Codes: The New Spectrum
Cautions dermatologist Eliot F. Battle, M.D., "Skin of color reacts differently from Caucasian skin to almost all medical and cosmetic dermatologic treatments," including sensitivity and increased likelihood of problems with scarring and discoloration. Though you may have learned a one-size-fits-all-skin-colors approach in esthetics school, the new skin of color requires a deeper understanding of skin physiology and histology.
exploding the myths
"Incorrect treatments and wrong products is a recipe for skin disaster" when treating skin of color, declares Heathman, creator of GlyMed Plus. Science reveals differences in the number of fibroblasts, hair follicles and elastic fibers in the skin. Yet many cosmetology schools don't teach modified or alternate treatments that may be healthier or more effective for these skin types. Heathman recommends all estheticians receive at least 100 hours of education on this subject, and her GlyMed Institute of Skin Sciences in Spanish Fork, Utah, offers advanced classes in theory and hands-on instruction.
Contrary to popular belief, darker skin types can actually be very sensitive, teaches Heathman. This means proceed with caution when performing aggressive peelsand be sure to get a full client history. You may want to forego microdermabrasion altogether. The mechanical irritation can lead the skin into overdrive in an attempt to repair itself, leading to unwanted spots and uneven tone. "Inflammation is the leading cause of pigmentation in skin of color," she says. She recommends an ultrasound machine like DermaSound, which uses water bubbles
instead of corundum crystals to achieve a similar effect, as a safer alternative.
Pigmentation is also an important issue when performing hair removal, says Dr. Battle, founder of Cultura Med Spa in Washington, D.C. "Hair removal, like waxing, threading, shaving and plucking, can have side effects like dark spots and scars when used on darker skin," he explains. In contrast, advanced technology and longer wavelengths have made laser hair removal safer than ever before for darker-skinned patients. To lessen the appearance of dark spots, Dr. Battle says lightening creams with hydroquinone or kojic acid are safe to use under a doctor's supervision.
taking a closer look
The visible symptoms of common skin conditions can look different depending on skin type. Dr. Battle says eczema and psoriasis can be misdiagnosed on skin of color, which again can lead to pigment problems, so it's important for both estheticians and doctors to be familiar with the unique conditions of darker skin.
"Know the genetic history of the skin you're working on," advises Heathman. Many ingredients in acne products, as well as aggressive extractions, can leave permanent marks or even scarring on many types of skin, she says. Be careful when determining acne, as rosacea—which mainly afflicts lighter skin tones, but can appear on any type of skin—can show up as bumps or pimple-type lesions. "When skin is darker, rosacea is more difficult to detect. This fact necessitates you ask a lot of questions," says Heathman, who adds that diet may be a rosacea trigger.
Most importantly, let your clients know that darker skin does not substitute for appropriate sun protection. On average, says Heathman, dark skin has an equivalent of SPF 13.4, but that figure varies depending on skin. Photodamage in both African and Asian skin will reveal itself with pigmentation spots. And, as with all your clients, advise them to check their skin frequently (or have a qualified dermatologist do so) for suspicious moles or spots that may be early stages of skin cancer. Says Dr. Battle, "Skin cancer may be easy to miss in people of color since cancerous lesions occur mostly on the extremities, particularly on the feet and scalp, where they may be hidden." By understanding the functions, challenges and special requirement of a wide range of skin types, you will be better equipped to care for all of your clients.