From the Guidelines
African Americans are prone to several distinctive skin conditions, including keloids, post-inflammatory hyperpigmentation, melasma, pseudofolliculitis barbae, vitiligo, and dermatosis papulosa nigra, which can be treated with various topical and procedural therapies, as well as preventive measures such as daily use of broad-spectrum SPF 30+ sunscreen. These conditions are often related to the skin's higher melanin content and can have a significant impact on quality of life. Some key treatments for these conditions include:
- Keloids: corticosteroid injections (triamcinolone 10-40 mg/ml every 4-6 weeks), silicone sheets, pressure therapy, or surgical excision followed by radiation for severe cases 1
- Post-inflammatory hyperpigmentation: topical hydroquinone 2-4% applied twice daily for 8-12 weeks, retinoids like tretinoin 0.025-0.1% nightly, or azelaic acid 15-20% twice daily
- Melasma: combination therapy including hydroquinone 4%, tretinoin 0.05%, and fluocinolone 0.01% applied nightly for 8 weeks, followed by maintenance therapy
- Pseudofolliculitis barbae: changing shaving habits, using electric razors, and applying benzoyl peroxide 5% or clindamycin 1% solution
- Vitiligo: topical corticosteroids (clobetasol 0.05% twice daily for 2-3 months), tacrolimus 0.1% ointment, or phototherapy
- Dermatosis papulosa nigra: electrodesiccation or cryotherapy It's essential to note that treatment often requires patience, as results may take weeks to months to become visible, and daily use of broad-spectrum SPF 30+ sunscreen is crucial to prevent worsening of these conditions. Additionally, health disparities in allergic and immunologic conditions, such as atopic dermatitis, can affect African Americans, and addressing these disparities through culturally sensitive education and improved access to care is vital 1. Overall, a comprehensive approach to treating these skin conditions, including preventive measures and addressing health disparities, can significantly improve quality of life for African Americans.
From the Research
Common Skin Conditions in African Americans
- Acne: a common skin condition in African Americans, with treatments including isotretinoin, adapalene, tazarotene, and dapsone 2
- Atopic dermatitis: characterized by a TH2/TH22-skewed molecular profile with attenuated Th1/Th17 response in African American patients 3
- Psoriasis: treatments include cyclosporine and etanercept, with African American patients having lower likelihood of receiving these therapies 2
- Postinflammatory hyperpigmentation and hypopigmentation: common pigmentary disorders in African Americans 4
- Vitiligo and melasma: other pigmentary disorders affecting African Americans 4
- Keloid scarring and pityriasis versicolor: conditions observed in African American patients 5
Treatment Disparities
- African American patients with acne have lower odds of receiving certain treatments, such as isotretinoin and adapalene, compared to white patients 2
- Hispanic patients with acne have lower odds of receiving tretinoin compared to non-Hispanic patients 2
- African American patients with atopic dermatitis are less likely to receive certain treatments, such as desonide and tacrolimus, compared to white patients 2
- African American patients with psoriasis have lower likelihood of receiving cyclosporine and etanercept compared to white patients 2
Skin Disease Spectrum
- A study of black patients in south-east London found a wide spectrum of skin disease, including atopic eczema, tinea capitis, acne, and keloid scarring 5
- The study also found that certain conditions, such as postinflammatory changes, were more common in black skin 5
- Another study found that African American patients with atopic dermatitis have a unique molecular profile, with attenuated Th1 and Th17 responses 3