January 24, 2006
Shedding light on darker skin
The treatment of ethnic skin a careful procedure
By Abigail Leichman
The Record (Hackensack N.J.)
Josabet Tecat-Suarez was pretty sure her face wasn’t supposed to sizzle during a laser hair-removal treatment.
But her gynecologist - yes, gynecologist - told her to stop flinching and held her head in place as he finished.
“When the nurse came in, I could tell from her look that all was not well,” said Tecat-Suarez. Her cheeks, she was horrified to find after a peek in the mirror, “had started to look like a tic-tac-toe board.”
Later, the wounds swelled and oozed before turning into a mask of milky dots marring her chocolate complexion.
This outcome is not uncommon for people with darker skin.
“Skin of color is more sensitive and more prone to side effects - such as discoloration and scarring - from medical skin treatments and even from piercing, plucking, waxing and shaving,” said Dr. Eliot Battle, assistant professor of dermatology at Howard University and founder of Cultura Medical Spa in Washington, D.C.
The key is choosing the right physician with the right equipment.
Battle is one of a growing number of ethnic-skin specialists. He spent three years at Harvard perfecting new “colorblind” lasers that are safe for treating highly pigmented skin.
A THIRD OF THE AMERICAN POPULATION has darker skin tones, including people of African, Asian, Indian, Hispanic, Arabic and/or Mediterranean descent. And their numbers are increasing.
“Society is turning brown,” Battle said, “and people of those ethnicities are a fast-growing consumer segment for cosmetic treatments such as laser hair removal, scar removal and Botox injections.”
New research and tools are providing “more ammunition to safely and effectively treat people of color for skin conditions,” Battle said, “but you have to choose your expert wisely.”
He advises using only a dermatologist and asking if that physician has an FDA-approved laser for people of color, as well as plenty of experience using it.
“Look around the waiting room and see who’s sitting there,” he suggested.
Tecat-Suarez had sought treatment from just such an expert a couple of years prior, when she wanted her skin in tip-top shape for her wedding in 2002.
Later on, she tried to save money by using her gynecologist’s hair-removal service. He assured her that he’d treated other women of color.
In a panic after that painful experience, she phoned her previous dermatologist, Jeanine Downie of Image Dermatology.
Downie told her to come to her Montclair, N.J., office right away.
“As soon as she saw me she hugged me,” Tecat-Suarez said. “She didn’t try to say it wasn’t so bad. She said it would take awhile but she’d fix it.”
After a year of chemical peel treatments to undo the damage, Tecat-Suarez is beginning laser hair removal with Downie.
“I’ve talked to other patients who’ve all had similar experiences,” said Downie, a frequent talk-show guest and author of “Beautiful Skin of Color.”
“I’ve seen (damaged skin) much more than I want to, mostly as a result of a patient going to a cosmetologist, aesthetician or laser technician instead of a dermatologist with the right expertise.”
OVER-THE-COUNTER SKIN TREATMENTS sometimes promise a less expensive solution, but most are formulated for lighter skin, even though the labels don’t say so, Battle cautioned. He’s hopeful that the FDA will one day require labeling guidelines for different skin types.
Downie is participating in a 10-center study of Restylane, a newly approved drug for filling in facial wrinkles and folds.
“They did studies, but not enough on brown patients,” she said. “We need to have documentation that it’s safe for all skin types.”
Both dermatologists urge “brown patients” to use sunscreen for its anti-aging effects as well as skin-cancer prevention.
Skin cancer is less prevalent in ethnic populations, but it shows up in spots where light-skinned people don’t get it.
“Bob Marley died from undiagnosed melanoma of the feet,” Battle said. “People of color tend to get skin cancer on the scalp and feet instead of the face, arms and legs as do Caucasians.”
To find area doctors who specialize in skin of color, use the Find a Dermatologist link on the American Academy of Dermatology Web site: aad.org.
Typical skin problems
Skin problems that are more common among people with darker skin tones:
Hyperpigmentation (dark spots). Often occur 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 light/laser treatments or skin grafting.
Pityriasis alba, which 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 blacks, mostly on women’s cheeks. They can be surgically removed.
Keloids. These overgrown scar tissue areas commonly form after piercing or surgery. Cortisone injections, pressure dressings, laser treatments and other methods can remove them, but they tend to grow back.
Ingrown hairs (razor bumps). Common after shaving. Dermatologists can suggest shaving methods to avoid this result, but some people opt for permanent hair removal from the troublesome areas. Laser hair removal often clears the skin’s texture and tone at the same time.