Individuals with darker skin tones often come across a unique set of skin challenges. These include hyperpigmentation, keloid scars and higher sensitivity to certain treatments like peels and lasers. Sadly, most medical schools and training programs do not cover skin of colour seriously. According to a study done in 2013, a meagre 22% of dermatology trainees reported getting formal training in skin of colour. Consequently, less than half of them felt properly able to treat people of colour who according to the last census make up 14.58% of the UK. There’s a wealth of misconceptions around skin of colour. So, we’re here to dispel these myths and provide clarity. So let’s dive into to understand the unique dermatological needs and best skincare for skin of colour.
Skin Problems Unique to Skin of Colour
Skin of colour is a term that covers a wide range of skin tones. Crudely speaking, it refers to non-white and Caucasian skin. People of African, Asian, Latin, Mediterranean and Middle Eastern descent tend to have higher melanin levels and usually have skin type 4-6 on the Fitzpatrick scale. Melanin rich skin burns offers some natural protection against sun damage. This means it it is less prone to photo-ageing and people with skin of colour are likely to experience signs of skin ageing 10-20 years later then their caucasian white skinned counter parts. That being said, there are also a number of specific skin concerns that skin of colour is at more risk of. These include hyperpigmentation, post-inflammatory hyperpigmentation (PIH), melasma and keloid scars.
Skin of Colour is More Prone to Hyperpigmentation
One of the most common issues that particularly affects skin of colour is hyperpigmentation. This is where the skin makes excess melanin in isolated areas. This leads to dark spots and uneven skin tone that can linger on the skin for months or even years. Darker skin tones have larger melanocytes which produce and contain more melanin. That is why skin of colour is more likely to suffer from hyperpigmentation.
What are the Triggers?
A variety of triggers can increase melanin production. These often include excessive sun exposure, inflammation or injury and hormonal fluctuations. Whilst skin of colour has better protection it is still susceptible to sun damage. Excess sun causes your skin to produce more melanin in order to protect it from UV rays. This presents as hyperpigmentation. Skin of colour is less susceptible to this type of hyperpigmentation compared with lighter skin tones. It is however not immune to it. Similarly, skin of colour can suffer from hyperpigmentation caused by hormonal changes which is also known as melasma. Skin of colour is also more likely to develop hereditary hyperpigmentation which normlly appears as patches of darker skin around the eyes, neck, chin and on the lips.
Skin of colour is far more likely to suffer from post-inflammatory hyperpigmentation compared with lighter skin tones. This is a type of hyperpigmentation where dark patches of skin develop after any type of trauma. This includes things like acne, burns or even eczema. Basically, the trauma causes inflammation which damages your melanocytes (the pigment producing skin cells). This results in melanin leaking out of the cells which then deposits into the skin where the melanocyte is located. Hence you get isolated patches of dark skin at the site of the injury.
Can You Prevent This?
It is difficult to completely avoid hyperpigmentation in skin of colour. You can however reduce the risk with easy wins like using sun protection, treating skin conditions like acne and eczema and avoid injuring your skin. There are also a number of treatments that can help fade hyperpigmentation which we will discuss below.
Keloids & Hypertrophic Scars are More Likely
People with skin of colour are also more prone to get keloids and hypertrophic scars. Keloids are tough, raised scars that expand beyond the original wound’s borders. Hypertrophic scars, although raised, remain within the wound’s initial boundary. Both these types of scars result from an over active healing response, where the body makes an excess amount of collagen to repair a wound or inflammation site. This leads to raised and thickened skin.
Why Do They Happen?
The risk of getting these scars is significantly higher in skin of colour. This is because raised melanin content not only influences the skin’s colour but also plays a role in the skin’s inflammatory and healing responses. This hyperactivity can tip the scales of the healing process. Hence leading to an over production of collagen and the formation of these abnormal scars.
Keloids and hypertrophic scars can occur following any skin injury including surgical cuts, piercings, burns, acne, or even minor skin abrasions. Moreover, keloids can continue to grow for many years and often recur even after surgical removal. Keloids can be itchy, tender or even painful. They can also have significant emotional and psychological impacts. This can then affect quality of life and self esteem. As such, it is important for those with skin of colour to be mindful of these risks and seek help early if you see any signs of unusual scars. You should also employ proactive measures to reduce skin trauma and manage inflammation to prevent these types of scars from forming in the first place.
Flesh Moles are More Apparent
Also known as dermal melanocytic nevi, flesh moles can occur in all skin types. However, they tend to be more common and noticeable in people with skin of colour. This is largely due to the contrast between the colour of the mole and the neighbouring skin. Flesh moles are usually benign and pose no health risk. However, changes in size, shape or colour of any mole should be chked out by a dermatologist. They should ideally be experienced in skin of colour as these could be signs of skin cancer.
Early Skin Cancer is Often Missed
Skin of colour has more melanin, the pigment that gives skin, hair, and eyes their colour, and also provides some natural protection against harmful UV radiation. However, it doesn’t provide complete protection. So although skin cancer is less common in people with darker skin, it can be more deadly because it’s often detected at a later stage. This is due to a lack of education for the public and also doctors on how skin cancer looks in skin of colour.
Therefore, if you have skin of colour and you’ve noticed a new mole or akin changes, it’s vital to discuss with a dermatologist who is experienced in treating people with skin of colour. This is also important if mole removal is needed so that they can reduce the risk of keloid scars.
Vitiligo is More Apparent in Skin of Colour
This is an autoimmune condition that leads to the loss of skin pigment in patches. Vitiligo can affect individuals of all skin tones but it’s often more noticeable in people with skin of colour due to the contrast between the pigmented and depigmented skin.
In skin of colour, Vitiligo can also be more emotionally distressing due to the pronounced contrast and cultural stigmas that may be associated with changes in skin colour. Many individuals experience significant psychosocial fallout including anxiety and depression.
In terms of treatment, the goal is to stop or slow the rate of pigment loss. There are various possible treatments such as as immune suppressants, topical corticosteroids, calcineurin inhibitors and light therapy. In some cases, tattooing (micropigmentation) or cosmetic camouflage might be an option. Its also crucial for individuals with vitiligo to protect their skin from the sun, as the depigmented areas are particularly susceptible to sunburn. Crucially, people with skin of colour and vitiligo should seek treatment from a dermatologist experienced in treating this condition in diverse skin types.
Ashiness
Dry skin or xerosis is usually more noticeable skin of colour. This is due to the higher visibility of dry, flaky skin against a darker skin tone. Ashiness occurs when the skin’s surface becomes dehydrated and loses water. This results in a dull, rough and often greyish or “ashy” appearance. Ashiness is caused by various extrinsic factors such as harsh soaps, over exposure to the sun, cold and dry weather and certain medical conditions or medications. Research also suggests that some skin of colour may be more prone to transepidermal water loss which causes skin dryness.
The best way to combat ashiness is to avoid factors that dry out the skin and use a hydrating skincare routine. This includes using gentle, non-irritating cleansers, regular exfoliation to remove dead skin cells and hydrating occlusive moisturisers.
Pseudofolliculitis Barbae
Pseudofolliculitis barbae, also known as “razor bumps“, is a common issue that disproportionately affects individuals with skin of colour, especially those with thick curly hair. This skin condition happens when hair that’s been shaved, plucked or waxed grows back into the skin. This causes inflammation and the development of painful bumps. Over time, this inflammatory response can also lead to hyperpigmentation.
Pseudofolliculitis barbae is thought to be more common in individuals with skin of colour due to the structure of the hair. Curly or coiled hair, when cut close to the skin’s surface, can curl back and pierce the skin. This triggers an inflammatory response as the body sees it as a foreign object. This inflammation gives rise to clogged pores and appearance of bumps. It also promotes melanin production thereby causing dark spots or patches.
Managing pseudofolliculitis barbae in skin of colour centres around preventative measures to reduce irritation and inflammation. These include avoiding close shaves, using single blade razors or electric clippers, shaving in the direction of hair growth and using a soothing aftershave. Skincare ingredients like salicylic and lactic acid can help exfoliate the skin and free up ingrown hairs. Skin-lightening agents may help fade any associated hyperpigmentation.
Problematic Skin Products & Treatments for Skin of Colour
When it comes to the skincare not all skin treatments are equally beneficial or safe for individuals with skin of colour. What works well on lighter skin tones might wreak havoc on skin of colour.
Challenging Skincare
Certain active skincare ingredients can be irritating and hence cause problems for skin of colour. One of the key culprits is high concentration glycolic acid which can irritate the skin and cause PIH. This can also occur with retinoids, beta hydroxy acids and even other alpha hydroxy acids normally seen as gentler alternatives to glycolic acid. Physical exfoliants are also potentially problematic for skin of colour. This is because they can cause micro injuries in the skin resulting in inflammation and PIH. Harsh soaps, alcohol and artificial fragrances can be drying and irritating hence causing ashiness and even PIH. Therefore, skin of colour needs a careful balance of effective yet gentle skincare. To protect against, always patch test any new skin products and start with lower strengths. Even better, seek the advice of a skincare professional who is experienced in treating people with skin of colour.
Risky Skin Treatments
Laser treatments can be incredibly effective for a range of skin condition such as hair removal, skin ageing, scars and texture as well as hyperpigmentation. However, they must be used with caution on skin of colour. The laser’s energy is absorbed by dark pigment which means that darker skin is at risk of absorbing more of this energy. This can lead to serious side effects such as burns, PIH and even scars. Similarly, certain types of chemical peels, particularly more aggressive ones like Glycolic and TCA peels, can pose a risk to skin of colour. If not used correctly, they can lead to PIH or even hypopigmentation in darker skin tones.
None of these treatments are off limits though. Its just crucial to go to a qualified practitioner who specialises in treating skin of colour. They will be able to choose the most effective and safest treatments and protocols for you.
Best Skin Treatments for Skin of Colour
The best skin treatments for skin of colour are those that can address skin concerns without causing unnecessary irritation or making hyperpigmentation worse.
Skincare for Skin of Colour
There are a number of good skin products that work well and are safe to use for skin of colour. Below we go through the key skin ingredients to look for to protect, treat and enhance your skin.
Hydration & Moisture
Look for products rich in vitamins B5, C and E as well as niacinamide and licorice root extract. These ingredients can help to even out skin tone, smooth texture and reduce the appearance of pores. Humectants like glycerol, hyaluronic and polyglutamic acid will increase your skin’s hydration. Combined with emollients and occlusives like ceramides, squalene and shea butter, these will seal in water and reduce ashiness.
Actives
Retinoids can also be very useful in skincare for skin of colour. They help to speed up cell turnover which improves the appearance of hyperpigmentation, fine lines and wrinkles. They also treat acne and scars. However, it’s crucial to start with a low strength retinoid and gradually build up to avoid potential irritation. For acne, you can also use azelaic acid and benzoyl peroxide.
For severe hyperpigmentation, Hydroquinone works well particularly when used alongside Tretinoin to suppress excess pigment and fade dark spots. As Hydroquinone and Tretinoin are prescription only medicines, you will need to see a doctor to access them and they will advise on how to use them safely and boost the results.
Sun Protection
Sunscreen is a must for all skin tones, including skin of colour. Although darker skin has more natural protection against UV rays, it is still vulnerable to sun damage as well as hyperpigmentation. Using a broad spectrum sunscreen of at least SPF 30 every day can help protect the skin from damage and maintain an even skin tone. A lot of physical sunscreens create a grey cast appearance. So, you may want to try a chemical sunscreen or better still opt for ones known to look good on skin of colour.
Professional Skin Treatments
Exfoliating acids can be used safely in skin of colour if you start with low strengths and use gradually as your skin tolerates them. Regardless of which skincare product you choose, always perform a patch test first to check if your skin can handle it.
When it comes to professional treatments, injectables like Profhilo, Botox and dermal fillers are generally safe to use in people with skin of colour. The same is true for microneedling or RF microneedling which can help boost skin quality and texture. If however you’re prone to hypertrophic scars or keloids then exercise caution. To be safe, get a consultation with a dermatologist who specialises in treating skin of colour to see if these treatments can work for you.
Chemical peels and laser can be highly useful in treating acne, scars, ageing and hyperpigmentation but only if they are done with care and caution. To avoid risks of burns, scars and PIH, see a medical practitioner who is experienced treating skin of colour.
Best Skincare Routine for Skin of Colour
Thankfully, there is a whole world of skincare products that can work really well for skin of colour. The best skincare routine will depend on your skin concerns, goals and lifestyle.
Cleansing
Opt for a gentle, sulfate free and hydrating cleanser. This will maintain your skin’s natural moisture and lipid barrier. If you want to double cleanse, use a cleansing balm or oil and follow up with a hydrating foaming cleanser.
Exfoliating
Avoid physical exfoliants at all costs. Use chemical exfoliants like gentler AHAs or BHAs sparingly to avoid skin damage and PIH. Consider enzyme exfoliants as these tend to be gentler than acids but regardless of what you select, go for the lowest strength possible, start slowly and patch test first.
Antioxidant Protection
Use antioxidants to combat free radicals and reduce inflammation. Try a low strength or gentler formulation of Vitamin C then gradually increase dose and frequency as your skin tolerates.
Addressing Acne, Hyperpigmentation and Scarring
- Incorporate benzoyl peroxide to spot treat pimples.
- Niacinamide will help with early signs of skin ageing, improves texture and reduces appearance of pores.
- Azaelic acid is a gentle treatment for acne, acne scars and hyperpigmentation for those with sensitive skin.
- Retinol and prescription retinoids like Adapalene and Tretinoin will help with skin ageing, texture, acne and hyperpigmentation. Start slow and low to reduce risks of PIH.
- For moderate to severe hyperpigmentation consider seeing a doctor for a short course of hydroquinone. Arbutin and Kojic acid are over the counter alternative but are less effective in skin of colour.
- Silicone sheets or gels can help reduce the appearance of keloids and hypertrophic scars. Ensure you are under the care of a dermatologist or plastic surgeon as these are difficult to treat.
Sun Protection
Use a broad spectrum sunscreen with SPF 30 or above to prevent skin cancer, hyperpigmentation and early ageing.
Moisturisers
Look for moisturisers with humectants, emollients and occlusives. Ingredients like glycerol, hyaluronic acid and ceramides will keep your skin moisturised and support the skin barrier.
Caring for skin of colour requires understanding its unique characteristics and susceptibilities. It is important to know about problematic skin treatments and adopt a bespoke skincare routine. This will address your individual skin concerns and keep your skin safe. For prescription and professional treatments always choose a doctor with experience in treating skin of colour. For keloids, skin changes and moles, please see a dermatologist with experience in treating skin of colour. They will be more likely to diagnose you correctly and manage you properly.
We are passionate about personalised skincare. That’s why we set up our virtual skin clinic. Our doctors are experienced in delivering safe and effective treatments for skin of colour. We provide prescription skincare products like Hydroquinone and Tretinoin to treat acne, hyperpigmentation, melasma and skin ageing all personalised to your needs. Book an online appointment or use our online consultation form today to take your first step towards better skin.
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