Cutaneous Aging in Skin of Color: A Narrative Review

Cutaneous aging is a complex biological process that follows a distinct trajectory in skin of color (Fitzpatrick skin types III-VI) compared with lighter skin types. While increased epidermal melanin provides partial photoprotection and often delays the development of rhytides, skin of color is disproportionately affected by pigmentary sequelae of aging, including mottled hyperpigmentation, solar lentigines, melasma, and post-inflammatory hyperpigmentation. These differences are further complicated by gaps in skin of color-specific clinical training, as well as heterogeneity across ethnic subtypes, cultural practices, and social determinants, making management of aging in skin of color uniquely challenging. In this narrative review, we summarize contemporary evidence on the clinical and histologic features of skin of color, key mechanisms underlying intrinsic aging and photoaging, and practical strategies to address common aging concerns in this population. We highlight that long-wavelength UVA (UVA1) and visible light can induce oxidative stress and persistent pigmentation, and that conventional sunscreens may inadequately protect against these wavelengths. Accordingly, broad-spectrum photoprotection, particularly formulations that provide visible-light coverage (e.g., tinted sunscreens with iron oxides), should be emphasized as a cornerstone intervention. We also review topical agents (including retinoids and pigment modulators), oral antioxidants, and procedural therapies, underscoring the need for cautious selection and technique given the higher propensity for post-inflammatory hyperpigmentation and scarring. These strategies are underpinned by the need for individualized counseling, culturally responsive education, and improved skin of color-specific training for dermatologists globally.