Although skin disease can affect anyone, it may not affect everyone in the same way -; and this is especially true for patients with skin of color.
"Skin conditions are color blind, occurring in patients of every skin tone, but certain conditions can affect patients with skin of color more frequently and more severely," says board-certified dermatologist Neelam Vashi, MD, FAAD, director of the Boston University Center for Ethnic Skin and the Boston University Cosmetic and Laser Center. "Moreover, certain dermatologic treatments may cause problems in this population if those treatments aren't performed properly by a qualified, experienced physician like a board-certified dermatologist."
According to Dr. Vashi, some of the most common problems reported by patients with skin of color include hypopigmentation, which involves patches of skin becoming lighter than the surrounding skin, and hyperpigmentation, which involves patches of skin becoming darker than the surrounding skin. These conditions are more visible in patients with darker skin tones, she says, and research has shown that pigmentation problems can have a negative effect on patients' quality of life. "These conditions may not be harmful," she says, "but patients are often distressed by how their skin looks."
Patients with skin of color can experience a variety of skin conditions throughout their lives, Dr. Vashi says, and their concerns may change as they age. For example, she says, younger patients in this population often have issues with hypopigmentation. Cases of acne and eczema in those with darker skin tones can begin at a young age and persist into adulthood, she says, and these conditions may lead to problems with hyperpigmentation and scarring as patients get older. As people with skin of color continue to age, she says, they may experience skin growths or issues with hyperpigmentation.
While hyperpigmentation caused by sun exposure over time is a common sign of aging in patients with all skin tones, it can be especially pronounced with patients with darker skin, Dr. Vashi says. In fact, she says, hyperpigmentation is one of the most common skin concerns in patients with skin of color as they get older, because other signs of aging like wrinkles and sagging skin tend to appear later and be less severe in this population.
"Patients with darker skin may think they don't need to protect themselves from the sun's harmful ultraviolet rays, but that is not the case," Dr. Vashi says. "Everyone, regardless of skin tone, should seek shade, wear protective clothing and use a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to help prevent skin cancer and premature skin aging."
Certain conditions, including skin cancer, may present differently in skin of color, Dr. Vashi says, but a board-certified dermatologist can provide both an accurate diagnosis and appropriate treatment for patients of all skin tones. While some dermatologic procedures may lead to side effects like hyperpigmentation in darker skin when performed improperly, research has shown that treatments like laser therapy, chemical peels and filler injections can be safe and effective for patients with skin of color when performed "in a methodical, careful way," she says.
"Dermatologists are always looking for newer, safer, more effective treatments for all patients, including those with skin of color," Dr. Vashi says. "A board-certified dermatologist with experience in treating darker skin tones can evaluate these patients' conditions and provide them with the best possible atment."