Conclusion

Evidence supports black skin having a higher TEWL, greater variable blood vessel reactivity, decreased skin surface pH, and larger mast cell granules than white skin. Although differences exist in water content, corneocyte desquamation, elastic recovery/extensibility, lipid content, and skin microflora, they are inconclusive (Table 11). Further evaluation of Asians and Hispanics is needed for a better understanding and less conflicting results.

It is known that the vulva is more permeable than the exposed skin due to its structure, hydration, occlusion, and susceptibility to friction. Future studies in

Table 10

Mast Cell Granules

Reference

Technique

Subjects

Site

Results

(23)

(mean age 29.2 + 3); Caucasian men (4) (mean age 29.4 + 1.2)

Medial-lateral buttock

• Mast cells contain 1.5x larger granules in black skin compared to white skin (P < 0.0001)

• Mast cells contain 15% more PLS in blacks compared to whites (P < 0.05)

• Mast cells contain 30% less curved lamellae in blacks compared to whites (P < 0.05)

• Tryptase immunoreactivity localized to PLS regions in black skin, compared to curved lamellae regions in white skin (P < 0.0001)

• Cathepsin G localized to electron-dense amorphous subregions in both black and white skin

Abbreviations'. EM, electron microscopy; PLS, parallel-linear striations. Source: Adapted from Ref. 2.

Abbreviations'. EM, electron microscopy; PLS, parallel-linear striations. Source: Adapted from Ref. 2.

Table 11 Conclusions

Evidence supports

Insufficient evidence for

Inconclusive

TEWL black > white skin Variable racial blood vessel reactivity pH black < white skin Larger mast cell granules, increased PLS, and increased tryptase localized to PLS in black compared to white skin

• Deductions regarding Asian and Hispanic skin

Racial differences in:

• Skin elastic recovery/extensibility

• Skin microflora

Racial differences in:

• Water content

• Corneocyte desquamation

• Lipid content

Abbreviations'. TEWL, transepidermal water loss; PLS, parallel-linear striations. Source: Adapted from Ref. 2.

Table 12 Considerations for Future Research of Racial Skin Differences

• Baseline versus "stress" test differences

• Anatomic site examined

• Open versus occluded stresses

• Ethnic groups in the same versus varying geography

• Comparable climatic conditions

• Presentation of hard data and statistical analysis

• Larger sample sizes

• Relationship of study parameters to degree of pigmentation

• Definition of ethnicity/race

• Comparable diets (e.g., controlled diets)

• Socioeconomic factors

• Prior dermatologic disease

Skin care prior to study

• Body mass relationship

Source: Adapted from Ref. 2.

dermatology should address such differences by studying vulvar skin directly (Table 12). We suggest using objective techniques similar to those listed in Table 1 when studying the vulva. Such studies will be more challenging to perform given the potential difficulty accessing the vulva and collecting objective data, and the potential difficulty in recruiting sufficient numbers of participants to achieve statistical power. A greater understanding of these ethnic/racial differences should lead clinicians to a more effective path toward management.

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