Diagnosing and treating Black skin is different than it is with other shades of skin.
“Dark and light skin can each have their own unique set of problems,” said board-certified dermatologist Dr. Carlos A. Charles. “They will also respond differently to certain medications and therapeutics.”
That’s, in part, why he founded Derma di Colore, a New York-based clinic that specializes in darker skin tones.
In addition to providing care for patients of all skin types, Derma di Colore also conducts national clinical research studies with the goal of “finding answers to the toughest questions for dermatologic issues that commonly affect pigmented skin types,” according to its website.
“If you have darker skin, you want to make sure you’re seeing a dermatologist that seems equipped in treating darker skin,” he said.
“Most dermatologists are [capable] … but it’s good to see someone who you feel comfortable with and has the knowledge.”
Dr. Tiffany Mayo agrees, saying Black skincare requires a different set of skills. She’s a board-certified dermatologist and professor at the University of Alabama at Birmingham who specializes in ethnic skin clinical treatment.
“Pigmented skin is very sensitive to developing discolouration to both topical products and laser treatments,” she said. “Seek advice from a professional experienced in skin of color prior to treating any conditions.”
Common Black skin conditions
The key difference between Black skin and other skin is melanin, which is thought to be the culprit behind a few different skin conditions.
“Physiologically speaking, dark skin and light skin have the same amount of melanocytes, which are the pigment cells, but with dark skin, these pigment cells are much more capable of producing melanin,” said Charles.
“The way the melanocytes work — they make much more of these things called melanosomes, which are little packets that make colour — and those packets are distributed into the skin much more efficiently in dark skin.”
It’s thought that when there’s inflammation in Black skin, caused by conditions like acne or eczema, the melanocytes are “revved up,” he said.
This is believed to cause the production of more melanin, which can lead to a skin condition called hyperpigmentation.
“That’s one mechanistic, physiologic difference,” he said.
This is “by and large” the biggest issue seen in darker skin, said Charles.
Hyperpigmentation, or dark spots on the skin, is caused by inflammation.
“Whether it’s acne or eczema or trauma from injury, all these things can lead to dark spots that won’t go away,” he said.
The trauma doesn’t have to be severe, either. Something as simple as a pimple can leave behind pesky dark spots.
“This can be challenging to treat because many lasers and other devices that target pigment are not safe in skin of colour,” Mayo said.
“Preferred treatments include topical products that decrease pigment, products that increase the turnover of pigmented cells and chemical peels. Sunscreen is also important to prevent dyspigmentation.”
A keloid is a lesion that can grow on the skin as a result of injury to the skin.
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It’s essentially a “large, raised scar,” said Charles. They’re more common in darker skin, and they can grow as a result of anything from a simple pimple to a c-section scar.
“It’s cosmetically disfiguring and it’s bothersome,” he said. “They can be really itchy and uncomfortable, and sometimes, they can even cause a little bit of pain.”
It’s also thought that darker skin may not be “as good” at holding moisture, said Charles.
“That’s really critical for eczema-prone skin, because one of the things we do when people have eczema is try to maintain as much moisture in the skin as we can.”
Eczema appears as a red hue on lighter skin, but on darker skin, it can be more difficult to diagnose.
“Sometimes the eczema is more like raised little hair follicles … and the inflammation itself and the activity of the eczema can take on a different hue, like a purplish hue,” said Charles.
“Someone who’s not experienced in looking at these things in darker skin may not think that it’s there or that it’s that severe, and that may not be true. It’s just that it looks different, but there’s still the same discomfort and the same level of severity.”
It will vary by condition, but Charles approaches treatment in a slightly different way when it’s for Black skin.
“A lot of times, my patients will come in complaining of dark spots. When I see them, I see that they have acne and hyperpigmentation, but they’re not really focusing on the acne,” he said.
“One thing that’s really important is kind of treating both of these things in tandem. So I’ll be a little bit more aggressive at getting down the inflammation of the acne, because that inflammation is going to lead me to the hyperpigmentation.”
Black people should avoid trying treatments on their own.
“Skin of colour responds differently than other skin types to aggressive treatment,” said Mayo.
“I recommend seeking advice from a board-certified dermatologist instead of trying over-the-counter products or treatments that may worsen the problem.”
Tips for everyday
When it comes to caring for Black skin on a regular basis, moisture is key.
“Moisturizing is super important for all skin types, but more essential in darker skin, especially in the wintertime,” said Charles.
He also recommends avoiding super hot water during bathing, and only bathing for a short period of time.
“Then use a heavy, fragrant-free moisturizer while you’re still moist after bathing,” he said.
Sunscreen is less important for darker skin than it is for lighter skin, but it’s still recommended.
“Sun-related skin cancer cells … may not be as prevalent in darker skin, but they can still happen,” Charles said. “Sunscreen is so important, and daily sunscreen helps to minimize some of that hyperpigmentation, too.”
Mayo suggests a daily skincare regimen that includes a “gentle cleanser, a vitamin C serum, a physical blocker sunscreen and a retinoid (if tolerated).”