Maxine McCrann

How to care for skin of color, according to Black and brown dermatologists

While Black (skin) certainly does not crack, it definitely does other interesting things as it ages. And so I’ve started to pay more attention to the copious amounts of skin care advice, products, and trends pushed on me by social media. Here’s the thing, though: Not much of that stuff is targeted toward my particular complexion and skin type.

Darker skin tones such as mine have unique concerns that people with lighter skin tones don’t. This isn’t just about blackheads, blemishes, and razor bumps, either — skin cancer manifests differently on darker skin. While skin cancer is not very common among Black Americans, we can still get it. And the grim reality is, the survival rate is significantly lower in Black Americans.

While it’s true that any dermatologist should be able to diagnose and treat your skin no matter what tone it is, that’s not always the case. From psoriasis to melanoma, certain dermatological conditions aren’t treated in the most effective way because a specialist — no matter how well-trained — just might not be as well-versed at how these conditions show up in darker skin.

And of course, our medical system is still plagued with racial bias and the dismissal of Black suffering. I’ve heard numerous stories of darker-skinned folk seeing a dermatologist and being misdiagnosed with conditions like anxiety when really they were experiencing a skin ailment. With this in mind, I decided to talk to Black and brown dermatologists about little-known ways we can care for our skin in the best way possible.

When it comes to dark spots and wrinkles, prevention is key

Hyperpigmentation is one of the most common concerns that bring young people of color to the derm’s office, according to Caroline Robinson, a Chicago-based board-certified dermatologist and founder of Tone Dermatology. Common skin issues such as acne can result in scarring (dark spots also known as hyper pigmentation) on your face — and treating those spots incorrectly could make them look worse.

“The treatment of dark spots and other types of hyperpigmentation is much more complicated than most people realize,” Robinson says, adding that this is why it tends to be a persistent issue. Whether the dark spot is caused by acne, sun damage, or something else, it can be a stubborn issue that needs to be addressed in multiple ways to be most effective. Robinson recommends that her patients start by wearing sunscreen consistently to prevent dark spots.

In addition to sunscreen — and I’ll get into detail on that below — Robinson suggests a gentle exfoliating cleanser to help lift pigment (one that contains mild alpha hydroxy acids), a retinoid (a vitamin based product that promotes skin cell turnover), and a dark spot corrector to target pigment production at the source is a great routine to start with. “I perform a lot of procedures in the office to address pigment changes too,” Robinson adds, adding that these include chemical peels, microneedling, and laser surgery.

Darker skinned people need to wear sunscreen too

It’s a common misconception that you don’t have to wear sunscreen if you’re Black or brown, but that’s not true, Robinson tells me. She recommends tinted sunscreens for her patients with hyperpigmentation because evidence supports them being more effective at protecting against the forms of light that exacerbate it. In addition to being a great prevention tool against melanomas, sunscreen can help prevent sunburns and sun poisoning as well, both of which people with brown skin can actually get.

“For a lot of people, the need to do daily sunscreen sounds like too much,” says Ope Odofile, a Marietta, Georgia-based dermatologist. But we still need to do it, even though we don't burn as easily as our fair skinned friends. Odofile’s faves are Black Girl Sunscreen for a non-greasy, residue-free glow, and Robinson’s suggestions include the easily blendable Dr. Brandt Liquid Sun Shield SPF 50, and Mele No Shade SunScreen Oil.

Hyperpigmentation, dark spots, and other blemishes are uninvited guests, of course, but while they may be cosmetically challenging, they can be the beginning signs of a much worse problem: skin cancer. That’s why protecting your skin as much as possible is crucial.

Even if you wear sunscreen daily, be vigilant about looking for abnormalities on your skin — even in places where the sun don’t shine. More Black Americans, Asians, and Latino people die of melanoma than white Americans because it’s more difficult to detect moles and other abnormalities on our skin.

“Approximately 60-75% of skin cancers diagnosed in people of color are in areas that are not regularly exposed to the sun,” says Naiara Braghiroli, a Miami-based dermatologist and chief of skin cancer at Miami Cancer Institute, adding that areas such as the palms of the hands, nail beds, soles of the feet, inside the mouth, or the genitalia area are rarely looked at for cancers and therefore much more insidious if not treated early.

Hair loss — which is a skin issue — is more common in Black women

Researchers from the National Institutes for Health surveyed 200 Black American women (from younger to elderly) in a Detroit church community — and about half of them reported hair loss. Another important study from a few years later surveyed 6,000 women of African descent and found that about 48% of respondents had experienced some type hair loss, mostly due to a hair condition most commonly known as traction alopecia (known in the medical community as CCCA, or Central centrifugal cicatricial alopecia).

“CCCA is the most common form of scarring hair loss affecting Black women,” says Robinson, adding that this form of hair loss classically starts on the central scalp and can spread outward to affect other areas of the scalp, and is often under-diagnosed and permanent. That’s a terrible combination, but it shows how crucial it is to both identify the issue and get into a dermatologist’s office as close to detection as possible.

Robinson tells me that early signs of CCCA include tenderness, tingling, burning and/or hair breakage centered on the top of the scalp. CCCA can be associated with uterine fibroids and diabetes. “We don’t fully understand it, but it appears that genetic and environmental factors both play a role,” Robinson says. She adds that hair styles and practices that place a great deal of tension or involve excess manipulation of the scalp are thought to cause or contribute to traction alopecia, but hair extensions and braids can contribute as well.

“For dry skin in the treatment of alopecia, I always encourage this keyword: gentle,” Robinson says. “Soaps, skin practices, and rich moisturizers that mimic the lipids of the skin and promote skin cell ceramide production all help, but they must be gentle.” Robinson adds that if diagnosed and treated early, the progression of the condition can be halted.

There are ways to avoid (and treat) keloids

People with darker skin are more prone to keloids, or a type of scar that has developed so much excess collagen over time that these collagen bundles extend beyond the area of the original scar. I still have one right behind my ear — I got it after I decided that I wanted to gauge my ears in high school (rest assured, I was cool). More than one relative of mine has gone through experiencing and trying to treat keloids, as it’s a common condition in people of African, Asian, and Latinx descent.

And piercings are not the only way that you can get them — tattoos can also cause this type of scarring, Odofile says, suggesting that your upper back and shoulder area are often problem spots for keloids when it comes to tattoos.

“Keloids can be difficult to treat which is why my biggest piece of advice involves prevention and seeking treatment early,” Robinson says. She recommends avoiding any elective surgeries or procedures for those with a history of keloids or a family history of keloids.

Since there are no at-home remedies or over-the-counter scar treatments that have been proven effective for keloids, Robinson recommends getting to your doctor swiftly. “I perform various types of injections as well as other treatments in the office to manage keloids,” Robinson adds. Surgical removal of keloids is always a last resort because of the high risk that these spots will return larger than the original keloid.

Razor bumps are preventable and have a simple solution

“When a hair becomes trapped in the skin this can lead to inflammation, pustules, or inflamed cysts,” Robinson says. When this happens on your face, it’s referred to as pseudofolliculitis barbae, or razor bumps. Scrabble-winning words aside, razor bumps are a common problem for African-American skin, especially for those of us who choose to shave. Ingrown hairs can be a major issue for those with thick, tightly curled hair because of the tendency of the strands to curve backward and pierce the skin or to become trapped under the skin in the first place, Robinson tells me.

Aggressive shaving techniques to remove the hair can sometimes lead to irritation and inflammation of the surrounding skin which is referred to as razor burn. Teenage me was shaving like a Caucasian person, using store-bought razors that shave close to the skin instead of shaving in more curled-hair friendly ways, like using a buzzer. I also wasn’t using a product like CLn Cleanser which, Odofile tells me, reduces razor bumps. Needless to say, my old shaving routine left my skin irritated.

Laser hair removal is a great option for those who no longer want hair in the area or in severe cases. For our downstairs areas, Robinson recommends Venus Pubic Hair & Skin Smoothing Exfoliant, which contains lactic acid and emollients to help reduce itch and minimizes the risk of ingrown hairs, while gently scrubbing to remove dead skin and oils. This helps prepare the area for shaving by minimizing the risk of hair trapping. “I recommend shaving in the direction of hair growth to minimize irritation,” she says.

After shaving, applying a topical serum can be helpful to soothe and maintain the skin. Robinson suggests watching The American Academy of Dermatology’s tutorials on YouTube — they have excellent guidance about shaving and information on other forms of hair removal like waxing, threading, prescription creams, and more, which can be helpful to review before you dive in.

Find a dermatologist you trust

Finding a dermatologist doesn’t need to be so hard, but it really is for a lot of us. I have always been reticent about taking a medical professional's advice on if they don’t share my skin tone. Odofile gets it: “The reason why Black dermatologists are highly valued is that you really trust somebody who feels like they understand where you're coming from. They know what you’re going through, so you're more likely to follow those directions since you feel like it's coming from a place of mutual understanding.”