Your consultation with a client is absolutely the key interaction, no matter what the client’s skin color. Establishing your role as the skin care expert early on will build trust with the client. Ask the right questions, dig a little deeper, and learn as much about them during the first consultation as this will help prevent problems in the future, since you will have solid reasoning for all your treatment and homecare recommendations.
A thorough health history and intake form that requires demographic information, but also asks relevant questions about lifestyle, habits, diet, medications, and commitment will give you a picture of the client outside of the treatment room. An awareness of the client’s heredity, as well as the unique characteristics of different ethnicities can guide a you in creating the optimal plan for reaching their skin care goals.
UNDERSTANDING SKIN TYPES
All skin of color struggles with post-inflammatory hyperpigmentation. You will need to take a slow-and-steady approach rather than aggressive to avoid rebound post-inflammatory hyperpigmentation, due to the skin’s reaction to a controlled injury like a chemical peel, microdermabrasion, or laser session.
Melasma is another common skin condition among clients with skin of color. A skin care professional must be able to determine if the hyperpigmentation is post-inflammatory hyperpigmentation, sun damage, or true melasma, in order to find the best solution. Is the client taking hormones like birth control pills or hormone supplements?
Familiarize yourself with the common disorders within specific ethnicities and ask the client about them during the consultation. For example, Asian skin has the highest rate of transepidermal water loss (TWEL) and is very reactive. Over 90% of Asians are lactose intolerant and this will be important when considering exfoliating treatments or homecare products that could produce irritation. Your female client with darker skin of African descent is more likely to have uterine fibroids and polycystic ovary syndrome (PCOS). Awareness of these gynecological and hormonal conditions will determine causes and best treatment for the manifestations on the skin, including hirsutism and acneic breakouts. Latinx clients will have a higher incidence of diabetes, which affects body metabolism and the healing process. Latinx clients have a greater incidence of cystic acne but are sensitive to benzoyl peroxide. Periorbital hyperpigmentation will be more prevalent in East Indian clients.
Some clients may feel uncomfortable answering questions about their ethnicity. Reassure the client that you need this information because some treatments and skin care products are not appropriate for every ethnicity. The goal is to propose an effective skin care plan that includes professional treatments, as well as homecare products. You want to minimize the risks and maximize the benefits of recommendations. Ask the client what ethnicity they identify with. What is their heritage? Ask questions about their parents and grandparents. Be sure to include questions about how they scar after an injury or a surgery. Do they keloid or get hypertrophic scars? These are common conditions in skin of color.
An awareness of cultural practices will also provide the best possible treatments for clients with skin of color. Women of African descent frequently sleep with silk scarves or bonnets to protect their hair and meticulously designed waves and curls framing the face is trendy right now. If a client has hairline acne, these could be contributing factors. Shadeism or discrimination against people with darker skin tones, is prevalent in some East-Indian communities. Could your client be using a skin lightener and not telling you? The use of skin-lightening products may be a factor in East-Indian client’s skin irritation. Inquire further if you believe this to be the case.
SKIN CLASSIFICATIONS TO CONSIDER
Consider adopting a skin-scale system beyond the Fitzpatrick. The Fitzpatrick scale originated in a study on the effects of ultraviolet radiation on middle-aged white men. It was not designed with skin of color in mind. The Glogau Scale measures skin laxity on a scale of one to four. One being no wrinkles and a grade of four is always wrinkled. The Roberts Scale combines the Fitzpatrick Scale and the Glogau Scale with a visual exam for hyperpigmentation and questions about scarring. You will prevent a negative outcome by using your investigative skills.
The next step after an in-depth interview is a physical examination of the skin. Skin of color has unique anatomical differences and understanding those will help you use the information gathered from the health history and intake form to formulate a treatment plan. Asian skin has the largest eccrine glands, so expect them to struggle with shiny skin. They also have the greatest transepidermal water loss, so ensure barrier function is not impaired when exfoliating. Skin of African descent has curved hair follicles and higher rates of pseudofolliculitis barbae, which can often imitate acne as the hair curls back into the skin. Latinx skin is also sensitive to sodium lauryl sulfate, the foaming agent in many cleansers, shampoos and toothpaste. Is the irritation on your Latinx client’s skin due to this? In a good skin exam, look at pore size, texture, fine lines, and skin laxity. Does the client have clogged pores or is their skin congested? Ask clients about their water intake. Is there a buildup of keratinocytes? What about pigmentation? Is it bilateral?
Combine all of your information together and create a logical skin care plan that exercises your client’s skin. Just as going to the gym increases your stamina and strength, you can condition a client’s skin tolerance, so the improvements are gradual. Understanding that skin of color is about more than just melanin will set you up for success.
A technician, educator, mentor, and business owner, Mary Nielsen has been at the forefront in medical aesthetics since its infancy in the early 1990s. She is currently vice chair and industry expert on the Oregon Board of Certified Advanced Estheticians. She is the author of “Fearless Beauties,” the book, along with other aesthetic texts. She is the executive director of an aesthetic school, the founder of Fearless Beauties, and the creator of Cascade Aesthetic Alliance and Skintelligent Resources.