"I had tried 50 million creams and was even told I'd just have to live with the eczema, but Dr. Taylor suggested things no one else had before. She understands my skin," says the postal worker and student in Lawnside, N.J.

Taylor is among a rising tide of dermatologists and spa owners who focus on the skin, hair and nail needs of women and men of color. Taylor, a spokeswoman for the American Academy of Dermatology, says all dermatologists should be well-versed in the differences between fair and dark skin.

"The demographics of our country are really changing, and many people of color are looking for a dermatologist familiar with their needs, even in the heartland, not just the metropolitan areas," Taylor says.

Easier to irritate brown skin

There's a definite need for such as specialty, says Rebat Halder, professor and chairman of the department of dermatology at Howard University in Washington, D.C. By 2050, Halder says, half the population in the USA will be either African-American, Hispanic, Asian or Native American. According to the U.S. Census Bureau, about one-third of the population now has skin of color.

Halder is president of a steadily growing professional organization, The Skin of Color Society, aimed at promoting education and research related to treating skin of color. Launched four years ago, its membership of mostly dermatologists has reached 100 and is increasing, Halder says.

Brown skin contains more melanin, or dark pigment, Taylor says. She says melanin levels vary dramatically among the ethnic groups.

Cells called melanocytes make the melanin. Melanocytes, the cells in the upper layer of the skin, are more reactive in darker skin and can release more melanin when they're irritated, says Hema Sundaram, a dermatologist in the Washington area.

"Any type of irritation to dark skin — an ingrown hair, acne or a poor laser treatment — can cause dark discoloration, called hyperpigmentation, that will last for months, even years," says Sundaram, who notes that scars on white skin tend to be pink and resolve more quickly.

Brown-skinned people are more vulnerable to melasma (dark patches resulting from pregnancy and genetics) and vitiligo (a genetic condition that causes uneven-shaped areas with no pigmentation at all) as well, Taylor says. Certain medications for high blood pressure, diabetes and heart disease also can cause brown skin to discolor.

Skin cancer is often overlooked in people of color because it is assumed they just don't develop the disease, says Peggy Fuller, a dermatologist in Charlotte. "Have you ever seen a skin cancer pamphlet with pictures of black skin with a melanoma?"

Says Taylor, "Skin conditions and treatments should not always be dealt with the same way in whites as they are in skin of color."

In whites, for example, washing the hair often helps clear up dandruff, while black women who shampoo daily may exacerbate a dry scalp and hair and cause increased breakage.

Who needs an expert?

Sundaram, a laser expert who has conducted research and lectured on the topic, says: "With brown skin, you need to use appropriate lasers and modified settings to avoid burns and discoloration.

"You may also need to be less aggressive with facial peels because taking off too many layers at once can lead to scarring."

Even women with the same brown skin tone but different cultural backgrounds may react differently to the same procedures, says Flor Mayoral, a dermatologist in Miami. Mayoral recommends that patients ask to have a test spot done before having a full skin procedure.

Mayoral, who is of Hispanic heritage, also advises patients to make sure their dermatologist "knows who you are, your ethnic background."

Though Sundaram applauds the fact that more dermatologists are taking an interest in treating patients of color, she is concerned that it sends the wrong message. "Does it imply that mainstream dermatologists can't treat patients of color?"

Sundaram says it also suggests that patients who go to experts in skin of color won't run into problems. She says at least one in five of her patients with brown skin initially come in because he or she has had inappropriate treatments, even at skin centers that promote themselves as experts in brown skin.

"I saw an African-American woman in her 30s the other day with dark moles on her face," Sundaram says. "A dermatologist had frozen them off, and it had caused permanent white spots. I would never use liquid nitrogen on the face of a patient of color, ever, ever.

"There needs to be better training, and patients need to research more carefully before selecting a skin expert."

Enlarge By William Thomas Cain for USA TODAY Patient Nakia Smith, left, meets with Susan Taylor in the dermatologist's Philadelphia office. Taylor says that as U.S. demographics change, more people of color need dermatologists who know how to treat their skin. Smith found just that: "Dr. Taylor suggested things no one else had before. She understands my skin."

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