Influence of Culture and Pigment on Skin Conditions in Children

James G. Dinulos; Elinor A. Graham

doi:10.1542/pir.19-8-268

This article has a correction. Please see:

Errata - November 01, 1998

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James G. Dinulos, MD^*
Elinor A. Graham, MD, MPH^†

^*Department of Medicine, Division of Dermatology.
^†Departments of Pediatrics, University of Washington, Seattle, WA.

IMPORTANT POINTS

Superficial inflammatory skin conditions commonly appear different in dark skin because of exaggeration of normal cutaneous reaction patterns.
Dyspigmentation from skin inflammation or injury may result in permanent color changes. Prompt diagnosis and appropriate management can modify adverse cosmetic outcomes from pigment changes.
Several skin conditions are more common in children who have dark skin, and common disorders such as atopic dermatitis and pityriasis rosea may have different presentations.
All patients who have dark skin should be counseled about the potential pigmentary changes that can occur with all classes of topical steroids. However, conditions that produce intense inflammation should be treated with appropriate-strength steroid to attempt to minimize long-lasting pigmentary changes.

Introduction

Many common skin disorders manifest themselves differently in children who have dark skin. This altered appearance is thought to occur in part because of exaggerated cutaneous reaction patterns to internal and external influences. Normal variations in pigment may be confused with bruises or disease. People from various cultures alter their skin as part of healing and grooming practices. Knowledge of the appearance of common skin disorders in dark skin, normal variations, and unique cultural skin manipulations is vital to the diagnosis and management of skin conditions in this group of patients. Excellent recent reviews have been published in the dermatology literature on this subject (see Suggested Reading).

This review outlines distinctive reaction patterns, the common skin conditions affected by them, and suggestions for effective management. We also discuss common cultural practices and non-Western healing techniques that result in unique skin findings.

Cutaneous Reaction Patterns

Pigment lability, follicular response, and mesenchymal response are three primary cutaneous reactions responsible for the altered appearance of common skin disorders in children who have dark skin. They represent normal cutaneous responses that are seen in all skin types, although they are exaggerated in many children who have …