Pityriasis Rosea

Assessment and Identification of Skin Disorders in Skin of Color

“…The skin is the largest and most visible organ on the human body; it is divided into epidermis and dermis 31–33. The epidermis is the avascular outermost layer; it is multilayered and renews itself by cell division in the deepest layers of epidermis.…”

“…The stratum lucidum lies directly below stratum corneum; it is found in area of the body where the epidermis is thicker, such as the soles of the feet and palms of the hands 32,33. The cells in this layer are not yet flattened and still have nuclei.…”

“…The innermost layer of the skin, often referred to as the basal layer, is a single layer of mitotically active cells and the area where cutaneous metabolism occurs 32,33. Cells formed in the basal layer migrate upward to the stratum corneum, usually over a period of 2 to 3 weeks.…”

“…Jackson-Richards and Pandya observed skin tones encompassing multiple racial and ethnic groups, including Asians, Hispanics, Middle Easterners, Native Americans, Pacific Islanders, and persons of African descent 32. They further asserted that while these individuals can be classified as Fitzpatrick phototype IV, V, or VI, the range of skin tones among individual human beings is infinite.…”

“…These differences can mask color contrasts seen with erythema in persons with lighter skin tones and may cause inflammation to appear as violet-black or black in tone 26,32,40. Because persons with DST have increased melanin, the appearance of blanching may also be muted creating challenges in identification of early skin injuries 32,42. Additional elements of the skin assessment to aid in differential diagnosis of pressure injury versus IAD include the location of the lesion (pressure injuries tend to occur over bony prominences or in conjunction with the use of medical devices while IAD occurs in areas of the skin exposed to fecal or urinary incontinence), borders of the skin damage, and a history that includes presence of incontinence (essential for a diagnosis of IAD) or risk factors for pressure injury including mobility.…”