Racial/Ethnic Variations in Skin Barrier: Implications for Skin Care Recommendations in Skin of Color

September 2021 | Volume 20 | Issue 9 | Original Article | 932 | Copyright © September 2021


Published online August 31, 2021

Andrew F. Alexis MD MPHa*, Heather Woolery-Lloyd MD FAADb*, Kiyanna Williams MD FAADc, Anneke Andriessen PhDd, Seemal Desai MD FAADe, George Han MD FAADf, Maritza Perez MD FAADg, Wendy Roberts MD FAADh, Susan Taylor MD FAADi

aWeill Cornell Medicine, New York, NY
bSkin of Color Division, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, FL
cSkin of Color Section, Department of Dermatology, Cleveland Clinic, Cleveland, OH
dRadboud UMC Nijmegen, Andriessen Consultants, Malden, NL
eDepartment of Dermatology, The University of Texas Southwestern Medical Center, Innovative Dermatology, PA, Dallas, TX
fDepartment of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
gDepartment of Dermatology, University of Connecticut School of Medicine New Canaan, CT
hGeneral and Cosmetic Dermatology, Rancho Mirage, CA
iSandra J Lazarus, Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA Wynnewood, PA

*co-first authors

Abstract
Background: Genetic and environmental factors influence stratum corneum (SC) barrier properties and function. Researchers increasingly focus on biophysical studies that may help clinicians provide their patients with an informed choice on tailormade skincare. This literature review on skin barrier properties comparing different ethnic populations aims to offer insights into the information's clinical relevance.
Methods: A literature review followed by panel discussions and an online review process aimed to answer the questions: Are there racial/ethnic differences in the SC barrier structure and healthy skin barrier function? Is there a need for specific cleansers and moisturizers?
Results: Ethnic categories based on race and ethnicity are often not well defined and inconsistent across different studies. Studies comparing ethnic groups' physical and biochemical skin barrier properties have reported differences in transepidermal water loss (TEWL), skin lipid levels, pH, and mast cell granule size. However, these studies frequently had methodological flaws, mainly were small, and demonstrated conflicting results. The literature suggests racial/ethnic variations in ceramide content, SC structure, and filaggrin mutations. Furthermore, studies have shown a greater burden of pruritus and atopic dermatitis among Black populations. Data on barrier properties in Hispanic/LatinX and South Asian populations are lacking.
Conclusion: Robust comparative studies are needed to understand these basic concepts to help tailor skincare and skin of color patients' education.

J Drugs Dermatol. 2021;20(9):932-938. doi:10.36849/JDD.6312

INTRODUCTION

While multiple studies have identified variations in skin barrier properties between different racial/ethnic populations, the clinical relevance of these findings have not been established.1-3 This project sought to help clarify the existing published data and provide consensus statements on variations in skin barrier properties that may be observed in populations with skin of color. We assembled a group of dermatologists with expertise in skin of color to examine the data and summarize the findings.

MATERIALS AND METHODS

A panel comprised of seven dermatologists from the US (the authors) convened a virtual meeting on October 10, 2020, to address the following questions using a modified Delphi process: 1) Are there racial/ethnic differences in skin barrier structure and function? 2) Is there a need for specialized approaches to skincare in patients with skin of color? Statements intended for healthcare providers caring for diverse patients and clinician-researchers were developed based on available literature and the panel's expert opinion.