Skin of Color
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Most skin diseases occur in all types of people, regardless of their skin color (pigment). Certain skin problems are more common among people with darker skin tones. A wide range of racial and ethnic groups, including African-Americans, Asians, Hispanics/Latinos, and Native Americans, constitute people who have skin of color.
Variations in Skin Color
Skin color is determined by cells called melanocytes. All races have the same number of these cells. Melanosomes are structures in the melanocytes that produce the pigment melanin. There are more and larger melanosomes in darker-skin melanocytes than in those of lighter skin. Although people with skin of color are better protected against skin cancer and premature wrinkling from sun exposure, a good broad-spectrum UVA/UVB sunscreen with SPF15 should be used routinely to protect all individuals with skin of color.
Postinflammatory Hyperpigmentation
Postinflammatory hyperpigmentation (the darkening of skin) may occur after an injury such as a cut, scrape, or burn, or after certain skin disorders such as acne or eczema. It is seen in all skin types but is more common and noticeable in darker skin. Early treatment of the underlying problem can help prevent development of dark spots.
Darkened areas of skin may take many months or years to fade, although medication may help. Chemical peeling, microdermabrasion, and bleaching medication prescribed by a dermatologist may fade pigment more rapidly. Avoid picking, harsh scrubbing, and abrasive treatments unless prescribed by a dermatologist.
The daily use of sunscreen is very important to prevent postinflammatory hyperpigmentation from becoming darker.
Vitiligo
Vitiligo is a condition in which pigment cells are destroyed and irregular white patches result. The exact cause is unknown, but it is thought to be an autoimmune disorder (the body makes antibodies to its own pigment).
The extent of color loss differs with each person. There is no way to predict how much pigment will be lost. Although rare, people may lose pigment over their entire body. Most patients with vitiligo do not regain skin color without treatment.
Several methods including cortisone or other creams, light treatments, laser treatments, intense pulsed light (IPL), or skin grafting may be used to treat vitiligo, but there are no perfect therapies. The most common method is PUVA therapy, combining a medication called psoralen and ultraviolet A light treatments. In cases where vitiligo affects most of the body, it is sometimes helpful to suggest destroying the remaining normal pigment. A dermatologist can determine what treatment is best based on the extent of the disease.
Vitiligo
Pityriasis Alba
Pityriasis alba is a condition in which there are round, light patches of skin covered with fine scales. Most commonly found in children, the patches can occur on any part of the body, but are most noticeable on the face and upper arms. The white patches are the result of mild eczema and the loss of color is only temporary. This condition can be treated by topical therapy.
Dry or "Ashy Skin"
Dry skin is a problem for individuals of all skin colors, but may be especially distressing to people with darker skin tones. It is uncomfortable and is easily noticed in people with darker skin because of its grayish, "ashy" appearance. The regular use of moisturizers can help, although, some of these moisturizing products may worsen conditions like acne (pimples). If acne develops or worsens, discontinue using the moisturizers and see a dermatologist.
Ashiness also can affect the scalp. Pomades or hair oils that make the hair more manageable can decrease scalp dryness, but may aggravate seborrhea, an inflammatory, scaly, itchy skin problem. If pomade or hair oil spreads onto the forehead, it can block pores, causing pimples or "pomade acne." If this occurs, stop using the product or apply pomades one inch behind the hairline.
Pomades also can contribute to a bacterial infection of the scalp called folliculitis, which produces pus, bumps, and redness around the hair. It can also cause hair loss. If this occurs, discontinue using the pomade and see a dermatologist.
Dermatosis Papulosa Nigra (Flesh Moles)
Occurs almost exclusively in African-Americans and most frequently in women. These brown or black raised, dark spots usually appear on the cheeks. They resemble moles or flat warts, although they are not the same. In fact, they are a variant of a benign growth called seborrheic keratoses. These are not cancerous, but some patients have them removed for cosmetic reasons.
Flesh moles
Keloids
When the scar from a cut or wound extends and spreads beyond the size of the original wound, it is known as a keloid. Keloids may vary in size, shape, and location, and are found more often in people with skin of color.
Common on the ear lobes, chest, back, or arms, keloids usually occur after an injury or infection. Occasionally, they occur spontaneously, especially on the mid-chest. Keloids frequently develop after surgery or after ear piercing.
Depending on the location, treatment may consist of cortisone injections, pressure dressings, silicone gels, surgery, laser treatment, cryosurgery, liquid nitrogen, radiation therapy, or combination therapy. Unfortunately, keloids are difficult to treat and tend to return, sometimes larger than before. Newer regimens are being developed.
Keloids
Acne Keloidalis Nuchae or Folliculitis Keloidalis
Some men, especially those who use a razor for cutting hair on the back of their necks, develop bumps and keloid-like scars. The area may itch and can sometimes become infected. Treatments include oral antibiotics, topical acne products, and topical or injected cortisone. When severe, lesions may need to be removed surgically or with a laser. Early treatment by a dermatologist is necessary for the best results.
Hair
African-American hair is unique in its shape and structure. The hair on the head and in the beard is likely to be tightly curled. Certain techniques and preparations used in styling can lead to a variety of problems.
Hair Loss
Hair loss or broken hairs at the hairline may be caused by repeated or frequent tight braiding (traction alopecia), hair straightening agents (perms, relaxers), tight rollers, and hair styled in a ponytail or single braid style. Dermatologists recommend changing hairstyles if the hair is falling out or breaking off along the hairline. In many cases, if discovered early, the hair will grow back.
Tracion alopecia
Hair Breakage
Hair straighteners use strong chemicals to change the structure of the hair. While straightened hair is easier to style, it also may become brittle and break. Used according to package directions, hair straighteners usually do not cause problems. If used improperly or on previously damaged hair, especially after the use of hair dyes, hair breakage or other difficulties may arise. Excessive brushing, backcombing, or other stresses like the use of curling or flat irons can also cause breakage.
Most hair loss from breakage is temporary because it does not affect normal hair growth. Hair will usually grow back, just as it does after it has been cut.
Tinea Capitis (Ringworm)
Ringworm is not caused by a worm, but by a fungus. It occurs most commonly in children and is contagious. Family members, as well as classmates, can catch it easily, especially from sharing combs and hats. When it occurs, ringworm produces itching, scaling, and redness. It can cause the hairs to break off, and may lead to hair loss. Sometimes severe inflammation and boil-like cysts develop. Mild to severe dandruff of the scalp can be confused with a fungal infection (ringworm). Fungal infections usually require many weeks of oral antifungal medicine to treat.
Ringworm
Pseudofolliculitis Barbae (Ingrown Hairs of the Beard – Razor Bumps)
The hair shafts of people from African descent are curved. This is true of beard hair as well as other body hair. After shaving, especially close shaving, the beard's sharp pointed hair may grow back into the skin. This causes a reaction resulting in bumps. Growing a beard is one solution. Men with ingrown hairs should try different methods of hair removal. Shaving with a safety razor may help. After applying lather or shaving cream, wait to let the soap soften the beard. Shave only in the direction of the hair growth, not against the stubble. Do not stretch the skin during shaving and do not shave on a daily basis. Lift up hairs that begin to in-grow with an alcohol-cleansed needle or tweezers (do not pluck) just before shaving. Occasionally, the use of a toothbrush or rough washcloth before shaving or bedtime may loosen hairs about to grow inward.
Razor bumps
Chemical depilatories remove hair, but should only be used every two days. They are not for everyone. They must be wiped off promptly according to package directions. Wash your face twice with soap and water immediately afterwards to guard against irritation.
Electrolysis may be an effective solution for this problem. Laser hair removal (reduction) is the latest method of treatment. This may be 80 percent permanent after several sessions. New medicated creams may be used to slow hair growth. Consult a dermatologist about treatment options.
Nails
Dark streaks or bands on multiple fingernails and toenails in people with skin of color are usually normal and tend to increase in number as a person ages. Increased darkening around the base of the nail, a change in the size, shape, and color of an existing band, or the development of a new single dark band could be a sign of a dangerous type of skin cancer called malignant melanoma and should be checked by a dermatologist.
Melanoma
Melanoma may occur on the palms, soles, fingers and toes (and in between them), nails, as well as the mucous membranes (such as the mouth or nose), in people with skin of color. A new dark mark or a mark that changes in size, shape, or color in these areas should be seen by a dermatologist immediately.
The skin, hair, and nail conditions common among people with skin of color are generally not serious, but they can be troubling. These conditions can be easily recognized and successfully treated by seeing a dermatologist.
To learn more about skin of color, call toll free (888) 462-DERM (3376) to find a dermatologist in your area.
AAD Web site: www.aad.org
Toll-free: (888) 462-DERM (3376)
Images used with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides
© 2005 American Academy of Dermatology
Revised 1991, 1993, 1994, 1996, 2001, 2005
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