Ethnic skin, or skin of color, refers to the broad range of skin types and complexions that characterize individuals with darkly pigmented skin, including (but not limited to) persons of African, Asian, Latino, Native American, and Middle Eastern descent (Figure 1.1). Differences in structure, function, and cultural practices in individuals with skin of color contribute to variations in the prevalence, clinical presentation, and impact on quality of life of numerous skin conditions. Understanding these differences is paramount in the treatment of persons with skin of color, especially in the context of cosmetic dermatology. Failure to recognize these differences can result in incorrect assumptions about an individual patient's standards of beauty as well as potentially disfiguring treatment complications. A thorough understanding of ethnic variations in skin structure and function, cultural practices, and responses to treatment is essential to safely and effectively treat the entire spectrum of patients who seek cosmetic dermatologic procedures. In this chapter, the clinical and cultural nuances that characterize skin of color are discussed. The challenges of defining or classifying skin of color are also addressed.
Spectrum of skin of color. (A) Woman of East Asian (Chinese) descent. (Used with permission from Andrew F. Alexis, MD.) (B) Woman of Egyptian descent. (Used with permission from Andrew F. Alexis, MD.) (C) Woman of South Asian (Indian) descent. (D) Woman of West African (Ghanaian) descent. (Used with permission from Andrew F. Alexis, MD.)
DEFINING SKIN OF COLOR—ISSUES AND CONTROVERSIES
When defining skin of color, the concepts of “race” and “ethnicity” are often invoked. The terms “race” and “ethnicity” are sociopolitical constructs that are poorly defined and are often used interchangeably or as an all-inclusive label, “racial/ethnic.” However, it is important to note that the terms have very different connotations. Historically, Homo sapiens have been classified into three to six racial taxons since the 18th century, before the development of genetics and evolutionary biology.1 The “modern” races included Caucasoid (Europeans, Arabs, Indians, Pakistanis), Mongoloid (Asians), Australoid (Australian Aborigines), Congoid or Negroid (Africans, Afro-Caribbeans, African Americans), and Capoid (Kung San tribe of Africa).2,3 These divisions were traditionally based on phenotypic characteristics, geographic origin, and even psychological impressions.1 Thus, the classification of individuals according to “race” is arbitrary and subjective, lacking a biologic basis. In essence, it is a method of classifying diverse populations into socially or politically defined categories. Although genetic studies reveal that genetic variation corresponds to geographic origin, or our concept of “race,” if an individual's ancestors are from one particular region, 85% to 90% of genetic variation is found within racial groups and only 10% to 15% is found between groups.4–7 As such, some authors have argued against the use of racial classifications in biomedical literature.8 Ethnicity, on the other hand, identifies individuals and populations ...