1) What is the basic skin biology of people of color?
There are three layers which comprise the human skin-the epidermis, the dermis and fat. Within the epidermis there are pigment producing cells called melanocytes; melanocytes produce melanin which is the substance that confers skin color. We all have the same number of melanocytes, regardless of complexion–the browner you are the more melanin you are producing. In short, melanin determines skin color. Melanin has many different functions in human skin. Most importantly, it provides inherent protection against the sun and is a natural antioxidant.
2) What are some of the common skin issues affecting people with darker skin tones? Are these issues different than people with lighter skin tones and if so, why?
Post inflammatory hyperpigmentation (PIH) is a condition which occurs more frequently in individuals with darker skin. It is localized skin darkening which occurs after trauma or inflammation. For example, when people of color get a pimple, for some reason melanocytes “rev” up and produce more melanin. As a result, when the lesion fades, the skin gets darker. The same phenomenon applies for cuts, bruises and resolving rashes. To treat PIH, you need to use an SPF of 30 or higher everyday, and give it time. Other remedies such as hydroquinones, retinol, glycolic acid, and chemical peels can also help speed up the process.
Melasma is another type of skin darkening that happens in individuals of African, Latin, Asian, Indian, Middle Eastern, and Mediterranean descent. Patients with melasma notice brown or gray-brown patches on the cheeks, bridge of nose, forehead, chin or upper lip. Although the exact cause is unknown, it is thought that pregnancy, birth control pills (or other hormone therapies), and some medications, together with sun exposure, may trigger this disease. Again, judicious application of SPF 30, or higher, and fading creams which include hydroquinone, are best forms of treatment.
There are some natural alternatives that treat both PIH and melasma as well, including soy, coffee berry extract, and licorice root.
3) Does a darker skin tone mean skin is slower to age? What should every dark-skinned person include in their daily skin care regimen?
People of color have more melanin, which provides “built-in” protection against the damaging effects of the sun. Because of the high level of melanin, darker skin tones show fewer signs of aging. In fact, a medium brown African -American person has a natural SPF of 13.4, versus a fair skinned Caucasian who has a natural SPF of 3.4 Plus, since melanin is a natural antioxidant, it protects against free radicals—the damaging particles that attack collagen and elastin and cause wrinkles— people of color have a tendency to have smoother, firmer skin longer. To boost the protective effects of melanin, you should apply an SPF of at least 30 and a serum or cream rich with antioxidants such as vitamin C and E, coffee berry, kojic acid, and/or retinols.
Daily SPF of 30 or higher is a must for everyone because darker skin can develop skin cancer. Because some physicians and patients erroneously think that brown skin is exempt from this disease, this misconception lends to a delay in diagnosis and treatment. There is no question that people of color are less likely to become afflicted with skin cancer. Sadly, however, they are much more likely to die from the disease. Because skin malignancy is curable if caught early, there is no reason for an increase in mortality to exist.
4) What skincare ingredients should darker skin tones avoid? What should they look for and why?
You should avoid products that are abrasive or irritating since they can contribute to hyperpigmentation. Steer clear of skincare that contains the following ingredients: fragrances, alcohol, propylene glycol, lanolin, dyes, or alpha hydroxy acids in high concentrations. Also, avoid cleansing with a puff or loofah, which can cause irritation. Look for broad spectrum SPF with natural minerals such as titanium or zinc oxide and make sure your cleansers, moisturizers and serums have antioxidant ingredients like vitamin C/E, coffee berry extract, licorice root, and soy (to name a few). Retinols (vitamin A derivatives) can help improve overall skin health when used properly in small amounts.
5) Regarding cosmetic procedures, such as laser resurfacing, microdermabrasion, and fillers, are there any that you recommend for people with darker skin tones or any to avoid?
People with darker skin tones should be careful before having certain cosmetic procedures. Botox, and injectable fillers have been studied and proven to be safe and effective in combating signs of aging in brown skin. Although micodermabrasion and laser resurfacing are options for those with darker complexions, you’re more likely to have post inflammatory hyperpigmenation and scarring after these procedures. If you do decide to try one of these treatments, make sure your doctor is proficient in performing them on a non-Caucasian population, otherwise permanent skin damage may result.
Mona Amira Gohara, M.D. Assistant Clinical Professor, Yale University School of Medicine Department of Dermatology, New Haven, CT Private Practice, Advanced DermCare, Danbury, CT Fellow, American Academy of Dermatology
