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INTRODUCTION

KEY POINTS

  • Race, cultural behavior, nature of occupation, hobbies, and smoking habit can affect the photoaging process.

  • The skin of people with skin of color varies considerably in its response to sun exposure and the process of photoaging in view of the wide range of skin phototypes.

  • The melanin in darker skin type appears to confer protection against the photoaging effect of ultraviolet B and A radiation.

  • Fairer-skinned individuals tend to develop earlier onset of photoaging and develop more prominent wrinkles and skin laxity than those with skin of color.

  • People with skin of color tend to have less coarse wrinkles, skin sagging, telangiectasia, actinic keratoses, and skin cancers but tend to manifest with more pigmentary disorders (eg, lentigo and melasma) and uneven skin tones. In addition, as a result of the reduced extrinsic aging changes, signs of intrinsic aging, such as volume loss, can appear accentuated.

Skin aging in all skin types can be divided into two basic processes: intrinsic aging and extrinsic aging (photoaging).1 Intrinsic aging is a natural process that occurs with time and manifests as skin thinning, laxity, fine wrinkles, and xerosis.2 Race, anatomic sites, and hormonal changes can influence the intrinsic aging process.3 On the other hand, extrinsic aging results in premature skin aging on chronically photodamaged skin. Photoaging is characterized by deep wrinkles, senile purpura, pigmentary disorders (eg, solar lentigines and seborrheic keratoses), telangiectasis, skin sagging, actinic keratoses, and skin cancers.2 Race, cultural behavior, nature of occupation, hobbies, and smoking habit can affect the photoaging process.3 There are differences in photoaging changes between people with skin of color and Caucasians.

DEFINING SKIN OF COLOR

Most of the world’s population are individuals with skin of color, including Asians, Hispanics, and Africans. Asians can be subdivided into East Asians (Chinese, Koreans, Japanese), Southeast Asians (Indonesians, Malaysians, Singaporeans, Thais, Cambodians, Vietnamese, Filipinos), and South Asians (Bangladeshis, Pakistanis, Sri Lankans, Indians). Both East Asians and Southeast Asians are of Mongoloid background. Those from East Asia have lighter skin color, whereas Southeast Asians have darker brownish skin color. South Asians, on the other hand, are of Caucasian origin but have brown to dark brown skin.4

Hispanics are a large group with varied skin color. A large number of Hispanics worldwide are brown-skinned, but European Hispanics who are of Caucasian origin are lighter in skin color. There are also Hispanics who are of mixed ancestry, with Caucasian and African American or Native American heritage. The geographic areas for brown-skinned Hispanics include North America, Mexico, Central and South America, and the Caribbean.4

Thus the term skin of color includes an extremely heterogeneous group of peoples. Patients with skin of color generally have Fitzpatrick skin phototypes III to VI. With this wide range of skin colors, the skin of people with skin of color varies considerably in its response to sun ...

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