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Am Fam Physician. 2023;107(1):26-34

Related editorial: Improving Diversity, Equity, and Inclusion in AFP

Patient information: See related handout on common skin conditions in skin of color.

Published online October 12, 2022.

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Individuals with skin of color represent a diverse population of racial and ethnic backgrounds, including but not limited to Black or African American, American Indian or Alaska Native, Asian American or Pacific Islander, Hispanic or Latino, and Middle Eastern or North African. Dermatologic health disparities exist in part because of systemic racism and are exacerbated by inadequate physician training and a lack of high-quality research on skin diagnoses that disproportionately affect people with skin of color. These conditions, which include postinflammatory hyperpigmentation, keloids, dermatosis papulosa nigra, pseudofolliculitis barbae, and acne keloidalis nuchae, are usually diagnosed clinically and not associated with an underlying systemic disease. They can have significant impacts on mental health and quality of life and are often underdiagnosed or undertreated in skin of color. Hydroquinone 4% is considered the standard treatment for postinflammatory hyperpigmentation. Standard treatment for keloids includes combination intralesional therapy with triamcinolone and fluorouracil. If treatment is preferred for dermatosis papulosa nigra, options include scissor excision, cryotherapy, curettage, electrodesiccation, and laser therapies. Shaving cessation is the best initial treatment for pseudofolliculitis barbae. Individuals with acne keloidalis nuchae should avoid frequent close shaves or short haircuts on the nuchal area of the scalp.

Individuals with skin of color make up 40.9% of the U.S. population, and this is expected to increase to 59.5% by 2060.1 Skin conditions account for 12.4% of all diagnoses seen by family physicians,212 highlighting the importance of educating physicians on common dermatologic conditions in skin of color (Table 1310,13,14). Although other skin conditions such as atopic dermatitis, psoriasis, and cellulitis can present differently in skin of color, this article focuses on five common diagnoses that disproportionately affect this population and can have a substantial impact on mental health and quality of life: postinflammatory hyperpigmentation, keloids, dermatosis papulosa nigra, pseudofolliculitis barbae, and acne keloidalis nuchae.

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