Dermis: Overall Architecture in .NET

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Dermis: Overall Architecture
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In a comparison of black and white facial skin, dermal differences are evident Some of these changes are related to UV damage and include decreased elastosis in black skin23 Other differences appear to be primary variations in the fibroblasts, macrophages, and giant cells In one study, black skin was reported to contain more fiber fragments composed of collagen fibrils and glycoproteins Fibroblasts were more numerous and larger in size They were frequently binucleated and multinucleated Additionally, there were more binucleated and multinucleated macrophages and giant cells23 The changes described in fibroblasts are especially significant in skin of color because of the increased risk of keloids and scarring in these patients Other differences in dermal structures reported between the races are described below23 ECCRINE GLANDS Research on ethnic differences in eccrine sweat glands is contradictory Of the four studies measuring sweat production in black and white subjects, two reported decreased sweating in black subjects and two reported no difference86 89 Four other studies have measured resistance to indirectly assess eccrine gland activity They have shown increased resistance in darker-skinned patients, which suggests increased eccrine gland activity46,90 92 Based on these studies, no conclusion can be made on eccrine gland activity between different ethnic groups APOCRINE GLANDS Research on ethnic differences in apocrine glands is limited Two small nonblinded studies suggest that apocrine glands are larger in black subjects93,94 One larger histologic analysis reported that apocrine glands are more numerous in black skin90 Based on
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Clinical Findings
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The clinical signs of aging in skin of color have been described In a study of French Caucasian and Chinese subjects, wrinkle onset was delayed by approximately 10 years in Chinese women Hyperpigmentation was a much more important sign of aging in Chinese women83 In a study of Japanese and Caucasian patients, young Japanese patients had significantly lower wrinkle scores The sagging score was also significantly lower in Japanese subjects older than 40 years when compared with Caucasian subjects Lower face aging was more common in Caucasian subjects84 In African Americans, the clinical signs of aging are less pronounced and tend to be delayed at least a decade when compared to Caucasian skin Many patients complain of dark circles and hollowing beneath the eyes, while others experience lower eyelid bags Lower-eyelid signs of aging usually start with midface aging during the 30s In midface aging, the malar fat pad descends from its location overlying the infraorbital rim and accumulates along the nasolabial fold This can lead to a hollowed appearance beneath the eyes and an apparent deepening of the nasolablial fold85 It is important to note that these changes occur with intrinsic aging and are less related to photodamage Photoaging in darker skin is manifested primarily by uneven pigmentation, which is one of the most common cosmetic complaints in skin of color The presence of seborrheic keratosis and der-
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Histologic Findings
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Despite the photoprotection conferred by darker skin, chronologic aging has
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these data, apocrine glands may be increased in black individuals APOCRINE-ECCRINE GLANDS Apocrineeccrine sweat glands have features of both eccrine and apocrine glands One study of facial skin reported more numerous apocrine-eccrine glands in black skin when compared to white skin23 SEBACEOUS GLANDS Studies of sebaceous glands and sebaceous gland activity reveal contradictory findings One study reported increased sebaceous gland size in black patients95 Another study reported increased sebum production in black patients96 Three studies indicated no difference in sebaceous gland activity between black and white subjects37,97,98 Research in Japanese subjects, however, found a correlation between skin surface lipids and increased pigmentation78 (see 10) HAIR Hair composition and structure has been studied between the races There is no difference in keratin between black and white subjects 99 One study has shown some differences in amino acid composition; however, a follow-up study demonstrated no difference100,101 Vellus hair follicular density has been studied in African American, Asian, and Caucasian subjects It has been proposed that vellus hair follicles are a potential reservoir for topically applied substances Vellus follicular hair density was lower in African Americans and Asians when compared to white subjects The authors suggested that this difference may impact skin absorption in different ethnic groups102 Differences in terminal hair structure between the races have been well studied and are described below AFRICAN HAIR In subjects of African descent, four distinct hair types are recognized: straight, wavy, helical, and spiral The spiral hair type is the most common subtype103 African hair has a flattened elliptical shape in cross-section with a ribbon-like appearance104 The hair is typically coiled tightly, and most naturally shed hairs have a frayed tip Spontaneous knotting is often seen Longitudinal splitting, fissures, and breaking of the hair shaft are also observed105 Other studies of black hair have revealed that black subjects had fewer elastic fibrils anchoring the hair to the dermis23 This has implications in several forms of alopecia frequently seen in
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black patients, particularly traction alopecia Additionally, there is decreased hair density in African American subjects when compared to white subjects106 CAUCASIAN HAIR Caucasian hair is typically straight or slightly curved The hair is elliptical in cross-section It has the smallest cross-sectional area among ethnic groups and naturally shed hairs usually have the original or cut tip104 Spontaneous knotting is rarely observed105 ASIAN HAIR Asian hair is typically straight The hair is round in crosssection It has the largest cross-sectional area and naturally shed hairs usually have original or cut tips104 No spontaneous knotting is observed105
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