DERMATOLOGIC ISSUES IN PEOPLE OF COLOR
Melanoma Arising in African-, Asian-, Latino- and Native-American Populations
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.
Semin Cutan Med Surg 28:96-102 © 2009 Elsevier Inc. All rights reserved.
Hair Care Practices in African-American Patients
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.
Semin Cutan Med Surg 28:103-108 © 2009 Elsevier Inc. All rights reserved.
Approach to Hair Loss in Women of Color
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.
Semin Cutan Med Surg 28:109-114 © 2009 Elsevier Inc. All rights reserved.
Differences in Perceptions of Beauty and Cosmetic Procedures Performed in Ethnic Patients
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.
Semin Cutan Med Surg 28:115-129 © 2009 Elsevier Inc. All rights reserved.
The Use of Lasers in Darker Skin Types
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
Semin Cutan Med Surg 28:130-140 © 2009 Elsevier Inc. All rights reserved.