What should be considered when caring for dark skin?

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What should be considered when caring for dark skin?

A dermatologist explains which skin diseases are more likely to occur with dark pigmentation, gives tips for the daily skincare routine and clears up common myths .

Can dark skinned BIPoC* safely do without sunscreen? Which products should not be missing (and which should be avoided) in the skincare routine of dark skin types? How do I recognize a rash on dark skin?

As a black person/ person of color* in a white majority society, it is often not easy to get information and products that match your own skin type or to find doctors who are also familiar with non-white skin. We have with Univ.-Prof. dr Angelika Hofer , Professor of Dermatology at Med Uni Graz , talked about the needs of dark skin – and learned a lot of new things:

BIPOC , BPOC , and POC are English acronyms that stand for Black and Indigenous and People of Color, Black and People of Color, and People of Color, respectively.

The myth keeps circulating that light and dark skin differ in texture or that dark skin is a bit thicker, firmer – complete nonsense or is there something to it?

Angelika: Myths of this kind come from studies that are mostly many years old. Unfortunately, the study situation on this topic is still not that comprehensive, but in individual areas we know a little more: The skin of darkly pigmented people is not thicker, but it is said that there are more cell layers, since the cells are connected to each other in a more compact way. This can mean that certain diseases can occur more easily than in people with lighter pigmentation.

There are also differences in the subcutaneous tissue, the dermis. For example, with the enzymes that break down connective tissue fibers, the activity of the cells is also likely to be slightly different, which explains why people with darkly pigmented skin have a particular tendency to scarring.

Which skin diseases are more likely to occur with dark skin types?

Various pigment disorders – also simply because they are more noticeable on dark skin than on light skin – and as far as the deeper skin layer is concerned, hair root inflammation, which can also lead to scarring. This is because the hair structure of darker pigmented people is slightly different than that of lighter pigmented people. The hair is often more curled, not quite as round in structure, but more of an elliptical shape, which irritates the hair root shaft a bit more, for example when the hair is pulled hard. This causes the hair roots to become more sensitive and inflammation to occur more often, and in some cases hair loss.

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What you see again and again in older people with dark skin: papules on the face, i.e. tiny, raised thickening of the skin like Morgan Freeman has. They are perfectly harmless, sometimes cosmetically unpleasing. We never see the same thing with lighter skin – this is where age spots come from.

In many cases it is not possible to tell whether these conditions or conditions occur because someone has dark or light skin or because the genetic predisposition has been passed on within a particular population.

Pigment disorders, scarring – can something be done about it?

You can definitely prevent it, that’s the most important thing here. Once there are scars – regardless of whether the skin is light or dark – they are difficult to treat. It is also important to give good advice here. If I have patients who are dark-skinned and require surgery, I explain that the scar thickens more easily in certain areas than in others.

This should also be taken into account when piercing and tattooing, for example. If tattoos are not done well and inflammation occurs, severe scarring can occur. It is important to treat injuries properly and to make sure that the whole thing does not become additionally inflamed and scars are the result.

Some people try to even out their skin tone with bleaching creams if they have pigment disorders. The problem with such creams is that they can cause spotty reactions and are often very harmful to health. Some of these creams contain mercury compounds or hydroquinone, a substance that causes massive cell damage. The use of this active ingredient is now regulated worldwide due to its severe side effects and is only permitted in very low concentrations in bleaching creams.

How to prevent pigment spots? Is that possible?

If people who have skin inflammation – especially those with dark skin – go out in the sun or if inflammation persists for a long time, dark spots often develop in the relevant areas, which then remain. It is therefore important to prevent this inflammation and, for example, to treat acne well preventively (open pores with appropriate care, …) so that serious pimples and severe inflammation do not occur in the first place. Should inflammation occur, dark skin types should avoid too much sun for a few days.

You should also be careful with care creams with fragrances (bergamot oil), which are not approved in the EU. In combination with sunlight, permanent dark discolouration can occur on the skin areas to which these fragrances have been applied.

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With a rash on white skin, you can see red spots. However, when a darkly pigmented person has a rash, you will see brown patches of various shades. Here it is important to rethink.
by Univ.-Prof. dr Angelica Hofer
Is it true that people with dark skin can stay in the sun for a long time without it damaging their skin?

The more pigmentation in the skin, the longer you can stay in the sun without getting sunburned or increasing your risk of skin cancer. In very heavily pigmented people, the likelihood of sunburn is actually low. Sunscreen is still useful, also to avoid these increased spots after inflammation.

What is often forgotten: Since the skin absorbs less sun due to the dark pigmentation, the body can produce vitamin D more difficult. In the vicinity of the equator, the sun is always sufficient to ensure vitamin D formation even in very darkly pigmented skin. This is often not the case with us, which is why it can do no harm to have the vitamin D level determined in a laboratory check and to substitute the vitamin D if necessary.

While the risk of melanoma is generally low in dark skin – where the skin is darkly pigmented – you are not protected from melanoma on the palms, soles, or genitals.

How to recognize melanoma on dark skin?

Even with very dark skin, birthmarks are usually still recognizable because the skin in this area is a bit darker. Melanomas are usually noticeable by growing and becoming elevated over time. As a rule, it is noticeable that a change is taking place.

And what about skin rashes?

This is actually often difficult for us doctors: if you have a rash on white skin, you can see red spots. However, when a darkly pigmented person has a rash, you will see brown patches of various shades. It is therefore important to rethink here, because brown spots on light skin types always mean that it is something old, something that is already healing, nothing acute.

I then ask myself the question, for example: what could it be if it were bright red spots? This way you can better assess how acute the disease is and find a diagnosis more easily. It definitely takes some practice.

A well-known example is erysipelas, a viral disease that often occurs in young adults. While the disease is relatively similar in people with white skin, you can see that people with dark skin often show very different courses, sometimes the face is affected, which is otherwise rarely affected, erysipelas often occurs repeatedly, etc.

Why do you only see signs of skin aging later in black skin?

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Skin aging is primarily caused by UV light. It ensures that collagen is broken down and the connective tissue becomes more brittle, elastic fibers multiply, and hyaluronic acid is broken down – this causes wrinkles. The dark pigmentation or the higher proportion of melanin absorbs UV radiation better, which is why signs of skin aging often appear around ten years later in people with very dark pigmentation.

Do you have any specific skincare routine tips?

People with darker pigmentation often tend to have oily skin, and acne is also common, so it would be important to avoid greasy ointments on the face. These cause inflammation. However, you should still moisturise, for example with a mild care cream containing hyaluronic acid. If dark skin is dry, it often looks a bit greyish. Moisturizing care achieves a very nice color intensity. A mild peeling, for example a chemical peeling with mild salicylic acid, can also help against acne. For sunscreen, SPF 15 is sufficient for very dark skin.

When it comes to anti-aging products like vitamin A acid supplements, I would advise paying close attention to what ingredients are included to avoid bleaching substances. Everything that is available in local shops can basically be used without any problems as long as there is no underlying disease.

Textbooks generally show far too few people with dark skin with the relevant skin diseases.
by Univ.-Prof. dr Angelica
You have already mentioned that it takes practice to recognize clinical pictures on different skin types – do you even learn that during your studies?

This is a very important point. I myself am a lecturer in dermatology at Med Uni Graz and my students have often told me that they want to see more photos of diseases on dark skin – so this is something that we are now very actively involved in.

Textbooks generally show far too few people with dark skin with the relevant skin diseases. Probably because the picture is not as memorable as with fair skin, but of course you would have to show both. I try to implement this in my lectures.

I also think that more studies are needed in general, for example to determine why certain diseases, such as keloids, are more likely to occur in darker skin. Research should deal more with how dark pigmented people can be protected in the best possible way, whether differences in the therapy of dark and light skin are necessary, etc. – we hardly know anything about that so far. It’s a subject that’s clearly under-researched, but the need is definitely there.

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