Ethnic Dermatology: Clinical Problems and Skin Pigmentation PDF

Preface

Doctors outside dermatology are often surprised that there are nearly 2000 different skin diseases. Depending on variations in medical practice worldwide, skin disorders may present to a wide range of clinicians, including specialist dermatologists, trainee dermatologists, family practitioners (general practitioners), and hospital doctors, in addition to other healthcare workers.

The aims of this book on ethnic dermatology are to improve the diagnostic skills of doctors and other healthcare workers, not only in patients with ‘white skin' (white Caucasians) but also in patients from different ethnic groups, and to provide an up-to-date approach to the investigation of patients with skin diseases, before making some therapeutic suggestions. I have used the term ‘ethnic' to mean ‘origin by birth or descent rather than nationality, relating to race or culture' and not to denote ‘non-European'. The comparison of skin disorders in white and deeply pigmented skin is an important way of learning. By using this book regularly, the reader will become familiar with the appearance of common and uncommon skin diseases in people with varying degrees of skin pigmentation. Even ‘white' skin is pigmented and different ethnic groups will have lighter or darker skin, ranging from the fair skin of Chinese Asians to the brown skin of Indian Asians to the dark brown, almost black skin of Afro- Caribbeans, African-Americans or Africans.

This book has evolved from Black and White Skin Diseases: an Atlas and Text*. As in that book, I have defined deeply pigmented or ‘black' skin broadly to include people of African, Black or African-American, Afro-Caribbean, Indian or Australasian origin.

From an early stage in my dermatology training, I realized that those dermatologists who were best at diagnosing skin diseases in deeply pigmented skin were those with most experience of such patients, a fact which is hardly surprising. This observation was reinforced when I later spent some time in Ethiopia, where I met a number of European doctors working in various parts of Africa. ‘We know very well how to recognize leprosy' one of them said, ‘but when it comes to even the commonest of other skin diseases, we have great difficulty, since nearly all of our medical school dermatology teaching was in white skin'.

Recognizing the enormous variety of skin diseases in white skin depends on the development of a number of visual skills that have to be developed still further to recognize skin diseases in deeply pigmented skin from different ethnic groups.The purpose of this book is to present a systematic approach to the diagnosis of a wide range of skin diseases seen in black and white skin. It is not intended to be a comprehensive atlas of tropical medicine, but one should always consider the possibility of diseases such as leprosy in patients who have lived in tropical countries.

I began Black and White Skin Diseases when working at the St John's Institute of Dermatology in London. I was appointed as Consultant Dermatologist and Honorary Clinical Senior Lecturer at Bristol Royal Infirmary (UBHT) and the University of Bristol in 1989. I am most grateful to the medical photographer Stuart Robertson of the Department of Education at the St John's Institute of Dermatology, St Thomas' Hospital, London for his invaluable help, and to the Consultant staff of St John's, past and present, for access to the collection of photographs at the St John's Institute of Dermatology.

In my time as Academic Vice President of the British Association of Dermatologists, I would like to acknowledge those who most influenced my early dermatology

thinking, in particularMac (DM)MacDonald, Charles (RS) Wells, and Rod Hay of Guy's Hospital, London, and Malcolm Greaves, Etain Cronin, Gerald Levene, Neil Smith, and Edward Wilson Jones of the St John's Institute of Dermatology, London. Many photographs are from the collection in Bristol and I am most grateful for the support of my colleagues in the Departments of Dermatology and Medical Illustration and Photography. Before moving to Bristol, I spent a most interesting 2 years as Research Fellow with Jon Hanifin at the Oregon Health Sciences University, Portland and was much influenced by the systematic approach to the teaching and learning of dermatology in the USA.

*Archer CB, Robertson SJ. Black and White Skin Diseases: an Atlas and Text. Oxford: Blackwell Science, 1995.