Approaches to skin conditions vary with skin color

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Contemporary PEDS Journal, Vol 38 No 5,

The signs of dermatologic conditions can be different in skin of color. A report offers clinical pearls on how to examine and treat common conditions in skin of color.

A recently-published report shares dermatologic clinical pearls for examining and treating pediatric and adolescent patients with skin of color in light of the empathy, effective communication, and shared decision-making that are key to patient satisfaction and good outcomes.

Acne: The increased potential for postinflammatory hyperpigmentation (PIH) with acne in skin of color calls for aggressive treatment. Use of topical retinoids is particularly important because it can start the treatment process for the PIH. Daily sunscreen use and patience also are essential.

Atopic dermatitis: Follicular prominence may be the only sign of atopic dermatitis in this population. Using the tips of your fingers to examine the skin may help determine whether a flare is present.

Seborrheic dermatitis: Encourage patients to wash their hair at least once every 1 to 2 weeks with antidandruff shampoos that contain tar, selenium sulfide, pyrithione zinc, or ketoconazole. To avoid excess dryness, counsel patients to apply the shampoo to the scalp only, rinse, then follow with a moisturizing shampoo and conditioner. For patients who use heavy pomades and oils, provide a topical steroid in ointment form.

Traction alopecia: Advise against hairstyles that place chronic tension on the hair. If you see signs of traction alopecia, educate the patient and family early on the risk factors and sequelae of traction alopecia.

Thoughts from Dr. Farber

This article has useful advice. One size does not fit all in dermatology. This applies not only to skin color, but, for example, to relative oiliness of the skin in deciding what products or formulations (eg, cream vs ointment) to use.

Reference

1. Grayson C, Heath C. Tips for addressing common conditions affecting pediatric and adolescent patients with skin of color. Pediatr Dermatol. March 2, 2021. Epub ahead of print. doi:10.1111/pde.14525