×

Warning

JUser: :_load: Unable to load user with ID: 31566

Customizing Treatment Pathways for Ethnic Skin

Traditional dictionary definitions of the word 'ethnic' refer to those who originate from non-western cultures. The word has also been used to describe people from cultures or nations different from where they reside. The U.S. is unique in that we are genuinely a melting pot. As a result, using the color or Fitzpatrick skin type of a patient to identify ethnicity may lead to incorrect treatment selection. Understanding the intricate variances that exist between the structure and function in the skin of people from differing geographic regions in the world is one important key to a successful treatment.

Truly most Americans are 'ethnic' as we have parents from disparate hereditary backgrounds that over generations have migrated between a wide range of countries. There are specific conditions and predispositions that are unique to lighter skin that can be present in a multiracial Fitzpatrick five patient. Conversely a patient with light skin may have a high tendency toward hyperpigmentation if their ancestry is mixed.

Upon deeper investigation, it becomes clear that color is only one of the important differences between the range of Fitzpatrick types. By identifying the key predispositions of skin from particular regions in the world, we can create tools to piece together the complex and unique identity of each patient's skin and therefore create successful treatment pathways. This includes using detailed patient history forms that identify heredity and conditions they may be combating. As the largest organ in the human body and the main source of protection and toxin elimination, a full and deep understanding of the influence heredity exerts on skin function is imperative when designing customized treatment plans for all of your patients.

The Skin as an Accommodating Organ
Our skin is integral to the proper function of our bodies. It regulates body temperature, retains moisture, and protects our DNA. In order for the skin to effectively perform these functions, over generations it has adapted to fend off the most damaging environmental culprits of a particular regional climate. This generational accommodation allows the skin to protect the ever-important DNA and therefore the body's ability to repair itself, minimizing the occurrence of disease and cancer. Ultraviolet radiation remains one of the worst threats for the health of the skin. In areas of the globe where this ultraviolet radiation is consistently more intense, the process of melanogenesis is more easily stimulated. As a result, people who originate from equator regions of the world where the UV radiation is extreme, naturally have darker skin. This is as a result of the quantity as well as the quality of the melanin in their skin. The skin of those whose ancestors were consistently exposed to low amounts of UV radiation deposits less melanin resulting in lighter colors of skin, hair, and eyes. These cold, harsh climates also lead to the development of a thicker adipose layer to protect the body from loss of heat and more skin redness due to stressed capillaries. These consistently cold climates also are thought to lead to tighter pores in Fitzpatricks one and two, which explains their ability to tolerate more surface stimulation. This all adds up to more protected nerves in the dermis and an ability to tolerate increased surface stimulation. These environmental and geographic indicators are important to identifying the common predispositions of patient's skin, and in outlining the best treatment plan.

More Than Meets the Eye
The most apparent difference in the skin of those from different ethnicities is of course the color, although there are also differences in skin thickness, vascularity, and predispositions to certain skin conditions and diseases. What lies beneath the surface of the skin is equally as important as what is visible on the surface when determining effective treatment pathways for
your patients.
Higher Fitzpatrick skin types are thought to have 22 layers in their
epidermis while that of lighter skin typically has 17. Additionally, transepidermal water loss (TEWL) tends to be greater in African American skin. The exposure to high heat and humidity in equator regions of the world may also be a reason for darker skin types having larger pores. This, in tandem with increased TEWL and a more compact and thicker dermis is thought to contribute to an amplified sensitivity to topical stimulation (e.g. peels) as there is inadequate protection of
nerve endings.
The sebaceous glands tend to be larger in African American skin leading to a greater likelihood of acne breakouts. Interestingly, there also tends to be more inflammation around typically non-inflammatory comedones in higher Fitzpatrick skin. We expect all Fitzpatrick skin types with acne grades three and four to have inflammation and redness, but not grades one and two. The fact that superficial blood vessels are more prominent and dilated in darker skin may play a role in this increased inflammation. It is important to be aware of this tendency, as it may be beneficial for darker skinned patients with lower grades of acne to be referred out to a physician earlier for antibiotic therapies than patients with light complexions. Antibiotics help reduce not only bacterial proliferation, but are also very beneficial for the reduction of inflammation. Customized acne daily care regimens for darker skin should include anti-inflammatory botanicals and ingredients like azelaic acid that acts as a competitive inhibitor of DHT, which reduces the hormonal component of acne while reducing the occurrence of post-inflammatory hyperpigmentation.

Pigmentary Variances
Melanin is the complex molecule that is responsible for the deposition of pigment in our bodies. Melanin acts as a photo-protectant that reduces UV penetration into the skin. Those with dark and light skin have the same number of melanocytes (the cells responsible for melanogenesis or pigment production), although their level of activity differs. As mentioned earlier, the dark skin of those who typically originate from regions of the world with extreme sun exposure, have melanocytes that will, out of necessity, start the process of melanin deposition much faster than someone with lighter skin. Those with mixed heritage may have lighter skin but still have a greater predisposition for hyperpigmentation than a typical Fitzpatrick one or two.

As a result of inflammation, the following process is stimulated:
An enzymatic reaction results in melanosome production within the melanocyte.
These melanosomes are 'packets' of pigment that can either be eumelanin (brown/black pigment) or pheomelanin (orange/red pigment).
Dark skin will tend to have more eumelanin. This more vigorous type of melanin contributes to the increased occurrence of hyperpigmentation.
Those with fairer skin and especially red hair will have predominantly pheomelanin.
Once the melanosomes are produced, they move along the dendrites of the melanocyte where they are deposited into the keratinocytes.
The melanosomes then travel through the keratinocyte, finally congregating in an umbrella-like configuration over the nucleus of the cells affected by the UV radiation or inflammation to protect that cell's DNA from damage. A tan is the body's way of protecting us against DNA damage from UV exposure if we don't protect ourselves with sun avoidance and SPF products.
The final color of the skin will be slightly different based on the ratio of eumelanin to pheomelanin as well as the quantity of sustained UV exposure to which someone's skin is subjected.
To avoid stimulating pigment deposit, it is wise to use lower percentages of ingredient blends that prevent melanogenesis rather than one ingredient at a high percentage that can be surface stimulating. Hydroquinone (HQ) is very effective at the low OTC percentage of two percent, especially when used in concert with other effective ingredients like lactic acid, kojic acid, ascorbic acid, and azelaic acid, to name a few. Care must be taken when using HQ at four percent or higher on darker skin as these are more irritating and can trigger post-inflammatory hyperpigmentation (PIH). In addition, therapies such as Retin-A® (retinoic acid) must be used with caution as inflammation can trigger both hypo- and hyperpigmentation in dark skin. A safer alternative is retinol. This member of the retinoid family is not surface irritating and is converted to retinoic acid within the skin on an 'as needed' basis. All patients working to overcome hyperpigmentation will benefit greatly from gentle blended chemical peels that increase cell turnover and remove surface darkened cells without the excessive inflammation that can stimulate
melanin production.
Over generations the Nordic or lighter skin types developed melanocytes that are much less responsive than those with darker skin, as the need for protection from UV radiation is less necessary. It is thought that as a result of this, these melanocytes are also less capable of repairing themselves and regenerating after damage. This inability to repair can lead to melanotoxicity or hypopigmentation. This cannot be corrected and happens typically from procedures that involve full thickness burns such as cryotherapy or CO2 laser. Hypopigmentation lesions can be thought of as a pigmentary scar and although not as common as hyperpigmentation, it is more disfiguring, traumatic, and typically permanent.
One of the most important steps in any daily care regimen is sun protection. A broad-spectrum moisturizer with an SPF of 15 or greater should be applied every day to all exposed areas. Although darker skin has more natural protection against UV exposure this is a step that cannot be omitted.

Identifying Rosacea
Another skin condition that is tied to hereditary background is rosacea. This is a chronic condition or disorder of the skin that is known to primarily affect the central third of the face (cheeks, nose, and central forehead). It is characterized by flushing and persistent redness, papules or pustules, and telangiectasia which can be controlled, but never cured. It is seen most frequently in women between the ages of 30 to 50, however can affect men more destructively.
Rosacea is most prevalent in those of English, Irish, Welsh, Russian, and Native American descent. This is a condition that could easily be missed if the patient has dark skin but mixed heritage. Although African American skin has more dilated superficial blood vessels, rosacea is not as common in this type of skin. If rosacea is not identified and the higher Fitzpatrick skin type is mistakenly treated for acne the condition will likely worsen. One way to uncover whether a dark skinned patient has acne or rosacea is to ask if they typically have irritated eyes or have a high incidence of styes. These are signs of ocular rosacea, which occurs in at least 50 percent of all rosacea patients.
It is difficult to identify the specific reasons rosacea affects particular hereditary backgrounds as there is no clear definition or etiology of the disease. One helpful advance in diagnosis and treatment was the introduction of the standard classification system developed by the National Rosacea Society. This four subtype classification system allows physicians and clinicians to have a common language in identifying this difficult condition. To view this document, please visit www.rosacea.org/class/index.php.
In order to mitigate the symptoms and keep rosacea from progressing, it is important to use gentle ingredients that interfere with the growth factors, prostaglandins, and cytokines responsible for the vascular issues that drive the redness. Specific algae extracts, caper bud extract, bisabolol, evening primrose and borage oils, as well as azelaic acid have all shown great promise at controlling this condition. Azelaic acid is available by prescription at 15 to 20 percent and is very effective. Again, gentle blends of multiple ingredients at lower percentages are extremely successful and non-irritating. Gentle antibacterial agents, like low percentage salicylic acid, are beneficial, especially for the papulopustular presentation.

Putting Together the Puzzle for Success
As the planet becomes more and more of a melting pot and world travel and communication increase, the incidence of a patient having one pure hereditary lineage will become increasingly unlikely. Because of the many combinations of races and cultures in most of us there cannot truly be one 'ethnic' skin treatment. Understanding the different hereditary influences in
each person's skin will allow the technician to identify potential conditions and risks to treatment. The ultimate success of any treatment plan is greatly increased by basing treatment on each 'ethnic' patient's unique combination of heredity.
Felicia Brown, LMBT is a licensed massage therapist and the owner of Spalutions!, a consulting firm that strives to educate, motivate, and empower spa and healing arts professionals. Brown is also the owner of Inspire Skin & Body Day Spa (www.inspireskinandbody.com) in Greensboro, N.C. Contact Brown at www.spalutions.com or This email address is being protected from spambots. You need JavaScript enabled to view it..

 

Related items

  • Dallas Based Entrepreneurs Launch Medical Hologram B+A and Marketing Assistant Serving the Aesthetic Community Dallas Based Entrepreneurs Launch Medical Hologram B+A and Marketing Assistant Serving the Aesthetic Community

    Aestheia Imaging, a hologram content management, and advertising subscription company introduced its disruptive technology at the American Society for Aesthetic Plastic Surgery last week at The Aesthetic Meeting in New Orleans. The company breaks the mold of in-practice marketing with the unveiling of XTHEIA; an interactive hologram display toting a Virtual Consult Assistant for medical office waiting rooms. Aestheia's launch poses a resolution to poor patient awareness; an underserved focal point of product education in the aesthetics industry.
    The company is led by Austin JM Podowski, CEO and accomplished Dallas Healthcare Business Tech executives Mike McDonald, President and Paul Herchman, Advisory Board Member. Well known Plastic Surgeon and photographer Dr. Barry DiBernardo of New Jersey Plastic Surgery leads the companies Medical Advisory Board and will continue to work to enhance upon the application. The company offers a connected holographic media platform to story map the patient journey to brand and product education. Through the research and development of Aestheia's Medical Advisory Group, the company will offer holographic before and afters to patients so they can see pre-operative and post-operative procedure outcomes in true 3D, not previously available in the space.


    "We are dedicated to providing novel and ground breaking product innovation for the entire Aesthetic Community," comments McDonald. The company today offers a fully-automated and comprehensive holographic playlist for physician waiting rooms tethered to a cloud-based solution developed by the management team.
    "We are changing the way medical companies and physicians communicate with their customers and patients. The ALEXA of Aesthetics is now in the room," states Podowski. The team has also designed a customer facing iPad Pro application that allows a physician to remote control the device offering an in-app camera for patient photos. Mr. Podowski later comments, "The response received at ASAPS The Aesthetic Meeting affirms that our vision and product meet a need and resuscitate a lost connection with the consumer."
    The management team is dedicated to further pioneering advancements in hologram, AI, and AR in the evolving medical practice of the 21st century. The company is finalizing a third-round capital raise and will begin placement of their technology throughout Plastic Surgery Offices in North America in July 2019. The technology will also be on display in direct to consumer retail kiosks throughout the United States later this year. To get a sneak peak of Aestheia, follow the team's development, or learn more about the technology, follow @aestheiaimaging or visit www.aestheiaimaging.com.
      www.aestheiaimaging.com

  • Micropigmentation Procedure October 2010
    By
    Micropigmentation Procedure October 2010

    Micropigmentation Procedure Helps Breast Cancer Survivors Regain Self-Esteem & Confidence!

    Cranberr facial mask

    Cranberr facial mask
    According to the American Cancer Society (ACS), it is estimated that in 2009 there were 192,370 new cases of invasive breast cancer diagnosed among women, and approximately 1,910 new cases in men. For the many men and women who have been, and will be diagnosed this year, the battle to get through treatment and surgery is only the beginning of the journey to survive. Although the feeling of survival is unsurpassed, the physical scars at times may leave some survivors anxious with their new appearance. Ruth Swissa has taken her passion and artistic expertise in the permanent makeup industry to provide areola pigmentation for breast cancer patients post reconstruction to help renew self-confidence and boost self-esteem.

    "Many of my patients have said that waking up every morning, and looking in the mirror is a constant reminder of their battle, which although comes with a sense of pride, it also at times causes insecurities because they don't feel like themselves," says Swissa.

    Micropigmentation is an alternative method of creating a realistic nipple and areola after a mastectomy, to achieve a more symmetrical shape and even coloring using artistic light and shade effects. Swissa works closely with her patients in order to achieve the desired coloring and size to create a natural looking effect. This procedure takes less than an hour and is usually painless.

    Ruth uses a customized medical tattooing technique for applying permanent makeup for areola pigmentation. This unique method proves to be more exact, very gentle, and less invasive than traditional cosmetic tattooing. The results look more natural and subtle in appearance.

  • Five Ways to Find Safe and Natural Relief from Osteoarthritis October 2010
    By
    Five Ways to Find Safe and Natural Relief from Osteoarthritis October 2010


    Five Ways to Find Safe and Natural Relief from Osteoarthritis

    by Deirdre Shevlin Bell

    Cranberr facial mask


    The search for safe and effective relief from osteoarthritis (OA), a condition that occurs when joint cartilage wears down over time, can feel like an uphill battle. Certain natural remedies can bring lasting relief from OA according to the Arthritis Research Council (ARC) study and other experts. That is good news, since the pain, stiffness, and loss of flexibility from arthritis makes it the nation's most common cause of disability.

    One massage, and call me in the morning
    Spa-lovers with osteoarthritis will be pleased to learn that all those massages that leave you feeling loose and limber are doing more than just helping you relax. According to a 2006 study published in the Archives of Internal Medicine, Swedish massage improves flexibility, decreases pain, and increases range of motion in individuals with osteoarthritis of the knee.

    Low-impact exercise
    "When people start to hurt, they tend to cut back on exercise," notes Michele Olson, Ph.D., professor of exercise physiology at Auburn University Montgomery and Fellow of the American College of Sports Medicine. But that is a mistake, as inactivity can make pain and stiffness even worse. Olson recommends Pilates and swimming or doing aqua-aerobics, but she emphasizes the importance of choosing gentle, weight-bearing exercise. Michael Murray, N.D. suggests that a person should find something they love, and find a way to continue doing it: If walking on concrete sidewalks is too hard on the joints, walk on the golf course.

    Spice rub
    Using a gel containing capsaicin, the active ingredient in chili, is very effective at providing temporary relief from osteoarthritis pain. Studies have found that capsaicin can deplete the substance that acts to transmit pain signals from nerve endings to the brain and cause inflammation in the joints.

    Healing herbs
    An ARC study evaluated several herbs and herbal combinations and found that one stood above the rest. Phytodolor, a branded combination of three herbs – aspen (Populus tremula), common ash bark (Franxinus excelsior), and golden rob herb (Solidago vigaurea) effectively manages the pain and inflammation associated with OA. Some studies have shown that aspen contains a substance that when ingested inhibits the production of certain prostaglandins in the nerves, resulting in pain relief. Common ash bark and golden rob herb also have pain-relieving properties, and common ash bark is an antioxidant – meaning it may reduce oxidative damage in the joint. The combination of the three herbs has been shown in animal studies to reduce inflammation. No major adverse effects have been reported, though some people do experience diarrhea, stomach upset, or skin reactions.

    The SAMe Game
    First discovered in 1952 and widely investigated for its usefulness in treating depression, S-adenosylmethionine (SAMe) is now showing promise as a treatment for OA. SAMe is a chemical compound that occurs naturally in the body, where it contributes to the synthesis of hormones and neurotransmitters. Studies suggest that when taken as a supplement, SAMe reduces pain and also stimulates the synthesis of collagen and proteoglycans, which are the major components of joint cartilage. Adverse effects are infrequent and mild, but can include nausea, restlessness, headache, dry mouth, and stomach upset. People with depression should consult with a healthcare provider before taking SAMe, as some incidences of anxiety and mania have been reported.

    Copyright© HealthyLifestyles.com

  • The Impact of Psoriasis on Personal Relationships October 2010
    By
    The Impact of Psoriasis on Personal Relationships October 2010


    The Impact of Psoriasis on Personal Relationships Survey Fact Sheet

    This survey was created in partnership with the National Psoriasis Foundation and Galderma Laboratories, L.P.

    Within this issue, as well as our November and December 2010 issues, we will be printing important findings revealed from the recent survey, "The Impact of Psoriasis on Personal Relationships." This survey, sponsored by Galderma Laboratories, was distributed to the National Psoriasis Foundation membership database via Survey Monkey. The survey was completed by approx 1,520 people; statistics below represent the percentage of people who answered a specific question (not always all 1,520 respondents). Statistics are rounded to nearest percentage point and percentages may not add up to 100 percent depending on the structure of the question. Not every respondent answered every question.i Below is a list of findings relating to psoriasis and its impact of social relationships.

    Nearly 80 percent (78.7%) of question respondents feel that psoriasis has had a negative impact on their personal relationships.ii

    Social Relationships

    • When having a psoriasis flare-up, 63.3 percent of respondents are less likely to go out socially iii and 53.6 percent have declined social invitations or cancelled plans because of a flare-up.iv Nearly 70 percent (69.6%) feel that psoriasis has impacted their social relationships.v
    • When meeting someone new, 74.3 percent of question respondents worry that the person will notice their psoriasis,vi and 72.1 percent of respondents are concerned that people that notice will think of them less favorably.vii
    • When going out for social occasions, 79.5 percent of respondents usually only wear outfits that cover up
      their psoriasis.viii
  • Pomegranate the Ancient Red Goddess October 2010
    By
    Pomegranate the Ancient Red Goddess October 2010


    Pomegranate the Ancient Red Goddess!

    by Natalie Pergar

    Cranberr facial mask

    Known not only as part of the elite group of super fruits, the all mighty pomegranate, English word comes from the Latin words for apple; "pomum" (apple) and "granatus" (seeded), has been dated as far back as 1,000 BC and was introduced to North America by Spanish settlers in 1769. This red beauty represents global symbolism and history ranging from righteousness, prosperity, and fertility.

    With over 760 varieties of pomegranate it is one of the oldest known medicines to man. Ancient Greek healers would use pomegranate juice to manage health problems similar to arthritis, circulation problems, digestive disorders, and infections. And to add to the wonders of the pomegranate, the fruit was also involved in ancient beauty concoctions. Today with our growing beauty culture and desire to turn back the clock, we find ourselves revisiting what our ancient friends already knew with the help of modern science and research.

    Pomegranates are packed with phytonutrients, vitamin B, and an abundance of vitamin C. They contain red arils, tiny edible seeds that are loaded with juice and provide valuable fiber. They are delicious and fantastic to eat - though I would not recommend eating the white membrane that surrounds the arils as it is quite bitter and the consensus is that it is not recommended. And for those of us that count calories, a 1/2 cup of raw pomegranate has 80 calories and 0 grams of fat!

    According to the American Association for Cancer Research (AACR), pomegranate fruit extract contains several polyphenols and anthocyanidins (pigment that gives certain fruits their dark red colors). Its antioxidant activity is higher than that of red wine and green tea and research suggests that pomegranate extract may have significant clinical benefits in decreasing risk for skin cancer.

    By taking pomegranate extract capsules, one could reduce or reverse the signs of aging by promoting cell turnover and creating new, healthy skin. But that is not all! Evidence shows that including it in your skin care regime can provide wonderful results too. Rich in ellagic acid to manage free radicals, pomegranate oil contains punicic acid, an omega 5 conjugated fatty acid effective in aiding cell regeneration and proliferation. Pomegranate also carries beneficial phytoestrogen and a rare plant-based source of conjugated linoleic acids (CLA), an anti-carcinogen.

    So I salute you, oh red goddess of history. Bring me health and wellness with all your super fruit power!

    Pomegranate, Almond Oil, and Honey Mask


    ½ pomegranate
    2 tsp almond oil
    ½ tbsp organic honey

    Warm up the honey until it becomes liquid (not too hot!) by putting it in a small glass or metal bowl which is immersed in hot water. Peel the pomegranate half, cut the fruit in pieces, and put these in a bowl or food processor. Add the honey and almond oil. Blend it all into a smooth and uniform paste. Spread this gently and equally with your fingertips on your clean face and neck: keep the eye area clear. Now lie down, relax, and leave the mask on for 20 minutes. Then, wash it off with lukewarm water and end with a splash of cold water; pat your skin dry with a clean towel. Finally, apply a moisturizer, this way you "seal" your skin to keep the water inside. (For all skin types). *This fruit mask recipe peels your skin and we do not recommend using it on acne skin.

    Copyright ® 2009-2010 Natural – Homeremedies-For-Life

    Pomegranate Oat Bran Scrub

    2 ounces pomegranate juice
    2 ounces orange juice
    2 tbsp honey
    2 tbsp sea salt
    3 to 4 ounces oat bran

    1. In a container large enough to hold two cups, combine pomegranate and orange juices. To this add the honey and mix together well.
    2. Now add sea salt and oat bran. Mix together and allow the oat bran to soak up the liquids, about 10 to 20 minutes.
    3. Make sure to apply to a clean face. Probably the easiest way is to apply in the shower after you clean your face and allow it to set while you do other things. The steam from the shower helps allow the ingredients to penetrate your skin. Then, gently scrub off as you shower.

    Copyright ® eHow.com

Login to post comments

More in Body

Featured Company

  • SAIANSAIANDescription: Saian Skin Care – Natural | Clinical As well-known specialists, Ms. Saian and her daughter have created a unique skincare line that focuses on the problems of acne and premature aging. They believe that youthful looking skin can be achieved at any age by ...

Next-Level Learning

  • Southeastern EstheticsSoutheastern EstheticsDescription: Welcome to Southeastern Esthetics Institute, a premier esthetics training institute located in the heart of South Carolina. SEEI is more than just an esthetics training program, we are a one of a kind esthetics school that offers an intimate setting and ...

Treatments