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INTRODUCTION

Asians are a diverse group of people from various parts of Asia. They consist of people from South Asia (Pakistan, India, and Sri Lanka), South-East Asia (Singapore, Malaysia, Indonesia, the Philippines, and Thailand), and East Asia (Japan, Korea, and China). In these regions, people with Fitzpatrick skin types III to V predominate.

Dermatoses that affect Asians may differ from those affecting Caucasians due to differences in skin phototypes, inherent genetic differences, and unique Asian cultural practices. This chapter will highlight several interesting dermatoses in Asians that may not have been covered adequately in the preceding chapters. These dermatoses are broadly divided into three categories:

  1. Pigmented skin dermatoses

  2. Dermatoses more common among Asians

  3. Dermatoses arising from unique Asian cultural practices

PIGMENTED SKIN DERMATOSES

Certain pigmented dermatoses are more common in darker skinned Asians (Figures 24–1 and 24–2). These include acanthosis nigricans and dermatosis papulosa nigra. Acanthosis nigricans is characterized by hyperpigmented velvety plaques of body folds. Involvement of the face can occur as well. It is caused by hyperinsulinemia, a consequence of insulin resistance that occurs in patients who are often obese. Dermatoses papulosa nigra is a condition that presents with multiple small, pigmented, papillated lesions affecting the face and neck of darker skinned Asians such as the Indians. It is asymptomatic, but it is of cosmetic concern to the patient. It usually begins in adolescence and increases in numbers and size with age.

Figure 24-1

Facial acanthosis nigricans

This Indian male has asymptomatic velvety hyperpigmentation over both cheeks. Similar hyperpigmentation is present over the neck and axillae as well. Acanthosis nigricans is characterized by darkening and thickening of the skin, occurring mainly over the axillae, groin, and nape of the neck. It is associated with obesity and insulin resistance.

Figure 24-2

Dermatoses papulosa nigra

This condition presents with multiple pigmented papillated lesions on the upper cheeks, periorbital region, and neck. They are asymptomatic and benign but patients often seek removal for cosmetic reasons. The papules are actually small seborrheic keratoses.

DERMATOSES MORE COMMON AMONG ASIANS

Due to inherent genetic differences, certain dermatological conditions such as primary cutaneous lichen amyloidosis, Ofuji’s disease, papulo erythroderma of Ofuji, and dermatosis cruris pustulosa et atrophicans are more common in Asians compared to the Caucasian population (Figures 24–3, 24–4, 24–5, 24–6, 24–7, 24–8, 24–9, 24–10).

Figure 24-3

Lichen amyloidosis—macular variant

Primary cutaneous amyloidosis refers to deposition of amyloid in apparently previously normal skin with no evidence of deposits in the internal organs. The macular variety shows a lace-like pigmentation with rippled appearance as present on the upper back of this middle-aged Indian lady.

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