Ushering in a new era for studying human cutaneous diversity
Authors: O.E. Dadzie
Journal: British Journal of Dermatology (2013)

The demographics of the UK are changing, with urban cities such as London becoming more racially and ethnically diverse. This is reflected in the latest UK census, which showed an increase in the 'nonwhite' population between 2001 (8·7%) and 2011 (14%), with a doubling in the proportion of the black African population over this period.1 The majority of this 'nonwhite' group in the UK comprises predominantly persons of South Asian (Indian, Pakistani and Bangladeshi origin), Afro-Caribbean and African ancestry, as well as intermixed groups.1 Similar demographic changes are also being observed on a global level, with the Central Intelligence Agency predicting that by 2020 the majority of the gains in the global population (1·5 billion people) will be accounted for by persons from Asia and Africa.2 Several studies have shown a link between human cutaneous diversity and the clinical manifestation of various dermatoses.3 Furthermore, exogenous factors, including cultural ones, can also impact upon disease presentation and management.3 In light of this, and within the context of the changing population demographics, there is a need for practising dermatologists to be cognizant of, as well as competent in, the management of dermatoses pertinent to an increasingly diverse patient population. It is within this context that we present this special supplement of the British Journal of Dermatology, featuring a comprehensive collection of articles focused on dermatoses pertinent to the UK's increasingly diverse population. Professor Nina Jablonski sets the scene for this supplement by discussing the importance and rationale for studying human cutaneous diversity. She also points out that we should be mindful of the concept of race and ethnicity, as well as the very notion of 'ethnic skin', both of which are imprecise. As new combinations of human phenotypes and genotypes emerge as a result of intermarriages, a new set of sophisticated vocabulary and terminologies is required to more accurately reflect the spectrum of human cutaneous diversity. Dr Antoine Petit and I then focus on medical dermatology, in particular four multisystemic diseases: lupus erythematosus, systemic sclerosis, sarcoidosis and Behçet disease. We discuss how human cutaneous diversity impacts on the epidemiology and cutaneous manifestations of these diseases. A disproportionate number of HIV-positive individuals reside in or originate from sub-Saharan Africa and Asia. With this in mind, Dr Mahreen Ameen reviews some of the observed differences in the cutaneous manifestations of HIV-related skin diseases in those with pigmented skin types. In a recent UK-based survey of dermatology trainees, regarding their training and exposure to dermatoses pertinent to the UK's 'ethnic' population (defined as individuals of African, Afro-Caribbean and South Asian origins, as well as intermixed groups), pigmentary, and hair and scalp disorders were highlighted to be the most poorly understood and/or worst managed by trainee dermatologists.4 For this reason, Drs Amr Salam, Sharon Aryiku and I present an overview of hair and scalp disorders in women of African descent, providing practical hints and tips to guide diagnoses and management. We also highlight the need to study inter- and intragroup variability of human hair phenotypes. Drs Sandra Del Bino and Françoise Bernerd then discuss variations in skin colour and the biological consequences of ultraviolet radiation exposure, while Drs Neelam Vashi and Roopal Kundu review the causes of facial hyperpigmentation, and discuss management strategies for dealing with this challenging problem. Vitiligo affects all races, ethnicities and skin types, but it is more obvious in persons with richly pigmented skin. Recently, guidelines for the management of vitiligo have been developed by the European Dermatology Forum.5 While serving as an excellent reference point for clinicians, these guidelines provide little additional information with regard to the surgical management of vitiligo. It is fitting, then, that Drs Sanjeev Mulekar and Prescilia Isedeh present an evidence-based review of surgical interventions for vitiligo, discussing the pros and cons of several techniques. Dr Viktoria Eleftheriadou then discusses some of the major challenges facing vitiligo researchers, as identified in the Cochrane Systematic Review 'Interventions for vitiligo', in 2010.6 She also discusses how various European and international societies are working together to overcome some of the barriers to vitiligo research. Keloid disease remains a very challenging problem in clinical practice. Drs S. Ud-Din and Ardeshir Bayat present a strategic management approach for keloid disease, supported by emerging evidence-based data. There is an increase in the demand for cosmetic procedures worldwide. It is important that physicians and other practitioners performing these cosmetic treatments are cognizant of the risks associated with the use of these techniques in diverse human phenotypes. Drs Amr Salam, Hassan Galadari and I provide an update on the use of chemical peeling in those with 'ethnic skin'. Lasers and light-based therapies are evolving and now have a wide variety of uses. Dr Andrew F. Alexis addresses the use of lasers and light-based therapies in 'ethnic skin', emphasizing the treatment options and recommendations for Fitzpatrick skin types V and VI. My thanks to L'Oréal and Beiersdorf for sponsoring this supplement, as well as the British Journal of Dermatology editorial team (Tanya Bleiker, Richard Hughes and Allen Stevens) for patiently guiding us through this project. A final thanks to Dr Ardeshir Bayat, who originally conceived the idea of publishing a selection of the conference proceedings of the 3rd International Ethnic Skin and Hair Conference, which was organized by London Ethnic Skin Limited in London in June 2012. This was the original stimulus for this supplement, which over a period of a year has evolved to include contributions not just from speakers from this conference, but also from an international cast of authors. It has been my honour to edit this supplement. It is my hope that the articles presented herein will guide clinicians as they treat an increasingly diverse patient population. I also hope that the comprehensive collection of articles presented in this supplement will inspire a new generation of dermatologists to embrace and contribute to the study of human cutaneous diversity. This supplement was kindly sponsored by L'Oréal Research & Innovation and Beiersdorf. O.E. Dadzie has received research funding from L'Oréal and speaker fees from Stiefel, a GSK company, Beiersdorf and LEO Pharma.