Why Women With Darker Skin Are Highly Susceptible To Skin Discoloration - Skin By Dr. Drew Karp

Why Women With Darker Skin Are Highly Susceptible To Skin Discoloration

This is from an article by Dr Susan Taylor:

“Skin pigmentation conditions can be a problem for all women (and men) with brown skin – people of Asian, African, Latin or Native American background. While the natural pigmentation in brown skin provides many advantages—sun protection and slowed signs of aging—it is also more highly susceptible to skin discolorations, which can cause distress in social situations, as well as psychological stress.

Melanin is the chemical that determines the color of skin. The more melanin there is in a person’s skin, the darker that person’s skin will be. Sometimes the cells that contain melanin are damaged or over stimulated. When this happens, the affected cells may begin to produce too much, or too little melanin. Too much melanin causes darker spots or patches, while too little causes lighter spots or patches. These lighter or darker spots appear on the surface of the skin, and can be unsightly. Unfortunately, these skin color problems are much more visible and common in people with skin of color.

Post-inflammatory hyper-pigmentation causes skin darkening and discoloration that show up as spots, or as large patches on a person’s body. This is because cells that normally produce brown pigment evenly across your skin go into overdrive and produce too much melanin. This happens because of an inflammatory reaction in, or to an injury to, the skin. If the excess melanin is produced in the upper layer of skin, the pigmentation color is a darker shade of brown. If the excess melanin is produced in the lower layer of skin (the dermis), a gray or blue discoloration becomes visible.”

Although Hyper-pigmentation can occur in all skin types, it is more common in people of Africa, Asia, Latin, and Indian background, and can affect men and women equally. Areas of the skin affected correspond with areas of previous inflammation or injury. When dark changes in your skin’s color remain after the underlying problem has gone away, you have PIH. The most common causes are injuries such as scratches, burns, cuts, or bruises. Rashes of any type can cause PIH (examples of which include eczema, psoriasis, pityriasis rosea, lichen planus, and fungal infections). Ordinary conditions such as acne or pimples are a very common cause of PIH in individuals with brown skin. PIH can also be caused by injury to the skin resulting from sunburns, surgery or cosmetic procedures such as chemical peels, dermabrasion, lasers and cryotherapy (liquid nitrogen treatments).


In the past, dermatologists have put their patients on medications that contain Hydroquinone, a chemical lightening agent that is applied directly to the dark mark. it blocks the formation of melanin and the dark area will lighten. It may take up to 6 months to clear the dark spot.

Hydroquinone for patients with PIH, the most common way to return the skin to its natural glowing complexion is through use of products containing Hydroquinone, a chemical lightening agent that is applied directly to the dark mark. Your dermatologist can determine if hydroquinone is appropriate for your skin. Many dermatologists consider hydroquinone to be the best treatment for PIH. Hydroquinone works by blocking an enzyme that is responsible for the production of the pigment melanin. By blocking the formation of melanin, the dark area will lighten. However, it is important to realize that you may need to use the hydroquinone medication for up to 6 months before clearing of the dark marks is seen.

Possible effects of hydroquinone products include redness, irritation and possible burning of the skin. It is also possible for your normal skin tone to become lighter in a ring around the dark discoloration.

Other doctors prescribe retinoids, but these should be used sparingly in brown skin. This treatment can take up to 40 weeks for the dark marks to fade completely.  Retinoids can cause irritation, dryness and peeling of the skin.

Azelaic acid is another prescription treatment for both acne and hyper-pigmentation. It has anti-inflammatory, anti-bacterial, and skin lightening properties.  Improvement in the dark marks can be seen after 6 months. A scientific study comparing the lightening ability of azelaic acid and hydroquinone for the pigmentation problem, melasma, found both forms of therapy to be effective when used for a total of 24-weeks. Azeleic acid has the potential of producing the side effects of skin irritation, burning, itching and redness.

Glycolic acid products are available over the counter and are also used as a treatment for hyper-pigmentation. These products work by gently exfoliating (removing) the upper-most layer of the skin and the dark marks with it.  Glycolic acid products should be considered medications, so it is important to consult with your dermatologist to determine if he or she thinks glycolic acid is appropriate for your skin. It can take 3-6 months before seeing an improvement in the dark marks.

Chemical Peels are a more intensive treatment used in cases of more persistent PIH or to hasten the lightening effects of the topical prescription products. Peels work by exfoliating the upper-most layer of your skin and the dark area with it. As with all cosmetic procedures, there are possible side effects. These include irritation of the skin, a rash, blistering, marked peeling, or discolorations of the skin. In a dermatologist’s office, the cost will range between $100- $200 per peel. Peels are generally performed once every three to four weeks.

Microdermabrasion is a cosmetic procedure, in which fine crystals are sprayed onto the skin’s surface to gently sand away the upper-most layers of the skin. As with chemical peels, microdermabrasion works by exfoliating the upper-most layer of your skin and the dark area with it. Even though microdermabrasion is generally well tolerated in brown skin, side effects are possible. These include irritation of the skin, redness, marked peeling, swelling or discolorations. Before having a microdermabrasion done, make sure that the person who performs the procedure is knowledgeable about brown skin.

The microdermabrasion procedure is usually performed every 2 to 4 weeks for a total of six to eight treatments. To maintain results, it is often advisable to periodically repeat the treamtent after the original sessions are completed. As it is a cosmetic procedure, microdermabrasion is not covered by insurance. The cost of microdermabrasion may range from $75 to $150.

Other treatments

At-home kits offer a milder version of the in-office procedures.  If you take matters in your own hands, it may lead to more harm than you could ever imagine.

Cocoa butter and aloe vera are commonly used home remedies for Hyper-pigmenation, especially in the African-American community. The cocoa butter preparation is applied to the skin once or twice daily for weeks or months. It provides moisturization to the skin. The gel from the aloe vera plant or a commercially available cream or lotion is applied directly to the skin. However, there is no scientific evidence that these effectively treats hyper-pigmentation.

Topical corticosteroid (cortisone) creams, both over-the-counter and prescription varieties, are used for a variety of skin disorders.These creams are inappropriately applied to the skin and in many instances are applied for a prolonged period of time. This leads to damaging side effects. The side effects include permanent thinning of the skin, permanent redness of the skin from overgrowth of blood vessels, the appearance of rashes on the skin and uncontrollable outbreaks of pimples. Topical cortisones should not be used for the treatment of PIH unless under the direct supervision of a dermatologist.

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