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Much
of the world’s population consists of people of color. The non-Caucasian
population is currently 29.4% with large estimated growth rates ranging from 8%
to 36% in many ethnic groups. By contrast, the estimated Caucasian growth rate
is 1.5%. If these estimates are correct, by the year 2050, more than 50% of the
U.S. population will be of non-European descent.
Contrary
to what some may believe ethnic skin is not darker because it holds more
melanocytes (which produce the melanin that creates pigment). There are
actually the same amount of melanocytes present in white and dark skin. There
are approximately 2,000 melanocytes per millimeter of skin.
The
difference in darker skin is that the cells are larger, not more numerous. This
produces more pigment. With Caucasian skin, as skin cells migrate toward the
skin surface, the melanin is broken down more rapidly than in darker skin.
The
stratum corneum is equally thick in white and darker skin. There is evidence,
however, that the stratum corneum in black skin contains more cell layers due
to greater cellular cohesion and will require more effort to remove.
There
are also significant differences among racial groups when it comes to the amount
of ceramides within the stratum corneum. The lowest levels are in black skin,
followed by white skin, Hispanic, and Asian skin, respectively. It is evident
that the lower the ceramide level is, the lower the water content of the skin
will be. Knowing this will aid professionals in recognizing which skin types
will require more hydration support.
A
third difference is in the inflammatory responses of Caucasian and non-white
skin. A darker skin affected by acne will often show significant inflammation
below the skin’s surface in what appears to be non-inflammatory lesions on the
skin’s surface. This is not so with Caucasian skin. This explains why acne in
darker skin, no matter how mild, will almost always result in PIHP.
In
addition, ethnic skin responds differently than white skin to comedogenic
ingredients. When exposed to pore-clogging substances, the response in white
skin is predominantly clinical inflammation with papules and pustules
developing in 2 to 3 weeks. In black skin, the clinical inflammation does not
usually occur, but multiple small, open comedones will appear after 2 weeks.
White
skin responds to comedogenic products by the follicular wall rupturing early in
the process, while black skin responds initially with hypertension keratosis,
which leads to open comedo early in the process.
Common
Skin Disorders Seen In Ethnic Clients
Post-Inflammatory
Hyperpigmentation is
one of the most common skin disorders for SOC (skin of color). It is estimated
that 65% of black patients and 53% of Hispanic and Asian patients experience
some form of hyperpigmentation. This may occur from skin inflammation due to
acne conditions, other skin eruptions and irritations, misuse and overuse of
certain skin products, over-stimulation from peelings and microdermabrasion,
and many more. There are definitely certain precautions that must be taken when
treating PIH, whether it is a home-care regimen or a professional treatment.
Pseudofolliculitis
Barbae –
PFB (the common layman’s term is razor bumps) is a condition that occurs
generally from shaving, waxing and irritation causing coarse ingrown hairs to
burrow back into the skin – leading to a blockage, inflammation and eventually
infection. This is more prevalent in African American men due to the coarser
hair, although it may be seen in skins of all nationality and color; women may
develop this on the cheek or chin area. PFB is generally easy to resolve if you
have a compliant client. The use of certain AHAs, beta acid, melanin
suppressants, buffing grains and a nutrient-based healing topical (epidermal
growth factor) will usually eliminate the problem. The most important thing is
to address it before it gets to the stage in which the skin has become inflamed
and then hyperpigmented.
Acne
or Folliculitis Keloidalis is a condition that occurs on the back of the neck and
is primarily due to irritation from haircuts (often from cutting tools that
have not been properly sanitized) and the rubbing of shirt collars (certain
detergents and starches will irritate the skin). Skins from many ethnic
backgrounds have the potential to form keloids and hypertrophic scars. Keloid,
which is an overgrowth of scar tissue, is seen more frequently in clients of
African, Asian and Hispanic descent. Hypertrophic scars are different from
keloids in that they remain within the border of the original wound. The
aesthetician’s role in this condition would be to support the care of the skin
after the dermatologist has removed them or begin the appropriate care to
prevent them from occurring in the first place. This is especially difficult to
do with men unless they are seeing you early for professional skin care.
Dermatosis
Papulosa Nigra,
or “flesh moles,” are almost exclusive to black skin and are considered to be
hereditary. The brown or black raised spots are not cancerous and usually
appear on the cheeks and just below the eye area.
Keratosis
Pilaris is
a condition that normally appears on the backs of the arms and is not limited
to any skin of color; it can appear in the fairest of skin to the darkest.
However, the outcomes can be very different. Keratosis Pilaris generally shows
itself as either red, irritated patches with a rough texture or small,
pinpoint-size white papules that look like very small milia. In skin of color,
the end result can be irritated, raised black dots.
Complications
That May Occur
Once
again, the most common complication among people of color is hyper-pigmentation
(PIHP). This can be treated with Brightening Cream Enhanced or Skin Brightening
Gel, Skin Smoothing Gel and Epidermal Growth Factor. Professionally, doing a
mild glycolic or lactic treatment with the Melanin Suppressant Solution or
Melanin Suppressant Solution and Vitamin A Peel will begin to suppress the
melanin and brighten skin.
Surface
hypopigmentation may also occur, and unless you have discussed the possibility
with your patient/client, he or she will be very upset. They need to understand
that this is temporary and normally within 10 days to as long as two months,
the pigment will return. It is not a complication one likes to deal with, but
it is treatable and only temporary.
Acne
conditions may sometimes worsen, but this is part of the healing process and
will usually abate within a week. Blemish Serum or Fruit Acid Botanical may be
recommended for lesions as well as the use of Epidermal Growth Factor.
Edema, pruritis, rash, milia, or extreme discomfort
are considered complications and must be noted in the patient/client chart. Be
careful with an SOC that is using certain medications, such as Tazarac, which
will cause the skin to be much more sensitive and thinner. This should be
discussed in the initial consultation and any medication that you are not
familiar with needs to be approved by the attending physician before proceeding
with a peeling treatment.
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