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The Treatment of Skin of Color
By: Jennifer Linder, MD
Posted: October 2, 2013, from the October 2013 issue of Skin Inc. magazine.
Skin care professionals are increasingly tasked to treat clients from a wide range of ethnic backgrounds, comprising a menagerie of skin tones and textures. Also, whereas it may previously have been possible to classify a client and adopt a treatment protocol based on their dominant ethnic background, this is no longer the case. With the removal of societal barriers, there are many more mixed-heritage individuals now than at any time in history. However, with this advancement comes a plethora of variables that must be considered when treating skin of color (SOC). Once it has been identified that a client does fall under the umbrella of SOC—either by appearance or heredity—it is of the utmost importance to apply caution in developing and administering a treatment protocol. There are specific issues that are more prevalent in SOC which, if not properly considered, can lead to adverse outcomes. Following are common issues you may encounter when treating skin of color.
One misconception that must be laid aside is that ethnic skin is easily identifiable by visual examination alone. Quite often, a client may appear to have skin that falls on the lower end of the Fitzpatrick scale, but she may, in fact, have a parent or grandparent who is of African-American descent or another ethnicity known for its increased skin pigmentation. Even if the light skin is the part of their heritage that is apparent, the potential for the reactivity that would be expected in higher Fitzpatrick types with darker skin remains. This is why it is imperative to conduct a thorough consultation with each client before designing and administering a course of treatment. The client should be questioned regarding both their maternal and paternal backgrounds in order to attain an accurate picture. Additionally, the client should be asked about how their skin has reacted in the past to any type of treatment, as well as to the daily care regimen they use at home. If you are unable to identify a client’s hereditary background due to adoption or other circumstances, always tread lightly when beginning a treatment pathway until you have first-hand knowledge of how that client’s skin reacts.
Common conditions for skin of color
There are predispositions to certain conditions to which SOC is more prone. Following are several of these conditions and their presentation, as well as effective ways in which to address them.
Hyperpigmentation. One of the most common complaints from clients with SOC is that of hyperpigmentation. It is important to understand that all skin types contain the same number of melanocytes (the cells responsible for melanin production). However, in those with darker complexions, the melanocytes are filled with larger melanin granules, and are deposited in a wider and more uniform manner, which then determines the level of coloring for the eyes, skin and hair. The melanocytes of higher Fitzpatrick skin types tend to be more reactive, therefore more likely to develop post-inflammatory hyperpigmentation (PIH). It is this increased melanocyte reactivity that causes deposits of pigment as a result of irritation or inflammation, such as in the case of a ruptured acne cyst or harsh exfoliation.
Acne. A tightly packed stratum corneum, in conjunction with larger oil glands than Caucasian counterparts, can often be responsible for an increase in bacterial proliferation and oxygen deprivation within the follicles, often resulting in acneic eruptions. Regular gentle exfoliation and the application of nonsurface-stimulating antibacterial topicals are essential for keeping darker skin free of acne breakouts. Inform clients with skin of color that over-treatment with aggressive topicals or inflammation-inducing mechanical exfoliation methods are strictly off limits to avoid the development of PIH.