SM 265: Skin of Color

Question 1

What is Skin of Color?

Answer 1

Individuals of racial and ethnic backgrounds with similar cutaneous characteristics and conditions as well as reaction patterns to those conditions

Question 2

How does Skin of Color compare to White Skin, in terms of number of Melanoycytes, and size/Melanin content/distribution of Melanosomes?

Answer 2

Same number of Melanocytes

More Melanin per Melanosome

Larger Melanosomes

Melanosomes distributed more uniformly in the epidermis

Question 3

What does the Fitzpatrick Skin type consider?

Answer 3

Natural skin color

Ability to Tan

Reaction to Sun Exposure

Question 4

When is the Fitzpatrick skin type less accurate?

Answer 4

Fitzpatrick skin type is less accurate in Asians and African Americans

Question 5

What are PIgmentary Demarcation Lines and who are they common in? Are they pathological?

Answer 5

PDL = abrupt transition in color of skin over a sharply demarcated line

Common in Infants + Adults of Color

Benign

Question 6

What is this showing?

Answer 6

A Pigmentary Demarcation Line - it’s benign

Question 7

What is Periorbital Hyperpigmentation, and who is it common in? Is it benign?

Answer 7

Periorbital Hyperpigmentation is dark circles around the lower eyelid, and is common in Patients of Color

Benign

Question 8

What is this showing?

Answer 8

Periorbital Hyperpigmentation

Question 9

What is this showing? Who is it common in? Is it Benign?

Answer 9

Palmar/Plantar Hyperpigmentation

Common in African Americans

May be benign or pathologic

Question 10

What are these? Are they benign?

Answer 10

Punctate Keratoses of Palmar Creases

Benign

Question 11

Where is Mucous Membrane Hyperpigmentation normal in Skin of Color?

Answer 11

Mucous Membrane Hyperpigmentation is common in the Oral mucosa in skin of color

Question 12

What is this? Who is it common in? Is it dangerous?

Answer 12

Melanonychia Striata

Common in older patients of color

Single Nail = Dangerous for Melanoma

Multiple Nails = Normal

Question 13

What is this? Where does it tend to occur? Is it dangerous?

Answer 13

Guttate Hypomelanosis: small white spots on the skin

Common in Upepr extremities and Anterior shin

Benign

Question 14

What is this? Where does it occur and in who? Is it dangerous?

Answer 14

Congenital Dermal Melanocytosis

Common in Asian/AA infants; blue-green patches around Sacrococyxial area

Benign and resolves on it’s own

Question 15

What is this? Who is it common in? Is it dangerous?

Answer 15

Dermatosis Papulosa Nigra

Common in adults of color, increasing with age

Not dangerous

Question 16

What is Dermatosis Papulosa Nigra?

Answer 16

1 -2 benign brown papules with a “stuck-on” appearance that are commonly found in adults of color, and increase in frequency with age

Question 17

What is this and why?

Answer 17

Acne Vulgaris: Comedone stage since there’s no cysts/papules/pustules

Question 18

What is this and why?

Answer 18

Acne Vulgaris: Inflammatory stage, due to presence of Papules/Pustules/Cysts

Question 19

How does Acne Fulminans vary in skin of color?

Answer 19

Less severe in African Americans than Hispanics and Whites

Question 20

How does Acne Vulgaris resolve differently in skin of color? How does this effect treatment?

Answer 20

Acne vulgaris is more likely to leave behind post-inflammatory hyperpigmentation as well as create scars like Keloids

Need to be more aggressive in treatment

Question 21

What is Atopic Dermatitis and how does it present on White skin?

Answer 21

Atopic Dermatitis is a symmetric, ill-defined erythematous patch that feels very itchy and leads to Lichenification; commonly found in:

Face/Extensor/Flexor/Head

Infants/Toddlers/Children/Adults

Question 22

How does Atopic Dermatitis differ in skin of color?

Answer 22

Still itchy, but less erythema is visible due to darker skin and more papular or follicular presentation in patients of color

Also more likely to end in post-inflammatory pigmentation changes

Question 23

What is this and why?

Answer 23

Atopic Dermatitis: symmetric lesion with lichenification prominent

Question 24

How does Psoriasis appear in white skin?

Answer 24

Psoriasis is a chronic inflammatory condition that presents as thickened rash with lots of Scale and a red outline on the Elbows and Knees

Question 25

How does Psoriasis differ in skin of color?

Answer 25

The Erythema looks more violaceous and the disease has more extensive body involvement, which resolves with more hyper/hypo-pigmentation

Question 26

What is this and why?

Answer 26

Psoriasis; you can see the thick scale and the violaceous inflammatory hue

Question 27

What is Lichen Planus?

Answer 27

An autoinflammatory skin condition that effects the wrist, ankles, oral mucosa, and scalp/nails and is associated with Hepatitis C

Question 28

What is this comparing?

Answer 28

Lichen Planus is shown due to the Planar, Polygonal and Pruritic appearance of the rash, with a purple hue

Question 29

What is this comparing?

Answer 29

Pityriasis Rosea

Question 30

How is Pityriasis Rosea seen in skin of color?

Answer 30

Folows a viral trigger like M. Pneumo, but has a violaceous appearance and can effect the extremities as well as the trunk; also has a scale

Question 31

What is this comparing?

Answer 31

Seborrheic Dermatitis, a chronic inflammatory condition that effects the nose and beard area In skin of color, less patches and scale with more hypopigmentation

Question 32

How does Seborrheic Dermatitis present in skin of color?

Answer 32

Polycyclic rings around the nose with less scale

Question 33

What is Sarcoidosis?

Answer 33

An immune mediated systemic granulomatous disorder that may effect the lungs/skin/heart/kidney/GI tract More common in African Americans

Question 34

What is this and what might it suggest?

Answer 34

Erythema Nodosum suggesting Sarcoidosis Harder to see the Erythema in skin of color than white skin

Question 35

What are these and what do they suggest?

Answer 35

Papules and plaques on the face and extremities suggests Sarcoidosis

Question 36

What is this and what does it suggest?

Answer 36

Red-brown papules on the face, nose, lips or ear are Lupus Pernio, which suggets Sarcoidosis with a bad prognosis

Question 37

If you see this, what should you consider?

Answer 37

Plaques on nose and face = Lupus Pernio = Sarcoidosis

Question 38

How does Sarcoidosis alter pigmentation?

Answer 38

Sarcoidosis causes annular hypopigmented plaques

Question 39

Where can Sarcoidosis granulomas have a tendency to develop outside the face?

Answer 39

Tatoos and scars

Question 40

What is Discoid Lupus Erythematous and who does it effec?

Answer 40

DLE is the most common form of chronic cutaneous lupus and it commonly effects women of color

Question 41

Where does Discoid Lupus Erythematous effect?

Answer 41

DLE commonly effects the face and scalp

Question 42

How can active and inactive DLE be distinguished?

Answer 42

Active DLE causes bright pink patches and allopecia

Question 43

What is this? Where on the body it common, and in what groups?

Answer 43

Hidradenitis Suppuritiva, an inflammatory disorder of the follicles associated with obesity and smoking Effects the axillae, groin, buttocks and breast Common in women of color

Question 44

What is this?

Answer 44

A keloid, common in african americans and at sites of traumu

Question 45

What is this and why?

Answer 45

Gray-blue macules on neck and upper body in an adult = Erythema Dyschromicum Perstans

Question 46

What is this and why?

Answer 46

Hypopigmented patch in skin of color on the face/neck/trunk = Pityriasis Alba

Question 47

What is Melasma?

Answer 47

A relapsing condition of hyperpigmented patches that effects sun-exposed areas of the face in young women of color

Question 48

If this is a young woman of color, what is this?

Answer 48

Melasma; recurrent hyperpigmentation on the face

Question 49

What is this, what causes it, and what does it increase risk for?

Answer 49

Oculocutaneous Albinism, due to a mutation in Melanin that leads to an increased risk of skin cancer

Question 50

What is Pseudofolliculitis Barbae?

Answer 50

A common inflammatory condition in men of color that involves corse curly hair penetrating the dermis and causing inflammation and scars/keloids

Question 51

What is this and why?

Answer 51

Curly hairs that circle back and peentrate the skin = Pseudofolliculitis Barbae, as the areas effected by penetration are showing inflammation on skin of color

Question 52

What is this and why?

Answer 52

Keloid or rash on the back of the neck of skin of color = Acne Keloidis Nuchae

Question 53

What is Traction Alopecia?

Answer 53

Alopecia due to tight hairstyles commonly seen in skin of color

Question 54

What is this and why?

Answer 54

Central hair breakage and bald patches = Central Centrifugal Cicatricial Alopecia (CCCA) May involve burning or itching

Question 55

What is Dissecting Cellulitis of the Scalp?

Answer 55

Painful boggy nodules + patchy hair loss in AA men

Question 56

How does Basal Cell Carcinoma present in skin of color?

Answer 56

Most common type of cancer, risk factors include sun exposure + scars + genetic disorders Preents as a pigmented leion in the head or neck

Question 57

How does Squamous Cell Carcinoma present in skin of color?

Answer 57

Presents in areas that are not sun exposed may cause chronic scarring

Question 58

How does Melanoma present in skin of color?

Answer 58

Rare, often shows up as a single effected fingernail

Question 59

What is this and how does it effect skin of color differently?

Answer 59

Cutaneous Lymphoma; effects african americans more and follows a more aggressive course