Some of the most common causes of scarring include acne, eczema, wounds, and sunburn. Scarring can either darken or lighten black skin. These effects are known as hyperpigmentation and hypopigmentation, respectively.
The treatment of the scar depends on its cause and prominence. For example, a keloid scar may require surgery, whereas medical-grade creams could be more suitable for acne scars. Fine scars may even fade on their own.
A dermatologist can advise a person on which treatment is likely to give them the best results.
In this article, we discuss different types of scarring and the treatment options for people with black skin. We also provide tips for preventing scarring.
Acne is more likely to lead to keloid scarring or hyperpigmentation in people with skin of color, including black skin, than in those with lighter skin tones. Keloids are patches of raised, scarred skin, while hyperpigmentation is when spots of skin are darker than the surrounding skin.
The American Academy of Dermatology (AAD) recommend that people focus on treating both acne and dark spots at the same time. This approach reduces the appearance of dark spots and helps the remaining acne clear before scarring develops.
The AAD also recommend retinoid and benzoyl peroxide products for skin of color, explaining that although benzoyl peroxide can bleach textiles, it cannot bleach the skin. However, starting with a low concentration (2.5%) will help people avoid potential irritation.
A 2013 review suggests that retinoids may help lessen complications from acne, such as hyperpigmentation. The review concludes that although retinoids are safe and beneficial for people with skin of color, they may cause irritation in those with sensitive skin.
As any form of skin irritation can develop into post-inflammatory hyperpigmentation (PIH) in people of color, people should ensure that any formulations that they use are extra gentle.
Treating acne with over-the-counter products may take a long time, and the results will not always be immediate. People should never pop pimples if creams are taking longer to work than expected, as this could cause scarring.
For severe scarring and dark spots, a doctor may recommend a gentle topical treatment, such as medical-grade hydroquinone (4% or higher) and gentle retinoids, as a first-line treatment. A doctor will advise a person on how long they can use hydroquinone, which is only safe to apply for short periods.
Before starting any new nonprescribed cream, people of color should speak with their doctor, who may refer them to a dermatologist. Dermatologists specialize in treating skin conditions, including acne, and can recommend a suitable treatment.
Eczema causes itchy, dry, irritated skin. People with eczema often experience flare-ups that alternate with symptom-free periods. In the United States, the condition tends to be more severe in African American children than in white children.
Eczema does not look the same on black skin as it does on lighter skin. Patches of dry skin can appear brown, purple, or grey.
Black people may also have other symptoms, such as dark circles around the eyes. They may also be prone to developing a form of eczema called papular eczema, which involves small goosebump-like protrusions.
Eczema may cause skin discoloration, particularly after a flare-up, with the skin appearing either darker or lighter than usual. In most people, the skin will eventually return to its original appearance, but this may take several months.
As eczema causes itchiness, it is a normal response to scratch the skin. However, too much scratching can cause scarring and skin thickening.
People may wish to use topical lotions and ointment to alleviate their dry, cracked, and itchy skin. These products aim to promote healing and prevent scarring.
Other conditions that can cause scarring on black skin include:
Raised scars are significantly thickened areas of skin that may require medical treatment. Keloids are a type of raised scar.
Some clinical therapies that reduce raised scars include:
- pressure therapy
- silicone gel
- polyurethane dressing
- laser treatment
- corticosteroid injections
- bleomycin injections
- scar surgery
However, not all clinical therapies are suitable for treating scarring on dark skin, as some may cause unwanted hyperpigmentation. For the best results, a person should speak with a dermatologist.
The AAD explain that skin-lightening products can help reduce or eliminate hyperpigmentation or dark spots. The ingredients in these products may include:
- glycolic acid
- azelaic acid
- kojic acid
- vitamin C
- 2% hydroquinone
However, when buying a skin-lightening product, it is essential to ensure that it is from a reputable retailer. Some products may contain undisclosed levels of steroids or even mercury. A person must also never use bleach to lighten their skin as this is extremely dangerous.
Applying sunscreen before going outside protects the skin against harmful UV rays and also reduces the likelihood of dark spots developing.
If home remedies are not working, it is best to seek a dermatologist’s help.
A person can prevent scarring by:
- refraining from picking, popping, or squeezing pimples or scabs
- seeking appropriate clinical treatment for acne
- using an emollient or lotion for eczema
- correctly caring for wounds
Some types of scars, such as keloid scars, are more common in African Americans than in white people. Eczema also presents differently on black skin, with affected areas appearing brown, grey, or purple.
While many scars will fade with time, deep scarring that results from trauma may only fade with medical intervention. Not all scarring treatments are appropriate for black skin, so it is best to speak with a dermatologist. These professionals can offer advice on how to minimize the risk of hyperpigmentation after treatment.