South Koreans discriminate against fat obese tourists

Peculiarities of non-white skin

Inflammatory dermatoses

Acne vulgaris, Acne medicamentosa, Acne cosmetica, Acne tropica

While acne vulgaris (acne and rosacea) seems to be more severe in white people than in dark-skinned people, the latter, in addition to the classic forms of acne, suffer more frequently from those variants that are caused by internal and external drugs or cosmetics.

Acne or acneiform drug eruptions, inducing preparations such as INH, testosterone and above all glucocorticoids are widely used in developing countries, for justified medical indications, out of helplessness and helplessness, both on the part of doctors and patients. Topicals containing glucocorticoids are also often used for skin whitening (see above). The application of heavily greasy creams and oils is particularly common in Africa to make the skin supple and give it the desired shiny appearance.

These forms of acne are characterized by follicular papules and monomorphic papulopustules, rarely secondary comedones. Post-inflammatory hyperpigmentation, as well as the development of hypertrophic scars and keloids, can be serious.

Acne tropica is understood as the colonization of acne vulgaris by staphylococci, which is promoted by sweating, with the corresponding aggravation of the clinical picture.

Granulomatous periorifical dermatitis

synonym

Facial Afro-Caribbean childhood eruption (FACE), Gianotti-type perioral dermatitis (Gianotti et al. 1970)

This dermatosis, which occurs mainly in Afro-American and Caribbean children and is usually self-limiting, is characterized by the appearance of grouped pale skin-colored small papules perioral and perinasal (rarely in other locations). It is viewed as a variant of granulomatous rosacea or perioral dermatitis (Chapter Acne and Rosacea). The skin changes often develop as a result of the abuse of potent topical glucocorticoids.

therapy

Preparations such as those used for rosacea are used; possibly in combination with tacrolimus.

Contact eczema

The practice of applying herbal active ingredients to the skin as part of self-medication or by traditional healers is widespread. Well-known potent allergens are contained in the sunflower and sumac family (mango), but also vegetable oils, menthol, camphor and tree resins (to name just a few examples from the traditional pharmacopoeia) can lead to the occurrence of irritative and allergic, and occasionally photo-aggravated, contact eczema.

Various materials are used in South and Southeast Asia to apply paint to the face (mainly to demonstrate religion, status or caste affiliation), which may contain saffron, turmeric, sandalwood, ash, clay and other potentially allergenic substances. The best known is bindi dermatitis, an allergic contact eczema after application of the point between the eyebrows based on turmeric powder or Congo red, which traditionally characterizes married women in Hinduism, but is now also a widespread fashion accessory.

Para-phenylenediamine (PPD) is a frequent component of the black henna tattoos popular with locals and tourists in South-East Asia, which means that sometimes severe allergic contact eczema is not uncommon (Fig. 7). Since black clothing freshly dyed with PPD is often worn in China on the occasion of deaths, the contact eczema that occurs there is also known as the disease of the mourners.
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Capsaicin dermatitis after handling chili pepper is known especially from Central and South America. The symptoms can be very pronounced with reddening, burning and pain in the hands.

Actinic prurigo

synonym

Hereditary polymorphic photodermatosis

The variant of polymorphic photodermatosis, known mainly from Central and South America (especially with mestizos), but also by Himalayan inhabitants, Native Americans and Eskimos, particularly affects people who live at altitudes above 1000 m (see section on photodermatoses). It is characterized by the increased occurrence of pruritic plaques, papules and vesicles on sun-exposed skin in spring and summer; lips and conjunctiva can also be affected. A familial accumulation can be observed in over 60% of the cases. The intense itching often leads to excoriations and hyperpigmented scars.

therapy

Sun protection is important. In less pronounced cases, topical glucocorticoids and systemic antihistamines are indicated, otherwise thalidomide 50–200 mg / day is an effective treatment option (off label). Affected conjunctiva respond well to 2% Cyclosporin A drops.

Lupus erythematosus

Discoid lupus erythematosus (Chapter Lupus erythematosus) can lead to considerable tissue destruction with permanent hair loss and scarred, depigmented areas, especially in sunny countries and with insufficient attention from the doctor and patient (Fig. 8). After a long period of time and repeated sunburns, spinocellular carcinomas can develop.
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Systemic lupus erythematosus affects all black people with the exception of Africans more frequently than whites. Mostly women are affected. The observation of a low prevalence of SLE in African women and high disease rates in black women in Great Britain indicates the influence of other environmental factors. Complications such as severe skin involvement, arthritis, nephritis and psychoses, combined with a poor prognosis, are characteristic of the course of the disease in dark-skinned people. Affected Asians are particularly likely to develop lupus nephritis.

Sarcoid

Sarcoid, rare in East Asians (see Granulomatous Diseases), is up to ten times more common in African-Americans than in whites, with 25% of patients showing skin changes. Hypopigmented annular and especially perinasal papular skin changes dominate, while erythema nodosum is seen less frequently. Löfgren's syndrome, which is associated with fever, bilaterally enlarged hilar lymph nodes, and polyarthralgia, occurs much less often in black Americans than in the white population.

Pityriasis rosea

Pityriasis rosea (chapter on erythematous, papulonodic and erythematosquamous diseases), not more common in dark-skinned people, but often more extensive than in whites, affects the face, axils, groin and abdomen in about 30% of cases in people with dark skin in addition to the trunk (pityriasis rosea inversa). The often more itchy, scaly and persistent dermatosis leaves many sufferers with post-inflammatory hypo- or hyperpigmentation.

Pityriasis lichenoides chronica

The morphologically variable and very protracted disease arising from pityriasis lichenoides et varioliformis acuta (PLEVA) or de novo (see section Erythematous, papulonodular and erythematosquamous diseases) also affects the face in Africans. It leaves a distinct post-inflammatory hyperpigmentation, while in Asian patients it leads to long-lasting hypopigmentation, usually with scars. A form of mycosis fungoides that is clinically similar to Pityriasis lichenoides chronica has been described in Korean children.

Eosinophilic pustular folliculitis

Synonyms

Ofuji disease, Ofuji syndrome, sterile eosinophilic pustulosis.

Eruption of itchy papules and sterile pustules with transition into annular plaques on the face, less on the trunk and extremities, occasionally on the palms of the hands and soles of the feet, which occurs in more than 80% of middle-aged men in North and East Asia (Chapter Diseases with Eosinophilia). The disease is chronic and recurrent. Its etiology is unclear. A neonatal / infantile variant and HIV-associated eosinophilic pustular folliculitis are also known.

therapy

Indomethacin 50–75 mg / day and / or topical and oral glucocorticoids, in therapeutically difficult situations also cyclosporin A systemically and tacrolimus 0.03% topically.

Papuloerythroderma Ofuji

The unusual dermatosis, which was initially described in older Japanese men, is characterized by itchy small papules and the red plaques that develop from them, leaving out the face, palms, plantae and transverse abdominal body folds (deck-chair sign, the erythema saves areas as if it had the affected person suffered sunburn in a deck chair position) (Chapter Malignant Lymphoma of the Skin), associated with peripheral lymphadenopathy. Elevated Ig-E levels and eosinophilia are found in the blood. The changes may indicate the presence of lymphoma and other visceral malignancies.

Kimura disease

The mostly benign disease, which occurs more frequently in younger East Asian men, is characterized by lymphadenopathy and single or multiple subcutaneous, occasionally itchy tumors as a result of atypical proliferation of the lymph follicles and vascular endothelia (see Chapter Cutaneous Vascular Tumors). The lesions are mostly localized on the head or neck, especially in the parotid area. Nephrotic syndrome can develop as a complication in approximately 20% of cases. The etiology is unclear; an excessive immune response to an unknown antigen was suspected. Angiolymphoid hyperplasia with eosinophilia (ALHE), on the other hand, is one of the epithelioid vascular tumors. The blood count shows increased IgE levels and eosinophilia.

therapy

Systemic and intralesional glucocorticoids, ciclosporin A or radiotherapy. Disturbing tumors are excised. It is important to rule out an underlying malignancy.

Pemphigus

Pemphigus vulgaris (chapter Bullous autoimmune dermatoses) affects Asians, especially Indians, more frequently and at a younger age than whites. Ashkenazi Jews and people from the Mediterranean region are also increasingly affected. In contrast, pemphigus foliaceus occurs more frequently in Africans. The endemic pemphigus foliaceus, fogo selvagem (Portuguese wild fire), is mainly found in the Amazon basin, southwestern Brazil and Colombia.

Infections

Pityriasis versicolor

The infection with Malassezia spp. (Chapter Mycoses) occurs more frequently in hot and humid climates; in dark-skinned people it usually appears in the form of discreet, scaling, hypopigmented macules, which, in addition to the typical predilection sites, can also appear on the neck and face area. The information that, even after successful therapy, the light spots only adjust in color to the surrounding skin after renewed exposure to the sun prevents repeated useless attempts at treatment.

leprosy

Over the past 20 years, more than 16 million patients have been diagnosed with leprosy in global programs coordinated by the WHO