Skin Disorders More Common Among Blacks

Keloids (benign growths which may be painful or itchy) result from proliferation of fibroblasts at trauma sites due to altered levels of immunoregulatory cytokines on collagen production. Collagen fibers have a random alignment whereas fibers of hypertrophic scars are linear. Treatment includes excision, corticosteroid injected in the scar, cryosurgery, laser surgery, and newer modalities (e.g., silicone sheeting).

Acne venenata (pomade acne) results from daily application of an oily substance (e.g., petroleum jelly). The resulting closed comedones are unlikely to progress to pustules because of a low follicular reactivity. Discontinuing use of oils is preventative.

Pseudofolliculitis barbae, an irritant dermatitis, results from close shaving of facial hair, which grows at an acute angle and coils close to the skin. The hair penetrates the side of the follicle or the dermal layers which causes a foreign-body reaction and may become infected. Prevention includes using an electric shaver and lifting up individual ingrown hair tips that have "looped" with a needle or manicure scissors tip.

Dermatosis papulosa nigra (DPN) is a common papular disorder which develops during adolescence and only in Blacks. The lesions are histologically identical to seborrheic keratosis. They are smooth, dome-shaped, brown-to-black papules seen mainly on the cheeks, neck and upper chest. Currently, the most successful treatment procedure is light electrodesiccation which dissolves the lesion without permanent hyper- or hypo-pigmentation.

Sarcoidosis is a multisystem disorder characterized by development of noncaseating granulomas and enhanced cellular immune response. Sarcoidosis is more prevalent in African-Americans living in the southeastern United States. The lesions appear as macules or papules that are scaly or smooth, flesh-colored or erythematous, or hypo- or hyper-pigmented and often require biopsy for diagnosis. Most resolve within two years. Disfiguring or extensive lesions require corticosteroids.

(Williams DF and Kaplan DL. Common dermatoses of black skin: A guide to recognition and therapy. Consultant 1998;38(1): 189-199)

COMMENT: Assessment of common normal variations and disorders require familiarity with patient groups. Appropriate teaching about benign conditions and referrals for disorders require assessment based on familiarity with conditions unique to patient groups.