Skin of Color Dermatology: Managing Hyperpigmentation and Keloids

Why Hyperpigmentation Hits Harder on Darker Skin

When you have darker skin, a pimple doesn’t just go away-it leaves a mark. That dark spot after a breakout, the patchy discoloration after a scrape, or the stubborn brown patches on your cheeks during pregnancy? That’s hyperpigmentation, and it’s not just a cosmetic issue. For people with skin of color, it’s a common, frustrating, and often emotionally heavy condition. The reason? More melanin. Darker skin has more pigment-producing cells, and when those cells get triggered by inflammation, sun, or hormones, they go into overdrive. The result? Tan, brown, or gray patches that stick around long after the original injury has healed.

Post-inflammatory hyperpigmentation (PIH) is the most frequent type. It shows up after acne, eczema, psoriasis, even harsh scrubs or hair removal. Melasma, another form, looks like symmetrical brown or gray patches, usually on the face. It’s more common in women, especially during pregnancy or while taking hormonal birth control. Unlike lighter skin tones, where redness fades quickly, darker skin doesn’t just blush-it bruises in pigment. And once it starts, it doesn’t want to leave.

Sun Exposure Makes It Worse-Even on Cloudy Days

One of the biggest mistakes people make? Thinking sunscreen is only for beach days. For skin of color, UV rays don’t just cause aging-they trigger melanin production, making dark spots darker. Even blue light from screens can contribute. That’s why dermatologists now recommend tinted sunscreens with iron oxides. These block not just UVA and UVB, but also the visible light that worsens hyperpigmentation. And it’s not just your face. Neck, chest, arms-any exposed skin needs protection.

Use a broad-spectrum SPF 30 or higher every single day, even if it’s overcast. Reapply every two hours if you’re outside. Wear wide-brimmed hats, long sleeves, and sunglasses. Skipping sunscreen isn’t just risky-it’s counterproductive. No treatment will work if you’re still baking your skin in the sun.

What Actually Works to Fade Dark Spots

Treatment starts with patience and consistency. There’s no overnight fix. Most dermatologists begin with a simple routine: sunscreen, gentle cleanser, moisturizer, and one or two active ingredients.

• Hydroquinone has been the gold standard for decades. It blocks melanin production. Prescription strength (4% or higher) works better than over-the-counter versions.
• Retinoids like tretinoin speed up skin cell turnover, helping shed pigmented cells faster. They also improve texture and reduce acne, which helps prevent new PIH.
• Azelaic acid is gentle, safe for sensitive skin, and reduces both inflammation and pigment. Great for those who can’t tolerate retinoids.
• Vitamin C is an antioxidant that brightens skin and blocks enzyme activity linked to melanin. Look for stable forms like L-ascorbic acid at 10-20%.
• Kojic acid and glycolic acid lighten spots by exfoliating the top layer of skin.

Newer options are showing strong results too. Tranexamic acid, usually taken orally or applied topically, has been shown to reduce melasma without the side effects of hydroquinone. 5% cysteamine cream is another emerging alternative that’s well-tolerated and effective for stubborn cases.

Why Some Treatments Backfire

What works for fair skin can damage darker skin. Chemical peels, laser treatments, and intense pulsed light (IPL) can trigger more pigmentation if not done carefully. This is called post-inflammatory hyperpigmentation from treatment-ironic, right? Dermatologists who specialize in skin of color know this. They use lower settings, fewer sessions, and often pair procedures with pre- and post-treatment brightening creams.

Don’t rush into laser clinics or spa treatments advertised as “miracle fixes.” Ask if the provider has experience treating skin of color. If they don’t mention it, walk away. Gentle is better. Slow is safer.

Keloids: When Scars Grow Beyond the Wound

While hyperpigmentation leaves flat dark marks, keloids are raised, thick, rubbery scars that spread beyond the original injury. They can form after piercings, acne, cuts, surgery, or even minor scratches. People with skin of color-especially those of African, Asian, or Hispanic descent-are far more likely to develop them. Unlike regular scars, keloids don’t stop growing. They can itch, hurt, and restrict movement if they form over joints.

They’re not dangerous, but they’re deeply distressing. Many people avoid piercings or surgeries because of the fear of keloids. And once they form, they’re hard to get rid of. Treatments include corticosteroid injections to shrink them, silicone gel sheets to flatten them, pressure earrings for ear piercings, and sometimes surgery-but only if followed by radiation or steroid injections to prevent recurrence. Laser therapy can help reduce redness and smooth texture, but again, it must be done by someone experienced with darker skin.

What to Do Before You Start Treatment

Before you buy any cream or book a procedure, ask yourself:

• Do I have an ongoing skin condition like acne, eczema, or psoriasis that needs treatment first?
• Am I using any medications or cosmetics that could be causing darkening? (Some antibiotics, antimalarials, and heavy fragrances can trigger it.)
• Am I wearing sunscreen every day-even indoors?
• Have I ever had a bad reaction to a peel, laser, or retinoid before?

If you answer yes to any of these, talk to a dermatologist who understands skin of color. Treating the root cause-like controlling acne or switching out a harsh cleanser-is often more effective than slathering on lightening creams.

Realistic Expectations Matter

Hyperpigmentation and keloids don’t vanish in a week. Even with the best treatments, it takes 3-6 months to see real improvement. Some spots fade completely. Others lighten but never disappear. Keloids may shrink but rarely vanish without ongoing care.

Success isn’t about perfection. It’s about progress. A 50% reduction in dark spots? That’s a win. A keloid that stops growing and becomes softer? That’s victory. The goal isn’t flawless skin-it’s skin you feel comfortable in.

When to See a Dermatologist

See a specialist if:

• Your dark spots are spreading or getting darker despite sunscreen
• You’ve tried over-the-counter products for 3 months with no change
• You’re developing raised, itchy scars after minor injuries
• Hyperpigmentation is affecting your confidence or daily life

Not all dermatologists are trained in skin of color. Look for ones who mention “pigmentary disorders,” “diverse skin tones,” or “melanin-rich skin” in their bio. Ask for before-and-after photos of patients with similar skin tones. If they don’t have any, keep looking.