Ethnic Skin Care

15. Ethnic Skin Care

Sammy Sinno, Zoe Diana Draelos

■ 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 injury⁵

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 light⁶

Table 15-1 Fitzpatrick Skin Type Classification

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.

DYSCHROMIA

■ Hypopigmentation: Melanocyte underproduction of melanin

■ Vitiligo: A condition of skin depigmentation from absent melanin production

• Particularly noticeable in people with darker skin, causing emotional distress

• Possible autoimmune condition directed at melanocytes

• Commonly associated with thyroid disorders (Hashimoto thyroiditis), pernicious anemia, diabetes

• Diagnosis with Wood lamp (black light)

• Some improvement can be seen with camouflage using stains, makeup, or self-tanning lotions.

• Treatment: Phototherapy, immunomodulators, topical steroids

■ Hyperpigmentation: Increased melanocyte stimulation, typically a postinflammatory response resulting in increased pigmentation

• Treatment: Skin-lightening agents suppressing melanin production by inhibiting tyrosinase

• Hydroquinone typically used in concentrations of 2% over-the-counter or 4% prescription strength

• Irritation and contact dermatitis common complications

• Commonly used pigmentation inhibitors listed in Table 15-2

Table 15-2 Commonly Used Pigmentation Inhibitors

Inhibitor	Mechanism of Action
Hydroquinone	Inhibits tyrosinase by inhibiting DNA and RNA synthesis
Kojic acid	Chelates copper bound to tyrosinase rendering it inactive
Azelaic acid	Naturally derived from grain products and by oxygenation of oleic acid Cytotoxic to melanocytes
Lactic acid	Suppresses formation of melanocytes
Retinoids	Inhibits tyrosinase activity
Arbutin	Found naturally in cranberries Inhibits melanosome maturation Less irritating than hyroquinone

SENIOR AUTHOR TIP: Infrared A is the source of heat from the sun, but may also induce hyperpigmentation, especially in individuals of higher Fitzpatrick skin type. Thus, persons with hyperpigmentation should also avoid heat exposure.

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