Clinical Observations

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Clinically, acute contact dermatitis occurs more commonly in whites than in blacks (1). Blacks, however, develop disorders of pigmentation and lichenifica-tion more often than whites. Hyperpigmentation is thought to occur more readily in black patients after contact with mild irritants. These data suggest that there are ethnic/racial predispositions to certain skin conditions.

Qualitatively, it has been noted that vulvar appearance in dark-skinned blacks and Hispanics is somewhat different from fair-skinned patients with atopic dermatitis and neurodermatitis (7). The erythema is masked by the dark skin color, leading examiners to underestimate the severity of the inflammatory process. Lichenification is often exaggerated and postinflammatory hyper-pigmentation is always present (24). Wesley and Maibach (2) concluded that differences exist, but that much remains to be done to clarify extent, mechanisms, and clinical relevance.

Racial (ethnic) differences in the skin of the vulva are likely to exist, considering such differences in other areas of the body. Given reasonable evidence of objective studies supporting differences in the skin function and physiology among ethnicities/races in general, it is likely that such difference also exists in regard to the skin of vulva, in particular. Racial hair differences are dramatic and unquestioned (25).

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