Keloids are scars, unique to humans, that grow beyond the boundaries of a cutaneous
injury, inflammation, burn, or surgical incision. Although benign, keloids are often aesthetically
malignant. The etiology of keloids is uncertain. However, we do know that they occur
more often in African-American and Asian than Caucasian patients. There is no one
therapeutic modality that either prevents the formation of keloids or treats active or inactive
lesions. Consequently, there are many therapeutic options. In this review, an approach to
medical and surgical management of keloids is provided, as well as a review of experimental
Semin Cutan Med Surg 28:71-76 © 2009 Published by Elsevier Inc.
The demographics of the United States continue to evolve, with a growing proportion of the
population consisting of non-Caucasian racial and ethnic groups. As darker skin types
become more prevalent, so will the need to better understand their skin, the conditions that
affect it, and optimal approaches for treatment. This population poses a special challenge
for practitioners in part as a result of the sequelae often associated with the conditions in
their own right—postinflammatory hyperpigmentation and scarring—and potential iatrogenic
adverse effects that may occur during treatment. Through careful consideration of
cultural, clinical, and therapeutic nuances, safe and effective management of common
disorders in skin of color is achievable.
Semin Cutan Med Surg 28:63-70 © 2009 Elsevier Inc. All rights reserved.
Dyschromias, in particular hyperpigmentation, are major issues of concern for people of
color. Pigmentary disorders such as melasma and postinflammatory hyperpigmentation
(PIH) can cause psychological and emotional distress and can pose a negative impact on
a person’s health-related quality of life. The precise etiology of these conditions is unknown.
Therapies for melasma and PIH target various points during the cycle of melanin
production and degradation. Therapies for these conditions include topical agents and
resurfacing procedures. Hydroquinone remains the gold standard of topical agents. Other
efficacious agents include kojic acid, azelaic acid, mequinol, and retinoids. Cosmeceutical
agents include licorice, arbutin, soy, N-acetyl glucosamine, and niacinamide. Resurfacing
procedures that have been used to treat melasma and PIH include chemical peels, microdermabrasion,
lasers, and intense pulsed light. These procedures are best used in combination
with topical bleaching agents. Given the propensity of darker skin to hyperpigment,
resurfacing procedures should be used with care and caution. Maximal results are best
achieved with repetitive, superficial, resurfacing modalities. In addition, ultraviolet protective
measures such as broad-spectrum sunscreens are fundamental to the successful
management of these conditions.
Semin Cutan Med Surg 28:77-85 © 2009 Elsevier Inc. All rights reserved.
Vitiligo is an acquired dyschromia of the skin in which there is a loss of epidermal
melanocytes. The prevalence of vitiligo is approximately 1% in the United States and
0.1-2% worldwide. The exact pathogenesis of vitiligo remains elusive and is likely multifactorial.
After completing this update, participants should be able to discuss the epidemiology
of vitiligo and summarize the proposed mechanisms for development of this
disease. In addition, they should be able to discuss physical findings, approach to the
patient, and some of the therapeutic modalities for this disorder.
Semin Cutan Med Surg 28:86-92 © 2009 Elsevier Inc. All rights reserved.
Skin cancer is the most common form of cancer in the United States. Although skin cancer
is less common in persons of color than in Caucasians, the rates of morbidity and mortality
associated with skin cancer often are significantly greater in darker-skinned ethnic groups.
This article reviews special considerations in the approach and management of nonmelanoma
skin cancer in patients of color.
Semin Cutan Med Surg 28:93-95 © 2009 Elsevier Inc. All rights reserved.