Written by: Lisa L. Miller MS, RN, CNP
Maintaining healthy beautiful skin is a struggle for everyone since we are all unique and we each have our own set of skin problems. But if you have skin of color, you may find yourself dealing with skin conditions more often due to the lack of availability of treatments geared toward the issues seen in darker skin types, difficulty with access or delay in care, or the use of generic skincare products and treatments that may not be ideal for skin of color.
There are some common skin conditions and misconceptions specific to those of us with skin of color, including skin cancer, post-inflammatory hyperpigmentation, and dermatosis papulosa nigra, to name a few. We’ll consider these and offer some recommendations on treatment specific to skin of color.
Although skin cancer is the most common cancer in the United States (one in five Americans will develop skin cancer by the age of 70 and more than two people die of skin cancer in the U.S. every hour), there is a common misconception that those with skin of color do not have to be as vigilant about skin protection as others. This couldn’t be further from the truth! All skin types, no matter the hue, are at risk of developing skin cancer and require conservative protection when exposed to the sun.
Skin cancer may be less frequently diagnosed In those with skin of color (individuals who are more richly pigmented and categorized as Fitzpatrick skin types III-VI), because there are notable differences in the clinical presentation and incidence of skin cancer. The increased levels of melanin (pigmented cells that give hair, skin, and eyes color) do provide greater UV protection, which results in a lower incidence of skin cancers. However, due to increased melanin, it can be more difficult to identify certain classic characteristics of skin cancers. For example, Basal cell carcinoma can classically present as a solitary pearly bump with a rolled edge and telangiectasias (superficial blood vessels). Basal cell carcinoma can also be pigmented, which occurs more commonly in persons with skin of color. These specific features can be difficult to see in darker skin types and may delay diagnosis.
Squamous cell carcinoma is the most common skin cancer in Blacks and Indians and commonly occurs in non-sun-exposed areas. This type of skin cancer classically presents as a scaly/crusted patch, scar, or nodule and can often be misdiagnosed or confused with eczema or psoriasis.
Melanoma, the deadliest type of skin cancer, is often diagnosed in its later stages in those with skin of color. In comparison to the general population, persons with skin of color usually have more advanced stages of melanoma at the time of diagnosis, which leads to lower survival rates and poorer outcomes overall. Characteristically, melanoma presents as a solitary changing pigmented flat blemish or bump. Similar to squamous cell carcinoma, melanoma is commonly located in non-sun-exposed sites in those with skin of color.
Overall, early detection is key to the most effective treatment. Annual skin cancer screening by your board-certified dermatologist is highly encouraged, however, it’s just as important for you to do monthly skin self-exams as well. You see most of your skin every day it is often our patients that detect skin irregularities/skin cancers first. We don’t expect you to have a trained eye, but the important thing to look for is change. If you notice a spot changing in shape, size, or color, or if you notice that “ugly duckling” spot that looks different than everything else, you should be evaluated by your dermatologist. These can all be red flags.
You can identify the warning signs of melanoma by looking for the “ABCDEs” — look for Asymmetry, irregular Borders, irregular or change in Color, a Diameter the size of a pencil eraser head (they can be smaller), and/or a lesion that is Evolving/changing or looks different than your other moles and spots. Prevent skin cancer by doing monthly skin self-exams, annual skin cancer screenings with your dermatologic provider, and protect your skin every day with broad-spectrum sunscreen in SPF 30 or higher. If you can, it also makes sense to practice sun avoidance between the hours of 10 AM and 2 PM, and to seek shade.
Post-inflammatory hyperpigmentation (PIH) can occur in any skin type, however, it is most common in persons with skin of color. PIH is the result of many conditions that cause inflammation of the skin such as acne, eczema, psoriasis, or any type of red and/or itchy rash. Higher levels of melanin are the cause of the increased incidence of PIH, so the darker your skin is, the greater the intensity of PIH. PIH does not require treatment and it will resolve on its own, but this can take six to twelve months for superficial PIH, and it can take years for deeper pigment to resolve.
Applying sunscreen may not be a common practice in darker-skinned individuals, however, I can’t emphasize the importance of this enough. UV protection with sunscreen of SPF 30 or higher will help in preventing PIH from getting darker. If you’re hoping to speed the fading of PIH, the treatment of choice is hydroquinone four percent, a prescription-strength fading cream, as well as retinoids. Retinoids accelerate the natural turnover of skin cells, and when used with hydroquinone this can help to drive the hydroquinone deeper in the skin to fade hyperpigmented lesions faster. Other treatment options include chemical peels (please be aware that not all chemical peels are ideal for those with skin of color and they can sometimes cause more harm than good), Azelaic acid, kojic acid, and corticosteroids. As mentioned, combination therapy will give you the optimal results. An evaluation by your dermatologic provider will be necessary to determine the best treatment option for you.
Dermatosis Papulosa Nigra
Dermatosis papulosa nigras (DPNs) are benign growths that most commonly occur on the face in individuals with skin of color, however, the neck, back, and chest can also be involved. The cause is unknown, however, there is a genetic predisposition for developing DPNs, and the onset is typically after puberty. Lesions can increase in number over time. There is no treatment required, but it is important to differentiate these benign growths from other potentially dangerous growths such as atypical nevi and melanoma.
DPNs can be removed through a process called electrodesiccation, a very safe and effective cosmetic procedure. One should not attempt to remove these lesions with home treatments, as more harm than good can be caused, particularly in individuals with skin of color who are more prone to PIH.
Celebrate Your Skin
If you are dealing with a skin condition that is not improving, or if you notice some irregular skin lesion or spots, it is important to seek care and evaluation by your dermatologist who can properly evaluate, diagnose, and treat the condition. Skin is the largest organ of the body, and it is important to take care of it just like you would any other organ.
Call us today for an evaluation or treatment, and let us help your skin be its best.