Assessing the role of race in quantitative measures of skin pigmentation and clinical assessments of photosensitivity

Division of Dermatology, George Washington University, Washington, Washington, D.C., United States
Journal of the American Academy of Dermatology (Impact Factor: 4.45). 04/2005; 52(4):609-15. DOI: 10.1016/j.jaad.2004.03.051
Source: PubMed


Given the increasing demographic diversity in the United States, clarifying relationships between race, color, ethnicity, and disease processes is critical.
We sought to examine the correlation between objective measures of skin pigmentation, racial identification, and physician-diagnosed and self-reported skin phototypes.
A total of 558 participants (76 nonwhite) were evaluated. A subset underwent spectrometric readings and digital photography of the upper aspect of the inner arm. Self-identified race was compared with 7 measures of pigmentation.
Race correlates best with physician-diagnosed skin phototype (r = 0.55, P < .01), whereas self-reported skin phototype, spectrometry, and colorimetry correlate poorly with race (r = 0.28, < 0.40, and r > -0.31, respectively, P < .01). Associations between race and subjective measures strengthen among patients with darker skin.
Objective measures of pigmentation fail to correlate well with race, whereas race correlates moderately with physician-diagnosed skin phototype. Including objective methods of analyzing skin color may reduce subjective influences of race in assessing photosensitivity and potential risk for skin cancer.

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    • "This tendency creates a potential bias in the subjective assessment of SPT, which might limit the utility of traditional phototyping in clinical studies or assessments. In addition, heterogeneity of various skin, eye, and hair colors within ethnic groups makes determination of SPT in multi-ethnic backgrounds difficult, producing type II errors in assessment of susceptibility to skin cancer (Rubegni et al., 1997; Lee and Kim, 1999; Chan et al., 2005). "
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    ABSTRACT: To date, human skin phototype (SPT) has been determined subjectively by self- or trained investigator assessment using sun burning and/or sun tanning responses, ethnicity, hair, and eye color. This study evaluated objective reflectance spectrophotometer (RS) assessment of SPT in 353 males or females (18-72 years old with Fitzpatrick SPT I-VI) using the area-under-the-intensity curve (AUIC) over the 450-615 nm wavelength interval of reflected light (AUIC). Photoprotected constitutive skin color sites produced higher AUIC values than photo-exposed facultative skin color sites. Constitutive skin color at the upper volar arm was equal to the buttocks. Within-site and between-site AUIC reproducibility of constitutive skin color at the upper volar arm was 3 and 5% coefficient of variation (CV), respectively, which was similar to seasonal variability (8% CV). AUIC values decreased proportionately at both constitutive and facultative sites as a function of increasing SPT from I to VI (r=0.8). RS-measured constitutive skin color at the upper volar arm fit a quadratic equation (r(2)=0.94) that differentiated (P<0.05) between each of the six SPTs and agreed +/-1 SPT category with clinician-assessed SPT. Thus, RS assessment of constitutive skin color at the upper volar arm provides a quick, noninvasive, precise, and accurate method to objectively determine SPT.
    Full-text · Article · Jul 2008 · Journal of Investigative Dermatology
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    • "Ethnicity, on the other hand, incorporates biological, environmental, and cultural factors and includes inducible skin changes such as skin color (Carter, 2003; Elgart et al., 2003). Fitzpatrick skin-typing, which was initially designed to describe photosensitivity, was later expanded to include categories that were racially determined and has been shown recently to correspond poorly to objective measures quantifying color (Quevedo et al., 1975; Chan et al., 2005). Quantitative assessments of color, while promising and ever improving, have been used only on a limited basis so far and, therefore, have provided little basis for comparison to date (Lu et al., 1996). "
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    ABSTRACT: Accurately determining the incidence and prevalence of dermatologic disease in most large populations has been challenging for reasons ranging from the lack of easily quantifiable tests and measures to imprecision around definitions of race, ethnicity, photo skin type, pigmentation, and population groups. Compounding the problems with these categorizations is the fact that skin disease and skin health are affected not just by inherent risk factors but also by habits and environment. Thus, a fundamental question remains as we evaluate the effects of cultural and environmental factors: do genetic factors account for most of the difference that we see in skin types? Is the primary influence the way the skin mediates the environmental insult of UV radiation or how inflammation is handled? Is melanization the primary characteristic that we should measure and consider? This article will provide an introduction to current knowledge and future directions researchers are taking in differentiating both the biological differences of skin and the clinical manifestations of skin disease among the groups described above. This discussion will be followed by a brief overview of cultural practices and environmental factors that are known to have significant impact on skin disease and a summary of the most common conditions that are encountered worldwide.
    Preview · Article · May 2008 · Journal of Investigative Dermatology Symposium Proceedings
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    • "pigmentation fail to correlate with race [41]. The conclusion is that skin color is not the same thing as race [42]. "
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    ABSTRACT: To understand the diversity of skin color now observed in people of the five continents, one has to go back in history. In fact, geology, archeological findings, biology and medical science, as well as anthropology, linguistics, and contemporary genetic techniques enable us to patch up a clear picture of the past up to the present - the evolution of the Homo sapiens. Owing to its undeniable visibility, skin color has always had a sociologic connotation, which has up to the present time caused division between people.
    Preview · Article · Aug 2007 · Dermatologic Clinics
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