Pediatric Dermatology in Patients with Skin of Colour

Pediatric patients with skin of colour, which refers to individuals with Fitzpatrick skin types III through VI, comprise many racial and ethnic groups, including but not limited to Africans, African Americans, Asians, Native Americans, Hispanics, and Latinos. In a recently updated review, researchers have reported that common diagnoses in pediatric dermatology may have unique clinical features in patients with skin of colour. The findings were published in the journal Dermatologic Clinics in the January 2022 issue.

Children with skin of colour represent a large proportion of the pediatric population. It is critical to recognize the vast and unique clinical presentations and treatment challenges of this growing population. Therefore, Dr. Candice Heath and her team discussed common dermatologic diagnoses in children with skin of colour, including:

• Transient Neonatal Pustular Melanosis
• Atopic Dermatitis (AD)
• Acne
• Vitiligo
• Traction Alopecia (TD)

Transient Neonatal Pustular Melanosis

With regards to transient neonatal pustular melanosis, they wrote, "Transient neonatal pustular melanosis occurs in up to 4% of neonates and has been reported to occur more commonly in infants and toddlers with a skin of colour." These children are presented with pustules, vesicles, papules, collarettes of scale, and hyperpigmented macules involving the head, lower trunk, and/or extremities otherwise healthy.

They wrote, "Although the eruption may persist for several months to a few years before complete resolution, unless symptomatic, treatment is not necessary. Gentle skincare may be used as supportive therapy. As with most conditions in skin of colour, the associated dyspigmentation may persist long beyond the active inflammatory process."

Atopic Dermatitis

Regarding atopic dermatitis in pediatric patients with skin of colour, they noted that it may present with follicular prominence or papular morphology with violaceous erythema.

Traction Alopecia

Concerning traction alopecia, they noted that it is most commonly seen in patients of black or African ancestry, who are more likely to wear hairstyles that tightly pull the hair shaft like braids, cornrows, and locs.

They wrote, "Traction alopecia is biphasic alopecia. Initially, it is reversible with early intervention and permanently scarring in later stages. Hairstyle modification during childhood can prevent devastating future permanent hair loss."

Acne

Acne is one of the most common dermatologic conditions in both children and adults worldwide. Regarding acne, they noted that the reactive inflammation of these units can result in papules, pustules, comedones, nodules, or a combination. Patients with skin of colour present with dark spots or marks. So, instead of treating dark spots/marks, the authors recommend treating the underlying acne.

Vitiligo

Vitiligo is an autoimmune condition in which melanocytes are rendered ineffective under cytotoxic T-cell attacks. They noted that the patient's intrinsic background pigmentation does not usually make clinical detection challenging in darker skin types, given the ready contrast between pigmented and depigmented areas.

Key Take-Aways

• When there is increased suspicion for contact allergy, they recommend referring for or performing patch testing.
• They noted that awareness of distinct clinical features in patients with skin of colour can improve outcomes for these patients.
• They further noted insight into socioeconomic factors contributing to disease incidence and treatment feasibility can inform clinical practice.
• They highlighted that common diagnoses in pediatric dermatology may have unique clinical features in patients with skin of colour.

The authors concluded, "Pediatric patients represent an important and unique subset of the population of the skin of colour. Although similar conditions present across all spectrums of skin colour in childhood and adolescence, varying morphologies exist based on background skin tone; such variance may delay diagnosis. Melanocyte biology, socioeconomic factors, such as urban residence, and cultural practices, for example, based on hair texture, may be linked directly to such presentations."

For Further Information

DOI: https://doi.org/10.1016/j.det.2021.09.002