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Global Skin: Climbing Your Client’s Family Tree

Michelle Goldsmith August 2013 issue of Skin Inc. magazine
Global skin

Skin care professionals use many tools to analyze clients’ skin. The most common is the Fitzpatrick scale. Developed in 1975 by Harvard dermatologist Thomas Fitzpatrick, MD, the Fitzpatrick scale was created to classify a client’s reaction to the sun based on skin color, featuring a range of types from I–VI, with I being the lightest and VI being the darkest. (See Fitzpatrick Scale and Correlating Sensitivity.) The original Fitzpatrick scale stated that Fitzpatrick type VI never burned; however, it is now known that this is not the case and, regardless of color, everyone will burn at some point. Another tool is the Global Heritage Model, which differs from the Fitzpatrick scale in that it classifies how clients’ skin will respond to topical activity and UV exposure based on their hereditary background, and not simply the color of their skin.

Because numerous people are of mixed hereditary backgrounds and many color their hair, wear colored contacts and may tan, either via topical products or UV exposure, it is increasingly difficult to determine a client’s heritage based solely on appearance. This is where the Global Heritage Model comes in. (See Global Heritage Model.) This tool helps determine the skin’s response to topical stimuli based upon inherited melanocyte activity. Once you are able to determine how each client’s melanocytes are likely to react, you will be better able to choose the best treatments and ingredients to suit each and every client.

Environmental protection

Skin is designed to protect from a variety of daily environmental insults. One is DNA damage within the nuclei of the keratinocytes due to UV exposure—the end result of which is likely skin cancer. With that in mind, if you look at the environment of the polar regions of the world, it is cold and dry with very little UV exposure. Because of this, clients whose ancestors come from these regions tend to have lighter skin, hair and eyes. This has to do with both the density of the melanin produced by the melanocytes, as well as how quickly those melanocytes respond to external stimuli. Because UV exposure is less intense in these regions, the inherited melanocyte response is often slow for these individuals, meaning they are less prone to produce pigment within the skin. It is because of their less-responsive melanocytes that clients of polar-region ancestry are able to tolerate more active topical treatments—they are less likely to produce pigment due to surface stimulation. As a result, they are not as likely to develop post-inflammatory hyperpigmentation (PIH) from treatments, but are more prone to developing skin cancer.

On the other hand, those with ancestry based in the equatorial regions of the world tend to have darker skin, hair and eyes due to the more intense UV exposure in those regions. Their melanin is also arranged more densely, and their melanocytes are very quick to respond to stimulation, making them more prone to PIH and less likely to develop skin cancer. (See Treatment How-to: Sensitive Melasma Facial for a treatment protocol for this type of global skin.)

In short, clients with polar region ancestry are often referred to as being “resilient,” because they are resilient to hyperpigmentation; whereas, those with equatorial region ancestry are typically considered “sensitive,” because they tend to hyperpigment more readily.

Function vs. color

It is imperative that skin care professionals understand how the skin functions in those with mixed ancestry. For example, a person who visually appears to be a Fitzpatrick I or II may indeed have a parent or other relative who is a Fitzpatrick IV, V or VI. It would be risky to create a treatment plan for this client based solely on the color of their skin. Therefore, obtaining a thorough history and profile is important for every client. You wouldn’t want to treat this client with ingredients or percentages that are too active. Ask the appropriate questions and never make assumptions based on appearances. A great starting question is: “What is your hereditary background based on your parents, grandparents and others?” Use yourself as an example. Say something along the lines of: “My mother is Norwegian, Scottish and Irish; my father is German and Mexican. Although I do not look Hispanic, my melanocytes are programmed to respond more readily based on this heritage instead of my other relations.”

Know your client’s ancestry

The goal of any treatment is to address a client’s skin concerns without causing trauma or creating unnecessary inflammation. By incorporating the Global Heritage Model, skin care professionals will be able to more accurately deliver optimal results, minimize the potential for complications, and increase client confidence and compliance. Understanding a client’s skin begins with the initial consultation. Don’t skimp on this important review to build a foundation and a relationship with each individual. Take the time to find out everything you can about each client, including their heritage. Learn their genetic history, based on their parents, grandparents or even great-grandparents.

But what if they don’t have that information? Suppose your client informs you during the initial consultation that they are adopted and don’t really know their ancestry. The best answer is to start treatment slowly and gently. Err on the side of caution. Once you’ve determined how the client’s skin responds to treatments, you can work up from there.

Following are suggestions that should be taken into account when determining treatment options.

• High-percentage, straight-acid peels should be avoided in clients with equator-region backgrounds, because these types of solutions can create more surface stimulation and could result in PIH.

• Clients with polar-region ancestry can usually tolerate stronger, more active formulations. However, be sure to determine whether or not these clients are prone to rosacea or vascular weakness before incorporating these treatments. This goes back to taking the time during the consultation to determine certain issues from which the client may be suffering.

• If unsure of ancestry or in the case of mixed heritage, lower-percentage, blended formulations are a great starting point.

• Because of their propensity toward PIH, equator-region skin types should also utilize low-percentage mixtures, with the addition of agents that inhibit melanogenesis.

A unique approach

Each and every client’s skin is unique to their hereditary background, lifestyle choices and product use. By incorporating the Global Heritage Model into your facility, you will be better able to create treatment plans as individual and unique as each client you treat.

Michelle+GoldsmithMichelle Goldsmith, a licensed esthetician, joined PCA Skin in 2003. She is a physician’s consultant, editorial liaison and educator. She also speaks at medical and esthetic meetings throughout the country, and mentors and trains physicians, skin care professionals and students.


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Fitzpatrick Scale and Correlating Sensitivity

Treatment How-to: Sensitive Melasma Facial

Global skin

Treatment How-to: Sensitive Melasma Facial

This protocol is designed to address stubborn melasma, a common condition in clients with an equatorial-region heritage, without creating undue inflammation in the skin.

Cost: $100–175

Duration: 30 minutes

Contraindications: Pregnant and lactating women, those with hypersensitive skin or those with a known allergy to any of the ingredients listed should not receive this treatment.

Supplies and equipment needed:

• Cotton pads
• Warm water
• Cotton swab
• Fan brush
• Gloves

Products needed:

• Lactic acid-, gluconolactone- and aloe vera-based cleanser
• Kojic and azelaic acid cleansing bar
• Vitamin-enhanced, alpha hydroxy toner
• Trichloroacetic (TCA) and lactic acid chemical peel
• Modified and enhanced Jessner’s solution with lightening ingredients
• Phenylethyl resorcinol, kojic acid, azelaic acid and lactic acid corrective product
• Retinoid complex, alpha arbutin, licorice root extract, and kojic, L-ascorbic and lactic acid corrective product
• 15% L-ascorbic acid cream
• Antioxidant serum
• Gentle skin-lightening product with phenylethyl resorcinol, alpha arbutin and undecylenoyl phenylalanine
• Calming balm
• Eye product with peptides
• Calming hydrator
• Broad-spectrum sunscreen

Step 1: Ask the client to complete a consultation form. Before the treatment, discuss any issues of concern regarding the form. Next, walk the client to the treatment room and ask her to lay face up on the treatment table.

Step 2: Cleanse the area to be treated thoroughly with a lactic acid-, gluconolactone- and aloe vera-based cleanser. Rinse and pat dry.

Step 3: Using a kojic and azelaic acid cleansing bar, cleanse the skin a second time. Allow the lather to remain on the skin for approximately two minutes. Remove using cotton pads dampened with warm water.

Step 4: Prep the skin with a vitamin-enhanced, alpha hydroxy toner using a cotton pad. Allow the skin to dry. Assess sensitivity by asking the client, “On a scale of one to 10, with 10 being extremely active, how do you rate this sensation (or feeling)?”

Step 5: Apply a blended chemical peel solution containing TCA and lactic acid to a cotton pad. Follow manufacturer’s layering guidelines and keep in mind the needs, goals and individual sensitivity of the clients. Use the scale of one to 10 mentioned previously to gauge sensitivity.

Step 6: With a cotton swab, spot-treat specific areas of concern using a modified and enhanced Jessner’s solution containing additional lightening ingredients, such as kojic and citric acids.

Step 7: Spot-treat specific melasma patches using a phenylethyl resorcinol, kojic acid, azelaic acid and lactic acid corrective product.

Step 8: Apply a corrective product containing retinoid complex, alpha arbutin, licorice root extract, and kojic, L-ascorbic and lactic acids to promote an even complexion.

Step 9: Apply a combination of a 15% L-ascorbic acid cream with an antioxidant serum to help fight against free-radical damage and promote an even skin tone.

Step 10: Apply a gentle skin-lightening product with phenylethyl resorcinol, alpha arbutin and undecylenoyl phenylalanine to the entire treatment area to encourage an even skin tone while calming and soothing the skin.

Step 11: Using a small fan brush or gloved hands, apply a thin layer of a calming balm to the area of treatment to reduce redness and soothe irritation.

Step 12: Gently apply an eye product containing peptides around the delicate eye area to reduce the appearance of dark circles, puffiness, fine lines and wrinkles.

Step 13: Combine a calming hydrator with a broad-spectrum sunscreen product to soothe and protect the skin from UVA and UVB exposure.

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