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Stratum Corneum: Thickness and Compaction
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The stratum corneum (SC) has been extensively studied in black and white skin Most studies confirm that SC thickness does not differ between black and white individuals19 23 However, studies have suggested that the SC of black skin is more compact than white skin22,24 Using repeated tape stripping, investigators reported that black skin required an average of 166 strips to remove the SC compared to 103 strips in white skin22 The authors concluded that although SC thickness was equal in both groups, the SC in black skin has more cell layers and increased intracellular adhesion A subsequent study confirmed these findings The investigators in this later study also examined recovery time after barrier damage and found that darker skin recovered more quickly after barrier damage from tape stripping24 This study included African American, Asian, and Hispanic subjects and found that the skin differences in SC cell layers and barrier function were related to skin color and not related to race Thus, it appears that although SC thickness is the same between the races, darker skin is more compact (Table 14-2)
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Taylor Hyperpigmentation Scale
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The Taylor Hyperpigmentation Scale is a validated scale to describe skin of color and to monitor treatment of hyperpigmentation16 It consists of 15 plastic cards representing different hues in skin phototypes IV through VI Each card also has 10 bands of progressively darker gradations of skin hue Clinicians can use this system to assess and define skin color in a given patient The Taylor Hyperpigmentation Scale also provides a simple, convenient tool to measure improvement after treatment of hyperpigmentation (Fig 14-1)
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Baumann s Skin Typing System addresses a very important cosmetic concern in skin of color, namely, the propensity to develop hyperpigmentation18 It does not define ethnicity or skin color Rather, this questionnaire aids in predicting which patients are most likely to hyperpigment after a given procedure It also addresses the fact that there are some patients with Fitzpatrick skin types IV to VI who do not have a strong tendency to hyperpigment despite their
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The Lancer Ethnicity Scale (LES) was specifically developed to assess risk and outcome in the cosmetic laser patient17 After completing a detailed history of
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Stratum Corneum: Lipid Content, Ceramides, and Barrier Function
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Lipids in the SC play an important role in the barrier function of the skin The
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TABLE 14-2 Summary of Findings: Racial Differences in Skin Structure and Function STRUCTURE/FUNCTION Stratum corneum: thickness and compaction Stratum corneum: lipid content, ceramides Stratum corneum: transepidermal water loss (TEWL) Stratum corneum: corneocyte surface Stratum corneum: spontaneous desquamation Stratum corneum: water content Percutaneous absorption Cutaneous blood vessel reactivity Skin irritancy pH Elastic recovery/extensibility Mast cell granules FINDINGS Stratum corneum thickness is the same between the races Darker skin is more compact Skin thickness as measured by calipers does not differ between white and black subjects Increased lipid content in black subjects Ceramide: Hispanic and Asian>white>black skin Considering the above ndings, data are unclear Contradictory and inconclusive data in black and Asian subjects No difference in TEWL between white and Hispanic subjects demonstrated No difference in corneocyte surface area between black, white, and Asian subjects Data are contradictory and inconclusive Data are contradictory and inconclusive Data are contradictory and inconclusive Five of the nine studies reported no signi cant difference between the races No clear difference in skin irritancy in skin of color when compared to white skin Data are contradictory and inconclusive Data are contradictory and inconclusive Electron microscopy of mast cells in black skin demonstrated larger granules, more parallel-linear striations, and less curved lamellae Histologic evaluation showed no difference in mast cell size and number No differences in innervation as measured by confocal microscopy were found between European Caucasian, Japanese American, and Chinese American subjects Darker-skinned subjects have large, singly dispersed melanosomes while lighter-skinned subjects have small grouped melanosomes within keratinocytes Melanosome grouping correlates with the degree of pigmentation in white, black, and Asian subjects Basal cell layer melanosomes correlate with the degree of pigmentation In black skin, melanosomes are not only increased in the basal layer but also distributed throughout all layers of the epidermis, in contrast to white skin where melanosomes are primarily limited to the basal layer Melanosomes greater than 035 m cannot form groups Total melanin content correlates with the degree of pigmentation PAR-2 and trypsin have greater expression in darkly pigmented skin when compared to lighter skin Black Intact and compact Stratum corneum 134 DNA damage in the suprabasal dermis White Swollen and cellular Malpighian layer 34 Epidermal and dermal DNA damage An in ux of neutrophils and active proteolytic enzymes Diffuse keratinocyte activation Darkly pigmented black skin has an MED up to 33 times greater than white skin MED correlated with skin color in Japanese subjects Pigmentation does not always consistently correlate with MED Black-Histology Black-Clinical Flattening of the dermal epidermal junction Dark circles and hollowing beneath the eyes Elastic ber degeneration Lower eyelid bags Increase in the super cial vascular plexus Midface aging Asian-Histology Asian-Clinical Epidermal atrophy Hyperpigmentation more prominent than in white subjects Cell atypia Lower wrinkle scores than in white subjects Poor polarity Lower sagging scores than in white subjects Disorderly differentiation Less prominent lower face aging than in white subjects Black More numerous and larger broblasts Binucleated and multinucleated broblasts Binucleated and multinucleated macrophages and giant cells (continued)
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