Skin of Color Dermatology: Managing Hyperpigmentation and Keloids

Why Hyperpigmentation Hits Harder in Darker Skin

When you have darker skin, a pimple doesn’t just fade away. It leaves behind a dark spot that can stick around for months-or even years. This isn’t just a cosmetic issue. For many people with skin of color, these patches of discoloration become a source of stress, self-consciousness, and even social withdrawal. The reason? Higher melanin levels. Melanin protects your skin from UV damage, but when your skin is irritated-by acne, a cut, a scratch, or even a harsh scrub-it overproduces pigment. That’s post-inflammatory hyperpigmentation, or PIH. It’s not an infection. It’s not an allergy. It’s your skin’s overreaction to trauma.

Unlike lighter skin tones where redness fades quickly, darker skin turns brown or gray. These spots don’t go away on their own. Sun exposure makes them worse. Even indoor lighting, especially from screens, can darken them over time. A 2023 report from the American Society for Dermatologic Surgery found that up to 65% of people with darker skin experience PIH after minor skin injuries. And melasma? That’s the hormonal version-dark, patchy discoloration on the cheeks, forehead, or upper lip. It’s more common in women, especially during pregnancy or while taking birth control pills.

What Causes Hyperpigmentation in Skin of Color?

It’s not just one thing. It’s a mix of biology and lifestyle. First, inflammation. Acne is the biggest trigger. Even mild breakouts can leave behind dark marks. Eczema, psoriasis, and even allergic reactions to hair dyes or cosmetics can do the same. Second, sun exposure. UV rays activate melanocytes, the pigment cells. In darker skin, those cells are already more active, so even a little sun can trigger darkening. Third, hormones. Melasma isn’t just about being pregnant-it’s about estrogen and progesterone levels. That’s why it often shows up after starting birth control or during menopause.

And here’s something most people don’t realize: blue light from phones and computers can also worsen hyperpigmentation. That’s why tinted sunscreens with iron oxides are now recommended. They block not just UVA and UVB rays, but also the blue light that contributes to pigment darkening. Regular sunscreens? They help-but they’re not enough on their own.

Why Standard Treatments Often Fail

Many treatments designed for lighter skin tones can backfire in darker skin. Hydroquinone, once the gold standard, is effective-but it can cause irritation, and long-term use risks ochronosis, a condition where the skin turns blue-black. Chemical peels? Too strong, and they can cause more pigmentation. Laser treatments? If not done by someone experienced with skin of color, they can burn or lighten the skin unevenly.

What works better? Gentler, targeted options. Azelaic acid, vitamin C, kojic acid, and tretinoin are all proven to reduce pigment without triggering inflammation. A 2022 study in the Journal of Clinical and Aesthetic Dermatology found that 5% cysteamine cream reduced melasma by nearly 50% in 12 weeks-with no side effects. Tranexamic acid, originally used for heavy periods, is now being applied topically to block pigment production at the source. These newer treatments are safer, more predictable, and better suited for sensitive, pigmented skin.

The Non-Negotiable: Daily Sun Protection

No treatment will work if you’re not wearing sunscreen every single day. Not just on sunny days. Not just when you’re at the beach. Every day. Rain or shine. Indoors or out. UV rays penetrate clouds. Blue light comes through windows. And if you’re not protecting your skin, you’re undoing months of progress.

Use a broad-spectrum sunscreen with SPF 30 or higher. Look for iron oxides in the ingredient list-they block blue light. Tinted formulas blend better with deeper skin tones and give a natural finish. Reapply every two hours if you’re outside. Wear wide-brimmed hats, long sleeves, and UV-blocking sunglasses. Avoid being outside between 10 a.m. and 4 p.m. when the sun is strongest. This isn’t optional. It’s the foundation of every successful treatment plan.

Keloids: When Scars Grow Beyond the Wound

While hyperpigmentation leaves flat patches, keloids are different. They’re raised, thick, rubbery scars that grow beyond the original injury. Think of a piercing, a cut, or even an acne bump that turns into a hard, itchy lump that keeps expanding. Keloids are far more common in people with skin of color-up to 15 times more likely than in lighter skin tones. They’re not dangerous, but they can be painful, restrict movement, and cause serious emotional distress.

Unlike normal scars, keloids don’t stop growing when the wound heals. They’re driven by overactive fibroblasts-cells that make collagen. Genetics play a big role. If your parent or sibling has keloids, you’re more likely to develop them. They’re most common on the chest, shoulders, earlobes, and jawline. Even minor trauma like acne or chickenpox can trigger them.

Treating Keloids: It’s Not Just About Creams

Topical creams alone won’t shrink keloids. You need a layered approach. First-line treatment? Silicone gel sheets or pressure earrings (for ear keloids). These work by flattening the scar and reducing collagen overproduction. Steroid injections directly into the keloid are next. They reduce inflammation and soften the tissue. Multiple sessions are needed, but results are often visible within weeks.

Laser therapy, especially pulsed dye lasers, can reduce redness and flatten keloids. Cryotherapy (freezing) is another option, but it carries a higher risk of pigment loss in darker skin. Surgery? Only if combined with radiation or steroid injections afterward-otherwise, the keloid often comes back bigger than before. The key is early intervention. The sooner you treat a rising scar, the better the outcome.

Putting It All Together: A Realistic Plan

Here’s what a successful treatment plan looks like for someone with skin of color dealing with both hyperpigmentation and keloids:

1. Identify triggers: Are you breaking out? Are you using harsh scrubs? Are you skipping sunscreen? Are you getting piercings or tattoos?
2. Stop the damage: Switch to gentle, non-comedogenic skincare. Avoid picking at acne. Use a soft washcloth, not a scrub.
3. Protect daily: Apply tinted sunscreen with iron oxides every morning. Reapply if outside.
4. Treat pigment: Use a combination of vitamin C in the morning and tretinoin or azelaic acid at night. Add tranexamic acid or cysteamine if needed.
5. Manage scars: For early keloids, start silicone sheets or pressure therapy. See a dermatologist for steroid injections if it’s growing.
6. Be patient: Pigment fades over 3-6 months. Keloids take 6-12 months to flatten. Consistency beats intensity.

When to See a Dermatologist

You don’t need to wait until it’s unbearable. If you’ve had dark spots for more than three months, if a scar is growing beyond the original wound, or if your current routine isn’t helping, it’s time to see a specialist. Not every dermatologist understands skin of color. Look for one who specializes in pigmentation disorders or has experience treating diverse skin tones. Ask if they’ve treated patients with PIH or keloids before. Don’t settle for a one-size-fits-all approach.

What Not to Do

• Don’t use lemon juice, baking soda, or raw honey as home remedies-they can burn or irritate your skin.
• Don’t skip sunscreen because it’s cloudy or you’re indoors.
• Don’t pick at acne or scabs.
• Don’t get laser treatments from someone who doesn’t have experience with darker skin.
• Don’t assume hyperpigmentation will fade on its own.

Final Thoughts

Hyperpigmentation and keloids aren’t just skin-deep. They affect confidence, relationships, and daily life. But they’re not untreatable. With the right knowledge, the right products, and the right care, you can see real improvement. It takes time. It takes consistency. And it takes finding a dermatologist who gets it. You’re not alone. Millions of people with skin of color are managing this every day. And with the right plan, you can too.