5 Common African American Skin Conditions
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 African American people 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, but 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.
Read about eczema treatments here.
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.
Read about keloid and hypertrophic scar treatments here.
Hidradenitis suppurativa
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.
Read about hidradenitis suppurativa treatments here.
Melasma
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.
Read about melasma treatments here.
Hyperpigmentation
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.
Read about hyperpigmentation treatments here and treating acne in dark skin here.
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.
Written by Marianne Wait, an award-winning health and wellness writer based in New Jersey.
Dark Spots & Hyperpigmentation
No one wants dark spots and skin discoloration, but the fact is millions of Americans have them. Hyperpigmentation is a general term that refers to a condition where the skin is discolored or darkened. Dark spots caused by hyperpigmentation can make you look older and can be the result of several factors including acne scarring, sun damage or inflammation from an eczema flare-up. Melasma is a type of hyperpigmentation that appears as a form of skin discoloration and is made worse by sun exposure. It affects more than five million Americans, mostly women. In order to properly treat these conditions, it’s important to understand the differences between them.
Hyperpigmentation
Hyperpigmentation includes any darkening of the skin. Acne, sun exposure, and skin rashes can stimulate the pigment-making cells of the skin, called melanocytes. When that happens, those cells often produce a surplus of pigment into lower levels of skin, causing a dark spot. The deeper the pigment, the harder it is to treat. It works much in the same way as a tattoo. The severity of skin darkening varies. When skin is consistently exposed to harmful UV rays without sunscreen protection, it will be more difficult to treat than a dark spot left over from a pimple that has been shielded from the sun.
Melasma
Melasma is a type of hyperpigmentation, more commonly seen in women and especially women with darker skin tones. It is believed to be triggered by UV exposure and hormones that increase during pregnancy and after starting oral contraceptive use or other hormonal therapies, which can make melasma tougher to treat than traditional hyperpigmentation.
You can usually tell if you have melasma based on the appearance of the spot, which typically appears as symmetric blotchy hyperpigmented patches on the face, often on the cheeks, nose, forehead, chin, and upper lip. It can occur on the neck and forearms as well as other parts of the body prone to sun exposure. Melasma generally is worse in the summer and improves in winter. It can also appear during pregnancy or after starting birth control or other hormonal treatments. Visible light and heat often contribute to melasma spreading. Some dermatologists recommend using makeup with iron oxide to help block visible light.
Treatment
Hyperpigmentation can be treated using chemical peels or with a variety of over-the-counter products that contain skin brighteners such as vitamin C, kojic acid, niacinamide, hydroquinone, and azelaic acid. Melasma is more difficult to treat. Because melasma remedies that work for one person do not necessarily work for another, it is difficult to identify one effective treatment. Many dermatologists recommend a combination of sunscreen to protect the skin, brightening ingredients, and laser treatments for patients with melasma.
Melasma often responds to treatment with lasers in low energy, such as the Clear + Brilliant laser which uses low energy fractionated technology for melasma, sun damage, and skin texture. At least three treatments are needed monthly followed up by treatment every six months to maintain results. Talk with your dermatologist to determine the right plan for your skin.
Skin Protection
Always use sunscreen to protect your skin. Use a moisturizer with sunscreen and apply sunscreen with an SPF of 30 or higher every two hours when you plan to be in the sun or even inside sitting near a window. Hyperpigmentation and melasma can likely be avoided by incorporating sunscreen into your daily skin regimen.
At Water’s Edge Dermatology, our board-certified physicians and medical support team can create an effective treatment plan to treat your hyperpigmentation or melasma.