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Racial and Gender Influences on Skin Disease

  • Daniel Callaghan
  • Neelam A. Vashi
Chapter

Abstract

Skin disorders are often multifactorial in nature, as both intrinsic factors such as genetics and extrinsic factors such as differing cultural practices can be implicated in disease pathogenesis. For this reason, there are a number of diseases that affect individuals with skin of color at a higher rate compared to Caucasians, and there are a number of diseases that affect males and females within these populations disproportionately. In this chapter, we discuss specific diseases that are more common in different genders and ethnicities, specifically follicular and scarring disorders and disorders of pigmentation. The follicular and scarring disorders include central centrifugal cicatricial alopecia, traction alopecia, acne keloidalis nuchae, pseudofolliculitis barbae and dissecting cellulitis. The disorders of pigmentation include nevus of Ota and melasma. Beyond exploring the clinical features, histology and treatment of these disorders, this chapter also highlights the epidemiology and pathogenesis of these diseases in an effort to explain why they may be more common in a certain ethnic group or gender.

References

  1. 1.
    Colby SL, Ortman JM. Projections of the size and composition of the US population: 2014 to 2060; 2015. P25-1143.Google Scholar
  2. 2.
    Taylor SC. Skin of color: Biology, structure, function, and implications for dermatologic disease. J Am Acad Dermatol. 2002;46(2).  https://doi.org/10.1067/mjd.2002.120790.
  3. 3.
    Kaidbey KH, Agin PP, Sayre RM, Kligman a M. Photoprotection by melanin—a comparison of black and Caucasian skin. J Am Acad Dermatol. 1979;1(3):249–60.  https://doi.org/10.1016/S0190-9622(79)70018-1.CrossRefGoogle Scholar
  4. 4.
    Zaidi Z. Skin of colour: characteristics and disease. J Pak Med Assoc. 2017;67(2):292–9.Google Scholar
  5. 5.
    Montagna W, Carlisle K. The architecture of black and white facial skin. J Am Acad Dermatol. 1991;24(6):929–37.  https://doi.org/10.1016/0190-9622(91)70148-U.CrossRefGoogle Scholar
  6. 6.
    Lindelöf B, Forslind B, Hedblad MA, Kaveus U. Human hair form. Morphology revealed by light and scanning electron microscopy and computer aided three-dimensional reconstruction. Arch Dermatol. 1988;124(9):1359–63.  https://doi.org/10.1001/archderm.1988.01670090015003.CrossRefGoogle Scholar
  7. 7.
    Lewallen R, Francis S, Fisher B, et al. Hair care practices and structural evaluation of scalp and hair shaft parameters in African American and Caucasian women. J Cosmet Dermatol. 2015;14(3):216–23.  https://doi.org/10.1111/jocd.12157.CrossRefGoogle Scholar
  8. 8.
    Loussouarn G, Lozano I, Panhard S, Collaudin C, El Rawadi C, Genain G. Diversity in human hair growth, diameter, colour and shape. An in vivo study on young adults from 24 different ethnic groups observed in the five continents. Eur J Dermatol. 2016;26(2):144–54.Google Scholar
  9. 9.
    Olsen EA, Callender V, McMichael A, et al. Central hair loss in African American women: incidence and potential risk factors. J Am Acad Dermatol. 2011;64(2):245–52.  https://doi.org/10.1016/j.jaad.2009.11.693.CrossRefGoogle Scholar
  10. 10.
    Davis EC, Reid SD, Callender VD, Sperling LC. Differentiating central centrifugal cicatricial alopecia and androgenetic alopecia in African American men report of three cases. J Clin Aesthet Dermatol. 2012;5(6):37–40.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Kyei A. Medical and environmental risk factors for the development of central centrifugal cicatricial alopecia. Arch Dermatol. 2011;147(8):909.  https://doi.org/10.1001/archdermatol.2011.66.CrossRefGoogle Scholar
  12. 12.
    Dlova NC, Jordaan FH, Sarig O, Sprecher E. Autosomal dominant inheritance of central centrifugal cicatricial alopecia in black South Africans. J Am Acad Dermatol. 2014;70(4):679–82.  https://doi.org/10.1016/j.jaad.2013.11.035.CrossRefGoogle Scholar
  13. 13.
    Herskovitz I, Miteva M. Central centrifugal cicatricial alopecia: challenges and solutions. Clin Cosmet Investig Dermatol. 2016;9:175–81.CrossRefGoogle Scholar
  14. 14.
    Miteva M, Tosti A. Dermatoscopic features of central centrifugal cicatricial alopecia. J Am Acad Dermatol. 2014;71(3):443–9.  https://doi.org/10.1016/j.jaad.2014.04.069.CrossRefGoogle Scholar
  15. 15.
    Callender VD, Lawson CN, Onwudiwe OC. Hair transplantation in the surgical treatment of central centrifugal cicatricial alopecia. Dermatol Surg. 2014;40(10):1125–31.  https://doi.org/10.1097/dss.0000000000000127.CrossRefGoogle Scholar
  16. 16.
    Samrao A, Price VH, Zedek D, Mirmirani P. The “fringe sign” - a useful clinical finding in traction alopecia of the marginal hair line. Dermatol Online J. 2011;17(11):1.Google Scholar
  17. 17.
    James J, Saladi RN, Fox JL. Traction alopecia in Sikh male patients. J Am Board Fam Med. 2007;20(5):497–8.  https://doi.org/10.3122/jabfm.2007.05.070076.CrossRefGoogle Scholar
  18. 18.
    Khumalo NP, Jessop S, Gumedze F, Ehrlich R. Hairdressing and the prevalence of scalp disease in African adults. Br J Dermatol. 2007;157(5):981–8.  https://doi.org/10.1111/j.1365-2133.2007.08146.x.CrossRefGoogle Scholar
  19. 19.
    Khumalo NP, Jessop S, Gumedze F, Ehrlich R. Determinants of marginal traction alopecia in African girls and women. J Am Acad Dermatol. 2008;59(3):432–8.  https://doi.org/10.1016/j.jaad.2008.05.036.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Donovan JC, Mirmirani P. Transversely sectioned biopsies in the diagnosis of end-stage traction alopecia. Dermatol Online J. 2013;19(4):11.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Madu P, Kundu RV. Follicular and scarring disorders in skin of color: presentation and management. Am J Clin Dermatol. 2014;15(4):307–21.  https://doi.org/10.1007/s40257-014-0072-x.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Callender VD, McMichael AJ, Cohen GF. Medical and surgical therapies for alopecias in black women. Dermatol Ther. 2004;17(2):164–76.  https://doi.org/10.1111/j.1396-0296.2004.04017.x.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kundu RV, Patterson S. Dermatologic conditions in skin of color: part II. Disorders occurring predominately in skin of color. Am Fam Physician. 2013;87(12):859–65. http://www.ncbi.nlm.nih.gov/pubmed/23939568 Google Scholar
  24. 24.
    Knable ALJ, Hanke CW, Gonin R. Prevalence of acne keloidalis nuchae in football players. J Am Acad Dermatol. 1997;37(4):570–4.  https://doi.org/10.1016/S0190-9622(97)70173-7.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kelly AP. Pseudofolliculitis barbae and acne keloidalis nuchae. Dermatol Clin. 2003;21(4):645–53.  https://doi.org/10.1016/S0733-8635(03)00079-2.CrossRefGoogle Scholar
  26. 26.
    Maranda EL, Simmons BJ, Nguyen AH, Lim VM, Keri JE. Treatment of acne keloidalis nuchae: a systematic review of the literature. Dermatol Ther (Heidelb). 2016;6(3):363–78.  https://doi.org/10.1007/s13555-016-0134-5.CrossRefGoogle Scholar
  27. 27.
    Herzberg AJ, Dinehart SM, Kerns BJ, Pollack SV. Acne keloidalis. Transverse microscopy, immunohistochemistry, and electron microscopy. Am J Dermatopathol. 1990;12(2):109–21. http://www.ncbi.nlm.nih.gov/pubmed/2331046 CrossRefGoogle Scholar
  28. 28.
    Sperling LC, Homoky C, Pratt L, et al. Acne keloidalis is a form of primary scarring alopecia. Arch Dermatol. 2016;136(4):479–84.  https://doi.org/10.1001/archderm.136.4.479.CrossRefGoogle Scholar
  29. 29.
    Lee A, Cho S, Yam T, Harris K, Ardern-Jones M. Staphylococcus aureus and chronic folliculocentric pustuloses of the scalp - cause or association? Br J Dermatol. 2016;175(2):410–3.CrossRefGoogle Scholar
  30. 30.
    Ogunbiyi A. Acne keloidalis nuchae: prevalence, impact, and management challenges. Clin Cosmet Investig Dermatol. 2016;14(9):483–9.CrossRefGoogle Scholar
  31. 31.
    Salami T, Omeife H, Samuel S. Prevalence of acne keloidalis nuchae in Nigerians. Int J Dermatol. 2007;46(5):482–4.  https://doi.org/10.1111/j.1365-4632.2007.03069.x.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Alexis A, Heath CR, Halder RM. Folliculitis keloidalis nuchae and pseudofolliculitis barbae: are prevention and effective treatment within reach? Dermatol Clin. 2014;32(2):183–91.  https://doi.org/10.1016/j.det.2013.12.001.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Winter H, Schissel D, Parry DAD, et al. An unusual Ala12Thr polymorphism in the 1A alpha-helical segment of the companion layer-specific keratin K6hf: evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae. J Invest Dermatol. 2004;122(3):652–7.  https://doi.org/10.1111/j.0022-202X.2004.22309.x.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Nguyen TA, Patel PS, Viola KV, Friedman AJ. Pseudofolliculitis barbae in women: a clinical perspective. Br J Dermatol. 2015;173(1):279–80.  https://doi.org/10.1111/bjd.13644.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Gray J, McMichael AJ. Pseudofolliculitis barbae: understanding the condition and the role of facial grooming. Int J Cosmet Sci. 2016;38:24–7.  https://doi.org/10.1111/ics.12331.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Conte M, Lawrence J. Pseudofolliculitis barbae. No “pseudoproblem”. JAMA. 1979;241(1):53–4.CrossRefGoogle Scholar
  37. 37.
    Mundi J, Marmon S, Fischer M, Kamino H, Patel R, Shapiro J. Dissecting cellulitis of the scalp. Dermatol Online J. 2012;18(12):8.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Badaoui A, Reygagne P, Cavelier-Balloy B, et al. Dissecting cellulitis of the scalp: a retrospective study of 51 patients and review of literature. Br J Dermatol. 2016;174(2):421–3.  https://doi.org/10.1111/bjd.13999.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Powers M, Mehta D, Ozog D. Cutting out the tracts: staged excisions for dissecting cellulitis of the scalp. Dermatol Surg. 2017;43:738.CrossRefGoogle Scholar
  40. 40.
    Bjellerup M, Wallengren J. Familial perifolliculitis capitis abscedens et suffodiens in two brothers successfully treated with isotretinoin. J Am Acad Dermatol. 1990;23(4 Pt 1):742–3.Google Scholar
  41. 41.
    Segurado-Miravalles G, Camacho-Martínez FM, Arias-Santiago S, et al. Epidemiology, clinical presentation and therapeutic approach in a multicentre series of dissecting cellulitis of the scalp. J Eur Acad Dermatol Venereol. 2016;31:e199–200.  https://doi.org/10.1111/jdv.13948.CrossRefGoogle Scholar
  42. 42.
    Bernárdez C, Molina-Ruiz AM, Requena L. Histologic features of alopecias: part II: scarring alopecias. Actas Dermosifiliogr. 2015;106(4):260–70.  https://doi.org/10.1016/j.ad.2014.07.006.CrossRefGoogle Scholar
  43. 43.
    Scerri L, Williams H, Allen B. Dissecting cellulitis of the scalp: response to isotretinoin. Br J Dermatol. 1996;134(6):1105–8.CrossRefGoogle Scholar
  44. 44.
    Mansouri Y, Martin-Clavijo A, Newsome P, Kaur MR. Dissecting cellulitis of the scalp treated with tumour necrosis factor-α inhibitors: experience with two agents. Br J Dermatol. 2016;174(4):916–8.  https://doi.org/10.1111/bjd.14269.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Sand FL, Thomsen SF. Off-label use of TNF-alpha inhibitors in a dermatological university department: retrospective evaluation of 118 patients. Dermatol Ther. 2015;28(3):158–65.  https://doi.org/10.1111/dth.12222.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Park JM, Tsao H, Tsao S. Acquired bilateral nevus of Ota-like macules (Hori nevus): etiologic and therapeutic considerations. J Am Acad Dermatol. 2009;61(1):88–93.  https://doi.org/10.1016/j.jaad.2008.10.054.CrossRefGoogle Scholar
  47. 47.
    Shah VV, Bray FN, Aldahan AS, Mlacker S, Nouri K. Lasers and nevus of Ota: a comprehensive review. Lasers Med Sci. 2016;31(1):179–85.  https://doi.org/10.1007/s10103-015-1834-2.CrossRefGoogle Scholar
  48. 48.
    Magarasevic L, Abazi Z. Unilateral open-angle glaucoma associated with the ipsilateral nevus of ota. Case Rep Ophthalmol Med. 2013;2013:924937.  https://doi.org/10.1155/2013/924937.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Saha A, Bandyopadhyay D. Nevus of Ota. Indian Pediatr. 2014;51(6):510.Google Scholar
  50. 50.
    Hori Y, Kawashima M, Oohara K, Kukita A. Acquired, bilateral nevus of Ota-like macules. J Am Acad Dermatol. 1984;10(6):961–4.CrossRefGoogle Scholar
  51. 51.
    Zhang Q, Tan C, Jiang P, Yang G. Clinical profile and triggering factors for acquired, bilateral nevus of Ota-like macules. Cutan Ocul Toxicol. 2017;36:327–30.CrossRefGoogle Scholar
  52. 52.
    Vashi N, Kundu R. Facial hyperpigmentation: causes and treatment. Br J Dermatol. 2013;169(Suppl 3):41–56.CrossRefGoogle Scholar
  53. 53.
    Teekhasaenee C, Ritch R, Rutnin U, Leelawongs N. Glaucoma in oculodermal melanocytosis. Ophthalmology. 1990;97(5):562–70.CrossRefGoogle Scholar
  54. 54.
    Tse JY, Walls BE, Pomerantz H, et al. Melanoma arising in a nevus of Ito: novel genetic mutations and a review of the literature on cutaneous malignant transformation of dermal melanocytosis. J Cutan Pathol. 2016;43(1):57–63.  https://doi.org/10.1111/cup.12568.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Levin MK, Ng E, Bae Y-SC, Brauer JA, Geronemus RG. Treatment of pigmentary disorders in patients with skin of color with a novel 755 nm picosecond, Q-switched ruby, and Q-switched Nd:YAG nanosecond lasers: a retrospective photographic review. Lasers Surg Med. 2016;48(2):181–7.  https://doi.org/10.1002/lsm.22454.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Lee HS, Kim M, Kang HY. Recurrence of nevus of Ota after successful laser treatment: possible role of dermal stem cells. Ann Dermatol. 2016;28(5):647–9.CrossRefGoogle Scholar
  57. 57.
    Handel AC, Miot LDB, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014;89(5):771–82.  https://doi.org/10.1590/abd1806-4841.20143063.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Ishiy P, Silva L, Penha M, Handel A, Miot H. Skin diseases reported by workers from the campus of UNESP Rubião Jr, Botucatu-SP (Brazil). An Bras Dermatol. 2014;89:529–31.CrossRefGoogle Scholar
  59. 59.
    Kang W, Yoon K, Lee E, Kim J, Lee K, Yim H. Melasma: histopathological characteristics in 56 Korean patients. Br J Dermatol. 2002;146:228–37.CrossRefGoogle Scholar
  60. 60.
    Taylor SC. Epidemiology of skin diseases in ethnic populations. Dermatol Clin. 2003;21(4):601–7.  https://doi.org/10.1016/S0733-8635(03)00075-5.CrossRefGoogle Scholar
  61. 61.
    Sheth VM, Pandya AG. Melasma: a comprehensive update: part I. J Am Acad Dermatol. 2011;65(4):689–97.  https://doi.org/10.1016/j.jaad.2010.12.046.CrossRefGoogle Scholar
  62. 62.
    Lieberman R, Moy L. Estrogen receptor expression in melasma: results from facial skin of affected patients. J Drugs Dermatol. 2008;7:463.Google Scholar
  63. 63.
    Jang YH, Lee JY, Kang HY. Oestrogen and progesterone receptor expression in melasma: an immunohistochemical analysis. J Eur Acad Dermatol Venereol. 2010;24:1312.CrossRefGoogle Scholar
  64. 64.
    Yalamanchili R, Shastry V, Betkerur J. Clinico-epidemiological study and quality of life assessment in melasma. Indian J Dermatol. 2015;60(5):519.CrossRefGoogle Scholar
  65. 65.
    Maymone M, Neamah H, Wirya S, Patzelt N, Zancanaro P, Vashi N. Sun-protective behaviors in patients with cutaneous hyperpigmentation: a cross-sectional study. J Am Acad Dermatol. 2017;76:841.CrossRefGoogle Scholar
  66. 66.
    Rivas S, Pandya AG. Treatment of melasma with topical agents, peels and lasers: an evidence-based review. Am J Clin Dermatol. 2013;14(5):359–76.  https://doi.org/10.1007/s40257-013-0038-4.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Grimes P. The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups. Dermatol Surg. 1999;25:18.CrossRefGoogle Scholar
  68. 68.
    Zhou LL, Baibergenova A. Melasma: systematic review of the systemic treatments. Int J Dermatol. 2017;56(9):902–8.  https://doi.org/10.1111/ijd.13578.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Lee HC, Thng TGS, Goh CL. Oral tranexamic acid (TA) in the treatment of melasma: a retrospective analysis. J Am Acad Dermatol. 2016;75(2):385–92.  https://doi.org/10.1016/j.jaad.2016.03.001.CrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Boston University Medical CenterBostonUSA
  2. 2.Dermatology, Boston University Center for Ethnic SkinBoston University School of MedicineBostonUSA

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