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CHAPTER 14 SKIN OF COLOR
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Epidermal innervation Melanosome distribution
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Melanin Protease-activated receptor-2 (PAR-2) UV reactivity and photoprotection Stratum lucidum Site of UV ltration SPF After solarsimulating radiation MED
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TABLE 14-2 (Continued) Summary of Findings: Racial Differences in Skin Structure and Function Eccrine glands Apocrine glands Apoeccrine glands Sebaceous glands Hair: keratin Hair: amino acid Hair:vellus Hair: African Data are contradictory and unclear May be increased in black patients May be increased in black patients Data are contradictory and unclear No difference identi ed Data are contradictory and unclear Vellus follicular hair density was lower in African Americans and Asians when compared to white subjects Tightly coiled Flattened elliptical shape in cross-section Naturally shed hairs have a frayed tip Spontaneous knotting is often observed Longitudinal splitting, ssures, and breaking of hair shaft are also observed Fewer elastic brils Decreased hair density Straight or slightly curved Elliptical in cross-section Smallest cross-sectional area Naturally shed hairs usually have original or cut tips Spontaneous knotting is rarely observed Straight Round in cross-section Largest cross-sectional area Naturally shed hairs usually have original or cut tips No spontaneous knotting is observed
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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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Hair: Caucasian
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major lipids of the epidermis are ceramides, cholesterol, and free fatty acids Studies have shown that there is greater lipid content in black SC when compared to white SC25,26 Once the lipids are removed from the SC, the weight of delipidized SC is equal in black and white patients22 Although greater overall lipid content has been demonstrated in black SC, a study in the early 1990s showed that ceramide levels were lowest in black skin In this report, ceramide levels were noted in decreasing order in Hispanic and Asian, white, and black skin Ceramide levels were inversely correlated with transepidermal water loss (TEWL) Additionally, the ceramide levels directly correlated with water content of the SC27 There is only one study examining lipid content in Asian patients Scalp lipids in British and Thai subjects were compared, with investigators finding no difference in scalp lipids between the two groups28 Based on the various studies discussed, the data regarding racial differences in lipid content are unclear and inconclusive
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Stratum Corneum: TEWL and Barrier Function
TEWL is one measure of SC barrier function Five studies of TEWL in black
skin indicate that TEWL is greater in black skin than white skin27,29 32 There are also six studies that contradict these findings Five reported no difference in baseline TEWL between the black and white subjects,33 37 and one reported decreased TEWL in black patients 38 The variations in the results of the latter study may be explained by the location of the skin examined39 Data on TEWL of Asian skin are inconclusive Studies have reported that TEWL in Asian skin is greater than, equal to, and less than TEWL in Caucasian skin27,31,40 One study comparing Chinese, Malaysian, and Indian subjects demonstrated no differences in TEWL (as measured by skin vapor water loss) among the three groups41 There has been no difference demonstrated in TEWL between Hispanic and white skin34,42 From the studies involving black subjects, five out of eleven studies concluded that TEWL was increased in black skin either at baseline or after irritation The significance of these data is far reaching If skin color truly does impact barrier function, these data would imply that acquired dyschromias may alter skin barrier properties 39 It also has implications regarding the ability of people with different skin colors to tolerate envi-
ronmental insults and to absorb topical agents
Stratum Corneum: Corneocyte Surface Area and Spontaneous Desquamation
Corneocytes are the nonnucleated cells that comprise the SC Corneocyte surface area has been demonstrated to influence skin permeabilty43 A study examining corneocyte surface area in black, white, and Asian subjects demonstrated no differences in corneocyte surface area among the groups44 In the same study, spontaneous desquamation was measured in black, white, and Asian subjects The investigators found that spontaneous corneocyte desquamation was equal in white and Asian patients; however, spontaneous corneocyte desquamation was greatest in black patients44 The increased desquamation seen in this study may explain the dry ashy skin often seen clinically in black patients (Fig 14-2) Subsequent studies have not confirmed these data One study reported a greater desquamation index in white subjects38 Another study reported no difference in the desquamation index between black and white patients45 The data on the differences in spontaneous corneocyte desquamation between these populations remain unclear
cadaveric skin may not reflect in vivo absorption Thus, the data regarding percutaneous absorption in skin of color are inconclusive
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