard.
Tinea capitis presentation can range from asymptomatic carriage to inflammatory disease with scaling and broken hairs to scattered patches of hair loss.7,8
Early initiation of antifungal therapy is crucial to avoid severe inflammation resulting in permanent hair loss.9,10
Traction Alopecia
Traction alopecia is a common form of hair loss seen in Black women of all ages resulting from tight braiding and hairstyles (Figure 1).11
Figure 1. Traction alopecia is a non-scarring alopecia due to prolonged tension exerted on the hair.
Photo courtesy: Heather Woolery-Llyod
The typical areas of involvement are the frontal and temporal hairlines. The presentation ranges from thinning hair, folliculitis with scattered broken hairs to follicular hyperkeratosis resulting in hair loss.
Treatment is aimed at educating patients to discontinue hair care practices that put tension on the hair. Local low-dose corticosteroid injections may help in extensive disease.
Pseudofolliculitis Barbae
Pseudofolliculitis barbae is an inflammatory condition commonly seen in Blacks. The usual presentation is erythematous and pruritic acneiform papules over the follicles with hyperpigmentation (Figure 2). This occurs due to the coiled nature of the hair growth, which enters the skin and produces a foreign-body inflammatory reaction.12
Figure 2. Pseudofolliculitis barbae is an inflammatory condition commonly seen in Blacks that typically presents as erythematous
and pruritic acneiform papules over the follicles with hyperpigmentation. Photos courtesy: Heather Woolery-Lloyd, MD,
and Fran Cook-Bolden, MD
Avoidance of shaving or cutting the hair with electric clippers to a minimum length of 1 mm is recommended.13,14
Reducing the inflammation with mild-to-medium-potency topical corticosteroids combined with benzoyl peroxide or with topical antibiotics may offer some relief. However, laser hair removal remains the most effective treatment as it completely removes the causative factor.
Acne Keloidalis Nuchae
Acne keloidalis nuchae is another condition seen in Black men resulting from the curvature of the hairs and follicles (Figure 3). It is similar in presentation to pseudofolliculitis barbae, but involves the back of the neck and occipital scalp. Subcutaneous abscesses and draining sinuses with scarring alopecia may develop if left untreated.
Intralesional steroid injections along with topical or oral antibiotics are used to reduce inflammation. Excision and carbon dioxide laser are best for severe involvement.11,12,15
Figure 3. Acne keloidalis nuchae is another condition seen in Black men resulting from the curvature of the hairs and follicles. Photo courtesy: Omar Torres, MD
Conclusion
Individuals of African descent and others have innate hair fragility due to the degree of curl and overall decreased hair density. Furthermore, cultural practices of hairstyling can cause excessive stress on fragile hairs that can lead to temporary and permanent alopecia.
Our recommendations are focused on changing one’s technique to include low-tension manipulation, appropriate washing frequency and a proper moisturization regimen that will allow the hair to flourish and stay healthy. We recommend once-weekly straightening and washing of hair in women with chemically treated hair. Daily maintenance with a light moisturizer is recommended to maintain a proper moisture balance.
It is important for clinicians to be aware of cultural and ethnic practices that affect the diagnosis and treatment plan. Considering patients ethnicity is an important component in individualizing patient care when managing skin and hair disorders. We encourage more research on skin and hair disorders in this population to optimize treatment options.
Dr. Dorizas is with Sadick Dermatology in New York, NY.
Dr. Henry is with Sadick Dermatology in New York, NY.
Dr. Nassar is with Sadick Dermatology, in New York, NY.
Dr. Sadick is with Sadick Dermatology, in New York, NY. He is also clinical professor in the Department of Dermatology at Weill Medical College of Cornell University in New York, NY.
Disclosures: The authors report no relevant financial disclosures.
Side bar:
Skin Considerations for People of Color
Although people of color have a lower risk of developing skin cancer than Caucasians, skin cancer is often diagnosed at a more advanced stage in people of color, thus making it more difficult to treat.
A study “Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public,” published in the Journal of the American Academy of Dermatology,1 provides recommendations for the prevention and early detection of skin cancer in people of color based on a comprehensive review of available data.
The 5-year survival rate for Blacks and Latinos diagnosed with melanoma is lower than Caucasians, likely due to the fact that it is often more advanced when diagnosed. For example, the 5-year survival rate for Black Americans is 73% compared to 91% in Caucasians.
Tips for Patients
“Many people of color mistakenly believe that they are not at risk, but skin cancer is color blind,” says Henry W. Lim, MD, FAAD, C.S. Livingood Chair and chairman of the department of dermatology at Henry Ford Hospital in Detroit, MI. “Skin cancer can look and develop differently in individuals with skin of color than it does in individuals with lighter skin.” In fact, when skin cancer is diagnosed in people of color, it is often found in areas of the skin that are not typically exposed to the sun. Specifically, the bottom of the foot is where 30% to 40% of melanomas are diagnosed in people of color. Nearly 8% of melanomas in Asian Americans occur in the mouth. Squamous cell carcinoma — the most commonly diagnosed skin cancer in Blacks — often develops on the buttocks, hip, legs and feet.
Dr. Lim recommends that patients with skin of color should be advised to check their skin monthly and make an appointment with their dermatologist if anything suspicious is noted. He also recommend that patients:
• Pay special attention to the palms of the hands, soles of the feet, the fingernails, toenails, mouth, groin and buttocks.
• Look for any spots or lesions that are changing, itching, or bleeding or any ulcers or wounds that will not heal.
Unprotected exposure to ultraviolet rays has been identified as a risk factor for skin cancer in people of color. Basal cell carcinoma, the most commonly diagnosed skin in cancer in Asian Americans and Latinos, is most frequently found on sun-exposed areas of the skin, such as the head and neck. Skin of color patients also can be reminded to:
• Seek shade whenever possible.
• Wear sun-protective clothing, including a wide-brimmed hat and sunglasses.
• Avoid tanning beds.
• Apply sunscreen with a sun protection factor of at least 30 to all exposed areas of the skin 15 to 30 minutes before going outdoors. When outdoors, reapply sunscreen every 2 hours, and after swimming or sweating.
• Take a vitamin D supplement because they are at a higher risk of vitamin D deficiency, especially individuals with darker skin.
Reference for sidebar article
1. Agbai ON, Buster K, Sanchez M, et al. Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4): 748-762.
References for main article
1. US Census Bureau. https://www.census.gov/population/projections/files/usinterimproj/natprojtab01a.pdf. Accessed April 16, 2014.
2. McMichael AJ. Hair and scalp disorders in ethnic populations. Dermatol Clin. 2003;21(4):629-644.
3. Del Rosso JQ. Adult seborrheic dermatitis: a status report on practical topical management. J Clin Aesthet Dermatol. 2011;4(5):32-38.
4. Halder RM. Hair and scalp disorders in blacks. Cutis. 1983;32(4):378-380.
5. Lobato MN, Vugia DJ, Freiden IJ. Tinea capitis in California children: a population-based study of a growing epidemic. Pediatrics. 1997;99(4):551-554.
6. Suh DC, Friedlander SF, Raut M, et al. Tinea capitis in the United States: Diagnosis, treatment, and costs. J Am Acad Dermatol. 2006;55(6):1111-1112.
7. Alvarez MS, Silverberg NB. Tinea capitis. Cutis. 2006;78(3):189-196.
8. Trovato MJ, Schwartz RA, Janniger CK. Tinea capitis: current concepts in clinical practice. Cutis. 2006;77(2):93-99.
9. Roberts BJ, Friedlander SF. Tinea capitis: a treatment update. Pediatr Ann. 2005;34(3):191-200.
10. Gonzalez U, Seaton T, Bergus G, Jacobson J, Martinzes-Monzon C. Systemic antifungal therapy for tinea capitis in children. Cochrane Database Syst Rev. 2007;4:CD004685.
11. Bolduc C, Shapiro J. Hair care products: waving, straightening, conditioning, and coloring. Clin Dermatol. 2001;19(4):431-436.
12. Quarles FN, Brody H, Johnson BA, et al. Pseudofolliculitis barbae. Dermatol Ther. 2007;20(3):133-136.
13. Brown LA. Pathogenesis and treatment of pseudofolliculitis barbae. Cutis. 1983;32(4):373-375.
14. Bridgeman-Shah S. The medical and surgical therapy of pseudofolliculitis barbae. Dermatol Ther. 2004;17(2):158-163.
15. Winter H, Schissel D, Parry DA, et al. An unusual Ala12Thr polymorphism in the 1A alpha-helical segment of the companion layer-specific keratin K6hf: evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae. J Invest Dermatol. 2004;122(3):652-657.
Patient populations are comprised of diverse ethnicities.The US Census Bureau projects people of color will account for half of the US population by 2050. This group includes Blacks, Asians, Latinos and other ethnicities.1 For clinicians, this is an important factor to keep in mind when considering differential diagnoses for many skin conditions. Skin type and hair texture affect management of both skin and hair disorders. This article focuses on 5 conditions affecting Blacks and other ethnicities with a predisposition for tightly curled hair. This hair type has an intrinsic fragility due to its shape, decreased density and tendency towards coiling and creating knots, which often results in hair loss and breakage.
Seborrheic Dermatitis
Seborrheic dermatitis is a chronic form of eczema that usually involves areas of the face and scalp. Its exact etiology is unknown but genetic, nutritional, hormonal and other environmental factors have been associated with this condition.
For mild seborrhea, antidandruff shampoos are widely used as the first-line treatment,2,3 while for moderate-to-severe cases the use of topical corticosteroids or tacrolimus is preferred. In the Black population, daily washing and drying of their hair can take hours, which leads to added damage to the hair shaft. Therefore, a once-weekly washing regimen with alternating antidandruff shampoos combined with a moisturizing conditioner is recommended.4
(See this related article on seborrheic dermatitis).
Tinea Capitis
Tinea capitis has become the leading dermatophyte infection in childhood and is prevalent in the Black population.5,6 Trichophyton and Microsporum are the responsible dermatophytes that attack the hair shaft. Diagnosis with potassium hydroxide prep and fungal cultures remains the gold standard.
Tinea capitis presentation can range from asymptomatic carriage to inflammatory disease with scaling and broken hairs to scattered patches of hair loss.7,8
Early initiation of antifungal therapy is crucial to avoid severe inflammation resulting in permanent hair loss.9,10
Traction Alopecia
Traction alopecia is a common form of hair loss seen in Black women of all ages resulting from tight braiding and hairstyles (Figure 1).11
Figure 1. Traction alopecia is a non-scarring alopecia due to prolonged tension exerted on the hair.
Photo courtesy: Heather Woolery-Llyod
The typical areas of involvement are the frontal and temporal hairlines. The presentation ranges from thinning hair, folliculitis with scattered broken hairs to follicular hyperkeratosis resulting in hair loss.
Treatment is aimed at educating patients to discontinue hair care practices that put tension on the hair. Local low-dose corticosteroid injections may help in extensive disease.
Pseudofolliculitis Barbae
Pseudofolliculitis barbae is an inflammatory condition commonly seen in Blacks. The usual presentation is erythematous and pruritic acneiform papules over the follicles with hyperpigmentation (Figure 2). This occurs due to the coiled nature of the hair growth, which enters the skin and produces a foreign-body inflammatory reaction.12
Figure 2. Pseudofolliculitis barbae is an inflammatory condition commonly seen in Blacks that typically presents as erythematous
and pruritic acneiform papules over the follicles with hyperpigmentation. Photos courtesy: Heather Woolery-Lloyd, MD,
and Fran Cook-Bolden, MD
Avoidance of shaving or cutting the hair with electric clippers to a minimum length of 1 mm is recommended.13,14
Reducing the inflammation with mild-to-medium-potency topical corticosteroids combined with benzoyl peroxide or with topical antibiotics may offer some relief. However, laser hair removal remains the most effective treatment as it completely removes the causative factor.
Acne Keloidalis Nuchae
Acne keloidalis nuchae is another condition seen in Black men resulting from the curvature of the hairs and follicles (Figure 3). It is similar in presentation to pseudofolliculitis barbae, but involves the back of the neck and occipital scalp. Subcutaneous abscesses and draining sinuses with scarring alopecia may develop if left untreated.
Intralesional steroid injections along with topical or oral antibiotics are used to reduce inflammation. Excision and carbon dioxide laser are best for severe involvement.11,12,15
Figure 3. Acne keloidalis nuchae is another condition seen in Black men resulting from the curvature of the hairs and follicles. Photo courtesy: Omar Torres, MD
Conclusion
Individuals of African descent and others have innate hair fragility due to the degree of curl and overall decreased hair density. Furthermore, cultural practices of hairstyling can cause excessive stress on fragile hairs that can lead to temporary and permanent alopecia.
Our recommendations are focused on changing one’s technique to include low-tension manipulation, appropriate washing frequency and a proper moisturization regimen that will allow the hair to flourish and stay healthy. We recommend once-weekly straightening and washing of hair in women with chemically treated hair. Daily maintenance with a light moisturizer is recommended to maintain a proper moisture balance.
It is important for clinicians to be aware of cultural and ethnic practices that affect the diagnosis and treatment plan. Considering patients ethnicity is an important component in individualizing patient care when managing skin and hair disorders. We encourage more research on skin and hair disorders in this population to optimize treatment options.
Dr. Dorizas is with Sadick Dermatology in New York, NY.
Dr. Henry is with Sadick Dermatology in New York, NY.
Dr. Nassar is with Sadick Dermatology, in New York, NY.
Dr. Sadick is with Sadick Dermatology, in New York, NY. He is also clinical professor in the Department of Dermatology at Weill Medical College of Cornell University in New York, NY.
Disclosures: The authors report no relevant financial disclosures.
Side bar:
Skin Considerations for People of Color
Although people of color have a lower risk of developing skin cancer than Caucasians, skin cancer is often diagnosed at a more advanced stage in people of color, thus making it more difficult to treat.
A study “Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public,” published in the Journal of the American Academy of Dermatology,1 provides recommendations for the prevention and early detection of skin cancer in people of color based on a comprehensive review of available data.
The 5-year survival rate for Blacks and Latinos diagnosed with melanoma is lower than Caucasians, likely due to the fact that it is often more advanced when diagnosed. For example, the 5-year survival rate for Black Americans is 73% compared to 91% in Caucasians.
Tips for Patients
“Many people of color mistakenly believe that they are not at risk, but skin cancer is color blind,” says Henry W. Lim, MD, FAAD, C.S. Livingood Chair and chairman of the department of dermatology at Henry Ford Hospital in Detroit, MI. “Skin cancer can look and develop differently in individuals with skin of color than it does in individuals with lighter skin.” In fact, when skin cancer is diagnosed in people of color, it is often found in areas of the skin that are not typically exposed to the sun. Specifically, the bottom of the foot is where 30% to 40% of melanomas are diagnosed in people of color. Nearly 8% of melanomas in Asian Americans occur in the mouth. Squamous cell carcinoma — the most commonly diagnosed skin cancer in Blacks — often develops on the buttocks, hip, legs and feet.
Dr. Lim recommends that patients with skin of color should be advised to check their skin monthly and make an appointment with their dermatologist if anything suspicious is noted. He also recommend that patients:
• Pay special attention to the palms of the hands, soles of the feet, the fingernails, toenails, mouth, groin and buttocks.
• Look for any spots or lesions that are changing, itching, or bleeding or any ulcers or wounds that will not heal.
Unprotected exposure to ultraviolet rays has been identified as a risk factor for skin cancer in people of color. Basal cell carcinoma, the most commonly diagnosed skin in cancer in Asian Americans and Latinos, is most frequently found on sun-exposed areas of the skin, such as the head and neck. Skin of color patients also can be reminded to:
• Seek shade whenever possible.
• Wear sun-protective clothing, including a wide-brimmed hat and sunglasses.
• Avoid tanning beds.
• Apply sunscreen with a sun protection factor of at least 30 to all exposed areas of the skin 15 to 30 minutes before going outdoors. When outdoors, reapply sunscreen every 2 hours, and after swimming or sweating.
• Take a vitamin D supplement because they are at a higher risk of vitamin D deficiency, especially individuals with darker skin.
Reference for sidebar article
1. Agbai ON, Buster K, Sanchez M, et al. Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4): 748-762.
References for main article
1. US Census Bureau. https://www.census.gov/population/projections/files/usinterimproj/natprojtab01a.pdf. Accessed April 16, 2014.
2. McMichael AJ. Hair and scalp disorders in ethnic populations. Dermatol Clin. 2003;21(4):629-644.
3. Del Rosso JQ. Adult seborrheic dermatitis: a status report on practical topical management. J Clin Aesthet Dermatol. 2011;4(5):32-38.
4. Halder RM. Hair and scalp disorders in blacks. Cutis. 1983;32(4):378-380.
5. Lobato MN, Vugia DJ, Freiden IJ. Tinea capitis in California children: a population-based study of a growing epidemic. Pediatrics. 1997;99(4):551-554.
6. Suh DC, Friedlander SF, Raut M, et al. Tinea capitis in the United States: Diagnosis, treatment, and costs. J Am Acad Dermatol. 2006;55(6):1111-1112.
7. Alvarez MS, Silverberg NB. Tinea capitis. Cutis. 2006;78(3):189-196.
8. Trovato MJ, Schwartz RA, Janniger CK. Tinea capitis: current concepts in clinical practice. Cutis. 2006;77(2):93-99.
9. Roberts BJ, Friedlander SF. Tinea capitis: a treatment update. Pediatr Ann. 2005;34(3):191-200.
10. Gonzalez U, Seaton T, Bergus G, Jacobson J, Martinzes-Monzon C. Systemic antifungal therapy for tinea capitis in children. Cochrane Database Syst Rev. 2007;4:CD004685.
11. Bolduc C, Shapiro J. Hair care products: waving, straightening, conditioning, and coloring. Clin Dermatol. 2001;19(4):431-436.
12. Quarles FN, Brody H, Johnson BA, et al. Pseudofolliculitis barbae. Dermatol Ther. 2007;20(3):133-136.
13. Brown LA. Pathogenesis and treatment of pseudofolliculitis barbae. Cutis. 1983;32(4):373-375.
14. Bridgeman-Shah S. The medical and surgical therapy of pseudofolliculitis barbae. Dermatol Ther. 2004;17(2):158-163.
15. Winter H, Schissel D, Parry DA, et al. An unusual Ala12Thr polymorphism in the 1A alpha-helical segment of the companion layer-specific keratin K6hf: evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae. J Invest Dermatol. 2004;122(3):652-657.
