From rashes to eczema to cancer, all sorts of conditions affect the skin. But skin conditions can look very different from person to person, depending on skin tone. Unfortunately, that can sometimes delay the diagnosis of skin conditions—even common conditions—in people of color.
“Modern dermatology started in Europe, and historically, textbooks described skin conditions based on how they appeared in white individuals,” says Henry W. Lim, M.D., a dermatologist at Henry Ford Health. Fortunately, that’s changing, and doctors today are more likely to be trained to recognize the way diseases appear in every skin tone. Still, not everyone is aware of the range of appearances in rashes or other skin problems.
Dr. Lim describes what you should know, and what to look for.
Signs of Skin Problems in Pigmented Skin
Skin gets its color from melanin, a pigment produced by cells called melanocytes in the skin. Melanin helps protect against UV rays, and darker skin colors evolved to protect people in areas of the world that receive a lot of sunlight.
Melanin doesn’t fully protect against the sun, however, Dr. Lim stresses. Even dark-skinned people can get sun damage if they don’t apply sunscreen or otherwise protect themselves from the sun.
Melanin doesn’t just change the color of one’s skin. It also impacts the appearance of certain skin conditions. Here’s what to expect.
Rashes
Rashes have many causes, including allergic reactions, infections and irritation from chemicals. In people with little melanin, rashes commonly look pink or reddish. In people with more melanin, rashes might be darker and less noticeable—or in some, they might look lighter.
One example of these differences is seborrheic dermatitis (commonly known as seborrhea), a condition that causes rashes with fine scales on oily areas like the scalp or face. In lighter-skinned people, that rash is usually red and raised. In darker-skinned people, it’s often flatter and can look purplish or pink, lighter than their natural skin tone.
Skin cancer
Skin cancers are more common in fair-skinned people, but anyone can develop them.
- Squamous cell carcinomas usually look like scaly, crusty sores. They can look reddish on fair skin but often look dark and pigmented on darker skin.
- Basal cell carcinomas appear as pink or red bumps on paler skin. They’re often translucent, so you can see blood vessels under the skin, Dr. Lim says. In darker-skinned people, these spots tend to have brown or black pigment.
- Melanoma is the most dangerous form of skin cancer. Melanomas can look like moles, and in fact they often develop from moles. The biggest difference in melanomas between people with different skin tones is their location, Dr. Lim says. In fair-skinned people, melanomas are more likely to develop in areas exposed to the sun. In darker-skinned people, they’re more often found on the soles of the feet.
Mycosis fungoides
Mycosis fungoides is a type of lymphoma, a blood cancer that can cause changes to the skin. In light-skinned people, it’s usually reddish or light brown in color, with fine wrinkling of the skin. But in darker-skinned people, the spots tend to be lighter than the surrounding skin. The disease also tends to be more aggressive in darker-skinned people, Dr. Lim adds.
Vitiligo
Vitiligo is an autoimmune disorder that affects melanocytes—the cells in the skin that produce melanin. The disease causes light or white patches on the skin where melanin is absent.
Vitiligo can affect people of all skin tones, but it’s often less obvious in fair-skinned individuals. “In darker-skinned individuals, there’s more contrast between light and dark areas, so it’s harder to mask,” Dr. Lim says. “For that reason, it can be more bothersome to dark-skinned people. Fortunately, we have treatments and patient support groups to help people manage this condition.”
Rosacea
Rosacea is a skin condition that affects the face. In people with light skin, the most common signs are red bumps with a pimple-like appearance. The condition also causes red blotches on the cheeks and nose. Darker-skinned people can also develop rosacea, but it might not be very noticeable in early stages, especially the red blotches.
Dermatology At Henry Ford
Acne
After pimples heal, it’s common to be left with some discoloration where the spot was. In fair-skinned people, that looks like a reddish spot that usually fades in a month or two. In darker-skinned people, acne can leave behind very dark discoloration known as post-inflammatory hyperpigmentation. “This discoloration can last as long as a year and is often more bothersome for people than the acne itself,” he says.
Fortunately, there are now good treatments to lighten post-inflammatory hyperpigmentation, so it’s worth talking to a dermatologist about your options. Protecting the skin from sunlight, including applying sunscreen, is a must to minimize post-inflammatory hyperpigmentation, Dr. Lim stresses. He recommends tinted mineral sunscreen that contains iron oxides. “Tinted sunscreen comes in different colors to match the natural skin tone of the user, so select one that is most appropriate for your skin tone,” he adds.
Whatever color your skin is, reach out to a dermatologist if you have any concerns, Dr. Lim says. And protecting skin from excessive sun exposure, including the use of sunscreen, is key for everyone, he adds. “No matter your skin tone, it’s important to protect your skin from sun exposure.”
Reviewed by Henry W. Lim, M.D., a dermatologist and the chair emeritus of the Department of Dermatology at Henry Ford Health. He sees patients at Henry Ford Cancer — Detroit and Henry Ford Medical Center — New Center One.
