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In the diverse world of aesthetics, understanding the unique needs of melanin-rich skin isn’t just an option – it is a necessity. Melanin is the pigment that gives skin its rich color, and it also plays a crucial role in how skin reacts to treatments, trauma, and even time. For skin care professionals, knowing when to treat confidently and when to refer clients to a dermatologist is critical to providing the best care possible.
THE MELANIN-RICH SKIN SPECTRUM
Understanding the melanin-rich spectrum is everything. Melanin-rich skin refers to a wide range of skin tones, from olive to deep brown. Beyond race or ethnicity, skin that is considered melanin-rich has more active melanocytes — the cells responsible for producing melanin, which means it can be more prone to certain skin issues, such as hyperpigmentation and keloids. Having a good grasp of this is the first step in providing tailored skin care.
GREEN LIGHT
There are several instances where professionals are green lit to proceed and offer our clients the best treatment plan and care to support them in achieving optimal skin results. Here are some of the top concerns and professional tips where we should move with confidence:
The Bread & Butter
Hyperpigmentation is considered one of the most common concerns among clients with melanin-rich skin. Uneven skin tone, dark spots, and post-inflammatory hyperpigmentation (PIH) are among the usual suspects. These concerns are often treatable within the clinic or spa setting. Gentle chemical peels, vitamin C serums, and niacinamide are some go-to, hero ingredients to employ here. When used correctly, these can help brighten skin without causing further damage.
Hyperpigmentation Pro Tip
Avoid aggressive exfoliants and peels that could trigger more pigmentation. Think progressive over aggressive. Opt for treatments like lactic acid peels or cocktail blends of hydroxy acids that are gentler and better suited for melanin-rich skin.
Handle with Care
Acne doesn’t discriminate, but melanin-rich skin can be much more sensitive to the aftermath, with scarring and dark spots (PIH) often sticking around longer. In fact, studies reveal that clients with melanin-rich skin exhibit hidden erythema, leading to more persistent scarring. Mild-to-moderate acne can usually be managed with some top favourites like salicylic acid or azelaic acid, but the focus should be on preventing marks. Treatments like LED therapy, which reduces inflammation and helps prevent future breakouts, are brilliant considerations.
Acne & Scarring Pro Tip
For acne scars, microneedling can be effective but requires a careful approach. Ensure that the needle depth is appropriate to avoid post-inflammatory hyperpigmentation.
Essential for Everyone
Maintaining the skin barrier is the underpinning to every effective treatment. Particularly with melanin-rich skin, this is often forgotten. Studies reveal that clients with melanin-rich skin can be more prone to transepidermal water loss (TEWL). Moisturizers rich in ceramides and hyaluronic acid can help skin remain hydrated and resilient. Regular treatments focusing on hydration, such as low and high molecule hyaluronic acid facials and masks, can be quite effective.
Barrier Repair & Hydration Pro Tip
Encourage clients to avoid the use of stripping cleansers and overuse of astringents that can deplete skin’s natural moisture function.
RED FLAGS
Professionals must expect that there will be times, however temporary or long term, when clients’ skin concerns expand our reach and expertise. This is not a negative reflection on nonmedical aesthetic professionals but rather, an indicator of a well-informed professional that knows the boundaries of effective treatments. Consider what is best for your client at that time. Here are the top four concerns and why referring that client is the best approach:
Severe Acne & Cystic Breakouts
While solutions for mild acne is within your everyday treatment arsenal, severe acne, especially cystic, should prompt a referral to a dermatologist. These conditions can lead to extensive scarring and hyperpigmentation due to their systemic nature. These may require prescription-strength treatments or procedures.
Dermatologists can prescribe stronger medications like retinoids, antibiotics, or isotretinoin, which are often necessary for controlling severe acne and preventing long-term skin damage. If ice-pick, rolled, or box scars are present, a cosmetic dermatologist can also perform subcision treatments (lifting the dermis from underneath).
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Charmaine Cooper, known as The Skin Theologian, is an award-winning international speaker, author, and educator with 28 years in the industry. Renowned for her passion and ability to connect with diverse audiences, she has trained skin professionals and educators globally for over 24 years. Cooper’s work emphasizes skin health equity and cultural intelligence, particularly for melanin-rich skin. A recipient of the 2024 Aestheticians’ Choice Award for favorite contributor and author of the acclaimed “No Compromise Black Skin Care Guide” series and “Melanin-Rich,” she continues to inspire through her international webinars, media engagements, and transformative workshops. Connect with her on Instagram @theskintheologian.
Hard as it may be to believe, many myths still persist when it comes to melanin-rich skin, mainly due to widespread misunderstandings. Both clients and skin care professionals can fall prey to these misconceptions. Our mission is to dispel these myths and provide accurate, culturally sensitive skin care advice.
COMMON MYTHS AMONG SKIN PROFESSIONALS
Before we tackle the myths clients believe, there are some misconceptions within the industry to address:
The reality is that every client’s skin is unique, and regardless of the professional’s skin type, continual education and understanding of different skin tones are crucial for effective treatment. While skin is fundamentally similar across all tones, various skin tones exhibit different concerns. Therefore, it is essential for skin professionals to develop confidence in treating diverse skin types through ongoing education.
Not All Equal: An Ingredient Guide for Melanin-Rich Skin
The bedrock of an exceptional skin regimen lies in the winning combination of ingredient formulations and an adept administration of treatment protocols. However, we must address the elephant in the room regarding the suitability and equality of ingredients within a broad spectrum of formulation choices. When it comes to caring for melanin-rich skin, the concentration and appropriateness of formula combinations are crucial for skin receptivity.
The role of skin professionals is to provide the appropriate recommendations for clients. To do this comprehensively, there needs to be not only a solid grasp of treatment approaches but also an understanding of the ideal selected ingredients and combinations for clients.
ONE SIZE FITS NONE
The reality is, not all ingredients are created equally, and this fact is not always top of mind for clients. Some particularly exceptional ingredients target primary concerns, like hyperpigmentation or lack of radiance. Take, for instance, vitamin C, which has been an industry-wide favorite for quite some time. Its benefits to skin health are numerous, including helping to induce collagen synthesis, brightening skin, and acting as a powerful agent against reactive oxygen species (ROS). However, when it comes to melanin-rich skin, vitamin C may not be the same holy grail ingredient it claims to be.
Charmaine Cooper, known as The Skin Theologian, is an award-winning international speaker, author, and educator with 28 years in the skin profession. Renowned for her passion and ability to connect with diverse audiences, she has trained skin professionals and educators globally for 24+ years. Cooper’s work emphasizes skin health equity and cultural intelligence, particularly for melanin-rich skin. A recipient of the ACA 2024 favorite contributor award and author of the acclaimed “No Compromise Black Skin Care Guide” series & “Melanin-Rich,” she continues to inspire through her international webinars, media engagements, and transformative workshops. Connect with her on Instagram @theskintheologian.
For skin care professionals, passion drives growth. The meteoric rate in which devices, treatment options, and formulations continue to evolve within the skin health industry is staggering, and professionals are here for it! When it comes to melanin-rich skin, we have been seeing greater traction in our space for more inclusive and specific protocols to confidently treat higher Fitzpatrick classifications. There are more and more resources being made available to build professional confidence in caring for deeper skin tones. It is also encouraging to observe the number of improvements throughout industry devices to safely care for all cultures, skin tones, and classification scales. However, without a firm ability to identify skin conditions or skin abnormalities, the effective application for those formulas and devices are short circuited.
MISSING FOUNDATION
The not-so-great news is this: there are commonly misdiagnosed or nondiagnosed skin disorders within melanin-rich skin. This is, in large part, due to the under-representation of melanin-rich skin disorders and their respective images within dermatology textbooks and skin education curriculum. It simply has not been commonly seen.
The good news is we are in a momentum of slow but steady change in this area. There are organizations and dermatology associations focusing on shifting that narrative. Increased research access to images of skin concerns in all shades is necessary in order to adequately assist skin care professionals and experts in familiarizing themselves with what to look for.
Until we see a larger scale-up of academic literature being more available, it is our responsibility to grow in our own education. Still, this can sometimes be limited, and the change is often at a snail-like rate.
THE NOT SO USUAL SUSPECTS
Most professionals are likely quite familiar with the most common skin concerns for melanin-rich, such as hyperpigmentation and hypopigmentation. However, there are some more uniquely observed and in-depth skin concerns that may have not received as much awareness.
Here are the top misdiagnosed or nondiagnosed skin disorders in melanin-rich skin that often fly under the radar for skin care professionals.
Acral Lentiginous Melanoma (ALM)
Acral Lentiginous Melanoma is a form of melanoma classified as a pigmentary disorder. The word acral is Greek, meaning ”extremity,” referring to the furthest parts from the center of the body (hands and feet). Lentiginous refers to the darkened pigment that shows up. This type of melanoma typically appears on the palms of the hands, soles of the feet, or underneath the nails. It accounts for around 5% to 10% of all melanoma cases – so it is rare but tends to be pretty aggressive. Identifying acral lentiginous melanoma in melanin-rich skin can be tricky. It might look like a dark patch or spot that seems out of place, like a stubborn bruise or a funny-colored mole on the hands or feet. Sometimes, it can be tough to spot because it doesn’t follow the typical rules of pigmentary changes. Excluding dermatologists, it is outside of the skin professionals scope of practice to diagnose acral lentiginous melanoma or any form of malignant growth. Always defer the client to a dermatologist or other appropriate medical doctor.
Rosacea
Rosacea is classified as an inflammatory disease and disorder of the capillaries. The awareness of this disease within skin of deeper tones is gaining greater traction, although slowly. Traditional beliefs of rosacea were once emphasized around specific Northern and Celtic ethnicities and cultures. With continual education and clinical studies, the industry is recognizing that venous inflammatory disorders are not limited to an ethnicity, but they are genetically coded and can show up in a variety of patients.
Common indicators are flushing, blushing, stinging, telangiectasia, ocular inflammation, papules, and pustules. Within skin that is melanin-rich, these inflammatory indicators show up differently. Rosacea is sometimes mistaken for acne in dark skin, because the redness usually associated with rosacea on lighter skin isn’t always as visible. This can lead to incorrect treatment which can actually cause far more problems.
It is essential for professionals to understand that inflammatory disorders can only be managed not cured. Traditional treatments have incorporated the use of topical, oral, laser, and light-based treatments. This is where advanced grade levels should be referred onto dermatologists.
Epidermal Melanosis
This condition is characterized by increased melanin in the epidermis, leading to hyperpigmentation. It can appear as brown or grayish patches on skin. Inflammation in the epidermis stimulates melanocytes to increase melanin synthesis and subsequently transfer it to the surrounding cells.
Treatments may include topical depigmenting agents such as hydroxy acids, chemical peels, green peels, hydroquinone (PhD-guided), retinoids, and corticosteroids.
Dermal Melanosis (Pendulous Melanocytes)
Dermal melanosis involves the accumulation of melanin in the dermis. Pendulous melanocytes are melanin-producing cells that have migrated into the dermis. In other words, if the basal layer is injured, melanin pigment becomes trapped by macrophages within the papillary dermis. This makes it more difficult to treat with conventional treatment approaches that impact the cell turnover within the epidermal layer. Unconventional treatments may include laser therapy, chemical peels, or cryotherapy.
The rule of thumb with laser options for melanin-rich skin is to use nonablative lasers. These have longer wavelengths, like the Nd:YAG laser at 1064 nm, and have a longer coefficient. This means the laser penetrates skin at a depth of up to 4mm, bypassing the melanocyte cell and removing the risk of excessive trauma.
The best treatment approach may involve a combination of traditional and unconventional methods based on the predominant features of the condition.
Extensor Side Joint Hyperpigmentation
Hyperpigmentation at joints may be associated with chronic inflammation in conditions like inflammatory arthritis. Addressing the underlying inflammatory condition is crucial.
Topical treatments may include corticosteroids, while doctor prescribed systemic medications and lifestyle changes may also be considered.
Ashy Dermatosis
Ashy dermatosis presents as gray or ashy patches on skin. This is not effectively addressed by moisturizers and serums alone, as the source is more genetically coded rather than symptomatic.
Management may involve emollients, topical corticosteroids, and avoiding potential triggers. Consultation with a dermatologist is essential.
Once you’ve obtained your qualifications as a skin care professional and put in the work to be up to date on your skin trend education, how do you win over new clients? You’re already passionate about supporting clients achieve their best skin possible. Yet, you still find somehow, that your confidence weans when clients who don’t look like you indirectly express their uncertainty in your capability to care for their skin. You’re not alone in this experience. This is a disconcerting, yet present reality for many skin care professionals and has been for some years.
MIRROR IMAGE
According to cultural leadership experts, selective ethnocentrism is when only one culture is known or embraced. Moreover, what is considered normal for that one culture is eventually expected to be normal for another. When differences in normalcy are noticed by either party, it then becomes challenging to accept new norms. Ethnocentrism is an inescapable reality for all people.
Selective ethnocentrism (SE) can be projected both by clients onto professionals and professionals onto clients. When it comes to supporting clients with melanin-rich skin, selective ethnocentrism can sometimes be responsible for barriers to trust.
References
Addressing hyperpigmentation is a top priority. With innovative formulas developed by professional brands and our expertise in treatment plans, skin care professionals continually strive to meet our client’s needs.
According to clinical analyses, the primary concern for clients with melanin-rich skin is hyperpigmentation. Hyperpigmentation presents itself in various forms and, depending upon the source, treatment times can vary. This is where the brilliance of an exceptional skin care professional shines the brightest – it is in how we help clients achieve optimal results while managing their expectations.
THE BASICS
As we continue our monthly insights on melanin-rich skin, we should understand that the topic of hyperpigmentation will always be a conversation starter for many clients. Firstly, we know that all clients have melanin. However, not all clients have eumelanin-influenced melanin. Eumelanin is one of the two influencers on the quality of melanin that is produced. Eumelanin is the influence on the melanin protein that produces a darker, more insoluble type of pigment. When hyperpigmentation occurs, it shows up as brownish-black pigment spots on skin. Pheomelanin is the other influence on melanin that produces a lighter, more soluble quality of pigment. It shows up as reddish-yellow (sometimes blueish) pigment spots.
The solubility of pheomelanin makes treating hyperpigmentation in lighter skin a bit less arduous, making active ingredients easily more readily efficacious in treating it. The insolubility of eumelanin makes treating hyperpigmentation in darker skin a bit more intentional, as the properties of pigment are more resistant in absorption capability. These active ingredients may require a bit more time to show results.
With these things in mind, it is of the utmost importance to set realistic goals and manage client expectations around hyperpigmentation concerns. It’s helpful to keep in mind that hyperpigmentation takes time to develop and therefore, will take time to treat.
C.R. Cooper is a connective, knowledgeable, and compassionate educator who has been a skin enthusiast for over 24 years. As the education manager and master educator for a renowned global institute of learning in the skin health industry, Cooper values organizational and individual industry standards, professional and personal brand integrity, but most importantly the inherent worth in every skin professional.
Welcome back to The Melanin Diaries – helping you to love melanin more by understanding it. In this month’s column, we’re going to call attention to the elephant in the room. That is, clients with melanin-rich skin who are not comfortable with going under the beam.
Lasers can be intimidating for clients with melanin-rich skin for several reasons, but it doesn’t have to be. We’ve all seen the trauma stories on social media and no doubt, so have our clients. The essential component to dismantling fear is having a solid understanding of lasers, along with the confident expertise of a skin professional.
The reality is, clients aren’t always clear on what lasers are or what they are best for.
Let’s quickly review. The word laser is an acronym that stands for light amplification by the stimulate emission of radiation. Not exactly what you necessarily want to explain to clients, yet, while that may not help the client to understand laser treatments, it is something fundamental for medical aestheticians to be competent around. When communicating the benefits of lasers with clients of all skin tones, the factors to emphasize are usually as follows:
How Do Lasers Work?
Laser light beams are absorbed by skin’s epidermal surface or the dermal tissue by materials found in skin called chromophores. This is the target of laser light and when absorbed, it causes the desired destruction of that particular material.
The three primary materials that contain chromophores and that are common areas of concern for clients are:
For individuals with melanin rich skin, the most common skin concern is centered around hyperpigmentation. This is where any interest from the client may be piqued. Unfortunately, traditional interest has been met with disappointment and fear as a result of improper clinical practice or devices. In those cases, almost always the assessment for client suitability was inadequate or there was an improper selection of laser settings or devices by the skin professional.
Have you ever sensed a bit of hesitation from clients when you first connect with them – specifically clients with melanin-rich skin? What if you could read the minds of your clients with deeper hues? What might you surprisingly discover, and what might not surprise you so much? Skin care professionals may wish we had the inherent ability to read minds and then put clients’ concerns and questions at rest with just the right answer and solution, but that is not possible.
Fortunately, skin professionals don’t need to have the magic power of reading minds in order to best support the needs and wants of their clients. Due to the prevailing misconceptions and underrepresentation in the skin space around melanin-rich skin, there’s still much work to be done. Many qualified skin professionals experience hesitation and skepticism from some clients as it pertains to entrusting their own skin to them.
The question remains, how do you handle that? Are there ways to even circumvent them? Or perhaps, we are asking the wrong questions and should, rather, seek a deeper understanding to the hesitations themselves?
Identifying and treating skin concerns is the basic calling card of every skin professional. The challenge, however, lies when the skin concern or condition is not as obvious to identify as we’d hope. Melanin-rich skin, to date, represents less than 20% of skin concerns in dermatology and basic industry curriculum textbooks. Not only do skin care professionals encounter uncertainties around traditionally identifying skin conditions, but for clients with melanin-rich skin, there exists an underlying belief of some levels of immunity to certain skin conditions. The truth is, all skin is susceptible to all skin aggressors and conditions. The primary factors skin care professionals should bear in mind are the variable nuances that can be masked and less than obvious skin concerns.
As always, The Melanin Diaries are here to provide you with a few pointers to help you successfully navigate your client support for clients with melanin-rich skin. Before we call out the usual suspects of top skin concerns for various darker skin tones, we need to lay a good foundation. Human skin is more similar than it is different. To support and care for melanin-rich skin, understanding the inherent similarities it holds with all skin is fundamental, prior to being able to understand its unique elements.
Reference
Welcome back to The Melanin Diaries. No one wants to walk on eggshells, especially passionate skin professionals. The bedrock of client care is effective communication, not the fear of offending them. There is a large advantage in leading a consultation with the positives of providing optimal solutions for clients and not with what could possibly go wrong. It is a level of confident empathy that can be felt.
Many skin professionals soar in their empathy levels, however, have to work a bit more on their confidence levels. It is not automatic for most. With the plethora of mishaps and miscalculated outcomes that have transpired in the treatment room for melanin-rich skin, some would argue that the concern is warranted. However, if risk alone was reason enough to not provide services, there would be no medical clinics, medical spas, or skin care studios.
Therefore, mitigating risks, negative experiences, and mishaps for clients, rests on the levels of knowledge skin professionals possess. When it comes to caring for melanin-rich skin, there are at times invisible barriers that clients come to a skin health space with.
As the new year begins, skin care professionals have immense opportunities to honestly reflect on business wins, client wins, and best practices from the previous year. The other side of that same coin is to also be brutally honest, while maintaining levels of optimism for continual growth for the year ahead.
How did your client growth strategies turn out last year? Was client diversification and inclusion a part of your growth strategies for the entire year? Have you asked yourself why?
Everyone loves a fresh start, clean slate, or new chapter, and January has a way of bringing that to top of our minds like no other month can. No doubt, you had some indisputable wins, along with some legitimate areas for growth.
MELANIN MATTERS
Although no one is asking you to whip out your 2024 resolution journal, you are invited to journey alongside “The Melanin Diaries” for the next 12 issues to explore how to deliver genuinely inclusive business and skin health practices where clients with melanin-rich skin are truly cared for.