Dermatology for People of Color: Growth Field

When Nada Elbuluk, MD, was a girl there were few dermatologists specializing in treating people of color. Things have changed.

Elbuluk is now assistant professor of dermatology at NYU Langone’s Ronald O. Perelman Department of Dermatology. Helping people of color is her dermatology specialty. It is growing field with a sizable patient demographic, she said.

“The US Census bureau predicts that by 2050 at least 50% of the US population will fall into a skin-of-color population,” Elbuluk said.

These patients benefit from having a specialist because “there a lot of conditions that disproportionately affect this group,” she said.

Pigmentation-related problems are common, because people of color have more melanin in their skin.

That can mean that when patients seek treatment for skin problems common to most racial groups, like acne, eczema or psoriasis, people of color can left with dark spots where the problems were.

“It’s very frustrating for these patients,“ she said. Her treatment arsenal includes creams, chemical peels, and lasers, and all can be effective. Other typical conditions she treats include ingrown hairs, often from shaving, an uncomfortable condition known as pseudofolliculitis barbae. Successful treatment usually includes finding a different way of hair removal, as well as the use of topical cream and washes.

Hair loss, sometimes related to wearing hairstyles that put tension on the scalp—such as tight braids, ponytails, and dreadlocks—can be helped with new looser hairstyles or having the patient vary the hairstyle over time. That condition is called tracton alopecia. But another condition leading to hair loss (central centrifugal cicatricial alopecia) once thought to be caused by use of hair relaxing chemicals and hot combs, more likely has a genetic component, she said. Those and other possible factors are being researched, she said.

Melasma, dark spots on places like the forehead and upper lip is common, and can appear during pregnancy or after using birth control products. "The difficulty in treatment is that patients have to be extremely diligent about sun protection," she said. Unprotected exposure to the sun can led to the return of the melasma.Laser therapy is an option, but can sometimes result in the problem coming back worse than it was before treatment.

“There’s not really any way to predict that,” she said, other than doing a test on a small area of skin.

Keloids, excessive scarring that can be disfiguring is another common complaint, one that affects up to 16% of people of color. These are not related to sun exposure and appear to have a genetic component, Elbuluk said.

The options for treatment include injection of steroids, freezing the keloids from the inside, and radiation treatment. “There is always the risk of them coming back bigger than before,” she said.

Dermatosis papulosa nigra, small bumps that are overgrowths of the top layer of skin that patients may mistake for moles is another condition affecting people of color.

“They are not moles, they cannot turn into cancer, but people don’t like them cosmetically,” Elbuluk said. “Treatment is usually successful, but patients will likely get more over time.”

On the good news front, laser use in treating people of color is getting safer and Elbuluk expects those improvement will continue. And perhaps the best news in the field is simply that it is getting the attention it needs. “It is wonderful,” she said, “we have textbooks, atlases, and more dermatologists.”

She discusses her work in the video below.

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