A GLOBAL REPORT
Wendy Lewis investigates best practices to safely treat darker skin types
Note: This article was originally published full on Prime and excerpts have reproduced here with permission.
OUR SKIN COLOR IS DETERMINED BY A combination of anatomical and physiological phenomena that occur within the uppermost layers of the skin. Skin of color individuals may be of diverse ethnic backgrounds hailing from any region around the world from North America to Asia Pacific, as well as people from these groups who have intermarried.
‘Four pigments contribute to skin color: melanin, carotene, oxygenated haemoglobin, and reduced haemoglobin. Of these, the particle size, shape, and location of melanin contribute most significantly to overall color; the more near the surface melanin is clustered, the darker skin will appear. Carotene gives the skin a yellow hue, while oxygenated and reduced haemoglobin are red and purplish-blue, respectively. In addition to melanin, all light-absorbing molecules and particles in the skin, or chromophores, play a part in perceived skin color1.
Aesthetic practitioners need to guide this group of patients through the best options and determine which will be safe and effective for their skin type and tone. For skin of colour patients, specialised expertise in treating darker skin is vital to achieving successful outcomes.
Key considerations in skin of colour
Regarding the development of signs of ageing, darker skin type patients may age a decade or more slower than their fair-skinned counterparts. They may not develop fine lines and wrinkles, but they may experience volume loss in the midface or laxity of the lower face and submental region.
While fair skin type patients tend to develop lines, wrinkles and laxity over time, skin of colour patients may be more concerned about age-related pigmentary changes. Hyperpigmentation is a big issue as they get older, perhaps because the classic signs of skin ageing tend to appear later and are less noticeable. Hyperpigmentation caused by cumulative sun exposure may be particularly pronounced in darker skin types.
Patients with darker skin may think they are pigment-protected so they don’t need to protect themselves from the daily assault from UV rays. This may present a challenge for practitioners to get them acclimated to using a broad spectrum SPF30 or higher year round and to follow safe sun habits, such as seeking shade during peak times and wearing protective clothing.
To further complicate matters, just by looking at a patient’s face and neck, it may not always be possible to know what their true ethnic background may be. Practitioners may ask if either or both of their parents have dark skin for starters. According to New York City Dermatologist Andrew Alexis, MD, MPH, ‘To determine skin phototype (Fitzpatrick skin type), I will ask about the patient’s response to sun in terms of their tendency towards burning or tanning. To assess their propensity for keloids or hypertrophic scars, I will inquire about any raised scars from piercings, skin injuries, previous surgeries, and examine them closely. To evaluate their tendency toward hyperpigmentation, I inquire about their history of developing dark spots following acne, insect bites, and minor skin injuries.’
Energy-based device debate
It is commonly accepted that darker skin types need to be treated with extra special care. When applying any laser or light-based device to a skin of colour patient, experts agree that pigmentation should always be top of mind.
‘There are several key important distinctions to consider when treating skin of colour patients,’ says Charlotte, NC dermatologist Gilly Munavalli, MD, MHS, FACMS. ‘People of colour have different cosmetic needs than patients with lighter skin tones; thus, they require different treatments and protocols, and different modalities to treat the same skin conditions. For example, these patients are often seeking treatment for hyperpigmentation, including dark spots, melasma, and PIH. They tend to be less concerned with wrinkles, laxity, and overall skin quality.’
He continues, ‘Despite the numerous advances in laser technology, side-effects on patients of skin of colour can be a challenge, especially for practitioners who have limited experience treating skin of colour. It is important to minimise inflammation and erythema, which can result in hyperpigmentation. Darker skin types can be more sensitive and reactive so a more conservative approach can help to avoid complications.’
‘Most lasers are able to safely treat skin of colour when used correctly. The key is to adjust the density and fluence, so they are appropriate for the skin type you are treating. My preference for skin laxity, neck lines, and to define the jawline in darker skin types is RF Microneedling. I use Profound (Candela) and Genius™ Intelligent RF Delivery (Lutronic). To improve skin texture and even out skin tone for patchy hyperpigmentation, I perform a technique known as laser toning using either a picosecond laser, Picoway (Candela) and/or the Spectra (Lutronic) 1064 nm Q-Switched Laser,’ said Dr. Munavalli.
For treating lines and wrinkles, there is a new kid on the block that is considered safe for all skin types. ‘The new Sofwave Ultrasound Beam technology (Sofwave Medical) is a good choice for mild to moderate rhytids and perioral lines in all skin types. This ultrasonic system is combined with a cooling system that generates High- Intensity Non-Focused Ultrasonic Pulses (HIUS), causing controlled thermal damage by elevating the temperature to 60–70°C in the dermis layer while sparing the epidermal layer using surface cooling,’ said Dr. Munavalli.