Pigmentation Disorders

Marcelyn K. Coley, MD, and Andrew F. Alexis, MD, MPH

The demographics of the United States continue to evolve, with a growing proportion of the population consisting of non-Caucasian racial and ethnic groups. As darker skin types become more prevalent, so will the need to better understand their skin, the conditions that affect it, and optimal approaches for treatment. This population poses a special challenge for practitioners in part as a result of the sequelae often associated with the conditions in their own right—postinflammatory hyperpigmentation and scarring—and potential iatrogenic adverse effects that may occur during treatment. Through careful consideration of cultural, clinical, and therapeutic nuances, safe and effective management of common disorders in skin of color is achievable.

*For a PDF of the full article, click on the link to the left of this introduction.

Marcelyn K. Coley, MD, and Andrew F. Alexis, MD, MPH

The demographics of the United States continue to evolve, with a growing proportion of the population consisting of non-Caucasian racial and ethnic groups. As darker skin types become more prevalent, so will the need to better understand their skin, the conditions that affect it, and optimal approaches for treatment. This population poses a special challenge for practitioners in part as a result of the sequelae often associated with the conditions in their own right—postinflammatory hyperpigmentation and scarring—and potential iatrogenic adverse effects that may occur during treatment. Through careful consideration of cultural, clinical, and therapeutic nuances, safe and effective management of common disorders in skin of color is achievable.

*For a PDF of the full article, click on the link to the left of this introduction.

Marcelyn K. Coley, MD, and Andrew F. Alexis, MD, MPH

The demographics of the United States continue to evolve, with a growing proportion of the population consisting of non-Caucasian racial and ethnic groups. As darker skin types become more prevalent, so will the need to better understand their skin, the conditions that affect it, and optimal approaches for treatment. This population poses a special challenge for practitioners in part as a result of the sequelae often associated with the conditions in their own right—postinflammatory hyperpigmentation and scarring—and potential iatrogenic adverse effects that may occur during treatment. Through careful consideration of cultural, clinical, and therapeutic nuances, safe and effective management of common disorders in skin of color is achievable.

*For a PDF of the full article, click on the link to the left of this introduction.

A. Paul Kelly, MD

Keloids are scars, unique to humans, that grow beyond the boundaries of a cutaneous injury, inflammation, burn, or surgical incision. Although benign, keloids are often aesthetically malignant. The etiology of keloids is uncertain. However, we do know that they occur more often in African-American and Asian than Caucasian patients. There is no one therapeutic modality that either prevents the formation of keloids or treats active or inactive lesions. Consequently, there are many therapeutic options. In this review, an approach to medical and surgical management of keloids is provided, as well as a review of experimental therapeutic modalities.

*For a PDF of the full article, click on the link to the left of this introduction.

A. Paul Kelly, MD

Keloids are scars, unique to humans, that grow beyond the boundaries of a cutaneous injury, inflammation, burn, or surgical incision. Although benign, keloids are often aesthetically malignant. The etiology of keloids is uncertain. However, we do know that they occur more often in African-American and Asian than Caucasian patients. There is no one therapeutic modality that either prevents the formation of keloids or treats active or inactive lesions. Consequently, there are many therapeutic options. In this review, an approach to medical and surgical management of keloids is provided, as well as a review of experimental therapeutic modalities.

*For a PDF of the full article, click on the link to the left of this introduction.

A. Paul Kelly, MD

Keloids are scars, unique to humans, that grow beyond the boundaries of a cutaneous injury, inflammation, burn, or surgical incision. Although benign, keloids are often aesthetically malignant. The etiology of keloids is uncertain. However, we do know that they occur more often in African-American and Asian than Caucasian patients. There is no one therapeutic modality that either prevents the formation of keloids or treats active or inactive lesions. Consequently, there are many therapeutic options. In this review, an approach to medical and surgical management of keloids is provided, as well as a review of experimental therapeutic modalities.

*For a PDF of the full article, click on the link to the left of this introduction.

Rebat M. Halder, MD, and Johnathan L. Chappell, MD

Vitiligo is an acquired dyschromia of the skin in which there is a loss of epidermal melanocytes. The prevalence of vitiligo is approximately 1% in the United States and 0.1-2% worldwide. The exact pathogenesis of vitiligo remains elusive and is likely multifactorial. After completing this update, participants should be able to discuss the epidemiology of vitiligo and summarize the proposed mechanisms for development of this disease. In addition, they should be able to discuss physical findings, approach to the patient, and some of the therapeutic modalities for this disorder.

*For a PDF of the full article, click on the link to the left of this introduction.

Rebat M. Halder, MD, and Johnathan L. Chappell, MD

Vitiligo is an acquired dyschromia of the skin in which there is a loss of epidermal melanocytes. The prevalence of vitiligo is approximately 1% in the United States and 0.1-2% worldwide. The exact pathogenesis of vitiligo remains elusive and is likely multifactorial. After completing this update, participants should be able to discuss the epidemiology of vitiligo and summarize the proposed mechanisms for development of this disease. In addition, they should be able to discuss physical findings, approach to the patient, and some of the therapeutic modalities for this disorder.

*For a PDF of the full article, click on the link to the left of this introduction.

Rebat M. Halder, MD, and Johnathan L. Chappell, MD

Vitiligo is an acquired dyschromia of the skin in which there is a loss of epidermal melanocytes. The prevalence of vitiligo is approximately 1% in the United States and 0.1-2% worldwide. The exact pathogenesis of vitiligo remains elusive and is likely multifactorial. After completing this update, participants should be able to discuss the epidemiology of vitiligo and summarize the proposed mechanisms for development of this disease. In addition, they should be able to discuss physical findings, approach to the patient, and some of the therapeutic modalities for this disorder.

*For a PDF of the full article, click on the link to the left of this introduction.

Brooke A. Jackson, MD

Skin cancer is the most common form of cancer in the United States. Although skin cancer is less common in persons of color than in Caucasians, the rates of morbidity and mortality associated with skin cancer often are significantly greater in darker-skinned ethnic groups. This article reviews special considerations in the approach and management of nonmelanoma skin cancer in patients of color.

*For a PDF of the full article, click on the link to the left of this introduction.

Brooke A. Jackson, MD

Skin cancer is the most common form of cancer in the United States. Although skin cancer is less common in persons of color than in Caucasians, the rates of morbidity and mortality associated with skin cancer often are significantly greater in darker-skinned ethnic groups. This article reviews special considerations in the approach and management of nonmelanoma skin cancer in patients of color.

*For a PDF of the full article, click on the link to the left of this introduction.

Brooke A. Jackson, MD

Skin cancer is the most common form of cancer in the United States. Although skin cancer is less common in persons of color than in Caucasians, the rates of morbidity and mortality associated with skin cancer often are significantly greater in darker-skinned ethnic groups. This article reviews special considerations in the approach and management of nonmelanoma skin cancer in patients of color.

*For a PDF of the full article, click on the link to the left of this introduction.

Brenda A. Shoo, MD, and Mohammed Kashani-Sabet, MD

This review highlights melanoma trends observed among African-, Asian-, Latino- and Native-American populations. Melanoma is the most lethal form of skin cancer, accounting for about 75% of all skin cancer deaths. Generally, incidence rates increase with age, peak after age 40, and are greater in men than women. However, these trends do not reflect what is typically seen in minority ethnic groups, where incidence rates are lower. In addition, for some groups, relative disease-specific survival also is lower compared with European-Americans. Melanomas in minority populations also tend to appear in atypical locations and are of unclear etiology. To improve our understanding of the causes of melanoma arising in ethnic minority populations future research efforts are needed. In addition, the general lack of awareness of this disease entity among minority populations and the fact that certain ethnic groups tend to present with advanced disease further highlight the need for educational programs for both patients and health care professionals.

*For a PDF of the full article, click on the link to the left of this introduction.

Brenda A. Shoo, MD, and Mohammed Kashani-Sabet, MD

This review highlights melanoma trends observed among African-, Asian-, Latino- and Native-American populations. Melanoma is the most lethal form of skin cancer, accounting for about 75% of all skin cancer deaths. Generally, incidence rates increase with age, peak after age 40, and are greater in men than women. However, these trends do not reflect what is typically seen in minority ethnic groups, where incidence rates are lower. In addition, for some groups, relative disease-specific survival also is lower compared with European-Americans. Melanomas in minority populations also tend to appear in atypical locations and are of unclear etiology. To improve our understanding of the causes of melanoma arising in ethnic minority populations future research efforts are needed. In addition, the general lack of awareness of this disease entity among minority populations and the fact that certain ethnic groups tend to present with advanced disease further highlight the need for educational programs for both patients and health care professionals.

*For a PDF of the full article, click on the link to the left of this introduction.

Brenda A. Shoo, MD, and Mohammed Kashani-Sabet, MD

This review highlights melanoma trends observed among African-, Asian-, Latino- and Native-American populations. Melanoma is the most lethal form of skin cancer, accounting for about 75% of all skin cancer deaths. Generally, incidence rates increase with age, peak after age 40, and are greater in men than women. However, these trends do not reflect what is typically seen in minority ethnic groups, where incidence rates are lower. In addition, for some groups, relative disease-specific survival also is lower compared with European-Americans. Melanomas in minority populations also tend to appear in atypical locations and are of unclear etiology. To improve our understanding of the causes of melanoma arising in ethnic minority populations future research efforts are needed. In addition, the general lack of awareness of this disease entity among minority populations and the fact that certain ethnic groups tend to present with advanced disease further highlight the need for educational programs for both patients and health care professionals.

*For a PDF of the full article, click on the link to the left of this introduction.

Ingrid E. Roseborough, MD and Amy J. McMichael, MD

The unique properties of hair in those patients of African descent allow a limitless range of hair-care options. For the clinician, a general understanding of hair-care practices is an important aid in the diagnosis and treatment of hair shaft and scalp disorders. This review highlights common hair-care practices in women, men, and children of color. Cleansing, moisturizing, and styling techniques are discussed, as well as potential complications associated with their use.

*For a PDF of the full article, click on the link to the left of this introduction.

Ingrid E. Roseborough, MD and Amy J. McMichael, MD

The unique properties of hair in those patients of African descent allow a limitless range of hair-care options. For the clinician, a general understanding of hair-care practices is an important aid in the diagnosis and treatment of hair shaft and scalp disorders. This review highlights common hair-care practices in women, men, and children of color. Cleansing, moisturizing, and styling techniques are discussed, as well as potential complications associated with their use.

*For a PDF of the full article, click on the link to the left of this introduction.

Ingrid E. Roseborough, MD and Amy J. McMichael, MD

The unique properties of hair in those patients of African descent allow a limitless range of hair-care options. For the clinician, a general understanding of hair-care practices is an important aid in the diagnosis and treatment of hair shaft and scalp disorders. This review highlights common hair-care practices in women, men, and children of color. Cleansing, moisturizing, and styling techniques are discussed, as well as potential complications associated with their use.

*For a PDF of the full article, click on the link to the left of this introduction.

Jennifer M. Fu, MD, and Vera H. Price, MD, FRCP(C)

Hair loss in women of color represents a unique diagnostic challenge that requires a systematic approach. In women of color, clinical examination of the hair and scalp is most helpful when performed first and used to guide subsequent history-taking to arrive at a clinical assessment. The most common hair problems in women of color are hair breakage, traction alopecia, and central centrifugal cicatricial alopecia. A careful detailed clinical examination and history will guide the clinician to appropriate counseling and management. It is important to recognize that a patient may have more than one of these 3 diagnoses and each requires separate attention. Traction alopecia is completely preventable with appropriate education of the public and medical establishment.

 *For a PDF of the full article, click on the link to the left of this introduction.

Jennifer M. Fu, MD, and Vera H. Price, MD, FRCP(C)

Hair loss in women of color represents a unique diagnostic challenge that requires a systematic approach. In women of color, clinical examination of the hair and scalp is most helpful when performed first and used to guide subsequent history-taking to arrive at a clinical assessment. The most common hair problems in women of color are hair breakage, traction alopecia, and central centrifugal cicatricial alopecia. A careful detailed clinical examination and history will guide the clinician to appropriate counseling and management. It is important to recognize that a patient may have more than one of these 3 diagnoses and each requires separate attention. Traction alopecia is completely preventable with appropriate education of the public and medical establishment.

 *For a PDF of the full article, click on the link to the left of this introduction.

Jennifer M. Fu, MD, and Vera H. Price, MD, FRCP(C)

Hair loss in women of color represents a unique diagnostic challenge that requires a systematic approach. In women of color, clinical examination of the hair and scalp is most helpful when performed first and used to guide subsequent history-taking to arrive at a clinical assessment. The most common hair problems in women of color are hair breakage, traction alopecia, and central centrifugal cicatricial alopecia. A careful detailed clinical examination and history will guide the clinician to appropriate counseling and management. It is important to recognize that a patient may have more than one of these 3 diagnoses and each requires separate attention. Traction alopecia is completely preventable with appropriate education of the public and medical establishment.

 *For a PDF of the full article, click on the link to the left of this introduction.

Lily Talakoub, MD and Naissan O. Wesley, MD

The United States has become progressively more multicultural, with the ethnic population growing at record rates. The US Census Bureau projects that, by the year 2056, greater than 50% of the US population will be of non-Caucasian descent. Ethnic patients have different cosmetic concerns and natural features that are unique. The cosmetic concerns of ethnic patients also differ as the result of differences in skin pathophysiology, mechanisms of aging, and unique anatomic structure. There is no longer a single standard of beauty. We must now adapt to the more diverse population and understand how to accommodate the diversity of beauty in the United States. Ethnic patients do not necessarily want a Westernized look because what constitutes beauty is determined by racial, cultural, and environmental influences. We as leaders in skin care must understand these differences and adapt our practices accordingly. This article will focus on the differences in aging in different ethnic populations and highlight procedures unique to skin of color.

*For a PDF of the full article, click on the link to the left of this introduction.

Lily Talakoub, MD and Naissan O. Wesley, MD

The United States has become progressively more multicultural, with the ethnic population growing at record rates. The US Census Bureau projects that, by the year 2056, greater than 50% of the US population will be of non-Caucasian descent. Ethnic patients have different cosmetic concerns and natural features that are unique. The cosmetic concerns of ethnic patients also differ as the result of differences in skin pathophysiology, mechanisms of aging, and unique anatomic structure. There is no longer a single standard of beauty. We must now adapt to the more diverse population and understand how to accommodate the diversity of beauty in the United States. Ethnic patients do not necessarily want a Westernized look because what constitutes beauty is determined by racial, cultural, and environmental influences. We as leaders in skin care must understand these differences and adapt our practices accordingly. This article will focus on the differences in aging in different ethnic populations and highlight procedures unique to skin of color.

*For a PDF of the full article, click on the link to the left of this introduction.

Lily Talakoub, MD and Naissan O. Wesley, MD

The United States has become progressively more multicultural, with the ethnic population growing at record rates. The US Census Bureau projects that, by the year 2056, greater than 50% of the US population will be of non-Caucasian descent. Ethnic patients have different cosmetic concerns and natural features that are unique. The cosmetic concerns of ethnic patients also differ as the result of differences in skin pathophysiology, mechanisms of aging, and unique anatomic structure. There is no longer a single standard of beauty. We must now adapt to the more diverse population and understand how to accommodate the diversity of beauty in the United States. Ethnic patients do not necessarily want a Westernized look because what constitutes beauty is determined by racial, cultural, and environmental influences. We as leaders in skin care must understand these differences and adapt our practices accordingly. This article will focus on the differences in aging in different ethnic populations and highlight procedures unique to skin of color.

*For a PDF of the full article, click on the link to the left of this introduction.

Eliot F. Battle, Jr, MD and Cylburn E. Soden, Jr, MD, MA

The demographics of the US population continue to change at an extremely rapid pace. As of 2008, Asians, Hispanics, and African Americans accounted for 31% of the US population, and it is estimated that by the year 2050 half of the population of America will be represented by darker ethnic skin types. With the increase in the total number of individuals of skin of color, the demand for safe and effective laser therapy in darker skin types continues to increase. However, despite the increase in demand, the current literature regarding the use of lasers in darker skin remains limited. Most of the treatment parameters defined for laser platforms have been established primarily through extensive testing on skin phototypes I to III, and those studies that have been conducted on darker skin phototypes have been overwhelmingly conducted on Asian skin. Nevertheless, it has become clear that effective cutaneous laser surgery in darker skin types can be accomplished despite a relative overall greater risk for complications. Therefore, as the diversity of America continues to grow, the laser surgeon needs to maintain a clear understanding of the complexities associated with treating ethnic skin and remain mindful of the current, and ever-changing, therapeutic modalities available. This will allow the conscientious physician to maximize outcome and minimize risk when performing laser surgery on darker skin types.

*For a PDF of the full article, click on the link to the left of this introduction.

Eliot F. Battle, Jr, MD and Cylburn E. Soden, Jr, MD, MA

The demographics of the US population continue to change at an extremely rapid pace. As of 2008, Asians, Hispanics, and African Americans accounted for 31% of the US population, and it is estimated that by the year 2050 half of the population of America will be represented by darker ethnic skin types. With the increase in the total number of individuals of skin of color, the demand for safe and effective laser therapy in darker skin types continues to increase. However, despite the increase in demand, the current literature regarding the use of lasers in darker skin remains limited. Most of the treatment parameters defined for laser platforms have been established primarily through extensive testing on skin phototypes I to III, and those studies that have been conducted on darker skin phototypes have been overwhelmingly conducted on Asian skin. Nevertheless, it has become clear that effective cutaneous laser surgery in darker skin types can be accomplished despite a relative overall greater risk for complications. Therefore, as the diversity of America continues to grow, the laser surgeon needs to maintain a clear understanding of the complexities associated with treating ethnic skin and remain mindful of the current, and ever-changing, therapeutic modalities available. This will allow the conscientious physician to maximize outcome and minimize risk when performing laser surgery on darker skin types.

*For a PDF of the full article, click on the link to the left of this introduction.

Eliot F. Battle, Jr, MD and Cylburn E. Soden, Jr, MD, MA

The demographics of the US population continue to change at an extremely rapid pace. As of 2008, Asians, Hispanics, and African Americans accounted for 31% of the US population, and it is estimated that by the year 2050 half of the population of America will be represented by darker ethnic skin types. With the increase in the total number of individuals of skin of color, the demand for safe and effective laser therapy in darker skin types continues to increase. However, despite the increase in demand, the current literature regarding the use of lasers in darker skin remains limited. Most of the treatment parameters defined for laser platforms have been established primarily through extensive testing on skin phototypes I to III, and those studies that have been conducted on darker skin phototypes have been overwhelmingly conducted on Asian skin. Nevertheless, it has become clear that effective cutaneous laser surgery in darker skin types can be accomplished despite a relative overall greater risk for complications. Therefore, as the diversity of America continues to grow, the laser surgeon needs to maintain a clear understanding of the complexities associated with treating ethnic skin and remain mindful of the current, and ever-changing, therapeutic modalities available. This will allow the conscientious physician to maximize outcome and minimize risk when performing laser surgery on darker skin types.

*For a PDF of the full article, click on the link to the left of this introduction.