Skin Color Types and Indian Skin Characteristics

Abstract

The color of human skin results from complex mechanisms involving different genes, mainly related to melanin biosynthetic pathway. With its different flows of migration, India presents a wide range of biological diversity. This chapter highlights the uniqueness of Indian skin with its large diversity of color skin tone covering a color scale from very dark to light. Globally skin complexion appears not strongly affected by age compared to other Asian countries with a slight darkening of skin color with age particularly in Southern region.
Skin color heterogeneity appears as a hallmark of Indian skin with an increase in facial skin color eveness with age. This heterogeneity can be explained by an increase in pigmentary disorders, i.e. hyper pigmented spots and spread macules. These disorders occur at early stages and increase with age,contributing to overall facial unevenness. Indian facial skin also presents some original hyperpigmented areas, such as lip corners, marionette lines and nose bridges. In india, dark circles are the most prevalent hyperpigmented areas, darkening with age.

Full text

INTRODUCTION
Dening Indian skin as “Asian skin” or “skin of color”
may lack of accuracy1 although India clearly pertains
to Asia geographically. e Indian population shows a
remarkable diversity with more than two thousand ethnic
groups. In addition, great variations exist in terms of
climate, diet and social parameters within the country. In
this context, Indian skin shows a wide variability in color
as well as some specicities. In particular pigmentary
disorders are a major concern in India; of a great
psychologic impact upon quality of life.2
Surprisingly, very few data are available on skin color
diversities in India. Few studies specically dedicated
to Indian population have been performed to date. is
chapter will mainly focus on a large typological study
conducted in 2011, on 1,204 Indian women from dierent
ages and dierent cities in India, Mumbai, Kolkata,
Chennai and New Delhi.
INSIGHTS ON INDIAN SKIN COLOR BASED ON
GENOME WIDE STUDIES
e evolutionary history of Indian ethnic groups and
subsequent migration from central Asia, west Asia and
southern China has resulted in a rich mosaic of socio-
cultural, linguistic and biological diversities that also
reects in the variety of skin colors present on the Indian
subcontinent. Broadly, Indians belong to Austro-Asiatic
(AA), Tibeto-Burman (TB), Indo-European (IE) and
Dravidian (DR) language families.3 Distinct religious
communities, hierarchical castes and sub-castes, and
isolated tribal groups that comprise the people of India
remain largely endogamous. e most comprehensive
survey of genetic variations in India so far analyzed
405 single nucleotide polymorphisms (SNPs) in 55 groups
and identied distinct clusters correlated to language
and geography.3
Association between human skin color and genetic
factors arose with the nding that zebrash with a
variation in the SLC24A5 gene is a golden color and with
fewer, smaller and lighter melanosomes than normal
zebrash.4 Humans also harbor the SLC24A5 gene and
consulting HapMap, a free publicly accessible database
of human genetic polymorphism, revealed that people
of European ancestry as compared to Africans and East
Asians have slightly dierent versions of the SLC24A5
gene Africans and East Asians. Since, the genetic basis
that underlies normal variation in the pigmentary traits
of skin or hair and eye color has been the object of intense
research aiming at understanding the diversity observed
between and within human populations. Several
approaches were undertaken, such as comparative
genomics of candidate genes, identication of the human
genome under positive selection and the genome-wide
and specic allele association studies. Findings from
these studies point towards independent selection
for dierent pigmentation gene sets between Asian,
European and African populations.5
At phenotypic level, human skin color is largely
determined by two biological components, melanin and
hemoglobin, and one major environmental component,
that is exposure to sun ultraviolet (UV) rays. In East
Chapter 4
Skin Color Types and Indian Skin Characteristics
Virginie Hourblin, L’Oréal Research and Innovation, Aulnay-Sous-Bois, France
Suzy Cointereau-Chardon, L’Oréal Research and Innovation, Chevilly-Larue, France
Namita Misra, L’Oréal Research and Innovation, Mumbai, Maharashtra, India
Frédéric Flament, L’Oréal Research and Innovation, Chevilly-Larue, France
Stéphanie Nouveau, L’Oréal Research and Innovation, Aulnay-Sous-Bois, France
Maya Vedamurthy, RSV Skin and Laser Centre and Apollo Hospitals, Chennai, Tamil Nadu, India
Shyam Verma, Nirvana Skin Clinic, Vadodara, Gujarat, India

|48
Basic Science for Modern Cosmetic Dermatology
Asians, additionally the skin adipose tissue or hypodermis
may provide an additional yellowish tinge. A qualitative
assessment of skin color variations on the Indian
subcontinent represents the variation seen throughout
the world. is is indeed reected by genetic studies on
Indian subpopulations. Four genes account for a major
component of color variation amongst Indians: SCL24A5
(ortholog of zebrash golden), TYR (ortholog of mouse
Albino gene), SLC45A2 (ortholog of mouse Underwhite)
and MC1R.6,7 ese genes have also been implicated in
color variation between Europeans and Africans. Light
skin in Europeans and dark skin in Africans is due to
alternate alleles in the same genes. At least some of the
same alleles responsible for this color dierence between
Europeans and Africans seem being involved in Indians.
e SLC45A2 SNP shows an allelic gradient from north to
south in Europe.5 Does this gradient also exists from North
to South in India is a question of much sense. Indeed, a
distinct genetic divergence is seen between Ancestral
North Indians (ANI) and Ancestral South Indians
(ASI) that may also manifest in skin colors of these two
populations.8 e region around the SLC24A5 gene shows
a considerable reduction in heterozygotes suggesting a
major selective sweep of this light skinned allele through
the population. Light skin in Indians and Central/
Western Eurasians have common origin independent of
those in Asians, especially the contribution of SLC24A5
allele. ese results are more indicative of an ancestral
origin rather than a selection sweep driven by sun UV-
damage. On the other hand, the results also suggest that
in South India and Sri Lanka natural selection may keep
a low frequency of the ‘light alleles’, such as SLC45A2.
us genomic variations associated with pigmentation in
South Asian population reect complex phenomenon of
ancestral origin, migration and environmental factors.
Functional testing of variant alleles is paramount
to connect phenotype correlations with biological
dierences. For instance, variant MC1R alleles show
direct correlations between the biochemical signaling
properties of the encoded receptor and the red-hair
fair skin pigmentation phenotype. Direct testing of
a range of clonal melanocyte cultures derived from
donor skin tissue characterized for three causal SNPs
within SLC45A2, SLC24A5 and OCA2 (blue-brown eye
color) has assessed their impact upon melanin content
and activity of tyrosinase. By culminating genetic and
functional studies, it is apparent that genes that impact
melanosome biogenesis or the melanin biosynthetic
pathway are candidates to explain the diversity seen in
human pigmentation that would also apply to Indian
population.
SKIN COLOR EVALUATION METHODS
Colorimetry is a technology used to quantify color, and
so describe objectively the color perception. It is similar
to spectrophotometry, but is distinguished by its interest
in reducing spectra to the physical correlates of color
perception, most often the CIE 1931 XYZ color space
tristimulus values and related quantities.
To assess and compare skin color in vivo some methods
are available using calibration and standardization
principles. We do not focus here on clinical tools but on
the interest of objective, non-invasive and reproducible
instrumental devices. Globally these instruments can be
divided into two categories: one, such as Chromameter®
or Spectrocolorimeter®, acquires color parameters and
the other quanties color by analyzing digital images in
RGB model.9,10
Chromasphere® (Fig. 1) is a reference tool11,12 for facial
skin color assessment thanks to its stability, reliability and
its capacity to use diuse lighting systems that faithfully
mimic sun natural daylight (CIE illuminant D65). e
whole face is illuminated with a homogeneous light. Such
Figure 1: Chromasphere®
©L’Oreal Research and Innovation

49|
Skin Color Types and Indian Skin Characteristics
a device is contact-free; avoiding any external pressure that
could aect blood ow and induce change in skin color.
Combining Chromasphere® with dierent equipments
allows various color characteristics to be quantied.
Calibrated images can be obtained with charge-
coupled device cameras, avoiding any drift in digital
camera recording and thus allowing the operator to
analyze data with dierent methods. e heterogeneity
of skin color can be then assessed with coxellography
index approach (co-occurrence matrix). Segmentation
and image analysis allow carnation and pigmented spot
areas to be detected and separated to obtain various
parameters. Spots density, size or color could then be
investigated. Meanwhile, colorimetric information is
computed to describe complexion and contrasts between
pigmented spots and surrounding areas.
Skin color can also be measured with a spectro-
radiometer. is kind of device acquires reectance of
skin from 380 nm to 780 nm every 4 nm. e spectrum
recorded on the visible eld (400–700 nm) is expressed
in the CIE 1976 standard colorimetric spaces L*a*b*C*h
D65/10° (Fig. 2).
 e lightness L* uses a grey scale and accounts for
more or less lightness and more or less darkness.
 e a* and b* are the color-opponent dimensions.
ese color axes are based on the fact that a color can
not be both red and green, or both blue and yellow,
because these colors oppose each other. On each axis
the values run from positive to negative. On the a-a’
axis, positive values indicate amounts of red while
negative values indicate amounts of green. On the
b-b’ axis, yellow is positive and blue is negative. For
both axes, zero is neutral grey.
 From the a* and b* values, the angle hue h and the
chroma C* are calculated. e angle hue h correspond
to the angle between the a* and b* axis and is the
colored coordinate. It characterizes the color from
red to yellow within the skin color space.
 e Chroma C* or saturation refers to the pureness or
vividness. It refers to the intensity of the hue.
INDIAN SKIN OVERALL COMPLEXION
Color Skin Tone in India as Compared to
Other Ethnicities
Previous works indicate that skin color of the Indian
population is very diversied,1,13,14 with phototypes III
to VI, types IV and V being predominant.15 Surprisingly,
skin-related typology studies on Indian population
are scarce. A few available papers being devoted to
colorimetric characterization of Indian women skin
and its specicities (age, homogeneities, etc). e
dierences of skin color across India, and its changes
with geographical location were recently investigated.16
In this article skin colors of 1,195 healthy Indian women
from 18 years to 85 years old originating from four cities
were quantied using an objective colorimetric tool,
Chromasphere®. Results showed a wide diversity of skin
color within Indian women: the population covers a large
range of skin colors, from very dark to light (Fig. 3).
e skin color of women from other ethnicities
was previously evaluated12,17,18 revealing a worldwide
continuum of skin color. e projection of Indian skin
Figure 2: CIE L*a*b* and L*C*h color space

|50
Basic Science for Modern Cosmetic Dermatology
color space in this continuum is closed to the one of
African women and women from African descent but
with a larger range of lightness (Fig. 3). e Indian skin
color space indeed overlaps those of Asian and Hispanic
women. is data highlights the wide diversity of skin
color in India as compared to other ethnicities.
Variation of Skin Color Tone within India:
Differences Depending on Geographical
Localization
Considering the diversity of climate/environment in
India, the impact of geographical location on skin color
has to be investigated. Results in Figure 3, arising from a
recently published study, cover populations of four cities
from north to south (Chennai and Delhi) and from west
to the east (Mumbai and Kolkata).16 Results of this study
showed a huge variability in skin color among the four
cities, suggesting an environmental impact upon skin
color (Fig. 4).
e wider variations in skin color are found in
Chennai. Instrumental measurements showed that
Figure 3: Skin color space in L* h plan measured by spectroradiometer in four dierent clusters of skin
color: Caucasian, Asian, Hispanic and African (see Table 1). Projection of Indian women skin color in this
worldwide skin color continuum
©L’Oreal Research and Innovation
Table 1: Skin color continuum studies; detailed studied
population referring to gure 3
Indian Women (n = 1195) From Mumbai, Chennai,
Kolkata and Delhi
Caucasian Women
(n = 2054)
France: Paris
Russia: Moscow
USA: Chicago/New York
Asian Women
(n = 4127)
China: Guangzhou, Shanghai,
Beijing
Japan: Tokyo
Korea: Seoul
ailand: Bangkok
France: Paris
Hispanic Women
(n = 223)
USA: New York
Brazil: Rio
Mexico: Mexico
African and Women
from African Descent
(n = 853)
South Africa: Johannesburg
France: Paris (with native of
the French West Indies)
USA: New York
the women living in this city present the largest hue
range as well as the darkest, less saturated and reddest

51|
Skin Color Types and Indian Skin Characteristics
Figure 4: Indian skin tones in four cities: Mumbai, Chennai, Kolkata and New Delhi (lightness by hue)
©L’Oreal Research and Innovation
Figure 5: Comparison of skin color parameters per facial area in four Indian cities (Chennai, Kolkata, Mumbai, New Delhi)
(n= 1195 women)

|52
Basic Science for Modern Cosmetic Dermatology
skin whatever the area of the face (Fig. 5). On a scale of
6 skin complexion types identied in India (Fig. 6), 74%
of women skin colors are described as “brown” or “dark
brown” by a dermatologist.16
e results for the three others cities are roughly
similar with some noticeable particularities.
Kolkata shows the largest range of skin lightness
and saturation. According to the graphic representation
(Fig. 4), there is a strong link between lightness and
hue: the darker the skin is, the redder and less vivid
(less saturated) it is. Although skin color in Kolkata is
quite darker as compared to Mumbai, hue or saturation
is similar (Fig. 5). Skin colors of women from Mumbai
and Delhi only dier by the hue component: cheeks are
redder in Delhi than in Mumbai. ose dierences of
skin color complexion were conrmed clinically with
a same rate (34%) of “medium brown” skin (Fig. 6) but
dierent prevalence of “brown” and “wheatish” skin: 41%
of “brown” and 21% of “wheatish” in Delhi versus 10% of
“brown” and 45% “wheatish” in Mumbai.16
Figure 6: Indian skin complexion: Dermatologist assessment
©L’Oreal Research and Innovation
Figure 7: Annual average of sun exposure19

53|
Skin Color Types and Indian Skin Characteristics
e trends observed on cheek or forehead are more
pronounced for the chin (perilabial area) (Fig. 5). is
area is more discriminant since it allows the four cities to
be dierentiated in terms of lightness and saturation.
According to these results, it would appear that there
is a latitude eect and an impact of the environment
(sun UV exposure, life habits, pollution, etc) upon the
skin color of Indian women. e skin colors of women
from Chennai, located in the South of India, are very
dierent from those of the Northern cities. India could
then be split diagonally from South West to North East.
e skin colors of the two cities of the East coast are
darker whereas the skin colors of the two Western cities
are lighter. is dierence was also found in another
study comparing Calicut and Delhi.18 Several hypotheses
could be proposed to explain this phenomenon. e
importance of UV exposure during the year could be
considered (Fig. 7). Chennai area indeed undergoes
higher sun exposure than other cities.19 Nevertheless,
this hypothesis alone might not suce to explain the
huge variations observed in skin color. is might be
also explained by the dierent ows of migration and
the interbreeding of two distinct ancestral lineages:
Dravidians and Indo-Europeans.8
Evolution of Indian Skin Color with Age
Skin darkening with age has been described in various
populations, e.g. a Chinese group living in Chicago as
reported by de Rigal et al.20 However, such age-related
changes were not observed in African-Americans,
Caucasians, and Mexicans living in the same area.20
A recent study on Chinese women living in China21,22
showed a rather linear darkening with age along the
life span. Another study conducted in eight Asian
cities including two Indian cities (Calicut and Delhi)
found that the melanin index increased with age
while L* value decreased, indicating that skin darkens
with age.18
e change in skin color with age in India was
deeper investigated in the study previously mentioned.16
Instrumental measurements showed that overall skin color
darkens with age (Fig. 8). By comparing the changes in L*
parameter with age between Indian women and women
from other countries, it has been highlighted that Indian
skin darkens at a dierent kinetics, i.e. twice slower than
Asian skin and slightly faster than Caucasian skin.
But this age eect has dierent intensity depending
on the Indian city (Fig. 9). Chennai is indeed the only
city where the age eect is signicant in the three color
Figure 8: Average skin lightness, Chroma and Hue according to dierent age groups. Measured on cheek with spectroradiometer®
(n = 1195 Indian women)

|54
Basic Science for Modern Cosmetic Dermatology
parameters with the highest darkening and a skin
becoming redder and less saturated with age.
No signicant change in skin color was found in
Mumbai. Unlike Mumbai, skin color of women from
Kolkata and Delhi darkens with age. is dierence of age
eect between those three cities could be related to the
dierence of skin color previously observed and by the
specic environmental conditions of each city.
The difference of Indian skin color change with age
between a rather photo-protected skin area (upper
inner arm) and an exposed area (cheek) was also
investigated (Fig. 10).16 Chromameter® measurements
showed that after 35 years, the skin becomes slightly
fairer with age on the photo-protected area (Lightness
increase by 6%), when it becomes barely darker on
photo-exposed area (Lightness decrease by 2%). This
may account for overall impression of facial darkening
compared to the whole body for women, although
facial darkening is of a low extent. This has been
investigated in other populations in large cohorts of
Caucasian’s and Korean’s (653 Caucasians and 497
Koreans).23,24 In Caucasians, a significant darkening of
exposed areas was observed after 20 years. Amongest
Koreans, skin color alteration seems close to that
found in the Indian study, the skin color remaining
rather stable with age.
SKIN COLOR UNEVENNESS IN INDIA
Overall Facial Skin Color Heterogeneity
Another issue concerning Indian skin color
has emerged with regard to its heterogeneity.
Coxellography index approach allows the overall
color heterogeneity of the face to be evaluated taking
into account the variations of color (hyperpigmented
and hypopigmented spots, telangiectasies), and
pores. Results showed that skin color heterogeneity of
the cheek increased with age (Fig. 11), which could
be explained by an increase in pigmentary disorders
and hyperpigmented areas.
Figure 9: Average skin Lightness, Chroma and Hue according to dierent age groups in four Indian cities (Chennai, Kolkata, Mumbai,
Delhi). Measured on cheek with Spectroradiometer® (n = 1195 Indian women)
Figure 10: Average skin lightness in age groups (years) measured
on cheek (photo-exposed area) and upper inner arm (photo-
protected area) (n = 1202)

55|
Skin Color Types and Indian Skin Characteristics
Figure 12: Hyperpigmented spots on two Indian women
©L’Oreal Research and Innovation
Figure 11: Overall skin color heterogeneity per age group in India
(n = 1195)
©L’Oreal Research and Innovation
years, dermatologists observed simplex lentigos
and actinic lentigines in more than 80% of women,
but differentiating them remain difficult. Many
seborrheic keratoses were also observed (about
70% of women). Such a high prevalence and early
onset of actinic lentigines and seborrheic keratoses
(at around 30 years) in India are striking.
Instrumental methods conrmed these results. An
individual analysis of pigmented spots with an automatic
detection of colored objects revealed no change in the
size of pigmented spots with age but an increase in
their number and visibility (by contrast with the skin
Pigmentary Disorders
Few studies document the increased frequency of
disorders characterized by hyperpigmentation in darker
ethnic groups.25-28 e importance of which is also
reported as a frequent concern in Indian population.
Some pigmentary disorders have been described in
India,29 hypopigmentary disorders, such as vitiligo,
pityriasis alba or versicolor, and also hyperpigmentary
disorders, such as melasma and some other facial
melanoses.30-33
Hyperpigmented Spots
Hyperpigmented spots are a major concern with an
early onset and an overall increase with age, well
described in some other Asian countries. Several
studies conducted in China showed that the early
onset of marked pigmented spots is a characteristic of
Asian skin aging.34,35,22 Galzote et al.18 also observed an
increase in mottled pigmentation with age in dierent
Asian populations, India included.
These results were confirmed in the Indian typology
study:16 more than 70% of women over 30 years show
more than 10 small hyperpigmented spots on their face
(Figs 12 and 13), increasing up to 80% in women over
50 years (p < 0.0001). Before 40 years, most of
these small spots are post-inflammatory marks, in
relation to the high prevalence of acne. From 30
Figure 13: Prevalence of hyperpigmented spots (according to age
group) assessed in situ by dermatologists (n = 1204)

|56
Basic Science for Modern Cosmetic Dermatology
complexion). Globally, the spots density increases
signicantly after 35 years, and shows no signicant
change after whereas the overall color contrast (∆E94)
between complexion and spots, i.e. the visibility of spots,
increases signicantly only from 50 years (Fig. 14).
Melasma and Patchily Hyperpigmented Macules
Melasma is a frequently described pigmentary disorder
in the Indian population. e worldwide reported
prevalence of melasma ranges from 8.8% among Latino
females in the Southern United States36 to 40% in Southeast
Asian populations.37 e Indian typology16 conrmed the
high prevalence of melasma in this country. e average
Figure 15: Melasma and dyspigmented macules observed in two
Indian women
©L’Oreal Research and Innovation
Figure 14: Density and overall contrast of facial spots according to age group in India
Figure 16: Prevalence of melasma (according to age group)
assessed in situ by dermatologists (n = 1204)
Figure 17: Prevalence of dyspigmented macules on forehead,
malar or mandibular area (according to age group) assessed
from photographs by dermatologists (n = 1196)

57|
Skin Color Types and Indian Skin Characteristics
age of women with melasma is 51 years with a prevalence
of 19% in the studied population. A peak of melasma
prevalence is observed in situ by dermatologists in
about 30% of women aged from 40 years to 65 years
(Figs 15 and 16).
However, melasma alone do not represent all the
dyspigmented spread macules observed in this study.
Dermatologists’ assessments distinguish other ill-
dened, patchily hyperpigmented macules on the face
which dier from melasma. e prevalence of moderately
to severely dyspigmented macules increases with age
particularly on the malar area reaching 70% of women
(p < 0.0001) (Fig. 17). Furthermore, the prevalence of
spread macules steadily increases with age, unlike the
bell curve distribution of melasma prevalence along life
span.
Hypopigmentary Disorders
e prevalence of vitiligo in India is often claimed higher,
of a 0.46–8.8% range.38 But according to a recent review
focusing on the prevalence of vitiligo in the general
population and excluding studies based on patients of
dermatology clinics, the worldwide prevalence of vitiligo
ranges 0.5–2%.39 is appears consistent with the results
from Hourblin et al.16 who reported a low prevalence
of vitiligo (0.9%), aecting less than 10% of women.
e main diagnoses associated with hypopigmentary
disorders were post-inammatory hypopigmented
marks and pityriasis alba. Some city-related eect
(p <0.0001) was noticed, with hypopigmentary disorders
prevalence varying from 5.2% in Chennai to 15.0% in
Mumbai.
Hyperpigmented Areas
Dark Circles
Periorbital melanoses are very common dermatological
disorders particularly in India. Despite its frequency,
little is known about its etiology and management.
Malakar et al.33,40 describe them as a dark brown to black
hyperpigmentation, usually bilaterally symmetrical, and
dene them as an extension of pigmentary demarcation
lines (PDL) of the face. e recent Indian typology
conrms the importance of this disorder in India,16 with
more than 50% of concerned women irrespective of
age, and up to 80% beyond 35 years old. According to
dermatologists’ assessment, almost all women have dark
circles on upper eyelid and on lower eyelid, of a dierent
Figure 18: Atlas of dark circles color intensity
©L’Oreal Research and Innovation
Figure 19: Overall contrast (∆E94) between cheek and dark
circles for each lightness complexion level

|58
Basic Science for Modern Cosmetic Dermatology
intensity with age (Fig. 18). e prevalence of women
with moderate to severe dark circles on upper eyelid,
increases with age from 50% up to 85%.
ese clinical results are conrmed by instrumental
measurements which quantify the dark circles color using
Spectroradiometer® associated with Chromasphere®. e
contrast with the cheek, i.e. their visibility, appears very
important. e visibility of dark circles increases with the
complexion lightness (Fig. 19); they are logically more
visible on the lightest skin.
Facial Pigmentary Demarcation Lines
Pigmentary demarcation lines are physiological abrupt
transition lines from areas of deeper pigmentation to
lighter areas. ey were rst classied into ve types on
the whole body, A through E.41 en it was suggested
that these lines can also occur on the face and lines F,
G and H were added.32 e facial lines dier from the
rest of PDL since they present later, usually around
puberty (lines A to E tend to present in early childhood),
and they aect males less frequently.42 e higher
proportion of aected females may indicate hormonal
inuences. Pregnancy is associated with worsening
of many pigmentary problems. ese lines are almost
always bilateral. In some people the lines merge with
the periorbital pigmented circle.40
Figure 20: Specic hyperpigmented areas on Indian skin. A, Lip
corners and B, Nose bridge
©L’Oreal Research and Innovation
Other Specicities: Perilabial Pigmentation
and Nose Bridge
As previously described,32 Indian typology conrms
that perilabial pigmentation is very frequent in Indian
women. About 30% of women of all ages show moderately
to severely pigmented upper lip. About 70% of women
over 30 years have moderately to severely pigmented lip
corners (Figs 20 and 21) whereas about 40% of women
over 30 years present moderately to severely pigmented
marionette lines.
A distinctive nding was pigmentation of the nose.
About 50% of women of all ages showed pigmentation
at the angles of the nose. In addition, 25% of women had
a hyperpigmented line across the nose (42% of Mumbai
women); in some of them, the line was broad and divided
the nose into a darker area on top and a lighter area
below (Figs 20 and 21). e prevalence of this disorder
increased with age from 10 to 30%. Recent studies have
described linear pigmentation across the nose associated
with a grove or ridge, referred to as transverse nasal
groove or nasal crease. e crease has been particularly
emphasized in the case of the allergic salute.43,44
Skin Color Contrasts of the Face
anks to the analysis of color contrasts between the
dierent facial areas (forehead, cheek, chin and dark
Figure 21: Prevalence of moderately to severely hyperpigmented
areas (according to age group) assessed in situ by dermatologists
(n = 1204)

59|
Skin Color Types and Indian Skin Characteristics
circles), ve clusters (Fig. 22) were identied to illustrate
the unevenness of the Indian women face. Dark circles
play a big part in the segmentation due to their high
frequence in India.
e cheek can be very light as compared to the rest
of face leaving the forehead very dark comparatively
(Group 4) or the chin can stand out by its darkness and
lack of vividness (Group 2).
is again illustrates the importance of skin color
heterogeneity in India with a wide diversity of skin color
contrasts existing between the dierent parts of the face.
CONCLUSION
e color of the human skin results from complex
mechanisms involving dierent genes, mainly related to
melanin biosynthetic pathway. With its dierent ows
of migration, India presents a wide range of biological
diversity. is chapter highlights the uniqueness of
Indian skin with its large diversity of color skin tone
covering a color scale from very dark to light. According
to this parameter, the country could be split diagonally
from South West to North East, with the darker skin in
the South and East. Globally skin complexion appears
Figure 22: Facial skin color types based on the analysis of skin color contrasts

|60
Basic Science for Modern Cosmetic Dermatology
not strongly aected by age compared to other Asian
countries with a slight darkening of skin color with age
particularly in the Southern region.
Skin color heterogeneity appears as a hallmark
of Indian skin with an increase in facial skin color
unevenness with age. is heterogeneity can be
explained by an increase in pigmentary disorders, i.e.
hyperpigmented spots and spread macules. ese
disorders occur at early stages and increase with age,
contributing to overall facial unevenness. Indian facial
skin also presents some original hyperpigmented
areas, such as lip corners, marionette lines and nose
bridges. In India, dark circles are the most prevalent
hyperpigmented areas, darkening with age. is data
raises the needs to further characterize and explore
the mechanisms underlying the early onset and high
prevalence of hyperpigmented spots, dyspigmented
spread macules, and specic pigmented lines observed
in the studied population.
ese features are obviously of high concern for
dermatological and cosmetological perspectives.
REFERENCES
1. Verma SB. Redening colour of Indian skin. J Eur Acad Dermatol
Venereol. 2008;22:1263-4.
2. Shenoi SD, Prabhu S. Role of cultural factors in the biopsychosocial
model of psychosomatic skin diseases: an Indian perspective. Clin
Dermatol. 2013;31:62-5.
3. Indian Genome Variation Consortium. Genetic landscape of the
people of India: a canvas for disease gene exploration. J Genetics.
2008;87:3-20.
4. Lamason RL, Mohideen MA, Mset JR, et al. SLC24A5, a putative
cation exchanger, aects pigmentation in zebrash and humans.
Science. 2005;310:1782-6.
5. Norton HL, Kittles RA, Parra E, et al. Genetic evidence for the
convergent evolution of light skin in Europeans and East Asians.
Mol Biol Evol. 2006;24:710-22.
6. Stokowski RP, Krishna Pant PV, Dadd T, et al. A genome wide
association study of skin pigmentation in a South Asian Population.
Am J Hum Genet. 2007;81:1119-32.
7. Mukherjee M, Mukerjee S, Sarkar-Roy N, et al. Polymorphism
of four pigmentation genes (SLC45A2, SLC24A5, MC1R and
TYRP1) among eleven endogamous population of India. J Genet.
2013;92:135-9.
8. Reich D, angaraj K, Patterson N, et al. Reconstructing Indian
population history. Nature. 2009;461:489-94.
9. Malacara D. Color Vision and Colorimetry: eory and Applications.
Society of Photo-Optical Instrumentation Engineers, Bellingham,
USA. 2002.
10. Schanda J, Editor. Colorimetry: Understanding the CIE System.
John Wiley & Son, 2007.
11. de Rigal J, Abella ML, Giron F, et al. Development and validation of
a new skin color chart. Skin Res Technol. 2007;13:101-9.
12. Caisey L, Grangeat F, Lemasson A, et al. Skin color and makeup
strategies of women from dierent ethnic groups. Int J Cosmet Sci.
2006;28:427-37.
13. Jaswal IJ. Pigmentary variation in Indian populations. Acta
Anthropogenet. 1983;7:75-83.
14. Jaswal IJ. Skin Colour in North Indian Populations. J Hum Evol.
1979;8:361-6.
15. Verma SB. Dermatology for the elderly: an Indian perspective. Clin
Dermatol. 2011;29:91-6.
16. Hourblin V, Nouveau S, Roy N, et al. Skin complexion and
pigmentary disorders in facial skin of 1204 women in 4 Indian cities.
Indian J Dermatol Venereol Leprol (in press).
17. Baras D, Caisey L. Skin, lips and lashes of dierent skins of color:
typology and make-up strategies. In: AP Kelly and SC Taylor, (eds).
Dermatology for Skin of Color. Mc Graw-Hill; Berkshire, UK: 2009.
pp. 541-9.
18. Galzote C, Estanislao R, Suero MO, et al. Characterization of facial
skin of various Asian populations through visual and non-invasive
instrumental evaluations: inuence of age and skincare habits. Skin
Res Technol; 2014.
19. Christiaens F. Geographical distribution of harmful UV radiation.
Poster 20th World Congress of Dermatology, Paris, France; 2002.
20. de Rigal J, Des Mazis I, Diridollou S, et al. e eect of age on
skin color and color heterogeneity in four ethnic groups. Skin Res
Technol. 2010;16:168-78.
21. Huixia Q, Xiaohui L, Chengda Y, et al. Instrumental and clinical
studies of the facial skin tone and pigmentation of Shanghaiese
women. Changes induced by age and a cosmetic whitening
product. Int J Cosmet Sci. 2012;34:49-54.
22. Qiu H, Long X, Ye JC, et al. Inuence of season on some skin
properties: winter vs. summer, as experienced by 354 Shanghaiese
women of various ages. Int J Cosmet Sci. 2011;33:377-83.
23. Lock-Anderson J, Knudstorp ND, Wulf HC. Facultative skin
pigmentation in Caucasians: an objective biological indicator
of lifetime exposure to ultraviolet radiation. Br J Dermatol.
1998;138:826-32.
24. Roh KY, Kim D, Ha SJ, et al. Pigmentation in Koreans: study of the
dierences from Caucasians in age, gender and seasonal variations.
Br J Dermatol. 2001;144:94-9.
25. Halder RM, Grimes PE, McLaurin CI, et al. Incidence of common
dermatoses in a predominantly black dermatologic practice. Cutis.
1983;32:388-90.
26. Sanchez MR. Cutaneous diseases in Latinos. Dermatol Clin.
2003;21:689-97.
27. Alexis A, Sergay AB, Taylor SC. Common dermatologic disorders of
skin of colour; a comparative practice survey. Cutis. 2007;80:387-94.
28. Grimes PE. Management of hyperpigmentation in darker racial
ethnic groups. Semin Cutan Med Surg. 2009;28:77-85.
29. Pasricha JS, Khaitan BK, Dash S. Pigmentary Disorders in India.
Dermatol Clin. 2007;25:343-52.
30. Khanna N, Rasool S. Facial melanoses: Indian perspective. Indian J
Dermatol Venereol Leprol. 2011;77:552-63.
31. Sarkar R, Puri P, Jain RK, et al. Melasma in men: a clinical,
aetiological and histological study. J Eur Acad Dermatol Venereol.
2010;24:768-72.
32. Somani VK, Razvi F, Sita VV. Pigmentary demarcation lines over the
face. Indian J Dermatol Venereol Leprol. 2004;70:336-41.
33. Malakar S, Lahiri K, Banerjee U, et al. Periorbital melanosis is an

61|
Skin Color Types and Indian Skin Characteristics
extension of pigmentary demarcation line-F on face. Indian J
Dermatol Venereol Leprol. 2007;73:323-5.
34. Nouveau-Richard S, Yang Z, Mac-Mary S, et al. Skin ageing: a
comparison between Chinese and European populations. A pilot
study. J Dermatol Sci. 2005;40(3):187-93.
35. Bazin R, Flament. Skin Aging Atlas volume 2. Asian type. Editions
Puce et Plume, MED’COM publishing; France Paris: 2010.
36. Werlinger KD, Guevara IL, Gonzalez CM, et al. Prevalence of self-
diagnosed melasma among pre-menopausal Latino women in
Dallas and Fort Worth, Tex. Arch Dermatol. 2007;143:424-5.
37. Sivayathorn A. Melasma in Orientals. Clin Drug Investig. 1995;10:
24-40.
38. Shah H, Mehta A, Astik B. Clinical and sociodemographic study of
vitiligo. Indian J Dermatol Venereol Leprol. 2008;74(6):701.
39. Krüger C, Schallreuter KU. A review of the worldwide prevalence
of vitiligo in children/adolescents and adults. Int J Dermatol.
2012;51:1206-12.
40. Malakar S, Dhar S. Pigmentary demarcation lines over the face.
Dermatology. 2000;200(1):85-6.
41. Selmanowitz VJ, Krivo JM. Pigmentary demarcation lines.
Comparison of Negroes with Japanese. Br J Dermatol. 1975;93:371-7.
42. Al-Samary A, Al Mohizea S, Bin-Saif G, et al. Pigmentary
demarcation lines on the face in Saudi women. Indian J Dermatol
Venereol Leprol. 2010;76(4):378-81.
43. Sathyanarayana BD, Basavaraj HB, Nischal KC, et al. Appraisal
of transverse nasal groove: A study. Indian J Dermatol Venereol
Leprol. 2012;78:439-42.
44. Myers WA. e “nasal crease”. A physical sign of allergic rhinitis.
JAMA. 1960;174:1204-6.