Dermatology in black skin | Anais Brasileiros de Dermatologia

array:22 ["pii" => "S0365059624000035" "issn" => "03650596" "doi" => "10.1016/j.abd.2023.10.001" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "889" "copyright" => "Sociedade Brasileira de Dermatologia" "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "pt" => array:18 [ "pii" => "S2666275224000079" "issn" => "26662752" "doi" => "10.1016/j.abdp.2024.01.007" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "889" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "pt" => array:12 [ "idiomaDefecto" => true "cabecera" => "Educação médica continuada" "titulo" => "Dermatologia na pele negra" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "327" "paginaFinal" => "341" ] ] "contieneResumen" => array:1 [ "pt" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1462 "Ancho" => 1675 "Tamanyo" => 150710 ] ] "descripcion" => array:1 [ "pt" => "Temas de destaque na pele negra." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maurício Mota de Avelar Alchorne, Katleen da Cruz Conceição, Leonardo Lora Barraza, Marilda Aparecida Milanez Morgado de Abreu" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Maurício Mota de Avelar" "apellidos" => "Alchorne" ] 1 => array:2 [ "nombre" => "Katleen da Cruz" "apellidos" => "Conceição" ] 2 => array:2 [ "nombre" => "Leonardo Lora" "apellidos" => "Barraza" ] 3 => array:2 [ "nombre" => "Marilda Aparecida" "apellidos" => "Milanez Morgado de Abreu" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059624000035" "doi" => "10.1016/j.abd.2023.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624000035?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224000079?idApp=UINPBA00008Z" "url" => "/26662752/0000009900000003/v1_202404300449/S2666275224000079/v1_202404300449/pt/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S0365059624000011" "issn" => "03650596" "doi" => "10.1016/j.abd.2023.06.005" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "887" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "A new proposal for phenotypic classification and outcome assessment of dermatomyositis based on clinical manifestations and serological testing" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "342" "paginaFinal" => "349" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 829 "Ancho" => 1675 "Tamanyo" => 100466 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Visualized subgroups of 162 DM patients by tsne algorithm. Scatter plot map showing the individuals and clusters they belonged to in DM. tsne algorithm was used to reduce the dimensionality of the data." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ting Huang, Ting Ding, Liqing Ding, Shasha Xie, Xiaojing Li, Qiming Meng, Xiaomeng Wu, Hui Luo, Hongjun Zhao" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Ting" "apellidos" => "Huang" ] 1 => array:2 [ "nombre" => "Ting" "apellidos" => "Ding" ] 2 => array:2 [ "nombre" => "Liqing" "apellidos" => "Ding" ] 3 => array:2 [ "nombre" => "Shasha" "apellidos" => "Xie" ] 4 => array:2 [ "nombre" => "Xiaojing" "apellidos" => "Li" ] 5 => array:2 [ "nombre" => "Qiming" "apellidos" => "Meng" ] 6 => array:2 [ "nombre" => "Xiaomeng" "apellidos" => "Wu" ] 7 => array:2 [ "nombre" => "Hui" "apellidos" => "Luo" ] 8 => array:2 [ "nombre" => "Hongjun" "apellidos" => "Zhao" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275224000055" "doi" => "10.1016/j.abdp.2024.01.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224000055?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624000011?idApp=UINPBA00008Z" "url" => "/03650596/0000009900000003/v1_202404281408/S0365059624000011/v1_202404281408/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Continuing Medical Education" "titulo" => "Dermatology in black skin" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "327" "paginaFinal" => "341" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Maurício Mota de Avelar Alchorne, Katleen da Cruz Conceição, Leonardo Lora Barraza, Marilda Aparecida Milanez Morgado de Abreu" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Maurício Mota de Avelar" "apellidos" => "Alchorne" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Katleen da Cruz" "apellidos" => "Conceição" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Leonardo Lora" "apellidos" => "Barraza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "Marilda Aparecida" "apellidos" => "Milanez Morgado de Abreu" "email" => array:1 [ 0 => "marilda@morgadoeabreu.com.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Faculty of Medicine, Universidade Nove de Julho, São Paulo, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Dermatology, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 1639 "Ancho" => 1508 "Tamanyo" => 647739 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Discoid lupus erythematosus: atrophic alopecic plaque on the frontoparietal region." ] ] ] "textoCompleto" => "Dermatology in black skinThe vast majority of dermatology publications refer to light skin, with few addressing the peculiarities of black skin. This lack of knowledge on the subject makes it difficult to recognize dermatoses on black skin and can generate fear among dermatologists about carrying out more invasive procedures on these patients, especially regarding the induction of scars and pigmentary changes.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>The black populationThere is no single definition of what it means to be black. Therefore, this subjectivity must be taken into account when interpreting studies. According to anthropologists, there are five races: Caucasoids, Mongoloids, Australoids, Negroids/Congoids and Capoids). Ethnicity refers to a social group with linguistic, cultural and ancestral affinities.<a class="elsevierStyleCrossRefs" href="#bib0005">1–4</a> In the Brazilian Portuguese dictionary, the definition of black is “one with a very dark color; of black skin". Taking into account Fitzpatrick's classification of phototypes, black people fall into types IV, V and VI, those who rarely or never burn in the sun and tan easily.<a class="elsevierStyleCrossRefs" href="#bib0005">1,3</a>While in the United States, black is someone who has a black ancestor at any point in the family tree, regardless of skin tone, in Brazil, the Brazilian Institute of Geography and Statistics (IBGE, Instituto Brasileiro de Geografia e Estatística) differentiates people by skin color, which can be white, black, yellow, brown and indigenous, considering brown and black people as black.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> The term “pardo” (brown) applies to the miscegenation between Indians, whites and blacks, that is, people with indigenous, European and African ancestry.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Due to the high degree of miscegenation of the Brazilian population, there is little precision in identifying a black person, with the criterion of self-declaration prevailing for statistical purposes.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>According to data from the National Household Sample Survey (PNAD Contínua, Pesquisa Nacional por Amostra de Domicílios) 2021, 43% of the Brazilians declared themselves as white, 47% as mixed race and 9.1% as black.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>Structural, biological and functional aspects of black skinEpidermisStratum corneumThere is no significant variation in the stratum corneum thickness, although black people have a greater number of layers which are more compact and cohesive.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> In lightly pigmented skin, 6 to 15 strips of tape are needed to remove the stratum corneum; in black skin, from 8 to 25. Due to greater cohesion, vesicles and bullae remain intact longer than in lightly pigmented skin.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Lipid compositionBlack skin presents lower levels of ceramides and greater transepidermal water loss,<a class="elsevierStyleCrossRefs" href="#bib0025">5,7</a> in addition to a 2.5-fold higher rate of spontaneous desquamation than white skin, justifying greater xerosis in this population.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Melanocytes/melanosomesThere is no difference in the number of melanocytes in black skin, but rather in the characteristics of the melanosomes, which are larger, non-aggregated and degrade more slowly compared to those in white skin. Its distribution also differs, present throughout the epidermis. Additionally, melanosomes have a more neutral pH and greater tyrosinase activity in black skin.<a class="elsevierStyleCrossRefs" href="#bib0025">5,7,9,10</a>There is greater melanogenesis in black people and the melanin content naturally confers a Sun Protection Factor (SPF) of 13.4 compared to 3.4 for white individuals.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Dark skin transmits 7.4% of ultraviolet rays (UVR) B compared to 29.4% in lightly pigmented skin,<a class="elsevierStyleCrossRefs" href="#bib0035">7,12,13</a> that is, approximately four times less UV reaches the upper dermis, minimizing photoaging and the propensity for skin tumors.<a class="elsevierStyleCrossRefs" href="#bib0035">7,12</a> However, as UVR deteriorates the defense system, black skin also requires photoprotection.<a class="elsevierStyleCrossRefs" href="#bib0035">7,12</a>The relative composition of eumelanin and pheomelanin is independent of the degree of pigmentation, but there is a low level of photoprotective eumelanin in lightly pigmented skin, explaining the greater sensitivity to UVR. <a class="elsevierStyleCrossRef" href="#bib0070">14</a>DermisThere is no difference regarding the thickness of the dermis between ethnic groups, although there is a difference at the cellular level.<a class="elsevierStyleCrossRefs" href="#bib0025">5,7,9</a> The collagen fiber bundles are smaller, macrophages are larger and more numerous, whereas mast cells differ only in the size of the granules, which are larger in black skin.<a class="elsevierStyleCrossRefs" href="#bib0025">5,7,9</a> Fibroblasts are larger, more numerous, bi- or multinucleated and hyperreactive, and are, associated with a constitutional decrease in collagenase, explaining the greater predisposition to keloids.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> These characteristics protect against the effects of age, delaying dermal atrophy in black people. There are no differences regarding elastic tissue.<a class="elsevierStyleCrossRefs" href="#bib0035">7,9</a>Adnexal glandsStudies on differences in adnexal glands present conflicting results. Some report that there are no differences in the number of eccrine glands. However, most agree that apocrine glands are more numerous and larger in black skin and also produce a larger amount of secretion, with a characteristic odor.<a class="elsevierStyleCrossRefs" href="#bib0025">5,7</a> The sebaceous glands do not differ in number, but they are larger and produce a larger amount of sebum,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> which can favor the appearance of acne lesions.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Scalp, hair follicles and hairScalpThe scalp presents macules that resemble asterisks, scales and cosmetic residues, with erythema being common. The color, seen in trichoscopy, varies between light brown and black and does not correlate with the skin color, with a perifollicular pigmented network, or honeycomb pattern, consisting of pigmented lines (corresponding to the melanocytes of the crest of the network) surrounding hypochromic areas (fewer melanocytes in the suprapapillary epidermis). A unique and normal characteristic is the presence of white dots between the follicular units, similar to the fibrosis sign of cicatricial alopecia.<a class="elsevierStyleCrossRef" href="#bib0075">15</a>Hair folliclesThe density and number of hair follicles are lower and there are differences in their shape: they are curved, spiral-shaped, elliptical on cross-section. There is an asymmetry in the shape and cellular distribution of the hair bulb and the internal and external root sheaths.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a> The melanosomes are present in the external root sheath and in the bulb of vellus hairs, which is why they are more heavily pigmented. The sebaceous glands are fewer and less active, secreting less sebum, leading to the dryness.<a class="elsevierStyleCrossRefs" href="#bib0080">16–18</a> Blood flow is reduced, increasing susceptibility to cicatricial alopecia. The elastic tissue anchorage to the hair follicle is reduced, favoring traction alopecia.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>HairNegroid hair is the most distinct phenotypic characteristic of black people. They are difficult to comb, requiring different care and less frequent washing. Hairs present knots, cracks, and longitudinal fissures along the shaft.<a class="elsevierStyleCrossRefs" href="#bib0035">7,19,20</a> There are varying degrees of curl, with mechanical fragility increasing with higher degrees of curvature. The shaft has a smaller diameter, thinner cuticle, and is drier (lower water and sebum content), with lower tensile strength, which favors breakage.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Several extracellular matrix proteins and adherens junctions are decreased,<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a> leading to differences in hair texture, strength, and manageability. The follicular units commonly have hair shafts emerging together and the wavy fibers emerge at an angle to the scalp. The chemical composition of keratin and amino acids is similar to that of hair of other ethnic groups. Small differences have been reported in the number of low- and high-sulfur proteins (disulfide bonds).<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a> When placed in water, African-American hair has a lower percentage of radial absorption than Asian and Caucasian hair, perhaps due to differences in lipid content.<a class="elsevierStyleCrossRefs" href="#bib0080">16,19,20</a>The main differences between black skin and lightly pigmrnted skin are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Dermatoses in black skinThere are variations in black skin that can be mistaken for abnormalities. On the other hand, some dermatoses are more frequent or practically exclusive to black people, while others present in a particular way, with characteristics inherent to the higher degree of pigmentation and a tendency to peculiar reaction patterns. These particularities require training for their identification and appropriate handling and are classified in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> in several topics.<a class="elsevierStyleCrossRefs" href="#bib0005">1,3</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>Black people tend to present four pathological reaction patterns:<a class="elsevierStyleCrossRef" href="#bib0005">1</a> (1) Pigmentary lability (tendency to form pigmentary lesions, resulting in hyperpigmentation and hypopigmentation); (2) Follicular response and follicular diseases; (3) Mesenchymal response (fibroblastic and granulomatous); (4) Bullous response.It is worth mentioning that red or brown dermatoses on lightly pigmentated skin, appear black, gray or purple on black skin because of the heavy pigmentation. Follicular, papular, and annular lesions are more common in Afro-Caribbean individuals.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Physiological peculiarities of black skinThe physiological changes of black skin are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<a class="elsevierStyleCrossRefs" href="#bib0105">21–27</a><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Dermatoses with higher incidence on black skinFive major dermatology diagnoses stand out in African-Americans: acne, unspecified eczema, atopic dermatitis, seborrheic dermatitis, and dyschromia.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>In the Angolan population with phototype V‒VI, in Luanda, the prevalence of acne, dermatophytosis and atopic dermatitis stands out. In individuals aged 13 or over, the main complaints were acne (23.6%), dermatophytosis (11.0%) and pityriasis versicolor (8.6%). In the pediatric population, atopic dermatitis (29.4%), tinea capitis (13.7%) and molluscum contagiosum (12.5%) were the most common disorders. In adult women, acne (31.3%) was the main condition, while in adult men, it was dermatophytosis (13.5%).<a class="elsevierStyleCrossRef" href="#bib0145">29</a>Sociocultural habits in black communities, aiming to mask changes in pigmentation with emollient products, produce folliculitis. The use of ointments, oils and creams on hair generally causes alopecia and cosmetic acne in the frontal region.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>AcneAcne is one of the most common conditions seen in black children and adolescents. Its pathogenesis is similar among different ethnic groups, but products frequently used on the skin and hair by black individuals may be comedogenic. Nodulocystic lesions are less frequent, but even lesions without clinical inflammation, such as comedones, have a high degree of inflammation histopathology, which may explain post-inflammatory hyperpigmentation. Keloid scars are frequent sequelae on the chest, back and jawline.<a class="elsevierStyleCrossRefs" href="#bib0005">1,30,31</a>EczemaContact eczemaBlack individuals are less susceptible to irritants. This is attributed to the greater cohesion of the stratum corneum cells in dark skin. This difference is undetectable if the stratum corneum is removed.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> The clinical characteristics in patients with dark skin include lichenification, hyperpigmentation, and early papular or follicular eruption with minimal erythema.In patch tests, there is a similarity in the general frequency of allergies between black and white individuals, but there are differences regarding sensitization to allergens, with positivity for nickel, fragrance mix, bacitracin, balsam of Peru and paraphenylenediamine (PPD). PPD, found in hair dyes, and imidazolidinyl urea, a formaldehyde-releasing preservative, were more frequently allergenic in black men compared to white men.<a class="elsevierStyleCrossRef" href="#bib0160">32</a> The use of darker hair dyes in the black community may explain the greater sensitization to PPD and differences in sensitization patterns are likely due to cultural practices.<a class="elsevierStyleCrossRef" href="#bib0165">33</a>Atopic dermatitis (AD)The pathogenesis of AD includes genetic and environmental factors, varying among different ethnic and racial populations. Black individuals are seven times more likely to seek care for AD than white ones.<a class="elsevierStyleCrossRef" href="#bib0170">34</a> There are differences in the skin barrier properties that may have implications for AD.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> Differences in S. aureus strains, including variability in the presence of superantigen genes, have been demonstrated between whites and blacks with AD.<a class="elsevierStyleCrossRef" href="#bib0175">35</a> Clinically, there are different expressions of erythema, due to background melanin, manifesting as reddish-brown, violet, gray or intensely hyperchromic plaques, instead of bright red. There is greater visibility of desquamation and dry skin. They are more frequently located in the extensor areas than in the flexural areas and pruritus is more frequent and more severe. Follicular and perifollicular papules, lichenoid or nodular-papular morphologies are common, in addition to periorbital lichenification and hyperchromia. Post-inflammatory hyperpigmentation is more frequent and persistent.<a class="elsevierStyleCrossRef" href="#bib0175">35</a>Seborrheic dermatitis (SD)SD is among the five most common diagnoses in black people.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> In adults and adolescents, the underlying erythema is barely visible and there is hypopigmentation in the classic areas of involvement,<a class="elsevierStyleCrossRef" href="#bib0180">36</a> possibly due to the inhibition of tyrosinase function in melanocytes by Malassezia metabolites, with less pigment production.<a class="elsevierStyleCrossRefs" href="#bib0185">37,38</a> Black children often present with erythema, desquamation and hypopigmentation of the affected areas and overlying AD, which accentuates the hypopigmentation.<a class="elsevierStyleCrossRefs" href="#bib0185">37,39</a>Scalp SD is prominent among black women and can be exacerbated by excessive use of hair oils or ointments and infrequent washing.<a class="elsevierStyleCrossRef" href="#bib0190">38</a> Children generally do not have the “cradle cap” seen in Caucasians.<a class="elsevierStyleCrossRefs" href="#bib0190">38,39</a> In other age groups, petaloid SD, with circinate lesions, polycyclic coalescing rings, either pink or hypopigmented, with furfuraceous desquamation, is observed on the hair implantation line or on other areas of the face.<a class="elsevierStyleCrossRef" href="#bib0195">39</a>DyschromiasPigmentary disorders are the third most common condition in black skin,<a class="elsevierStyleCrossRef" href="#bib0140">28</a> and can be either hyperpigmentation or hypopigmentation/achromia, with the latter being psychologically devastating, due to the marked contrast with normal skin, in addition to resistance to treatment.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Post-inflammatory hyperpigmentation (PIH)Among pigmentation disorders in black skin, PIH is the most common. It occurs after skin inflammation or injury,<a class="elsevierStyleCrossRefs" href="#bib0150">30,40,41</a> resulting from excessive production or irregular dispersion of melanin.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> There are several etiologies, including infections, inflammatory diseases and skin injury caused by physical or chemical agents, including cosmetic procedures. PIH manifests as macules in the same distribution as the initial inflammatory process, the intensity of which may have a direct correlation with phototypes (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<a class="elsevierStyleCrossRef" href="#bib0205">41</a><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Post-inflammatory hypopigmentationPost-inflammatory hypopigmentation is more common and more evident in people with dark skin. It results from inflammatory (AD, SD, contact dermatitis, psoriasis, etc.), neoplastic (mycosis fungoides), infectious (syphilis), traumatic (wounds, burns) or iatrogenic conditions (post laser, cryotherapy or chemical peelings). It appears as single or multiple hypochromic macules, without desquamation.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Progressive macular hypomelanosis (PMH)PMH is a common and poorly diagnosed dermatosis. It is distributed worldwide, being more common in tropical countries in black people, preferentially affecting young women. C. acnes is believed to produce a depigmenting factor, as this bacteria can be grown from follicles in hypopigmented areas, but not from neighboring normal-appearing skin. It is characterized by confluent, ill-defined, non-desquamative hypopigmented patches located on the trunk, around the midline and, rarely, extending to the proximal extremities and head and neck regions.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> There is no pruritus, pain or previous inflammation; it is stable or progresses slowly for years, with spontaneous disappearance later in life.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> Wood's lamp examination may show red follicular fluorescence in hypopigmented areas. Dermoscopy reveals whitish, poorly defined areas without desquamation.<a class="elsevierStyleCrossRef" href="#bib0210">42</a> Histopathology shows a decrease in melanin in the epidermis, while the dermis appears normal.<a class="elsevierStyleCrossRefs" href="#bib0215">43,44</a>Pityriasis alba (PA)PA begins around three to 16 years of age, without sex predilection, occurring more commonly in darker skin.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> Its etiopathogenesis remains unknown; however, it is believed to represent nonspecific dermatitis with residual post-inflammatory hypopigmentation. Associated findings include atrophic sebaceous glands, iron-deficiency anemia, and low serum copper levels.<a class="elsevierStyleCrossRef" href="#bib0220">44</a> Black children may be genetically predisposed to xerosis, which can lead to PA.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> Environmental factors such as sun exposure, long and frequent baths and mechanical exfoliation seem to be predisposing factors on susceptible skin.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> It is important to inquire about personal or family history of atopy, as it is one of the minor criteria for AD.<a class="elsevierStyleCrossRefs" href="#bib0155">31,44</a> In dark skin, early lesions present as subclinical dermatitis and erythema is barely evident.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> The initial lesions are desquamative papules that evolve into clearly visible hypochromic areas, different from lightly pigmented skin, due to the contrast with healthy skin. It generally affects the face, neck and arms; histopathological findings are nonspecific.<a class="elsevierStyleCrossRefs" href="#bib0155">31,44</a>MelasmaMelasma is a common acquired hyperpigmentation, typically occurring on the face, with a high prevalence in women and darker skin types. Family history, especially in darker skin, is an important risk factor.<a class="elsevierStyleCrossRefs" href="#bib0225">45,46</a> Clinically, the pigmentation is more intense and persistent. On histopathology, melanophages have been detected in the superficial dermis, with a very heterogeneous distribution, varying from one lesion to another in the same patient and even within the same area of melasma.<a class="elsevierStyleCrossRef" href="#bib0230">46</a>Dermatoses highly specific for black skinPseudofolliculitis barbae (PFB)PFB, also known as pili incarnati or sycosis barbae, is a common chronic disease, seen almost exclusively in black men, between 14 and 25 years of age, with a prevalence between 45% and 83%. It causes problems in professions that require a clean-shaven appearance.<a class="elsevierStyleCrossRef" href="#bib0235">47</a> It is a foreign body type inflammatory reaction around the hair due to its structural characteristics and growth orientation, which curves downwards and penetrates the epidermis and dermis (extrafollicular penetration) or grows inside the follicle, perforating its wall and penetrating the dermis (transfollicular penetration). The latter generally results from an incorrect shaving technique, such as stretching the skin, and the use of blades that pull the hair instead of cutting it, causing retraction with the tip below the skin surface. Molecular biology studies detected the substitution of a single nucleotide in the specific keratin of the hair follicle layers (K6hf).<a class="elsevierStyleCrossRef" href="#bib0240">48</a> The mutation in K6hf is believed to lead to a weakened cytoskeleton, increasing the chances of ingrown hairs. Carriers of the A12T polymorphism of the gene that encodes keratin have a six-fold greater chance of developing PFB. About 76% of men who shave regularly and who carry the A12T polymorphism develop PFB, making this a significant risk factor for the disease. Finally, PFB has been associated with the use of cyclosporine and corticosteroids in kidney transplant patients and also with violin pressure under the jaw (violinist's neck).<a class="elsevierStyleCrossRef" href="#bib0245">49</a> Clinically, they are follicular papulo-pustules, where the hair can be seen in a linear groove. It mainly affects the face and neck of men, but it is also seen in women in areas where hair removal is practiced, such as the armpits, pubic region and legs during menopause or in hirsute young women. Pustules may be secondary to infection, usually by Staphylococcus epidermidis. Post-inflammatory hyperpigmentation and keloids may occur. Histopathology shows invagination of the epidermis, neutrophilic inflammatory infiltrate, microabscesses, foreign body-type granulomas and fibrosis.<a class="elsevierStyleCrossRef" href="#bib0245">49</a>KeloidKeloids and hypertrophic scars are considered distinct types of scars. They are benign excessive growths of scar tissue at sites of skin injuries. Clinically, keloids are smooth, shiny and firm, red or pink papules, plaques, or nodules, with progressive hyperpigmentation, that spread into the surrounding normal skin. Hypertrophic scars do not grow beyond the limits of the original injury. On histopathology, keloids tend to have a large volume of thick, eosinophilic, hyaline collagen and many blood vessels, the opposite occurring in hypertrophic scars. However, the scar may present the growth pattern and histopathological characteristics of both hypertrophic scars and keloids, suggesting that the two types of scars are manifestations of the same fibroproliferative disease, differing only in the intensity and duration of inflammation.<a class="elsevierStyleCrossRefs" href="#bib0250">50,51</a>Dermatosis papulosa nigraThese are benign skin lesions of unknown etiology, but with a genetic predisposition, with more than 50% of patients reporting a family history.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> The highest prevalence is found in black people, between 10% and 30%. It begins after puberty, as multiple hyperpigmented, rounded or filiform papules, measuring 1 to 5 mm, on the face, neck and trunk, gradually increasing in number (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). They are generally asymptomatic, although they can cause skin irritation and pruritus.<a class="elsevierStyleCrossRef" href="#bib0035">7</a><elsevierMultimedia ident="fig0015"></elsevierMultimedia>Sickle cell anemia ulcersUlcers are a common complication of sickle-cell disease. Geographic origin is a factor in the occurrence of this disease.<a class="elsevierStyleCrossRefs" href="#bib0260">52,53</a> The most common genotypes are, in decreasing order of frequency: homozygous SS sickle cell anemia, compound heterozygous Sb0 thalassemia, and sickle cell trait hemoglobin. The incidence of ulcers varies with the total hemoglobin level and the fetal hemoglobin level. When low, they are associated with an increased risk. These are very painful ulcers, located on the legs, which are difficult to heal. The prognosis is associated with its clinical characteristics, and not with the biological characteristics of sickle cell disease. Complete healing was achieved within six months in 75% of cases, when the area was less than 8 cm2 and the duration was less than nine weeks, comparable to the healing rates observed in venous ulcers.<a class="elsevierStyleCrossRefs" href="#bib0260">52,53</a>AinhumAlso known as dactylolysis spontanea or ayun (in the Yoruba language, it means ‘cutting’), it occurs worldwide, but is more common in African countries, with a low prevalence (0.015%). In Brazil, it affects individuals with different phenotypes.<a class="elsevierStyleCrossRef" href="#bib0270">54</a>It begins with an asymptomatic fissure at the base of the fifth toe, evolving into a fibrous constrictive painful ring leading to mutilation due to ischemia. Occasionally, it may be bilateral.<a class="elsevierStyleCrossRefs" href="#bib0275">55,56</a> It differs from pseudo-ainhum, secondary to conditions that cause constriction, by its spontaneous and idiopathic onset. The clinical diagnosis includes at least one of the following three criteria: soft tissue constriction, bulbous enlargement of the toes, and thinning or lysis of the phalanx bones, and requires radiographic confirmation.<a class="elsevierStyleCrossRef" href="#bib0280">56</a>Confluent and reticulated papillomatosis (CRP) of Gougerot-CarteaudDermatosis that affects adolescents and young adults, especially women, twice as common in black people than in whites. It may be associated with insulin resistance and obesity.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> It is characterized by thin, scaly papules, initially erythematous and later brown, which merge into reticulated, hyperkeratotic or verrucous plaques on the chest and back, asymptomatic or slightly pruritic. Histopathology shows hyperkeratosis, with irregular papillomatosis, focal acanthosis and increased melanin. Acanthosis nigricans is the main differential diagnosis.<a class="elsevierStyleCrossRef" href="#bib0155">31</a>Hair and scalp diseasesFragile and brittle hairBreakage is a common problem in black hair, leading to deficient growth and alopecia, due to the intrinsic characteristics of fragility and reduced tensile strength. Fragility results from the elliptical shape of the shafts originating from the curved follicle, different hair diameters and dry scalp. Transverse asymmetry, with points of weakness, reduces tensile strength.<a class="elsevierStyleCrossRefs" href="#bib0285">57,58</a> Damage to the hair shaft resulting from the removal of proteins or 18-methyl eicosanoic acid (18-MEA), the main lipid of the hair cuticle, contributes to breakage. of hair, secondary to excessive use of heat or chemical agents, in addition to hairstyles that exert traction.<a class="elsevierStyleCrossRefs" href="#bib0085">17,59,60</a>Dermoscopy (trichoscopy) shows trichorrhexis nodosa, where the shaft is nodularly dilated and lighter, and distal trichoptilosis (cracking of the ends) or central trichoptilosis (longitudinal division in the central part of the hair shaft).<a class="elsevierStyleCrossRefs" href="#bib0085">17,61–63</a>Traction alopeciaCaused by repetitive tension in hair from braids, ponytails, turbans, buns, dreadlocks, weaves, extensions, among others,<a class="elsevierStyleCrossRef" href="#bib0320">64</a> traction alopecia generally begins in childhood.<a class="elsevierStyleCrossRefs" href="#bib0320">64,65</a> The pattern is characteristic, reflecting the distribution of traction, affecting the temporal, pre-auricular and above-the-ears regions, and may involve other parts of the scalp. Folliculitis, reduced hair density and broken hairs are seen in these areas, in addition to the fringe sign (long terminal hairs anterior to the alopecia area, which consist of fine or miniaturized residual hairs). It may be associated with headache, relieved by loosening the hair.<a class="elsevierStyleCrossRefs" href="#bib0325">65,66</a> Early diagnosis is important, when it is still reversible. Trichoscopy in the early stage shows the honeycomb pattern of the preserved scalp, perifollicular erythema, reduced hair density and vellus hairs. The advanced stage is characterized by loss of follicular openings.<a class="elsevierStyleCrossRefs" href="#bib0085">17,65,66</a> Histopathology in the initial stage shows a normal number of hair follicles, but a greater number of telogen and catagen follicles, in addition to trichomalacia (remnants of hair shafts in the ostia). In advanced stages, there is a decrease in the number of terminal follicles, replaced by fibrous tracts. There is no inflammatory infiltrate during the course of this disease.<a class="elsevierStyleCrossRef" href="#bib0330">66</a>Folliculitis keloidalis nuchaeIt results from ingrown hairs, extrafollicular or transfollicular penetration of the skin, generally secondary to the cutting of black hair.<a class="elsevierStyleCrossRefs" href="#bib0335">67,68</a> It presents as papules, pustules, plaques and nodules on the posterior region of the scalp, commonly associated with alopecia and keloids. Trichoscopy shows broken hairs with tufts, ingrown hairs and peripilar casts (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<a class="elsevierStyleCrossRefs" href="#bib0335">67,68</a><elsevierMultimedia ident="fig0020"></elsevierMultimedia>Dissecting folliculitis (cellulitis)Also called folliculitis and perifolliculitis capitis abscedens et suffodiens, it is a chronic scalp disorder, observed mainly in young men. The lesions, initially papulopustular, develop into painful, multifocal inflammatory nodules, connected by intercommunicating sinuses, resulting in cicatricial alopecia.<a class="elsevierStyleCrossRefs" href="#bib0035">7,69</a> On trichoscopy, characteristics of non-scarring alopecia are initially observed, with regularly distributed pinpoint white dots, enlarged follicular openings, “3D” yellow spots (accumulation of sebum and keratin), black spots and fractured hair shafts. In the terminal stage, cicatricial lesions appear, characterized by ivory-white confluent areas, without follicular ostia.<a class="elsevierStyleCrossRefs" href="#bib0340">68–70</a>Central centrifugal cicatricial alopecia (CCCA)Formerly known as hot comb alopecia (a method of straightening hair), pseudopelade, and follicular degeneration syndrome, CCCA is most common in young to middle-aged women of African descent. The etiology is unknown but with an apparent influence of genetic factors, traction, heat and chemicals. It is characterized by a chronic and progressive lesion on the vertex of the scalp, which progresses in a centrifugal and symmetrical manner, with activity in the peripheral zone, surrounding the central zone of cicatricial alopecia.<a class="elsevierStyleCrossRefs" href="#bib0035">7,71–73</a> Signs of inflammation are absent, although erythema, follicular pustules and desquamation may appear. It is usually asymptomatic, but pain, pruritus or burning sensation in the scalp may occur.<a class="elsevierStyleCrossRefs" href="#bib0365">73,74</a> There is a spontaneous reduction in inflammation after years or decades.<a class="elsevierStyleCrossRef" href="#bib0375">75</a> Trichoscopy reveals a preserved pigmented honeycomb network and irregularly distributed white dots. A grayish-white peripilar halo is a specific and sensitive sign, corresponding on histopathology to follicular ostia surrounded by fibrosis.<a class="elsevierStyleCrossRefs" href="#bib0370">74,75</a> Other characteristics include hair shaft variability, perifollicular erythema, broken hairs as black dots within the follicular openings or as short broken shafts, asterisk-like pigmented macules with sparse, vellus-like terminal hair shafts and scattered white patches.<a class="elsevierStyleCrossRefs" href="#bib0370">74–76</a> In the early stage histopathology reveals a perifollicular lymphocytic infiltrate with perifollicular fibroplasia. In later stages, there is destruction of the follicular epithelium and fragments of hair shafts sorrounded by granulomatous inflammation, followed by replacement of the follicles by connective tissue besides tufting/polytrichia of the hair follicles.<a class="elsevierStyleCrossRef" href="#bib0380">76</a>Some dermatoses with peculiar aspects in black skinSarcoidosisAfrican Americans tend to develop sarcoidosis at a younger age and are at greater risk of developing severe lung and skin disease. Lupus pernio is associated with a worse prognosis for both systemic disease and more chronic skin lesions.<a class="elsevierStyleCrossRefs" href="#bib0385">77,78</a> Black people have sarcoidosis at a younger age, on average around the 40 s, and women more so than men. Most of the time, the initial lesions are asymptomatic, with the first consultation being motivated by disfigurement. Papules on the face and neck are the main observed lesions. Erythema nodosum is less common than in white individuals. There is a greater propensity for more severe disease, with a greater number of extracutaneous organs being involved, in the following order: lungs, lymph nodes and heart. Mortality rates are higher.<a class="elsevierStyleCrossRefs" href="#bib0385">77,78</a> Lupus pernio is associated with a worse prognosis for both systemic disease and more chronic skin lesions.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Lichen planus (LP)Hypertrophic, pigmentosus, and actinic types of LP are characteristic of dark-skinned individuals.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> The violaceous color, typical of light skin, is less visible on dark skin and PIH is intense. On dermoscopy, the most common features include: pigmentary changes, pearly whitish structures and a purple background.<a class="elsevierStyleCrossRef" href="#bib0395">79</a>LP pigmentosus (LPP)LPP is a rare variant of LP, which begins after the age of 30, predominantly in black women.<a class="elsevierStyleCrossRef" href="#bib0400">80</a> Although the pathogenesis is the same as in classic LP,<a class="elsevierStyleCrossRef" href="#bib0405">81</a> sunlight is an important factor, in addition to chemical agents (contactants and drugs) and microorganisms.<a class="elsevierStyleCrossRefs" href="#bib0400">80,81</a> The initial lesions are small round or oval macules, gray or brown, with irregular ill-defined edges, which coalesce to form diffuse, reticulated, perifollicular or annular pigmented areas,<a class="elsevierStyleCrossRefs" href="#bib0400">80,82</a> distributed mainly in body regions exposed to the sun, starting on the face and neck, spreading to the upper extremities and trunk, symmetrically, rarely affecting the oral mucosa, the scalp, nails, palms and soles.<a class="elsevierStyleCrossRefs" href="#bib0400">80,82</a> There are no Wickham striae.<a class="elsevierStyleCrossRef" href="#bib0410">82</a> Eventually, there are classic LP lesions. Pruritus is mild or absent.<a class="elsevierStyleCrossRef" href="#bib0405">81</a> One variant is LPP inversus, which affects skin not exposed to the sun, particularly flexural and intertriginous areas, in which a transition from papules to macules can be observed (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). Mechanical stimuli are triggers. Other variants are: localized, segmental, linear, zosteriform and oral mucosa LPP.<a class="elsevierStyleCrossRefs" href="#bib0400">80–82</a><elsevierMultimedia ident="fig0025"></elsevierMultimedia>Dermoscopy of LPP inversus shows homogeneous brown areas (epidermal pigmentation), as well as brown-gray or blue-gray dots and globules (pigmentary incontinence), which are initially grouped into a diffuse pattern of black pigmentation. Over time, they converge forming reticular, linear and cobblestone patterns. White dots are secondary to lack of pigmentation in the follicular openings, and the absence of pigment in the grooves may be due to lack of exposure to friction.<a class="elsevierStyleCrossRef" href="#bib0410">82</a>Histopathologically, the lichenoid inflammatory infiltrate is similar to the one seen in classic LP,<a class="elsevierStyleCrossRef" href="#bib0405">81</a> but it regresses quickly, without the proliferation of keratinocytes, and the melanin deposited in the dermis remains for months to years.<a class="elsevierStyleCrossRef" href="#bib0410">82</a> Direct immunofluorescence is rarely positive, with IgM and C3 at the dermal-epidermal junction and IgG and IgA in keratinocytes.<a class="elsevierStyleCrossRefs" href="#bib0405">81,82</a> It can be associated with hepatitis C, endocrinopathies, autoimmune diseases and malignancies, as well as other variants of LP.<a class="elsevierStyleCrossRefs" href="#bib0400">80–82</a>PsoriasisPsoriasis in dark-skinned patients is characterized by less distinguishable erythema, thicker plaques, greater desquamation and greater body involvement (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). The resolution of the lesions results in pigmentary changes (hyper- and hypopigmentation). The frequency of psoriatic arthritis in blacks is approximately half that in Caucasians.<a class="elsevierStyleCrossRef" href="#bib0415">83</a> The most common dermoscopic features include: light red background, red dotted vessels, regular vessels, white scales, irregular distribution, and pigmentary changes.<a class="elsevierStyleCrossRef" href="#bib0395">79</a><elsevierMultimedia ident="fig0030"></elsevierMultimedia>Lupus erythematosus (LE)Discoid LE (DLE) has a higher incidence and severity in black women.<a class="elsevierStyleCrossRef" href="#bib0420">84</a> The lesions are mostly located in exposed areas, with greater involvement of the scalp and ears, with depigmentation and cicatricial alopecia being prominent (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>).<a class="elsevierStyleCrossRef" href="#bib0420">84</a> Lesions vary from desquamative to hypertrophic or verrucous and tend to have an annular morphology. Depigmentation is obvious and can be disfiguring.<a class="elsevierStyleCrossRef" href="#bib0420">84</a> PIH is also prominent,<a class="elsevierStyleCrossRefs" href="#bib0420">84,85</a> with a risk of hypertrophic scars. Hair care practices contribute to more frequent and severe cicatricial alopecia.<a class="elsevierStyleCrossRef" href="#bib0420">84</a><elsevierMultimedia ident="fig0035"></elsevierMultimedia>The prevalence of systemic LE (SLE) is approximately three-fold higher among black people, with women being most affected.<a class="elsevierStyleCrossRef" href="#bib0430">86</a> The disease shows rapid progression and greater severity, with kidney and cardiovascular damage and higher and earlier mortality rates.<a class="elsevierStyleCrossRefs" href="#bib0430">86,87</a> The causes of these disparities are multifactorial, including genetic, epigenetic, socioeconomic, and racial discrimination ones.<a class="elsevierStyleCrossRef" href="#bib0435">87</a> Cutaneous involvement occurs in around 80% of cases, the majority due to specific lesions, which are associated with less severe disease.<a class="elsevierStyleCrossRef" href="#bib0440">88</a> Among non-specific lesions, Raynaud's phenomenon, oral ulcers and diffuse melanonychia affect almost 40% of the patients. Acute lupus erythematosus, the most common form of SLE in Caucasians, is uncommon in black individuals, and is associated with kidney disease, livedo reticularis, non-cicatricial alopecia, and oral ulcers. DLE occurs in about 50% of cases and is associated with arthritis. Subacute lupus erythematosus is rare, perhaps because subtle erythematous eruptions and photosensitivity are difficult to detect.<a class="elsevierStyleCrossRef" href="#bib0445">89</a>VitiligoVitiligo is very debilitating in dark skin due to its highly inaesthetic characteristic, with a profound effect on the patients quality of life. Its prevalence varies greatly within the same race and among different races. In addition to the usual etiopathogenic factors, Koebner phenomenon is implicated in dark skin. The lesion occur mainly in areas exposed to the sun, especially the lips. The genitals are also often affected. Depending on the intensity of the acromia, speckled and trichromatic vitiligo seems to be specific for black skin, with a high contrast between lesions and healthy skin (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>).<a class="elsevierStyleCrossRef" href="#bib0450">90</a><elsevierMultimedia ident="fig0040"></elsevierMultimedia>SyphilisSecondary syphilis in black people sometimes shows intense desquamation, giving the lesions a psoriasiform appearance. On the face, the papules tend to cluster around the nose and mouth, simulating seborrheic dermatitis. Periorificial lesions assume characteristic annular and circinate configurations (elegant syphilis; <a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>). In the inguinocrural region, due to friction and humidity, the papules, rich in treponemas, become vegetative and macerated (flat condyloma). On the oral mucosa, white vegetative plaques can be observed on an eroded base, and are contagious.<a class="elsevierStyleCrossRef" href="#bib0455">91</a><elsevierMultimedia ident="fig0045"></elsevierMultimedia><elsevierMultimedia ident="fig0050"></elsevierMultimedia>Pityriasis versicolor (PV)Some studies report the predilection of PV for individuals with darker skin. It initially presents as round or oval hypopigmented or, less frequently, hyperpigmented macules, measuring 3 to 5 mm, symmetrically distributed on the upper trunk, shoulders or flexural areas. Facial and cervical involvement is more common. Subsequently, they spread and coalesce to form larger, irregularly shaped patches. When active, there is subtle desquamation associated with pruritus. After treatment, pigmentary changes without desquamation may persist for months.<a class="elsevierStyleCrossRef" href="#bib0460">92</a>NeoplasmsAlthough the risk for skin cancer is lower in black people, exposure to UV rays is also a risk factor.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> The repair of DNA damage induced by UV radiation is more efficient in black people. <a class="elsevierStyleCrossRef" href="#bib0465">93</a> Black individuals are less likely to use sun protection, as they believe it is unnecessary.<a class="elsevierStyleCrossRef" href="#bib0150">30</a><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a><a class="elsevierStyleCrossRefs" href="#bib0465">93–95</a> illustrates the main characteristics and differences between non-melanoma and melanoma cancer in black skin.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Primary cutaneous T-cell lymphoma (CTCL)Mycosis fungoides (MF) is the most common type of lymphoma in black skin, accounting for more than 50% of CTCLs,<a class="elsevierStyleCrossRef" href="#bib0150">30</a> with an incidence rate of 4.0 and 6.1/100,000 for white and black patients, respectively.<a class="elsevierStyleCrossRefs" href="#bib0480">96,97</a> Black individuals present with MF at an earlier age and at a higher T stage than white ones. Clinically, MF generally presents as patches, plaques or tumors located, preferably, in covered areas, but can also present with erythroderma. The lesions are hyperpigmented in darker skin, rather than erythematous, with a hypopigmented variant. Hyperpigmented lesions correlate with shorter survival, while hypopigmented ones correlate with longer survival and an indolent course.<a class="elsevierStyleCrossRef" href="#bib0480">96</a>Sezary Syndrome (SS) is a rare leukemic variant of CTCL, defined by the triad of erythroderma, neoplastic T cells (Sezary cells) in the blood, and lymphadenopathy. Like MF, SS also has a higher prevalence in black individuals compared to white ones. As on lightly pigmented skin, it can be difficult to differentiate it from other diffuse eruptions. The biggest concern is that pruritus and changes secondary to scratching are attributed to xerosis.<a class="elsevierStyleCrossRefs" href="#bib0480">96,97</a>Endemic Kaposi sarcomaIt is limited to sub-Saharan Africa and is typically seen in young, HIV-negative black men, aged 25 to 40. Clinical manifestations can range from indolent to aggressive and lethal. Its presentation can be locally invasive or aggressive with/or without mucocutaneous involvement. There are four subtypes: benign nodular; locally aggressive with invasion of soft tissues and bones; florid and disseminated with the involvement of skin and viscera; and lymphadenopathic, spreading rapidly to lymph nodes and viscera. The last is the most aggressive and is associated with African children aged one to five years.<a class="elsevierStyleCrossRefs" href="#bib0035">7,98</a>Dermatofibrosarcoma protuberans (DFSP)DFSP is a rare, slow-growing, spindle cell neoplasm located in the dermis or subcutaneous tissue. The incidence among black people is twice as high and the tumors are larger than in white individuals, one explanation being the delay in diagnosis.<a class="elsevierStyleCrossRef" href="#bib0495">99</a> It is more common in the trunk than in the head and neck, with no difference for the extremities.<a class="elsevierStyleCrossRef" href="#bib0500">100</a> The risk of death in black individuals is 1.7-fold greater than in whites and depends on size.<a class="elsevierStyleCrossRefs" href="#bib0495">99,100</a>There is a rare, pigmented variant, called Bednar tumor, which occurs in 5% of cases, mainly in blacks,<a class="elsevierStyleCrossRef" href="#bib0500">100</a> observed in young and middle-aged adults, occasionally in the pediatric age group. Histogenesis is unexplained and may be related to remnants of embryonic breast tissue or local trauma, with two theories having been proposed: neuroectodermal differentiation or melanocytic colonization.<a class="elsevierStyleCrossRefs" href="#bib0495">99,100</a> It has been reported in association with dermal melanocytosis (nevus of Ito) and is believed that it originates from a neuromesenchymal cell. It is most commonly located on the trunk, especially on the shoulders and back, and can also affect the head and neck, as well as the extremities. <a class="elsevierStyleCrossRefs" href="#bib0495">99,100</a> Clinically, it resembles a keloid. The majority appear as masses, plaques, or protruding, firm, multilobulated nodules, with a wide base and slow growth, in the dermis and subcutaneous tissue. On histopathology, it consists of spindle cells, with mild pleomorphism.<a class="elsevierStyleCrossRefs" href="#bib0495">99,100</a> Pigment-laden dendritic cells differentiate this lesion from conventional DFSP.<a class="elsevierStyleCrossRef" href="#bib0500">100</a> Immunohistochemistry detects CD34 positivity in the cells.<a class="elsevierStyleCrossRef" href="#bib0495">99</a> The biological behavior is that of intermediate malignancy and it must be differentiated from other pigmented, fusiform skin lesions.<a class="elsevierStyleCrossRefs" href="#bib0495">99,100</a>Financial supportNone declared.Conflicts of interestNone declared.Authors' contributionsMaurício Mota de Avelar Alchorne: Design and planning of the study; critical review of important intellectual content; effective participation in research orientation; approval of the final version of the manuscript.Katleen da Cruz Conceição: Critical review of the literature; data collection; drafting and editing of the manuscript; approval of the final version of the manuscript.Leonardo Lora Barraza: Critical review of the literature; collection of data; drafting and editing of the manuscript; approval of the final version of the manuscript.Marilda Aparecida Milanez Morgado de Abreu: Design and planning of the study; critical review of important intellectual content; drafting and editing of the manuscript; approval of the final version of the manuscript." "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres2136749" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1814417" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Dermatology in black skin" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "The black population" ] 4 => array:3 [ "identificador" => "sec0015" "titulo" => "Structural, biological and functional aspects of black skin" "secciones" => array:4 [ 0 => array:3 [ "identificador" => "sec0020" "titulo" => "Epidermis" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Stratum corneum" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Lipid composition" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Melanocytes/melanosomes" ] ] ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Dermis" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Adnexal glands" ] 3 => array:3 [ "identificador" => "sec0050" "titulo" => "Scalp, hair follicles and hair" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Scalp" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Hair follicles" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Hair" ] ] ] ] ] 5 => array:2 [ "identificador" => "sec0070" "titulo" => "Dermatoses in black skin" ] 6 => array:2 [ "identificador" => "sec0075" "titulo" => "Physiological peculiarities of black skin" ] 7 => array:3 [ "identificador" => "sec0080" "titulo" => "Dermatoses with higher incidence on black skin" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0085" "titulo" => "Acne" ] 1 => array:3 [ "identificador" => "sec0090" "titulo" => "Eczema" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0095" "titulo" => "Contact eczema" ] ] ] 2 => array:2 [ "identificador" => "sec0100" "titulo" => "Atopic dermatitis (AD)" ] 3 => array:2 [ "identificador" => "sec0105" "titulo" => "Seborrheic dermatitis (SD)" ] 4 => array:3 [ "identificador" => "sec0110" "titulo" => "Dyschromias" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0115" "titulo" => "Post-inflammatory hyperpigmentation (PIH)" ] 1 => array:2 [ "identificador" => "sec0120" "titulo" => "Post-inflammatory hypopigmentation" ] 2 => array:2 [ "identificador" => "sec0125" "titulo" => "Progressive macular hypomelanosis (PMH)" ] 3 => array:2 [ "identificador" => "sec0130" "titulo" => "Pityriasis alba (PA)" ] 4 => array:2 [ "identificador" => "sec0135" "titulo" => "Melasma" ] ] ] ] ] 8 => array:3 [ "identificador" => "sec0140" "titulo" => "Dermatoses highly specific for black skin" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0145" "titulo" => "Pseudofolliculitis barbae (PFB)" ] ] ] 9 => array:3 [ "identificador" => "sec0150" "titulo" => "Keloid" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0155" "titulo" => "Dermatosis papulosa nigra" ] 1 => array:2 [ "identificador" => "sec0160" "titulo" => "Sickle cell anemia ulcers" ] 2 => array:2 [ "identificador" => "sec0165" "titulo" => "Ainhum" ] 3 => array:2 [ "identificador" => "sec0170" "titulo" => "Confluent and reticulated papillomatosis (CRP) of Gougerot-Carteaud" ] 4 => array:3 [ "identificador" => "sec0175" "titulo" => "Hair and scalp diseases" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0180" "titulo" => "Fragile and brittle hair" ] 1 => array:2 [ "identificador" => "sec0185" "titulo" => "Traction alopecia" ] 2 => array:2 [ "identificador" => "sec0190" "titulo" => "Folliculitis keloidalis nuchae" ] 3 => array:2 [ "identificador" => "sec0195" "titulo" => "Dissecting folliculitis (cellulitis)" ] 4 => array:2 [ "identificador" => "sec0200" "titulo" => "Central centrifugal cicatricial alopecia (CCCA)" ] ] ] ] ] 10 => array:3 [ "identificador" => "sec0205" "titulo" => "Some dermatoses with peculiar aspects in black skin" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0210" "titulo" => "Sarcoidosis" ] 1 => array:3 [ "identificador" => "sec0215" "titulo" => "Lichen planus (LP)" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0220" "titulo" => "LP pigmentosus (LPP)" ] ] ] 2 => array:2 [ "identificador" => "sec0225" "titulo" => "Psoriasis" ] 3 => array:2 [ "identificador" => "sec0230" "titulo" => "Lupus erythematosus (LE)" ] 4 => array:2 [ "identificador" => "sec0235" "titulo" => "Vitiligo" ] 5 => array:2 [ "identificador" => "sec0240" "titulo" => "Syphilis" ] 6 => array:3 [ "identificador" => "sec0245" "titulo" => "Pityriasis versicolor (PV)" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0250" "titulo" => "Neoplasms" ] 1 => array:2 [ "identificador" => "sec0255" "titulo" => "Primary cutaneous T-cell lymphoma (CTCL)" ] 2 => array:2 [ "identificador" => "sec0260" "titulo" => "Endemic Kaposi sarcoma" ] 3 => array:2 [ "identificador" => "sec0265" "titulo" => "Dermatofibrosarcoma protuberans (DFSP)" ] ] ] ] ] 11 => array:2 [ "identificador" => "sec0270" "titulo" => "Financial support" ] 12 => array:2 [ "identificador" => "sec0275" "titulo" => "Conflicts of interest" ] 13 => array:2 [ "identificador" => "sec0280" "titulo" => "Authors' contributions" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-07-23" "fechaAceptado" => "2023-10-17" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1814417" "palabras" => array:5 [ 0 => "Dermatopathies" 1 => "Ethnicity" 2 => "Pigmentation" 3 => "Population" 4 => "Skin" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The vast majority of publications in dermatology refer to lightly pigmented skin, with few addressing the peculiarities of black skin. In addition there is no consensus on what it means to be black in different regions of the world. The lack of knowledge on the subject makes it difficult to recognize and manage dermatoses in this type of skin. This article aims to review the literature on intrinsic characteristics, as well as epidemiological and clinical aspects of the cutaneous manifestations of different dermatoses in black skin. It was found that there are sometimes striking differences, in the structural, biological, and functional aspects when comparing lightly pigmented and black skin. There are also physiological changes that need to be recognized to avoid unnecessary interventions. Some dermatoses have a higher incidence in black skin, such as acne, eczema, dyschromia and dermatophytosis. On the other hand, several dermatoses are more specific to black skin, such as pseudofolliculitis barbae, keloid, dermatosis papulosa nigra, ulcers caused by sickle-cell anemia, dactylolysis spontanea, confluent and reticulated papillomatosis of Gougerot and Carteaud, and some diseases of the hair and scalp (including fragile and brittle hair, traction alopecia, folliculitis keloidalis nuchae, folliculitis dissecans and central centrifugal cicatricial alopecia). A spectrum of peculiar aspects of specific dermatoses, including sarcoidosis, lichen planus (with emphasis on the pigmentosus variant), psoriasis, lupus erythematosus, vitiligo, syphilis, pityriasis versicolor, and neoplasms are highlighted. In the latter, characteristics of basal cell carcinoma, squamous cell carcinoma, and melanoma are compared, in addition to highlighting unusual aspects of primary cutaneous T-cell lymphoma, endemic Kaposi sarcoma, and dermatofibrosarcoma protuberans." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "Study conducted at the Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil." ] ] "multimedia" => array:13 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1475 "Ancho" => 1675 "Tamanyo" => 145016 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Highlighting topics in black skin." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1133 "Ancho" => 1508 "Tamanyo" => 250561 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Post-inflammatory hyperpigmentation: hyperchromic macules on the lumbosacral and gluteal regions." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1133 "Ancho" => 1508 "Tamanyo" => 274958 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Dermatosis papulosa nigra: hyperchromic papules on the face." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1675 "Ancho" => 1258 "Tamanyo" => 646139 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Keloid folliculitis of the neck: sessile nodule on the back of the neck." ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 852 "Ancho" => 1508 "Tamanyo" => 241259 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Lichen planus pigmentosus: slightly raised papules and bright hyperchromic macules in the axilla." ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 2008 "Ancho" => 1508 "Tamanyo" => 430402 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Psoriasis: hyperchromic plaques with thick symmetrical scales on the anterior surface of the legs." ] ] 6 => array:8 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 1639 "Ancho" => 1508 "Tamanyo" => 647739 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Discoid lupus erythematosus: atrophic alopecic plaque on the frontoparietal region." ] ] 7 => array:8 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 1361 "Ancho" => 2175 "Tamanyo" => 539885 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Vitiligo: achromic macules on the scalp and neck (A) and on the dorsum of the hands (B)." ] ] 8 => array:8 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 718 "Ancho" => 1508 "Tamanyo" => 103960 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Elegant syphilis: erythematous papule and annular plaque on the face." ] ] 9 => array:8 [ "identificador" => "fig0050" "etiqueta" => "Figure 10" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr10.jpeg" "Alto" => 980 "Ancho" => 1508 "Tamanyo" => 212665 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Acral melanoma: blackish macule on the hallux (B). Dermoscopic appearance (A)." ] ] 10 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Modified from Zaid, 2017.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Black skin \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lightly pigmented skin \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stratum corneum</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Same thickness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Same thickness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Compact stratum corneum cells, with great intercellular cohesion. More cell layers</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Less compact cells \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fewer cell layers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Melanocytes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Equal number \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Equal number \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Melanosomes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elongated, not grouped, present throughout the epidermis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Small, grouped, absent in the superficial layers of the epidermis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Melanin content \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Higher \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smaller \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hair \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spiral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smooth, helical, wavy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Follicular degeneration syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">++ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Traction alopecia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">++ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mast cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Large granules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Small granules \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pruritus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">++ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Collagen fibers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Small and stacked \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fiber fragments occasionally present. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scarring and keloid formation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+++ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fibroblasts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Long and in greater number \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Small and fewer in number \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vitamin D production \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+++ \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3522471.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Differences between black skin and lightly pigmented skin." ] ] 11 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alteration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Incidence \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Etiopathogenesis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Melanosis of the malar area<a class="elsevierStyleCrossRef" href="#bib0105">21</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Equal regarding gender; older than 50 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown. In young women, it seems to be related to atopy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperchromia, with imprecise borders, symmetrically distributed in the malar regions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perioral hyperpigmentation<a class="elsevierStyleCrossRef" href="#bib0105">21</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Higher in females \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown. It does not seem to be a consequence of inflammation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperchromia in the skin adjacent to the angles of the mouth \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Periorbital melanosis<a class="elsevierStyleCrossRef" href="#bib0110">22</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Higher in the female sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multifactorial: genetics, post-inflammatory hyperpigmentation, periorbital edema, hypervascularization and shadowing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bilateral periorbital and eyelid hyperchromia, sometimes compromising the upper part of the nose and glabella. There is an increase in the amount of melanin in the papillary dermis, melanophages and vasodilation in the reticular dermis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maturational hyperpigmentation<a class="elsevierStyleCrossRef" href="#bib0110">22</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4‒5th decades of life. Fitzpatrick skin phototypes IV‒V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic sun exposure and possibly obesity and diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperchromic patches, with ill-defined edges that eventually disappear into normal skin, affecting areas exposed to the sun, including the sides of the face and the back of the hands and feet. On histopathology, proliferation of melanocytes with reports of papillomatous epidermal proliferation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Voigt-Futcher lines<a class="elsevierStyleCrossRefs" href="#bib0035">7,23</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17% to 40% of blacks; higher in women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown. Congenital or acquired (hormonal -pregnancy) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Well-defined bilateral lines, which separate more pigmented areas from lighter areas. It can occur on the limbs, chest or abdomen, along the dermatomes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Midline hypopigmentation<a class="elsevierStyleCrossRef" href="#bib0035">7</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30% to 40% of blacks; higher in males; less visible with age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Autosomal dominant inheritance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypochromic linear band on the sternal region, which may extend to the linea alba and infraclavicular region \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Palmoplantar hyperpigmentation<a class="elsevierStyleCrossRef" href="#bib0035">7</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Common and more frequent with greater skin pigmentation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Small, well-defined hyperchromic macules, variable in number and size, on the palmoplantar surfaces \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Melanonychia striata<a class="elsevierStyleCrossRefs" href="#bib0035">7,24</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">More frequent with greater skin pigmentation; up to 77% of young African-American adults and nearly 100% of those over 50 years, increasing in intensity with age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Melanocytic activation in the matrix, with melanin deposition on the nail plate. Less commonly, melanocytic hyperplasia in the nail matrix or bed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pigmentation in longitudinal or diffuse bands on the nail, from the matrix to the tip, more common in the 1st and 2nd fingers. On dermoscopy, homogeneous grayish background, with longitudinal parallel grayish lines. Pseudo-micro-Hutchinson sign (cuticle pigmentation) may be seen \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperpigmentation of the oral mucosa<a class="elsevierStyleCrossRef" href="#bib0035">7</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Develops during the first 2 decades of life \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Melanocytic activation with melanin deposition in the epithelium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperchromic patches, localized or disseminated. In the gums, they are more common and unaesthetic, especially when there is a high smile line \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mongolian spot<a class="elsevierStyleCrossRef" href="#bib0125">25</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40% to 90% of black newborns. Usually disappears by the age of 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown. When extensive, it is associated with systemic conditions, such as congenital errors of metabolism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blue-gray spot, usually single, on the lumbosacral region. Melanocytes in the dermis. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral leukoedema<a class="elsevierStyleCrossRef" href="#bib0130">26</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70% to 90% of black adults and 50% of children; more frequent in men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Physiological, but irritation caused by smoking or poor oral hygiene are factors. There is accumulation of fluid in the epithelial cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grayish-white, edematous plaques on the buccal mucosa, seen bilaterally, which disappear if the mucosa is distended. White folds or lines may cross the affected area \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pearly penile papules<a class="elsevierStyleCrossRef" href="#bib0135">27</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14% to 48% of black men; in post-pubertal age or early adulthood, diminishing with age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">They are believed to be vestigial structures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic, benign, pearly-white, dome-shaped or filiform papules, measuring 1 to 4 mm, around the glans, in single or double row. Dermoscopy shows a cobblestone or bunch of grapes pattern with dotted or comma-shaped central vessels. Histopathology shows it to be angiofibroma \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3522472.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Physiological peculiarities of black skin." ] ] 12 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BCC, Basal cell carcinoma; SCC, Squamous cell carcinoma; HIV, Human immunodeficiency virus; HPV, Human papilloma virus; UV, Ultraviolet." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Skin cancer \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Incidence in blacks \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical presentation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Risk factors \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCC</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Around 80% of skin cancers. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Solitary pearly papule or nodule, with telangiectasias that are difficult to observe.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UV radiation, albinism, ulcers, exposure to ionizing radiation, ingestion of arsenic, oral psoralen, immunosuppression, among others.</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Second most common. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Predominance in females. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pigmented variants are more prevalent \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SCC</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Around 20% of skin cancers. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous, hyperkeratotic papules, plaques or nodules, generally in places not exposed to the sun (scalp, lower extremities, anogenital area).</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic healing processes such as burn scars and chronic ulcers, HPV (including subtypes 16 and 18), immunosuppression, radiotherapy, albinism, epidermodysplasia verruciformis.</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The most common \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Melanoma</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The least common \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperpigmented macule, plaque or nodule. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UV radiation.</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lower incidence rate in women (0.9/100,000/year).</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acral lentiginous (palms, soles, nails) is the most common (<a class="elsevierStyleCrossRef" href="#fig0050">Fig. 10</a>). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Late diagnosis. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3522470.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main characteristics of non-melanoma and melanoma skin cancers.<a class="elsevierStyleCrossRefs" href="#bib0150">30,93–95</a>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:100 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatologia na pele negra" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2008" "volumen" => "83" "paginaInicial" => "7" "paginaFinal" => "20" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatoses na pele negra" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "O.Rotta" "titulo" => "Guia de dermatologia: clínica, cirúrgica e cosmiátrica" "paginaInicial" => "593" "paginaFinal" => "608" "serieFecha" => "2008" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Características étnico-raciais da população classificações e identidades. Ed. 2" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2013" "editorial" => "Instituto Brasileiro de Geografia e Estatística – IBGE" "editorialLocalizacion" => "Rio de Janeiro" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Instituto Brasileiro de Geografia e Estatística – IBGE. [Homepage] consultado em 17-03-2023. <a target="_blank" href="https://educa.ibge.gov.br/jovens/conheca-o-brasil/populacao/18319-cor-ou-raca.html">https://educa.ibge.gov.br/jovens/conheca-o-brasil/populacao/18319-cor-ou-raca.html</a>." ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin of color: biology, structure, function, and implications for dermatologic disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2002.120790" "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2002" "volumen" => "46" "numero" => "2 Suppl Understanding" "paginaInicial" => "S41" "paginaFinal" => "62" "link" => array:1 [ …1] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cell layers and density of negro and caucasian stratum corneum" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1523-1747.ep12679412" "Revista" => array:7 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "1974" "volumen" => "62" "paginaInicial" => "563" "paginaFinal" => "568" "link" => array:1 [ …1] "itemHostRev" => array:3 [ …3] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin of colour: characteristics and disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pak Med Assoc" "fecha" => "2017" "volumen" => "67" "paginaInicial" => "292" "paginaFinal" => "299" "link" => array:1 [ …1] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Racial (ethnic) differences in skin properties: the objective data" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/00128071-200304120-00004" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2003" "volumen" => "4" "paginaInicial" => "843" "paginaFinal" => "860" "link" => array:1 [ …1] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Race, ancestry, and medical research" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2018.14438" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2018" "volumen" => "320" "paginaInicial" => "1539" "paginaFinal" => "1540" "link" => array:1 [ …1] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Regulation of the catalytic activity of preexisting tyrosinase in black and caucasian human melanocyte cell cultures" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1006/excr.2000.5092" "Revista" => array:6 [ "tituloSerie" => "Exp Cell Res" "fecha" => "2001" "volumen" => "262" "paginaInicial" => "197" "paginaFinal" => "208" "link" => array:1 [ …1] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Photoprotection by melanin--a comparison of black and caucasian skin" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1979" "volumen" => "1" "paginaInicial" => "249" "paginaFinal" => "260" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Photoprotection in skin of color" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Photochem Photobiol Sci" "fecha" => "2023" "volumen" => "22" "paginaInicial" => "441" "paginaFinal" => "456" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin from various ethnic origins and aging: an in vivo cross-sectional multimodality imaging study" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0846.2009.00365.x" "Revista" => array:6 [ "tituloSerie" => "Skin Res Technol" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "306" "paginaFinal" => "313" "link" => array:1 [ …1] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemical analysis of constitutive pigmentation of human epidermis reveals constant eumelanin to pheomelanin ratio" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pigment Cell Melanoma Res" "fecha" => "2015" "volumen" => "28" "paginaInicial" => "707" "paginaFinal" => "717" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trichoscopy tips" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.det.2018.05.008" "Revista" => array:6 [ "tituloSerie" => "Dermatol Clin" "fecha" => "2018" "volumen" => "36" "paginaInicial" => "413" "paginaFinal" => "420" "link" => array:1 [ …1] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The what, why and how of curly hair: a review" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Proc Math Phys Eng Sci" "fecha" => "2019" "volumen" => "475" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cuidados del cabelo afroamericano" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Asoc Colomb Dermatol Cir Dematol" "fecha" => "2021" "volumen" => "29" "paginaInicial" => "269" "paginaFinal" => "281" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemical and physical properties of hair: comparisons between Asian, Black, and Caucasian hair" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:6 [ "editores" => "C.Aguh, G.A.Okoye" "titulo" => "Fundamentals of ethnic hair: the dermatologist’s perspective" "paginaInicial" => "3" "paginaFinal" => "13" "edicion" => "1st ed." "serieFecha" => "2017" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Curly hair: measured differences and contributions to breakage" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2012.05555.x" "Revista" => array:7 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2012" "volumen" => "51" "numero" => "Suppl 1" "paginaInicial" => "8" "paginaFinal" => "11" "link" => array:1 [ …1] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Keratins and lipids in ethnic hair" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ics.12035" "Revista" => array:6 [ "tituloSerie" => "Int J Cosmet Sci" "fecha" => "2013" "volumen" => "35" "paginaInicial" => "244" "paginaFinal" => "249" "link" => array:1 [ …1] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Common dermatoses in moderately pigmented skin: uncommon presentations" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2005.01.020" "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2005" "volumen" => "23" "paginaInicial" => "446" "paginaFinal" => "456" "link" => array:1 [ …1] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Facial hyperpigmentation in skin of color: special considerations and treatment" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40257-016-0239-8" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2017" "volumen" => "18" "paginaInicial" => "215" "paginaFinal" => "230" "link" => array:1 [ …1] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Voigt-Futcher pigmentary demarcation lines" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jocd.12884" "Revista" => array:6 [ "tituloSerie" => "J Cosmet Dermatol" "fecha" => "2019" "volumen" => "18" "paginaInicial" => "700" "paginaFinal" => "702" "link" => array:1 [ …1] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanonychia striata: clarifying behind the Black Curtain. A review on clinical evaluation and management of the 21st century" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijd.14464" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2019" "volumen" => "58" "paginaInicial" => "1239" "paginaFinal" => "1245" "link" => array:1 [ …1] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comprehensive review of Mongolian spots with an update on atypical presentations" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00381-018-3929-0" "Revista" => array:6 [ "tituloSerie" => "Childs Nerv Syst" "fecha" => "2018" "volumen" => "34" "paginaInicial" => "2371" "paginaFinal" => "2376" "link" => array:1 [ …1] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normal variations of oral anatomy and common oral soft tissue lesions: evaluation and management" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.mcna.2014.08.004" "Revista" => array:6 [ "tituloSerie" => "Med Clin North Am" "fecha" => "2014" "volumen" => "98" "paginaInicial" => "1281" "paginaFinal" => "1298" "link" => array:1 [ …1] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of pearly penile papules" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1557988316654138" "Revista" => array:6 [ "tituloSerie" => "Am J Mens Health" "fecha" => "2018" "volumen" => "12" "paginaInicial" => "624" "paginaFinal" => "627" "link" => array:1 [ …1] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Top dermatologic conditions in patients of color: an analysis of nationally representative data" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Drugs Dermatol" "fecha" => "2012" "volumen" => "11" "paginaInicial" => "466" "paginaFinal" => "473" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A study of skin disease spectrum occurring in Angola phototype V-VI population in Luanda" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijd.13958" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2018" "volumen" => "57" "paginaInicial" => "849" "paginaFinal" => "855" "link" => array:1 [ …1] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatologic conditions in skin of color: part I. Special considerations for common skin disorders" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Fam Physician" "fecha" => "2013" "volumen" => "15" "numero" => "87" "paginaInicial" => "850" "paginaFinal" => "856" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Common skin disorders in pediatric skin of color" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pedhc.2019.04.019" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Health Care" "fecha" => "2019" "volumen" => "33" "paginaInicial" => "727" "paginaFinal" => "737" "link" => array:1 [ …1] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of patch test results with a standard series among white and black racial groups" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/ajcd.2001.20110" "Revista" => array:6 [ "tituloSerie" => "Am J Contact Dermat" "fecha" => "2001" "volumen" => "12" "paginaInicial" => "77" "paginaFinal" => "82" "link" => array:1 [ …1] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patterns of allergic contact dermatitis in African Americans in a major metropolitan area over a 10-year period" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DER.0000000000000831" "Revista" => array:6 [ "tituloSerie" => "Dermatitis" "fecha" => "2022" "volumen" => "33" "paginaInicial" => "70" "paginaFinal" => "79" "link" => array:1 [ …1] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insights in skin of color patients with atopic dermatitis and the role of skincare in improving outcomes" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Drugs Dermatol" "fecha" => "2022" "volumen" => "1" "numero" => "21" "paginaInicial" => "462" "paginaFinal" => "470" ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of bacterial skin infections in atopic dermatitis: expert statement and review from the International Eczema Council Skin Infection Group" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.18643" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2020" "volumen" => "182" "paginaInicial" => "1331" "paginaFinal" => "1342" "link" => array:1 [ …1] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seborrheic dermatitis in skin of color: clinical considerations" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Drugs Dermatol" "fecha" => "2019" "volumen" => "18" "paginaInicial" => "24" "paginaFinal" => "27" "link" => array:1 [ …1] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hair oils may worsen seborrheic dermatitis in black patients" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000527778" "Revista" => array:6 [ "tituloSerie" => "Skin Appendage Disord" "fecha" => "2023" "volumen" => "9" "paginaInicial" => "151" "paginaFinal" => "152" "link" => array:1 [ …1] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatologic conditions in skin of color compared to white patients: similarities, differences, and special considerations" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Dermatol Res" "fecha" => "2023" "volumen" => "315" "paginaInicial" => "1089" "paginaFinal" => "1097" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hair and scalp disorders in adult and pediatric patients with skin of color" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cutis" "fecha" => "2017" "volumen" => "100" "paginaInicial" => "31" "paginaFinal" => "35" "link" => array:1 [ …1] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Clin Aesthet Dermatol" "fecha" => "2010" "volumen" => "3" "paginaInicial" => "20" "paginaFinal" => "31" "link" => array:1 [ …1] "itemHostRev" => array:3 [ …3] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin microneedling for acne scars associated with pigmentation in patients with dark skin" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jocd.12520" "Revista" => array:7 [ "tituloSerie" => "J Cosmet Dermatol" "fecha" => "2018" "volumen" => "17" "paginaInicial" => "390" "paginaFinal" => "395" "link" => array:1 [ …1] "itemHostRev" => array:3 [ …3] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Progressive macular hypomelanosis: an overview" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/00128071-200708010-00002" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2007" "volumen" => "8" "paginaInicial" => "13" "paginaFinal" => "19" "link" => array:1 [ …1] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy of pigmentary disorders in brown skin" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.det.2018.05.014" "Revista" => array:6 [ "tituloSerie" => "Dermatol Clin" "fecha" => "2018" "volumen" => "36" "paginaInicial" => "473" "paginaFinal" => "485" "link" => array:1 [ …1] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin diseases associated with atopic dermatitis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2018.05.004" "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2018" "volumen" => "36" "paginaInicial" => "631" "paginaFinal" => "640" "link" => array:1 [ …1] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melasma: an up-to-date comprehensive review" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s13555-017-0194-1" "Revista" => array:6 [ "tituloSerie" => "Dermatol Ther (Heidelb)" "fecha" => "2017" "volumen" => "7" "paginaInicial" => "305" "paginaFinal" => "318" "link" => array:1 [ …1] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0230" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melasma: histopathological characteristics in 56 Korean patients" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.0007-0963.2001.04556.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2002" "volumen" => "146" "paginaInicial" => "228" "paginaFinal" => "237" "link" => array:1 [ …1] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0235" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudofolliculitis barbae in the U.S. Military, a review" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/milmed/usaa243" "Revista" => array:6 [ "tituloSerie" => "Mil Med" "fecha" => "2021" "volumen" => "186" "paginaInicial" => "e52" "paginaFinal" => "e57" "link" => array:1 [ …1] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0240" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An unusual Ala12Thr polymorphism in the 1A alpha-helical segment of the companion layer-specific keratin K6hf: evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.0022-202X.2004.22309.x" "Revista" => array:6 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "2004" "volumen" => "122" "paginaInicial" => "652" "paginaFinal" => "657" "link" => array:1 [ …1] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0245" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudofolliculitis barbae; current treatment options" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Cosmet Investig Dermatol" "fecha" => "2019" "volumen" => "12" "paginaInicial" => "241" "paginaFinal" => "247" ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0250" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Are keloid and hypertrophic scar different forms of the same disorder? A fibroproliferative skin disorder hypothesis based on keloid findings" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1742-481X.2012.01118.x" "Revista" => array:6 [ "tituloSerie" => "Int Wound J" "fecha" => "2014" "volumen" => "11" "paginaInicial" => "517" "paginaFinal" => "522" "link" => array:1 [ …1] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0255" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endothelial dysfunction may play a key role in keloid and hypertrophic scar pathogenesis ‒ Keloids and hypertrophic scars may be vascular disorders" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.mehy.2016.09.024" "Revista" => array:6 [ "tituloSerie" => "Med Hypotheses" "fecha" => "2016" "volumen" => "96" "paginaInicial" => "51" "paginaFinal" => "60" "link" => array:1 [ …1] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0260" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors predictive of leg-ulcer healing in sickle cell disease: a multicentre, prospective cohort study" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.15241" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2017" "volumen" => "177" "paginaInicial" => "206" "paginaFinal" => "211" "link" => array:1 [ …1] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0265" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic factors associated with healing of venous leg ulcers: a multicentre, prospective, cohort study" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.12570" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2013" "volumen" => "169" "paginaInicial" => "1106" "paginaFinal" => "1113" "link" => array:1 [ …1] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0270" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dactylolysis spontanea (ainhum)" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Radiol Bras" "fecha" => "2015" "volumen" => "48" "paginaInicial" => "264" "paginaFinal" => "265" ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0275" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ainhum. [Updated 2022 Oct 12]" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "StatPearls [Internet]" "fecha" => "2023 Jan" "editorial" => "StatPearls Publishing" "editorialLocalizacion" => "Treasure Island (FL)" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.ncbi.nlm.nih.gov/books/NBK546612/" ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0280" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ainhum" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "editores" => "L.Azulay-Abulafia, L.Hanauer de Moura, F.R.P.C.Leal, D.R.Azulay" "titulo" => "Atlas de dermatologia: da semiologia ao diagnóstico" "edicion" => "3ª ed." "serieFecha" => "2020" ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0285" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of hair care products for black individuals" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cutis" "fecha" => "2014" "volumen" => "93" "paginaInicial" => "289" "paginaFinal" => "293" "link" => array:1 [ …1] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0290" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Understanding curly hair mechanics: fiber strength" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jid.2019.06.141" "Revista" => array:6 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "2020" "volumen" => "140" "paginaInicial" => "113" "paginaFinal" => "120" "link" => array:1 [ …1] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0295" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Degradation of hair surface: importance of 18-MEA and epicuticle" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cosmetics" "fecha" => "2019" "volumen" => "6" "paginaInicial" => "31" ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0300" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An overview of chemical straightening of human hair: technical aspects, potential risks to hair fibre and health and legal issues" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ics.12093" "Revista" => array:7 [ "tituloSerie" => "Int J Cosmet Sci" "fecha" => "2014" "volumen" => "36" "paginaInicial" => "2" "paginaFinal" => "11" "link" => array:1 [ …1] "itemHostRev" => array:3 [ …3] ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0305" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trichoscopy of dark scalp" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000488885" "Revista" => array:6 [ "tituloSerie" => "Skin appendage disord" "fecha" => "2018" "volumen" => "5" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ …1] ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0310" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopic diagnosis of hair breakage caused by styling procedures in patients of African descent" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2015" "volumen" => "72" "numero" => "1 Suppl" "paginaInicial" => "S39" "paginaFinal" => "40" ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib0315" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatologic conditions in skin of color: part II. Disorders occurring predominately in skin of color" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Fam Physician" "fecha" => "2013" "volumen" => "87" "paginaInicial" => "859" "paginaFinal" => "865" "link" => array:1 [ …1] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0320" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Positive Jacquet’s sign in traction alopecia" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.14974" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2018" "volumen" => "32" "paginaInicial" => "e446" "paginaFinal" => "e447" "link" => array:1 [ …1] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib0325" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traction alopecia: a neglected entity in 2017" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Indian J Dermatol Venereol Leprol" "fecha" => "2017" "volumen" => "83" "paginaInicial" => "644" "paginaFinal" => "649" ] ] ] ] ] ] 65 => array:3 [ "identificador" => "bib0330" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traction Alopecia. [Updated 2022 Aug 8]" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "StatPearls [Internet]" "fecha" => "2023 Jan" "editorial" => "Stat Pearls Publishing" "editorialLocalizacion" => "Treasure Island (FL)" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.ncbi.nlm.nih.gov/books/NBK470434/" ] ] ] ] ] ] 66 => array:3 [ "identificador" => "bib0335" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trichoscopy findings in dissecting cellulitis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.abd.2019.09.006" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2019" "volumen" => "94" "paginaInicial" => "608" "paginaFinal" => "611" "link" => array:1 [ …1] ] ] ] ] ] ] 67 => array:3 [ "identificador" => "bib0340" "etiqueta" => "68" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dissecting cellulitis of the scalp: a retrospective study of 51 patients and review of literature" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.13999" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2016" "volumen" => "174" "paginaInicial" => "421" "paginaFinal" => "423" "link" => array:1 [ …1] ] ] ] ] ] ] 68 => array:3 [ "identificador" => "bib0345" "etiqueta" => "69" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Yellow dots in trichoscopy: relevance, clinical significance and peculiarities" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/abd1806-4841.20176157" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2017" "volumen" => "92" "paginaInicial" => "724" "paginaFinal" => "726" "link" => array:1 [ …1] ] ] ] ] ] ] 69 => array:3 [ "identificador" => "bib0350" "etiqueta" => "70" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology, clinical presentation and therapeutic approach in a multicentre series of dissecting cellulitis of the scalp" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.13948" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2017" "volumen" => "31" "paginaInicial" => "e199" "paginaFinal" => "e200" "link" => array:1 [ …1] ] ] ] ] ] ] 70 => array:3 [ "identificador" => "bib0355" "etiqueta" => "71" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Black women’s hair: the main scalp dermatoses and aesthetic practices in women of African ethnicity" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/abd1806-4841.20152845" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2015" "volumen" => "90" "paginaInicial" => "450" "paginaFinal" => "465" "link" => array:1 [ …1] ] ] ] ] ] ] 71 => array:3 [ "identificador" => "bib0360" "etiqueta" => "72" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary care provider understanding of hair care maintenance as a barrier to physical activity in African American women" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Board Fam Med" …4 ] ] ] ] ] ] 72 => array:3 [ "identificador" => "bib0365" "etiqueta" => "73" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "On the history of African hair care: more treasures await discovery" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1473-2165.2008.00396.x" "Revista" => array:5 [ …5] ] ] ] ] ] 73 => array:3 [ "identificador" => "bib0370" "etiqueta" => "74" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic approach to Afro-textured hair disorders: dermatoscopy and when to biopsy" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.det.2013.11.005" "Revista" => array:6 [ …6] ] ] ] ] ] 74 => array:3 [ "identificador" => "bib0375" "etiqueta" => "75" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Central centrifugal cicatricial alopecia: new insights and a call for action" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ …5] ] ] ] ] ] 75 => array:3 [ "identificador" => "bib0380" "etiqueta" => "76" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Central Centrifugal cicatricial alopecia. [Updated 2022 May 8]" "autores" => array:1 [ …1] ] ] "host" => array:2 [ 0 => array:1 [ "LibroEditado" => array:2 [ …2] ] 1 => array:1 [ "WWW" => array:1 [ …1] ] ] ] ] ] 76 => array:3 [ "identificador" => "bib0385" "etiqueta" => "77" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased risk of systemic and cardiac sarcoidosis in black patients with cutaneous sarcoidosis" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2021.04.079" "Revista" => array:6 [ …6] ] ] ] ] ] 77 => array:3 [ "identificador" => "bib0390" "etiqueta" => "78" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiological, clinical, and paraclinic aspect of cutaneous sarcoidosis in Black Africans" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ …3] ] ] ] ] ] 78 => array:3 [ "identificador" => "bib0395" "etiqueta" => "79" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopic features of psoriasis, lichen planus, and pityriasis rosea in patients with skin type IV and darker attending the regional dermatology training centre in Northern Tanzania" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5826/dpc.0901a11" "Revista" => array:6 [ …6] ] ] ] ] ] 79 => array:3 [ "identificador" => "bib0400" "etiqueta" => "80" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lichen planus pigmentosus: a clinico-etiological study" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/idoj.IDOJ_253_18" "Revista" => array:6 [ …6] ] ] ] ] ] 80 => array:3 [ "identificador" => "bib0405" "etiqueta" => "81" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lichen planus pigmentosus and its variants: review and update" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijd.13806" "Revista" => array:6 [ …6] ] ] ] ] ] 81 => array:3 [ "identificador" => "bib0410" "etiqueta" => "82" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lichen planus pigmentosus: the controversial consensus" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-5154.190108" "Revista" => array:6 [ …6] ] ] ] ] ] 82 => array:3 [ "identificador" => "bib0415" "etiqueta" => "83" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis in skin of color: insights into the epidemiology, clinical presentation, genetics, quality-of-life impact, and treatment of psoriasis in non-white racial/ethnic groups" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40257-017-0332-7" "Revista" => array:6 [ …6] ] ] ] ] ] 83 => array:3 [ "identificador" => "bib0420" "etiqueta" => "84" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Discoid lupus erythematosus skin lesion distribution and characteristics in black patients: a retrospective cohort study" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ …3] ] ] ] ] ] 84 => array:3 [ "identificador" => "bib0425" "etiqueta" => "85" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The incidence and prevalence of systemic lupus erythematosus, 2002‒2004: The Georgia lupus registry" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.38239" "Revista" => array:6 [ …6] ] ] ] ] ] 85 => array:3 [ "identificador" => "bib0430" "etiqueta" => "86" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of end-stage renal disease among newly diagnosed systemic lupus erythematosus patients: the Georgia lupus registry" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ …5] ] ] ] ] ] 86 => array:3 [ "identificador" => "bib0435" "etiqueta" => "87" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased risk of death in African American patients with end-stage renal disease secondary to lupus" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ …5] ] ] ] ] ] 87 => array:3 [ "identificador" => "bib0440" "etiqueta" => "88" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Racial discrimination, disease activity, and organ damage: the black women’s experiences living with lupus (BeWELL) study" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/aje/kwz105" "Revista" => array:6 [ …6] ] ] ] ] ] 88 => array:3 [ "identificador" => "bib0445" "etiqueta" => "89" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spectrum of cutaneous lupus erythematosus in South Africans with systemic lupus erythematosus" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0961203319856091" "Revista" => array:6 [ …6] ] ] ] ] ] 89 => array:3 [ "identificador" => "bib0450" "etiqueta" => "90" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vitiligo on black skin: epidemiological and clinical aspects in dermatology, Cotonou (Benin)" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijd.13366" "Revista" => array:6 [ …6] ] ] ] ] ] 90 => array:3 [ "identificador" => "bib0455" "etiqueta" => "91" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sífilis: diagnóstico, tratamento e controle" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ …5] ] ] ] ] ] 91 => array:3 [ "identificador" => "bib0460" "etiqueta" => "92" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tinea versicolor in dark-skinned individuals" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijd.12345" "Revista" => array:6 [ …6] ] ] ] ] ] 92 => array:3 [ "identificador" => "bib0465" "etiqueta" => "93" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basal cell carcinoma, squamous cell carcinoma, and cutaneous melanoma in skin of color patients" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.det.2019.05.009" "Revista" => array:6 [ …6] ] ] ] ] ] 93 => array:3 [ "identificador" => "bib0470" "etiqueta" => "94" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanoma in skin of color: part I. epidemiology and clinical presentation" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2022.04.056" "Revista" => array:6 [ …6] ] ] ] ] ] 94 => array:3 [ "identificador" => "bib0475" "etiqueta" => "95" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanoma in skin of color: part II. racial disparities, role of UV, and interventions for earlier detection" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2022.04.057" "Revista" => array:6 [ …6] ] ] ] ] ] 95 => array:3 [ "identificador" => "bib0480" "etiqueta" => "96" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics, prognostic factors, and survival of 393 patients with mycosis fungoides and Sézary syndrome in the southeastern United States: a single-institution cohort" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2014.10.019" "Revista" => array:6 [ …6] ] ] ] ] ] 96 => array:3 [ "identificador" => "bib0485" "etiqueta" => "97" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poorer prognosis of African-American patients with mycosis fungoides: an analysis of the SEER dataset, 1988 to 2008" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clml.2013.12.018" "Revista" => array:6 [ …6] ] ] ] ] ] 97 => array:3 [ "identificador" => "bib0490" "etiqueta" => "98" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of Kaposi sarcoma: review and description of the nonepidemic variant" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijd.14080" "Revista" => array:6 [ …6] ] ] ] ] ] 98 => array:3 [ "identificador" => "bib0495" "etiqueta" => "99" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of patient demographic characteristics with dermatofibrosarcoma protuberans tumour size at diagnosis in the U.S. national cancer database" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.15357" "Revista" => array:6 [ …6] ] ] ] ] ] 99 => array:3 [ "identificador" => "bib0500" "etiqueta" => "100" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variant of dermatofibrosarcoma protuberans: bednar tumor" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-5154.147893" "Revista" => array:5 [ …5] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009900000003/v1_202404281408/S0365059624000035/v1_202404281408/en/main.assets" "Apartado" => array:4 [ "identificador" => "80634" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Continuing Medical Education" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009900000003/v1_202404281408/S0365059624000035/v1_202404281408/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624000035?idApp=UINPBA00008Z"]

Statistics

Continuing Medical Education

Dermatology in black skin

Maurício Mota de Avelar Alchornea, Katleen da Cruz Conceiçãob, Leonardo Lora Barrazab, Marilda Aparecida Milanez Morgado de Abreuc,

Corresponding author

marilda@morgadoeabreu.com.br

Corresponding author.

a Faculty of Medicine, Universidade Nove de Julho, São Paulo, SP, Brazil

b Department of Dermatology, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

c Department of Dermatology, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil

Read

3886

Times
was read the article

1165

Total PDF

2721

Total HTML

Share statistics

 array:22 [
  "pii" => "S0365059624000035"
  "issn" => "03650596"
  "doi" => "10.1016/j.abd.2023.10.001"
  "estado" => "S300"
  "fechaPublicacion" => "2024-05-01"
  "aid" => "889"
  "copyright" => "Sociedade Brasileira de Dermatologia"
  "copyrightAnyo" => "2024"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "pt" => array:18 [
      "pii" => "S2666275224000079"
      "issn" => "26662752"
      "doi" => "10.1016/j.abdp.2024.01.007"
      "estado" => "S300"
      "fechaPublicacion" => "2024-05-01"
      "aid" => "889"
      "copyright" => "Sociedade Brasileira de Dermatologia"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "pt" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Educa&#231;&#227;o m&#233;dica continuada</span>"
        "titulo" => "Dermatologia na pele negra"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "tieneResumen" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "327"
            "paginaFinal" => "341"
          ]
        ]
        "contieneResumen" => array:1 [
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1462
                "Ancho" => 1675
                "Tamanyo" => 150710
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Temas de destaque na pele negra&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Maur&#237;cio Mota de Avelar Alchorne, Katleen da Cruz Concei&#231;&#227;o, Leonardo Lora Barraza, Marilda Aparecida Milanez Morgado de Abreu"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Maur&#237;cio Mota de Avelar"
                "apellidos" => "Alchorne"
              ]
              1 => array:2 [
                "nombre" => "Katleen da Cruz"
                "apellidos" => "Concei&#231;&#227;o"
              ]
              2 => array:2 [
                "nombre" => "Leonardo Lora"
                "apellidos" => "Barraza"
              ]
              3 => array:2 [
                "nombre" => "Marilda Aparecida"
                "apellidos" => "Milanez Morgado de Abreu"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0365059624000035"
          "doi" => "10.1016/j.abd.2023.10.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624000035?idApp=UINPBA00008Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224000079?idApp=UINPBA00008Z"
      "url" => "/26662752/0000009900000003/v1_202404300449/S2666275224000079/v1_202404300449/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S0365059624000011"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2023.06.005"
    "estado" => "S300"
    "fechaPublicacion" => "2024-05-01"
    "aid" => "887"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "A new proposal for phenotypic classification and outcome assessment of dermatomyositis based on clinical manifestations and serological testing"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "342"
          "paginaFinal" => "349"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 829
              "Ancho" => 1675
              "Tamanyo" => 100466
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Visualized subgroups of 162 DM patients by tsne algorithm&#46; Scatter plot map showing the individuals and clusters they belonged to in DM&#46; tsne algorithm was used to reduce the dimensionality of the data&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ting Huang, Ting Ding, Liqing Ding, Shasha Xie, Xiaojing Li, Qiming Meng, Xiaomeng Wu, Hui Luo, Hongjun Zhao"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "Ting"
              "apellidos" => "Huang"
            ]
            1 => array:2 [
              "nombre" => "Ting"
              "apellidos" => "Ding"
            ]
            2 => array:2 [
              "nombre" => "Liqing"
              "apellidos" => "Ding"
            ]
            3 => array:2 [
              "nombre" => "Shasha"
              "apellidos" => "Xie"
            ]
            4 => array:2 [
              "nombre" => "Xiaojing"
              "apellidos" => "Li"
            ]
            5 => array:2 [
              "nombre" => "Qiming"
              "apellidos" => "Meng"
            ]
            6 => array:2 [
              "nombre" => "Xiaomeng"
              "apellidos" => "Wu"
            ]
            7 => array:2 [
              "nombre" => "Hui"
              "apellidos" => "Luo"
            ]
            8 => array:2 [
              "nombre" => "Hongjun"
              "apellidos" => "Zhao"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275224000055"
        "doi" => "10.1016/j.abdp.2024.01.005"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224000055?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624000011?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009900000003/v1_202404281408/S0365059624000011/v1_202404281408/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Continuing Medical Education</span>"
    "titulo" => "Dermatology in black skin"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "327"
        "paginaFinal" => "341"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Maur&#237;cio Mota de Avelar Alchorne, Katleen da Cruz Concei&#231;&#227;o, Leonardo Lora Barraza, Marilda Aparecida Milanez Morgado de Abreu"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "Maur&#237;cio Mota de Avelar"
            "apellidos" => "Alchorne"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Katleen da Cruz"
            "apellidos" => "Concei&#231;&#227;o"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Leonardo Lora"
            "apellidos" => "Barraza"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:4 [
            "nombre" => "Marilda Aparecida"
            "apellidos" => "Milanez Morgado de Abreu"
            "email" => array:1 [
              0 => "marilda@morgadoeabreu.com.br"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Faculty of Medicine&#44; Universidade Nove de Julho&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Dermatology&#44; Santa Casa de Miseric&#243;rdia do Rio de Janeiro&#44; Rio de Janeiro&#44; RJ&#44; Brazil"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Department of Dermatology&#44; Universidade do Oeste Paulista&#44; Presidente Prudente&#44; SP&#44; Brazil"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0035"
        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 1639
            "Ancho" => 1508
            "Tamanyo" => 647739
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Discoid lupus erythematosus&#58; atrophic alopecic plaque on the frontoparietal region&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dermatology in black skin</span><p id="par0005" class="elsevierStylePara elsevierViewall">The vast majority of dermatology publications refer to light skin&#44; with few addressing the peculiarities of black skin&#46; This lack of knowledge on the subject makes it difficult to recognize dermatoses on black skin and can generate fear among dermatologists about carrying out more invasive procedures on these patients&#44; especially regarding the induction of scars and pigmentary changes&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">The black population</span><p id="par0010" class="elsevierStylePara elsevierViewall">There is no single definition of what it means to be black&#46; Therefore&#44; this subjectivity must be taken into account when interpreting studies&#46; According to anthropologists&#44; there are five races&#58; Caucasoids&#44; Mongoloids&#44; Australoids&#44; Negroids&#47;Congoids and Capoids&#41;&#46; Ethnicity refers to a social group with linguistic&#44; cultural and ancestral affinities&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> In the Brazilian Portuguese dictionary&#44; the definition of black is &#8220;one with a very dark color&#59; of black skin&#34;&#46; Taking into account Fitzpatrick&#39;s classification of phototypes&#44; black people fall into types IV&#44; V and VI&#44; those who rarely or never burn in the sun and tan easily&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">While in the United States&#44; black is someone who has a black ancestor at any point in the family tree&#44; regardless of skin tone&#44; in Brazil&#44; the Brazilian Institute of Geography and Statistics &#40;IBGE&#44; <span class="elsevierStyleItalic">Instituto Brasileiro de Geografia e Estat&#237;stica</span>&#41; differentiates people by skin color&#44; which can be white&#44; black&#44; yellow&#44; brown and indigenous&#44; considering brown and black people as black&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The term &#8220;<span class="elsevierStyleItalic">pardo</span>&#8221; &#40;brown&#41; applies to the miscegenation between Indians&#44; whites and blacks&#44; that is&#44; people with indigenous&#44; European and African ancestry&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Due to the high degree of miscegenation of the Brazilian population&#44; there is little precision in identifying a black person&#44; with the criterion of self-declaration prevailing for statistical purposes&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">According to data from the National Household Sample Survey &#40;PNAD Cont&#237;nua&#44; <span class="elsevierStyleItalic">Pesquisa Nacional por Amostra de Domic&#237;lios</span>&#41; 2021&#44; 43&#37; of the Brazilians declared themselves as white&#44; 47&#37; as mixed race and 9&#46;1&#37; as black&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Structural&#44; biological and functional aspects of black skin</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Epidermis</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Stratum corneum</span><p id="par0025" class="elsevierStylePara elsevierViewall">There is no significant variation in the stratum corneum thickness&#44; although black people have a greater number of layers which are more compact and cohesive&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> In lightly pigmented skin&#44; 6 to 15 strips of tape are needed to remove the stratum corneum&#59; in black skin&#44; from 8 to 25&#46; Due to greater cohesion&#44; vesicles and bullae remain intact longer than in lightly pigmented skin&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Lipid composition</span><p id="par0030" class="elsevierStylePara elsevierViewall">Black skin presents lower levels of ceramides and greater transepidermal water loss&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a> in addition to a 2&#46;5-fold higher rate of spontaneous desquamation than white skin&#44; justifying greater xerosis in this population&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Melanocytes&#47;melanosomes</span><p id="par0035" class="elsevierStylePara elsevierViewall">There is no difference in the number of melanocytes in black skin&#44; but rather in the characteristics of the melanosomes&#44; which are larger&#44; non-aggregated and degrade more slowly compared to those in white skin&#46; Its distribution also differs&#44; present throughout the epidermis&#46; Additionally&#44; melanosomes have a more neutral pH and greater tyrosinase activity in black skin&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7&#44;9&#44;10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">There is greater melanogenesis in black people and the melanin content naturally confers a Sun Protection Factor &#40;SPF&#41; of 13&#46;4 compared to 3&#46;4 for white individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Dark skin transmits 7&#46;4&#37; of ultraviolet rays &#40;UVR&#41; B compared to 29&#46;4&#37; in lightly pigmented skin&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;12&#44;13</span></a> that is&#44; approximately four times less UV reaches the upper dermis&#44; minimizing photoaging and the propensity for skin tumors&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;12</span></a> However&#44; as UVR deteriorates the defense system&#44; black skin also requires photoprotection&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;12</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The relative composition of eumelanin and pheomelanin is independent of the degree of pigmentation&#44; but there is a low level of photoprotective eumelanin in lightly pigmented skin&#44; explaining the greater sensitivity to UVR&#46; <a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Dermis</span><p id="par0050" class="elsevierStylePara elsevierViewall">There is no difference regarding the thickness of the dermis between ethnic groups&#44; although there is a difference at the cellular level&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7&#44;9</span></a> The collagen fiber bundles are smaller&#44; macrophages are larger and more numerous&#44; whereas mast cells differ only in the size of the granules&#44; which are larger in black skin&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7&#44;9</span></a> Fibroblasts are larger&#44; more numerous&#44; bi- or multinucleated and hyperreactive&#44; and are&#44; associated with a constitutional decrease in collagenase&#44; explaining the greater predisposition to keloids&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> These characteristics protect against the effects of age&#44; delaying dermal atrophy in black people&#46; There are no differences regarding elastic tissue&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Adnexal glands</span><p id="par0055" class="elsevierStylePara elsevierViewall">Studies on differences in adnexal glands present conflicting results&#46; Some report that there are no differences in the number of eccrine glands&#46; However&#44; most agree that apocrine glands are more numerous and larger in black skin and also produce a larger amount of secretion&#44; with a characteristic odor&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a> The sebaceous glands do not differ in number&#44; but they are larger and produce a larger amount of sebum&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> which can favor the appearance of acne lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Scalp&#44; hair follicles and hair</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Scalp</span><p id="par0060" class="elsevierStylePara elsevierViewall">The scalp presents macules that resemble asterisks&#44; scales and cosmetic residues&#44; with erythema being common&#46; The color&#44; seen in trichoscopy&#44; varies between light brown and black and does not correlate with the skin color&#44; with a perifollicular pigmented network&#44; or honeycomb pattern&#44; consisting of pigmented lines &#40;corresponding to the melanocytes of the crest of the network&#41; surrounding hypochromic areas &#40;fewer melanocytes in the suprapapillary epidermis&#41;&#46; A unique and normal characteristic is the presence of white dots between the follicular units&#44; similar to the fibrosis sign of cicatricial alopecia&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Hair follicles</span><p id="par0065" class="elsevierStylePara elsevierViewall">The density and number of hair follicles are lower and there are differences in their shape&#58; they are curved&#44; spiral-shaped&#44; elliptical on cross-section&#46; There is an asymmetry in the shape and cellular distribution of the hair bulb and the internal and external root sheaths&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> The melanosomes are present in the external root sheath and in the bulb of vellus hairs&#44; which is why they are more heavily pigmented&#46; The sebaceous glands are fewer and less active&#44; secreting less sebum&#44; leading to the dryness&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a> Blood flow is reduced&#44; increasing susceptibility to cicatricial alopecia&#46; The elastic tissue anchorage to the hair follicle is reduced&#44; favoring traction alopecia&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Hair</span><p id="par0070" class="elsevierStylePara elsevierViewall">Negroid hair is the most distinct phenotypic characteristic of black people&#46; They are difficult to comb&#44; requiring different care and less frequent washing&#46; Hairs present knots&#44; cracks&#44; and longitudinal fissures along the shaft&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;19&#44;20</span></a> There are varying degrees of curl&#44; with mechanical fragility increasing with higher degrees of curvature&#46; The shaft has a smaller diameter&#44; thinner cuticle&#44; and is drier &#40;lower water and sebum content&#41;&#44; with lower tensile strength&#44; which favors breakage&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Several extracellular matrix proteins and adherens junctions are decreased&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> leading to differences in hair texture&#44; strength&#44; and manageability&#46; The follicular units commonly have hair shafts emerging together and the wavy fibers emerge at an angle to the scalp&#46; The chemical composition of keratin and amino acids is similar to that of hair of other ethnic groups&#46; Small differences have been reported in the number of low- and high-sulfur proteins &#40;disulfide bonds&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> When placed in water&#44; African-American hair has a lower percentage of radial absorption than Asian and Caucasian hair&#44; perhaps due to differences in lipid content&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;19&#44;20</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The main differences between black skin and lightly pigmrnted skin are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Dermatoses in black skin</span><p id="par0080" class="elsevierStylePara elsevierViewall">There are variations in black skin that can be mistaken for abnormalities&#46; On the other hand&#44; some dermatoses are more frequent or practically exclusive to black people&#44; while others present in a particular way&#44; with characteristics inherent to the higher degree of pigmentation and a tendency to peculiar reaction patterns&#46; These particularities require training for their identification and appropriate handling and are classified in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> in several topics&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Black people tend to present four pathological reaction patterns&#58;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> &#40;1&#41; Pigmentary lability &#40;tendency to form pigmentary lesions&#44; resulting in hyperpigmentation and hypopigmentation&#41;&#59; &#40;2&#41; Follicular response and follicular diseases&#59; &#40;3&#41; Mesenchymal response &#40;fibroblastic and granulomatous&#41;&#59; &#40;4&#41; Bullous response&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">It is worth mentioning that red or brown dermatoses on lightly pigmentated skin&#44; appear black&#44; gray or purple on black skin because of the heavy pigmentation&#46; Follicular&#44; papular&#44; and annular lesions are more common in Afro-Caribbean individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Physiological peculiarities of black skin</span><p id="par0095" class="elsevierStylePara elsevierViewall">The physiological changes of black skin are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;27</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Dermatoses with higher incidence on black skin</span><p id="par0100" class="elsevierStylePara elsevierViewall">Five major dermatology diagnoses stand out in African-Americans&#58; acne&#44; unspecified eczema&#44; atopic dermatitis&#44; seborrheic dermatitis&#44; and dyschromia&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In the Angolan population with phototype V&#8210;VI&#44; in Luanda&#44; the prevalence of acne&#44; dermatophytosis and atopic dermatitis stands out&#46; In individuals aged 13 or over&#44; the main complaints were acne &#40;23&#46;6&#37;&#41;&#44; dermatophytosis &#40;11&#46;0&#37;&#41; and pityriasis versicolor &#40;8&#46;6&#37;&#41;&#46; In the pediatric population&#44; atopic dermatitis &#40;29&#46;4&#37;&#41;&#44; tinea capitis &#40;13&#46;7&#37;&#41; and molluscum contagiosum &#40;12&#46;5&#37;&#41; were the most common disorders&#46; In adult women&#44; acne &#40;31&#46;3&#37;&#41; was the main condition&#44; while in adult men&#44; it was dermatophytosis &#40;13&#46;5&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Sociocultural habits in black communities&#44; aiming to mask changes in pigmentation with emollient products&#44; produce folliculitis&#46; The use of ointments&#44; oils and creams on hair generally causes alopecia and cosmetic acne in the frontal region&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Acne</span><p id="par0115" class="elsevierStylePara elsevierViewall">Acne is one of the most common conditions seen in black children and adolescents&#46; Its pathogenesis is similar among different ethnic groups&#44; but products frequently used on the skin and hair by black individuals may be comedogenic&#46; Nodulocystic lesions are less frequent&#44; but even lesions without clinical inflammation&#44; such as comedones&#44; have a high degree of inflammation histopathology&#44; which may explain post-inflammatory hyperpigmentation&#46; Keloid scars are frequent sequelae on the chest&#44; back and jawline&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;30&#44;31</span></a></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Eczema</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Contact eczema</span><p id="par0120" class="elsevierStylePara elsevierViewall">Black individuals are less susceptible to irritants&#46; This is attributed to the greater cohesion of the stratum corneum cells in dark skin&#46; This difference is undetectable if the stratum corneum is removed&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The clinical characteristics in patients with dark skin include lichenification&#44; hyperpigmentation&#44; and early papular or follicular eruption with minimal erythema&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In patch tests&#44; there is a similarity in the general frequency of allergies between black and white individuals&#44; but there are differences regarding sensitization to allergens&#44; with positivity for nickel&#44; fragrance mix&#44; bacitracin&#44; balsam of Peru and paraphenylenediamine &#40;PPD&#41;&#46; PPD&#44; found in hair dyes&#44; and imidazolidinyl urea&#44; a formaldehyde-releasing preservative&#44; were more frequently allergenic in black men compared to white men&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> The use of darker hair dyes in the black community may explain the greater sensitization to PPD and differences in sensitization patterns are likely due to cultural practices&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Atopic dermatitis &#40;AD&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">The pathogenesis of AD includes genetic and environmental factors&#44; varying among different ethnic and racial populations&#46; Black individuals are seven times more likely to seek care for AD than white ones&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> There are differences in the skin barrier properties that may have implications for AD&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Differences in <span class="elsevierStyleItalic">S&#46; aureus</span> strains&#44; including variability in the presence of superantigen genes&#44; have been demonstrated between whites and blacks with AD&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Clinically&#44; there are different expressions of erythema&#44; due to background melanin&#44; manifesting as reddish-brown&#44; violet&#44; gray or intensely hyperchromic plaques&#44; instead of bright red&#46; There is greater visibility of desquamation and dry skin&#46; They are more frequently located in the extensor areas than in the flexural areas and pruritus is more frequent and more severe&#46; Follicular and perifollicular papules&#44; lichenoid or nodular-papular morphologies are common&#44; in addition to periorbital lichenification and hyperchromia&#46; Post-inflammatory hyperpigmentation is more frequent and persistent&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Seborrheic dermatitis &#40;SD&#41;</span><p id="par0135" class="elsevierStylePara elsevierViewall">SD is among the five most common diagnoses in black people&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> In adults and adolescents&#44; the underlying erythema is barely visible and there is hypopigmentation in the classic areas of involvement&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> possibly due to the inhibition of tyrosinase function in melanocytes by <span class="elsevierStyleItalic">Malassezia</span> metabolites&#44; with less pigment production&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;38</span></a> Black children often present with erythema&#44; desquamation and hypopigmentation of the affected areas and overlying AD&#44; which accentuates the hypopigmentation&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;39</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Scalp SD is prominent among black women and can be exacerbated by excessive use of hair oils or ointments and infrequent washing&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Children generally do not have the &#8220;cradle cap&#8221; seen in Caucasians&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#44;39</span></a> In other age groups&#44; petaloid SD&#44; with circinate lesions&#44; polycyclic coalescing rings&#44; either pink or hypopigmented&#44; with furfuraceous desquamation&#44; is observed on the hair implantation line or on other areas of the face&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Dyschromias</span><p id="par0145" class="elsevierStylePara elsevierViewall">Pigmentary disorders are the third most common condition in black skin&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> and can be either hyperpigmentation or hypopigmentation&#47;achromia&#44; with the latter being psychologically devastating&#44; due to the marked contrast with normal skin&#44; in addition to resistance to treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Post-inflammatory hyperpigmentation &#40;PIH&#41;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Among pigmentation disorders in black skin&#44; PIH is the most common&#46; It occurs after skin inflammation or injury&#44;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;40&#44;41</span></a> resulting from excessive production or irregular dispersion of melanin&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> There are several etiologies&#44; including infections&#44; inflammatory diseases and skin injury caused by physical or chemical agents&#44; including cosmetic procedures&#46; PIH manifests as macules in the same distribution as the initial inflammatory process&#44; the intensity of which may have a direct correlation with phototypes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Post-inflammatory hypopigmentation</span><p id="par0155" class="elsevierStylePara elsevierViewall">Post-inflammatory hypopigmentation is more common and more evident in people with dark skin&#46; It results from inflammatory &#40;AD&#44; SD&#44; contact dermatitis&#44; psoriasis&#44; etc&#46;&#41;&#44; neoplastic &#40;mycosis fungoides&#41;&#44; infectious &#40;syphilis&#41;&#44; traumatic &#40;wounds&#44; burns&#41; or iatrogenic conditions &#40;post laser&#44; cryotherapy or chemical peelings&#41;&#46; It appears as single or multiple hypochromic macules&#44; without desquamation&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Progressive macular hypomelanosis &#40;PMH&#41;</span><p id="par0160" class="elsevierStylePara elsevierViewall">PMH is a common and poorly diagnosed dermatosis&#46; It is distributed worldwide&#44; being more common in tropical countries in black people&#44; preferentially affecting young women&#46; <span class="elsevierStyleItalic">C&#46; acnes</span> is believed to produce a depigmenting factor&#44; as this bacteria can be grown from follicles in hypopigmented areas&#44; but not from neighboring normal-appearing skin&#46; It is characterized by confluent&#44; ill-defined&#44; non-desquamative hypopigmented patches located on the trunk&#44; around the midline and&#44; rarely&#44; extending to the proximal extremities and head and neck regions&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> There is no pruritus&#44; pain or previous inflammation&#59; it is stable or progresses slowly for years&#44; with spontaneous disappearance later in life&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Wood&#39;s lamp examination may show red follicular fluorescence in hypopigmented areas&#46; Dermoscopy reveals whitish&#44; poorly defined areas without desquamation&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> Histopathology shows a decrease in melanin in the epidermis&#44; while the dermis appears normal&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43&#44;44</span></a></p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Pityriasis alba &#40;PA&#41;</span><p id="par0165" class="elsevierStylePara elsevierViewall">PA begins around three to 16 years of age&#44; without sex predilection&#44; occurring more commonly in darker skin&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Its etiopathogenesis remains unknown&#59; however&#44; it is believed to represent nonspecific dermatitis with residual post-inflammatory hypopigmentation&#46; Associated findings include atrophic sebaceous glands&#44; iron-deficiency anemia&#44; and low serum copper levels&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> Black children may be genetically predisposed to xerosis&#44; which can lead to PA&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Environmental factors such as sun exposure&#44; long and frequent baths and mechanical exfoliation seem to be predisposing factors on susceptible skin&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> It is important to inquire about personal or family history of atopy&#44; as it is one of the minor criteria for AD&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#44;44</span></a> In dark skin&#44; early lesions present as subclinical dermatitis and erythema is barely evident&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> The initial lesions are desquamative papules that evolve into clearly visible hypochromic areas&#44; different from lightly pigmented skin&#44; due to the contrast with healthy skin&#46; It generally affects the face&#44; neck and arms&#59; histopathological findings are nonspecific&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#44;44</span></a></p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Melasma</span><p id="par0170" class="elsevierStylePara elsevierViewall">Melasma is a common acquired hyperpigmentation&#44; typically occurring on the face&#44; with a high prevalence in women and darker skin types&#46; Family history&#44; especially in darker skin&#44; is an important risk factor&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45&#44;46</span></a> Clinically&#44; the pigmentation is more intense and persistent&#46; On histopathology&#44; melanophages have been detected in the superficial dermis&#44; with a very heterogeneous distribution&#44; varying from one lesion to another in the same patient and even within the same area of melasma&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a></p></span></span></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Dermatoses highly specific for black skin</span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Pseudofolliculitis barbae &#40;PFB&#41;</span><p id="par0175" class="elsevierStylePara elsevierViewall">PFB&#44; also known as pili incarnati or sycosis barbae&#44; is a common chronic disease&#44; seen almost exclusively in black men&#44; between 14 and 25 years of age&#44; with a prevalence between 45&#37; and 83&#37;&#46; It causes problems in professions that require a clean-shaven appearance&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> It is a foreign body type inflammatory reaction around the hair due to its structural characteristics and growth orientation&#44; which curves downwards and penetrates the epidermis and dermis &#40;extrafollicular penetration&#41; or grows inside the follicle&#44; perforating its wall and penetrating the dermis &#40;transfollicular penetration&#41;&#46; The latter generally results from an incorrect shaving technique&#44; such as stretching the skin&#44; and the use of blades that pull the hair instead of cutting it&#44; causing retraction with the tip below the skin surface&#46; Molecular biology studies detected the substitution of a single nucleotide in the specific keratin of the hair follicle layers &#40;K6hf&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> The mutation in K6hf is believed to lead to a weakened cytoskeleton&#44; increasing the chances of ingrown hairs&#46; Carriers of the A12T polymorphism of the gene that encodes keratin have a six-fold greater chance of developing PFB&#46; About 76&#37; of men who shave regularly and who carry the A12T polymorphism develop PFB&#44; making this a significant risk factor for the disease&#46; Finally&#44; PFB has been associated with the use of cyclosporine and corticosteroids in kidney transplant patients and also with violin pressure under the jaw &#40;violinist&#39;s neck&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> Clinically&#44; they are follicular papulo-pustules&#44; where the hair can be seen in a linear groove&#46; It mainly affects the face and neck of men&#44; but it is also seen in women in areas where hair removal is practiced&#44; such as the armpits&#44; pubic region and legs during menopause or in hirsute young women&#46; Pustules may be secondary to infection&#44; usually by <span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&#46; Post-inflammatory hyperpigmentation and keloids may occur&#46; Histopathology shows invagination of the epidermis&#44; neutrophilic inflammatory infiltrate&#44; microabscesses&#44; foreign body-type granulomas and fibrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a></p></span></span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Keloid</span><p id="par0180" class="elsevierStylePara elsevierViewall">Keloids and hypertrophic scars are considered distinct types of scars&#46; They are benign excessive growths of scar tissue at sites of skin injuries&#46; Clinically&#44; keloids are smooth&#44; shiny and firm&#44; red or pink papules&#44; plaques&#44; or nodules&#44; with progressive hyperpigmentation&#44; that spread into the surrounding normal skin&#46; Hypertrophic scars do not grow beyond the limits of the original injury&#46; On histopathology&#44; keloids tend to have a large volume of thick&#44; eosinophilic&#44; hyaline collagen and many blood vessels&#44; the opposite occurring in hypertrophic scars&#46; However&#44; the scar may present the growth pattern and histopathological characteristics of both hypertrophic scars and keloids&#44; suggesting that the two types of scars are manifestations of the same fibroproliferative disease&#44; differing only in the intensity and duration of inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">50&#44;51</span></a></p><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Dermatosis papulosa nigra</span><p id="par0185" class="elsevierStylePara elsevierViewall">These are benign skin lesions of unknown etiology&#44; but with a genetic predisposition&#44; with more than 50&#37; of patients reporting a family history&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The highest prevalence is found in black people&#44; between 10&#37; and 30&#37;&#46; It begins after puberty&#44; as multiple hyperpigmented&#44; rounded or filiform papules&#44; measuring 1 to 5&#8239;mm&#44; on the face&#44; neck and trunk&#44; gradually increasing in number &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; They are generally asymptomatic&#44; although they can cause skin irritation and pruritus&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Sickle cell anemia ulcers</span><p id="par0190" class="elsevierStylePara elsevierViewall">Ulcers are a common complication of sickle-cell disease&#46; Geographic origin is a factor in the occurrence of this disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">52&#44;53</span></a> The most common genotypes are&#44; in decreasing order of frequency&#58; homozygous SS sickle cell anemia&#44; compound heterozygous Sb0 thalassemia&#44; and sickle cell trait hemoglobin&#46; The incidence of ulcers varies with the total hemoglobin level and the fetal hemoglobin level&#46; When low&#44; they are associated with an increased risk&#46; These are very painful ulcers&#44; located on the legs&#44; which are difficult to heal&#46; The prognosis is associated with its clinical characteristics&#44; and not with the biological characteristics of sickle cell disease&#46; Complete healing was achieved within six months in 75&#37; of cases&#44; when the area was less than 8&#8239;cm<span class="elsevierStyleSup">2</span> and the duration was less than nine weeks&#44; comparable to the healing rates observed in venous ulcers&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">52&#44;53</span></a></p></span><span id="sec0165" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Ainhum</span><p id="par0195" class="elsevierStylePara elsevierViewall">Also known as dactylolysis spontanea or ayun &#40;in the Yoruba language&#44; it means &#8216;cutting&#8217;&#41;&#44; it occurs worldwide&#44; but is more common in African countries&#44; with a low prevalence &#40;0&#46;015&#37;&#41;&#46; In Brazil&#44; it affects individuals with different phenotypes&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">It begins with an asymptomatic fissure at the base of the fifth toe&#44; evolving into a fibrous constrictive painful ring leading to mutilation due to ischemia&#46; Occasionally&#44; it may be bilateral&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">55&#44;56</span></a> It differs from pseudo-ainhum&#44; secondary to conditions that cause constriction&#44; by its spontaneous and idiopathic onset&#46; The clinical diagnosis includes at least one of the following three criteria&#58; soft tissue constriction&#44; bulbous enlargement of the toes&#44; and thinning or lysis of the phalanx bones&#44; and requires radiographic confirmation&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a></p></span><span id="sec0170" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Confluent and reticulated papillomatosis &#40;CRP&#41; of Gougerot-Carteaud</span><p id="par0205" class="elsevierStylePara elsevierViewall">Dermatosis that affects adolescents and young adults&#44; especially women&#44; twice as common in black people than in whites&#46; It may be associated with insulin resistance and obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> It is characterized by thin&#44; scaly papules&#44; initially erythematous and later brown&#44; which merge into reticulated&#44; hyperkeratotic or verrucous plaques on the chest and back&#44; asymptomatic or slightly pruritic&#46; Histopathology shows hyperkeratosis&#44; with irregular papillomatosis&#44; focal acanthosis and increased melanin&#46; Acanthosis nigricans is the main differential diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p></span><span id="sec0175" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Hair and scalp diseases</span><span id="sec0180" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Fragile and brittle hair</span><p id="par0210" class="elsevierStylePara elsevierViewall">Breakage is a common problem in black hair&#44; leading to deficient growth and alopecia&#44; due to the intrinsic characteristics of fragility and reduced tensile strength&#46; Fragility results from the elliptical shape of the shafts originating from the curved follicle&#44; different hair diameters and dry scalp&#46; Transverse asymmetry&#44; with points of weakness&#44; reduces tensile strength&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">57&#44;58</span></a> Damage to the hair shaft resulting from the removal of proteins or 18-methyl eicosanoic acid &#40;18-MEA&#41;&#44; the main lipid of the hair cuticle&#44; contributes to breakage&#46; of hair&#44; secondary to excessive use of heat or chemical agents&#44; in addition to hairstyles that exert traction&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;59&#44;60</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Dermoscopy &#40;trichoscopy&#41; shows trichorrhexis nodosa&#44; where the shaft is nodularly dilated and lighter&#44; and distal trichoptilosis &#40;cracking of the ends&#41; or central trichoptilosis &#40;longitudinal division in the central part of the hair shaft&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;61&#8211;63</span></a></p></span><span id="sec0185" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Traction alopecia</span><p id="par0220" class="elsevierStylePara elsevierViewall">Caused by repetitive tension in hair from braids&#44; ponytails&#44; turbans&#44; buns&#44; dreadlocks&#44; weaves&#44; extensions&#44; among others&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a> traction alopecia generally begins in childhood&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">64&#44;65</span></a> The pattern is characteristic&#44; reflecting the distribution of traction&#44; affecting the temporal&#44; pre-auricular and above-the-ears regions&#44; and may involve other parts of the scalp&#46; Folliculitis&#44; reduced hair density and broken hairs are seen in these areas&#44; in addition to the fringe sign &#40;long terminal hairs anterior to the alopecia area&#44; which consist of fine or miniaturized residual hairs&#41;&#46; It may be associated with headache&#44; relieved by loosening the hair&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">65&#44;66</span></a> Early diagnosis is important&#44; when it is still reversible&#46; Trichoscopy in the early stage shows the honeycomb pattern of the preserved scalp&#44; perifollicular erythema&#44; reduced hair density and vellus hairs&#46; The advanced stage is characterized by loss of follicular openings&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;65&#44;66</span></a> Histopathology in the initial stage shows a normal number of hair follicles&#44; but a greater number of telogen and catagen follicles&#44; in addition to trichomalacia &#40;remnants of hair shafts in the ostia&#41;&#46; In advanced stages&#44; there is a decrease in the number of terminal follicles&#44; replaced by fibrous tracts&#46; There is no inflammatory infiltrate during the course of this disease&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a></p></span><span id="sec0190" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Folliculitis keloidalis nuchae</span><p id="par0225" class="elsevierStylePara elsevierViewall">It results from ingrown hairs&#44; extrafollicular or transfollicular penetration of the skin&#44; generally secondary to the cutting of black hair&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">67&#44;68</span></a> It presents as papules&#44; pustules&#44; plaques and nodules on the posterior region of the scalp&#44; commonly associated with alopecia and keloids&#46; Trichoscopy shows broken hairs with tufts&#44; ingrown hairs and peripilar casts &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">67&#44;68</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0195" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Dissecting folliculitis &#40;cellulitis&#41;</span><p id="par0230" class="elsevierStylePara elsevierViewall">Also called folliculitis and perifolliculitis <span class="elsevierStyleItalic">capitis abscedens et suffodiens</span>&#44; it is a chronic scalp disorder&#44; observed mainly in young men&#46; The lesions&#44; initially papulopustular&#44; develop into painful&#44; multifocal inflammatory nodules&#44; connected by intercommunicating sinuses&#44; resulting in cicatricial alopecia&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;69</span></a> On trichoscopy&#44; characteristics of non-scarring alopecia are initially observed&#44; with regularly distributed pinpoint white dots&#44; enlarged follicular openings&#44; &#8220;3D&#8221; yellow spots &#40;accumulation of sebum and keratin&#41;&#44; black spots and fractured hair shafts&#46; In the terminal stage&#44; cicatricial lesions appear&#44; characterized by ivory-white confluent areas&#44; without follicular ostia&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">68&#8211;70</span></a></p></span><span id="sec0200" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Central centrifugal cicatricial alopecia &#40;CCCA&#41;</span><p id="par0235" class="elsevierStylePara elsevierViewall">Formerly known as hot comb alopecia &#40;a method of straightening hair&#41;&#44; pseudopelade&#44; and follicular degeneration syndrome&#44; CCCA is most common in young to middle-aged women of African descent&#46; The etiology is unknown but with an apparent influence of genetic factors&#44; traction&#44; heat and chemicals&#46; It is characterized by a chronic and progressive lesion on the vertex of the scalp&#44; which progresses in a centrifugal and symmetrical manner&#44; with activity in the peripheral zone&#44; surrounding the central zone of cicatricial alopecia&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;71&#8211;73</span></a> Signs of inflammation are absent&#44; although erythema&#44; follicular pustules and desquamation may appear&#46; It is usually asymptomatic&#44; but pain&#44; pruritus or burning sensation in the scalp may occur&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">73&#44;74</span></a> There is a spontaneous reduction in inflammation after years or decades&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">75</span></a> Trichoscopy reveals a preserved pigmented honeycomb network and irregularly distributed white dots&#46; A grayish-white peripilar halo is a specific and sensitive sign&#44; corresponding on histopathology to follicular ostia surrounded by fibrosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">74&#44;75</span></a> Other characteristics include hair shaft variability&#44; perifollicular erythema&#44; broken hairs as black dots within the follicular openings or as short broken shafts&#44; asterisk-like pigmented macules with sparse&#44; vellus-like terminal hair shafts and scattered white patches&#46;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">74&#8211;76</span></a> In the early stage histopathology reveals a perifollicular lymphocytic infiltrate with perifollicular fibroplasia&#46; In later stages&#44; there is destruction of the follicular epithelium and fragments of hair shafts sorrounded by granulomatous inflammation&#44; followed by replacement of the follicles by connective tissue besides tufting&#47;polytrichia of the hair follicles&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">76</span></a></p></span></span></span><span id="sec0205" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Some dermatoses with peculiar aspects in black skin</span><span id="sec0210" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Sarcoidosis</span><p id="par0240" class="elsevierStylePara elsevierViewall">African Americans tend to develop sarcoidosis at a younger age and are at greater risk of developing severe lung and skin disease&#46; Lupus pernio is associated with a worse prognosis for both systemic disease and more chronic skin lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">77&#44;78</span></a> Black people have sarcoidosis at a younger age&#44; on average around the 40&#8239;s&#44; and women more so than men&#46; Most of the time&#44; the initial lesions are asymptomatic&#44; with the first consultation being motivated by disfigurement&#46; Papules on the face and neck are the main observed lesions&#46; Erythema nodosum is less common than in white individuals&#46; There is a greater propensity for more severe disease&#44; with a greater number of extracutaneous organs being involved&#44; in the following order&#58; lungs&#44; lymph nodes and heart&#46; Mortality rates are higher&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">77&#44;78</span></a> Lupus pernio is associated with a worse prognosis for both systemic disease and more chronic skin lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0215" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">Lichen planus &#40;LP&#41;</span><p id="par0245" class="elsevierStylePara elsevierViewall">Hypertrophic&#44; pigmentosus&#44; and actinic types of LP are characteristic of dark-skinned individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The violaceous color&#44; typical of light skin&#44; is less visible on dark skin and PIH is intense&#46; On dermoscopy&#44; the most common features include&#58; pigmentary changes&#44; pearly whitish structures and a purple background&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a></p><span id="sec0220" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0230">LP pigmentosus &#40;LPP&#41;</span><p id="par0250" class="elsevierStylePara elsevierViewall">LPP is a rare variant of LP&#44; which begins after the age of 30&#44; predominantly in black women&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">80</span></a> Although the pathogenesis is the same as in classic LP&#44;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">81</span></a> sunlight is an important factor&#44; in addition to chemical agents &#40;contactants and drugs&#41; and microorganisms&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">80&#44;81</span></a> The initial lesions are small round or oval macules&#44; gray or brown&#44; with irregular ill-defined edges&#44; which coalesce to form diffuse&#44; reticulated&#44; perifollicular or annular pigmented areas&#44;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">80&#44;82</span></a> distributed mainly in body regions exposed to the sun&#44; starting on the face and neck&#44; spreading to the upper extremities and trunk&#44; symmetrically&#44; rarely affecting the oral mucosa&#44; the scalp&#44; nails&#44; palms and soles&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">80&#44;82</span></a> There are no Wickham striae&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">82</span></a> Eventually&#44; there are classic LP lesions&#46; Pruritus is mild or absent&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">81</span></a> One variant is LPP inversus&#44; which affects skin not exposed to the sun&#44; particularly flexural and intertriginous areas&#44; in which a transition from papules to macules can be observed &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; Mechanical stimuli are triggers&#46; Other variants are&#58; localized&#44; segmental&#44; linear&#44; zosteriform and oral mucosa LPP&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">80&#8211;82</span></a></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0255" class="elsevierStylePara elsevierViewall">Dermoscopy of LPP inversus shows homogeneous brown areas &#40;epidermal pigmentation&#41;&#44; as well as brown-gray or blue-gray dots and globules &#40;pigmentary incontinence&#41;&#44; which are initially grouped into a diffuse pattern of black pigmentation&#46; Over time&#44; they converge forming reticular&#44; linear and cobblestone patterns&#46; White dots are secondary to lack of pigmentation in the follicular openings&#44; and the absence of pigment in the grooves may be due to lack of exposure to friction&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">82</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">Histopathologically&#44; the lichenoid inflammatory infiltrate is similar to the one seen in classic LP&#44;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">81</span></a> but it regresses quickly&#44; without the proliferation of keratinocytes&#44; and the melanin deposited in the dermis remains for months to years&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">82</span></a> Direct immunofluorescence is rarely positive&#44; with IgM and C3 at the dermal-epidermal junction and IgG and IgA in keratinocytes&#46;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">81&#44;82</span></a> It can be associated with hepatitis C&#44; endocrinopathies&#44; autoimmune diseases and malignancies&#44; as well as other variants of LP&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">80&#8211;82</span></a></p></span></span><span id="sec0225" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0235">Psoriasis</span><p id="par0265" class="elsevierStylePara elsevierViewall">Psoriasis in dark-skinned patients is characterized by less distinguishable erythema&#44; thicker plaques&#44; greater desquamation and greater body involvement &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46; The resolution of the lesions results in pigmentary changes &#40;hyper- and hypopigmentation&#41;&#46; The frequency of psoriatic arthritis in blacks is approximately half that in Caucasians&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">83</span></a> The most common dermoscopic features include&#58; light red background&#44; red dotted vessels&#44; regular vessels&#44; white scales&#44; irregular distribution&#44; and pigmentary changes&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a></p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0230" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0240">Lupus erythematosus &#40;LE&#41;</span><p id="par0270" class="elsevierStylePara elsevierViewall">Discoid LE &#40;DLE&#41; has a higher incidence and severity in black women&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">84</span></a> The lesions are mostly located in exposed areas&#44; with greater involvement of the scalp and ears&#44; with depigmentation and cicatricial alopecia being prominent &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">84</span></a> Lesions vary from desquamative to hypertrophic or verrucous and tend to have an annular morphology&#46; Depigmentation is obvious and can be disfiguring&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">84</span></a> PIH is also prominent&#44;<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">84&#44;85</span></a> with a risk of hypertrophic scars&#46; Hair care practices contribute to more frequent and severe cicatricial alopecia&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">84</span></a></p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0275" class="elsevierStylePara elsevierViewall">The prevalence of systemic LE &#40;SLE&#41; is approximately three-fold higher among black people&#44; with women being most affected&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">86</span></a> The disease shows rapid progression and greater severity&#44; with kidney and cardiovascular damage and higher and earlier mortality rates&#46;<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">86&#44;87</span></a> The causes of these disparities are multifactorial&#44; including genetic&#44; epigenetic&#44; socioeconomic&#44; and racial discrimination ones&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">87</span></a> Cutaneous involvement occurs in around 80&#37; of cases&#44; the majority due to specific lesions&#44; which are associated with less severe disease&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">88</span></a> Among non-specific lesions&#44; Raynaud&#39;s phenomenon&#44; oral ulcers and diffuse melanonychia affect almost 40&#37; of the patients&#46; Acute lupus erythematosus&#44; the most common form of SLE in Caucasians&#44; is uncommon in black individuals&#44; and is associated with kidney disease&#44; livedo reticularis&#44; non-cicatricial alopecia&#44; and oral ulcers&#46; DLE occurs in about 50&#37; of cases and is associated with arthritis&#46; Subacute lupus erythematosus is rare&#44; perhaps because subtle erythematous eruptions and photosensitivity are difficult to detect&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">89</span></a></p></span><span id="sec0235" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0245">Vitiligo</span><p id="par0280" class="elsevierStylePara elsevierViewall">Vitiligo is very debilitating in dark skin due to its highly inaesthetic characteristic&#44; with a profound effect on the patients quality of life&#46; Its prevalence varies greatly within the same race and among different races&#46; In addition to the usual etiopathogenic factors&#44; Koebner phenomenon is implicated in dark skin&#46; The lesion occur mainly in areas exposed to the sun&#44; especially the lips&#46; The genitals are also often affected&#46; Depending on the intensity of the acromia&#44; speckled and trichromatic vitiligo seems to be specific for black skin&#44; with a high contrast between lesions and healthy skin &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Fig&#46; 8</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">90</span></a></p><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span><span id="sec0240" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0250">Syphilis</span><p id="par0285" class="elsevierStylePara elsevierViewall">Secondary syphilis in black people sometimes shows intense desquamation&#44; giving the lesions a psoriasiform appearance&#46; On the face&#44; the papules tend to cluster around the nose and mouth&#44; simulating seborrheic dermatitis&#46; Periorificial lesions assume characteristic annular and circinate configurations &#40;elegant syphilis&#59; <a class="elsevierStyleCrossRef" href="#fig0045">Fig&#46; 9</a>&#41;&#46; In the inguinocrural region&#44; due to friction and humidity&#44; the papules&#44; rich in treponemas&#44; become vegetative and macerated &#40;flat condyloma&#41;&#46; On the oral mucosa&#44; white vegetative plaques can be observed on an eroded base&#44; and are contagious&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">91</span></a></p><elsevierMultimedia ident="fig0045"></elsevierMultimedia><elsevierMultimedia ident="fig0050"></elsevierMultimedia></span><span id="sec0245" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0255">Pityriasis versicolor &#40;PV&#41;</span><p id="par0290" class="elsevierStylePara elsevierViewall">Some studies report the predilection of PV for individuals with darker skin&#46; It initially presents as round or oval hypopigmented or&#44; less frequently&#44; hyperpigmented macules&#44; measuring 3 to 5&#8239;mm&#44; symmetrically distributed on the upper trunk&#44; shoulders or flexural areas&#46; Facial and cervical involvement is more common&#46; Subsequently&#44; they spread and coalesce to form larger&#44; irregularly shaped patches&#46; When active&#44; there is subtle desquamation associated with pruritus&#46; After treatment&#44; pigmentary changes without desquamation may persist for months&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">92</span></a></p><span id="sec0250" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0260">Neoplasms</span><p id="par0295" class="elsevierStylePara elsevierViewall">Although the risk for skin cancer is lower in black people&#44; exposure to UV rays is also a risk factor&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> The repair of DNA damage induced by UV radiation is more efficient in black people&#46; <a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">93</span></a> Black individuals are less likely to use sun protection&#44; as they believe it is unnecessary&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a><a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">93&#8211;95</span></a> illustrates the main characteristics and differences between non-melanoma and melanoma cancer in black skin&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0255" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0265">Primary cutaneous T-cell lymphoma &#40;CTCL&#41;</span><p id="par0300" class="elsevierStylePara elsevierViewall">Mycosis fungoides &#40;MF&#41; is the most common type of lymphoma in black skin&#44; accounting for more than 50&#37; of CTCLs&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> with an incidence rate of 4&#46;0 and 6&#46;1&#47;100&#44;000 for white and black patients&#44; respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">96&#44;97</span></a> Black individuals present with MF at an earlier age and at a higher T stage than white ones&#46; Clinically&#44; MF generally presents as patches&#44; plaques or tumors located&#44; preferably&#44; in covered areas&#44; but can also present with erythroderma&#46; The lesions are hyperpigmented in darker skin&#44; rather than erythematous&#44; with a hypopigmented variant&#46; Hyperpigmented lesions correlate with shorter survival&#44; while hypopigmented ones correlate with longer survival and an indolent course&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">96</span></a></p><p id="par0305" class="elsevierStylePara elsevierViewall">Sezary Syndrome &#40;SS&#41; is a rare leukemic variant of CTCL&#44; defined by the triad of erythroderma&#44; neoplastic T cells &#40;Sezary cells&#41; in the blood&#44; and lymphadenopathy&#46; Like MF&#44; SS also has a higher prevalence in black individuals compared to white ones&#46; As on lightly pigmented skin&#44; it can be difficult to differentiate it from other diffuse eruptions&#46; The biggest concern is that pruritus and changes secondary to scratching are attributed to xerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">96&#44;97</span></a></p></span><span id="sec0260" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0270">Endemic Kaposi sarcoma</span><p id="par0310" class="elsevierStylePara elsevierViewall">It is limited to sub-Saharan Africa and is typically seen in young&#44; HIV-negative black men&#44; aged 25 to 40&#46; Clinical manifestations can range from indolent to aggressive and lethal&#46; Its presentation can be locally invasive or aggressive with&#47;or without mucocutaneous involvement&#46; There are four subtypes&#58; benign nodular&#59; locally aggressive with invasion of soft tissues and bones&#59; florid and disseminated with the involvement of skin and viscera&#59; and lymphadenopathic&#44; spreading rapidly to lymph nodes and viscera&#46; The last is the most aggressive and is associated with African children aged one to five years&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;98</span></a></p></span><span id="sec0265" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0275">Dermatofibrosarcoma protuberans &#40;DFSP&#41;</span><p id="par0315" class="elsevierStylePara elsevierViewall">DFSP is a rare&#44; slow-growing&#44; spindle cell neoplasm located in the dermis or subcutaneous tissue&#46; The incidence among black people is twice as high and the tumors are larger than in white individuals&#44; one explanation being the delay in diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">99</span></a> It is more common in the trunk than in the head and neck&#44; with no difference for the extremities&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">100</span></a> The risk of death in black individuals is 1&#46;7-fold greater than in whites and depends on size&#46;<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">99&#44;100</span></a></p><p id="par0320" class="elsevierStylePara elsevierViewall">There is a rare&#44; pigmented variant&#44; called Bednar tumor&#44; which occurs in 5&#37; of cases&#44; mainly in blacks&#44;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">100</span></a> observed in young and middle-aged adults&#44; occasionally in the pediatric age group&#46; Histogenesis is unexplained and may be related to remnants of embryonic breast tissue or local trauma&#44; with two theories having been proposed&#58; neuroectodermal differentiation or melanocytic colonization&#46;<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">99&#44;100</span></a> It has been reported in association with dermal melanocytosis &#40;nevus of Ito&#41; and is believed that it originates from a neuromesenchymal cell&#46; It is most commonly located on the trunk&#44; especially on the shoulders and back&#44; and can also affect the head and neck&#44; as well as the extremities&#46; <a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">99&#44;100</span></a> Clinically&#44; it resembles a keloid&#46; The majority appear as masses&#44; plaques&#44; or protruding&#44; firm&#44; multilobulated nodules&#44; with a wide base and slow growth&#44; in the dermis and subcutaneous tissue&#46; On histopathology&#44; it consists of spindle cells&#44; with mild pleomorphism&#46;<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">99&#44;100</span></a> Pigment-laden dendritic cells differentiate this lesion from conventional DFSP&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">100</span></a> Immunohistochemistry detects CD34 positivity in the cells&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">99</span></a> The biological behavior is that of intermediate malignancy and it must be differentiated from other pigmented&#44; fusiform skin lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">99&#44;100</span></a></p></span></span></span><span id="sec0270" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0280">Financial support</span><p id="par0325" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0275" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0285">Conflicts of interest</span><p id="par0330" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0280" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0290">Authors&#39; contributions</span><p id="par0335" class="elsevierStylePara elsevierViewall">Maur&#237;cio Mota de Avelar Alchorne&#58; Design and planning of the study&#59; critical review of important intellectual content&#59; effective participation in research orientation&#59; approval of the final version of the manuscript&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">Katleen da Cruz Concei&#231;&#227;o&#58; Critical review of the literature&#59; data collection&#59; drafting and editing of the manuscript&#59; approval of the final version of the manuscript&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">Leonardo Lora Barraza&#58; Critical review of the literature&#59; collection of data&#59; drafting and editing of the manuscript&#59; approval of the final version of the manuscript&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">Marilda Aparecida Milanez Morgado de Abreu&#58; Design and planning of the study&#59; critical review of important intellectual content&#59; drafting and editing of the manuscript&#59; approval of the final version of the manuscript&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:15 [
        0 => array:3 [
          "identificador" => "xres2136749"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1814417"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Dermatology in black skin"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "The black population"
        ]
        4 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Structural&#44; biological and functional aspects of black skin"
          "secciones" => array:4 [
            0 => array:3 [
              "identificador" => "sec0020"
              "titulo" => "Epidermis"
              "secciones" => array:3 [
                0 => array:2 [
                  "identificador" => "sec0025"
                  "titulo" => "Stratum corneum"
                ]
                1 => array:2 [
                  "identificador" => "sec0030"
                  "titulo" => "Lipid composition"
                ]
                2 => array:2 [
                  "identificador" => "sec0035"
                  "titulo" => "Melanocytes&#47;melanosomes"
                ]
              ]
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Dermis"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Adnexal glands"
            ]
            3 => array:3 [
              "identificador" => "sec0050"
              "titulo" => "Scalp&#44; hair follicles and hair"
              "secciones" => array:3 [
                0 => array:2 [
                  "identificador" => "sec0055"
                  "titulo" => "Scalp"
                ]
                1 => array:2 [
                  "identificador" => "sec0060"
                  "titulo" => "Hair follicles"
                ]
                2 => array:2 [
                  "identificador" => "sec0065"
                  "titulo" => "Hair"
                ]
              ]
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Dermatoses in black skin"
        ]
        6 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Physiological peculiarities of black skin"
        ]
        7 => array:3 [
          "identificador" => "sec0080"
          "titulo" => "Dermatoses with higher incidence on black skin"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Acne"
            ]
            1 => array:3 [
              "identificador" => "sec0090"
              "titulo" => "Eczema"
              "secciones" => array:1 [
                0 => array:2 [
                  "identificador" => "sec0095"
                  "titulo" => "Contact eczema"
                ]
              ]
            ]
            2 => array:2 [
              "identificador" => "sec0100"
              "titulo" => "Atopic dermatitis &#40;AD&#41;"
            ]
            3 => array:2 [
              "identificador" => "sec0105"
              "titulo" => "Seborrheic dermatitis &#40;SD&#41;"
            ]
            4 => array:3 [
              "identificador" => "sec0110"
              "titulo" => "Dyschromias"
              "secciones" => array:5 [
                0 => array:2 [
                  "identificador" => "sec0115"
                  "titulo" => "Post-inflammatory hyperpigmentation &#40;PIH&#41;"
                ]
                1 => array:2 [
                  "identificador" => "sec0120"
                  "titulo" => "Post-inflammatory hypopigmentation"
                ]
                2 => array:2 [
                  "identificador" => "sec0125"
                  "titulo" => "Progressive macular hypomelanosis &#40;PMH&#41;"
                ]
                3 => array:2 [
                  "identificador" => "sec0130"
                  "titulo" => "Pityriasis alba &#40;PA&#41;"
                ]
                4 => array:2 [
                  "identificador" => "sec0135"
                  "titulo" => "Melasma"
                ]
              ]
            ]
          ]
        ]
        8 => array:3 [
          "identificador" => "sec0140"
          "titulo" => "Dermatoses highly specific for black skin"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0145"
              "titulo" => "Pseudofolliculitis barbae &#40;PFB&#41;"
            ]
          ]
        ]
        9 => array:3 [
          "identificador" => "sec0150"
          "titulo" => "Keloid"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0155"
              "titulo" => "Dermatosis papulosa nigra"
            ]
            1 => array:2 [
              "identificador" => "sec0160"
              "titulo" => "Sickle cell anemia ulcers"
            ]
            2 => array:2 [
              "identificador" => "sec0165"
              "titulo" => "Ainhum"
            ]
            3 => array:2 [
              "identificador" => "sec0170"
              "titulo" => "Confluent and reticulated papillomatosis &#40;CRP&#41; of Gougerot-Carteaud"
            ]
            4 => array:3 [
              "identificador" => "sec0175"
              "titulo" => "Hair and scalp diseases"
              "secciones" => array:5 [
                0 => array:2 [
                  "identificador" => "sec0180"
                  "titulo" => "Fragile and brittle hair"
                ]
                1 => array:2 [
                  "identificador" => "sec0185"
                  "titulo" => "Traction alopecia"
                ]
                2 => array:2 [
                  "identificador" => "sec0190"
                  "titulo" => "Folliculitis keloidalis nuchae"
                ]
                3 => array:2 [
                  "identificador" => "sec0195"
                  "titulo" => "Dissecting folliculitis &#40;cellulitis&#41;"
                ]
                4 => array:2 [
                  "identificador" => "sec0200"
                  "titulo" => "Central centrifugal cicatricial alopecia &#40;CCCA&#41;"
                ]
              ]
            ]
          ]
        ]
        10 => array:3 [
          "identificador" => "sec0205"
          "titulo" => "Some dermatoses with peculiar aspects in black skin"
          "secciones" => array:7 [
            0 => array:2 [
              "identificador" => "sec0210"
              "titulo" => "Sarcoidosis"
            ]
            1 => array:3 [
              "identificador" => "sec0215"
              "titulo" => "Lichen planus &#40;LP&#41;"
              "secciones" => array:1 [
                0 => array:2 [
                  "identificador" => "sec0220"
                  "titulo" => "LP pigmentosus &#40;LPP&#41;"
                ]
              ]
            ]
            2 => array:2 [
              "identificador" => "sec0225"
              "titulo" => "Psoriasis"
            ]
            3 => array:2 [
              "identificador" => "sec0230"
              "titulo" => "Lupus erythematosus &#40;LE&#41;"
            ]
            4 => array:2 [
              "identificador" => "sec0235"
              "titulo" => "Vitiligo"
            ]
            5 => array:2 [
              "identificador" => "sec0240"
              "titulo" => "Syphilis"
            ]
            6 => array:3 [
              "identificador" => "sec0245"
              "titulo" => "Pityriasis versicolor &#40;PV&#41;"
              "secciones" => array:4 [
                0 => array:2 [
                  "identificador" => "sec0250"
                  "titulo" => "Neoplasms"
                ]
                1 => array:2 [
                  "identificador" => "sec0255"
                  "titulo" => "Primary cutaneous T-cell lymphoma &#40;CTCL&#41;"
                ]
                2 => array:2 [
                  "identificador" => "sec0260"
                  "titulo" => "Endemic Kaposi sarcoma"
                ]
                3 => array:2 [
                  "identificador" => "sec0265"
                  "titulo" => "Dermatofibrosarcoma protuberans &#40;DFSP&#41;"
                ]
              ]
            ]
          ]
        ]
        11 => array:2 [
          "identificador" => "sec0270"
          "titulo" => "Financial support"
        ]
        12 => array:2 [
          "identificador" => "sec0275"
          "titulo" => "Conflicts of interest"
        ]
        13 => array:2 [
          "identificador" => "sec0280"
          "titulo" => "Authors&#39; contributions"
        ]
        14 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-07-23"
    "fechaAceptado" => "2023-10-17"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1814417"
          "palabras" => array:5 [
            0 => "Dermatopathies"
            1 => "Ethnicity"
            2 => "Pigmentation"
            3 => "Population"
            4 => "Skin"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The vast majority of publications in dermatology refer to lightly pigmented skin&#44; with few addressing the peculiarities of black skin&#46; In addition there is no consensus on what it means to be black in different regions of the world&#46; The lack of knowledge on the subject makes it difficult to recognize and manage dermatoses in this type of skin&#46; This article aims to review the literature on intrinsic characteristics&#44; as well as epidemiological and clinical aspects of the cutaneous manifestations of different dermatoses in black skin&#46; It was found that there are sometimes striking differences&#44; in the structural&#44; biological&#44; and functional aspects when comparing lightly pigmented and black skin&#46; There are also physiological changes that need to be recognized to avoid unnecessary interventions&#46; Some dermatoses have a higher incidence in black skin&#44; such as acne&#44; eczema&#44; dyschromia and dermatophytosis&#46; On the other hand&#44; several dermatoses are more specific to black skin&#44; such as pseudofolliculitis barbae&#44; keloid&#44; dermatosis papulosa nigra&#44; ulcers caused by sickle-cell anemia&#44; dactylolysis spontanea&#44; confluent and reticulated papillomatosis of Gougerot and Carteaud&#44; and some diseases of the hair and scalp &#40;including fragile and brittle hair&#44; traction alopecia&#44; folliculitis keloidalis nuchae&#44; folliculitis dissecans and central centrifugal cicatricial alopecia&#41;&#46; A spectrum of peculiar aspects of specific dermatoses&#44; including sarcoidosis&#44; lichen planus &#40;with emphasis on the pigmentosus variant&#41;&#44; psoriasis&#44; lupus erythematosus&#44; vitiligo&#44; syphilis&#44; pityriasis versicolor&#44; and neoplasms are highlighted&#46; In the latter&#44; characteristics of basal cell carcinoma&#44; squamous cell carcinoma&#44; and melanoma are compared&#44; in addition to highlighting unusual aspects of primary cutaneous T-cell lymphoma&#44; endemic Kaposi sarcoma&#44; and dermatofibrosarcoma protuberans&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#8902;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Universidade do Oeste Paulista&#44; Presidente Prudente&#44; SP&#44; Brazil&#46;</p>"
      ]
    ]
    "multimedia" => array:13 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1475
            "Ancho" => 1675
            "Tamanyo" => 145016
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Highlighting topics in black skin&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1133
            "Ancho" => 1508
            "Tamanyo" => 250561
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Post-inflammatory hyperpigmentation&#58; hyperchromic macules on the lumbosacral and gluteal regions&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1133
            "Ancho" => 1508
            "Tamanyo" => 274958
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermatosis papulosa nigra&#58; hyperchromic papules on the face&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1675
            "Ancho" => 1258
            "Tamanyo" => 646139
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Keloid folliculitis of the neck&#58; sessile nodule on the back of the neck&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 852
            "Ancho" => 1508
            "Tamanyo" => 241259
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lichen planus pigmentosus&#58; slightly raised papules and bright hyperchromic macules in the axilla&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 2008
            "Ancho" => 1508
            "Tamanyo" => 430402
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Psoriasis&#58;</span> hyperchromic plaques with thick symmetrical scales on the anterior surface of the legs&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "fig0035"
        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 1639
            "Ancho" => 1508
            "Tamanyo" => 647739
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Discoid lupus erythematosus&#58; atrophic alopecic plaque on the frontoparietal region&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "fig0040"
        "etiqueta" => "Figure 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 1361
            "Ancho" => 2175
            "Tamanyo" => 539885
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0040"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Vitiligo&#58; achromic macules on the scalp and neck &#40;A&#41; and on the dorsum of the hands &#40;B&#41;&#46;</p>"
        ]
      ]
      8 => array:8 [
        "identificador" => "fig0045"
        "etiqueta" => "Figure 9"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr9.jpeg"
            "Alto" => 718
            "Ancho" => 1508
            "Tamanyo" => 103960
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0045"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Elegant syphilis&#58; erythematous papule and annular plaque on the face&#46;</p>"
        ]
      ]
      9 => array:8 [
        "identificador" => "fig0050"
        "etiqueta" => "Figure 10"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr10.jpeg"
            "Alto" => 980
            "Ancho" => 1508
            "Tamanyo" => 212665
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0050"
            "detalle" => "Figure 1"
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Acral melanoma&#58; blackish macule on the hallux &#40;B&#41;&#46; Dermoscopic appearance &#40;A&#41;&#46;</p>"
        ]
      ]
      10 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0055"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Modified from Zaid&#44; 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Black skin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lightly pigmented skin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stratum corneum</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Same thickness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Same thickness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Compact stratum corneum cells&#44; with great intercellular cohesion&#46; More cell layers</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Less compact cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fewer cell layers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melanocytes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Equal number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Equal number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melanosomes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elongated&#44; not grouped&#44; present throughout the epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Small&#44; grouped&#44; absent in the superficial layers of the epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melanin content&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Higher&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smaller&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hair&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spiral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smooth&#44; helical&#44; wavy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Follicular degeneration syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Traction alopecia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mast cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Large granules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Small granules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pruritus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Collagen fibers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Small and stacked&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fiber fragments occasionally present&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Scarring and keloid formation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fibroblasts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Long and in greater number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Small and fewer in number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vitamin D production&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3522471.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Differences between black skin and lightly pigmented skin&#46;</p>"
        ]
      ]
      11 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0060"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alteration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Incidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Etiopathogenesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melanosis of the malar area<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Equal regarding gender&#59; older than 50 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unknown&#46; In young women&#44; it seems to be related to atopy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperchromia&#44; with imprecise borders&#44; symmetrically distributed in the malar regions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perioral hyperpigmentation<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Higher in females&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unknown&#46; It does not seem to be a consequence of inflammation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperchromia in the skin adjacent to the angles of the mouth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Periorbital melanosis<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Higher in the female sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multifactorial&#58; genetics&#44; post-inflammatory hyperpigmentation&#44; periorbital edema&#44; hypervascularization and shadowing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilateral periorbital and eyelid hyperchromia&#44; sometimes compromising the upper part of the nose and glabella&#46; There is an increase in the amount of melanin in the papillary dermis&#44; melanophages and vasodilation in the reticular dermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maturational hyperpigmentation<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#8210;5th decades of life&#46; Fitzpatrick skin phototypes IV&#8210;V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chronic sun exposure and possibly obesity and diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperchromic patches&#44; with ill-defined edges that eventually disappear into normal skin&#44; affecting areas exposed to the sun&#44; including the sides of the face and the back of the hands and feet&#46; On histopathology&#44; proliferation of melanocytes with reports of papillomatous epidermal proliferation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Voigt-Futcher lines<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#37; to 40&#37; of blacks&#59; higher in women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unknown&#46; Congenital or acquired &#40;hormonal -pregnancy&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Well-defined bilateral lines&#44; which separate more pigmented areas from lighter areas&#46; It can occur on the limbs&#44; chest or abdomen&#44; along the dermatomes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Midline hypopigmentation<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37; to 40&#37; of blacks&#59; higher in males&#59; less visible with age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Autosomal dominant inheritance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypochromic linear band on the sternal region&#44; which may extend to the linea alba and infraclavicular region&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Palmoplantar hyperpigmentation<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Common and more frequent with greater skin pigmentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Small&#44; well-defined hyperchromic macules&#44; variable in number and size&#44; on the palmoplantar surfaces&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melanonychia striata<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">More frequent with greater skin pigmentation&#59; up to 77&#37; of young African-American adults and nearly 100&#37; of those over 50 years&#44; increasing in intensity with age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melanocytic activation in the matrix&#44; with melanin deposition on the nail plate&#46; Less commonly&#44; melanocytic hyperplasia in the nail matrix or bed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pigmentation in longitudinal or diffuse bands on the nail&#44; from the matrix to the tip&#44; more common in the 1<span class="elsevierStyleSup">st</span> and 2<span class="elsevierStyleSup">nd</span> fingers&#46; On dermoscopy&#44; homogeneous grayish background&#44; with longitudinal parallel grayish lines&#46; Pseudo-micro-Hutchinson sign &#40;cuticle pigmentation&#41; may be seen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperpigmentation of the oral mucosa<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Develops during the first 2 decades of life&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melanocytic activation with melanin deposition in the epithelium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperchromic patches&#44; localized or disseminated&#46; In the gums&#44; they are more common and unaesthetic&#44; especially when there is a high smile line&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mongolian spot<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#37; to 90&#37; of black newborns&#46; Usually disappears by the age of 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unknown&#46; When extensive&#44; it is associated with systemic conditions&#44; such as congenital errors of metabolism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blue-gray spot&#44; usually single&#44; on the lumbosacral region&#46; Melanocytes in the dermis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral leukoedema<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#37; to 90&#37; of black adults and 50&#37; of children&#59; more frequent in men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Physiological&#44; but irritation caused by smoking or poor oral hygiene are factors&#46; There is accumulation of fluid in the epithelial cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grayish-white&#44; edematous plaques on the buccal mucosa&#44; seen bilaterally&#44; which disappear if the mucosa is distended&#46; White folds or lines may cross the affected area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pearly penile papules<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#37; to 48&#37; of black men&#59; in post-pubertal age or early adulthood&#44; diminishing with age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">They are believed to be vestigial structures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asymptomatic&#44; benign&#44; pearly-white&#44; dome-shaped or filiform papules&#44; measuring 1 to 4&#8239;mm&#44; around the glans&#44; in single or double row&#46; Dermoscopy shows a cobblestone or bunch of grapes pattern with dotted or comma-shaped central vessels&#46; Histopathology shows it to be angiofibroma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3522472.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Physiological peculiarities of black skin&#46;</p>"
        ]
      ]
      12 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0065"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">BCC&#44; Basal cell carcinoma&#59; SCC&#44; Squamous cell carcinoma&#59; HIV&#44; Human immunodeficiency virus&#59; HPV&#44; Human papilloma virus&#59; UV&#44; Ultraviolet&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Skin cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Incidence in blacks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical presentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Risk factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCC</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Around 80&#37; of skin cancers&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Solitary pearly papule or nodule&#44; with telangiectasias that are difficult to observe&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UV radiation&#44; albinism&#44; ulcers&#44; exposure to ionizing radiation&#44; ingestion of arsenic&#44; oral psoralen&#44; immunosuppression&#44; among others&#46;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Second most common&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Predominance in females&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pigmented variants are more prevalent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SCC</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Around 20&#37; of skin cancers&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythematous&#44; hyperkeratotic papules&#44; plaques or nodules&#44; generally in places not exposed to the sun &#40;scalp&#44; lower extremities&#44; anogenital area&#41;&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chronic healing processes such as burn scars and chronic ulcers&#44; HPV &#40;including subtypes 16 and 18&#41;&#44; immunosuppression&#44; radiotherapy&#44; albinism&#44; epidermodysplasia verruciformis&#46;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The most common&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melanoma</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The least common&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperpigmented macule&#44; plaque or nodule&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UV radiation&#46;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lower incidence rate in women &#40;0&#46;9&#47;100&#44;000&#47;year&#41;&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acral lentiginous &#40;palms&#44; soles&#44; nails&#41; is the most common &#40;<a class="elsevierStyleCrossRef" href="#fig0050">Fig&#46; 10</a>&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Late diagnosis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3522470.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Main characteristics of non-melanoma and melanoma skin cancers&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;93&#8211;95</span></a></p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:100 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatologia na pele negra"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2008"
                        "volumen" => "83"
                        "paginaInicial" => "7"
                        "paginaFinal" => "20"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatoses na pele negra"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "editores" => "O&#46;Rotta"
                        "titulo" => "Guia de dermatologia&#58; cl&#237;nica&#44; cir&#250;rgica e cosmi&#225;trica"
                        "paginaInicial" => "593"
                        "paginaFinal" => "608"
                        "serieFecha" => "2008"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Caracter&#237;sticas &#233;tnico-raciais da popula&#231;&#227;o classifica&#231;&#245;es e identidades&#46; Ed&#46; 2"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2013"
                        "editorial" => "Instituto Brasileiro de Geografia e Estat&#237;stica &#8211; IBGE"
                        "editorialLocalizacion" => "Rio de Janeiro"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Instituto Brasileiro de Geografia e Estat&#237;stica &#8211; IBGE&#46; &#91;Homepage&#93; consultado em 17-03-2023&#46; <a target="_blank" href="https://educa.ibge.gov.br/jovens/conheca-o-brasil/populacao/18319-cor-ou-raca.html">https&#58;&#47;&#47;educa&#46;ibge&#46;gov&#46;br&#47;jovens&#47;conheca-o-brasil&#47;populacao&#47;18319-cor-ou-raca&#46;html</a>&#46;"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin of color&#58; biology&#44; structure&#44; function&#44; and implications for dermatologic disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mjd.2002.120790"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2002"
                        "volumen" => "46"
                        "numero" => "2 Suppl Understanding"
                        "paginaInicial" => "S41"
                        "paginaFinal" => "62"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cell layers and density of negro and caucasian stratum corneum"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1523-1747.ep12679412"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Invest Dermatol"
                        "fecha" => "1974"
                        "volumen" => "62"
                        "paginaInicial" => "563"
                        "paginaFinal" => "568"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin of colour&#58; characteristics and disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pak Med Assoc"
                        "fecha" => "2017"
                        "volumen" => "67"
                        "paginaInicial" => "292"
                        "paginaFinal" => "299"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Racial &#40;ethnic&#41; differences in skin properties&#58; the objective data"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2165/00128071-200304120-00004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Dermatol"
                        "fecha" => "2003"
                        "volumen" => "4"
                        "paginaInicial" => "843"
                        "paginaFinal" => "860"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Race&#44; ancestry&#44; and medical research"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2018.14438"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2018"
                        "volumen" => "320"
                        "paginaInicial" => "1539"
                        "paginaFinal" => "1540"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Regulation of the catalytic activity of preexisting tyrosinase in black and caucasian human melanocyte cell cultures"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1006/excr.2000.5092"
                      "Revista" => array:6 [
                        "tituloSerie" => "Exp Cell Res"
                        "fecha" => "2001"
                        "volumen" => "262"
                        "paginaInicial" => "197"
                        "paginaFinal" => "208"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photoprotection by melanin--a comparison of black and caucasian skin"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1979"
                        "volumen" => "1"
                        "paginaInicial" => "249"
                        "paginaFinal" => "260"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photoprotection in skin of color"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Photochem Photobiol Sci"
                        "fecha" => "2023"
                        "volumen" => "22"
                        "paginaInicial" => "441"
                        "paginaFinal" => "456"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin from various ethnic origins and aging&#58; an in vivo cross-sectional multimodality imaging study"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1600-0846.2009.00365.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Skin Res Technol"
                        "fecha" => "2009"
                        "volumen" => "15"
                        "paginaInicial" => "306"
                        "paginaFinal" => "313"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chemical analysis of constitutive pigmentation of human epidermis reveals constant eumelanin to pheomelanin ratio"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pigment Cell Melanoma Res"
                        "fecha" => "2015"
                        "volumen" => "28"
                        "paginaInicial" => "707"
                        "paginaFinal" => "717"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trichoscopy tips"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.det.2018.05.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Clin"
                        "fecha" => "2018"
                        "volumen" => "36"
                        "paginaInicial" => "413"
                        "paginaFinal" => "420"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The what&#44; why and how of curly hair&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Proc Math Phys Eng Sci"
                        "fecha" => "2019"
                        "volumen" => "475"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cuidados del cabelo afroamericano"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Asoc Colomb Dermatol Cir Dematol"
                        "fecha" => "2021"
                        "volumen" => "29"
                        "paginaInicial" => "269"
                        "paginaFinal" => "281"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chemical and physical properties of hair&#58; comparisons between Asian&#44; Black&#44; and Caucasian hair"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:6 [
                        "editores" => "C&#46;Aguh, G&#46;A&#46;Okoye"
                        "titulo" => "Fundamentals of ethnic hair&#58; the dermatologist&#8217;s perspective"
                        "paginaInicial" => "3"
                        "paginaFinal" => "13"
                        "edicion" => "1<span class="elsevierStyleSup">st</span> ed&#46;"
                        "serieFecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Curly hair&#58; measured differences and contributions to breakage"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-4632.2012.05555.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2012"
                        "volumen" => "51"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "8"
                        "paginaFinal" => "11"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Keratins and lipids in ethnic hair"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ics.12035"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cosmet Sci"
                        "fecha" => "2013"
                        "volumen" => "35"
                        "paginaInicial" => "244"
                        "paginaFinal" => "249"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Common dermatoses in moderately pigmented skin&#58; uncommon presentations"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2005.01.020"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol"
                        "fecha" => "2005"
                        "volumen" => "23"
                        "paginaInicial" => "446"
                        "paginaFinal" => "456"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Facial hyperpigmentation in skin of color&#58; special considerations and treatment"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40257-016-0239-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Dermatol"
                        "fecha" => "2017"
                        "volumen" => "18"
                        "paginaInicial" => "215"
                        "paginaFinal" => "230"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Voigt-Futcher pigmentary demarcation lines"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jocd.12884"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Dermatol"
                        "fecha" => "2019"
                        "volumen" => "18"
                        "paginaInicial" => "700"
                        "paginaFinal" => "702"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Melanonychia striata&#58; clarifying behind the Black Curtain&#46; A review on clinical evaluation and management of the 21st century"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijd.14464"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2019"
                        "volumen" => "58"
                        "paginaInicial" => "1239"
                        "paginaFinal" => "1245"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comprehensive review of Mongolian spots with an update on atypical presentations"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00381-018-3929-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Childs Nerv Syst"
                        "fecha" => "2018"
                        "volumen" => "34"
                        "paginaInicial" => "2371"
                        "paginaFinal" => "2376"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normal variations of oral anatomy and common oral soft tissue lesions&#58; evaluation and management"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.mcna.2014.08.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Clin North Am"
                        "fecha" => "2014"
                        "volumen" => "98"
                        "paginaInicial" => "1281"
                        "paginaFinal" => "1298"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and management of pearly penile papules"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1557988316654138"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Mens Health"
                        "fecha" => "2018"
                        "volumen" => "12"
                        "paginaInicial" => "624"
                        "paginaFinal" => "627"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Top dermatologic conditions in patients of color&#58; an analysis of nationally representative data"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Drugs Dermatol"
                        "fecha" => "2012"
                        "volumen" => "11"
                        "paginaInicial" => "466"
                        "paginaFinal" => "473"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A study of skin disease spectrum occurring in Angola phototype V-VI population in Luanda"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijd.13958"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2018"
                        "volumen" => "57"
                        "paginaInicial" => "849"
                        "paginaFinal" => "855"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatologic conditions in skin of color&#58; part I&#46; Special considerations for common skin disorders"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Fam Physician"
                        "fecha" => "2013"
                        "volumen" => "15"
                        "numero" => "87"
                        "paginaInicial" => "850"
                        "paginaFinal" => "856"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Common skin disorders in pediatric skin of color"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pedhc.2019.04.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Health Care"
                        "fecha" => "2019"
                        "volumen" => "33"
                        "paginaInicial" => "727"
                        "paginaFinal" => "737"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of patch test results with a standard series among white and black racial groups"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/ajcd.2001.20110"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Contact Dermat"
                        "fecha" => "2001"
                        "volumen" => "12"
                        "paginaInicial" => "77"
                        "paginaFinal" => "82"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patterns of allergic contact dermatitis in African Americans in a major metropolitan area over a 10-year period"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DER.0000000000000831"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatitis"
                        "fecha" => "2022"
                        "volumen" => "33"
                        "paginaInicial" => "70"
                        "paginaFinal" => "79"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Insights in skin of color patients with atopic dermatitis and the role of skincare in improving outcomes"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol"
                        "fecha" => "2022"
                        "volumen" => "1"
                        "numero" => "21"
                        "paginaInicial" => "462"
                        "paginaFinal" => "470"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of bacterial skin infections in atopic dermatitis&#58; expert statement and review from the International Eczema Council Skin Infection Group"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.18643"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2020"
                        "volumen" => "182"
                        "paginaInicial" => "1331"
                        "paginaFinal" => "1342"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Seborrheic dermatitis in skin of color&#58; clinical considerations"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol"
                        "fecha" => "2019"
                        "volumen" => "18"
                        "paginaInicial" => "24"
                        "paginaFinal" => "27"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hair oils may worsen seborrheic dermatitis in black patients"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000527778"
                      "Revista" => array:6 [
                        "tituloSerie" => "Skin Appendage Disord"
                        "fecha" => "2023"
                        "volumen" => "9"
                        "paginaInicial" => "151"
                        "paginaFinal" => "152"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatologic conditions in skin of color compared to white patients&#58; similarities&#44; differences&#44; and special considerations"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Dermatol Res"
                        "fecha" => "2023"
                        "volumen" => "315"
                        "paginaInicial" => "1089"
                        "paginaFinal" => "1097"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hair and scalp disorders in adult and pediatric patients with skin of color"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cutis"
                        "fecha" => "2017"
                        "volumen" => "100"
                        "paginaInicial" => "31"
                        "paginaFinal" => "35"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postinflammatory hyperpigmentation&#58; a review of the epidemiology&#44; clinical features&#44; and treatment options in skin of color"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Clin Aesthet Dermatol"
                        "fecha" => "2010"
                        "volumen" => "3"
                        "paginaInicial" => "20"
                        "paginaFinal" => "31"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin microneedling for acne scars associated with pigmentation in patients with dark skin"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jocd.12520"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Cosmet Dermatol"
                        "fecha" => "2018"
                        "volumen" => "17"
                        "paginaInicial" => "390"
                        "paginaFinal" => "395"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Progressive macular hypomelanosis&#58; an overview"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2165/00128071-200708010-00002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Dermatol"
                        "fecha" => "2007"
                        "volumen" => "8"
                        "paginaInicial" => "13"
                        "paginaFinal" => "19"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermoscopy of pigmentary disorders in brown skin"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.det.2018.05.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Clin"
                        "fecha" => "2018"
                        "volumen" => "36"
                        "paginaInicial" => "473"
                        "paginaFinal" => "485"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin diseases associated with atopic dermatitis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2018.05.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol"
                        "fecha" => "2018"
                        "volumen" => "36"
                        "paginaInicial" => "631"
                        "paginaFinal" => "640"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Melasma&#58; an up-to-date comprehensive review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s13555-017-0194-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Ther &#40;Heidelb&#41;"
                        "fecha" => "2017"
                        "volumen" => "7"
                        "paginaInicial" => "305"
                        "paginaFinal" => "318"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Melasma&#58; histopathological characteristics in 56 Korean patients"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.0007-0963.2001.04556.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2002"
                        "volumen" => "146"
                        "paginaInicial" => "228"
                        "paginaFinal" => "237"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pseudofolliculitis barbae in the U&#46;S&#46; Military&#44; a review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/milmed/usaa243"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mil Med"
                        "fecha" => "2021"
                        "volumen" => "186"
                        "paginaInicial" => "e52"
                        "paginaFinal" => "e57"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An unusual Ala12Thr polymorphism in the 1A alpha-helical segment of the companion layer-specific keratin K6hf&#58; evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.0022-202X.2004.22309.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Invest Dermatol"
                        "fecha" => "2004"
                        "volumen" => "122"
                        "paginaInicial" => "652"
                        "paginaFinal" => "657"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pseudofolliculitis barbae&#59; current treatment options"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Cosmet Investig Dermatol"
                        "fecha" => "2019"
                        "volumen" => "12"
                        "paginaInicial" => "241"
                        "paginaFinal" => "247"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are keloid and hypertrophic scar different forms of the same disorder&#63; A fibroproliferative skin disorder hypothesis based on keloid findings"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1742-481X.2012.01118.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Wound J"
                        "fecha" => "2014"
                        "volumen" => "11"
                        "paginaInicial" => "517"
                        "paginaFinal" => "522"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endothelial dysfunction may play a key role in keloid and hypertrophic scar pathogenesis &#8210; Keloids and hypertrophic scars may be vascular disorders"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.mehy.2016.09.024"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Hypotheses"
                        "fecha" => "2016"
                        "volumen" => "96"
                        "paginaInicial" => "51"
                        "paginaFinal" => "60"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors predictive of leg-ulcer healing in sickle cell disease&#58; a multicentre&#44; prospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.15241"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2017"
                        "volumen" => "177"
                        "paginaInicial" => "206"
                        "paginaFinal" => "211"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic factors associated with healing of venous leg ulcers&#58; a multicentre&#44; prospective&#44; cohort study"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.12570"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2013"
                        "volumen" => "169"
                        "paginaInicial" => "1106"
                        "paginaFinal" => "1113"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dactylolysis spontanea &#40;ainhum&#41;"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Radiol Bras"
                        "fecha" => "2015"
                        "volumen" => "48"
                        "paginaInicial" => "264"
                        "paginaFinal" => "265"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ainhum&#46; &#91;Updated 2022 Oct 12&#93;"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "titulo" => "StatPearls &#91;Internet&#93;"
                        "fecha" => "2023 Jan"
                        "editorial" => "StatPearls Publishing"
                        "editorialLocalizacion" => "Treasure Island &#40;FL&#41;"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;books&#47;NBK546612&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ainhum"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "editores" => "L&#46;Azulay-Abulafia, L&#46;Hanauer de Moura, F&#46;R&#46;P&#46;C&#46;Leal, D&#46;R&#46;Azulay"
                        "titulo" => "Atlas de dermatologia&#58; da semiologia ao diagn&#243;stico"
                        "edicion" => "3&#170; ed&#46;"
                        "serieFecha" => "2020"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A review of hair care products for black individuals"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cutis"
                        "fecha" => "2014"
                        "volumen" => "93"
                        "paginaInicial" => "289"
                        "paginaFinal" => "293"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Understanding curly hair mechanics&#58; fiber strength"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jid.2019.06.141"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Invest Dermatol"
                        "fecha" => "2020"
                        "volumen" => "140"
                        "paginaInicial" => "113"
                        "paginaFinal" => "120"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Degradation of hair surface&#58; importance of 18-MEA and epicuticle"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cosmetics"
                        "fecha" => "2019"
                        "volumen" => "6"
                        "paginaInicial" => "31"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An overview of chemical straightening of human hair&#58; technical aspects&#44; potential risks to hair fibre and health and legal issues"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ics.12093"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Cosmet Sci"
                        "fecha" => "2014"
                        "volumen" => "36"
                        "paginaInicial" => "2"
                        "paginaFinal" => "11"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trichoscopy of dark scalp"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000488885"
                      "Revista" => array:6 [
                        "tituloSerie" => "Skin appendage disord"
                        "fecha" => "2018"
                        "volumen" => "5"
                        "paginaInicial" => "1"
                        "paginaFinal" => "8"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermoscopic diagnosis of hair breakage caused by styling procedures in patients of African descent"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2015"
                        "volumen" => "72"
                        "numero" => "1 Suppl"
                        "paginaInicial" => "S39"
                        "paginaFinal" => "40"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatologic conditions in skin of color&#58; part II&#46; Disorders occurring predominately in skin of color"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Fam Physician"
                        "fecha" => "2013"
                        "volumen" => "87"
                        "paginaInicial" => "859"
                        "paginaFinal" => "865"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Positive Jacquet&#8217;s sign in traction alopecia"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.14974"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2018"
                        "volumen" => "32"
                        "paginaInicial" => "e446"
                        "paginaFinal" => "e447"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traction alopecia&#58; a neglected entity in 2017"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Indian J Dermatol Venereol Leprol"
                        "fecha" => "2017"
                        "volumen" => "83"
                        "paginaInicial" => "644"
                        "paginaFinal" => "649"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traction Alopecia&#46; &#91;Updated 2022 Aug 8&#93;"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "titulo" => "StatPearls &#91;Internet&#93;"
                        "fecha" => "2023 Jan"
                        "editorial" => "Stat Pearls Publishing"
                        "editorialLocalizacion" => "Treasure Island &#40;FL&#41;"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;books&#47;NBK470434&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trichoscopy findings in dissecting cellulitis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.abd.2019.09.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2019"
                        "volumen" => "94"
                        "paginaInicial" => "608"
                        "paginaFinal" => "611"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            67 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "68"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dissecting cellulitis of the scalp&#58; a retrospective study of 51 patients and review of literature"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.13999"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2016"
                        "volumen" => "174"
                        "paginaInicial" => "421"
                        "paginaFinal" => "423"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            68 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "69"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Yellow dots in trichoscopy&#58; relevance&#44; clinical significance and peculiarities"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20176157"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2017"
                        "volumen" => "92"
                        "paginaInicial" => "724"
                        "paginaFinal" => "726"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            69 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "70"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology&#44; clinical presentation and therapeutic approach in a multicentre series of dissecting cellulitis of the scalp"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.13948"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2017"
                        "volumen" => "31"
                        "paginaInicial" => "e199"
                        "paginaFinal" => "e200"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            70 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "71"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Black women&#8217;s hair&#58; the main scalp dermatoses and aesthetic practices in women of African ethnicity"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20152845"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2015"
                        "volumen" => "90"
                        "paginaInicial" => "450"
                        "paginaFinal" => "465"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            71 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "72"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary care provider understanding of hair care maintenance as a barrier to physical activity in African American women"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Board Fam Med"
                         …4
                      ]
                    ]
                  ]
                ]
              ]
            ]
            72 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "73"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "On the history of African hair care&#58; more treasures await discovery"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1473-2165.2008.00396.x"
                      "Revista" => array:5 [ …5]
                    ]
                  ]
                ]
              ]
            ]
            73 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "74"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic approach to Afro-textured hair disorders&#58; dermatoscopy and when to biopsy"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.det.2013.11.005"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            74 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "75"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Central centrifugal cicatricial alopecia&#58; new insights and a call for action"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [ …5]
                    ]
                  ]
                ]
              ]
            ]
            75 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "76"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Central Centrifugal cicatricial alopecia&#46; &#91;Updated 2022 May 8&#93;"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "LibroEditado" => array:2 [ …2]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [ …1]
                    ]
                  ]
                ]
              ]
            ]
            76 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "77"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased risk of systemic and cardiac sarcoidosis in black patients with cutaneous sarcoidosis"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2021.04.079"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            77 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "78"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiological&#44; clinical&#44; and paraclinic aspect of cutaneous sarcoidosis in Black Africans"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [ …3]
                    ]
                  ]
                ]
              ]
            ]
            78 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "79"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermoscopic features of psoriasis&#44; lichen planus&#44; and pityriasis rosea in patients with skin type IV and darker attending the regional dermatology training centre in Northern Tanzania"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5826/dpc.0901a11"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            79 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "80"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lichen planus pigmentosus&#58; a clinico-etiological study"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/idoj.IDOJ_253_18"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            80 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "81"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lichen planus pigmentosus and its variants&#58; review and update"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijd.13806"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            81 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "82"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lichen planus pigmentosus&#58; the controversial consensus"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0019-5154.190108"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            82 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "83"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psoriasis in skin of color&#58; insights into the epidemiology&#44; clinical presentation&#44; genetics&#44; quality-of-life impact&#44; and treatment of psoriasis in non-white racial&#47;ethnic groups"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40257-017-0332-7"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            83 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "84"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Discoid lupus erythematosus skin lesion distribution and characteristics in black patients&#58; a retrospective cohort study"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [ …3]
                    ]
                  ]
                ]
              ]
            ]
            84 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "85"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The incidence and prevalence of systemic lupus erythematosus&#44; 2002&#8210;2004&#58; The Georgia lupus registry"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.38239"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            85 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "86"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of end-stage renal disease among newly diagnosed systemic lupus erythematosus patients&#58; the Georgia lupus registry"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [ …5]
                    ]
                  ]
                ]
              ]
            ]
            86 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "87"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased risk of death in African American patients with end-stage renal disease secondary to lupus"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [ …5]
                    ]
                  ]
                ]
              ]
            ]
            87 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "88"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Racial discrimination&#44; disease activity&#44; and organ damage&#58; the black women&#8217;s experiences living with lupus &#40;BeWELL&#41; study"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/aje/kwz105"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            88 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "89"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spectrum of cutaneous lupus erythematosus in South Africans with systemic lupus erythematosus"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0961203319856091"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            89 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "90"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vitiligo on black skin&#58; epidemiological and clinical aspects in dermatology&#44; Cotonou &#40;Benin&#41;"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijd.13366"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            90 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "91"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "S&#237;filis&#58; diagn&#243;stico&#44; tratamento e controle"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [ …5]
                    ]
                  ]
                ]
              ]
            ]
            91 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "92"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tinea versicolor in dark-skinned individuals"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijd.12345"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            92 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "93"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Basal cell carcinoma&#44; squamous cell carcinoma&#44; and cutaneous melanoma in skin of color patients"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.det.2019.05.009"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            93 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "94"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Melanoma in skin of color&#58; part I&#46; epidemiology and clinical presentation"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2022.04.056"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            94 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "95"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Melanoma in skin of color&#58; part II&#46; racial disparities&#44; role of UV&#44; and interventions for earlier detection"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2022.04.057"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            95 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "96"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics&#44; prognostic factors&#44; and survival of 393 patients with mycosis fungoides and S&#233;zary syndrome in the southeastern United States&#58; a single-institution cohort"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2014.10.019"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            96 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "97"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Poorer prognosis of African-American patients with mycosis fungoides&#58; an analysis of the SEER dataset&#44; 1988 to 2008"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clml.2013.12.018"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            97 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "98"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of Kaposi sarcoma&#58; review and description of the nonepidemic variant"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijd.14080"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            98 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "99"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of patient demographic characteristics with dermatofibrosarcoma protuberans tumour size at diagnosis in the U&#46;S&#46; national cancer database"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.15357"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            99 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "100"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Variant of dermatofibrosarcoma protuberans&#58; bednar tumor"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0019-5154.147893"
                      "Revista" => array:5 [ …5]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03650596/0000009900000003/v1_202404281408/S0365059624000035/v1_202404281408/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "80634"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Continuing Medical Education"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009900000003/v1_202404281408/S0365059624000035/v1_202404281408/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624000035?idApp=UINPBA00008Z"
]

Article information

ISSN: 03650596
Original language: English

DOI:10.1016/j.abd.2023.10.001

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	47	11	58
2024 October	287	92	379
2024 September	292	109	401
2024 August	355	129	484
2024 July	305	123	428
2024 June	397	133	530
2024 May	599	161	760
2024 April	200	130	330
2024 March	147	90	237
2024 February	92	187	279

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter