Skin Conditions in Dark Skin

Medically Reviewed by Debra Jaliman, MD on September 14, 2023
7 min read

Skin comes in all colors, from the palest ivory to the darkest brown and nearly every shade in between.

Skin problems, however, are generally color-blind, meaning that most skin conditions can occur in every race and in all skin types.

That said, there are certain skin conditions that seem to affect dark skin more frequently or with more severity. Further, many treatments used for common skin conditions can sometimes lead to even more problems when used on people of color.

But before you can learn how to protect your face and body, it's important to know a little something about the biology of dark skin.

The color of all skin stems from cells called melanocytes. They produce melanosomes, packets containing the natural chemical melanin.

Studies show that all people have roughly the same number of melanocytes in skin tissue, regardless of color. What differs is both the size and distribution of the melanosomes. The more and larger they are, the darker skin will be.

Since the role of melanin in the skin is to absorb and scatter energy from ultraviolet (UV) light, having a dark complexion reduces the risk of sun damage, particularly as it pertains to skin aging and skin cancer formation.

At the same time, dark skin is more likely to develop pigmentation problems. Even minor skin injuries, such as bug bites, can cause an change in skin pigment, allowing dark spots called hyperpigmentation to occur.

When not properly administered, any cosmetic treatment that injures the skin -- such as laser surgery, dermabrasion (removal of dead skin cells), wrinkle-filling injections like Restylane, or Botox injections -- has the potential to cause pigmentation problems.

In hyperpigmentation, the skin either produces too much pigment or the pigment is deposited deep within the skin, resulting in dark spots. When color is lost, it's called hypopigmentation, which results in light-colored patches. All people with dark skin are at risk for both skin conditions.

Among the most common types of pigment problems in dark skin is post-inflammatory hyperpigmentation. This occurs as a result of skin injury, such as a cut, scrape, or burn. It can also occur in conjunction with eczema or acne.

The darkened area of skin can take from months to years to fade, though medical treatments can help. Treatments include removing layers of skin via a chemical peel and prescription bleaching treatments. These treatments won't work on pigment deeper in the skin.

Daily use of a broad-spectrum, tinted sunscreen will also help keep a pigmented area from becoming darker.

Those with sensitive skin are at greatest risk for pigmentation problems. In fact, any skin care product ingredient that irritates or dries skin increases the risk.

The most common products include benzoyl peroxide and salicylic acid (used to treat acne) and anti-aging compounds such as retinoids and glycolic acid. In some patients, the skin-bleaching compound hydroquinone can also irritate skin.

In those with lighter skin, product-related irritation normally subsides once use is discontinued. But in people of color, the irritations often give way to post-inflammatory hyperpigmentation. This can develop within one to two weeks after stopping the product and can linger for several months or longer.

It's important to note that all these ingredients can be successfully used on dark complexions as long as they are used correctly.

Also known as dermatitis, this skin condition is characterized by an itchy, red rash that comes on gradually and lasts a long time. It can be triggered by such things as stress, extreme changes in temperature, dry skin, pet or plant allergies, or irritations caused by skin care or cosmetic ingredients.

When eczema occurs as the result of an inherited tendency, it is known as atopic dermatitis.

Eczema is believed to occur twice as frequently in children with dark skin. One study found its incidence is higher in Mexican-American teens than either whites or blacks. Other research found a greater incidence in Chinese and Vietnamese babies, compared with white babies.

When eczema occurs in those with dark complexions, it presents a two-fold problem:

  • It is often misdiagnosed, leading to long periods of no treatment or the wrong treatment.
  • When not treated early on, it can increase the risk of pigmentation problems.

Treatment for eczema consists of identifying and avoiding products that irritate skin. Use of moisturizer can help a lot, along with steroid creams. Sometimes, ultraviolet light therapy is effective.

It is essential to seek help as soon as possible for any red, itchy rash. Doing so will help avoid pigmentation problems.

Acne can occur in any skin type. But due to its link to hyperpigmentation, it is of greatest concern for people with dark skin. Acne develops when there is an overproduction of oil in the skin. That oil mixes with bacteria within the pores and blocks the pore openings. This causes inflammation just under the skin, which results in lesions -- anything from small, discreet bumps to large cysts.

Not only can this trauma lead to pigmentation problems in dark skin, but so can many medications used to treat acne. This is also true of certain oral antibiotics, particularly minocycline. In some people, it can produce a darkening of the skin, which can take months to fade.

If you have dark skin and develop acne, see a dermatologist skilled in treating ethnic complexions as soon as possible. The earlier you seek treatment, the less likely you are to suffer permanent pigmentation scars.

This skin condition is characterized by bumps under the surface of the skin, and is often confused with acne. But the problem actually stems from ingrown hairs. It most often occurs in black and Hispanic people, due to the distinct shape of the hair follicle.

If the bumps are squeezed or manipulated in any way, they can become inflamed or infected. But even when left alone, they can be difficult to cover and sometimes cause pain.

Recent studies have shown that laser hair removal is an effective treatment.

Because this condition is often confused with acne, it's important to have your diagnosis confirmed by a dermatologist familiar with dark skin.

Any time dark skin is injured in certain areas, there's an increased risk of keloids -- a scar that spreads beyond the boundary of the original injury and develops into a growth. The most common causes of keloids are cuts or burns. The most common locations are the earlobes, chest, back, and arms. While they can develop immediately after an injury, they can also take months or even years to grow -- and they can continue growing over a period of time.

In some people, keloids may itch, cause pain and burning, and be tender to the touch.

Though no one is certain why keloids develop, they are thought to be linked to a defect in collagen production. Treatments include cortisone injections, radiation therapy, pressure dressings, and silicone gel applications. Keloids can also be removed via surgery or with a laser. Regardless of the treatment, keloids return between 45% and 100% of the time.

In this condition, skin becomes depigmented. The loss of color causes large, white patches to appear. Vitiligo occurs in up to 2% of the population but is most noticeable in those with dark skin. Vitiligo is thought to develop when melanin-producing cells are damaged, though no one is certain why this happens. A genetic susceptibility perhaps triggered by a factor in the environment may result in an autoimmune disorder, causing the destruction of pigment cells.

When vitiligo hits the scalp, hair turns white -- and it's occasionally the cause of prematurely gray hair.

Treatment includes various procedures to "re-pigment" the skin. One such method is controlled exposure to UV light, called phototherapy. This can help increase the amount of melanocyte cells at the skin's surface.

Another approach uses topical eczema ointment tacrolimus, which is sometimes effective. When applied to the skin twice daily, research shows, normal pigmentation may return, although it may take months. Still, another approach is the use of strong steroid creams, which can be effective if used on certain areas of the body such as the face and neck.

There is a new treatment available which is a topical cream ruxolitinib. It is a new technology called JAK inhibitors which affect your immune system to treat vitiligo.  It is used twice daily. 

Although dark-skinned people have a natural protection against skin cancer, that doesn't mean it can't occur. It does -- most frequently where skin is lightest, such as the palms, soles of the feet, and around the nail bed. This is most true for Asians, Native Americans, and people of African descent. In Hispanics, melanoma occurs most frequently on the legs.

Because it is frequently misdiagnosed as plantar warts (on the soles of the feet), tinea manuum (a fungus occurring on the palms of the hands), or a condition known as talon noir or black heel, and because many people do not seek treatment early on, the melanoma death rate is highest among people with dark skin.

The lifesaving answer lies in awareness and early diagnosis.