8 Skin Conditions to Watch For If You Have Melanin-Rich Skin

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This story is a part of The Melanin Edit, a platform in which Allure will explore every facet of a melanin-rich life — from the most innovative treatments for hyperpigmentation to the social and emotional realities — all while spreading Black pride.

Skin is such a critical and complex part of the human body. Add a dash of melanin, and it's no surprise that it makes for even more complexities. Still, darker skin, in all its glory, should be celebrated and cared for, notes Susan C. Taylor, a board-certified dermatologist in Philadelphia.

In 2004, Taylor established and served as the first president of the Skin of Color Society, an organization committed to educating providers and the general public on dermatologic health related to skin of color, calling the need for a thorough understanding of dark skin "critically important." She notes that as the nation's population becomes more ethnically diverse, the dermatological community will continue to see and treat skin conditions that occur more often, present differently, or are unique to Black people and other people of color.

"Since [establishing the Skin of Color Society], we have made terrific inroads in terms of understanding skin of color a little bit better and prioritizing skin of color," says Taylor, adding that the collective endeavor has led to lectures and conferences centered around dark skin and more representation in mainstream dermatology textbooks.

In this guide, we'll dive into the most common skin conditions for those with darker skin, breaking down exactly what you need to know to identify — and treat — them. 

First, what is melanin and how does it work?

Before we talk about how to properly treat melanin-rich skin, it's important to know exactly what melanin is. Melanin is the pigment that causes your skin color. There are two types of melanin: eumelanin (brown pigment) and pheomelanin (yellow pigment).

A quick search of the hashtags #melanin and #melaninqueen on Instagram validates that the term "melanin-rich skin" has become mostly associated with darker skin tones. But Jenna Lester, a board-certified dermatologist based in San Francisco, says most people have some sort of balance of the two types of melanin. 

Depending on a person's skin color, they may have more of one type than the other. In general, eumelanin is more prevalent in people with darker skin. "So it's not that people with dark skin have more melanin, they just have more of a different type of melanin," says Lester.

Melanin is produced in cells called melanocytes, which are present in the lower layer of the skin, says Taylor. After making melanin, the melanocytes put it into packages called melanosomes, which are then transferred into the skin cells. In addition to providing pigmentation, melanin also serves as a protective agent. For example, eumelanin protects you to some extent from burning when exposed to the sun, says Taylor.

Common skin conditions that impact dark skin tones

Click to jump to a specific condition:

• Post-inflammatory hyperpigmentation
• Melasma
• Keloids
• Dermatosis papulosa nigra
• Pseudofolliculitis barbae
• Traction alopecia
• Acanthosis nigricans
• Vitiligo

Post-inflammatory hyperpigmentation (PIH) is a result of injury to the skin, be that acne, a burn, insect bites, or any other damage. Because skin of color has more brown pigment, there is more of a chance for PIH, says Michelle Henry, a board-certified dermatologist in New York City.

"Those little melanosomes are full of pigments, and they’re so full that they’re almost bursting," she explains. "So that means anything can kind of bump them and cause them to leak." Leakage of that dark-colored pigment results in hyperpigmentation (which is, essentially, more color) in areas of the skin where it typically isn't. Cue those dark marks or spots left behind after a pimple.

When it comes to the treatment of hyperpigmentation, Massachusetts-based board-certified dermatologist Uchenna Okereke says studies have shown sunscreen use alone can help significantly reduce the appearance of dark marks in darker skin.

"Consistent use of sunscreen is really the first step in treating hyperpigmentation," she says. "Sunscreens with physical blockers like zinc oxide and titanium dioxide help block harmful UV rays from the sun, which will prevent worsening of dark marks."

There are a number of ingredients that can be used to help improve hyperpigmentation, including hydroquinone, glycolic acid, cystamine, kojic acid, azelaic acid, and alpha arbutin. Okereke advises seeing your board-certified dermatologist to help identify which are best for you.

Many times, there are over-the-counter options to help treat discoloration due to hyperpigmentation. We like the Topicals Faded Brightening & Clearing Gel, which is made with kojic acid and licorice root, as well as the Best of Beauty Award-winning CeraVe Resurfacing Retinol Serum, formulated with niacinamide and retinol.

Topicals Faded Brightening & Clearing Gel

CeraVe Resurfacing Retinol Serum

Melasma is an acquired skin condition that presents as darkened patches on the skin, typically on the forehead, cheeks, and upper lip. Breaking it down to the skin cells, people with darker skin have more active melanocytes than people with lighter skin, according to the American Academy of Dermatology Association (AADA). In the case of someone diagnosed with melasma, those pigment-producing cells are stimulated to create more pigment, resulting in darker discoloration, says Lester.

Melasma is also referred to as "the mask of pregnancy." That's because it's sometimes linked to hormones, says Henry. "We see it with pregnancy, we see it post-menopause, any of these hormonal changes can cause it," she says.

But melasma isn't isolated to periods of hormonal shift, Henry notes. She's seen people with melasma at all stages of life, adding that the patches and blotches sometimes go away on their own or they can stick around for a longer period of time.

Foundational to the treatment of melasma is the use of sunscreen, says Taylor. "People with melasma want to block out [ultraviolet (UVA and UVB) light] and visible light," she explains. "Because those three wavelengths of light can worsen melasma, make it darker, and can prevent medications from being as effective as they could be."

She notes that in addition to sun protection, lightening products may also be used. A prescription topical medication Taylor recommends is Tri-Luma, which contains hydroquinone (4 percent), tretinoin (.05 percent), and the corticosteroid fluocinolone acetonide (.01 percent). "Those three ingredients together have been demonstrated to be superior in lightening melasma as compared to a combination of any two of those ingredients paired together," she notes.

Some dermatologists also recommend the SkinCeuticals Discoloration Defense Serum, which is formulated with kojic acid, tranexamic acid, and niacinamide, but we also like the niacinamide- and pro-retinol-laced Melé Even Dark Spot Control Serum as an under-$25 option. Chemical peels can also be integrated into treatment to lighten the pigmentation of melasma, Taylor says.

SkinCeuticals Discoloration Defense Serum

Melé Even Dark Spot Control Serum

Keloids are an overgrowth of scar tissue. They present as a thick, dense, hard lump on the skin that can range in size. Clinically, Lester has seen patients develop a keloidal scar after having their ears pierced, as a result of a surgical incision or an acne lesion, or after another injury to the skin.

"Keloids are most common in our patients with skin of color," says Elizabeth Kiracofe, a board-certified dermatologist in Chicago. "And those of African descent are at the highest risk for the development of keloids." Kiracofe says the reports of familial cases suggest a genetic contribution to the development of keloidal scars. "When it does occur in families, it does so in an autosomal-dominant fashion, meaning that half of the family is at risk," she adds.

It is critical to understand the impact of a keloid on a person's quality of life, says Kiracofe. The growth of a keloid scar can sometimes be marked with itching or pain. And, depending on the size and location of the scar, it can carry aesthetic concerns or discomfort with movement. Plus, there's the frequency of the keloid returning after removal.

While there is no one treatment that is 100 percent effective at preventing the recurrence of keloids, Kiracofe stresses that keloids are treatable. Treatment options include intralesional steroid injections into the keloid, surgical removal, and laser therapy, among others. Depending upon the case, your dermatologist may recommend more than one treatment at a time.

Dermatosis papulosa nigra (DPN) is a condition where benign growths resembling moles or freckles grow on the cheeks and around the eyes. They are known colloquially as "Morgan Freeman spots," as the raised growths on the actor's face have become more prominent throughout his decades-long career. "They usually start out as small, flat, brown to black lesions that slowly become larger in size with time," says DiAnne Davis, a board-certified dermatologist based in Dallas.

As many patients report a family history of DPN, this may suggest that there is a genetic predisposition to developing the papules. DPN is not dangerous and doesn't require treatment, though some people opt to have the growths removed for cosmetic reasons.

The removal procedure is called electrodesiccation. Davis explains that topical lidocaine is used to numb the skin before the procedure. Next, a needle-shaped electrode is used at a very low setting to "dry up the tissue" using a high-frequency electric current.

"After the procedure, the lesions will turn darker for a couple of days and slowly fall off," she says. Removal is permanent, says Davis, but patients can develop new growths in other places, like the neck and chest. 

Pseudofolliculitis barbae (PFB), also known as razor bumps, is an inflammatory condition of the skin caused by a hair-removal process, like shaving.

PFB is seen more frequently in skin of color as a consequence of the shape of the hair follicle, says Henry. For Black people, the follicles tend to be curved instead of straight and that encourages the hair to curl back toward the skin. "Black, curly hair may start to curl while it's growing, even before it exits the follicle, or it may curl right after exiting the follicle," Henry explains. "And so now you've cut the hair, and it's growing out, and it's going to pierce the skin, come back in, and create an ingrown hair."

Barbae is Latin for beards, so people tend to associate PFB only with Black men because of their facial hair, says Lester. But she also sees PFB in women of color who have hair growth on the face or in the groin or bikini area.

For a more delicate zone like the bikini area, Lester recommends shaving with the hair growth instead of against it and using a sharp, multi-blade razor. She also recommends depilatory hair removal creams, like Nair or similar products, but warns to be vigilant in assuring that it doesn't get into any sensitive areas down below.

Gillette Venus Sensitive Razor

Nair Hair Remover

Constant pulling on the hair in styles like braids, weaves, cornrows, and tight ponytails leads to long-standing trauma and then hair loss, known as traction alopecia, explains Henry. It's important to note that high-tension hairstyles cause hair loss in both natural or chemically relaxed hair, she adds.

In cases of traction alopecia, because the hair loss follows where there's tension on the scalp, stopping whatever process is causing that stress is key, says Yolanda Lenzy, a board-certified dermatologist in Chicopee, Massachusetts. "I recommend for patients to rotate their hairstyles," Lenzy explains. "So if you had braids in for four to six weeks, you need to wear your hair out for at least that period of time to give it a break from the tension and the weight."

The second step in treatment for traction alopecia is to target the inflammation, she says. With a small, hand-held dermatoscope, Lenzy is able to look at her patients' hair follicles to see indicators of the condition. "I can see redness, I can see small bumps called pustules, like little puss bumps, around the follicles," she says. "And that's a sign that those follicles are under a lot of stress." To decrease the inflammation, Lenzy recommends topical anti-inflammatories, like cortisones. Depending on the severity of the case, she sometimes compounds that with minoxidil, which is the active ingredient in Rogaine.

"What that will do is help those residual hairs to thicken," Lenzy explains. "Because a lot of times, the hairs that are left are very, very thin and fragile." Depending upon the severity of the case, treatment can also include hair transplantation surgery, she says.

When talking about some of these hairstyles that can cause traction alopecia, the context of Black women adhering to Eurocentric beauty standards as a survival mechanism cannot be discounted, says Lester. If you've been told your natural hair is unprofessional, "it's very easy to internalize that in a way that suggests you should change your hair somehow, so that it looks like all the things you're seeing and associating with beauty," she says.

Progress in that area looks like legislation called the Creating a Respectful and Open Workplace for Natural Hair (CROWN) Act. In 2019, California became the first state to sign the CROWN Act into law, which banned discrimination against natural Black hairstyles. The CROWN Act is law in eight states, as of April 2021.

Hair loss at the crown of the head that spreads outward is known as central centrifugal cicatricial alopecia, or CCCA. The exact cause of CCCA is unknown. While certain hair-care practices and hairstyles have been associated with triggering scarring in the crown area that leads to hair loss, a lot more research is being conducted to try and pinpoint why CCCA happens, says Lester. "There are people who've always used low-tension hairstyles and have never used chemicals or anything like that who also get it," she says. "So it's not just about hairstyling."

Cicatricial comes from the Latin word for scar and CCCA is the most common form of scarring hair loss in Black women, as noted by multiple dermatologists on our expert panel. Inflammatory cells, such as lymphocytes, lead to the destruction of the hair follicle, explains Lenzy. 

In her practice, Lenzy performs a biopsy to diagnose the condition. Under a microscope, the pathologist can see the inflammatory cells. "The hair follicle becomes replaced with scar tissue," she says, "so if we look at it under the [dermatoscope] we no longer see the hair follicles. We see scar tissue." Areas that are scarred in this way generally do not grow back, says Lenzy. Some people, however, will have hairs that have "stunted growth," she notes, which dermatologists can encourage to grow back by controlling the inflammation and adding in other treatment options. 

This is why the early and accurate diagnosis of CCCA is so important, she says, adding that she also tends to treat CCCA more aggressively. "I have found that when it's not treated aggressively enough, it tends to progress faster," she says. "So I use things like oral antibiotics, not because it's an infection, but because the antibiotics are anti-inflammatory."

Lenzy uses some of the same treatments for CCCA as she does for traction alopecia (topical cortisones compounded with minoxidil). And she sometimes opts for steroid injections for deeper penetration into the scalp and nutraceuticals to help with the growth and thickness of the residual hairs. Treatment for CCCA is often a months-long, complex process, says Lenzy. She recommends that patients seek out a board-certified dermatologist, preferably one who specializes in hair loss.

Cancer is an uncontrolled proliferation of cells, explains Taylor. When that abnormal, out-of-control growth of cells occurs in the skin, it's called skin cancer. 

Skin cancer is the most common cancer in the nation, Taylor notes, meaning dermatologists see and treat it quite often. The most common types of skin cancer include basal cell carcinoma, squamous cell carcinoma, and melanoma. Melanoma is the most serious form of skin cancer because of its tendency to spread, according to the American Academy of Dermatology (AAD).

One must-have that reigns supreme, regardless of skin color, is sunscreen. This is because sunscreen also acts as a protectant against accelerated aging, which in darker skin doesn't necessarily mean wrinkles, says Lester. It can appear as uneven skin tone or other evidence of chronic sun exposure.

Skin cancer, in general, is less common in people with darker skin, but that doesn't mean it can't happen, she says.

For example, people with darker skin are more likely to get skin cancer in areas that are typically protected from the sun, such as the palms, soles of the feet, or under the nails, says Lester. This is called acral lentiginous melanoma, which can begin as a patch of discolored skin or a dark streak on the nails.

Despite it occurring less commonly, Black people diagnosed with melanoma have poorer survival rates than white people, according to a 2019 study by researchers at the Centers for Disease Control and Prevention (CDC) and the American Cancer Society. That's why it's important for people of color to keep an eye on those areas. And if they see a new dark spot or streak appear or a dark spot growing in size, Lester encourages them to go to their dermatologist to determine if there's cause for concern. 

Acanthosis nigricans (AN) is a skin condition characterized by "velvety" darker and thicker patches, says Hope Mitchell, a board-certified dermatologist in Ohio. It is most commonly found in the armpit, groin, or neck folds and creases, where skin lines become deeper and more noticeable. Symptoms in these areas may include itching and odor and can also be accompanied by skin tags.

AN is much more common in people with darker skin pigmentation, Mitchell says. She's found the discoloration and change in skin texture due to AN can be quite vexing for her patients of color. "Some people believe the skin is dirty or tainted with a product that has discolored the skin," she says of the patients who come to see her for diagnosis. "During the evaluation, people may report scrubbing the skin because, for example, they believe they have a dirty neck."

The presence of acanthosis nigricans may represent an underlying health condition in association with obesity, insulin resistance, prediabetes, diabetes, thyroid disease, or polycystic ovary syndrome (PCOS), notes Mitchell. If this is the case, your doctor may address those underlying health concerns first, which may help improve the skin discoloration.

The treatment of AN is multifaceted, "partly because there can be more than one association with the condition," says Mitchell. She recommends clindamycin (an antibiotic) and antibacterial cleansers applied directly to the area to decrease any odor from secondary infection in the folds. Topical or oral retinoids may also aid in thinning the areas that are thicker than the surrounding skin, she says. And creams with exfoliative and lightening properties may be used as well. Some of Mitchell's favorite ingredients used for the treatment of this condition include urea, salicylic acid, retinoids, glycolic acid, lactic acid, and hydroquinone. 

We recommend Ole Henriksen's Invigorating Night Transformation Gel, a glycolic and lactic acids-based treatment, along with the newly launched La Roche-Posay Glycolic B5 10% Pure Glycolic Acid Serum. The drugstore serum has glycolic acid as well as tranexamic acid and is better suited for sensitive skin types.

Ole Henriksen Invigorating Night Transformation Gel

La Roche-Posay Glycolic B5 10% Pure Glycolic Acid Serum

Vitiligo is a condition that causes the skin to lose its natural pigment. It's an autoimmune condition, which means your body is producing inflammatory T-cells that attack the melanocytes (the cells that produce pigment), explains Lenzy. "And then you're left with these white patches. They can pretty much happen anywhere on the body."

It's unclear exactly what causes vitiligo, but doctors believe there is a genetic susceptibility combined with an autoimmune condition, like lupus or thyroid disease, that mistakenly attacks the melanocytes, says Mitchell. Vitiligo is neither contagious nor life-threatening. It can occur in people of any race, age, ethnicity, or gender, she says. Though the white patches may blend into someone with lighter skin, they are very noticeable in people with darker skin, Mitchell says. "Because vitiligo affects a person's physical appearance, the psychosocial burden may be significant," she explains, adding that varying levels of emotional distress and stigmatization may occur.

Sun protection is essential for people who have vitiligo because the loss of melanin will cause them to burn more easily. Mitchell also recommends that patients try to avoid trauma and limit stress as both can "start a cascade of inflammation that can attack the melanocytes, causing pigment loss." Treatment begins with correcting any underlying autoimmune conditions, says Mitchell. Options to promote re-pigmentation are available and have proven to be effective, says Lenzy. She has found success using tacrolimus ointment, a nonsteroidal anti-inflammatory agent.

Phototherapy, where exposure to light sources is used to treat certain medical conditions, is also an option, says Mitchell. Also known as light therapy, the treatment is conducted at your doctor's office with a set frequency over a period of months to see improvement, she says.

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