The dermatology textbooks and atlases underrepresent disease presentation in people of color. Recognizing subtle color changes of erythema and purpura can be challenging in darker-skinned patients. Depigmentation is very easy to detect in darker-skinned patients, but it is subtle in lighter-skinned patients.
The violaceous color of purpura is obvious on the this light-skinned child
In a darker-skinned patient, purpura appears dark brown rather than violaceous
The depigmentation of vitiligo is striking in this very dark-skinned patient
The depigmentation of vitiligo at the base of the thumb and wrist could easily be missed in this light-skinned patient