Darker skin? Handle with care
Dermatologists offer ways to reduce the risks faced by ethnic clients
Contra Costa Times
Michele Byers didn’t have any skin problems, but she wanted to do something nice for herself as she approached her 50th birthday.
Byers went to an at-home aesthetician for microdermabrasion, a nonsurgical procedure that polishes away dead skin. After a session, bumps started appearing on Byers’ face. Her cheeks were covered in pock marks.
“It looked like a railroad track on my forehead and nose,” says Byers, who lives in Castro Valley, Calif. “Here I was trying to do something nice for myself and I ended up looking worse than I ever had in my life.”
The potential side effects of microdermabrasion are common for people with ethnic, or darker, skin. Contrary to popular belief, darker skin is not tougher; in fact, while extra melanin does have its benefits – sun protection and slowed signs of aging – it makes the skin more sensitive and vulnerable to injury.
“If the skin is darker it is prone to scarring and hyperpigmentation, so we have to be more careful with skin of color,” says Terri Dunn, a Berkeley, Calif., dermatologist. One-third of Dunn’s patients are of Latin, Asian, Indian, Mediterranean or African American descent, and thus require special skin care.
Even acne or laser hair removal should be handled differently on dark skin.
Peggy Fuller, a board-certified dermatologist in Charlotte who specializes in ethnic skincare at Esthetics Center for Dermatology in the Elizabeth neighborhood, would rather err on the side of being conservative with patients. Many of her patients of color can tolerate topical prescription creams, but she always starts them on a low dose.
That goes for other cosmetic therapies, too. Whether you’re getting laser hair removal or a facial, Fuller says, it’s important to do a test treatment, especially on African American skin, which is prone to scarring and pigmentation problems.
And as cosmetic procedures – and medi-spas – grow in popularity, Dunn and other specialists advise their dark-skinned patients to proceed cautiously and realize their skin is at risk. Many common cosmetic procedures are geared toward lighter skin, and it’s only recently, as the country’s ethnic population has grown to 40 percent, that science is playing catch-up, so to speak.
“In the past couple of years, devices, cosmetics and topical medications are being tested on people of different colors because we realize that the skin reacts differently,” says Philadelphia dermatologist Susan Taylor, founder of New York’s Skin of Color Center and author of “Brown Skin: Dr. Susan Taylor’s Prescription for Flawless Skin, Hair and Nails” ($24.95, Amistad). “Even the FDA is requiring companies to make sure their clinical trials include individuals from different backgrounds.”
Among the most common side effects are hyper or hypopigmentation, dark or light skin spots that result from any type of trauma, be it a cut, burn, acne or eczema. Bleaching creams and retinoids can be used to treat hyperpigmentation, Dunn says.
Hyperpigmentation is also a side effect of many cosmetic procedures.
To avoid it, specialists prime the skin and use a lower-strength solution when doing chemical peels on darker patients. They leave it on for a shorter time, Dunn explains, and recommend longer intervals for optimum results. With microdermabrasion, they use linear strokes at a lower setting.
“There are lasers that transmit a long pulse and are better suited for pigmented skin,” Taylor says. “Physicians should test spots to check for side effects over a period of 24 to 72 hours. Also, either the dermatologist should do the procedure or someone who is trained by him. You don’t want to go to a medi-spa where there isn’t a physician.”
In dark skin, popular fillers such as Restylane and collagen and even piercings and tattoos can cause keloids, or raised scar tissue, that must be surgically removed and tend to grow back. Laser hair removal, another simple procedure, can burn, blister and scab the skin if the laser is too strong.
When researching dermatologists, Taylor advises, ask whether the physician has the FDA-approved lasers for ethnic skin, and what percentage of his clientele has dark skin. The best place to start, she says, is with recommendations from family and friends who’ve had good experiences.
That’s how Byers found Dunn. But not before she went to another dermatologist, who put her on Accutane, misdiagnosing her damaged skin as severe acne. Next, an Oakland medi-spa with ethnic-skinned aestheticians who said they knew what they were doing. That didn’t work either.
When choosing a dermatologist, Fuller says to “make sure that person has experience treating ethnic skin, and if not experience, willingness to learn.” And she says it’s important to find an aesthetician who’s sensitive to cultural nuances.
Two years after her initial ordeal, Byers is working toward the glow she always wanted. But not after diffusing another huge myth about her dark skin: the need for sunscreen.
Just because you’re dark, Fuller says, don’t think you can skip the sunscreen.
In the past decade, she says, there’s been an increase in the number of cases of non-melanoma skin cancers among people of color.
Dunn recommends a minimum SPF of 15 on the face and 30 on the body, preferably one that contains zinc or titanium. For those who don’t want the white residue these products create, Dunn prescribes chemical-based sunblocks.
Fuller recommends avoiding products with tropical fragrances because they can cause irritation, too.
Dark-skinned patients who wear sunscreen also are less likely to experience scarring or hyperpigmentation when acne or a rash fades, says William Ting of Dermatology Associates in California’s San Francisco Bay area.
Another tip from Ting: Take short, lukewarm showers and moisturize immediately to avoid one of the most common and treatable problems of dark-skinned folks – dry skin.
“On one hand, they (people with dark skin) age a lot slower because they have more melanin in their skin,” he says. “But they can age even more gracefully with sun protection.”
Common Skin Problems
HYPERPIGMENTATION: Patches of skin become darker. Often occurs after a cut, scrape or burn, or as a result of acne or eczema. Chemical peels, microdermabrasion or bleaching medication may help.VITILIGO: A disorder in which pigment cells are destroyed and replaced with white patches. Treated with cortisone creams, intense pulsed laser treatments or skin grafting.
PITYRIASIS ALBA: Causes round, light patches of scaly skin, most often in children, on the face and upper arms. Topical medications may help.
FLESH MOLES: Brown or black raised dark spots seen almost exclusively in African Americans, mostly on women’s cheeks. They can be surgically removed.
KELOIDS: Overgrown scar-tissue areas commonly formed after piercing or surgery. Cortisone injections, laser treatments and other methods remove them, but they tend to grow back.
HAIR LOSS AND BREAKAGE: Most common among African Americans. Change tight hairstyles frequently and use caution with hair-straightening products.
INGROWN HAIRS/RAZOR BUMPS: Common after shaving. Dermatologists can suggest shaving methods to avoid them, but permanent laser hair removal is also popular.
Sources: Susan Taylor, M.D., American Academy of Dermatology (www.aad.org)
Skin Care Tips for Darker Skin
Cleanse daily to remove dirt, oil and makeup but avoid abrasive cleansers or products (puffs, loofahs), which can irritate skin of color. Irritation may lead to disfiguring hyperpigmentation.
Use products designed for your skin but avoid those that contain irritants such as fragrance, alcohol, propylene glycol, dye and lanolin.
Don’t overdo it. Cleansing too often or too roughly will harm brown skin.
Avoid using home microdermabrasion and chemical peel kits too roughly. Use according to the directions and discontinue use if irritation occurs.
Exfoliate to remove dull, dead skin cells but test the product on a small patch of skin first.
Sources: Peggy Fuller of Charlotte; Terry Dunn of Berkeley, Calif.; and Susan Taylor of New York.
Products to Try
Here are some of the products that Charlotte dermatologist Peggy Fuller recommends:
Aveeno Active Naturals Positively Radiant Daily Moisturizer in SPF 30.
Neutrogena Ultra Sheer Dry-Touch Sunblock SPF 55.
Sensitive Skin Dove.
Purpose Redness Reducing Moisturizer with SPF 30.
Cetaphil Gentle Skin Cleanser; Cetaphil Moisturizing Lotion.
These can be found at drug stores, grocers and at retailers such as Target and Wal-Mart.
For more on Dr. Fuller: Esthetics Center for Dermatology, 353 Clement Ave.; 704-370-2700; www.hellohappyskin.com.