Medical Review By: Rachelle Lacey, MD
Everyone’s skin is different — dry versus oily, thick versus thin, light versus dark. African American skin is different from Caucasian skin in that the top layer contains more pigment, called melanin. But the differences don’t end there. Certain gene mutations more common in Blacks mean that certain skin conditions are more common, too.
Rachelle Lacey, MD, a dermatologist at Water’s Edge Dermatology and an expert in treating conditions in skin of color, reveals some of the skin problems she sees most in African American patients.
Atopic dermatitis (eczema)
“Atopic dermatitis is something I see more in African American populations, and the reasons are both environmental and genetic,” said Dr. Lacey. “One major cause is due to the change in the filaggrin in the skin.” Filaggrin is a protein in the top layer of skin that’s essential to maintaining the skin’s barrier function and keeping skin hydrated. A mutation in the gene that codes filaggrin causes a filaggrin deficiency.
African Americans are not only more prone to eczema, they’re also more prone to severe cases of eczema. In dark skin tones, an eczema rash may appear darker brown, purple or grey instead of red.
Keloids and hypertrophic scars
African American skin may contain gene mutations that increase the expression of fibroblasts in scar tissue. fibroblasts are cells that create collagen. An excess of collagen makes skin much more vulnerable to scar-like formations, including keloids and hypertrophic scars.
Keloids are raised, firm growths of tissue that form over and beyond a wound, such a burn, cut, incision, acne blemish, injection site or ear piercing. They can occur anywhere on the body, but they often develop in less fatty areas, such as on the face, neck, earlobe, chest or shoulders. They can grow much larger than the original wound and may be painful or itchy.
Hypertrophic scars are similar but they don’t typically grow beyond the site of the injury. They may continue to thicken for several months, but they may slightly flatten over a long period of time.
In hidradenitis suppurativa, also called acne inversa, cyst-like bumps develop in hair follicles in areas where the skin rubs together, such as the underarms, groin, between the buttocks and under the breasts. The bumps can grow deep into the skin. “A lot of times, they can be very painful, and they can drain fluid onto clothing,” said Dr. Lacey. Deep scars can form as the bumps heal.
Tunnels, known as sinus tracts, may develop under the skin between bumps, and they may produce foul-smelling pus if the skin breaks. Sinus tracks also contribute to scarring.
Hidradenitis suppurativa is chronic, but your dermatologist can develop a treatment plan to reduce and help manage flares.
Melasma, which mostly affects women, causes dark patches, usually on the face. “It’s definitely more noticeable in darker skin types. Often, you can have even more darkening of the cheeks and the forehead because of the increased pigmentation that is naturally found in skin of color,” said Dr. Lacey. “And it can be harder to treat as well.”
Melasma can run in families. Triggers include pregnancy, birth control pills, hormone therapy and sun exposure. In dark-skinned people, skin irritation is another possible trigger, so choosing gentle skin care products is important.
African American skin contains more melanosomes, tiny structures within melanocytes that make pigment. Melanosomes are also less clustered together within melanocytes and there is also increased transmission of melanin to the surface of the skin. That’s the reason the skin of color appears darker.
As a result, said, Dr. Lacey, “rashes and other skin issues can look a little different. They may also resolve and heal differently. You may have leftover hyperpigmentation that lasts for months once the issue resolves.” In hyperpigmentation, darker patches or spots develop.
“In African American patients, hyperpigmentation is one of the most common issues I see,” said Dr. Lacey.
One type of hyperpigmentation, known as post-inflammatory hyperpigmentation (PIH), can occur as a result of inflammatory acne or even harsh products used to treat it. “You can also get hyperpigmentation as a result of atopic dermatitis, bug bites and even psoriasis,” said Dr. Lacey.
Whatever skin problem you face, it is important to consult a dermatologist who has experience treating patients with your skin tone to avoid creating new problems, including scarring, hyperpigmentation and hypopigmentation (areas of lighter skin). An experienced, knowledgeable provider can also suggest products and procedures to help your skin look and feel its best.