Dermatology Q&A: Cosmetic Treatment in Skin of Color
IU School of Medicine Oct 06, 2022
Skin of color (SOC) in the dermatology community refers to the broad grouping of individuals with pigmented skin which can include many different ethnic groups and cultures. Patients with SOC often experience unique cosmetic concerns. Cosmetic dermatologists play an important role in addressing their patient’s aesthetic goals while balancing expectations. With SOC, cultural competency is essential to patient satisfaction and positive outcomes. In this interview, Janelle Nassim, MD, a board-certified dermatologist at IU, discusses special considerations for cosmetic treatment in SOC.
What are the most common cosmetic conditions treated in patients with SOC? What type of procedures do we offer at IU for these conditions?
In my practice, in both the medical and cosmetic realms, I see a lot of melasma. This condition is extremely common in all skin types, but especially in SOC. Melasma is a very tricky diagnosis and requires a personalized approach for each patient. Sun/photoprotection is of the utmost importance, and we can also use a combination of topical treatments, sometimes oral treatments, lasers, and chemical peels.
I also treat facial brown spots quite often, which usually consist of a combination of seborrheic keratoses and lentigines - typically I use lasers, cryotherapy, or a combination of both to treat this.
Another common cosmetic consult I see is the patient coming in for general uneven texture and tone - they are looking for smooth, even, glowy skin. I love helping patients learn about skincare, including matching their skin tone to a good quality sunscreen that works well for them (our cosmetic nurses are amazing at this!), educating patients about the power of retinol/retinoids, as well as other skincare ingredients that build a strong foundation. Then, we can get into a multi-dimensional cosmetic approach including lasers, chemical peels, and injectable treatments to achieve their goals.
Other common consults I get are for laser hair removal, dermatosis papulosa nigra (benign growths that some people seek removal of), and improvement of scars.
What are the special considerations to treat the cosmetic patient with SOC? Why is it important to have someone who has treated SOC before, treat these concerns?
A thorough understanding of SOC is absolutely essential when formulating a cosmetic treatment plan. There is no cookie-cutter approach. For example, a treatment plan for laser hair removal for light skin is entirely different from a treatment plan for dark skin. In our specialty, we, unfortunately, see devastating complications in patients with SOC who were treated with inappropriate laser settings. Laser is not simple - it is actually very complex and involves a lot of physics. Understanding the principles of how lasers work and affect different skin colors is key to safe and effective laser treatment.
Similarly, when introducing any physical medium - including cryotherapy or heat - to the skin, there are considerations. There is a greater risk of dyspigmentation in darker skin.
Something I learned in my residency training is that sometimes it is our job to talk a patient OUT of a certain procedure. This may not be the recommendation they came in seeking or wanting, but it is our duty to be honest and realistic about the risks and benefits, and there are times when a treatment is simply not appropriate or in the patient's best interest.
What over-the-counter products or ingredients are most effective in treating cosmetic concerns in SOC? Which ones do you like and which do we offer at our offices?
I tell my patients all the time that if I had to take 2 things with me if I was stranded on an island that they would be a good SPF and a retinoid!
Although the melanin in darker skin does provide some protection from UV rays, sun damage (and although less common, skin cancer) does occur. Regular use of sunscreen is important in SOC to prevent skin discoloration or hyperpigmentation, as well as wrinkling and sagging of the skin. We carry tinted sunscreen products in our office that are shade-inclusive, as well as options that go on clear (no white casts on our watch!).
Retinoids have multiple benefits - not only do they help turn over skin cells faster, unclog pores, and boost collagen, they help fade certain types of hyperpigmentation, which is especially relevant in SOC. Retinoids require patience and knowledge of proper use - my nurses and I place special emphasis on this because we know when patients get the hang of them, they love them!
We carry several medical-grade skin care lines in our office that offer excellent products containing various acids - I happen to love some of the combination acid products. For example, one serum that I love contains a combination of azelaic, glycolic, and salicylic acids, and we also have a complexion pad product that contains a combination of glycolic and salicylic acids. When used properly, these can help treat hyperpigmentation and improve brightness and texture.
Lastly, I love growth factor/ peptide serums for all skin types. This is an all-around beneficial skincare step to promote collagen and elastin, reduce fine lines, and improve skin texture and tone.
Janelle Nassim, MD
Assistant Professor of Clinical Dermatology
Adaure Amuzie is a fourth year medical student at Indiana University School of Medicine. Her academic interests include topics related to the improvement of minority health disparities and cultural competency in medical training.
Sahand Rahnama-Moghadam, MD
Dr. Sahand Rahnama-Moghadam is an assistant professor of clinical dermatology at Indiana University School of Medicine.