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INTRODUCTION

KEY POINTS

  • Skin color is the major contributor to race consciousness and prejudice, with psychological implications for the individual that are often overlooked.

  • Dermatologic conditions are frequently linked to psychiatric disorders such as anxiety, depression, and social phobia.

  • Medications for skin imperfections sometimes induce depression or suicidal thoughts.

  • Skin abnormalities should be evaluated to determine if they represent an underlying psychiatric disorder.

  • Some psychotropic medications are associated with a wide range of skin lesions that can be serious or even life-threatening.

  • Skin bleaching, tattooing, and branding are culturally specific forms of self-mutilation in people with skin of color.

  • Shared management and close collaboration among clinicians treating individuals with psychocutaneous disorders are important for the best outcome.

Skin color, texture, and tone are among the first things that we notice about a person. In a culture where appearances and first impressions dominate interpersonal interactions, it is appropriate that we consider the role that the skin plays in psychological health. Although race is largely a sociopolitical concept, skin color is perhaps the single largest contributor to race consciousness, whereas other, less prominent physical characteristics play a secondary role.

For centuries, social inequalities have been linked to race and, as a result, to the characteristics of one’s skin. The institution of slavery for African Americans was predicated in large part on the ability to distinguish one group of individuals from another based on the color of their skin. However, other examples of bias based on skin tone and color exist throughout the globe and across most cultures. Brazilians identify social classifications along lines of skin color rather than racial ancestry.1 In fact, Brazilian Portuguese has more than 30 words to describe various skin colorations. In preapartheid South Africa, elaborate social classification schemata were developed based on skin tone and other racial features. For healthcare providers, it is essential to recognize the interrelationships between colored skin and mental health.

Research has demonstrated that cultural stereotypes exist based on skin tone bias. This is true for both Caucasians and minorities. An illustration of this fact comes from a historic rhyme popular among African Americans in the mid-1900s: “If you’re white, you’re all right; if you’re yellow, you’re mellow; if you’re brown, stick around; if you’re black, get back.”2 In The Future of Race, Henry Louis Gates Jr. described being subjected to the “paper bag principle” during a social event that he encountered at Yale University in the late 1960s.3 The party involved a traditional discriminatory practice that illustrates skin tone bias in the southern United States. People darker than a brown paper bag placed on the door of the party were denied entry.3 Although empirical evidence about the relative advantages of lighter or darker skin is limited, several examples in the literature demonstrate that many people attribute positive personality characteristics to lighter-skinned individuals and negative traits to those with darker skin.4,5...

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