How Dermatologists Treat Skin Conditions in Different Skin Tones

When it comes to diagnosing and treating skin conditions, one size does not fit all especially in dermatology. Skin tone plays a crucial role in how various skin issues appear, how they’re diagnosed, and which treatments are most effective. Yet, this nuance is often overlooked, not only by the general public but sometimes even by healthcare professionals without specialised dermatological training.

Skin conditions such as eczema, psoriasis, acne, or rosacea don’t always look the same across different skin tones. For instance, what may appear as redness or flushing on lighter skin may present as dark patches or greyish undertones in darker skin. This variability can lead to delayed diagnoses or inappropriate treatments if the practitioner isn’t experienced in recognising these subtleties.

At our dermatology clinic in London, we’ve worked with patients from all ethnic backgrounds and with a wide spectrum of skin tones from very fair to richly pigmented. Over the years, we’ve seen firsthand how vital it is to take skin tone and ethnicity into account when offering care. A treatment that works well for someone with pale skin might not be suitable or safe for someone with melanin-rich skin.

In this guide, we’ll explore why skin tone matters in dermatology, how common conditions can manifest differently depending on pigmentation, and what you should expect from a tailored, inclusive approach to treatment. Whether you’re managing an ongoing skin issue or simply want to understand how your skin type influences your dermatological care, this article aims to equip you with the knowledge to advocate for better, more personalised skin health.

Why Skin Tone Matters in Dermatology

Your skin tone is primarily determined by the amount and type of melanin your body’s natural pigment that your skin produces. While this difference in pigmentation is often considered purely cosmetic, it has far-reaching implications in dermatology. In fact, skin tone influences everything from how skin conditions present, to how the skin heals, and even how it responds to certain treatments.

Melanin doesn’t just give skin its colour it also offers some degree of natural protection against sun damage. However, melanin-rich skin tones (classified as Fitzpatrick skin types IV to VI) also have unique dermatological characteristics that require specialised attention. For example:

• Increased Risk of Pigmentation Issues: People with darker skin tones are more prone to post-inflammatory hyperpigmentation (PIH) dark marks left behind after acne, rashes, or other forms of trauma. In some cases, the opposite may occur, resulting in hypopigmentation, where areas of the skin lose their colour.
• Distinct Scarring Tendencies: Wound healing can differ significantly in darker skin. Melanin-rich skin is more likely to develop keloids or hypertrophic scars types of raised, thickened scarring that go beyond the original injury site or remain enlarged over time.
• Masked Symptoms: Classic signs of skin issues like redness (erythema) can be less visible or present differently in darker skin tones. Instead of pink or red patches, you might see purplish, greyish, or brown discolouration making it harder for untrained eyes to detect conditions such as rosacea, eczema, or even skin infections.

Unfortunately, most dermatology training and medical textbooks have historically centred around lighter skin tones, often neglecting how common conditions look on Black, Brown, and Asian skin. This lack of representation and training can lead to misdiagnoses, underdiagnoses, or delayed treatment ultimately impacting patient outcomes.

That’s why it’s so important for dermatologists to have experience treating all skin tones, and for patients to feel empowered to seek care from practitioners who understand the unique needs of their skin type. A truly inclusive approach to dermatology ensures that everyone regardless of skin colour receives accurate diagnoses, effective treatments, and respectful, personalised care.

How Common Skin Conditions Look in Darker Skin

Many skin conditions present differently depending on the amount of melanin in the skin. Unfortunately, most dermatological imagery and education has long been based on lighter skin tones, which can make it difficult to recognise certain conditions in people with darker complexions. Below, we take a closer look at how some of the most common skin issues show up in melanin-rich skin and why recognising these differences is crucial for timely and effective treatment.

1. Eczema (Atopic Dermatitis)

• In lighter skin tones: Eczema typically appears as red, inflamed, and sometimes scaly patches, especially in areas like the inner elbows, behind the knees, and on the face.
• In darker skin tones: The redness may be much less visible or not visible at all. Instead, eczema often presents as grey, brown, purplish, or ashen areas. These patches may look dry, rough, or leathery and are often intensely itchy. Over time, repeated scratching can cause the skin to thicken, a condition known as lichenification, which may appear even darker than the surrounding skin. Once the inflammation subsides, it often leaves behind long-lasting dark spots (post-inflammatory hyperpigmentation), particularly in children.

2. Psoriasis

• In lighter skin tones: Psoriasis is usually characterised by well-defined, raised red plaques with silvery-white scales, typically found on the scalp, elbows, knees, and lower back.
• In darker skin tones: The plaques can appear more violet, purple, dark brown, or even greyish rather than red. The scaling may still be present, but the colour contrast can be less obvious. Post-inflammatory pigmentation changes are also common once the plaques begin to heal making long-term discolouration a concern.

3. Acne

• In lighter skin tones: Acne generally appears as red pimples, whiteheads, blackheads, or cysts, with redness being a dominant feature.
• In darker skin tones: The active breakouts may not always look red and can be mistaken for darker bumps. One of the biggest concerns is the after-effect post-inflammatory hyperpigmentation (PIH) which causes dark spots that linger long after the acne itself has healed. These marks can sometimes be more distressing than the acne itself and may take months or even years to fade without proper treatment.

4. Rosacea

• In lighter skin tones: Rosacea is known for redness across the cheeks, nose, and forehead, often accompanied by visible blood vessels and occasional pustules.
• In darker skin tones: Because redness is less visible in melanin-rich skin, rosacea may go unrecognised. Instead, patients may present with persistent warmth, rough texture, dryness, or acne-like breakouts. The lack of visible flushing can lead to misdiagnosis, especially in individuals of African, Asian, or South Asian descent.

5. Tinea Versicolor (a fungal infection)

• In lighter skin tones: Appears as pale, pink, or light brown patches with slight scaling, usually on the chest, back, or shoulders.
• In darker skin tones: The condition often shows as lighter (hypopigmented) or darker (hyperpigmented) patches than the surrounding skin, sometimes giving a “mottled” appearance. This colour change is typically more dramatic and may persist even after the infection is treated, leading to long-term discolouration concerns.

6. Vitiligo

• In lighter skin tones: Vitiligo causes white patches that may be more subtle or harder to notice.
• In darker skin tones: The contrast is much more pronounced, with stark white patches standing out significantly against the surrounding skin. This often leads to heightened emotional and social distress due to the visibility of the condition.

7. Melasma and Hyperpigmentation

Melasma is a chronic pigmentary disorder that appears as dark, blotchy patches, commonly on the cheeks, nose, forehead, and upper lip. It is especially common in women with medium to dark skin tones such as those of South Asian, Middle Eastern, and Latin American backgrounds and can be triggered by hormonal changes, sun exposure, and heat.

• In lighter skin tones: Melasma may appear light brown and blend gradually into the surrounding skin.
• In darker skin tones: The contrast is often much more striking, and the patches may appear deep brown or even slate-grey. These individuals are also more prone to post-inflammatory hyperpigmentation, making it crucial to approach treatment with care.

8. Rosacea

Rosacea is a chronic skin condition often associated with facial redness, visible blood vessels, and periodic flushing. It’s commonly diagnosed in people with lighter skin, particularly of Northern European descent, but it also occurs in individuals with darker skin and is often underdiagnosed.

• In lighter skin tones: Rosacea presents with obvious facial redness (erythema), broken capillaries, and sometimes acne-like pustules.
• In darker skin tones: The typical redness can be much harder to detect. Instead, patients may report sensations of stinging, burning, dryness, or the presence of small, rough bumps. These symptoms can easily be mistaken for acne, eczema, or allergic reactions leading to delayed or incorrect diagnoses.

Tailored Treatment Plans for Diverse Skin Tones

Treating patients of colour isn’t just about recognising visual differences in how skin conditions appear it also requires a thoughtful, evidence-based approach to treatment that takes the unique characteristics of melanin-rich skin into account. Dermatologists must consider the increased risk of pigmentation changes, scarring, and sensitivity when developing treatment plans for patients with medium to dark complexions.

Safe Use of Lasers and Light Therapies

Lasers and light-based treatments can be effective for a variety of skin concerns, from hair removal and acne scars to pigmentation and resurfacing. However, in darker skin tones, these treatments come with greater risk. Devices such as Intense Pulsed Light (IPL) or fractional CO₂ lasers can inadvertently cause burns, blisters, or post-inflammatory hyperpigmentation if not used correctly.

That’s why specialised equipment and expertise are essential. At our clinic, we use FDA-approved laser systems that are specifically calibrated for use on melanin-rich skin. Before proceeding with treatment, we always conduct a test patch to assess how the skin responds and minimise the risk of adverse effects. Choosing the right wavelength, energy level, and cooling technology can make a significant difference in both safety and results.

Topical Treatments with Extra Care

Topical products are often the first line of treatment for many conditions such as acne, melasma, and eczema. However, active ingredients like retinoids, benzoyl peroxide, and hydroquinone while effective can sometimes cause irritation or lead to unwanted pigmentation in darker skin tones if used incorrectly.

To prevent irritation-induced hyperpigmentation, dermatologists may:

• Recommend gentler formulations or lower concentrations of active ingredients
• Adjust the frequency of use to help the skin build tolerance
• Compound customised topical solutions tailored to the individual’s skin sensitivity and treatment goals

In many cases, treatment is not only about clearing the condition itself but also about managing the pigmentation that often follows. This dual focus requires a comprehensive and personalised skincare approach, especially for those with skin types IV to VI on the Fitzpatrick scale.

Emphasis on Sun Protection

One of the most common myths in skincare is that darker skin doesn’t need sun protection. While melanin does offer some natural defence against UV radiation, it does not provide complete protection. In fact, sun exposure can exacerbate pigmentation problems such as melasma, post-inflammatory hyperpigmentation, and even certain types of scarring across all skin tones.

That’s why year-round sun protection is an essential part of any dermatological treatment plan regardless of skin colour. For patients with melanin-rich skin, we recommend:

• Broad-spectrum SPF 30 or higher, applied daily and reapplied every two hours when outdoors
• Tinted sunscreens containing iron oxide, which not only guard against UVA and UVB rays but also protect against visible light a lesser-known contributor to hyperpigmentation in darker skin
• Education on sun safety beyond the summer months, highlighting that UV rays are present year-round, even on cloudy days

Helping patients build sun protection into their daily routine is one of the most powerful tools for preventing pigmentation issues and enhancing treatment results.

Keloid-Prone Skin Needs Extra Precautions

Darker skin tones, particularly among individuals of African, Caribbean, or South Asian descent, are more prone to developing keloids raised, thickened scars that grow beyond the boundaries of the original injury. These can result from acne, surgery, piercings, or even minor skin trauma.

For patients with a known history of keloid formation, we take proactive steps to minimise the risk. This might include:

• Avoiding certain invasive procedures such as deep microneedling, aggressive chemical peels, or ablative laser treatments, which may trigger excessive scarring
• Preventative treatment after skin injury, using options like silicone gel sheets or ointments to flatten and soften scars as they heal
• Corticosteroid injections or cryotherapy, which may be administered early in the healing process to reduce inflammation and prevent keloid formation

Open communication and careful procedural planning are key when working with keloid-prone patients. The goal is not just aesthetic improvement, but also prevention of long-term complications.

The Importance of Inclusive Dermatology

Everyone deserves dermatological care that not only treats their skin concerns but also understands the unique characteristics of their skin tone. Unfortunately, many patients with medium to dark skin tones have experienced dismissive or ineffective care in the past often because their symptoms were misunderstood, or their concerns weren’t taken seriously.

At our dermatology clinic in London, we believe inclusivity should be at the heart of modern skincare. This means more than just offering suitable treatments. It involves educating our team to recognise how conditions manifest across different skin tones, investing in equipment safe for melanin-rich skin, and fostering open, respectful communication with every patient who walks through our doors.

If you’re from a diverse background and have ever felt overlooked, misdiagnosed, or unsure about how to care for your skin, you’re not alone. Many of our patients come to us after years of trial and error particularly with complex issues like pigmentation, scarring, or chronic acne that have been mismanaged elsewhere.

A tailored approach isn’t just more effective it’s safer, more compassionate, and more empowering. When dermatologists acknowledge the diversity of skin types and adapt care accordingly, patients can feel confident that their skin is being treated with the respect and expertise it deserves.

Final Thought: Your Skin Deserves Personalised Care

Skin health shouldn’t be based on outdated assumptions. When dermatologists consider your unique skin tone, everything from diagnosis to treatment becomes more accurate and more effective.

If you’ve struggled to find skincare that works for your tone, or just want a more personalised experience, you can get in touch with us to book a consultation with one of our expert dermatologists in London. We’re here to help your skin thrive no matter your tone or texture.

References

1. Reid, D., Malak, S., Khadka, M., Hanna, R., Pharr, T., Wyant, W.A. & Albers, S. (2025) Keloids and hypertrophic scars in individuals with darker Fitzpatrick skin types: a systematic review of treatment efficacy and quality of life outcomes. Archives of Dermatological Research, 317(1), pp. 795–810. doi:10.1007/s00403-025-04292-x.
   Available at: https://pubmed.ncbi.nlm.nih.gov/40459590/
2. Bronte, J., Zhou, C., Vempati, A., Tam, C., Khong, J., Hazany, S. & Hazany, S. (2025) A comprehensive review of non‑surgical treatments for hypertrophic and keloid scars in skin of color. Scar Healing Institute, Los Angeles.
   Available at: https://www.researchgate.net/publication/381520901_A_Comprehensive_Review_of_Non‑Surgical_Treatments_for_Hypertrophic_and_Keloid_Scars_in_Skin_of_Color
3. Sarkar, R., Trivedi, M.K., Yang, F.C. & Cho, B.K. (2017) A review of laser and light therapy in melasma. International Journal of Women’s Dermatology, 3(2), pp. 118–127.
   Available at: https://www.researchgate.net/publication/318707312_A_review_of_laser_and_light_therapy_in_melasma
4. Pan, W. & Lee, A.Y. (2023) Treatment of melasma on darker skin types: a scoping review. Cosmetics, 10(1), p. 25. Available at: https://www.mdpi.com/2079-9284/10/1/25
5. Khosravi‑Hafshejani, T., Mar, K., Khalid, B., Maazi, M., Ahmed, R. & Wang, E. (2024) Treatment of post‑inflammatory hyperpigmentation in skin of colour: a systematic review. Journal of Cutaneous Medicine and Surgery, Jul–Oct 2024, pp 1–13. doi:10.1177/12034754241265716. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514325/