Skin of Color Dermatology: Managing Hyperpigmentation and Keloids

Why Hyperpigmentation Hits Harder on Darker Skin

When you have darker skin, a pimple, a scrape, or even a harsh scrub doesn’t just go away-it leaves behind a dark spot that can stick around for months. This isn’t just a cosmetic issue. It’s a real, measurable condition called post-inflammatory hyperpigmentation (PIH), and it’s far more common-and more persistent-in people with skin of color.

It happens because melanocytes, the cells that make pigment, go into overdrive after skin trauma. In lighter skin, this might show up as a faint pink mark. In darker skin, it turns into a deep brown or gray patch that can look like a stain. The more melanin your skin naturally has, the more likely it is to overproduce after injury. That’s why acne, eczema, razor bumps, or even a poorly done chemical peel can trigger lasting dark spots.

And it’s not just acne. Sun exposure, hormonal shifts, and even certain hair removal methods can trigger it. Melasma, a type of hyperpigmentation that shows up as blotchy brown patches on the face, affects up to 70% of pregnant women with darker skin tones. It’s not just about looks-it affects confidence, social interactions, and mental well-being. Many patients delay seeing a doctor because they think it’s "just a spot," but untreated, it can get worse and harder to fix.

The Sun Doesn’t Care About Your Skin Tone-But You Should

If you have darker skin, you might think you don’t need sunscreen. That’s a dangerous myth. Yes, melanin gives you some natural protection, but it doesn’t stop UV rays from triggering more pigment production. In fact, sun exposure is the #1 thing that makes hyperpigmentation worse-and keeps it from fading.

Studies show that daily sunscreen use can cut the severity of PIH by up to 50%. But not just any sunscreen works. You need broad-spectrum protection (UVA and UVB), SPF 30 or higher, and crucially, iron oxides. These minerals block blue light from phones, computers, and LED lights, which can also darken skin tones. Tinted sunscreens are especially helpful-they blend with deeper skin tones and act like a light cover-up while protecting.

Wear it every day, even when it’s cloudy. Reapply every two hours if you’re outside. Cover your face with a wide-brimmed hat. Stay in the shade between 10 a.m. and 4 p.m. These aren’t suggestions-they’re medical necessities for anyone dealing with hyperpigmentation.

What Actually Works: Topical Treatments That Don’t Backfire

There’s a long list of creams and serums marketed for dark spots, but not all are safe-or effective-for skin of color. Some can cause irritation, which makes hyperpigmentation worse. The goal isn’t to bleach your skin. It’s to calm the pigment cells and slow down overproduction.

First-line treatments include:

• Hydroquinone (2-4%): The gold standard for fading dark spots. It blocks melanin production. Used short-term under a dermatologist’s care, it’s safe and effective.
• Tretinoin (retinoids): Speeds up skin turnover, helping shed darkened cells faster. Often combined with hydroquinone for better results.
• Azelaic acid (15-20%): Reduces inflammation and pigment. Gentle enough for sensitive skin and safe during pregnancy.
• Vitamin C: An antioxidant that brightens skin and blocks UV-induced pigment. Best used in the morning under sunscreen.
• Kojic acid and glycolic acid: Lighten spots by exfoliating gently. Avoid if your skin is already irritated.

Newer options like tranexamic acid (topical or oral) and 5% cysteamine cream are showing strong results with fewer side effects than hydroquinone. These are especially helpful for melasma and stubborn PIH that doesn’t respond to older treatments.

Don’t try to speed things up with strong peels or lasers unless you’re under the care of a dermatologist who specializes in skin of color. Many light-based treatments can trigger more pigmentation in darker skin-making the problem worse.

Keloids: When Scars Grow Beyond the Wound

While hyperpigmentation leaves flat dark spots, keloids are a different beast entirely. They’re raised, thick, rubbery scars that grow beyond the edges of the original injury. Think of a piercing, a cut, or even an acne cyst that turns into a bumpy, itchy, sometimes painful mound of scar tissue.

Keloids are far more common in people with African, Asian, or Hispanic ancestry. Up to 15% of people with darker skin develop them after minor trauma. They can appear anywhere but are most common on the chest, shoulders, earlobes, and jawline. Unlike normal scars, keloids don’t stop growing on their own. They can keep expanding for months-or years.

They’re not dangerous, but they’re emotionally taxing. Many people avoid piercings, tattoos, or even shaving because they fear a keloid forming. They can be itchy, tight, and restrict movement. And unlike hyperpigmentation, they rarely fade without treatment.

Treating Keloids: It’s Not Just About Creams

Keloids respond poorly to topical treatments alone. You need a layered approach:

• Silicone sheets or gel: Applied daily for months, these help flatten and soften keloids. One study showed 60-80% improvement with consistent use.
• Corticosteroid injections: The most common treatment. Injected every 4-6 weeks, they shrink the scar and reduce redness and itching.
• Cryotherapy: Freezing the keloid with liquid nitrogen can help flatten it, especially when combined with steroid shots.
• Laser therapy: Pulsed dye lasers reduce redness and flatten the scar. Must be done by an expert-poor technique can make keloids worse.
• Surgery: Cutting out a keloid alone has a 50-100% recurrence rate. Always combine it with steroid injections or radiation afterward.

Prevention is key. If you know you’re prone to keloids, avoid unnecessary piercings, tattoos, or aggressive skin procedures. Treat acne early. Don’t pick at scabs. Use gentle skincare. And if you do get a wound, keep it covered with silicone dressing from day one.

When to See a Dermatologist

You don’t have to live with dark spots or raised scars. If you’ve tried over-the-counter brighteners for 3 months with no change, or if a scar is growing after an injury, it’s time to see a specialist.

Look for a dermatologist who has experience with skin of color. Ask if they treat PIH and keloids regularly. Don’t settle for a provider who says, "Just use hydroquinone and wait." That’s not a plan-it’s a delay.

Good treatment means:

• Identifying the root cause (acne? hormones? sun exposure?)
• Creating a personalized regimen-not a one-size-fits-all product
• Monitoring progress and adjusting treatments every 6-8 weeks
• Using combination therapy when needed

Improvement takes time. Hyperpigmentation can take 3-6 months to fade. Keloids need months of consistent care. But with the right approach, both can be managed-sometimes even reversed.

What Not to Do

There’s a lot of misinformation out there. Avoid:

• Using lemon juice, vinegar, or baking soda on your skin-these burn and worsen pigmentation.
• Skipping sunscreen because "I’m dark, I’m fine." You’re not.
• Trying laser treatments at a spa or salon without a dermatologist’s supervision.
• Waiting to treat acne-every breakout is a potential dark spot waiting to happen.
• Ignoring a growing scar. Early intervention makes keloids much easier to control.

Real-Life Strategies That Work

One patient, a 32-year-old woman from Toronto with African heritage, had PIH from hormonal acne. She started with a morning routine: tinted sunscreen with iron oxides, vitamin C serum, and a gentle moisturizer. At night, she used azelaic acid and tretinoin. Within 4 months, her dark spots faded by 70%. She didn’t use hydroquinone because she was trying to conceive.

Another man, 28, developed a keloid after ear piercing. He tried silicone gel daily for 6 months, plus monthly steroid injections. His keloid shrank by 80% and stopped itching. He now wears clip-on earrings instead.

These aren’t miracle stories. They’re the result of consistency, the right tools, and professional guidance.

Final Thoughts: You Deserve Clear Skin

Hyperpigmentation and keloids aren’t flaws-they’re biological responses to injury and inflammation. They’re common, treatable, and far from rare. Too many people suffer in silence because they think nothing can be done. That’s not true.

With daily sun protection, targeted treatments, and early intervention, you can take back control. It won’t happen overnight. But with patience and the right care, your skin can heal-not just look better, but feel better too.