Recently, the National Geographic concluded in its Population 7 Billion series on the human race that the most common person today is a 28 yr. old male Han Chinese Man of which there are 900 million. Over the next 20 years the most typical person will probably reside in India, with the most common face on the planet being of Indian descent.
In multi-cutural countries where a mix of skin types are abundant, understanding skin of colour, pigmented skin and racial prototypically will be essential in all aesthetic clinics; especially if we are providing a comprehensive service to all our patients and addressing their specific concerns. If you are performing procedures and treatments on skin (first and foremost) you need to focus on skincare, not injectables. People with skin of colour are more concerned with pigmentation and scaring than lines and wrinkles, unlike Caucasian patients.
When injecting people with skin of colour, the more puncture sites and larger the puncture sites the greater the risk of post-inflammatory hyperpigmentation (PIH).
A misconception amongst many is that people with skin of colour do not require sun protection. This is definitely not true, and it is now being suggested that people with skin of colour may be more affected not by UVA and UVB light, but by simple plain light. With a recent study showing that pigmentation can occur in people with skin of colour with plain in-office light.
There are many causes of pigmentation or staining on skin and these need to be thoroughly investigated before initiating any form of treatment, along with appropriately counseling and working with the person to ensure compliance and risk minimization.
Some of the things that can cause pigmentation include:
- Sunlight – direct and indirect
- Watches / Bangles
- Vascular disease
- Permanent and Temporary tattoos
- Some make-up and hair dye
Some of the treatments available for pigmentation include:
- Chemical Peels
- Light based therapies – IPL, Laser
- Topical treatments (hydroquinone, Vitamin K, Vitamin A, Retinols)
- Home made remedies: Garlic Juice, Lemon Juice
- Bleaching agents
- Over the counter topical whitening products
Chemical peels can be used in people with skin of colour, however the deeper and stronger the peel the greater risk of PIH. So it is advised to take things slowly, carefully and considerately. Mind you that should be the mantra when appraching skin of colour with any of the above modailities.
As we move forward in understanding skin of colour, and its idiosyncratic behavior, working with patients to understand, prevent and treat pigmentation will become an increasing service that clinicians’ will need to grapple with in their practices moving forward.
Treating pigmentation and skin issues in people with skin of colour, like all things it is recommended to treat cautiously and conservatively, and ALWAYS start with SUNSCREEN!
Independent Consultant, Aesthetic Dermatology