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People of African, Asian, Latin and Native American backgrounds know that their skin, hair and nails are subject to conditions that do not affect lighter skinned people. “While most of these are not serious, they may be disturbing, troubling or unsightly,” says Joshua Fox, MD, a leading dermatologist, founder of Advanced Dermatology and an official spokesperson for the American Academy of Dermatology and the American Society of Dermatologic Surgery.
“Fortunately, your dermatologist is well acquainted with these conditions and can help people with dark skin to diagnose and treat their concerns early and quickly,” says Dr. Fox. He offers the following listing of the top skin conditions faced by people of color and how it differs from lighter-skinned individuals.
1. Acne – Many dark skinned women suffer from acne vulgaris, sometimes combined with hyper pigmentation, or skin darkening in spots or patches, which occurs in response to the outbreak of acne. Unlike fairer-skinned individuals, the discoloration plays an integral role in treatment. Surprisingly, these patients are more bothered by the discoloration than the acne itself. Treatments may include topical skin lightening creams for dark spots, sunscreen and topical, prescription acne medications.
2. Dermatosis Papulosa Nigra – These brown or black raised spots, which commonly affect African American women and people of Asian descent, may look like moles or flattened warts. They are always benign, never lead to skin cancer and are not harmful. However, some people do have them removed for cosmetic reasons. Typically, up to 50 percent of Dermatosis Papulosa Nigra patients have a family history of the condition, and up to 35 percent of adult blacks in the United States have it. They are easily removed with minimal to no marks.
3. Eczema – Very common among those with brown skin, eczema is an itchy, irritating rash that can occur in skin of any type or color. However, according to the National Eczema Society, it is found twice as often in black skin. When it does occur, differences in the structure of black from Caucasian skin can cause related problems including excessive pigmentation and a thickening of the skin that can also cause changes in skin color. “Because eczema is harder to identify in dark skin, and is often confused with psoriasis or fungal infections, getting the right diagnosis and treatment can be difficult,” Dr. Fox says. “Once the correct diagnosis has been made, topical medicines are quite helpful.”
4. Keloids – Scar tissue caused by abnormal healing of the skin occurs frequently in individuals with brown skin. Any time dark skin is injured, the risk of keloids is dramatically increased. According to Skin & Aging magazine, up to 16% of black and Asian people suffer from keloids. Keloids can develop immediately following an injury or take a long time to grow. Sometimes they itch, are painful and burning or feel tender to the touch. Treatments include cortisone and other injections, radiation therapy, pressure dressings, silicone gel applications and several types of lasers are extremely helpful. Keloids can also be removed via traditional or laser surgery.
5. Traction Alopecia – This hair loss condition is caused by damage to the hair follicle from constant pulling or tension over a long period of time. It is most common in African Americans who braid their hair tightly, but can also be caused by over processing of the hair through dyes, bleaches or straighteners. According to the National Institutes of Health, some 17% of African-American schoolgirls (6-21 years) and more than 30% of women (18-86 years) suffer from traction alopecia. While this condition can be reversed if diagnosed early, it can lead to permanent hair loss if it is undetected for a long period. These people – mainly women – should change to looser, gentler hair styles and should see a dermatologist. Unfortunately, no medical treatment is available to reverse late-stage traction alopecia; hair grafts, transplants or wigs have been identified as the only practical solution.
6. Melanoma — Those with brown skin often have a false sense of security when it comes to skin cancer. “While increased skin pigmentation offers some protection against the sun’s harmful UV rays,” Dr. Fox says, “melanoma can and does occur,” unlike in the lighter-skinned individual, it occurs especially on the palms, soles, fingers and toes, nails and mucous membranes (such as the mouth or nose). “A new dark mark or a mark that changes in size, shape or color in these areas should be seen by a dermatologist immediately. Even people with dark skin should always use a sunscreen when spending extensive time in the sun,” he says.
7. Pigmentation – Women with brown skin, particularly those of African and Latino descent, have a high incidence of hypertension, diabetes and heart disease and thus take medications for those medical problems. These, as well as other commonly used medications (LIST MEDICATIONS THAT CAN CAUSE PROBLEMS) can cause various types of allergic reactions that frequently lead to hyperpigmentation, or dark patches. While the dark spots can fade over time, women should seek treatment early. Procedures such as chemical peels and skin bleaching, designed to lighten the darkened areas, can help, as can diligent use of sunscreen. The new Fraxel™ is the first laser approved for treatment of melasma – a type of pigmentation disorder of the face.
8. Vitiligo – Skin gets its color from pigment cells. When those cells are damaged or destroyed, they no longer produce pigment, causing white or colorless spots to appear. The spots can grow larger over time and eventually blend together so that large portions of the skin have no color at all. While no one knows why this occurs, many suspect it is related to problems within the autoimmune system. Vitiligo also may be hereditary. While people of any skin color can develop Vitiligo, it is most obvious and therefore debilitating on dark skin. One common treatment is PUVA — a repigmentation therapy involving the drug psoralen combined with exposure to UV light. A simpler, newer and equally efficacious treatment is narrowband UVB light treatment. The newest laser treatment though is that of the Excimer laser 308nm which markedly shortens the number to treatments and spares unwanted streaks. This process help increase the amount of pigment cells at the skin’s surface. Other treatments include prescription-strength corticosteroid cream, light/laser treatments and, in rare instances, skin grafting.