Dermatology in black skin

Abstract

The vast majority of publications in dermatology refer to lightly pigmented skin, with few addressing the peculiarities of black skin. In addition there is no consensus on what it means to be black in different regions of the world. The lack of knowledge on the subject makes it difficult to recognize and manage dermatoses in this type of skin. This article aims to review the literature on intrinsic characteristics, as well as epidemiological and clinical aspects of the cutaneous manifestations of different dermatoses in black skin. It was found that there are sometimes striking differences, in the structural, biological, and functional aspects when comparing lightly pigmented and black skin. There are also physiological changes that need to be recognized to avoid unnecessary interventions. Some dermatoses have a higher incidence in black skin, such as acne, eczema, dyschromia and dermatophytosis. On the other hand, several dermatoses are more specific to black skin, such as pseudofolliculitis barbae, keloid, dermatosis papulosa nigra, ulcers caused by sickle-cell anemia, dactylolysis spontanea, confluent and reticulated papillomatosis of Gougerot and Carteaud, and some diseases of the hair and scalp (including fragile and brittle hair, traction alopecia, folliculitis keloidalis nuchae, folliculitis dissecans and central centrifugal cicatricial alopecia). A spectrum of peculiar aspects of specific dermatoses, including sarcoidosis, lichen planus (with emphasis on the pigmentosus variant), psoriasis, lupus erythematosus, vitiligo, syphilis, pityriasis versicolor, and neoplasms are highlighted. In the latter, characteristics of basal cell carcinoma, squamous cell carcinoma, and melanoma are compared, in addition to highlighting unusual aspects of primary cutaneous T-cell lymphoma, endemic Kaposi sarcoma, and dermatofibrosarcoma protuberans.

Keywords: Dermatopathies; Ethnicity; Pigmentation; Population; Skin.

Figure 1

Highlighting topics in black skin.

Figure 2

Post-inflammatory hyperpigmentation: hyperchromic macules on the lumbosacral and gluteal regions.

Figure 3

Dermatosis papulosa nigra: hyperchromic papules on the face.

Figure 4

Keloid folliculitis of the neck: sessile nodule on the back of the neck.

Figure 5

Lichen planus pigmentosus: slightly raised papules and bright hyperchromic macules in the axilla.

Figure 6

Psoriasis: hyperchromic plaques with thick symmetrical scales on the anterior surface of the legs.

Figure 7

Discoid lupus erythematosus: atrophic alopecic plaque on the frontoparietal region.

Figure 8

Vitiligo: achromic macules on the scalp and neck (A) and on the dorsum of the hands (B).

Figure 9

Elegant syphilis: erythematous papule and annular plaque on the face.

Figure 10

Acral melanoma: blackish macule on the hallux (B). Dermoscopic appearance (A).