Treating skin of color

Conclusion of a 4-part column




Most skin diseases occur in people of all nationalities, regardless of their skin color. Certain problems encountered in the skin are more common in people with different hues of skin, and sometimes a disorder seems more prominent because it affects skin color. This week concludes our review of these disorders and their treatments.



Tinea capitis

Tinea capitis, also known as ringworm, is endemic in African American children. Any child with a scaling, itching scalp should be thoroughly investigated for tinea capitis. One of the clues to this is enlarged lymph nodes in the nape of the neck.

I recommend a topical anti-itch/anti-inflammatory lotion in addition to an oral antifungal agent. No matter what agent is used, it is important that treatment occurs for at least eight weeks at a somewhat high dose, as advised by a board-certified dermatologist.

It is also recommended that all objects that touch the hair, such as combs, barrettes, rubber bands and pillowcases, be replaced or treated to prevent re-infection.

I also advise all members of the household to use an anti-fungal shampoo throughout the treatment period for two months. This is a very common, yet easily treatable condition in young children. I believe that as people get older, the milieu of the sebum in the scalp changes, preventing an active infection. However, many adults can be carriers and pass it to their children, who are prone to the infection.

Melanonychia striata
Melanonychia striata


Melanonychia striata

This is a condition where brown to black longitudinal bands occur in many, if not all, fingernails and toenails. This is a common, benign condition that is often seen in multiple family members. However, if one band should occur spontaneously without a family history, this should be evaluated for an underlying mole or melanocytic malignancy.


Voigt or Futcher lines

These are lines seen most commonly on the upper arms and sometimes thighs and are normal variations. They were named after a physician and anatomist who first described these near the turn of the century. They are harmless and only reassurance need be given.


Mongolian spots

These are slightly grey, round patches seen on the lower back and buttocks of children of color. These are harmless and represent a failure of migration of melanocytes during fetal development.

The vast majority, if not all, of these will resolve by adolescence. A similar process can be seen on the cheeks and the sclerae (whites of the eyes), known as nevus of Ito and nevus of Ota.


Midline hypopigmentation

Often the central chest area can be slightly lighter than other parts of the area, and this too is a normal variation in pigment of the skin.


Pityriasis rosea

Pruritic rosea is a very mild skin eruption that most likely represents a cutaneous skin reaction to a very mild viral infection. In Caucasian skin, oval patches with mild scaling can appear, almost like a spruce-tree pattern on the back. In approximately half, if not more, of all cases, one large lesion known as the “herald patch” precedes all the other lesions by one to two weeks.

In pigmented skin, however, the lesions tend to be more bumpy and not necessarily flat and oval. Histologically, the condition is the same in all skin but the variation in different skin colors can be confusing when it comes to the diagnosis.

Pityriasis rosea usually runs its course in two to six months and is treated with only reassurance unless it is bothersome. At that point, topical anti-inflammatory lotions and phototherapy can be quite effective.


Lichen nitidus

Lichen nitidus is a common, small, bumpy eruption that can occur on the abdomen of children of color. It can also occur quite extensively involving the legs, arms and face.

Unless the lesions are bothersome, most children will outgrow these by their adolescent years, and they are usually of no consequence. If they are bothersome, topical anti-inflammatory ointments, creams and lotions can be used with good results.


Traction alopecia

Hair that is braided tightly can actually produce hair loss in children. This occurs in a classic pattern that can be easily detected. If a small child has hair loss, hair-care patterns should be reviewed. In addition, if the hair loss is occurring in areas of traction or pressure from braiding, these practices should be modified, and the hair re-growth should occur in a few months.


It is important to remember that no matter what the skincare concern, there is almost always a way to improve the condition.


Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians,