The skin is the body’s largest organ and it’s important to keep it healthy. And while skin conditions can affect anyone, an extra kiss from the melanin gods can sometimes give Black and brown folks the kind of ‘love’ that makes for a rather unique set of scenarios.
Ahead, experts break down six of the most common skin conditions in darker skin, how we can identify their symptoms, and the best advice on how to treat them.
Post-inflammatory hyperpigmentation
As the most common skin issue for individuals with darker-hued complexions, post-inflammatory hyperpigmentation (PIH) is what happens when there is an injury or irritation to the skin. Dermatologists say that just about any type of damage (bug bites, scratches or pimples, for example) can cause the skin to darken because its melanocytes — the skin cells that produce melanin — are full of pigment that leaks into areas where it is compromised.
How to manage it: Depending on the source of the injury, doctors say the first line of defense in controlling PIH is typically with the daily use of sunscreen. Studies have shown it can help to significantly reduce the appearance of dark spots while fending off the sunlight that makes them more shaded.
Massachusetts-based, board-certified dermatologist Uchenna Okereke agrees: “Consistent use of sunscreen is really the first step in treating hyperpigmentation,” she tells Allure. “Sunscreens with physical blockers like zinc oxide and titanium dioxide help block harmful UV rays from the sun, which will prevent worsening of dark marks.”
The specialist also recommends a number of ingredients that prove effective in improving hyperpigmentation — those like glycolic acid, hydroquinone and retinol — but says consulting with a board-certified dermatologist to know which options are right for you is the best first step.
Melasma
According to the American Academy of Dermatology Association, darker-skinned women are most likely to develop melasma. For them, when it appears, it can cause tan, brown or bluish-gray patches and freckle-like spots, usually on certain areas of the face, forehead, chin, cheeks and above the upper lip. Although anyone at any stage in their life can develop it, the condition is often referred to as “the mask of pregnancy” due to its common link to hormonal changes that include pregnancy and post-menopause.
The condition is quite common in dark skin because it contains more melanocytes than lighter skin. So when these color-producing cells are stimulated, they create more pigment, resulting in deeper, more saturated discoloration.
How to manage it: Just like the treatment of PIH, the use of sunscreen is a foundational treatment for melasma. Dermatologists say it blocks out UVA and UVB light, preventing further darkening on the skin. It also aids in boosting the efficacy of topical medications.
Doctors also note that in addition to sun protection, lightening products such as Tri-Luma (it is formulated with a blend of hydroquinone, tretinoin and a corticosteroid) are quite effective, as well as chemical peels and topical serums such as azelaic acid, cysteamine and niacinamide.
Hidradenitis suppurativa
If you’ve ever noticed painful lumps deep in your armpits, inner thighs, groin or around your breasts, then it is possible you’re suffering from hidradenitis suppurativa (HS). An extremely uncomfortable, long-term skin condition that causes abscesses and scarring on the skin. Experts aren’t sure of its exact cause, but it typically begins to develop when hair follicles become blocked. It often appears as a tender spot that resembles a deep pimple but is also known to present as a boil (an infected bump filled with liquid).
How to manage it: When dealing with moderate to severe cases of HS, doctors can prescribe TNF inhibitors (drugs that curb inflammation), adopt the use of lasers like the Nd:YAG laser (it’s great for treating HS, especially in areas with dark, thick hairs) or remedy it with surgery. Other medications like antibiotics, corticosteroids, immunosuppressants and retinoids are typically used to treat less-aggressive forms of HS.
Dermatosis papulosa nigra
Dermatosis papulosa nigra (DPN) are harmless epidermal growths that usually appear as small, dark or skin-colored bumps on the face, neck and upper torso. They usually start out as small, flat lesions, slowly becoming larger over time. While some people will have only a few, others may develop many that cover large areas of their skin.
How to manage it: Dermatologists indicate a genetic predisposition to DPN (many patients report a family history of developing the papules), but they say it is important to note the skin condition is not dangerous and does not require treatment. However, for cosmetic reasons, some people opt to have them removed with a procedure called electrodesiccation. During its process, topical lidocaine is used to first numb the skin, followed by the insertion of a needle-shaped electrode that dries up the tissue of the lesions using a high-frequency electrical current. In about one to two weeks, the lesions will darken, harden, and slowly fall off. The removal is permanent, but doctors say patients can develop new growths in other places.
Keloids
An overgrowth of scar tissue, typically presenting as thick, dense, sometimes itchy and painful lumps on the skin, keloids are most prevalent in those of African descent. Research suggests the benign skin condition is a result of a strong genetic susceptibility that typically occurs across multiple generations of families in what’s known as an autosomal-dominant fashion. This means that typically half of the family is at risk.
The condition has a tendency to occur as a result of injuries to the skin, surgical incisions or acne lesions.
How to manage it: Depending on the size and location of a keloid, it can sometimes trigger discomfort with movement or pose aesthetic concerns. There is also the challenge of dealing with the frequency of keloids returning after removal.
While there is no one treatment that is 100% successful at preventing their recurrence, experts say keloids are treatable. Their care includes options such as silicone sheets or gel to flatten raised scarring, steroid injections, surgical removal or laser therapy. However, depending on the case, dermatologists may recommend more than one treatment at a time.
Melanoma
A form of skin cancer, melanoma is the most common cancer in the United States, and dermatologists see and treat it quite often. Although the disease is less common in individuals with darker skin, it doesn’t mean it can’t occur, so darker-skinned individuals should also enlist in daily sunscreen use for optimal protection.
However, studies have shown that people with dark skin are more likely to get skin cancer in areas that do not appear to be related to sun exposure, such as under the nails, the palms or the soles of the feet, a type known as acral lentiginous melanoma.
How to manage it: Per the Journal of the American Academy of Dermatology, those patients of color diagnosed with acral lentiginous melanoma have alarmingly poorer survival rates than white people, so it is critical to keep an eye on the areas most likely to reveal its symptoms. If they notice a new dark spot or streaks that appear to grow in size, then dermatologists encourage immediate assistance to find out if there is cause for concern.
