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Most skin diseases occur in people of all nationalities, regardless of their skin color. Certain problems encountered in the skin are more common in people with different hues of skin, and sometimes a disorder seems more prominent because it affects skin color. This week continues our review of these disorders and their treatment.

Dermatosis papulosa nigra

This most commonly occurs in African American patients. Some people call them “flesh moles,” “Bill Cosby spots,” “Morgan Freeman spots,” and more recently, “Condoleezza Rice spots.” It tends to occur slightly more frequently in women than in men.

These are tan to brown to black, raised papules that can occur on the forehead, cheeks, and neck. Under the microscope, they resemble other benign growths known as seborrheic keratoses. We use a special surgical technique in our clinic that can achieve excellent results in treating dermatosis papulosa nigra. Indications for treatment can be pain, itching, irritation, and cosmetic reasons.

Acne

When treating persons of color, post-inflammatory hyperpigmentation (brown spots after the acne blemishes have healed) and active acne need to be differentiated. It is important to note that when one is treating acne, the brown spots that occur afterwards are only residual effects, not active acne.

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Dermatosis papulosa nigra before (l) and after treatment

I usually employ a combination therapy when I am treating acne to achieve optimal results. This usually involves topical treatments, oral treatments, laser treatments and, in persons of color, topical lightening agents that can include retinol, anti-inflammatory agents, and the bleaching agents cogic acid and hydroquinone. I also discuss with patients the difference between active inflammatory bumps and the flat, brown spots left behind.

Dry or ‘ashy’ skin

This is a problem seen in all patients, but when one has tan, brown, or dark-brown skin, dry skin tends to turn silvery white. This phenomenon is often referred to as having ‘ashy’ skin.

I believe the most important component of any skin care program is a gentle, non-detergent cleanser and an ultra-moisturizing lotion. I recommend the lotion be applied immediately after patting the skin dry after a bath or shower. This seals in the moisture achieved from the shower, and the appropriate moisturizing lotion can provide continual moisture and protection throughout the day. Often, two or three days of this program can completely reverse dry or ‘ashy’ skin.

Next week: more skin problems common to people of color

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.

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