Dermatology for Skin of Color:
Conditions, Skin Cancer, and Care

Skin of color describes the range of skin tones in people of African, Hispanic, Asian, Middle Eastern, Native American, and Pacific Islander descent, roughly Fitzpatrick skin types IV to VI. Darker skin has more active melanocytes, which protect against sun damage but also respond to any inflammation by producing dark marks, and it is more prone to keloid scarring. Some conditions are more common in skin of color, several look different and are easily misdiagnosed, and skin cancer, while less frequent, is often found later and in unexpected places such as the palms, soles, and nails. Belaray Dermatology cares for patients of every skin tone at its Hicksville and Stony Brook offices, with treatment plans chosen to protect pigment.

Why Does Skin of Color Need Specific Expertise?

Three biological differences shape dermatology in darker skin. First, melanocytes in skin of color are more reactive, so acne, eczema, a cut, or an aggressive treatment can leave a dark mark that lasts months (post-inflammatory hyperpigmentation). Second, the skin forms thicker, more exuberant scars, including keloids. Third, redness, the main sign of inflammation that dermatologists are trained to spot in lighter skin, is muted in darker skin and may look violet, gray, or dark brown instead, so rashes such as eczema, psoriasis, and rosacea are more often missed or diagnosed late. Treatment is also adjusted: lasers, peels, and even some topical medications must be chosen and dosed to avoid triggering pigment changes.

Conditions That Are More Common or Look Different

Post-Inflammatory Hyperpigmentation (PIH)

Dark marks left behind by acne, eczema, insect bites, cuts, burns, or procedures are the most common reason patients with skin of color see a dermatologist. The mark is flat, matches the shape of the original injury, and fades over months, faster with daily sunscreen and prescription lightening agents such as azelaic acid, hydroquinone, retinoids, and tranexamic acid. The most effective strategy is preventing the inflammation in the first place, which is why early, gentle treatment of acne and eczema matters so much in darker skin.

Melasma

Melasma, the symmetrical brown patches on the cheeks, forehead, and upper lip driven by hormones and light, is especially common in Hispanic, Asian, Middle Eastern, and African American women. Tinted mineral sunscreen that blocks visible light is essential. See melasma treatment.

Keloids and Hypertrophic Scars

Keloids are firm, raised scars that grow beyond the original wound, most often on the earlobes, chest, shoulders, upper back, and jawline, and they are far more common in Black and Asian patients. They are treated with cortisone injections, silicone, pressure earrings after earlobe surgery, and in some cases careful excision followed by injections to prevent regrowth. Tell your dermatologist about any history of keloids before a biopsy, piercing, or surgery. See earlobe repair and keloid removal.

Hair and Scalp Conditions

• Central centrifugal cicatricial alopecia (CCCA) is a scarring hair loss that begins at the crown and spreads outward, seen almost exclusively in Black women. Early symptoms are itching, tenderness, or thinning at the crown. Because scarred follicles do not regrow, early diagnosis and anti-inflammatory treatment are critical.
• Traction alopecia from tight braids, weaves, locs, and extensions is reversible early and permanent later; the first sign is thinning at the temples and hairline.
• Pseudofolliculitis barbae (razor bumps) affects most Black men who shave closely. Curved hairs re-enter the skin and cause inflamed bumps and dark marks. Treatment includes changing the shaving technique (see our men's shaving guide), topical retinoids and anti-inflammatories, and laser hair reduction, which is safe in dark skin with the right device settings.
• Seborrheic dermatitis of the scalp is common and may be managed differently in textured hair that is washed less often; medicated shampoo on wash day, left on five minutes, works well. See scalp conditions and hair loss.

Other Conditions

• Acanthosis nigricans: velvety darkening of the neck, armpits, and groin that is often a sign of insulin resistance and should prompt a diabetes screen.
• Dermatosis papulosa nigra: small, harmless dark bumps on the cheeks and temples, common in Black and Asian adults, that can be removed if desired.
• Vitiligo: more visible in darker skin and more distressing; highly treatable, especially early. See vitiligo treatment.
• Eczema: more common in Black children and more likely to show as small bumps around hair follicles, thickened dark patches, or gray-violet rather than red areas.
• Sarcoidosis, lupus, and lichen planus: more common in skin of color and often first noticed on the skin.

Skin Cancer in Skin of Color

Skin cancer is less common in darker skin, but it is diagnosed later and has worse outcomes, largely because patients and even clinicians do not expect it. Melanin provides some protection, roughly equivalent to SPF 13 in the darkest skin, but not immunity.

• Melanoma in Black, Asian, and Hispanic patients most often appears on skin that gets little sun: the palms, the soles, under the nails (a dark streak in a nail, especially one that widens or spreads to the surrounding skin), and inside the mouth or genitals. This type, acral lentiginous melanoma, is not caused by sun and is often mistaken for a bruise, wart, or fungal infection. Any new or changing dark spot on the palms, soles, or nails needs a dermatologist’s exam.
• Squamous cell carcinoma is the most common skin cancer in Black patients and frequently arises in old scars, burns, chronic wounds, or areas of long-standing inflammation rather than sun-exposed skin.
• Basal cell carcinoma in darker skin is often pigmented, appearing as a shiny brown or black bump that can be mistaken for a mole.

Monthly self-checks should include the palms, soles, between the toes, and the nails. See how to check for skin cancer and melanoma.

How Treatments Are Adjusted for Skin of Color

• Lasers and light devices are chosen and set for darker skin. Longer wavelengths (such as Nd:YAG) and conservative settings reduce the risk of burns and pigment change, and some devices, including IPL, are avoided or used cautiously. Laser hair reduction is safe in dark skin with the right technology and an experienced operator.
• Retinoids and acne treatments are started at lower strength and built up slowly, because irritation causes dark marks.
• Procedures such as biopsies and excisions are planned with keloid risk in mind, and cortisone may be injected at the time of surgery in patients with a keloid history.
• Botox and fillers work the same in all skin tones; injection technique is adjusted to minimize bruising, which can leave a mark.
• Diagnosis relies on texture, pattern, and dermoscopy as much as color, and on a provider who has seen each condition in darker skin.

When Should I See a Dermatologist?

• Any new or changing dark spot on the palms, soles, or under a nail.
• Dark marks that are not fading after three months, or acne or eczema that keeps leaving them.
• A raised, growing, or itchy scar.
• Hair thinning at the crown or temples, or scalp itching and tenderness, especially with tight hairstyles.
• Velvety darkening of the neck or armpits.
• A rash that looks gray, violet, or dark brown and has not responded to over-the-counter treatment.

Frequently Asked Questions

Can Black people get skin cancer?

Yes. Skin cancer is less common in Black patients but is diagnosed later and has worse outcomes. Melanoma in darker skin most often appears on the palms, soles, and under the nails, areas that get little sun, and squamous cell carcinoma often arises in old scars or chronic wounds. Monthly self-checks should include the hands, feet, and nails, and any new or changing dark spot there needs a dermatologist’s exam.

Why does my skin get dark marks after acne or a rash?

Melanocytes in skin of color react to any inflammation by producing extra pigment, leaving a flat dark mark in the shape of the original pimple, rash, or injury. This is post-inflammatory hyperpigmentation. It fades over months, faster with daily sunscreen and prescription lightening agents such as azelaic acid, retinoids, or hydroquinone. Treating acne and eczema early and gently prevents most marks.

Is laser treatment safe for dark skin?

Yes, with the right device, settings, and an experienced provider. Longer-wavelength lasers such as Nd:YAG and conservative settings reduce the risk of burns and pigment change in darker skin, and some devices, including IPL, are avoided or used cautiously. Laser hair reduction, in particular, is safe and effective in dark skin with appropriate technology. Always ask about a provider’s experience with your skin tone.

Do people with dark skin need sunscreen?

Yes. Melanin provides some protection, roughly equivalent to SPF 13 in the darkest skin, but not immunity to sun damage, aging, or skin cancer. In skin of color, sunscreen also prevents dark marks and melasma from deepening, since visible light and UV both stimulate pigment. A tinted mineral sunscreen with iron oxides blends into darker skin tones without a white cast and blocks visible light.

What causes a dark streak in a fingernail or toenail?

A brown or black band running the length of a nail is usually benign in people with darker skin, especially when several nails are affected and the bands have been stable for years. However, a single new band, one that is widening, darker at one edge, or spreading onto the skin around the nail (Hutchinson sign) can be melanoma under the nail and must be examined by a dermatologist promptly.

Why is my hair thinning at the crown?

In Black women, thinning that starts at the crown and spreads outward, often with itching or tenderness, is frequently central centrifugal cicatricial alopecia (CCCA), a scarring hair loss. Because scarred follicles do not regrow, early diagnosis and anti-inflammatory treatment are critical. Thinning at the temples and hairline is more often traction alopecia from tight styles, which regrows if the tension is relieved early.

How can I prevent keloids?

If you or a family member has formed keloids, tell your dermatologist before any piercing, biopsy, or surgery. Avoid unnecessary skin trauma and elective piercings on the chest, shoulders, and ears. After a necessary procedure, silicone sheets or gel, pressure earrings after earlobe surgery, and early cortisone injections into a scar that is thickening reduce keloid formation. Existing keloids are treated with injections and, in selected cases, excision followed by injections.

Related reading: melasma treatment, earlobe repair and keloid removal, hair loss, melanoma, our sunscreen guide, and the patient education hub.