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  • Dyspigmentation is often a major concern in adolescents with skin of color.

  • Phytophotodermatitis can be misdiagnosed as ecchymoses from abuse.

  • Epidermal nevus is the primary differential diagnosis for lichen striatus.

  • The erythema in atopic dermatitis may be underestimated in skin of color.

  • Adolescents with filaggrin mutations associated with atopic dermatitis have skin barrier dysfunction.

This chapter will address selected dermatologic topics in skin of color pertaining to the age group from 13 to 19 years.1


Acne is one of the most common dermatologic disorders in adolescence. The incidence in adolescents with skin of color is similar to that of adolescents with European ancestry; however, special attention is necessary for treatment choices and anticipating pigment changes.

Acne is an inflammatory dermatosis that is concentrated in areas of increased sebaceous glands. The four issues that are the major driving factors for acne development are: (1) abnormal keratinization leading to follicular plugging; (2) androgenic stimulation of sebaceous gland activity; (3) the effect of Propionibacterium acnes on sebum; and (4) inflammation.2

Characteristic acne lesions are open comedones (blackheads), closed comedones (whiteheads), inflammatory papules, pustules, nodules, and cysts.

Differential diagnoses include adenoma sebaceum, perioral dermatitis, rosacea, folliculitis, and drug-induced acneiform eruption.3

Treatment regimens are addressed in multiple articles2,4,5 and Chapters 42 and 84 of this textbook. Of mention, topical retinoids (which are considered a first-line medical treatment for acne) should be prescribed cautiously in patients with skin of color.5 Care should be taken to avoid irritation and subsequent dyspigmentation. Noncomedogenic facial moisturizers containing sunscreen are recommended for daily use along with acne therapies in any patient with a tendency to have dyspigmentation to specifically avoid further darkening of hyperpigmented areas.6 Newer therapies with visible light, photodynamic therapy, and lasers have shown some efficacy.7


Kawasaki disease is a disorder characterized by a systemic vasculitis that was first described by Dr. Tomisaku Kawasaki in 1967.8 It is the leading cause of acquired cardiac disorders in children in the United States and other developed nations. Although Kawasaki disease typically occurs in young children, on occasion, adolescents can develop the disease. Because it is uncommon in adolescents and adolescents may have atypical clinical findings, proper diagnosis can be delayed.9 It is crucial that the proper diagnosis be confirmed promptly because instituting treatment early with intravenous immunoglobulin has been shown to decrease the incidence of coronary artery aneurysms.8

Kawasaki disease affects children of color disproportionately. The incidence is highest in Japanese individuals and lowest in Caucasians with an intermediate incidence in African Americans and Hispanics. Recognizing the cutaneous signs of the disorder can assure that appropriate treatment regimens are initiated.

The criteria that compose the ...

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