Different skin tones require different skincare. Patients with darker skin tones are much more prone to experiencing hyperpigmentation and keloid scarring than those with lighter skin tones, and this is an essential consideration to make when selecting ideal skincare products and in-office cosmetic treatments. Melanoma, the most severe form of skin cancer, is also often overlooked in patients with darker skin tones, being diagnosed in much later stages than in patients with light skin. Dr. Michele Green in New York City is a board-certified cosmetic dermatologist with over two and a half decades providing patients from around the world, with all different skin tones, with the best in everything related to overall skin health and appearance.
It’s important for dermatologists to have a thorough understanding of how skin conditions manifest in patients of different skin tones, as well as have the expertise to recommend treatments that are appropriate, safe, and effective. Patients of different skin tones should not be disadvantaged when it comes to receiving proper care for their skin due to a healthcare providers inexperience with their skin tone. Not only do some skin conditions, like eczema and psoriasis, present differently on patients with darker skin tones, but the treatments that are appropriate for managing different dermatological conditions can also be influenced by skin tone of a patient.
Dr. Michele Green in NYC is a cosmetic board certified dermatologist with a wealth of experience treating patients of different ethnicities, male and female, at her private office in the Upper East Side Neighborhood of New York City. New York City prides itself as being one of the most ethnically diverse cities in the world, and Dr. Green uses the latest technology in dermatology treatments, including chemical peels, Cosmelan, and laser skin treatments, in order to find the best solution for patients of any skin tone. From skin cancer to hair loss, ethnic skin needs special care and thoughtful consideration, and Dr. Green always prioritizes customizing patient treatment plans to cater to their unique needs. The following guide provides an overview on some of the more common issues surrounding darker skin tones and the treatments that Dr. Green utilizes at her Upper East Side NYC dermatology office.
Dermatologists and skin cancer exams
Skin cancer screenings are the most common exams performed in medical dermatology. Dermatologists, like Dr. Michele Green in NYC, treat a myriad of skin diseases, from alopecia, melasma, dermatosis papulosa nigra (DPNs), to skin cancer. Skin cancer is an important consideration that is too often forgotten in patients with skin of color. Dr. Michele Green offers each new patient a complete skin cancer examination, since all patients are susceptible to the serious effects of skin cancer and melanoma. One of the most important health considerations in patients with darker skin tones, is that patients are often diagnosed with skin cancer in its later stages. According to the Skin Cancer Foundation, the 5-year survival for African American patients in the United States is 65% compared with 91% in Caucasian patients. In general, skin cancer among African Americans in the US account for 1-2 percent of all skin cancers, Hispanic patients 4-5 percent, and Asian patients 2-4 percent. Since it can be more difficult to diagnose skin cancer in darker skin patients, it is very important to consult an expert dermatologist since the delay in diagnosis can have such serious implications.
The most common area for patients with dark skin to develop a skin cancer is on the bottom, or plantar surface of the foot. Between 30 and 40 percent of all skin cancers in people of color occurs in the plantar area of the foot. The most common areas for skin cancer in African American patients are the:
- Plantar surface of feet
- Mucous membranes such as the mouth
- Lower legs
- Anogenital area
It is extremely important to have a complete skin cancer exam, especially for African American patients, since early diagnosis leads to prompt treatment and improved patient outcome.
Acne treatment, 10 months before and after
African American Skin
African American skin varies in tones and shades and differs in skin properties than lighter skin tones. Studies have found that the dermis, the middle layer of the skin, tends to be thicker due to a higher amount of collagen in the skin. This means that the skin has better protection against the visible signs of aging such as fine lines, wrinkles, sun damage, and skin laxity. Fibroblasts, the skin cells responsible for collagen production, are also at a higher concentration in darker skin. A higher concentration of fibroblasts can lead to increased risk of thick scars and keloids. Melanocytes are the skin cells that are responsible for generating pigment. In individuals with darker skin, the melanocytes produce more melanin than in individuals with lighter skin. Melanin is the pigment that determines the skin color. This increased amount of melanin is beneficial when it comes to protecting the skin from sun damage and sun burns, however, it also contributes to making darker skin toned individuals more prone to discoloration because the melanocytes are more sensitive. Hyperpigmentation and an uneven skin tone are common issues in African American skin. Furthermore, there is evidence that suggests that black skin has higher transepidermal water loss, which means that darker skin loses moisture more easily.
Skin care in skin of color
Proper skin care in patients with darker skin tones, is extremely important since ethnic skin is very sensitive. There are unique considerations in treating dark skin, which one must be cognizant of, in order to treat skin of color effectively and safely. Darker skin tones are much more susceptible to discoloration and hyperpigmentation. Since darker skin tones are more prone to hyperpigmentation and sunspots, proper sunscreen is essential to use on a daily basis. Dr. Green recommends an SPF of 50 daily which has both UVA and UVB protection. Vitamin C serum is also a very effective antioxidant to help repair the daily damage from the sun and restore an uneven complexion. Gentle cleansers are also vital for sensitive skin, as are daily moisturizers. In acne prone skin, it is very important to use non-comedogenic products. This is especially true in patients with darker skin, as they are more susceptible to hyperpigmentation and dark scars from acne breakouts. Hydrafacial is also a very effective way to maintain healthy and clean skin, and both prevent and treat discoloration and uneven skin tone.
What is the best facial cleanser for African American skin?
The best facial cleanser for African American skin will be a non-irritating and gentle formula. Cerave Foaming Face Wash is a perfect gentle cleanser option for sensitive and acne-prone skin. The formula is effective for achieving a deep cleanse without the inclusion of any harsh exfoliating agents that may lead to skin irritation. This cleanser is also packed with hyaluronic acid, niacinamide, and essential ceramides that provide essential skin hydration. These ingredients boost the health of the natural protective barrier of skin, enhancing skin protection and helping skin look and feel its best. When you consult with board-certified cosmetic dermatologist Dr. Michele Green in her boutique dermatology office located in the Upper East Side neighborhood of Manhattan, you’ll have the opportunity to discuss with her in-depth regarding your specific skin concerns, and discover which skincare products are best for you and your skin.
What is the best facial product for African American skin?
SPF is one of the most important facial products for patients of every skin tone. Although African Americans are less likely to develop skin cancer due to some natural sun protection provided by melanin in skin, African American patients who are diagnosed with skin cancer are, unfortunately, diagnosed in later stages than patients with light skin tones. Having regular skin cancer screenings and wearing sunscreen on a daily basis can help keep patients healthy. Sunscreen should be broad-spectrum, indicating that it offers protection against both UVA and UVB rays. It should also be reapplied every 1.5-2 hours for best coverage. Active ingredients like zinc oxide and titanium dioxide should be included in the sunscreen’s formula. Regular use of sunscreen can also help protect against the development of melasma. Melasma is a skin condition characterized by brown or grey-brown patches on the skin that are darker in color than the rest of surrounding skin. Because African American skin is more susceptible to development of melasma and hyperpigmentation, skin-brightening ingredients like vitamin C are one of the best to incorporate into a daily skincare regiment. Vitamin C is a powerhouse of a skincare ingredient, boosting collagen production in the skin that leads to firmer, brighter, smoother, and healthier skin overall.
Botox, Voluma 1 syringe and Juvederm 1 syringe
Acne Scarring and Hyperpigmentation in African American skin
There are a number of different ways to treat the scarring that has resulted from a previous episode of acne, however not all the treatments on the market are necessarily suitable for darker skin tones. For example, African American patients respond differently to laser treatments than those with lighter skin types. The goal is to prevent acne breakouts, and provide the best acne treatment to avoid unwanted acne scarring. Since skin of color is prone to hyperpigmentation, careful laser selection and use of these lasers, is critical in having safe and effective cosmetic results.
One common issue that can affect darker skin is post-inflammatory hyperpigmentation (PIH), which results in the darkening of the skin from acne and acne scars. This discoloration is pigmentation can occur in Asian, Hispanic, & Native American skin tones, in addition to African American skin. The best treatment for this type of hyperpigmentation and dark scars are chemical peels combined with topical skin lightening agents. Dr. Green utilizes her unique MGSKINLABS line of skin care products which have powerful hydroquinone and retinoids to treat these problem areas. After a series of chemical peels, the discoloration will be reduced and your skin tone will be even and restored. Proper sunscreen and sun avoidance is essential in maintaining the best results.
In addition to chemical peels, acne scars can be treated with laser treatments and dermal fillers. The eMatrix laser is a “color blind” laser, and through radiofrequency heat, acne scars are improved and new collagen is stimulated. With a series of eMatrix laser treatments, acne scars can be minimized and your complexion restored. Dr. Green combines laser treatments with dermal fillers, such as Restylane, Sculptra, Bellafill, and Juvederm, to immediately restore lost collagen and volume in all types of acne scars. This immediate improvement in scars also has long term improvement in stimulating new collagen production. Dr. Green is an expert in treating acne scars, and combines multiple modalities, especially in patients with ethnic skin.
Keloid Scars and treatment options in darker skin
A keloid is an overgrowth of scar tissue that develops around a wound, usually after the wound has healed. Approximately ten percent of individuals experience keloid scars. Keloids most commonly develop in patients with darker skin tones, especially in African American patients. Typically, keloids affect younger patients, between 15 and 30 years of age. Keloid scars can occur years after the initial scar is created, and tend to occur most often on the face, earlobes, neck, and chest areas. Studies have showed that there is a genetic predisposition to keloid scars, which may be related to the AHNAK gene. There are many skin injuries which predispose to keloid formation. The most common injuries which result in keloid scars are:
- Acne scars
- Surgical scars
- Ear piercing
- Vaccination sites
- Chicken pox scars
Keloids can be a cosmetic issue since the keloid scar is often much larger than the original wound. Dr. Green has great success in treating these keloid scars with a combination of Vbeam laser treatments and intralesional cortisone injections. In recalcitrant cases, Dr. Green may recommend surgical removal of a very large keloid scar. Topical silicone gel pads also help reduce pressure on keloids and minimize their formation.
6 months after DPN treatment
Dermatosis Papulosa Nigra
Dermatosis Papulosa Nigra (DPN) is a skin condition in which small, firm, dark bumps or papules can develop on the face and neck. These epidermal growths are benign and their presence does not pose any risk to your overall health. It often presents first during adolescence and gradually becomes more pronounced with age. DPNs are very common in African American skin, presenting in 35% of black Americans, and can also occur among Asians and Polynesians with darker skin. Women are twice as likely to develop these benign growths than men.
DPNs are likely hereditary and studies show that 40-50% of patients with DPN have a family history of these growths. Studies have suggested that there is a potential association between DPNs and ultraviolet exposure, as the growths commonly present on the face, neck, and upper trunk where the UV exposure is at its greatest. Treatment is not necessary for DPNs, but the presence of these dark spots may affect a patient’s self-esteem and social life. Cosmetic removal of DPNs is a common procedure performed in dermatology. Because darker skin tones are prone to discoloration, cosmetic treatment of DPNs should be performed by an experienced dermatologist, such as Dr. Michele Green.
Vitiligo is a chronic skin condition characterized by patches of hypopigmented or lighter skin that usually increase in size with age. Vitiligo can also affect other parts of the body, such as hair and eyes. When vitiligo affects the scalp, it often presents as patches of white hair growth. Vitiligo occurs when the body attacks its own melanocytes, which are the skin cells responsible for producing melanin, or skin pigment. Therefore, vitiligo may be an autoimmune disease, where the immune system attacks its own body’s cells. The exact cause of vitiligo is unknown, though it has been found to be not contagious and not life-threatening. There may be a genetic component involved in vitiligo, as it often presents in patients with a family history. However, vitiligo often negatively affects one’s self-esteem and social life, and can even lead to serious depression. There is not yet a cure available for Vitiligo, although some patients benefit by using topical corticosteroids on hypopigmented patches to induce melanin production.
Cosmelan and Microneedling – before and after
A common skin condition which Dr. Green treats in skin of color are razor bumps, or pseudofolliculitis barbae. Pseudofolliculitis is a common condition in which shaving causes inflammation and bumps to develop on the skin. This medical condition is more common in men than women, and commonly occurs on the face or neck. Clinically, one sees groups of red or dark bumps around each hair follicle, with characteristic inflammation. Treatment may consist of changing shaving habits, topical antibiotics, and in more bothersome cases, laser hair removal. Pseudofolliculitis also commonly occurs in patients who tweeze or pluck coarse hairs. Since the hairs tend to be more curved, the hair gets retracted below the skin surface, and pierces the follicular wall from the inside. The result can lead to these painful bumps which can scar, cause dark spots, and even keloids. Prompt medical attention by an experienced dermatologist, like Dr. Green, is essential to prevent these unwanted side effects and treat the underlying cause of this skin condition.
Tattoo removal in skin of color
Dr. Green is an expert at tattoo removal for various skin tones and patients, including those with African American skin. For tattoo removals on darker skin, she uses the Alex TriVantage laser, which can remove tattoos after several sessions. The number of sessions depends on both the patient’s skin type and the various colors in the tattoo itself. A consultation with Dr. Green is the first step in formulating a treatment plan for your tattoo removal.
Any procedure including laser treatment has potential risks of hypopigmentation or hypertrophic scarring in darker skin tones. Because there is more melanin in darker skin, there is an increased potential of having the laser emit too much energy. This is why the laser tattoo removal process is a gradual one and requires multiple sessions.
The good news is that laser tattoo removal is relatively pain free. There will be some minor discomfort and generally the feeling reminds some of an elastic band snapping on the skin. It can take a series of laser treatments, spaced approximately two months apart, to clear the unwanted tattoo. The deeper the colors, such as pink and green, the more difficult it can be to remove the tattoo.
Dark Spots in Skin of Color
For darker skin tones, there can be some issues with chemical peels and laser treatments. Traditionally, many of the techniques that may be suitable for lighter skin tones are not necessarily effective on darker skin and can even be potentially damaging. Due to the increased melanin in ethnic skin, the laser can potentially burn healthy skin.
Another potential serious side effect that can be caused by these treatments is an “over lightening” of the skin color along with hyperpigmentation issues. African Americans should opt for light chemical peel treatments and avoid strong chemical peels since these can potentially cause hypopigmentation or further scarring.
Female – Before and after Chemical Peel (2 treatments)
Skin Lightening in Skin of Color
Another treatment that Dr. Green is often asked about are skin lightening techniques in order to achieve a brighter and more even skin tone. Here the goal is to brighten the skin and improve the overall look and feel without overly lightening the skin. There are a number of methods available to lighten the skin such as Cosmelan, chemical peels and laser treatments. The best approach initially is to book a consultation with Dr. Green to discuss the results that you are looking to achieve and then a tailored course of treatments can be designed for you.
Hair loss in African American patients
In addition to skin care, there are numerous hair conditions which dermatologists, like Dr. Green, specialize in treating. Many patients suffer from hair loss, or alopecia. For some individuals, hair loss may be genetic or hormonal. For others, there is an increased association of hair loss with autoimmune diseases such as Lupus and Hashimoto’s disease. Many women suffer a gradual hair loss from menopause. Still others, suffer from traction alopecia from hair styles such as braids which are too tight. Dr. Green is a specialist in hair loss, and will do a comprehensive examination and testing to identify the cause of your hair loss. Once the cause is identified, a comprehensive hair loss protocol will be designed for you. One of the most popular treatments for hair loss, for both men and women are PRP injections for hair loss. By utilizing your own blood, Dr. Green is able to utilize our own natural growth factors and encourage the re-growth of thinning hair.
Cosmelan for Melasma in skin of color
Melasma (also known as the mask of pregnancy) manifests in facial pigmentation which can be caused by hormones, sun exposure and various other factors. Darker skin tones are prone to producing an excess of melanin, which can cause the skin to be even darker in certain areas. Since black skin is prone to this discoloration, and hyperpiguentaion, treating this issue is one of the most popular procedures in Dr. Green’s NYC office. Cosmelan is a type of chemical peel commonly used in Melasma treatment and can help treat this type of hyperpigmentation.
Cosmelan masks include a professional-grade cream that is applied in Dr. Green’s office. The mask is left in place for several hours and then can be easily removed by the patient. Three weeks later, a second Cosmelan mask is applied. Between both of these appointments, various creams will be prescribed in order to keep the skin clear of pigmentation. One must also avoid sunlight during this period to achieve maintain the best cosmetic results.
Cosmelan treatment – 8 months
Cosmetic Dermatology in African American skin
Dr. Green is an internationally renown expert in minimally invasive cosmetic procedures. Some of the most popular cosmetic procedures in her office are Botox, Juvederm, lip augmentation, Kybella, Thermage, Microneedling, and neck rejuvenation. The accessibility and short downtime of these minimally invasive cosmetic treatments make them a perfect lunchtime procedure for those with busy lives. The trend currently in cosmetic dermatology is for a more natural looking result and general skin rejuvenation. Dr. Green’s “less is more” philosophy extends to Botox where she believes in using “Baby Botox” or “Botox sprinkles” so that patients don’t look “frozen”. Similarly, with cheek augmentation and lip enhancement, the goal is to look younger, remove fine and deeper lines, and look refreshed. Through a combination of treatments, such as laser treatments, HydraFacials, dermal fillers, and the right skin care, the goal is to both restore and maintain these rejuvenated results.
Laser Hair Removal for dark skin
African American patients must be careful to select the appropriate laser for their skin tone. Laser hair removal procedures are highly sensitive to all color and melanin, which plays a critical role in the treatments of darker skin types. The laser is designed to target water, hemoglobin or brown melanin. If the proper wavelength or depth of penetration is not correctly set for darker skin patients, the skin can be easily damaged.
Dr. Michele Green utilizes the Candela Gentle Yag (ND:Yag laser) since this laser is equipped with long wavelengths and pulse width, which is most effective and safe for ethnic tones and all darker skin patients.
The reason the GentleYAG works so well is that it penetrates deeper than traditional laser treatments, which means the pigment in the skin is not affected in the same way. The GentleYAG laser can bypass the melanin in the surface of the skin and targets the hair root, providing safe and effective results. One of the risks with laser hair removal is hyperpigmentation or hypopigmentation (white spots) from the laser treatment. The Candela Gentle Yag was designed specifically for patients with darker skin tones, to avoid this unwanted side effect.
Does Black skin need sunscreen?
Yes! Sunscreen is an essential component of everyone’s skincare routines, including those with darker skin. The harmful effects of the sun’s ultraviolet (UV) rays are the cause of sun damage like fine lines, wrinkles, and discoloration. When the UV rays make contact with unprotected skin, it causes changes in DNA at a cellular level, permanently damaging the skin’s structure. There are different types of UV rays: UV-A and UV-B. UV-A rays causes damage at all levels, ranging from the epidermis to the dermis. UV-A damage collagen and elastin fibers in the dermis, which are responsible for providing youthfulness and elasticity to the skin. UV-B rays cause photoaging and actinic keratosis (precancerous cells) by damaging the DNA on the epidermis. Therefore, it is important to seek out “broad-spectrum” sunscreens with at least SPF 30 that protect against both UV-A and UV-B rays.
Signs of photoaging include wrinkles, decreased elasticity, and pigmentation changes such as age spots, sun spots, and freckles. UV rays also stimulate melanocytes, which are skin cells responsible for producing melanin or skin pigment. With frequent UV exposure over time, the melanin produced by melanocytes clumps together to produce sun spots. Furthermore, skin conditions like melasma can be triggered or exacerbated by UV exposure. Melasma occurs when melanocytes are overstimulated and produce too much melanin. As discussed, the sun’s UV rays stimulate these melanocytes to produce melanin, worsening the melasma present on the skin. Because UV rays penetrate deep into the skin, the signs of photoaging may not appear on the skin until years later. Therefore, daily sunscreen application and reapplication is an essential part of skincare to prevent early signs of aging, sun spots, and of course, skin cancer.
Accutane – 7 months
Should African American patients go to a dermatologist?
Yes! Since Black Americans make up about 13% of the population in the United States, and only about 3% of dermatologists identify as Black, many people may initially feel hesitant about going to the dermatologist. Even if you are treated by a provider who is not African American themselves, when you have an appointment with an experienced and knowledgeable board-certified dermatologist, like Dr. Green in New York City, you can guarantee that your skin concerns will be safely and effectively addressed. The skin is the largest organ of the body and requires regular maintenance and care to keep it functioning at its best. Dr. Green is well-versed in the diagnosis and treatment of skin conditions in patients of every skin tone, and can recommend the best in specially formulated skincare products and in-office treatments to keep you looking and feeling refreshed, radiant, and healthy.
Is African American skin dry or oily?
African American skin can be dry or oily, however, African American skin generally tends to be on the oilier side. This is due to the fact that there are typically larger and more numerous oil glands present in African American skin. Oily skin can be a benefit when it comes to preventing the development of signs of aging. Oil acts as a lubricant for the skin, keeping it moisturized and helping to combat the formation of fine lines, wrinkles, and skin laxity. If you’re unsure as to what skin type you have and are interested in learning more about the best practices for skincare, schedule a consultation with Dr. Green in NYC. Dr. Green is a board-certified dermatologist with over 25 years of experience treating men and women of every skin tone and skin type, and can help you personalize your skincare regimen so that it is perfectly tailored to the unique needs of your skin.
How to Care for African American Skin
Finding a dermatologist to care for African American skin concerns, who understands and appreciates the different needs of patients with various skin tones, can feel like a challenge. Luckily, Dr. Michele Green in NYC is here to help. Dr. Green is a board-certified dermatologist with over 25 years of experience treating men and women from around the world for a myriad of medical skin conditions and cosmetic skin concerns. Dr. Green has been consistently voted as one of the best dermatologists in NYC by Castle Connolly, the New York Times, and Super Doctors. She has the expertise and experience to customize a treatment plan that is catered to your specific needs and will achieve your ideal cosmetic results.
Dr. Green is internationally renowned for her holistic approach and “less is more” philosophy when it comes to facial rejuvenation, and utilizes the best non-invasive treatment modalities to help her patients look and feel their absolute best. For more information about treating ethnic skin with a dermatologist, including chemical peels, acne scar treatments, Cosmelan, laser tattoo removal, laser hair removal, skin lightening and other dermatology treatments for African American skin, schedule a consultation today with Dr. Michele Green at 212-535-3088 or contact us online