According to a 2012 review, "47 percent of dermatologists and dermatology residents reported that their medical training (medical school and/or residency) was inadequate in training them on skin conditions in Blacks." Let that soak in.
I'm sure you can understand why people of color approach their visit to the dermatologist with an agonizing feeling of apprehension, due to this blatant lack of education. It's unfortunate, to say the least, but should propel us even further to stay woke on everything we need to know about our skin.
People with dark skin tones deal with some skin issues more commonly, such as hyperpigmentation, inflammation, sensitivity to lasers, and more. There are also many misconceptions about skin of color, which is why we made it our business to clear them up all in one place, with all of the most common questions answered. We talked to dermatologists Fran Cook-Bolden, MD, and Corey Hartman, MD, about what people of color need to know about our specific dermatological needs. Read on for the most trusted dermatologist tips for dark skin.
Any Trauma Can Cause Post-Inflammatory Hyperpigmentation
Chances are if you have a darker skin tone, you've had a pimple disappear just for a flat, deeply pigmented spot to take its place. This post-inflammatory hyperpigmentation is the result of trauma triggering pigment cells, and it's more likely to happen to those with darker skin tones.
"Darker skin tones are more likely to develop hyperpigmentation after inflammatory conditions like acne and eczema because it contains larger melanocytes and more melanin," says Hartman. "When skin cells are damaged by inflammation, the pigment drops out and is deposited into the skin as a remnant. It is this pigment that’s responsible for dark spots."
"Inflammation goes hand in hand with pigmentation because they’re right near each other and stimulate inflammatory cells," says Cook-Bolden. "The proximity of the pigment cells to the inflammatory cells is what activates our cells even more. In acne, there are two main types of cells: clogged pores and pimples. Many years ago our pioneers at the Howard University Medical School noticed that with people of color, we also get dark marks around clogged pores, which we didn’t expect because clogged pores have always been designated as non-inflammatory cells.
They decided to do a biopsy of those non-inflammatory cells to see why they left dark spots on darker skin tones. They discovered that clogged pores associated with dark spots are a unique trend to people of color."
We're More Prone to Other Skin Conditions as Well
Due to genetics, those with melanin-rich skin are more likely to experience certain skin conditions. Among them:
- Keloids and hypertrophic scars: "The morphology and location of our pigment cells are different than in other skin types—they’re larger and located differently than other skin types, which allows us to be more reactive and prone to different kinds of discolorations," says Cook-Bolden. "With keloids and scarring our fibroblasts and collagen cells are also more reactive. Specifically, in African-Americans and Asians, our fibroblasts and healing cells are disobedient. This makes hypertrophic scars and keloids harder to get rid of because our healing process never stops, it keeps going."
- Flesh Moles: "Flesh moles or dermatosis papulose nigra are just genetically associated with those with darker skin just like freckles are associated with fair-skinned, red-headed people," says Hartman. Adds Cook-Bolden: "It’s definitely genetics that makes us more prone."
- Ashiness: While everyone can be ashy, the darker your skin is, the more likely you are to see it. "When skin is dry, it develops gray, white superficial patches that are simply more visible on darker skin because there is more contrast. Anyone can be ashy but brown skin is more likely to show it," says Hartman. Fortunately, treating ashiness is one click away: "My favorite product to combat [ashiness] is the Vaseline Cocoa Radiant Lotion ($4)," says Cook-Bolden. "One of the myths with Vaseline is that it clogs pores, but it does not. I love that the products are infused with Vaseline and have pure cocoa butter, which we’ve been using forever and a nutrient for our skin. It’s the perfect solution.”
There Are Products That Can Help Lighten Dark Spots
When it comes to treating dark spots, an ounce of prevention is worth a pound of cure—and that means addressing inflammation, ASAP. "When women of color notice they're having issues with acne, they should treat it more aggressively so they’re not left with dark marks," says Cook-Bolden."
"The cause of the inflammation should be diagnosed and then treated with targeted therapy," says Hartman. "All inflammation is not the same. For instance, topical corticosteroids are useful for the control of eczema but make acne worse. Acne inflammation is controlled with topical and oral antibiotics, retinoids, benzoyl peroxide, and hydroxy acids like salicylic acid.
After the inflammation has been taken care of, your dermatologist has a variety of treatments they can prescribe to help lessen the appearance of dark spots. "I like cysteamine, tranexamic acid, and hydroquinone to lighten dark spots on skin of color," says Hartman.
"There are certain medications that are focused on breaking up and exfoliating pigments like over-the-counter retinoids and Retin-A," says Cook-Bolden. "I love a morning topical product called Finacea, it’s azelaic acid. This is phenomenal for helping get rid of pigment associated with acne. I usually give my patients prescriptions and topical pharmaceuticals that do more than one thing."
There are also options like "vitamin C, which is proven to break up pigment for skin of color and slow down the aging process," says Cook-Bolden. But make sure to steer clear of anything with super high percentages of acids. "Women of color are more prone to scarring and dark spots with these," she says.
You Can Try Chemical Peels and Microdermabrasion, Too
“In terms of tried-and-true procedures to fade dark spots, chemical peels and microdermabrasion are traditional treatments women can turn to,” says Cook-Bolden. “Chemical peels chemically break up skin pigments, and microdermabrasion mechanically breaks up the pigment." Cook-Bolden notes that procedures such as microneedling are known to help as well.
After your treatment, make sure to follow your dermatologist's aftercare instructions to the T to maximize your results. "With all procedures, the important thing is the healing process," she says.
Approach Laser Hair Removal With Caution
Not all lasers for hair removal are created equal—and when it comes to laser hair removal for darker skin tones, Cook-Bolden and Hartman agree that one stands head and shoulders above the crowd: the 1064 Nd:YAG. "This laser is selective for the pigment in the hair and bypasses the pigment in the skin so that there is no blistering or scarring associated with the procedure," says Hartman.
When undergoing laser hair removal, it's crucial to visit a professional with experience treating darker skin tones. "Remember, hair removal is advanced laser surgery and the operator of the device is just as important as selecting the appropriate laser," says Hartman.
A seasoned pro will make sure they're using the right setting to meet your specific needs. "The biggest step is to always do a test first," adds Cook-Bolden. "The test helps us to identify patients who just can’t tolerate laser at all and helps us figure out the highest setting they can safely tolerate—the higher the laser’s setting, the quicker the results and the fewer treatments needed. Ten people with the same depth of darkness in their skin tone will tolerate a completely different laser setting. One laser certainly does not fit all; it should be done on a case-by-case basis per patient.”
Don't Skip the Sunscreen
We at Team Byrdie will always emphasize the importance of daily sunscreen, and that directive extends across the spectrum of skin tones.
"People with darker skin tones and melanin-rich skin have inherent sun protection in the range of 8-13, so we don’t burn as easily and experience skin aging that begins at older ages and in different, less apparent ways," says Hartman (this can include mid-face volume loss, deep grooves, and the overall darkening of the background skin, notes Cook-Bolden).
Because of these factors, "there is a myth that’s been prevalent in communities of color that sunscreen is unnecessary and only for white people," says Hartman. As more studies have shown the danger in delayed skin cancer diagnoses for people of color, however, the importance of wearing sunscreen is clear.
"Since there are elegant physical sunscreens today, there is no excuse for not finding the ideal product for daily use," says Hartman. "Sunscreen is paramount to the treatment of any discoloration as the sun is a major influence on hyperpigmentation and melasma. The SPF, or sun protection factor, should be in the range of 30–50; I tell my patients that anything more than 50 is a waste of money and anything less than 30 is a waste of time."
"Bottom line, everyone needs sunscreen," says Cook-Bolden.
Treat the Skin On Your Body, Too
Taking care of darker skin doesn't stop at the neck. “We’re very focused on our faces, but we also have all the other skin on our bodies,” says Cook-Bolden. “I always tell patients you need to treat the skin on your body like the skin on your face: Cleanse, tone, and hydrate, and treat it."
"I like Vanicream and Aveeno products for overall moisturization and control of eczema for the body in people with skin of color to combat the ashiness, provide a replenished skin barrier, improve hydration and keep the skin tone even and free of hyperpigmentation," adds Hartman.
Find a Dermatologist Who Specializes in Darker Skin Tones
As anyone with natural hair will tell you, it's important to find a stylist who feels confident and comfortable with taking care of your curls. Needless to say, the same goes for your skin.
“If a person doesn’t know how to treat skin of color, they shouldn’t guess,” explains Cook-Bolden. “Coming out of my dermatology training, I was very well-versed on all skin types. I can’t believe that after many years later that is still an issue. There are so many resources on the internet now."
Those resources include databases that help locate derms who are experienced with darker skin tones. "The best method is always word of mouth, but if that proves unsuccessful, I recommend the website blackdermdirectory.com," says Hartman. "This site is run by Black dermatologists and contains an up-to-date national directory of board-certified dermatologists."
Another option: "When you call to make an appointment, ask if there’s any dermatologist there with skin of color or who specializes in dark skin," says Cook-Bolden. "The best thing you can do is to find someone who has expertise in skin of color.”
Buster KJ, Stevens EI, Elmets CA. Dermatologic health disparities. Dermatol Clin. 2012;30(1):53-viii. doi:10.1016/j.det.2011.08.002
Gupta AK, Bharadwaj M, Mehrotra R. Skin cancer concerns in people of color: risk factors and prevention. Asian Pac J Cancer Prev. 2016;17(12):5257-5264.