Most skin diseases occur in all types of skin, regardless of the pigment of the skin. However, certain skin problems are more common among African-Americans.

Dry or "Ashy Skin"
Dry skin is a problem for individuals of all skin colors, but may be very distressing to persons with black skin. It's uncomfortable in all populations, but it is easily noticed in persons with black skin because of its grayish, "ashy" appearance. Using moisturizers regularly can help tremendously. However, some of these products may worsen acne pimples. All patients with acne should select "non-comedogenic" (meaning won't plug pores or cause acne) moisturizers. If the problem persists, a dermatologist should be seen.

Ashiness can also affect the scalp. Pomades that make the hair more manageable can decrease scalp dryness, but may aggravate the dryness of seborrhea. If pomade spreads to the forehead it can block pores, causing pimples called pomade acne. If this occurs, stop using the pomade or apply it one inch behind the hairline.

Pomade can also contribute to a bacterial infection of the scalp called folliculitis. Folliculitis produces pus, bumps, and redness around the hair. It can also cause hair loss or can spread infection. If this occurs, discontinue using the pomade and see a dermatologist.

Variations in Skin Color
Skin color is determined by cells called melanocytes. All races have the same number of these cells. In the melanocytes are structures called melanosomes which produce the pigment melanin. Black skin melanocytes have larger and more melanosomes that are different than white skin. Because of their dark skin color, African-Americans are better protected against skin cancer and premature wrinkling from sun exposure.

Post inflammatory hyperpigmentation is quite common in blacks even after minor trauma. An area of the skin may darken after an injury such as a cut or a scrape, or after certain skin disorders such as acne. Often black patients will request treatment for pigmentation secondary to acne. Treatment of acne will usually prevent development of dark spots, and old dark spots will resolve with time. If pigmented lesions persist, they can then be treated with a bleaching agent.

If you get a rash, treat skin gently. To avoid or reduce post inflammatory hyperpigmentation, avoid picking, harsh scrubbing, and abrasive treatments, unless prescribed by your dermatologist. Darkened areas of skin may take many months or years to fade, although medication may help. Chemical peeling and prescribed bleaches by your dermatologist may fade pigment more rapidly.

Vitiligo
Vitiligo is a common condition where pigment cells are destroyed and irregular white patches on the skin appear. No one knows what causes this.

The extent of color loss differs with each person and there is no way to predict how much pigment a person will lose. Some people lose pigment over their entire bodies. Most patients with vitiligo do not regain skin color without treatment.

Several methods are used to treat vitiligo, but none are perfect. The most common method is PUVA therapy, combining light treatments and medication. In cases where vitiligo affects most of the body it is sometimes best to destroy the remaining normal pigment. A dermatologist can determine what treatment is best based on the extent of the disease.

Pityriasis Alba
People with pityriasis alba have round, light patches of the skin ("fade spots") covered with fine scales. It is most common in children. The patches can occur on any part of the body, but are most noticeable on the face and upper arms. The light patches are the result of mild eczema, and the loss of color is only temporary. This condition can be treated by a dermatologist.

Dermatosis Papulosa Nigra
Also called flesh moles, dermatosis papulosa nigra occurs almost exclusively in African-Americans, and most frequently in women. These brown or black raised dark spots usually appear on the cheeks. They resemble moles or flat warts. They are not cancerous but some patients have them removed for cosmetic reasons.

Keloids
When the scar from a cut or wound extends and spreads beyond the size of the original wound, it is known as a keloid. Keloids may vary in size, shape, and location. They occur more often in black skin.

Keloids are common on the ear lobes, neck, hands, or forearms, and usually occur after an injury or infection. Occasionally they occur spontaneously, especially on the mid-chest area. Keloids often follow the injury caused by acne on the face, chest, and back. Some people develop keloids after surgery (i.e. they may appear on the ear lobes after ear piercing).

Depending on the location of the keloid, treatment may consist of cortisone injections, pressure, silicone gels, surgery, laser treatment, or radiation therapy. Unfortunately, keloids tend to return and even enlarge, especially after treatment with surgery.

Folliculitis Keloidalis
Some black men, especially those who use razors for cutting hair on the back of their necks, develop keloid-like scars on the back of their necks. The area may itch and sometimes becomes infected. Treatment consists of oral antibiotics, topical acne products, and topical or injected cortisone. When severe, the area of involvement may need to be removed surgically or with a laser. Early treatment can prevent large keloids, so see a dermatologist as soon as the lesions appear.

Hair
Hair of African-Americans is unique in its shape and structure. The hair on the head, as well as in the beard, is likely to be tightly curled. Certain techniques and preparations used to style black hair can lead to a variety of problems:

Hair Loss - Hair loss or broken hairs at the scalp margins in women may be a problem. It may be caused by repeated or frequent tight braiding (traction alopecia), hair straightening agents (i.e. perms, relaxers), or tight rollers, and as a result of hair styled in a ponytail or single braid style. Dermatologists usually recommend changing hair styles if the hair is falling out or breaking off along the scalp margins. In many cases, if discovered early in the process (i.e. traction alopecia), the hair will grow back.

Hair Breakage - Hair straighteners use strong chemicals to change the structure of the hair. While straightened hair is easier to style, it may also become brittle and break easily. Used according to package directions, hair straighteners usually do not cause problems. If used improperly or on previously damaged hair, especially after the use of hot combs, hair breakage or other difficulties may arise. Excessive brushing, back-combing, or other stresses also cause breakage. Most hair loss from breakage is temporary because it does not affect normal hair growth. Hair will usually grow back just as it does after it has been cut.

Tinea Capitis (Ringworm) - Ringworm is caused by a fungus. When it occurs on the scalp it produces itching, scaling, redness, and can cause hair loss. It occurs most commonly in children. Sometimes severe inflammation and boil-like cysts develop. It is contagious so family members as well as classmates can catch it easily, especially from sharing combs and hats. It usually requires many weeks of oral medicine to cure. Severe dandruff of the scalp can be confused with ringworm.

Ingrown Hairs of the Beard (Razor Bumps) - The hair shafts of African-Americans are curved. This is true of beard hair as well as other body hair. After shaving, especially close shaving, the beard's sharp pointed hair may turn back into the skin. It may pierce the wall of the hair follicle, causing a reaction resulting in bumps. Dermatologists call this condition "Pseudofolliculitis Barbae." Growing a beard is one solution to this problem. This will cure the condition, but is not always an option.

Men with ingrown hairs ("hair bumps") should try different methods of hair removal. Shaving with a special type of safety razor that does not permit a very close shave may help. After applying lather or shaving cream, wait to let the soap soften the beard. Shave only in the direction of the hair growth, not against the stubble. Don't stretch the skin during shaving and don't shave on a daily basis. If hairs begin to ingrow, lift them up with an alcohol-cleaned needle (don't tweeze or pluck) just before shaving. Occasionally, using a toothbrush or rough washcloth before shaving or bedtime may loosen hairs about to grow inward.

Chemical depilatories remove hair but should only be used every two days or less, and should not be used alternately with a razor. They must be wiped off promptly according to package directions. Wash your face twice with soap and water immediately afterwards to guard against irritation.

Electrolysis, the permanent removal of hair performed by an experienced operator, may be an effective solution for this problem. New medicated creams may slow hair growth and help. The use of a special type of laser is the newest method of treating ingrowing hairs. Hair removal in the beard area may be permanent after several sessions. Consult your dermatologist about treatment options.

Nails
Dark streaks or bands on multiple fingernails and toenails in African-Americans are usually normal. They tend to increase in number as a person ages. However, the development of a new single dark band on a nail could be a sign of a dangerous type of skin cancer called malignant melanoma and should be checked by your dermatologist.

The skin, hair, and nail conditions common among African-Americans are generally not serious. They can easily be recognized and usually are successfully treated. If you have any questions about skin problems, see your dermatologist.