Expert Q and A: People of Color Face Unique Skin Problems

An interview with Andrew F. Alexis, MD, MPH

From the WebMD Archives

People of color will account for approximately half of the U.S. population by 2050, according to projections from the U.S. Census Bureau. This group, which includes blacks, Asians, Latinos, and other ethnicities, are more prone to certain skin conditions because of their genetic make-up and in some cases cultural practices.

At the annual meeting of the American Academy of Dermatology in Miami Beach, Fla., Andrew F. Alexis, MD, MPH, assistant clinical professor of dermatology at Columbia University College of Physicians and Surgeons in New York City, discussed the leading medical and cosmetic dermatologic concerns in darker-skinned populations and how to treat those conditions.

Why are people of color more prone to certain skin conditions, and what are the most common conditions?

Although people of color have more natural protection from ultraviolet (UV) radiation because of the increased amount of melanin (the pigment that gives skin its color), the cells that make melanin pigment tend to be more reactive to inflammation and injury. So pigmentation problems are more common in skin of color.

In a recent study, acne was the most common skin condition in blacks, followed by pigmentation problems, or dyschromias.

The most common dyschromia in people of color is post-inflammatory hyperpigmentation (PIH). This refers to increased pigmentation or dark spots at the sites of inflammation.

Acne is one trigger for PIH, and the resulting dark spots are often of greater concerns than the original pimples.

In terms of strategies, we can block the production of melanin by using hydroquinone and other bleaching creams; we can block the transfer pigment to the upper layers of the skin by using retinoid creams, which are vitamin A derivatives; we can remove excess pigment in the skin using chemical peels; and we employ sun protection to prevent increased pigment production and UV exposure.

Melasma, often referred to as the "mask of pregnancy" as that's when it commonly kicks in, is the second most common pigmentation problem in people of color. It presents as dark patches on the cheek, forehead, upper lips, and, rarely, off the face.

More women than men are affected, but the condition can occur independent of pregnancy and is commonly seen in people in their 40s, 50s, and 60s. Contributing factors are genetic predisposition and hormone and UV exposure.

It's treated similarly to PIH. However, you have to be really careful with chemical peels as you can run the risk of pigmentary problems, and if very deep peels, even scarring.


What are razor bumps?

It’s a common follicular problem that affects a disproportionately large number of dark-skinned patients. Studies show that the condition, called pseudofolliculitis barbae, affects 45% to 83% of black men.

Hair wise, the most striking difference between fair-skinned and dark-skinned people is that the hair shaft is curved in people of African descent. After shaving, especially close shaving, the sharp tip of shaved hair grows back into the skin, causing inflammation and bumps.

Though not mentioned as much, women are affected too, often on the chin, below the chin, and back area.

A safety razor can help, as can shaving only in the direction of hair growth after applying shaving cream.

Laser treatment can help. But because they target melanin, lasers carry a higher risk of discoloration, blistering, burning, and other side effects in darker-skinned people. A recent study showed that the long-pulsed 1064 Nd:YAG laser is associated with the least complications in people of color.

Creams and gels, including topical retinoids, topical antibiotics, topical steroids, and the topical prescription medication eflornithine, may also help.

What about hair loss?

One particularly disfiguring form of hair loss that I see almost every day used to be called hot comb alopecia (hair loss), and is now called central centrifugal cicatricial alopecia (CCCA). It begins on the crown and leads to a big balding spot on the top of the head.

The cause is not really known, but one study suggests that hair practices that put tension on the hair, specifically sewn-in hair weaves and cornrow or braided hair with artificial extensions is associated with this type of hair loss.

Unfortunately, many people do not seek care until there's a lot of hair loss and once a hair follicle is scarred, it cannot produce hair any longer. But if caught early, hair loss can be treated with a variety of anti-inflammatory therapies, including injections of steroids into the affected areas of the scalp, topical steroids, and oral antibiotics. Minoxidil can help to stimulate hair growth in healthy hair follicles.

And of course, patients must style their hair differently.

There have been no clinical trials on this disorder, but I am involved in the first in which we will compare four anti-inflammatory medications for CCCA.

WebMD Feature Reviewed by Laura J. Martin, MD on March 12, 2010



68th Annual Meeting of the American Academy of Dermatology, Miami Beach, Fla. March 5-9, 2010.

Andrew F. Alexis, MD, MPH, assistant clinical professor of dermatology, Columbia University College of Physicians and Surgeons, New York City.

© 2010 WebMD, LLC. All rights reserved.


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