February is Black History Month in the U.S. In recognition, this brief review explores select literature focused on Black skin and hair, including: topical retinoids, atopic dermatitis (AD), pruritus, sun protection, hormones in Black hair care, Pseudofolliculitis barbae, optical properties of different skin ethnicities, skin whitening and the question of whether white people see variation in Black skin tones.
Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color...
Callender, V.D., et al.; American Journal of Clinical Dermatology. November 2021.
Acne is a common cause for post-inflammatory hyperpigmentation (PIH), particularly in patients with skin of color (SOC), and can be more distressing than the acne itself. Topical retinoids are approved to treat acne and pigmentation disorders, and according to the authors, reduce hyperpigmentation. As such, treatment with topical retinoids is recommended as early as possible (unless contraindicated), and the use of formulations or application of moisturizers can help to reduce irritation. Further, combining retinoids with other topical agents and procedures, e.g., peels, can improve hyperpigmentation. In relation, the authors recommend providing clinicians and researchers with more education about the presentation and management of dermatologic conditions in patients with SOC.
Dermatological Conditions in Skin of Color—Managing Atopic Dermatitis
Sangha, A.M.; Journal of Clinical and Aesthetic Dermatology. March 2021.
According to these researchers, population studies within the United States show that atopic dermatitis (AD) disproportionately affects African Americans (AA), in comparison with other ethnic populations. AD is a complex and multifaceted skin disorder that has recently shown key molecular phenotypic differences among varying ethnic populations. These studies demonstrate there are immunologic variabilities between racial groups, and that further studies are needed to examine and identify other phenotypic variabilities.
Sun Exposure and Black Skin
Fajuyigbe, D. and Verschoore, M.; Current Problems in Dermatology (2021). Karger, Basel.
As these authors explain, Black skin, compared with white skin, is generally assumed to be more resistant to sun exposure due to its melanin content. However, recent evidence shows that Black skin is susceptible to sunlight. For example, Black skin can warm, burn and peel; and sun exposure can cause hyperpigmentation and photoaging. These misconceptions prevent engagement in sun-safe behaviors. As such, the authors conclude more research is needed to convey the effectiveness of sun protection for the Black population.
American Contact Dermatitis Society (ACDS) Position Statement: Dermatitis and Skin of Color
Okeke, C.A.V., et al. Dermatitis: Contact, Atopic, Occupational and Drug. January/February 2022.
In this statement, the ACDS recognizes disparities in skin of color (SOC) education, research and representation; for example, the lack of racial minorities within medicine including dermatology, and the need to improve our understanding and care of skin disorders in SOC. As such, diversity, equity and inclusion (DEI) and health care disparities (HDs) are identified as areas of focus by the society. Herein, the group outlines its current understanding and plans for a path forward.
Pruritus in Black Skin: Unique Molecular Characteristics and Clinical Features
McColl, M., et al. Journal of the National Medical Association. February 2021.
In this paper, the authors explain how the pathogenesis and severity of chronic itch can vary significantly with race. Black skin reportedly has inherent structural and molecular characteristics that exacerbate pruritus, leading to unique presentations of pruritic conditions. Examples include increased transepidermal water loss, decreased ceramide levels, lower pH in the stratum corneum and an increased size of mast cells. This review discusses these structural variances, subsequent epidemiological disparities, and the clinical management of itch in Black patients. The authors conclude further mechanistic studies are needed to characterize racial differences in biomarkers and therapeutic targets of chronic itch.
Hormonal Activity in Commonly Used Black Hair Care Products ... as a Plausible Contribution to Health Disparities
James-Todd, T., et al. Journal of Exposure Science & Environmental Epidemiology. May 2021.
Certain types of hair products are commonly used by Black women and according to these authors, studies have shown they contain potentially endocrine-disrupting chemicals associated with adverse health outcomes. Here, the authors tested six commonly used hair products (used by > 10% of the population) from the Greater New York Hair Products Study for their hormonal activity. All products showed hormonal activity, varying in the amount and effect. Three samples showed estrogen agonist properties, and all but one showed androgen antagonist properties. Finally, four samples showed antagonistic and agonistic properties to progesterone and glucocorticoid. The authors concluded, given their frequent use, these products could have negative health implications.
Ethnic Equity Implications in the Management of Pseudofolliculitis Barbae
Sharma, D., Dalia, Y. and Patel, T.S. Journal of the American Board of Family Medicine. January 2022.
Pseudofolliculitis barbae (PFB) is common in Black men, presenting as erythema, and follicular or perifollicular papules and pustules predominantly on the neck and chin. While according to these authors, the most definitive treatment is cessation of close shaving, many Black men must comply with clean-shaven policies in the workforce. The authors propose if primary care providers can identify and spread awareness of the legitimacy of the disease, it may be easier for patients to receive medical waivers and encourage employers to reflect on the ethnic equity of this practice.
Diffractive Optical Elements on Different Skin Types
Kim, H., Choi, J. and Kang, H.W. SPIE Advanced Biophotonics Conference (SPIE ABC 2021), 121590H. Jan. 11, 2022.
As these authors explain, melasma is caused by hyperpigmentation of the skin and risk factors include UV light exposure, hormonal malfunction and genetic predisposition. However, since melasma occurs regardless of regions and races, treatment planning should consider the optical characteristics of skin colors to enhance clinical outcomes. The present work evaluated the laser-induced optical breakdown effects during picosecond laser irradiation on different colors of ex vivo porcine skin tissue. Laser-induced vacuoles were observed in the dermis of both Black and white skin, although the latter displayed deeper and larger vacuoles.
#RealBleachers: Black Women’s Knowledge of Skin Whitening Risks
Ashley, R.R. Journal of Black Studies. October 2021.
This study aimed to understand Black women’s knowledge of, and how they communicate about, the health impacts of skin whitening/brightening products. In-depth interviews, and field and participant observations showed that Black women using the products conceptualize the risks relative to their knowledge of the product's content and potential impacts. Thus, strategies of communication could enhance health literacy.
Do White People See Variation in Black Skin Tones? Reexamining a Purported Outgroup Homogeneity Effect
Hannon, L., et al. Social Psychology Quarterly. Nov. 2, 2020.
Last in our literature review, this study refers to previous research that found white survey interviewers remember black respondents’ skin tones in a much narrower range than Black interviewers. This finding has been used to suggest that white individuals do not perceive meaningful differences between light- and dark-skinned Black people. In re-analyzing the evidence, however, these authors found significant heterogeneity in ratings assigned by white interviewers when taking into account the ordinal nature of the skin tone measures. The results suggest that beyond formal racial classification schemes, skin tone is used to categorize others along a continuum of "Blackness." The findings also indicate that increases in white racism intensify white colorism.