Ethnic Skin Problems-Recommended Treatment

 

Skin Type Tanning Ability
1     Pale skin, blue eyes Always burns, does not tan
11     Fair skin, blue eyes Tans after initial burn
111   Darker white skin Burns easily, tans poorly
1V Light brown skin Burns minimally, tans easily
V   Brown skin Rarely burns, tans darkly easily
V1   Brown/black skin Never burns, always tans darkly

Skin type can be classified according to Fitzpatrick skin photo- type (SPT). This system is predicated on the reactions of various types of skin to sunlight and ultraviolet radia- tion (UVR). It correlates the color of skin, and thus its mela- nin content, with its ability to respond to UV light with burning or tanning. SPT denotes 6 different skin types, skin colors, and reaction to sun exposure. The defining feature in ethnic skin is the amount Melanin is a brown-black, light-absorbing pigment, protecting the skin against ultraviolet rays, and thus photo-damage. Differences in racial pigmentation are not due to differences in the number of melanocytes, but rather to differences in melanocyte activity and epidermal distribution of melanin. The melanin pigmentary system is composed of melanocytes that supply melanin pigment to a group of about 36 keratinocytes. Pigmentation is determined primarily by the amount of melanin transferred to the keratinocytes. In ethnic skin, there is greater production of melanosomes, higher degree of melanization of melanosomes, and larger unaggregated melanosomes showing slow degradation.

It is no secret that the majority of aesthetic patients are Caucasian. However since the development of new concepts in Aesthetic Medicine there has been an ethnic diversity developing. Because of this growing ethnic diversity, with its increasing number of ethnic patients, it is vital for the Skin Care Physician to have awareness of the difference and unique needs of those with darker skin.

To meet the changing demographics of patients undergoing aesthetic procedures it is important to have a thorough understanding of the structure and function of pigmented skin. As well as how it differs from other skin types.

The Ying and the Yang

There are morphological & structural differences between the different ethnicities. These differences have effect on treatment modalities for ethnic skin types. Knowledge of these differences is crucial to the Aesthetic Physician for optimal success in treatment of a range of Fitzpatrick Skin Types.

The Epidermis of Ethnic Skin

The stratum corneum of the epidermis in blacks is more compact than that of epidermis in whites and has more cell layers. There is greater lipid content in black stratum corneum compared to the white stratum corneum.

The Dermis of Ethnic Skin

Black dermis is generally thick and compact when compared to white dermis due to smaller collagen fiber bundles closely stacked and running more parallel to epidermis. Fibroblasts and lymphatic vessels are more numerous in black skin. Fibroblast hyperactivity combined with a decrease in the activity of the collagenase enzyme, probably results in keloid formation. The high melanin content of black skin, the amount of photo-damage observed in older Caucasian skin is usually less apparent in black skin

Hair Follicle-Black Skin

Melanosomes were found to be in both the outer root sheath and in the bulb of vellus hairs in blacks but not in whites. ( important in laser therapy)

Dermal Implantation of the black hair follicle is curved and golf club shaped, in contrast to the white hair follicle (cause of PDF) In-vitro growth rate of black hair, at .25 mm/day, is slightly slower than that of Caucasian hair follicles, which was .30 mm/day. (important in laser hair removal)

Common Skin Problems in Ethnic Skin

  • Pseudofolliculitis Barbae
  • II. Dermatosis Papulosa Nigra
  • III. Melasma

Pseudofolliculitis Barbae

Pseudofolliculitis Barbae (PFB) is the “acne-like” breakout commonly referred to as “razor bumps” or “shaving bumps”. As naturally curly hairs be- gin to grow back after shaving, waxing or plucking, they get trapped inside the follicle, resulting in irritation and swelling.

The result is inflammation in the hair follicle. Any one can get shaving bumps, but they’re more common in black skin.

  • Let the beard grow 3-4 weeks (once the hairs get to be a certain length they will not grow back into the skin, allowing lesions to subside).
  • 1% Hydrocortisone Cream to beard area daily
  • After 3-4 weeks, shaving every other day, rather than daily, will improve pseudofolliculitis barbae.
  • DO NOT USE A RAZOR TO SHAVE!!!!
  • Use an electric shaver ( will help the condition because it does not cut as close as blades do).
  • Do not stretch skin while shaving and shave with the grain of beard growth. Avoid multiple repetitions of strokes in the same area. Do not press razor head hard against the skin. Shave every other day. Prevent shaving closer than 1mm cut of whisker hair.
  • Apply Witch Hazel Gel (Witch Doctor) immediately after shaving
  • Easy TCA Peel (to bearded areas) 4 Cycles with pre & post treatment skin regimens
  • Best to permanently remove the hair

 

Dermatosis Papulosa Nigra (DPN)

DPN is a benign cutaneous condition common in only black skin. It is characterized by multiple, small, hyperpigmented, asymptomatic papules on the face of adult blacks. There are several treatment options, and it is usually up to the patient’s discretion which option suits them best. These consist of:

  • Curettage – The dermatologist will inject a local anesthetic into the area surrounding the DPN to be removed. This will make the skin go numb so no pain should be felt during the

procedure. The skin lesion is scraped off with a curette, which is like a small spoon with very sharp edges

2) Electrocautery- An anesthetic cream is put on the face 30 minutes before this procedure is done. Then the DPN’s are burned by a high- frequency electric current applied with a needle- shaped electrode.

3) Scissor Excision- The same anaesthetic procedure is done as above. The individual DPN’s are then surgically snipped with a pair of small curved surgical scissors.

Melasma

Melasma is a light to dark brown pigmentation that can appear on the forehead, cheeks, upper lip and chin of mostly women.  Melasma is caused by increase in melanin production. It most often occurs in women over 25.

Three broad factors that influence the develop- ment of Melasma:

1) Genetic Susceptibility

2) Hormonal factors, like taking Oral Contraceptive Pill and pregnancy

3) Sun Exposure

There are quite a few treatment options for Melasma, but whatever treatment option is chosen the regular application of a sunblock combined with minimizing sun exposure is essential. If possible also stop the Oral Contraceptive Pill.

One good way to treat Melasma is the application of a specially mixed Hydroquinone containing cream plus good sunblock for at least one month. This is followed, if required, by treatment with Chemical Peels. The specially mixed Hydroquinone cream, if it is working well enough, can be continued for as long as the Melasma improves. The Chemical Peel Treatment can also be repeated

Melasma is prone to recurrence so maintenance treatment is important. Once an acceptable level of improvement is achieved the patient must continue with sunblock during the day and a milder melanin suppressing cream, like Blending Bleaching Cream.   For more Information on ethnic skin care, please contact Flawless Face and Body at info@flawlessuk.co.uk.

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