Skin health: Our skin is not immune

Our skin is much more than a barrier. One of the things I love about skin is that it is an external reflection of what is happening inside us, which makes it a very good guide to our general wellbeing. In this piece I want to focus on the conditions that more commonly affect Black skin (eczema, seborrhoeic dermatitis and acne) and then on one we far too often assume we are protected from: skin cancer.

Eczema: why Black skin is more prone

Eczema is a chronic condition that causes dry, itchy skin and rashes. It is more common in Black skin, partly because of genetic factors and partly because we tend to have fewer ceramides, the fats that hold moisture in the skin. With less moisture held in, the skin dries out and becomes more prone to eczema. Harsh skincare practices common in some of our communities make this worse by leaving the skin more sensitive.

On Black skin, an eczema rash can look more aggressive and much drier, and it does not always look the way textbooks describe. That makes it harder to recognise, especially for clinicians who are less used to examining Black skin, and it can lead to delayed diagnosis and sometimes poor treatment.

Managing eczema comes down to three things:

1. Identify your triggers. Keep a diary of foods, environmental factors and flare-ups to spot patterns.
2. Use the power of moisture. Regular moisturising keeps skin hydrated and reduces flares. Look for fragrance-free, hypoallergenic products. "Natural" does not automatically mean better for your skin.
3. Use medical treatment when needed. Even when you are doing everything right, flares can still happen, and prescribed creams are often the best way to settle them.

Seborrhoeic dermatitis: more than dandruff

Seborrhoeic dermatitis is similar to eczema but not the same, and I often hear it described as eczema of the scalp. It is common in people of African descent and can be very uncomfortable and upsetting. It causes flaking that looks like dandruff, and the scalp becomes inflamed, which can look red or, on darker skin, simply darker, with a greasy appearance. It can also affect the face, chest and other areas.

It is a complex condition that is not fully understood, but several factors play a part:

• Yeast: a yeast called Malassezia builds up on the scalp, driving flaking and oiliness.
• Genetics: it is more common if parents or siblings have had it.
• Environment: flares are more likely in cold, dry weather.
• Stress and exhaustion: both can make flares more persistent.
• Other conditions: it is more common in people with HIV, Parkinson's disease and even depression, which shows how complicated it can be.

The good news is that seborrhoeic dermatitis can be managed very practically, and many treatments are available in shops. Options include medicated shampoos, topical antifungals to reduce the yeast, topical steroids to calm inflammation, and non-steroid creams called calcineurin inhibitors. When the scalp or body is severely affected, oral antifungals can help, and for a small number of people, specialist phototherapy may be used.

Acne: treating the spots and the marks they leave

Acne happens when pores and hair follicles become clogged. It can appear as small, medium or large bumps, sometimes painful and pus-filled, and it can be disfiguring. It is caused by a mix of excess oil, a build-up of dead skin cells, bacteria and hormones.

For many Black patients, the biggest struggle is not the acne itself but the hyperpigmentation it leaves behind: the dark or discoloured marks that remain as the skin heals. This is caused by inflammation and by how our skin chooses to heal.

Treatment can include creams applied to the face, oral medication for more severe or scarring acne, and procedures such as laser or chemical peels, often sought privately, to treat active acne and the marks it leaves. But prevention is key:

• Cleanse regularly. Use a mild, non-comedogenic (non-pore-blocking) cleanser twice a day. In the evening, a double cleanse removes sweat, oil, dead skin, make-up and skincare products.
• Keep your skin hydrated. Even oily skin needs moisturiser. Choose an oil-free moisturiser made for acne-prone skin.
• Wear sun protection. Sun exposure worsens hyperpigmentation, darkens acne scars and can even trigger a form of acne. Use SPF 30 or above every day, including on cloudy and rainy days.
• Exfoliate gently. This does not mean scrubbing your face. It means using the right ingredients to remove dead skin without irritation.

Be gentle and kind to your skin. You only have one.

Skin cancer: a myth we need to bust

Many people believe skin cancer does not affect Black skin. Because of our higher melanin levels, skin cancer may be less common in Black people, but it certainly is not something we are completely excluded from. When it does occur, it is often detected later, because nobody is looking for it. In England, only about 6 in 10 melanomas in Black patients are found at an early stage, compared with 8 in 10 in white patients, and later diagnosis means poorer outcomes.

Melanoma, the most dangerous form, often appears in places that get little sun: under the nails, on the soles of the feet, on the palms, and on mucous membranes such as the inside of the mouth. This form of skin cancer, found under his toenail, took Bob Marley from us in 1981 at just 36, after it spread. Acting early on any change, and getting the full treatment recommended, makes all the difference. The more common skin cancers, basal cell carcinoma and squamous cell carcinoma, also affect Black people, but they can look different and often appear as pigmented forms. In Black people, squamous cell carcinoma often appears in areas that get little sun, including the genitals, or in old scars and wounds that do not heal.

Risk factors include a family history of skin cancer, excessive sun exposure, using tanning beds (a complete no for me as a clinician), previous radiotherapy for another condition, and skin injuries, persistent inflammation or wounds that do not heal. Any of these is a reason to seek medical attention.

Most skin cancers are treated by cutting them out. Depending on the type and stage, treatment may also include chemotherapy, radiotherapy, immunotherapy or targeted therapy, guided by a specialist. Early detection significantly improves the chances of successful treatment and gives you far more options. Early detection saves lives.

A skincare routine for Black skin

Here are my five steps to healthy, radiant skin:

1. Cleanse with a gentle, hydrating cleanser suited to your skin type. Avoid abrasive soaps that strip natural oils, which can cause dryness and make the skin produce even more oil. Look for glycerin, ceramides and hyaluronic acid.
2. Exfoliate gently to remove dead skin and unblock pores, using an exfoliating cleanser or toner. Black skin can scar and become irritated, so never scrub.
3. Tone to target your particular skin needs. Some products work as both exfoliant and toner.
4. Moisturise to keep skin hydrated and protected. Look for humectants, which draw moisture into the skin and help lock it in.
5. Protect from the sun whatever the weather, with a broad-spectrum SPF 30 or above. Choose at least 4-star UVA protection, and reapply every 2 hours and straight after swimming, towel drying or sweating. Hats and sun-protective clothing help too. The main thing is that you are wearing some protection.

Why regular skin checks matter

There is no NHS skin cancer screening programme, so check your own skin regularly, including your palms, the soles of your feet, under your nails, inside your mouth and your genitals. Regular self-checks help detect skin cancer earlier, lowering the risk of serious complications and improving outcomes. They can also spot precancerous changes so they can be treated before cancer takes hold. If you notice anything changing on your skin, see your GP.

My final message is consistency, consistency, consistency. Your skin's texture, tone and health will improve if you stick to a good routine, adjusting it as the seasons change. Build a relationship with your GP or dermatologist, keep up with checks, and remember that prevention is always better than cure.