How Common Skin Conditions Can Look Differently on Skin of Colour

When you Google common skin conditions like keratosis pilaris (KP), rosacea, eczema and psoriasis, you’re probably flooded with images of these conditions on white or fair skin tones. Additionally, most textbook photos presented through studies tend to be of lighter skin rather than skin of colour.

It is true that over 80 per cent of readily available images of skin conditions are of lighter-skinned people.

As the Australian multicultural community rises it is important to gain a thorough understanding of lesion manifestations not just on Caucasian skin types, but also how pigmentation and various skin conditions may present on ethnic skin types. 

Without such knowledge, accurate diagnosis can be difficult and may result in a misdiagnosis, which is a common phenomenon even among doctors.

According to dermatologist Dr. Kung, from New York, many times, patients will come to see her with a concern that they have shingles, when in fact their condition is psoriasis.

Or they will say they have acne, when it’s keratosis pilaris, or they say they have a fungus, and it is eczema.

So, here are some dermatological observations to consider

Eczema

•  In cases of eczema lesions may present very differently in people of colour.

• Due to the potential redness that may be hidden on darker skin, it is frequently hard to determine.
• Eczema may instead appear as a dark brown, purple, or ashen grey colour.
• This can lead to delayed or incorrect diagnoses.
• Affected areas may also appear as thick, scaly patches that are darker than the surrounding skin.
• This can also be more frequent than what we commonly see in light skin types.
• Some other signs of eczema include itching, dry skin, and a rash.

Psoriasis

In people with darker skin tones, psoriasis can appear as dark patches or thickened, scaly plaques that may be mistaken for eczema or other skin conditions, says Dr. Baum.

• She notes that the usual redness of the condition is often less apparent on the skin of colour. The lesions can often appear as silvery scales or could appear a deep eggplant colour.

Acne

• Acne lesions can appear darker or redder on the skin of colour due to increased melanin production.
• Additionally, post-inflammatory hyperpigmentation (PIH) can be more common and more severe in people with darker skin tones
• Leading to long-lasting dark marks after the acne clears.
• Dr. Baum and Dr. Downie also noted that patients frequently come in concerned about acne, but it turns out to be dark spots.

Skin cancer: “Skin cancers do look different in skin of colour versus lighter skin types,” says Dr. Downie. If you have a non-healing pimple or a non-healing wound, you should have these checked by a dermatologist to make sure that it’s not a skin cancer.

Rosacea

• Rosacea often presents as a flush of pink and red on those with lighter skin tones

• Dr. Downie says it can appear more violet and purple on darker skin tones.

On dark and black skin, it may be challenging to recognise the flushing or blushing, associated with rosacea. Keep an eye out for additional symptoms of the illness, says Dr. Chacon. Rosacea is a common skin disorder that makes your face look flushed and has visible blood vessels. Moreover, it could result in tiny, pus-filled pimples.

Keratosis pilaris

• Dr. Downie says KP may look like a generalised rash on the skin of colour.
• While KP tends to appear as white or red bumps on lighter skin, they may be brown or flesh-coloured on darker skin tones
• Frequently appears as raised, darker lumps on the upper arms, butt, and thighs.

We believe that lesion recognition warrants a specialised area of study, and we will pursue encouraging educational providers to develop such a course. 

In the meantime, be mindful of the above recommendations and if in doubt refer to a dermatologist.

It is crucial to bridge this information gap and shed light on how common skin conditions may manifest on skin of colour.

By promoting diversity in visual representation and advancing research that encompasses a broader range of skin tones, we can foster a more inclusive and informed understanding of dermatological conditions, empowering individuals of all backgrounds to make informed decisions about their skin health.