Dark Skin - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Dark Skin or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Training and working at four inner-city university hospitals in NYC and Philadelphia allows us the opportunity and experience to treat a diverse range of skin ethnicity. People of different origins ineed have significant differences in the composition of their skin.
On one hand, darker pigment protects our skin from the sun but on the other hand inflammation of the skin could result in significant unwanted discoloration. As darker skin runs the potential risk of discoloration, different lasers, procedures, and medications may be appropriate to safely and effectively treat not only medical but also cosmetic conditions.
As a large portion of our patients are from a diverse and mixed ethnic background, we invested in technology that is specifically suited to their skin condition and it could even be said that it is ‘color blind’. We provide various treatments including peels that correct dark pigmentation, remove dark ‘moles’ (dermatosis papulose nigra) and treat keloids with unique cryoscope technology.
Keloids are a genetic condition that is more common among black and the Mediterranean. For more information about keloids and possible treatments please visit our keloids page.
Treating acne scars on dark skin requires special considerations. Improper treatment can result in permanent damage to the skin without improving the scar texture. Fortunately, there are now two new technologies that allow us to treat scars with minimal risk of damaging the healthy skin around the scar.
With the Picosure laser, we can safely soften scar tissue. This is followed by the Infini microneedling treatment that triggers collagen production and raises the skin in the scarred area. A new treatment protocol has been developed for darker patients that is now able to achieve results that were previously not possible.
For post-inflammatory hyperpigmentation to be prevented, it is imperative to control inflammation caused by acne as early as possible. Topical medications that contain irritating ingredients should also be avoided.
Various treatments including Picosure laser, Microdermabrasion, Photodynamic therapy, and Melanage treatments can help lift dark pigment and restore the original and lighter complexion for those who find it difficult to control their acne and have focal or widespread dark marks.
For dark skin, there is no laser hair removal that is safe and effective. NDYag lasers can permanently reduce 80-90% of the hair in 6-8 treatments. Other laser types can be less effective and can cause hyper and hypopigmentation.
In contrast, the diode laser (often referred to as "the laser for all skin types") requires more treatments and is not suitable for darker Indian or African American skin tones. There is a high risk of hyperpigmentation with IPL hair removal, and the effectiveness of hair removal is very low.
The Alexandrite laser hair removal treatment should never be performed on Mediterranean or darker skin.
Please visit our Laser Hair Removal page for more information about potential treatments for dark skin.page for more information about potential treatments for dark skin.
Hi I’m African American, 40 year old female with soft skin and this past Tuesday I noticed my left knee, right elbow and parts of my palms are rough to the touch all of a sudden. I’m not sure why its happening and exfoliating isn’t making it go away. Why might this be happening?
Friction, allergic reactions as well as exposure to detergents or irritants are some of the reason that skin can turn rough. The bacterial infection Scarlet fever can result in rough skin in the armpits, groin and on the neck. Use of emollients over a period of 3 weeks usually resolves this roughness as long as the culprit was removed. Please note that this blog addresses general concepts. I am unable to provide a customized diagnosis. If you wish to have a personal consultation, please schedule a telehealth visit with or office.
Hi. I’m a 32 year old African American man and I have developed a few keloids around my beard area, including one along my jawline that is unsightly. Is there anything that can be done for keloids besides injections? I’ve been to a dermatologist before and had to come back every so often to get injections. It’s painful and I’d rather avoid it if possible.
The ability to form keloids is a genetic trait and cure is not yet available. Treatment aims at managing symptoms and shrinking keloids. Treatment that is known to aggravate keloids, such as surgical removal, must be avoided. Treatments that have a low risk of exacerbating keloids other than steroid injections are pressure (e.g. silicone strips over night), cryosurgery from the outside or from within (Cryoshape), combination of fluorouracil-steroid injections, pulsed dye laser, and Nd:YAG laser treatments. Most treatments other than external pressure cause some brief discomfort and st of these will need to be repeated until keloid gives in.
Hello, I’m a 30 y.o female with hyperpigmentation on my underarms. I reside in Northern California and would appreciate any recommendations. I’ve tried combo creams with hydroquinone.
Hyperpigmentation in the under arm area is often genetically determined, and rarley, it is associated with an endocrinologic condition. There is no known cure or treatment for the genetic trait which is usually present since puberty. Incidentally, laser hair reduction in the underams improves it in many people. If the darkened skin occurred only recently or occurred with significant weight gain, you should seek evaluation by a dermatologist to find out if you have acanthosis nigricans. This condition can be associated with insulin receptor dysfunction and additional work up may be needed. If associated with significant weight gain, it will resolve once the weight is lost.
Hello, I had surgery over a year ago to remove lumps from my airpits and now I am experiencing very painful keloids under my arms. Is there anything that can be done to remove them? Scarring of the skin runs in my family.
Keloids are caused by minor trauma or surgery in a person who is susceptible. They are often challenging to treat as there is no cure yet that stops our genetic trait from making them or making them bigger. Treatment aims at managing symptoms (pain) and shrinking keloids. Treatment that is known to aggravate keloids, such as surgical removal, must be avoided. Treatments that have a low risk of exacerbating keloids are pressure, cryosurgery, fluorouracil or steroid injections, pulsed dye and Nd:YAG laser treatment. Pain can be alleviated with pressure, e.g. tennis balls in the underarm area with relative inactivity (sitting at a computer, during meals etc). If pain is not alleviated by this or your keloids are growing out of control you may schedule an urgent appointment at our Haverford office during the COVID 19 crisis. After the crisis, we will accommodate you in either office.
Hi, my 12yo AA daughter has never had hair grow past chin length. Is a dermatologist the first place I should start?
Yes, the dermatologist can help determine if it is hair breakage that leads to the limit in hair length. The most common cause for hair breakage at chin length, compared to breakage near the scalp, is chemical processing (relaxers) and repeated heating of hair (hot comb, blow dryer). This makes hair fragile and at some point of time it might break. Rare genetic conditions can also lead to breakage at chin level and a dermatologist will be able to diagnose this. Even rarer is a genetic trait were otherwise healthy and well hydrated hair only grows to a certain length
Hello! Do you have any recommendations for doctors specializing in AA skin in Los Angeles?
Unfortunately, I do not have a specific recommendation. I would like to pint out that dermatologist who practice in an area of high diversity will have ample experience treating diverse ethnic skin concerns. Therefore, you should be able to find well versed dermatologist in a large metropolitan areas such as Los Angeles.
Thank you Dr. Ringpfeil for starting this blog and highlighting an under served patient population, especially with regards to dermatologic care. I’m currently a first year medical student trying to manage recurrent furuncle-like inflammation of the jaw line that can be very distracting :/
Maybe I’ll be visiting your office one day in the future 🙂
Looking forward to seeing you in the office!
Hi I am a 56 year old black female that has Hashimoto’s DS and my hair has thin out so bad in the top and some balding. I wondered if you could recommend me a African American dermatologist in The Colony TX area or Lewisville area that could tell me by what I need to do or if you can help me please please
We are in the Philadelphia area. Unfortunately, I have no in-depth knowledge of dermatologists in your area. Please check the dermatologist locator at http://www.aad.org. Some post profiles or links to their websites to make the decision easier.
Hi I am a 35 y.o. African American woman and the skin on my neck is noticeably darker than the skin on my face, chest and the rest of my body. Is this something that could be helped through dermatology? I have looked into skin lightening creams but I do not want to damage my skin. I note that I also have eczema and sensitive skin, although I have not had an eczema flare-up (that caused dark patches) since I was a teenager. I live in South Brunswick, NJ
Dark neck skin can have several different sources, ranging from exposure to sun light or past eczema breakouts to an endocrinologic abnormality. Evaluation by a dermatologist is strongly recommended. With a proper diagnosis, treatment and management can be tailored to your needs.
I’m a 31 year old Hispanic male and I have a mild form of trichoepithelioma around my nose, upper lips, and eyes. I wanted to know if laser treatments or anything can be done to help this, and if this kind of treatment can be helpful long term. My dermatologist told me that it is possible this kind of surgery can help, and there’s a ‘cream’ that’s been known to treat this kind of issue. How true this may be I don’t know, as I am leaning towards not using this dermatologist anymore due to the lack of concrete solution or plan for this.
My 5 year old daughter has shown signs of skin allergies and skin moles like mines, so I want to be able to have the steps and procedures done for myself should it be time when she’s much older for her to ever to seek treatment.
At this point, the only known remedy for trichoepithelioma is excision. There are no laser treatments or creams that provide lasting results as of yet. If you have many trichoepitheliomas and if indeed your daughter has them, too, please be sure to undergo the regular screening examinations that your dermatologist recommended.