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INTRODUCTION

KEY POINTS

  • The term skin of color identifies individuals of racial groups with skin darker than Caucasians, such as Asians, Africans, Native Americans, and Pacific Islanders.

  • Patients with skin of color often have distinctive cutaneous and hair characteristics, disorders, and reaction patterns, as well as diverse cultural practices affecting skin care.

  • There is a diversity of skin hues, cutaneous diseases, and responses to cutaneous stimuli within each racial or ethnic group.

  • Top dermatologic diagnoses in patients with skin of color include alopecia, keloidal scarring, and seborrheic dermatitis in African Americans; seborrheic dermatitis in Asians; and dyschromias in Hispanics.

  • The rapid increase of the population with skin of color in the United States and worldwide requires dermatologists and other physicians to study texts focusing on the distinct cutaneous disorders, reaction patterns, and cultural practices of this population.

HOW DO WE DEFINE SKIN OF COLOR?

The term skin of color identifies individuals of particular racial and ethnic groups who share similar cutaneous characteristics and disorders, as well as reaction patterns to those disorders. In general, these individuals have darker skin hues and tend to fall into the first four of the five racial categories created by the U.S. Census [Table 2-1]. It is important to recognize that using the term race as a surrogate for biological or genetic inheritance is not ideal and is controversial. When using the term race, it is important to bear in mind that no single gene, trait, or characteristic distinguishes all members of one race from all members of another.1 Because humans have always mixed freely and widely, the vast majority of the human gene pool is shared. For example, 85% of all human variation can be found in any local population, and 94% can be found on any continent.2 Thus, regardless of racial classification, the vast majority of humans share a common genetic pool. Moreover, race does not completely represent ancestry because individuals may have mixed racial backgrounds. Thus, someone racially identified as African American may have parents with primarily European ancestry; nevertheless, because of a distant relative of African ancestry, they are still classified as African American, a categorization that ignores any European ancestry and genetic pool. Some genetic studies suggest that “geographic ancestry” may be a better proxy than “race” for a shared genetic pool because geographical isolation of populations over time can result in genetic diversity.1,3

TABLE 2-1Five categories for race in the United Statesa

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