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      Updates in the understanding and treatments of skin & hair disorders in women of color ☆☆

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          Abstract

          Skin of color comprises a diverse and expanding population of individuals. In particular, women of color represent an increasing subset of patients who frequently seek dermatologic care. Acne, melasma, and alopecia are among the most common skin disorders seen in this patient population. Understanding the differences in the basic science of skin and hair is imperative in addressing their unique needs. Despite the paucity of conclusive data on racial and ethnic differences in skin of color, certain biologic differences do exist, which affect the disease presentations of several cutaneous disorders in pigmented skin. While the overall pathogenesis and treatments for acne in women of color are similar to Caucasian men and women, individuals with darker skin types present more frequently with dyschromias from acne, which can be difficult to manage. Melasma is an acquired pigmentary disorder seen commonly in women with darker skin types and is strongly associated with ultraviolet (UV) radiation, genetic factors, and hormonal influences. Lastly, certain hair care practices and hairstyles are unique among women of African descent, which may contribute to specific types of hair loss seen in this population, such as traction alopecia, trichorrhexis nodosa and central centrifugal cicatricial alopecia (CCCA).

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          Most cited references183

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          Frontal fibrosing alopecia: a multicenter review of 355 patients.

          To our knowledge, there are no large multicenter studies concerning frontal fibrosing alopecia (FFA) that could give clues about its pathogenesis and best treatment.
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            Skin of color: biology, structure, function, and implications for dermatologic disease.

            People with skin of color constitute a wide range of racial and ethnic groups-including Africans, African Americans, African Caribbeans, Chinese and Japanese, Native American Navajo Indians, and certain groups of fair-skinned persons (eg, Indians, Pakistanis, Arabs), and Hispanics. It has been predicted that people with skin of color will constitute a majority of the United States and international populations in the 21st century. There is not a wealth of data on racial and ethnic differences in skin and hair structure, physiology, and function. What studies do exist involve small patient populations and often have methodologic flaws. Consequently, few definitive conclusions can be made. The literature does support a racial differential in epidermal melanin content and melanosome dispersion in people of color compared with fair-skinned persons. Other studies have demonstrated differences in hair structure and fibroblast size and structure between black and fair-skinned persons. These differences could at least in part account for the lower incidence of skin cancer in certain people of color compared with fair-skinned persons; a lower incidence and different presentation of photo aging; pigmentation disorders in people with skin of color; and a higher incidence of certain types of alopecia in Africans and African Americans compared with those of other ancestry. However, biologic or genetic factors are not the only ones impacting on these differences in dermatologic disorders. Cultural practices also can have a significant impact. Further studies are needed to help dermatologists optimally treat people with skin of color.
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              Melasma. Etiologic and therapeutic considerations.

              P Grimes (1995)
              Melasma is a common acquired symmetric hypermelanosis characterized by irregular light- to gray-brown macules and patches involving sun-exposed areas of skin. Etiologic factors in the pathogenesis of melasma include genetic influences, exposure to UV radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications. Melasma is often a therapeutically challenging disease, and current treatments include hypopigmenting agents, chemical peels, and lasers. Hypopigmenting agents include phenolic and nonphenolic derivatives. Phenolic agents include hydroquinone and hydroquinone combination preparations. Despite controversies regarding the issue of hydroquinone-induced ochronosis, hydroquinone remains the most effective topically applied bleaching agent approved by the Food and Drug Administration for the treatment of melasma. Nonphenolic bleaching agents include tretinoin and azelaic acid. Superficial, medium, and deep chemical peels are more often used in lighter-complexioned patients. Such peels should be used with caution in blacks. Although lasers have demonstrated significant efficacy in the treatment of a variety of hyperpigmentary disorders, their precise efficacy and place in the therapy of melasma have yet to be established. In the hierarchy of therapies for melasma, the treating physician must consider the devastating psychosocial impact of pigmentary imperfections within the realm of the benefits and risks associated with each treatment.
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                Author and article information

                Contributors
                Journal
                Int J Womens Dermatol
                Int J Womens Dermatol
                International Journal of Women's Dermatology
                Elsevier
                2352-6475
                16 February 2017
                March 2017
                16 February 2017
                : 3
                : 1 Suppl
                : S21-S37
                Affiliations
                [a ]Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
                [b ]Callender Dermatology & Cosmetic Center, Glenn Dale, Maryland
                [c ]Department of Dermatology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
                [d ]Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
                Author notes
                [* ]Address correspondence and reprint requests to: Christina N. Lawson, MD, Howard University Hospital, Department of Dermatology, 2041 Georgia Avenue NW, Suite 2107, Washington, DC 20060. Tel.: + 1 202 865 6725; fax: + 1 202 865 1757. clawson2011@ 123456gmail.com
                Article
                S2352-6475(17)30016-3
                10.1016/j.ijwd.2017.02.006
                5419061
                28492050
                8d726110-63ff-484a-b502-330f55bdb085
                © 2015 The Author(s)

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 22 December 2014
                : 15 April 2015
                : 15 April 2015
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