Shedding light on ethnic skin

For decades, if not centuries, people of color were a greatly underserved population in dermatology. However, in the past 10 years, the field has made great strides in providing cosmetic and medical services, specifically for African Americans, Asians, Latinos and other people with skin of color. Here in New York City – America’s melting pot – where more than half the city’s population has ethnic skin, the need couldn’t be greater.

“There’s high demand in New York City for skin care tailored to people with darker skin tones and the unique challenges they face in how they care for their skin,” says Andrew Alexis, MD, MPH, dermatologist and Director of the Skin of Color Center at St. Luke’s and Roosevelt Hospitals, a part of Continuum Hospitals of New York. The Center formed in 1999 to educate, research and treat patients with ethnic skin and hair conditions.

Ethnic skin biology 101

Everyone has skin cells called melanocytes, which produce melanin – the component that determines your skin tone. The more melanin your skin produces, the darker your pigmentation. In darker skin, melanin can slow the signs of aging and provide some sun protection. Unfortunately, those same cells can cause or worsen common skin conditions:

• Skin discoloration. Uneven skin tone from conditions like acne or autoimmune disorders can dramatically change skin color in uneven patches. Hyper-pigmentation (dark spots), hypo-pigmentation (light spots) and vitiligo (the loss of pigmentation), are the most common. 
• Skin cancer. People with dark skin are less likely to get skin cancer than Caucasians, but those who do get it are at higher risk of dying from it. Why? One reason is that darker skin types are frequently diagnosed later and present with skin cancer in uncommon places, like the sole of the foot or beneath the fingernails and toenails. Take Bob Marley for example; he died from melanoma, which started on the sole of his foot. Learn more about skin cancer and skin of color.
• Acne and acne scarring. Since pimples and acne are caused by skin inflammation, even mild cases can leave dark spots weeks or months after the blemish has cleared up. If severe acne is left untreated, it can lead to dark spots that penetrate the deep layers of the skin and cause severe scarring.
• Hair loss and scalp irritation. Premature hair loss or scalp conditions can be either hereditary, dependent on hair care practices, or both. Next time you think about getting a chemical relaxer, braids or a weave, remember that if done too aggressively they weaken the hair follicles and shaft, leading to hair loss and breakage. Another form of hair loss that happens in the center of the crown, called CCCA, could be linked to your family history and possibly some hair care practices.
• Scarring. Surgery, injuries or trauma to the skin can cause raised, enlarged scars known as keloids, which are more common in darker skin types. Even something as simple as an ear piercing could trigger severe scars.

Finding skin solutions

Whether you’re looking for solutions to one of these chronic skin conditions, or trying to prevent them, Dr. Alexis suggests the following:

1. Consider cosmetic procedures. Laser and other cosmetic treatments, such as chemical peels and phototherapy, can be specialized for darker skin types. “Laser procedures are an area where treatment options have in the past been quite limited for darker skin because of the side effects, like scarring or discoloration,” Dr. Alexis says. Now, safer options such as fractional laser skin resurfacing can safely be used on darker skin types to treat acne scarring, uneven skin tone and sun damage.
2. Practice gentle skin and hair care routines. Begin each day with an SPF 30 sunscreen or higher, use sensitive-skin products, and limit over-the-counter treatments for problem areas until you know it’s safe for your skin. “In general, people with ethnic skin should use mild, non-irritating products to avoid skin discoloration or flare-ups,” Dr. Alexis says.
3. Seek treatment from a specialized dermatologist. “People with darker skin have a higher risk for pigmentary complications from numerous cosmetic procedures,” Dr. Alexis says. “That’s why it’s important they see someone who understands these nuances. ”

Get expert skin of color care advice at any one of our three locations. Visit chpnyc.org or call 1-855-411-5969 to learn more.