According to a 2012 review, "47% of dermatologists and dermatology residents reported that their medical training (medicl 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 because of the blatant lack of education almost half of dermatologists admit to having on dark skin. 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, skin cancer, sensitivity to lasers, and more. There are 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 Fran Cook-Bolden, MD, of Skin Specialty group, who happens to be an experienced dermatologist who specializes in skin of color, about everything people of color need to know. Read on for the most trusted dermatologist tips for dark skin.
Fact #1: Skin of color is more prone to conditions like hyperpigmentation, flesh moles, ashiness, and keloids
“A lot of it is our genetics in relation to our unique features,” explains Cook-Bolden. “With skin of color, we suffer a lot from post-inflammatory hyperpigmentation, melasma, or any problem with dyschromia, which causes dark or light spots. We see these issues because our pigment cells are more active than other skin types, whether that’s responding with a light spot or responding with a dark spot. We have different types of pigment than people with other skin tones and ethnicities.
“There are three or four types of melanin, and we have the darkest version of melanin. This is why in skin of color, you’re going to see when we react to any type of stimuli, whether it’s a trauma, breakout, or inflammation because it excites our cells. 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. 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. With flesh moles in women of color, it’s definitely genetics that make us more prone. Everyone has ashy skin, but because our color spectrum is darker and ash is light, you can see it better on skin of color. It’s literally just a matter of the shade of our skin tone.”
Fact #2: Any trauma leads to excess melanin, which causes post-inflammatory hyperpigmentation (dark spots)
According to Cook-Bolden, whenever there’s a trauma, it also stimulates our pigment cells. "Inflammation plays a huge part in acne," she continues. "If you break out, you get red, elevated, or puss bumps. Inflammation goes hand in hand with pigmentation because they’re right near each other and stimulate inflammatory cells. 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."
Fact #3: There are specific products formulated to lighten dark spots and inflammation on skin of color
One of the first things Cook-Bolden suggests to do is stop the inflammation. "A lot of basic treatments like topical antibiotic cream or gel for acne help with inflammation. 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. To get rid of dark spots, there are certain medications that are focused on breaking up and exfoliating pigments like over-the-counter retinoids and Retin-A. 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.
“You can also consider traditional bleaching creams to get rid of hyperpigmentation, like hydroquinone. Although the FDA was unsure about approving this cream, it’s very safe to use as long as it’s not abused and over-bleaches your skin. There are tons of natural alternatives to lighten dark spots like vitamin C, which is proven to break up pigment for skin of color and slow down the aging process. There’s a new topical product called Melaclear from Isdin Ceuticals ($75). It’s created in Barcelona and contains vitamin C and phytic acid. Phytic acid is something that’s found in legumes and soy products and works like a miracle for hyperpigmentation. It came to the United States early this year, and we can’t nearly keep in the office because it works so well for our patients.
“I also love Trufora Day Serum ($60). It’s all-natural, vegan, and cruelty-free. It’s made from natural botanical products, which are awesome for sensitive skin dealing with hyperpigmentation. Be wary of products with super-high percentages of acid for excessive inflammation. Women of color are more prone to scarring and dark spots with these. Skin of color tends to be more drying which causes visible ashiness. My favorite product to combat that is the Vaseline Coco Radiant Lotion ($6). 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.”
Fact #4: Chemical peel and microdermabrasion procedures have proven to be effective for hyperpigmentation
“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. Newer procedures we’ve known to help are micro needling, which is a set of needles that lightly puncture the skin to stimulate collagen production and physically break up the cell’s pigment. With all procedures, the important thing is the healing process. You can also consider a mild laser treatment to break up your skin’s pigment. We’ve done clinical research studies using a laser called the light pod neo laser, which has a very short pulse and focuses right at the pigment. Keep in mind that for these treatments to be effective they need to be done in the right hands.”
Fact #5: When you have dark skin, you need to approach laser hair removal with caution
Cook-Bolden believes that contrary to its bad rep, laser hair removal is actually one of the safest options as long as you approach your laser with caution. "The best laser for dark skin is the 1064 Nd:YAG laser," she confirms. “Even if you’re just learning about laser, the biggest step is to always do a test first. 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.”
Fact #6: Skin cancer rates in skin of color is at an all-time high. You must apply sunscreen
“We’re seeing many more cases of skin cancer in darker skin tones. Bottom line, everyone needs sunscreen. We have natural sun protectant in our pigment, which is equal to a SPF of 13.4. Why not help our natural pigment even more by using a sunscreen? Skin cancer ages us terribly and leads to greater laxity, which breaks up our collagen fibers. Our skin manifests sun damage by becoming wrinkly with blotchy discoloration. Sunscreen should be the first step in our anti-aging process. Sunscreens only work great for up to two hours, so you need to reapply. Sunscreens are traditionally very thick, chalky, and leave the skin looking pasty. Now we have a lot of elegant choices where the sunscreens are ultra-sheer for dark skin tones.”
Fact #7: It’s essential to find a dermatologist who specializes in dark skin tones
“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. When you call to make an appointment, ask if there’s any dermatologist there with skin of color or who specializes in dark skin. The best thing you can do is to find someone who has expertise in skin of color.”
Fact #8: The skin on your body is just as important as the skin on your face
“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.”
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Buster KJ, Stevens EI, Elmets CA. Dermatologic health disparities. Dermatol Clin. 2012;30(1):53-viii. doi:10.1016/j.det.2011.08.002