15. Ethnic Skin Care
People of color are 40% of the population in the United States. 1
Hispanics and blacks are the groups growing in number most rapidly.
Racial minorities receive approximately 20% of all cosmetic procedures.
Unique issues to ethnic skin care can include: 2 , 3
Restoring uniform pigmentation
Hair removal
Acne care
Skin hydration
Ethnic skin contains:
More cell layers in stratum corneum (22 layers in black skin versus 17 in white skin) 4
Increased lipid content
Increased desquamation
Decreased ceramide content
Increased photoprotection with darker skin, but also robust response to epidermal/dermal injury 5
Tip:
Understanding the subtleties of treating various ethnicities is essential to maximize results.
Patient Evaluation
Fitzpatrick scale was developed by Dr. Thomas Fitzpatrick, a Harvard dermatologist, in 1975 (Table 15-1).
Used for classifying response of different skin types to UV light 6
Skin Type | Characteristics | Sun Exposure History |
I | Pale white, freckles, blue eyes, blond or red hair | Always burns, never tans |
II | Fair white, blue/green/hazel eyes, blond or red hair | Usually burns, minimally tans |
III | Cream white, any hair or eye color | Sometimes burns, tans uniformly |
IV | Moderate brown (Mediterranean) | Rarely burns, always tans well |
V | Dark brown (Middle Eastern) | Rarely burns, tans easily |
VI | Dark brown to black | Never burns, tans easily |
Tip:
The number of melanocytes does not differ between skin types, but darker-skinned individuals produce more melanin.
Senior Author Tip:
Fitzpatrick skin types are not always accurate presently as many individuals are now biracial. Persons with an African father and an Irish mother may have dark skin, but freckle with sun exposure.
Obtain accurate patient history.
Identify natural hydration level of skin:
Normal
Dry
Oily
Combination
Dark-skinned people can be predisposed to oily or dry skin. 7
Also can have severe reactions to treatment and poor wound healing with excessive scar formation (keloids or hypertrophic scars) and postinflammatory hyperpigmentation
Hydration
Darker skin tends to dry and crack more easily and has a higher propensity to develop acne.
Associated with higher transepidermal water loss (TEWL)
Pigmented skin scale produces ashy appearance, magnifying dry skin problems.
Drying over-the-counter products should be avoided.
Impaired barrier function can lead to inflammation, irritation, increased hyperpigmentation after treatments.
Tip:
Gentle cleansers and emollient moisturizers smooth skin scale and help to optimize appearance in skin of color.
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