Skin Concerns

There are some skin conditions that are more common or just look different on darker skin.

Having a good basic understanding, will help you look after your skin better. The Black Skin Directory Skin Concern Glossary is your one stop shop to the most common skin complaints on Black skin, how they look, their causes and solutions.

 

Acne

  • Acne can be mild, moderate or severe and is caused by over production of sebum in the sebaceous glands of the skin. At the same time, old skin cells are not being shed properly and they clog the pores. In combination with the excess sebum, the pore becomes blocked forming blackheads and whiteheads.

    The acne bacterium p. acnes is present in every skin, usually harmless, causing no problems. However, in people prone to acne, the build up of excess sebum and old skin cells creates a sticky environment in which this bacteria can feed off and multiply. This sets off inflammation within the skin creating raised angry spots and cysts, sometimes filled with pus.

    Hormonal changes during puberty, pregnancy, irregularities in menstrual cycle, polycystic ovary syndrome or medication can greatly influence the onset of acne as they influence the oil production within the skin. Additionally, squeezing, popping and using irritants can make acne worse and lead to scarring which is a problem for skin of colour.

  • Diagnosis of acne usually doesn’t require testing but by observing lesions and when/where they occur on the body.

    There isn't a cure for acne therefore treatments are usually aimed at clearing existing acne and tackling the source. Careful management of skin health can keep it under control and it’s useful to look at lifestyle factors that exacerbate acne e.g. sleeping in make up, use of unsuitable cosmetic products.

    Treatments often include topical and oral antibiotics and retinoids - antibiotics treat infections that come from severe pus filled acne and, vitamin A based creams, gels and oral isotretinion helps to reduce and regulate oil production.

    In clinic treatments such as chemical skin peels, laser and LED light treatments are also beneficial.

Acne is a common skin problem which is also sometimes called pimples or breakouts. It can manifest at any age on the face, neck, back and shoulders. They occur when the body’s natural oils (sebum) and old skin cells together block the skin’s pores. This causes inflammation of the skin. 

Dermatosis Papulosa Nigra

  • The cause of DPN is unknown. The spots can be isolated or in clusters, varying from one to hundreds of flat spots or they can hang off the skin like a skin tag.

  • DPN is easily recognised through visual examination.

    Many people chose to have DPN removed for cosmetic reasons, though the decision for removal must be considered carefully as it is not always possible to completely remove all spots. Treatment options include scissor excision, electrosurgery, cryosurgery, laser, dermabrasion and curettage.

    It’s important to consider the risk of pigmentation defects at the original site, where the skin may go lighter or darker or even scar following the removal treatment and this outcome can also be undesirable. Minimising the appearance of DPN is a more suitable option in most cases.

DPN appears on the skin as small brown or black spots
especially around the cheekbones and eyes. The spots may also be found on other areas of the face, neck, chest, and back.  

DPN occurs most frequently in people of colour, especially women.  They tend to appear with age and grow in size and number. Whilst they are not cancerous or of medical concern, they can sometimes be irritating or cosmetically undesired. 

Keloids

  • Unfortunately keloids are a poorly understood and researched skin concern with ethnicity, genetics, epigenetics and pigment (melanin), wound depth and intensity being contributory factors.

    Most theories of keloid development centre on keloids forming after trauma to the skin of an individual who already has a genetic predisposition.

    Keloids tend to develop months or even years after the trauma has occurred and also have a tendency to continue to grow, taking some time to reach a growth plateau. In some cases they don’t cause any discomfort but because they can be unsightly they become a cosmetic concern.

    They have been found to be painful, itchy and sore, especially during the active growth phase and can also cause contracture over or near a joint resulting in restrictions to movement. As a result many sufferers will seek medical relief from any discomfort and/or to improve their range of movement in the affected area.

  • Keloids are easily diagnosed following a visual assessment of the skin and on a rare occurrence, a biopsy may be requested.

    Unfortunately, there is no conclusive treatment pathway for keloids. The first therapy is avoidance of inessential activities that cause trauma in individual genetically predispositioned to keloid or hypertrophic scarring e.g. ear piercing, tattoos, cosmetic procedures.

    Surgical removal is an option, especially for bulky and uncomfortable keloids; however, the healing of the skin post op must be monitored carefully as keloids have a habit of returning - there is also the risk of pigmentation irregularities occurring in the area that has been treated which is also undesirable.

    Corticosteroids injections, creams and tapes also have beneficial effect in treating keloids.

    Some studies have shown off label use of Botulinum toxin A (BoTox) also effective when used as an early intervention.

    Cryotherapy can also be tried alone or in combination with other treatment methods, though it can cause pigment loss.

    There is emerging research investigating combination therapies are highly effective in removing keloids including the use of surgery, radiation and steroid tape/plaster all of which provide the individual benefits of mass reduction (radiation and surgery) and anti-inflammatory activity (steroids).

A keloid is a scar that forms beyond the boundary of a wound and develops to become thick, fleshy and raised. This scarring occurs due to an over production of collagen, which is the structural protein of the skin.

Keloids develop after trauma to the skin which can be caused by a range of factors including an acne spot, piercings, surgery, blisters, minor injury and vaccinations - If the healing of a scar resulting from trauma is abnormal, it can spread well beyond the original site of trauma to form a keloid.

Image courtesy of DermNet NZ.

Melasma

  • The exact cause of melasma is unknown but it commonly affects people with a family history of the condition and is associated with hormonal changes due to pregnancy or use of contraceptive pills; thus this condition is sometimes called the mask of pregnancy

    Exposure to the sun and light are most common reasons for the appearance of melasma as ultraviolet rays from the sun can stimulate pigmentation via melanocytes within the skin. Which leads to those exposed areas having darker patches compared to the rest of the skin. Irritation of the skin and the healing process can leave remnants of staining after it has healed.

  • Melasma can be easily diagnosed by a dermatologist during a skin examination; in some cases, a skin biopsy may be required to confirm the diagnosis.

    Treatments that are available for this skin conditions may not work for every case and prevention via daily application of topical sunscreens (UVB and UVA) or physical items like visors and umbrellas are advised as sun and lighting are the main causes of melasma. Whilst hormonal influences such as those caused by oral contraceptive pills can be difficult to manage due to the necessity of the medication, speaking to a skin specialist and healthcare professional is helpful for deciding on the best management plan.

    Azelaic and Kojic acids are good agents for depigmentation of the skin, whilst combination creams containing Tretinoin also work well to increase skin cell turnover. Hydroquinone is the main depigmenting agent used and is available on prescription from a medical practitioner.

    Procedures such as skin peels, microdermabrasion and laser surgery may be helpful, especially in combination with cosmeceutical preparations. To go down this route, treatments should be administered by practitioners who are familiar and experienced in treating people of colour.

Melasma is a disorder of the skin where brown/pigmented patches appear on high points of the face primarily the face, cheeks, bridge of nose, forehead and upper lip. This occurs in a high percentage to women of colour primarily within the Latin-America, Asia, Northern Africa and Middle Eastern communities.

Post Inflammatory Hyperpigmentation

  • Due to the presence of pigment/melanin, any form of irritation or inflammation of the skin from acne, eczema, psoriasis, burns, allergic reactions, UV radiation or even bites can lead to the overproduction of melanin in the affected area. This affects the top layer of the skin - the Epidermis and sometimes further layer underneath i.e. the Dermis.

  • This can be diagnosed by a skin care practitioner i.e. an Aesthetician or Dermatologist and involves a physical examination and sometimes in extreme cases a biopsy. When the pigmentation involved is mixed and within the dermal layer, it may be difficult to treat as the hyperpigmentation is within the deeper layers of the skin.

    Chemical peeling and laser treatment are a more extensive forms of treatment alongside using topical treatments like prescribed hydroquinone, retinoids, corticosteroids and Alpha Hydroxy Acids.

This occurs after there is irritation, trauma or damage to the skin which brings about the over production of melanin pigment (hyperpigmentation) to the area. Post Inflammatory Hyperpigmentation affects over 60% of people of colour.

Traction Alopecia

  • Traction Alopecia can be very common amongst women of colour who:

    - regularly wear their hair in heavy extensions and weaves.

    - Regularly have braids and cornrows that are too tight.

    - Use glue to seal the hair line of wigs.

    - Use chemical relaxers and rollers.

    - Extensively use gel type products on the hairline.

  • Traction Alopecia can present in many ways. The scalp could be itchy, dry and scaly with small rash like bumps.

    In addition, there could be multiple broken and thinned, short hairs especially around the front hair line. Another classic tell tale sign can be patchy hair loss, leaving the scalp shiny and exposed due to the complete destruction of the hair follicle. At this point, Alopecia is permanent.

    The simplest initial treatment options include:

    - Changing hairstyles to a style with less tension and pulling.

    - Cutting long hair.

    - Avoiding the use of chemical treatments and excessive heat.

    - Avoiding the use of heavy styling products.

    Medical treatments can involve antibiotics, topical or injectable steroids, hair growth supplements, anti fungal shampoos, mesotherapy and hair replacement surgery.

An acquired hair loss brought on by the sufferer through extensive and repetitive tension on hair follicles through the use of particular hair styles and practices. Whilst it can affect people from any ethnic background, it is very common amongst people with skin of colour.

Image courtesy of DermNet NZ.

Vitiligo

  • VitilIgo is caused by the loss of melanin in the skin. Melanin is the pigment which protects the skin from the sun rays and gives the skin its colour. It is presumed to be an autoimmune condition and patches occur around the fingers, wrists, neck, genitalia, eyes and mouth and also within skin folds such as armpits and groin.

    The onset can be triggered by exposure to certain chemicals, damage to the skin from a burn, childbirth and emotional stress. Vitiligo usually develops before 20 years of age.

    There’s segmental and non-segmental vitiligo and it is based on which parts/ sides of the body the patches are affected. Segmental patches are specific to one side of the body and non-segmental are symmetrical on both sides of the body. Non-segmental can be found in up to 90% of people affected.

  • This is diagnosed by a simple examination of the skin with questions to ascertain when the symptoms started to develop. Tests may be run to determine if there are underlying conditions such autoimmune conditions influencing the development of vitiligo.

    A referral to a dermatologist may be made for a second opinion and treatment may be commenced if the condition has progressed to 20% or more of your body, you are pregnant or initial treatments have not been effective.

    There is no cure for this condition but self tanning, makeup and skin camouflage products are offered as temporary cover ups, if desired.

    Phototherapy may be used to stimulate the skin to produce melanin and corticosteroids can be applied to reduce the destruction of the melanocytes which help give the skin its colour.

    In further cases, skin grafting which is when normal skin is removed from one body part to cover up patches on other parts, may be done and also depigmentation where the entire area is made to look the same non-pigmented colour can be achieved through topical treatments using prescribed hydroquinone under medical supervision.

This is a condition that leads to the loss of pigment in the skin leaving patches of pale white skin.  This is basically due to the loss of melanin due to the loss of melanocytes in the skin.

Vitiligo affects up to 2% of the world population and are prevalent in people with darker skin.

Pseudo Folliculitis

Image courtesy of DermNet NZ.

  • The condition mainly affects people of colour with thick curly Afro hair that when cut, grows back into the skin causing painful inflammation, swelling of the hair follicle and hyperpigmentation. Infection is caused by the bacteria Staphylococcus aureus.

    Whilst this condition affects mainly men who experience it in the nape and lower face/neck, women can also be affected if they suffer from excessive facial hair growth on the chin and cheek area and from hair removal on the legs and bikini area.

    It can appear to look like a painful rash or acne, often looking very sore and inflamed.

    If not treated, the area can become infected this requiring antibacterial treatment.

  • Visual examination of the skin is all that's necessary to determine the condition. A dermatologist or trichologist is usually better equipped to help than a GP.

    It is important to look at the shaving implement being used – single blade razors like the Bevel have been specifically made to prevent razor bumps in people with thick, curly and coarse Afro hair.

    It is important to keep skin smooth and free from dry skin build up. Regularly exfoliating with a mild AHA face wash and moisturising lotion will help and also will tackle the resulting post inflammatory hyperpigmentation.

    Topical and/or oral antibiotics can also help to reduce inflammation.

Commonly known as razor bumps or ingrowing hair.

BECOME A BSD INSIDER

BECOME A BSD INSIDER