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

1995;131(10):1134-8. PubMed PMID: 7574829.
6. Thomson ML. Relative efficiency of pigment and horny layer thickness in protecting the skin of Europeans and Africans against solar ultraviolet radiation. J Physiol. 1955;127(2):236-46. doi: 10.1113/jphysiol.1955.sp005252. PubMed PMID: 14354667; PubMed Central PMCID: PMCPMC1365770.
7. Weigand DA, Haygood C, Gaylor JR. Cell layers and density of Negro and Caucasian stratum corneum. J Invest Dermatol. 1974;62(6):563-8. doi: 10.1111/1523-1747.ep12679412. PubMed PMID: 4835777.
8. Whitmore SE, Sago NJ. Caliper-measured skin thickness is similar in white and black women. J Am Acad Dermatol. 2000;42(1 Pt 1):76-9. doi: 10.1016/ s0190-9622(00)90012-4. PubMed PMID: 10607323.
9. Muizzuddin N, Hellemans L, Van Overloop L, et al. Structural and functional differences in barrier properties of African American, Caucasian and East Asian skin. J Dermatol Sci. 2010;59(2):123-8. doi: 10.1016/j. jdermsci.2010.06.003. PubMed PMID: 20654785.
10. Corcuff P, Lotte C, Rougier A, Maibach HI. Racial differences in corneocytes. A comparison between Black, white and oriental skin. Acta Derm Venereol. 1991;71(2):146-8. PubMed PMID: 1675524.
11. Warrier AG, Harper RA, Bowman J, Wickett RR. A comparison of black and white skin using noninvasive methods. J Cosmet Sci. 1996(47):229-40.
12. Manuskiatti W, Schwindt DA, Maibach HI. Influence of age, anatomic site and race on skin roughness and scaliness. Dermatology. 1998;196(4):401-7. doi: 10.1159/000017932. PubMed PMID: 9669115.
13. Grimes P, Edison BL, Green BA, Wildnauer RH. Evaluation of inherent differences between African American and white skin surface properties using subjective and objective measures. Cutis. 2004;73(6):392-6. PubMed PMID: 15224783.
14. Berardesca E, Pirot F, Singh M, Maibach H. Differences in stratum corneum pH gradient when comparing white Caucasian and black African-American skin. Br J Dermatol. 1998;139(5):855-7. doi: 10.1046/j.1365-2133.1998.02513.x. PubMed PMID: 9892954.
15. Young MM, Franken A, du Plessis JL. Transepidermal water loss, stratum corneum hydration, and skin surface pH of female African and Caucasian nursing students. Skin Res Technol. 2019;25(1):88-95. doi: 10.1111/srt.12614. PubMed PMID: 30028039.
16. Williams HC, Pembroke AC, Forsdyke H, et al. London-born black Caribbean children are at increased risk of atopic dermatitis. J Am Acad Dermatol. 1995;32(2 Pt 1):212-7. doi: 10.1016/0190-9622(95)90128-0. PubMed PMID: 7829705.
17. Fu T, Keiser E, Linos E, et al. Eczema and sensitization to common allergens in the United States: a multiethnic, population-based study. Pediatr Dermatol. 2014;31(1):21-6. doi: 10.1111/pde.12237. PubMed PMID: 24283549.
18. Shaw TE, Currie GP, Koudelka CW, Simpson EL. Eczema prevalence in the United States: data from the 2003 National Survey of Children's Health. J Invest Dermatol. 2011;131(1):67-73. doi: 10.1038/jid.2010.251. PubMed PMID: 20739951; PubMed Central PMCID: PMCPMC3130508.
19. Ben-Gashir MA, Hay RJ. Reliance on erythema scores may mask severe atopic dermatitis in black children compared with their white counterparts. Br J Dermatol. 2002;147(5):920-5. doi: 10.1046/j.1365-2133.2002.04965.x. PubMed PMID: 12410701.
20. McColl M, Boozalis E, Aguh C, Eseonu AC, Okoye GA, Kwatra SG. Pruritus in black Skin: Unique Molecular Characteristics and Clinical Features. J Nat Med Assn. 2020. doi: 10.1016/j.jnma.2020.07.002. PubMed PMID: 32747312.
21. Whang KA, Khanna R, Thomas J, Aguh C, Kwatra SG. Racial and Gender Differences in the Presentation of Pruritus. Medicines (Basel). 2019;6(4). doi: 10.3390/medicines6040098. PubMed PMID: 31569651; PubMed Central PMCID: PMCPMC6963580.
22. Shaw FM, Luk KMH, Chen KH, Wrenn G, Chen SC. Racial disparities in the impact of chronic pruritus: A cross-sectional study on quality of life and resource utilization in United States veterans. J Am Acad Dermatol. 2017;77(1):63-9. doi: 10.1016/j.jaad.2017.01.016. PubMed PMID: 28365042.
23. Mekic S, Jacobs LC, Gunn DA, et al. Prevalence and determinants for xerosis cutis in the middle-aged and elderly population: A cross-sectional study. J Am Acad Dermatol. 2019;81(4):963-9 e2. doi: 10.1016/j.jaad.2018.12.038. PubMed PMID: 30586613.
24. Taylor SC. Skin of color: biology, structure, function, and implications for dermatologic disease. J Am Acad Dermatol. 2002;46(2 Suppl Understanding):S41-62. doi: 10.1067/mjd.2002.120790. PubMed PMID: 11807469.
25. Palmer CN, Irvine AD, Terron-Kwiatkowski A, et al. Common loss of function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet. 2006;38:441-446.
26. Margolis DJ, Apter AJ, Gupta J et al. The persistence of atopic dermatitis and filaggrin (FLG) mutations in a US longitudinal cohort. J Allergy Clin Immunol. 2012; 130:912–917.
27. Zhang H, Guo Y, Wang W et al. Mutations in the filaggrin gene in Han Chinese patients with atopic dermatitis. Allergy. 2011;66:420–427.
28. Nomura T, Akiyama M, Sandilands A et al. Specific filaggrin mutations cause ichthyosis vulgaris and are significantly associated with atopic dermatitis in Japan. J Invest Dermatol. 2008;128:1436–1441.
29. Cascella R, Foti Cuzzola V, Lepre T et al. Full sequencing of the FLG gene in Italian patients with atopic eczema: evidence of new mutations, but lack of an association. J Invest Dermatol. 2011;131:982–984.
30. Howell MD, Kim BE, Gao P et al. Cytokine modulation of atopic dermatitis filaggrin skin expression. J Allergy Clin Immuno. 2007;120:150–155.
31. Gao PS, Rafaels NM, Hand T et al. Filaggrin mutations that confer risk of atopic dermatitis confer greater risk for eczema herpeticum. J Allergy Clin Immunol. 2009;124:507–513.
32. Winge MC, Bilcha KD, Lieden A et al. Novel filaggrin mutation but no other loss-of-function variants found in Ethiopian patients with atopic dermatitis. Br J Dermatol. 2011;165:1074–1080.
33. Berardesca E, Maibach HI. Racial differences in sodium lauryl sulphate induced cutaneous irritation: black and white. Contact Dermatitis. 1988;18(2):65-70.
34. N. Luther M.E. Darvin W. Sterry J. Lademann A. Patzelt. Ethnic Differences in Skin Physiology, Hair Follicle Morphology and Follicular Penetration. Skin Pharmacol Physiol. 2012;25:182–191
35. Johnson LC, Corah NL. Racial Differences in Skin Resistance. Science. 1963;139(3556):766-767.
36. Kompaore F, Marty JP, Dupont C. In vivo evaluation of the stratum corneum barrier function in blacks, Caucasians and Asians with two noninvasive methods. Skin Pharmacol. 1993;6(3):200-207.
37. Sugino K, Imokawa G, Maibach H. Ethnic difference of stratum corneum lipid in relation to stratum corneum. J Invest Dermatol. 1993;100:587-597.
38. Wilson D, Berardesca E, Maibach HI. In vitro transepidermal water loss: differences between black and white human skin. Br J Dermatol. 1988;119(5):647-652.
39. Pinnagoda J, Tupker RA, Agner T, Serup J. Guidelines for transepidermal water loss (TEWL) measurement. A report from the Standardization Group of the European Society of Contact Dermatitis. Contact Dermatitis. 1990;22(3):164-178.
40. Berardesca E, de Rigal J, Leveque JL, Maibach HI. In vivo biophysical characterization of skin physiological differences in races. Dermatologica. 1991;182(2):89-93.
41. De Luca R, Balestrieri A, Dinle Y. [Measurement of cutaneous evaporation. 6. Cutaneous water loss in the people of Somalia]. Boll Soc Ital Biol Sper. 1983;59(10):1499-1501.
42. Reinertson RP, Wheatley VR. Studies on the chemical composition of human epidermal lipids. J Invest Dermatol. 1959;32(1):49-59. 43. La Ruche G, Cesarini JP. [Histology and physiology of black skin]. Ann Dermatol Venereol. 1992;119(8):567-574.
44. Hellemans L. Characterization of stratum corneum properties in human subjects from a different ethnic background. J Invest Dermatol. 2005;124(S4):A62.
45. Jungersted JM, H gh JK, Hellgren LI, Jemec GB, Agner T. Ethnicity and stratum corneum ceramides. Br J Dermatol. 2010;163(6):1169-1173.
46. Whang KA, Khanna R, Thomas J, Aguh C, Kwatra SG. Racial and Gender Differences in the Presentation of Pruritus. Medicines (Basel). 2019 Sep 27;6(4):98. doi: 10.3390/medicines6040098. PMID: 31569651; PMCID: PMC6963580.
47. Sueki H, Whitaker‐Menezes D, Kligman AM. "Structural diversity of mast cell granules in black and white skin." Br J Dermatol. 144.1 (2001): 85-93.
48. Larson VA, Tang O, St nder S, Kang S, Kwatra SG. Association between itch and cancer in 16,925 patients with pruritus: Experience at a tertiary care center. J Am Acad Dermatol. 2019Apr;80(4):931-937. doi: 10.1016/j.jaad.2018.08.044. Epub 2018 Sep 11. PMID: 30217520; PMCID: PMC6907086.
49. See JA, Goh CL, Hayashi N, Suh DH, Casintahan FA. Optimizing the use of topical retinoids in Asian acne patients. J Dermatol. 2018;45(5):522-528.
50. Rawlings AV. Ethnic skin types: are there differences in skin structure and function? Int J Cosmet Sci. 2006;28(2):79-93.
51. Aramaki J, Kawana S, Effendy I, Happle R, Loffler H. Differences of skin irritation between Japanese and European women. Br J Dermatol. 2002;146(6):1052-1056.
52. Wan DC, Wong VW, Longaker MT, Yang GP, Wei FC. Moisturizing different racial skin types. J Clin Aesthet Dermatol. 2014;7(6):25-32.

AUTHOR CORRESPONDENCE

Anneke Andriessen PhD anneke.a@tiscali.nl