Common dermatologic disorders in skin of color: a comparative practice survey

There is a paucity of data on the epidemiology of dermatologic disease in populations with skin of color. Our objective was to compare the most common diagnoses for which patients of various racial and ethnic groups were treated at a hospital-based dermatology faculty practice. We reviewed the diagnosis codes of 1412 patient visits from August 2004 through July 2005 at the Skin of Color Center at St. Luke's-Roosevelt Hospital Center, in New York. New York, in whom race and ethnicity were recorded. The most common diagnoses observed during dermatologic visits by black and white patients were compared. The leading diagnoses observed during the study period differed between black and white patients. During visits by black patients, the 5 most common diagnoses observed at our center were acne (ICD-9 [International Classification of Diseases, Ninth Revision] 706.1); dyschromia (ICD-9 709.09); contact dermatitis and other eczema, unspecified cause (ICD-9 692.9); alopecia (ICD-9 704.0); and seborrheic dermatitis (ICD-9 690.1). During visits by white patients, the 5 most common diagnoses recorded were acne (ICD-9 706.1); lesion of unspecified behavior (ICD-9 238.2); benign neoplasm of skin of trunk (ICD-9 216.5); contact dermatitis and other eczema, unspecified cause (ICD-9 692.9); and psoriasis (ICD-9 696. 1). Although similarities were seen in the frequency of acne and eczema, conditions such as dyschromia and alopecia were commonly seen during black patient visits but were not among the leading 10 diagnoses made during white patient visits.

Differences of skin irritation between Japanese and European women

BACKGROUND

After using cosmetics, Japanese women frequently complain about sensitive, stinging skin. We wondered whether Japanese women's skin is more sensitive than that of Caucasians.

OBJECTIVES

To examine possible racial differences of skin irritation and subjective sensations.

METHODS

We performed patch testing on the forearm with sodium lauryl sulphate (SLS) at different concentrations (0.25%, 0.5%) and 24-h exposure time. Skin reaction was evaluated by measurement of transepidermal water loss (TEWL), stratum corneum hydration, sebum secretion, laser Doppler flowmetry (LD), content of melanin and erythema. During a stinging test with 10% lactic acid (applied to one side of the cheeks) the subjects were asked to describe the present intensity of any sensation. We used a Chromameter to measure skin colour before and after application of lactic acid. This study was performed in Marburg, Germany, with healthy Japanese and German women living in Marburg.

RESULTS

After SLS testing, we found no significant differences of the barrier function in the stratum corneum, but we found significant subjective sensory differences between Japanese and German women.

CONCLUSIONS

Japanese women may complain about stronger sensations reflecting a different cultural behaviour rather than measurable differences in skin physiology; however, a faster penetration of SLS in Japanese cannot be excluded.

Ethnic variations in self-perceived sensitive skin: epidemiological survey

To examine possible ethnic variations in perception of sensitive skin, an epidemiological survey was performed in the San Francisco area. Approximately 800 telephone interviews were conducted with women from four different ethnic groups (Afro-Americans, Asians, Euro-Americans, Hispanics; approximately 200 women per group). In addition to sensitive facial skin assessments, age and other general skin condition data were collected. 52% of the subjects identified themselves as having sensitive facial skin. There was no statistical difference between the ethnic groups in terms of sensitive skin prevalence. Nevertheless, some differences were noted between ethnic subgroups of sensitive skin. Euro-Americans were characterized by a higher skin reactivity to wind and tended to be less reactive to cosmetics. Afro-Americans presented diminished skin reactivity to most environmental factors and a lower frequency of recurring facial redness. Asians appeared to have greater skin reactivity to spicy food, to sudden changes in temperature and to wind, and tended to suffer from itching more frequently. Hispanics presented a lower incidence of skin reactivity to alcohol. The differences in skin sensitivity between ethnic groups concerned mostly factors of skin reactivity and, to a lesser extent, its symptomatology. But, taken together, we note the similarities in comparing how women of varying ethnic backgrounds perceive the sensitive skin condition.

Evacuation of an Aboriginal community in response to an outbreak of blistering dermatitis induced by a beetle (Paederus australis)

OBJECTIVE

To describe an outbreak of dermatitis induced by the beetle Paederus australis and the public health measures implemented to control it.

SETTING

A remote Aboriginal community in the Northern Territory of Australia.

METHODS

Inspection of the community and interviews with residents to document skin lesions, sleeping locations and beetle activity. Samples of the beetle were collected for identification.

RESULTS

The community was affected by a plague of beetles. All 40 residents reported painful, blistering, skin lesions. Four required hospitalisation for treatment of an extensive exfoliating and ulcerating dermatitis. The community was evacuated to allow skin lesions to heal and the beetle plague to decline.

CONCLUSION

This is the first reported en masse outbreak of Paederus dermatitis in Australia. Paederus dermatitis should be considered as a differential diagnosis of vesicular dermatitis in tropical Australia.

Changing trends in the epidemiology of contact dermatitis in Singapore

All patients seen in the Contact Dermatitis Clinic of the National Skin Centre, Singapore (and the former Middle Road Hospital) between January 1986 and December 1990 were analysed retrospectively. 5557 patients comprising 2634 (47.4%) males and 2923 (52.6%) females were patch tested. 3154 (56.8%) patients had 1 or more positive reactions. The majority of the patients were Chinese (78.0%), followed by Malays (11.5%), Indians (8.1%) and other minority races (2.4%). The majority of positive reactions belonged to the 21-40 age group. The incidence of positivity decreased after 60 years. The commonest allergens responsible were nickel (17.7%), fragrance (13.3%), neomycin (6.9%), colophony (6.6%) and proflavine (6.5%). Both neomycin and proflavine were commonly used as over-the-counter medicaments. Compared to an earlier report in 1988, there were differences in the incidence of contact sensitivity to some allergens. Potassium dichromate, which used to be a common allergen, was less common. Some allergens (carba-mix, naphthyl-mix, caine-mix and PCMX) have been removed from our standard series as they were uncommon causes of contact allergy. Thimerosal and Amerchol L-101 were added in their place.

Sensitive and ethnic skin. A need for special skin-care agents?

Sensitive skin is a complex problem with genetic, individual, environmental, occupational, and ethnic implications. Further work is needed to rank irritants and irritant reactions to classify sensitive skin on the basis of standard models. The development of topical products designed for sensitive and ethnic skin may be advisable to optimize drug activity with minimal side effects. The availability of transdermal systems for drug delivery highlights the problem. Occlusive transdermal patch systems for delivery of clonidine show sensitization rates of 34% in white women, 18% in white men, 14% in black women, and 8% in black men. Besides ethnic differences in transcutaneous penetration, individual and ethnic skin sensitivity may play an important role in determining both patient compliance and therapeutic efficacy of drugs and cosmetics; furthermore, a drug formulation considering skin physiology may prevent unwanted local and general adverse effects.

Cosmetics in blacks

Blacks comprise a phenotypically heterogeneous group with respect to skin and hair. They are uniquely multihued with at least 35 different possible shades of pigmentation, and there is considerable variability in hair texture. This accounts for many of the unique skin and hair cosmetic requirements and customs in the black race. These grooming practices may present perplexing problems for the dermatologist when viewed in the context of resultant skin disease; therefore, an awareness and understanding of skin and hair products used by blacks, grooming techniques, and their consequences are essential for clinicians caring for black patients.

Contact sensitivity to topical medicaments

Of patients patch tested at a contact dermatitis clinic between 1985 and 1986, 22.5% (379/1685) had medicament sensitivity. The prevalence in men was 22.8% (193/847) and in women, 22.1% (186/838) (difference not significant). The rate appears to increase with age, 17.9% (216/1205) for patients less than 40 years old and 34.0% (163/480) for patients over 39 years old (difference, p less than 0.001). The differences in prevalence between Chinese (22.8%), Malay (21.3%), Indians (20.4%), and others (33.3%) were not statistically significant. Common sensitizers included neomycin (7.8%), proflavine (7.1%), clioquinol (4.3%), colophony (3.3%), and wool alcohol (2.7%). Proflavine sensitivity was significantly more common in men (9.9%) than women (4.2%) (p less than 0.001). Most dermatitis occurs on the limbs (upper limbs, 44.3%; lower limbs, 43.0%). Facial dermatitis was more common in women (37.4%) than men (19.2%) (difference not significant).

The usefulness of detailed information to patients with contact allergy

To find out if patients with contact allergy are helped by computerized information lists, a retrospective study was carried out on 58 patients with contact allergy to lanolin, traced through our local database DALUK. All were sent a questionnaire about their usage of the information list, clearance of their eczema, their education and other details. Clearance of the patient's eczema was found to correlate with use of the information list. It was also found that the effectiveness of the information depended on factors such as education, family circumstances, ethnic background and, most of all, how and where the information list was used.

Contact dermatitis in blacks

Black skin is characterized by structural and functional differences such as increased stratum corneum cohesion, melanin content, and stratum corneum layers. These differences seem to make black skin difficult for irritants and light to penetrate, thus explaining the common opinion that skin in blacks is harder and develops contact dermatitis less frequently. The paucity of interpretable epidemiologic data and of clinical and experimental studies does not permit confirmation of this hypothesis, and the few data available are controversial. This article describes the main physiologic differences between black and white barrier function and reviews the literature on irritation, sensitization, and transcutaneous penetration. We found that the data are still too incomplete to generalize on the resistance, or lack thereof, of black skin (versus white skin) to chemical irritation, sensitization, and penetration.