Not all skin is the same.
When it comes to skin of color, there are certain dermatological considerations to take into account. Some skin conditions occur exclusively in people with skin of color, some skin conditions occur in anyone but are more common in darker skin types, and some common skin conditions manifest differently on darker skin. Unfortunately, despite the unique issues to consider, dermatologists are often trained to diagnose skin conditions on lighter skin complexions. The glaring omission of different skin tones in dermatological training may lead to misdiagnosis and unnecessary suffering. This is starting to change as there is more and more research on skin of color and now there are even global organizations dedicated to skin of color and helping dermatologists become better informed.
While skin disease occurs worldwide, affecting people of all nationalities and skin types, there is a genetic component that may present differently in certain populations. There currently has been little research on this, however, if population-based differences exist, treatment should be optimized for each population.
There has been recent recognition that there is a paucity of research and literature concerning skin color in the medical literature. While differences in skin color have been long recognized in dermatology, investigational research has been lagging. That is starting to change. Dermatological training now incorporates educational programs to assist dermatologists in diagnosis and treatment. Skin of color signals different genetic predispositions for as well as protection from certain conditions. It is also necessary to identify important nuances and differences within skin of color. Brown skin should be delineated into several categories such as East Asian, South Asian, West Asian, Hispanic/LatinX, and South Pacific just to name a few. Understanding the differences not only in genetic variation but cultural differences in skin care as well as environmental influences will be necessary to provide the best skin care to all people.
Dr. Kaplan currently provides an introductory lecture on skin of color at UMKC School of Medicine as well as the KU Medical School in hopes of raising awareness and improving quality of care. Hopefully, the educational process will continue to provide improved care and outcomes for future generations.
Common Skin Conditions and How They Affect Skin of Color
Acne and Eczema Discoloration
Acne and eczema are common skin conditions in all skin types and colors. However, people of color may experience skin discoloration, darkening or lightening, as a result of acne and eczema. It is possible for these changes to also occur after the acne and eczema clear up. These pigmentation changes may be more troubling than the original skin condition.
While there are treatment options, prevention goes a long way. Dark spots are more chronic with UV exposure. It is important for affected individuals to be diligent about sunscreen use.
Melasma
Melasma presents as dark patches, most often on the face. Sometimes it develops during pregnancy – called the mask of pregnancy – or during other hormonal life changes. Women are at an increased risk, especially women of color. UV light stimulates pigment-producing cells and makes melasma worse. This condition can resolve itself on its own in a matter of weeks or may persist and take years to clear up. It’s important to consult a qualified dermatologist if you suffer from persistent melasma.
Keloid Scarring
This skin condition presents as dense, raised scars. Keloids can occur wherever a skin injury exists, and often are caused by an underlying skin condition, such as acne. Keloids commonly present on earlobes, shoulders, cheeks or the chest. The scars left behind vary dramatically in size but commonly grow beyond the original wound. Skin of color is more prone to developing keloids, particularly in people of African descent.
Skin Cancer
While skin disease can affect anyone, it may not affect everyone the same way – this is especially true for patients with skin of color. Patients with darker skin generally have a lower risk of developing melanoma due to their higher levels of melanin providing natural protection against damaging UV rays. However, melanomas are still present in these populations. Additionally, as a population at a lower risk, patients of color may be screened less often and with less scrutiny. The majority of melanomas in patients of color occur on parts of the body not exposed to the sun, such as the soles of feet, palms of hands, or under nails. Risk factors include radiation therapy, albinism, and pre-existing pigmented lesions. If caught early, melanoma is easily treated, therefore it is important to do self-skin examinations and visit your dermatologist annually. An experienced dermatologist can provide an accurate diagnosis and appropriate treatment for patients of all skin tones.
Alopecia
Among the most common dermatological diagnoses for patients of color, Alopecia is a condition marked by hair loss. There are several dermatological disorders associated with hair loss that are more common in patients of color, including central centrifugal cicatricial alopecia (CCCA), dissecting cellulitis, discoid lesions of lupus erythematosus, traction alopecia, seborrheic dermatitis, and hair breakage. In addition, common hair loss disorders, such as telogen effluvium and pattern hair loss are present in patients of color. Many of these hair loss conditions, such as CCCA, are under-researched and almost exclusively impact patients of color. CCCA for example presents in black women aged 30-55 years. CCCA is often misdiagnosed as female-pattern hair loss, a less damaging condition. When caught early, CCCA can be treated but if not, it can cause irreversible hair loss.
A careful, detailed clinical examination is key for appropriate dermatological management. Hair disorders in patients with skin of color present unique challenges and knowledge of accurate clinical presentation and possible treatment approaches are essential to provide quality care. Additionally, cultural nuances are at play when choosing treatment options. Even simple dandruff treatments often fail because they are designed to be used multiple times a week, while the overwhelming majority of black women wash their hair at most once a week. Medical practitioners need to understand the complexities and nuances related to hair care and styling-related hair loss. Hair loss is an emotional condition and treatment recommendations need to be tailored for the population rather than simply recommending abandoning hairstyling.
Care with Cosmetic Procedures
Skin rich in melanin pigment is more likely to scar or darken. Even mole and skin tag removal carry a higher risk. Even more so, cosmetic procedures may have poor results for patients of color. However, while some cosmetic procedures may lead to hyperpigmentation in darker skin, when performed properly, treatments like laser therapy, chemical peels, and filler injections can be safe and effective for patients of color. Such procedures need to be performed with the right techniques and equipment by an experienced dermatologist.
When to See Your Dermatologist
Skin color should not affect medical care.
Skin conditions are color blind and occur in patients of every skin tone. However, it’s important for dermatologists to be aware of differences in skin tones. Certain conditions may affect patients with skin of color more frequently and more severely. Certain dermatological treatments may cause specific challenges in patients of color if those treatments are not performed properly by qualified, experienced dermatologists.
Dr. Kaplan and his team have expert training and understanding of different skin types, skin conditions, how to evaluate them properly, and the treatment options that exist. We are here to help. Call our office today at (913) 469-1115 to schedule an appointment today.