Updates in the understanding and treatments of skin & hair disorders in women of color

Abstract

Skin of color comprises a diverse and expanding population of individuals. In particular, women of color represent an increasing subset of patients who frequently seek dermatologic care. Acne, melasma, and alopecia are among the most common skin disorders seen in this patient population. Understanding the differences in the basic science of skin and hair is imperative in addressing their unique needs. Despite the paucity of conclusive data on racial and ethnic differences in skin of color, certain biologic differences do exist, which affect the disease presentations of several cutaneous disorders in pigmented skin. While the overall pathogenesis and treatments for acne in women of color are similar to Caucasian men and women, individuals with darker skin types present more frequently with dyschromias from acne, which can be difficult to manage. Melasma is an acquired pigmentary disorder seen commonly in women with darker skin types and is strongly associated with ultraviolet (UV) radiation, genetic factors, and hormonal influences. Lastly, certain hair care practices and hairstyles are unique among women of African descent, which may contribute to specific types of hair loss seen in this population, such as traction alopecia, trichorrhexis nodosa and central centrifugal cicatricial alopecia (CCCA).

Fig. 1

Acne in an African American female (Courtesy of Susan C. Taylor, MD, et al; from Treatments for Skin of Color, copyright Elsevier 2011).

Fig. 2

Acne and Postinflammatory Hyperpigmentation (Courtesy of Valerie Callender, MD; Callender Dermatology & Cosmetic Center, Glenn Dale, MD).

Fig. 3

Pomade acne. Note the closed comedones on the forehead and temples. (Courtesy of Valerie Callender, MD; from Treatments for Skin of Color by Susan C. Taylor, MD, et al, copyright Elsevier 2011).

Fig. 4

Acne and PIH algorithm (Modified from Treatments for Skin of Color by Susan C. Taylor, MD, et al, copyright Elsevier 2011).

Fig. 5

Melasma, malar variant (Courtesy of Jean Bolognia, MD; from Dermatology, copyright Elsevier, 3rd ed., 2012).

Fig. 6

Melasma, centrofacial variant with sparing of the philtrum (Courtesy of Jean Bolognia, MD; from Dermatology, copyright Elsevier, 3rd ed., 2012).

Fig. 7

(Left to right) Electric curling iron, hot comb and ceramic flat iron (Courtesy of Valerie Callender, MD; from Treatments for Skin of Color by Susan C. Taylor, MD, et al, copyright Elsevier 2011).

Fig. 8

Chemical relaxer application to hair (Courtesy of Susan C. Taylor, MD, et al; from Treatments for Skin of Color, copyright Elsevier 2011).

Fig. 9

Traction alopecia (Courtesy of Valerie Callender, MD; from Treatments for Skin of Color by Susan C. Taylor, MD, et al, copyright Elsevier 2011).

Fig. 10

Trichorrhexis nodosa in the temporal scalp region (Courtesy of Valerie Callender, MD; from Treatments for Skin of Color by Susan C. Taylor, MD, et al, copyright Elsevier 2011).

Fig. 11

Early stage CCCA (Courtesy of Susan C. Taylor, MD, et al; from Treatments for Skin of Color, copyright Elsevier 2011).

Fig. 12

CCCA (Courtesy of Susan C. Taylor, MD, et al; from Treatments for Skin of Color, copyright Elsevier 2011).

Fig. 13

CCCA in an African American woman (Courtesy of Jean Bolognia, MD; from Dermatology, copyright Elsevier, 3rd ed., 2012).

Fig. 14

Late stage CCCA (Courtesy of Susan C. Taylor, MD, et al; from Treatments for Skin of Color, copyright Elsevier 2011).

Fig. 15

FFA in an African American female. Note the symmetrical band-like loss of hair on the frontotemporal hairline and scalp. (Courtesy of Valerie Callender, MD; Callender Dermatology & Cosmetic Center, Glenn Dale, MD).