Abstract: The evaluation and treatment of skin disease in patients of color has long presented a challenge to many dermatologists. From deep pigmentation masking erythema to a predilection for pilar structures, skin disease in African-Americans has many distinguishing factors that may not be observed in other populations. Most dermatologists have little formal training in examining skin of various levels of pigmentation, so it is necessary to identify common presentations of disease in this population. Pigment lability is a common concern among patients of deeply pigmented skin, and it is necessary to understand what is known about therapeutic options for dyschromia. Follicular prominence, granulomatous, and fibromatous changes are common presentations of disease in this population where differential diagnosis must be broadened to ensure correct diagnosis and effective treatment. For all these disorders there are options for treatment that should be enumerated to patients along with potential side effects of treatment. The goal of improving understanding of cutaneous disease in patients of color is to dispel myths that cultural impact is the primary variable causing reaction patterns in African-Americans and to report on the findings of skin disease in this group, which represents an intermixed population. As dermatologists broaden their view of potential disease presentation, patient satisfaction, treatment choices, and, potentially, access to care will be improved. This monograph provides an overview of the ultrastructure of the pigmentation system at the cellular level and what is understood about the role the pigmentation system may play in living patients in response to sun exposure, irritants, allergens, and trauma. Normal variants of skin seen in patients of color are described and what is known about the epidemiology of these normal states is reported. Diagnosis, treatment, and the psychosocial impact of vitiligo is reported as a representative disease of dyschromia. Pseudofolliculitis barbae is discussed as a prototypic disorder of the pilar apparatus and the approach to treatment is discussed. Special attention is given to children with the disorders discussed, and the need to amend therapy to fit a younger patient is explored. Finally, skin cancer in African-American patients is discussed. Reports of predisposing variables to the various forms of skin cancers including basal cell, squamous cell, Bowen's disease and melanoma are discussed. Pigmentation may play a role in protection but is clearly not the only factor protecting against the development of cutaneous malignancy. What is known about incidence, mortality, and response to treatment for cutaneous basal cell, squamous cell, Bowen's disease, and melanoma are discussed.

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   |texte=   Diagnosis and treatment of cutaneous disorders in African-American patients
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