Abstract
Understanding cutaneous disease in the black races requires that the physician first be able to discern normal from abnormal pigmentary patterns and second be able mentally to add or subtract the patient's color, so that classic textbook descriptions of disease become applicable. Blacks tend to have four exaggerated pathologic reaction patterns: (1) pigment lability (frequent hyperpigmentation and hypopigmentation), (2) follicular responses and follicular diseases, (3) mesenchymal responses (fibroplastic and granulomatous), and (4) bullous responses. Social patterns in black communities aimed at masking hypopigmentation by use of emollients produce a wide spectrum of folliculitides rarely seen in whites. Methods of hair care commonly cause alopecias. Tinea capitis, which mimics four other varied scalp diseases, is now almost exclusively seen in blacks. Infesations, such as scabies and pediculosis capitis, are almost unheard of in American blacks.
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