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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.

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Rosacea. Rosacea may be more common in certain hereditary backgrounds such as Irish, English, Scottish, Welsh, Russian, Polish, Czech, Native American and Asian, or it may be due to genetic predisposition. Characterized by flushing, persistent redness or pustules on the face, rosacea is mainly isolated to the central region comprising the cheeks, nose and central forehead. The condition mainly affects women between the ages of 30–50, but can manifest in men, as well. Rosacea cannot be cured; however, it can be controlled.1

Although rosacea primarily affects those with lighter skin, it is also possible for darker-skinned clients to develop the condition. In many cases, clients who have SOC and experience rosacea are of mixed heritage and, even though they have darker skin, the predisposition remains. It is often missed as a diagnosis, because the flushing is less apparent in darker skin. It is imperative to determine if one of your SOC clients has rosacea and not acne, because traditional acne treatments—even ones that are gentle—can be too stimulating for a higher Fitzpatrick skin type with rosacea. A means of differentiating between regular acne and rosacea is to ask the client whether they experience irritation of the eyes or styes on a frequent basis. This can be a sign of ocular rosacea, which occurs in 50% of all rosacea cases.

Hypersensitivity. Individuals with SOC often experience increased sensitivity to topical stimulation in the form of chemical peels. This is due to a higher level of transepidermal water loss found in clients of Asian and African descent, which leads to reduced barrier function. When selecting a chemical peel for these clients, it is critical to err on the side of caution and utilize the gentlest solution available, which will limit the potential for irritation, inflammation and potentially PIH. Many gentle-blended peel solutions available today create minimal surface stimulation, but still deliver excellent results.

Ingredients and treatments to avoid

When treating clients with SOC, it is important to avoid ingredients and treatments that can cause adverse effects, such as deep peeling that can lead to PIH. Ingredients and techniques that should be avoided include the following.

  • Harsh microdermabrasion techniques or exfoliants utilizing nut hulls, pits or similarly abrasive materials. Smooth bead exfoliators are preferred.
  • Hydroquinone in doses of 4% or greater, because it can stimulate PIH.
  • Retinoic acid should be used with caution because it can cause inflammation, which can result in both hypo- and hyperpigmentation in SOC. Retinol is a safer alternative, because it is nonsurface-irritating.
  • Ablative CO2 laser treatment is an anti-aging resurfacing technique that stimulates collagen production beneath skin’s surface. However, this causes full thickness burns, more commonly known as third-degree burns, and typically manifests as hypo- or hyperpigmentation. Newer fractional CO2 modalities only treat a percentage of the skin at a time, reducing the risk of these complications. Caution should still be used when treating SOC or mixed-heritage clients.

Customizing treatment pathways

When developing treatment plans for your clients, it is critical to approach each case on an individual basis and perform preliminary research into the client’s heredity, skin history, and any potential or current health concerns at the initial appointment.