Structural and functional differences in darker skin types contribute to skin and hair problems
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According to projections from the United States Census Bureau, people with skin of color will comprise approximately half of the U.S. population by 2050. This group, which includes African-Americans, Asians, Latinos and other ethnicities, are more prone to certain dermatologic problems than those with lighter skin tones due to their genetic make-up and in some cases cultural practices. For that reason, dermatologists – who understand the nuances of different skin tones – are poised to help patients of color by diagnosing and treating these conditions.
Speaking today at the 68th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Andrew F. Alexis, MD, MPH, FAAD, assistant clinical professor of dermatology at Columbia University College of Physicians and Surgeons and staff member at St. Luke’s-Roosevelt Hospital Center, both in New York, discussed the leading medical and cosmetic dermatologic concerns in darker-skinned populations.
“Although people of color have more natural protection from ultraviolet (UV) radiation due to the increased amount of melanin in their skin, the cells that make melanin pigment tend to be more reactive to inflammation and injury, and therefore pigmentation problems are more common in skin of color,” said Dr. Alexis. “These natural genetic factors, coupled with cultural differences in their skin and hair care practices, can result in differences in the appearance of common dermatologic conditions and the frequency in which they can occur.”
Treating Pigmentation Disorders Takes Patience
The most common pigmentation problem (dyschromia) of the skin that can occur in people of color is post-inflammatory hyperpigmentation (PIH), which refers to increased pigmentation or dark spots at the sites of inflammation. Acne is one trigger for PIH, and the resulting dark spots often can be of equal or greater concern than the original pimples.
Dr. Alexis explained that although there are several effective treatments that can be used for PIH, none of these treatments are quick fixes and each requires time to take effect – from several weeks to several months in most cases. Common treatments include retinoid creams (vitamin A derivatives), bleaching creams (containing hydroquinone) and chemical peels.
“While in-office procedures, such as chemical peels or any skin resurfacing cosmetic treatment, can help correct pigmentation problems, they have to be administered with caution due to the higher risk of inducing other pigmentary abnormalities,” stated Dr. Alexis. “That’s why it is important to consult a dermatologist with an expertise not only in using these procedures, but in treating darker skin tones as well.”
Melasma, often referred to as the “mask of pregnancy,” is the second most common pigmentation problem occurring in skin of color patients. More women than men are affected by melasma, but the condition can occur independent of pregnancy and is commonly seen in people in their 40s, 50s and 60s. The cause of melasma is a combination of genetic and hormonal factors and UV exposure. Dr. Alexis added that melasma can be treated with the same topicals and in-office procedures used for PIH, and in some cases, lasers can be effective.
Since sun exposure can worsen dark spots, Dr. Alexis stressed that year-round sun protection is extremely important. “I recommend that my patients wear a moisturizer with sunscreen every day to protect their skin from further damage,” said Dr. Alexis.