Ethnic Skin Treatments

Various skin types require various treatment methods.  Ethnic skin varies not only in content of melanin, but also skin thickness, texture, tone, moisture, and sensitivity.  Within the general confines of an ethnic skin type, there are additional variables such as environmental exposures, medical conditions such as eczema or psoriasis, diet, acne, hormonal imbalances, and personal aesthetic preferences that may affect delivery and outcomes of skin treatments.  For instance, whereas Caucasians often prefer a slightly tanned complexion, Asians often prefer a white porcelain face free of blemishes, moles, or discolorations.

Cultural beliefs and practices may also influence an individual’s receptivity of treatments.  Folk medicine or home remedies are at times deemed standard of care and continued throughout management of certain skin conditions.  Caring for ethnic skin requires an understanding of how all these factors uniquely affect an individual’s skin and treatment plan.  Ethnic skin is challenging to treat, but in the same vein, very rewarding when managed well.  

Hyperpigmentation / Melasma

Hyperpigmentation is the most common skin condition occurring in ethnic skin requesting aesthetic services.  Hyperpigmentation occurs when there is an overproduction of melanin in the skin.  The term encompasses both smaller brown spots and larger patches of brown on the skin called melasma. 

A combination of higher melanin content and increased skin sensitivity to the sun, skin injury, hormone levels, hair growth (more prevalent in African American, Indian, and Middle Eastern hair) makes ethnic skin more susceptible to hyperpigmentation.  Products containing fewer irritants should be used to decrease the risk of inflammation and possible hyperpigmentation. 

Because hyperpigmentation can occur after some cosmetic treatments such as lasers, chemical peels and dermabrasion, skin testing is recommended to determine the level of an individual’s sensitivity before undergoing a full facial treatment.  Any history of hypertrophic scarring, keloids, eczema, psoriasis is important for the provider to know as this may preclude you from certain procedures. 

Patients must also stay committed to pretreatment and posttreatment regimens prescribed by their provider.   Because when hyperpigmentation does develop, it can often be more difficult and costly to treat, usually requiring a combination of therapies including topical skincare, chemical peels, and resurfacing procedures such as lasers and microneedling. 

A well-trained and knowledgeable aesthetician is of utmost importance in guiding patients with darker skin tones through treatments to avoid any permanent side effects or discoloration.

Microneedling

Traditional skin tightening procedures such as chemical peels, IPL and CO2 laser therapy can result in inflammation, scarring and hyperpigmentation in ethnic skin.  These treatments intended for hyperpigmentation in lighter skin tones, may actually result in worsening of hyperpigmentation in moderate to dark skin tones.

Microneedling is a method of skin tightening and resurfacing that can be applied to all skin types.  There is no heat applied or produced with microneedling, and thus less risk of inflammation and hyperpigmentation.  Microneedling can safely be used in all skin types to treat acne, scarring, melasma, wrinkles, and uneven skin tone. 

The addition of platelet rich plasma (PRP) can further improve upon results with microneedling as the anti-inflammatory and anti-bacterial properties of PRP decrease the risk of irritation, redness and hyperpigmentation.

Chemical Peels

Chemical peels involve the application of a solution to cause sloughing of the top layers of skin called the epidermis.  They are categorized based on the depth of skin penetration: superficial, medium and deep. 

Chemical peels can be quick and effective in treating skin conditions such as uneven skin tone, photo-aging, acne, inflammation, hyperpigmentation, and rough, dry skin.  However, in darker skin types, the chemical irritation of peels can cause an inflammatory response resulting in hyperpigmentation, hypopigmentation, hypertrophic scars and possibly even keloids.  Thus, the treating aesthetician must have an in-depth knowledge of these risks and range of chemical peels that may be used in darker skin types.

Superficial peels are typically safe for darker skin tones.  This includes peels such as lactic acid, mandeleic acid, glycolic acid and salicylic acid which individually or in combination can effectively treat fine lines, acne, enlarge pores, oily skin, melasma or hyperpigmentation, and uneven skin tone in darker skin types.  

The addition of treatment specific serums and soothing LED light therapy after a chemical peel can further enhance treatment effects and decrease skin inflammation.

Radiofrequency Microneedling

Radiofrequency microneedling takes the benefits of traditional microneedling and delivers radiofrequency energy to deeper layers of the skin to more effectively treat skin laxity, hyperpigmentation, atrophic acne scarring, surgical scars and skin texture issues. 

Not all needles and settings with radiofrequency microneedling are safe for darker skin tones.  The technician must be selective in the needle depth, thermal zones and use of specific types of needles (insulated vs. non-insulated) in treatment of darker skin tones.  By using deeper needle depths, treatment can avoid damage to the more superficial epidermis where melanocytes reside.  Thermal zones can also be selected to prevent more diffuse spreading of heat which has a higher chance of inflaming melanocytes, limiting heat distribution between the needles and being more precise with energy delivery.  The use of insulated needles also protects the epidermis as it allows the more superficial epidermis to remain cool and the resident melanocytes to remain unbothered. 

Skin conditions such as scarring span the skin depth from epidermis to deep dermis and require the use of non-insulated needle tips for effective results. 

Studies have shown it safe to use radiofrequency microneedling with non-insulated needles for acne scarring in patients with Fitzpatrick III-V skin types.  

Laser Treatments

Due to the risk of hyperpigmentation, many aesthetic lasers such as CO2 lasers, Fraxel, and light therapies such as Intense Pulsed-Dye Light (IPL) and Broad Banned Light (BBL) therapies are not safe for darker skin tones.  These ablative lasers treat the superficial skin to slough the top layers of skin to reveal newer, tighter, and more even textured skin. 

However, this can cause significant side effects of hyperpigmentation, hypopigmentation, scarring and even keloids in darker Fitzpatrick skin types.  IPL and BBL therapies for skin rejuvenation and hair removal also treat through the skin surface which increases risks of scarring and hyperpigmentation in darker skin types.  IPL hair removal requires a higher color contrast between skin and hair follicle to avoid damage to the skin, and in darker skin tones where the contrast between skin color and hair follicle is not high, IPL can cause significant burns to the skin. 

This is not to say there is not effective laser treatment for darker skinned patients. The Nd:YAG laser has been shown to be the safest and ideal laser for skin rejuvenation, scar reduction and hair removal in darker skin tones. The longer wavelengths of ND:Yag allows it to penetrate the deeper layers of the skin where dermis and hair follicles live, and allowing more superficial layers of the epidermis to stay cool. Quicker pulses of the laser on the level of picoseconds also help minimize heat and damage to surrounding tissues.

Regardless of the procedure, commitment to pretreatment and posttreatment regimens, sun protection and guidance by an experienced provider with ethnic skin treatments will help you achieve your skin goals.