While there are best practices that will help improve results and prevent unwanted complications from occurring in the treatment room, when it comes to working with skin of different ethnicities, skin care professionals must be knowledgeable about the differences between skin colors and how those differences will impact treatment outcomes. Professionals should also understand the possible complications that may occur and the precautions to take.
GOING BEYOND SKIN TONE
In less than a few decades, there will be a major shift in the United States popular. According to the United States Census Bureau, populations that are currently considered minorities will become the majority. Even if that were not the case, most people have a varied ancestral background that greatly impacts how the skin and body responds to various stimuli. Skin care professionals who understand the needs of skin of diverse backgrounds will be better equipped to diagnose challenges and produce better results. While skin tone is important to consider, there are other characteristics that must be addressed when working with skin of any color, primarily because there is a broad spectrum of skin tones within nearly every ancestry. For example, a client with fair skin could be of Italian, Romanian, Spanish, or Asian descent. Similarly, someone with darker tones could be Filipino, African, Spanish, or Italian. There is not a universal characteristic of any one tone of skin.
While skin tone may reveal important characteristics, such as the size of the melanocytes and the melanin breakdown that occurs, there is much more that must be uncovered. One commonly held myth is that darker skin has more melanocytes; all skin tones contain approximately the same number of melanocytes – typically 2,000 per millimeter of skin – but the difference is in regard to the melanin contained within the cell. In darker skin, there is more melanin and the melanin granules are larger and darker.
A client's ancestry provides pertinent information on other key differences as well, helping to shape the best course of treatment.
Cell Layers – The stratum corneum will be equally thick in all skins, however, some research has shown darker skin to contain more cell layers, which is due to increased cellular cohesion or adherence. As such, more effort is typically required to remove these layers.
Ceramides – Ceramides are the lipid molecules that assist in cell regulation. The amount of ceramides in the stratum corneum will vary significantly between racial groups. Darker skin contains the lowest level of ceramides, followed by white skin, Hispanic skin, and Asian skin. The lower the ceramide level, the lower the water content in the skin.
Inflammatory Responses – Darker skin affected by acne will often reveal significant inflammation below the skin's surface via non-inflammatory lesions on the surface. This heightened sensitivity to inflammation explains why acne in darker skin, no matter how mild, will almost always result in post-inflammatory hyperpigmentation.
Based on these three factors, it is evident that both the client's specific skin tone and ancestry will shape how the skin may respond to certain ingredients and treatment protocols. With these differences in mind, skin care professionals are better equipped to create effective treatment plans. There are, however, a few common skin challenges specific to certain ancestries that must also
Though there are many universal skin issues affecting all ethnicities, genders, and ages, every group has common skin disorders unique to them. These skin challenges can also show up in different ways depending on skin type. For instance, keratosis pilaris is a common skin issue among all groups, but the way in which it appears in fair skin versus dark skin is very different.
At a glance, some of the challenges more specific to Caucasian skin include susceptibility to premature aging, dryness, and rosacea. Asian skin tends to be more sensitive and prone to acne discoloration. Latino and Hispanic skin tends to be more prone to hyperpigmentation, scarring, post-inflammatory hyperpigmentation, and uneven skin tone. Darker skin is sensitive to post-inflammatory hyperpigmentation, keloid formation, and pseudofolliculitis barbae.
Post-inflammatory hyperpigmentation is one of the most common skin disorders facing skin of color. Some form of hyperpigmentation impacts an estimated 65 percent of individuals with black skin, 53 percent of those with Hispanic skin, and 47 percent of people with Asian skin. This discoloration results from a variety of issues including inflammation caused by acne, skin eruptions and irritations, misuse and overuse of certain products, and overstimulation from peels and microdermabrasion.
Proper precautions must be taken when working with skin challenged by post-inflammatory hyperpigmentation, especially when creating a homecare regimen and performing a professional treatment as certain ingredients and modalities may aggravate the issue.
Pseudofolliculitis barbae, or razor bumps, typically result from shaving, waxing, and irritation, causing course, ingrown hairs that burrow back into the skin. This condition leads to blockage, inflammation and, eventually, infection; impacts clients of all ancestries, and is not limited to one gender.
Luckily, razor bumps are generally easy to resolve with certain alpha and beta hydroxy acids, melanin suppressants, buffing grains, and nutrient-based healing topicals like epidermal growth factors. The key to treating razor bumps is addressing it before the skin becomes inflamed, which can lead to hyperpigmentation.
When treating acne or folliculitis keloidalis, typically, salicylic, glycolic, and L-lactic acids; retinol; and epidermal growth factors are effective for most skin types. It is important to note, however, certain ethnicities may be more prone to forming hypertrophic scars and keloids as a result of acne. These conditions are similar in the sense that they are both a result of excess collagen buildup that appear as raised scar tissue. Hypertrophic scars, however, do not grow beyond the original wound area, tend to be more common, and may fade over time with proper treatment.
Keloids, on the other hand, are overgrowths of scar tissue. They occur when fibroblasts continue to multiply after a wound has been filled. While they are not as common as hypertrophic scars, they are seen more frequently in darker, Asian, and Hispanic individuals and are one of the most difficult conditions to treat.
It is important for skin care professionals to be aware of clients who may be susceptible to this type of scar tissue formation and offer skin-strengthening topicals such as epidermal growth factors and mild retinals.
Since Asian skin tends to be more sensitive, keep product selection minimal. A minimal selection will allow the skin care professional to determine what is and is not working as Asian skin has reactive tendencies. Avoid topicals with fragrances or dyes and, in the treatment room, begin with progressive peelings and corrective facials, using extreme caution if integrating microdermabrasion.
For individuals with darker skin, the professional will also want to use caution when it comes to corrective, rejuvenating treatments, but this skin type will generally respond well to a more rapid progression and mildly aggressive homecare. Topicals that stimulate cell turnover – like alpha hydroxy acids, retinol, and salicylic acid – and offer lightening, brightening, and antibacterial support – like kojic acid, daisy flower, and L-arbutin – will help restore and maintain skin health.
PRODUCING RESULTS FOR ALL SKIN TYPES
Skin care professionals can ensure an optimum outcome for all skin types by beginning slowly – there is much to be achieved in supporting skin of diverse ancestries. By working gradually, the professional will get to know each skin type and what is most suitable.
When professionals are working with a skin type that they have not treated before, they should proceed with focused awareness to not overstimulate, but still provide rejuvenation. An appropriate homecare regimen, along with professional treatment, is essential. Epidermal growth factors, brightening serums, and a quality mineral sunscreen will work well as daily topicals during a skin peeling program. Again, the program should be customized based on the client's specific skin type rather than just their skin tone.
The goal in the treatment room is to not be too aggressive at the risk of increasing pigment or disrupting the skin by overdoing extractions, using too many layers of acid, or being heavy-handed with microdermabrasion. Targeted treatments, whether a facial or corrective treatment, should offer exfoliation while infusing the skin with nourishing, corrective support. The following ingredients work well in the treatment room:
Melanin Suppressant Solution – This solution is typically a combination of natural lightening ingredients, such as kojic acid, L-arbutin, azelaic acid, and L-ascorbic acid. It will support even pigmentation.
Papaya- and Pineapple-Based Enzymes – These ingredients soften dead skin cells and provide the skin with natural healing elements.
Mandelic Acid and Arginine – This combination helps correct the signs of photoaging and irregular pigmentation and delivers potent antioxidant and anti-bacterial support.
Retinol and Peptides – This powerful duo provides peeling support, reduces fine lines and uneven pigmentation, and strengthens the skin.
These ingredients are just a few of the combinations that work well to support the needs of skin of varied ancestries, however, it will be up to the skin care professional to customize an appropriate treatment plan for the client.
WHAT TO KNOW IN THE TREATMENT ROOM
The most common complication when treating ethnic skin is post-inflammatory hyperpigmentation. This condition may be treated with a mild glycolic or L-lactic acid treatment with a melanin suppressant solution or a lightening blend of low-strength acids and hydrogen peroxide.
Because surface hypopigmentation may also occur, it is important to alert clients about this possibility prior to performing a treatment. Hypopigmentation is not a complication any professional wants to see, but it is one that is treatable and temporary – pigmentation will typically return within 10 days to two months. If hypopigmentation does occur, be sure the client uses epidermal growth factors twice daily and avoids sun exposure while using an SPF of 30 daily.
It is also common for acne conditions to worsen in certain instances. This worsening is simply a part of the healing process and generally abates within one week. Edema, pruritis, rash, milia, and extreme discomfort are also considered complications and should be notated in the client's chart.
Prior to the treatment, ask the client about any medications they may be using; with ethnic skin, certain acne medications may increase the skin's sensitivity and reduce the thickness. The use of medications and estrogen supplements and the client's previous sun damage and post-inflammation from chemical peels should be discussed during the initial consultation. For clients using any unfamiliar medications, it is imperative to get clearance from their physician prior to performing a peel treatment.
In addition to knowing a client's ancestry and skin care history, there are a few other ways to help ensure success. Using patch tests and the Fitzpatrick scale can help gauge how a client's skin might respond to chemical peels and their risk level of hyperpigmentation and sensitivity.
Treatment intensities will always vary by client rather than skin color or ancestry. Most skin care professionals will follow three designations for superficial skin peels: progressive, mid-depth, and deep. Progressive peels only remove the stratum corneum and do not typically cause immediate exfoliation. Mid-depth works at the intraepidermal layer, with exfoliation occurring two to three days after the treatment. Deep peel treatments work at the deepest intraepidermal layer, with the skin undergoing significant peeling within three to four days.
When determining treatment intensity, there are a few important factors to consider:
Type of Skin – Is the client's skin thin, thick, oily, acneic, sensitive, or hyperpigmented? Typically, thin skin types respond well to progressive treatments, while thicker skin often does better with a mid-depth treatment.
Previous Peels – Has the client previously been peeled? If so, find out how many times, what types of treatments were used, and, most importantly, how recently they last had a peel.
Homecare – Is the client using any alpha hydroxy acids, retinols, or Retin-A? These ingredients and medications make the skin more receptive to acids and can intensify the peel treatment.
History – Ask the client about previous treatments, use of medications, and past sun damage. The goal is to get as much information about the client's skin as possible.
Do not be fearful of working with a wide variety of skin types. Gaining the proper knowledge and experience will help to ensure success in the treatment room. If the best practices are being implemented, it is very likely that the skin care professional is already equipped to meet the unique needs of a variety of skin types.
Just as with the treatment room, homecare should be customized to the client as each person will have different ingredients that work best with their skin type. There are a few ingredients, however, that typically support most skin types and produce beautiful results. The following intelligent ingredients will help restore health and protect against the abovementioned skin challenges:
Daisy Flower (Bellis perennis) Extract – As a gentle, yet highly effective, natural skin lightener, this ingredient influences different pathways involved in melanin formation, counteracting age spots and
Epidermal Growth Factor – This ingredient is an essential protein and powerful cell regenerator that supports cell renewal and wound repair.
Mandelic Acid – This safe, go-to acid can be used successfully on all skin colors. Derived from almonds, this antiseptic and rejuvenating acid has lightening and restorative properties.
Alpha Hydroxy Acids – These acids are naturally occurring, nontoxic, and organic. The most commonly used choices include glycolic acid – from sugar canes – and lactic acid – from milk. Other options include malic (apples), tartaric (grapes), and citric (citrus) acids.
Salicylic Acid – This beta hydroxy acid is extracted from wintergreen and birch. It is a relatively safe, low-risk acid as it is self-neutralizing and produces a drying and lifting effect.
Retinol – This ingredient is a vitamin A derivative that converts to retinoic acid and regulates DNA. It assists in the synthesis of collagen, aids in the formation of blood vessels, and encourages healthy cell formation.
Thermus thermophilus Ferment Extract – This deep-sea microorganism is used to fight free radicals.
Resveratrol – This potent antioxidant is found in red grapes and wine and delivers polyphenols, anti-inflammatory properties, and ultraviolet and free radical protection.
Zinc – As a natural mineral, this ingredient acts as a shield to reflect ultraviolet rays and protect the skin against sun damage.
In addition to a skin history and lifestyle assessment, a client's ancestry is an important piece of the skin puzzle. These components will help the skin care professional to shape an effective treatment and mitigate risks and undesired outcomes. Knowledge will also help reduce any anxiety that may surround working with a new skin type and help ensure an optimum outcome.
Rhonda Allison, a pioneer in the skin care industry, is the founder and CEO of Rhonda Allison Cosmeceuticals and RA for Men. Allison is also an author and an internationally-known speaker with more than 30 years of aesthetic experience. rhondaallison.com and ramethod.com