Impact of skin color and ethnicity
Section snippets
Race versus ethnicity: what’s the difference?
The terms race and ethnicity are frequently used almost interchangeably; however, there is a stark difference regarding the origin of these words, their definitions, and their use in clinical research and practice. The concept of race was used in the early 18th century as a tool by which to classify humans. The racial classifications were based primarily on skin color.1 Although it is widely accepted that race is a social construct and is an arbitrary descriptor, it continues to be used in
Skin color as it influences skin structure
Skin color is dependent on several factors, including the type of melanin present, melanosome content, genetics, UV exposure, and additional chromophores in the skin.10 The perception of skin color is, in part, impacted by the presence of varying combinations of four chromophores: hemoglobin, oxyhemoglobin, melanin, and carotenoids. The combination of these chromophores leads to differing absorption and reflection of light, causing the skin to appear as varying shades. In white skin, hemoglobin
Skin color as it influences skin function
Investigations into functional differences in the skin between patients of different skin colors have often been hampered by limitations such as small sample sizes, poor study designs, and conflicting results. Two studies examining the absorption of drugs through black and white skin showed that there was no difference in percutaneous absorption of topical medications,[48], [49] whereas three other studies suggested decreased absorption of topical medications through black skin.[50], [51], [52]
Skin color and the impact on hair
Hair is a central component of self-identity and is a visually apparent characteristic that is frequently used by others to categorize and label. Hair color and texture have been correlated with differences in the cross-sectional shape of individual hair shafts. Cross sections of hair shafts obtained from African patients are noted to be elliptical, appearing flattened in cross section, and spontaneously curving into spirals.[71], [72] Asian hair tends to be rounder in cross section and has the
Prevalence of skin disorders between ethnic groups
National databases have allowed for ranking of the top five dermatologic diagnoses made by US dermatologists by population: in black populations the top five diagnoses are acne, dermatitis, seborrheic dermatitis, atopic dermatitis, and dyschromia; in Asian populations the top five diagnoses are acne, dermatitis, benign neoplasms, psoriasis, and seborrheic keratoses; in Hispanic populations the top five diagnoses are dermatitis, acne, psoriasis, benign neoplasms, and warts; and in white
Effects of cultural practices on dermatologic disease
How people choose to care for their skin and hair is influenced by an ever expanding array of influences, fueled by the access to social media and other electronic inputs. Cultural roots provide the foundation shaping other choices and decisions. The structural and functional variations observed in skin of different colors likely influences the skin and hair care practices that have been historically adopted by ethnic groups. Some of these practices may be introduced as remedies for perceived
Dermatologic health care disparities
Health care disparities exist for a multitude of reasons, ranging from lack of access to care to lack of trust in the health care system and providers to biased care delivery. The groups that tend to be most affected by these disparities are ethnic minorities and people of lower socioeconomic status.118 Studies have shown that black patients are more likely than white and Hispanic patients to report cost as a barrier to dermatology follow-up care.119 furthermore, only 8% of patients who are
Diverse skin types and dermatology training
Dermatology training for US medical students is generally relatively limited, and any significant focus on skin disease by skin color is even more limited. Dermatology training makes up an average of 16 to 22 hours over the course of the medical school curriculum, or slightly less than 1% of the total undergraduate medical training hours. Only 40% of primary care residents report feeling prepared to manage common skin conditions in general.[132], [133], [134], [135] A survey of dermatologists
Conclusions
Pigmentation of skin and hair impacts the structure, function, response to insult, and choices individuals make regarding their skin and hair health and care. More research is needed to better elucidate disease pathophysiology as it affects skin of color and to optimize management of skin and hair conditions in all populations. Dermatology training must ensure adequate exposure and education for all skin types. A diverse workforce of dermatologists is critical to appropriately caring for the
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