THE WORLD AT YOUR TREATMENT TABLE: Customizing Care for Ethnic Skin
By Margaret Ancira
America's palette is growing more colorful every year and so is the demand to meet the evolving needs of ethnic skin. While most Caucasian women fall into four or five skin color categories, women of color including Asian, African, Hispanic and Native American comprise dozens of different shades of yellow, brown and black. This presents skin care professionals with a challenge to better understand the complexities of ethnic skin, and the opportunity to put that knowledge to use in a rapidly growing, and highly lucrative ethnic market.
Ethnic skin can be safely and effectively treated once its characteristics are identified. One of the most established guidelines to categorizing skin color is the Fitzpatrick skin phototype (SPT) system. For decades, physicians and aestheticians have relied on this method to determine skin�s hereditary components based on its reaction to UV exposure. The classification falls into six sun reactive categories, from Level I being the fairest skin tone and most likely to burn, to Level VI representing those with black skin that is resistant to sunburn.
While helpful, Fitzpatrick does not account for the differences often found within a race. Researchers are responding with newer classification systems that delve deeper into a person's ancestry to reveal nuances that may be subtly visible, but could dramatically influence the choice of treatment and impact the outcome of a treatment. One of these newer classification systems is the Lancer Ethnicity Scale. This scale identifies not only the individual's skin color, but also takes into account the person's ancestry to determine their tolerance for cosmetic procedures. The World Classification system divides skin color into five categories: white, light brown, yellow, brown and black. Each skin color is further divided into three subcategories that judge the level skin's ability to tan, burn and develop post-inflammatory pigmentation. Sub-group A represents pale skin that does not tan, burns easily, but does not develop post-inflammatory pigmentation (PIP). Sub-group B represents skin that tans, rarely burns and rarely develops PIP. Subgroup C skin tans deeply, never burns, but does develop PIP.
A paper recently published in Cosmetic Dermatology proposes that the variations of skin color among African Americans require yet another new classification system that will improve treatment outcomes and the development of skin care products that will treat conditions without the risk of post-inflammatory hyperpigmentation. The author, Dr. Isaac Willis, a clinical professor of dermatology at Morehouse School of Medicine in Atlanta, Georgia, created a skin classification system for people of African descent that is divided into four categories: light brown, medium brown, brown and dark brown. The system also takes into consideration each group's reaction to UV light and propensity for pigmentary disorders. He offers this model as an alternative to identifying the variety of skin phototypes within the African American population.
The Asian American population presents even greater variations of skin color. Skin color in countries such as Singapore, Korea and Japan is much lighter than in southern parts of Asia, while skin color in China varies from region to region. One trait that most Asian skin does share is its delicate, porcelain like appearance. It is this transparent quality that makes blemishes and hyperpigmentation more visible. Asian skin also has a high degree of sensitivity to fragrances, preservatives, harsh chemicals or mechanical stimulation, which leaves it at risk for post-inflammatory hyperpigmentation.
Once the skin's nuances have been identified, there are some basic guidelines for effectively customizing your superficial chemical peel treatments to achieve maximum results. Before every superficial chemical treatment, cleanse the skin with a gentle cleanser that will effectively remove all oil and makeup. Excess sebum in the skin will neutralize your acid and make the peel less effective. This is true for clients with all skin types, conditions and hereditary backgrounds. The next step is applying an alpha hydroxy acid toner to continue to degrease the skin, but more importantly, to "patch test" your clients for sensitivity before you select a peel solution. This is where your real customizing begins. Using a scale of one-to-ten, ten being very irritating, ask your client how much they can feel the toner you apply. This one-to-ten scale is a very effective tool in properly customizing a treatment for your client to achieve maximum results. As the technician, you are the decision-maker who determines which solution will be appropriate and how many layers will be applied. The combination of your education and experience in conjunction with the use of the one-to-ten scale to properly gauge your client's sensitivity will lead to great success.
The next piece of this customizing puzzle is the selection of your chemical peeling agent. In order to make your peel selection an informed one, be certain that you are looking at each client holistically. The patch test using the one-to-ten scale is your main guide, but also make your selections based on skin types and conditions such as oily, dry, hyperpigmented, dehydrated, wrinkled or acneic. Based on your client's response to the one-to-ten scale during the application of your AHA toner, you can make a very confident selection of a superficial chemical peel solution. The Nordic, light-skinned, Fitzpatrick I and II skin types will usually rate between zero and two on the one-to-ten scale during your patch test. Because of the environment to which their skin has accommodated traditionally has low sun exposure; these types of clients will have less responsive melanin and few challenges with hyperpigmentation. Therefore, the low rating on the one-to-ten scale, indicating low surface sensitivity, in conjunction with infrequent instances of hyperpigmentation, make stronger solutions an appropriate choice. If the client is very oily, a modified and enhanced Jessner's solution is fitting, as it will break down oil while smoothing, strengthening and controlling bacteria. If your client is peri-menopausal, it is important not to dehydrate the skin. A TCA and lactic acid blend solution that contains progesterone will enhance hydration and plumping in the skin.
When working with higher Fitzpatrick skin types (IV-VI) that originate from the equator regions of the world, the possibility of triggering melanogenesis and causing hyperpigmentation makes the avoidance of blanching and burning critical. During your pre-peel patch test these clients will normally range anywhere from five to ten on the one-to-ten scale. It is important to select a solution that is formulated to deliver smoothing, lightening and strengthening benefits while creating very little burning sensation. A solution containing a low percentage of TCA, lactic acid and kojic acid for lightening benefits and L-ascorbic acid would be an effective choice. You will probably apply fewer layers of your selected solution on these clients. With the application of each layer you will continue to ask your client on the scale of one-to-ten, how much (rating it) they can feel the solution you are applying. While you may be safe taking a Nordic client to a seven on the scale of one-to-ten with a multiple layer treatment, every effort should be made to keep your equator region clients in the four to six range. Your results can be very dramatic even without the heat generation traditionally associated with chemical peeling.
When customizing for your Scotch/Irish and English clients, a solution that will not cause over-heating is also quite important. The instances of hyperpigmentation are much lower than with your equator region clients but their challenge is broken surface capillaries. It is important to also keep these clients cool during treatments, as over-heating will contribute to couperose and telangiectasia conditions. This hereditary group is also quite prone to rosacea. One of the major enemies in the fight against rosacea is inflammation. A treatment that will produce a low stinging sensation and also infuse the skin with anti-bacterial and anti-inflammatory agents would be ideal.
After the selection and application of your superficial chemical peel solution your next phase of customizing begins. The skin is a sponge, especially after the application of a superficial chemical peel solution. The skin is exfoliated and open and accepting, so this is the perfect time in your treatment to layer on topical vitamins, anti-oxidants, tyrosinase inhibitors and anti-inflammatory agents. Target each different condition that may be present to ensure that your treatment will be complete.
Your next step will be to cool, calm, soothe and seal your treatment. Use a product that has a pH of 7 (or close to it) to adjust the acidified skin back up to a comfortable pH of 5.5. Having vasoconstrictors, essential fatty acids and aloe formulated into your post peel products will help any Fitzpatrick skin type to be balanced and soothed after a superficial chemical peel treatment.
Your last, final and most important step is the application of a broad-spectrum sun protection moisturizer. The inclusion of avobenzone (Parsol 1789) in the formulation will give you even better protection.
As skin classification systems become more refined, they will continue to make our jobs as skin care professionals easier and more rewarding in determining the best course of treatment for ethnic clients. By customizing your superficial chemical peel treatments and incorporating the latest in technology and product development now available, you will bring the best that the world of skin care has to offer to your clients of the world. |
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