Dermatology is not one-size-fits-all. Skin of color, which encompasses a wide range of skin tones and ethnic backgrounds, presents unique challenges in diagnosis, treatment, and long-term care.
To better understand these nuances, Dr. Christina Sun and Gabriella Amige, PA-C, share their insights on common conditions, misconceptions, and best practices when caring for skin of color.
Q: Are there any challenges to treating skin of color?
One of the primary challenges in treating skin of color is that redness (erythema) is often less visible due to increased melanin. Because redness is a key indicator of inflammation, this can make certain skin conditions harder to detect and, in some cases, delay diagnosis.
Additionally, patients with skin of color are at a higher risk for pigmentary changes, such as post-inflammatory hyperpigmentation, as well as keloid scarring. For this reason, treatments and procedures must be carefully selected and tailored to minimize irritation or injury that could worsen discoloration or scarring.
Q: What chronic conditions are more prevalent in skin of color?
Several chronic dermatologic conditions are more prevalent or more severe in patients with skin of color. These include:
- Post-inflammatory hyperpigmentation
- Keloids
- Pseudofolliculitis barbae (razor bumps)
- Traction alopecia
- Central centrifugal cicatricial alopecia (CCCA)
- Melasma
Inflammatory conditions such as eczema, psoriasis, and sarcoidosis may also present differently or with increased severity in darker skin tones. Because of these differences, it is especially important for patients to seek care from dermatology providers trained to recognize how conditions appear in skin of color, helping to avoid misdiagnosis or delayed treatment.
Q: Are people with darker skin tones less likely to get skin cancer?
A common belief is that people with darker skin tones do not get skin cancer. While it is true that skin cancer related to chronic sun damage is less common, it can still occur, and certain types may be more dangerous.
People with skin of color have a higher risk of acral lentiginous melanoma, a type of melanoma that typically develops on the palms, soles of the feet, or under the nails. These melanomas can behave aggressively and are often diagnosed at later stages.
Individuals who are immunosuppressed, such as organ transplant recipients or those taking immunosuppressive medications for autoimmune conditions like systemic lupus erythematosus, may also be at increased risk and should be closely monitored.
Q: What differences in skin care are there for people with darker complexions?
In general, the basics of skincare do not differ between lighter and darker skin tones. However, extra caution is needed when using certain active ingredients that can irritate the skin and trigger hyperpigmentation.
Ingredients that commonly cause irritation include:
- Vitamin C
- Topical retinoids
- Alpha hydroxy acids (AHAs)
- Beta hydroxy acids (BHAs)
These products can still be used on skin of color, but they should be introduced gradually and, when possible, under professional guidance.
Q: Are there any misconceptions about darker skin tones and dermatology?
One of the most common misconceptions in dermatology is that people with darker skin do not develop skin cancer. While less common, skin cancer in skin of color is often diagnosed later, leading to worse outcomes. It may also appear in less typical locations, such as the palms, soles, or beneath the nails, making awareness and regular skin exams essential.
Another misconception is that skin conditions look the same across all skin tones. In reality, many conditions, including eczema, psoriasis, rosacea, and rashes, can appear very different in darker skin, often showing less redness and more pigment changes.
The Importance of Specialized Care
Understanding how skin conditions present in skin of color is critical for accurate diagnosis and effective treatment. Dermatology providers with training and experience in skin of color can help ensure earlier detection, safer treatments, and better outcomes for patients of all skin tones.
