Skin of Color
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There are a variety of skin, hair and nail conditions that are common in people with skin of color, such as African Americans, Asians, Latinos, and Native Americans. Your dermatologist can help diagnose and treat these skin conditions.
SKIN CONDITIONS THAT CAUSE DARKENING OF THE SKIN
This common condition causes brown to dark brown patches, usually on the cheeks, upper lip and between the eyebrows. It occurs most often in women who have Latina, African, or Asian ancestry. Men can get melasma, too.
Melasma can also appear on other parts of the body that get lots of sun exposure, such as the forearms and neck. What causes melasma is not yet clear. It likely occurs when the color-making cells in the skin (melanocytes) produce too much color. People with skin of color are more prone to melasma because they have more active melanocytes than those with light skin. Melasma may be associated with pregnancy (it is sometimes called “the mask of pregnancy”), birth control pills, or estrogen replacement therapy. It may also be hereditary.
Melasma can fade on its own, but it may be very difficult to treat. After treatment it often recurs. Your dermatologist can provide prescription topical treatment to help the condition fade. Procedures including chemical peels, laser treatments and microdermabrasion may also help.
To prevent melasma from becoming worse, protecting your skin from the sun is very important. Seek shade, wear protective clothing, and apply a broad-spectrum, water-resistant sunscreen with a Sun Protection Factor (SPF) of 30 or higher.
POSTINFLAMMATORY HYPERPIGMENTATION (PIH)
This condition causes dark marks or dark patches on skin and often occurs as your skin heals from acne, eczema, or other rashes or even after a cut, scrape or mosquito bite. The dark marks are often referred to as “blemishes.” PIH often fades, but the darker the PIH, the longer fading can take.
Your dermatologist can help restore your skin’s color more quickly. Prescription medicines containing retinoids or hydroquinone (an ingredient that reduces the production of melanocytes in the skin), and procedures, such as chemical peels and microdermabrasion, may help. Your dermatologist will also encourage you to wear sunscreen to avoid further darkening of the skin from sun exposure and prevent more PIH from developing.
Treatment products available over-the-counter rarely help and can make PIH more noticeable.
SKIN CONDITIONS THAT CAUSE LIGHTENING OF THE SKIN
Vitiligo is a condition that causes the skin to lose color. While it can develop anywhere on the body, vitiligo often starts on the face, hands/feet, groin or armpits. Some people develop a few spots that lighten or turn completely white. Others have more widespread color loss. Sometimes, it also causes a patch of hair to turn white.
Skin color may return on its own, but that is not common. For many people, the color loss can be permanent.
Treatment cannot cure vitiligo, but it can help repigment the skin in many cases. The treatment that your dermatologist recommends depends on many factors. Some treatments work best on certain types of vitiligo or certain areas of the body. Your dermatologist also considers how much of your skin is affected, your age, and general health.
This is a common skin condition in children with skin of color. It causes round, light patches of skin that are covered with fine white scale. The patches can occur on any part of the body, but are most likely to develop on the face, neck, trunk, or arms. Pityriasis alba is often seen in children who have eczema.
The patches often go away without treatment. Most children no longer have patches by the time they become an adult. Your dermatologist can determine if treatment would be beneficial. They also may recommend applying moisturizer to the skin, as well as protecting the skin from the sun.
Taking certain medicines can cause skin discoloration or dark patches, especially in people of African or Latino descent. Medicines that can cause discoloration include those taken for high blood pressure, diabetes, and heart disease.
You should not stop taking a medicine without talking with your medical doctor. If you take medicine and notice discoloration, talk with your doctor who prescribed the medicine.
If you apply pomade or hair oil to your scalp regularly, you may notice pimples along your forehead and temples. This is often called “pomade acne” and occurs when the pomade or oil spreads onto the forehead.
To treat pomade acne, try applying the pomade further back from your hairline, at least one inch from the hairline. If you wear a headscarf at bed, make sure it is not touching your forehead, as this can spread oils onto the skin, and worsen acne on the forehead.
If changing your application process with these products does not clear your skin, stop using the product or see your dermatologist who can provide treatment options.
Seborrhea usually begins on the scalp as oily, itchy, flaky patches. It can spread to the face and along the ears, neck
Using pomade or hair oil can worsen seborrhea, so stop using the product. Also, washing your hair at least once or
twice a week can help reduce flaking. Your dermatologist can prescribe medications to treat the itchiness.
This is a bacterial infection that causes pus-filled or red bumps as well as red, itchy skin on the scalp.
Pomades are one cause of folliculitis but bacteria are the most common cause. Since this is an infection, you should stop using pomade and see your dermatologist. Your dermatologist may prescribe antibiotics or topical treatments.
TINEA CAPITIS (SCALP RINGWORM)
This infection causes bald, itchy patches of skin or flaking similar to, but worse than dandruff, on the scalp. Despite the
name, worms do not cause this condition. It is actually a skin infection caused by fungus.
This is a very common condition in African American and Latino children. Children can quickly spread scalp ringworm to everyone in their household and to their classmates. Sharing combs, brushes, and hats can spread the disease.
Close contact also spreads scalp ringworm.
It is important to see a dermatologist for treatment. Shampoos will not cure this infection. Your dermatologist will treat scalp ringworm with a prescription anti-fungal medicine that is taken by mouth. With the right treatment, hair that is lost may grow back in time.
SKIN CONDITIONS DUE TO SHAVING
Occurring most often in the beard area and neck, this condition is caused by the structure of the hair follicle in African American men and women. The hair follicle is curved in people with skin of color and when you shave, it can cause the sharp tip of shaved hair to grow back into the skin resulting in a raised, red bump.
This can also occur when a hair is tweezed from the face. The condition is often painful or uncomfortable. Treatments can improve the problem but you may need to eliminate shaving temporarily or permanently.
Small, firm, bumps on the back of the scalp near the neck may enlarge into large scars called keloids. These occur in men who shave their scalp or cut their hair very short at the nape of their neck. Women also can get acne keloidalis, but much less frequently. Without treatment,this skin condition can cause hair loss.
To prevent new bumps from either of these conditions, you may need to change how you remove unwanted hair. Some men choose to let the hair grow or shave less often.
If this is not an option, talk with your dermatologist about laser hair removal. You can also ask for shaving tips that can reduce skin irritation and about a prescription cream that can slow the growth of facial hair.
OTHER COMMON SKIN CONDITIONS
Everyone occasionally gets dry skin. People with skin of color often see their skin turn an ashy color. Applying moisturizer every day can help but does not cure the problem.
If you have dry skin and also have acne on your face or body, you should select a moisturizer that is labeled non-comedogenic or oil-free. This means it won’t clog pores and should not worsen acne. However, if your acne worsens or new acne appears, stop using the moisturizer and see your dermatologist.
DERMATOSIS PAPULOSA NIGRA
Dermatosis papulosa nigra (DPN) causes clusters of brown or black growths most commonly on the cheeks. Many people mistake DPN for moles or warts and refer to these growths as “fleshy moles.” DPN is a type of seborrheic keratosis, a non-cancerousskin growth.
Men and women can both develop DPN. The number of DPN that appear on the skin can increase as you age.
If you do not like the appearance of DPN, your dermatologist can remove them. Check with your insurance carrier to
be sure treatment is covered by your health insurance. Treatment options include surgically cutting out the growths
or burning them off with an electric needle. This treatment can cause temporarily discoloration where the DPN was
removed, but this usually fades.
A keloid is a raised scar that grows beyond the size of the scar. Keloids often become extremely thick, rubbery, and large. A keloid may form after a skin injury such as a deep cut or other wound. Some people develop a keloid after surgery. Keloids can even form after getting your ears pierced or from an old acne spot. Some keloids itch. They can also be tender and painful.
Treatment may not get rid of the keloid, but it can reduce discomfort and flatten the keloid. Your dermatologist can treat keloids with corticosteroid shots to soften and flatten the scar, or shots of interferon to make the keloid smoother. Your dermatologist may also recommend scar surgery, laser treatments, or cryotherapy (freezing the scar) to help shrink keloids. A combination of treatments often produces the best result.
People with skin of color can and do get skin cancer. When skin cancer is diagnosed in people of color, it’s often in a late stage. Treatment for any type of skin cancer can be difficult in the late stages. This can also be deadly if you are diagnosed with melanoma, a type of skin cancer that can spread quickly.
Dermatologists recommend that everyone examine their skin for signs of skin cancer. People with skin of color should pay special attention to the palms of the hands, soles of the feet, the fingernails, toenails, mouth, groin, and buttocks. Visit SpotSkinCancer.org to learn how to perform a skin self-exam and what to look for on your skin. If you see a new spot or notice something changing, itching or bleeding on your skin, see your dermatologist right away.
People with skin of color often have dark streaks or bands on their fingernails and toenails. Most are harmless,
especially if on multiple nails.
However, if you see any of these changes to your nails, you should see your dermatologist:
- Skin around the base of a nail gets progressively darker
- The size, shape, or color of an existing band changes
- A new, single dark band
These could be signs of melanoma. When detected early, melanoma is highly treatable.
There are many reasons why hair loss affects African Americans
- Hair can be fragile due to chemical relaxers. Simply combing or brushing your hair can cause
- Some styling practices, such as tight braiding, weaves or ponytails may cause a type of hair loss called traction alopecia.
- African American women commonly experience central centrifugal cicatricial alopecia, which is a type of thinning in the crown
If you notice hair loss or your hair breaking off, dermatologists recommend the following tips:
- If you use a hair straightener, follow the package directions. Most products do not cause problems when used as directed.
- Do less brushing and backcombing
- Use curling and flat irons less often
- Loosen tight hairstyles, such as braids and weaves, or wear your hair in a natural style. If these tips do not help, talk with your dermatologist about hair loss
A board-certified dermatologist is a medical doctor who specializes in treating the medical, surgical, and cosmetic
conditions of the skin, hair, and nails. To learn more about alopecia areata, visit aad.org or call toll free
(888) 462-DERM (3376) to find a board-certified dermatologist in your area.
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Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.
Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides
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