Skin of Color – An enigma: A systematic review

The color of human skin varies according to race, ethnicity, and geographic location, which leads to differing appearances of the same cutaneous condition. The nonwhite population is projected to increase worldwide in the coming decades owing to globalization and changing demographics. Thus, this review aims to focus on the varying nature of cutaneous conditions in this population, which differ from traditional descriptions in textbooks. A thorough search of PubMed, MEDLINE, Cochrane, and Google Scholar databases was done for relevant articles focusing on appearances of various dermatoses in skin of color. Erythematous diseases such as psoriasis, pityriasis rosea, and atopic dermatitis presented with inconspicuous/less conspicuous erythema in individuals with colored skin. Postinflammatory pigmentary changes were frequent in individuals with Fitzpatrick Grading III to VI and in the darker phenotypes, the hyperpigmentation may be difficult to distinguish from normal skin color. Acne hyperpigmented macules are encountered as primary lesions in colored skin, causing a considerable amount of apprehension in affected individuals. Hypopigmented disorders such as arsenicosis, macular postkala-azar dermal leishmaniasis, and dhoti or saree-induced depigmentation were particularly observed in this population. A focused review addressing the visual aspects, especially the color of skin diseases in individuals with Fitzpatrick Grading III to VI is the need of the hour to sensitize dermatologists regarding the specific dermatoses and reaction patterns occurring in this population.