How the Conversation on Treating Skin of Color Is Changing

From lasers and skin-cancer treatments to SPF and trusted ingredients, skin solutions aren’t one-size-fits all—and these experts have spent their careers taking on the sometimes-complicated topic of skin-health issues as it relates to skin color.

Montclair, NJ dermatologist Jeanine Downie, MD succinctly categorizes the conversation of treating skin of color as “somewhat having progressed” since she was in med school.

While she does peg last year as moving the needle a bit (“when the American Medical Association declared racism a public health threat back in November, that was a full stop”), she describes her own personal experiences with racism in medicine as “varied and very ugly.”

“Despite the fact that my mother is a part-time practicing pediatrician; despite the fact that my grandfather before her was a dentist back in the roaring days of Harlem; despite the fact that I was raised in the north; and despite the fact that I was raised upper middle class—none of these things mattered when I was in medical school,” she says. “I was told I should not even dream of becoming a dermatologist, and that dermatology was way above anything I could ever hope to achieve. #WhateverThatSurgeonWasWrong!”

“The very ugly details of racism and sexism in my education, medical school, residency, and now even as a private practice doctor, could take me hours to explain. In any event, suffice it to say that we need to do much, much more.”

“Many people want to act like they are colorblind—we are not. As a society, we need to meet each other at our humanity and move forward from there. As an industry, we need textbooks that train resident physicians on treating skin of color, and we need caring, compassionate doctors of every race to treat all patients, including those with skin of color.”

“At the end of the day, each and every doctor, each and every nurse, each and every PA, and each and every person involved in healthcare needs to treat all patients as they themselves wish to be treated. It’s so simple,” Dr. Downie says. “When we all see each other as humans and treat each other as human beings, this will be better for each and every patient—regardless of skin type, religion, ethnic origin, and sexual orientation. When this is accomplished, every patient will have better health outcomes.”

The Patient Population

Dallas dermatologist Elizabeth Bahar Houshmand, MD also notes the importance of all dermatologists being able to identify different conditions of the skin in all skin types—and points to what she refers to as the cultural connection.

Black dermatologists account for about only 3% of the field in the U.S.

Source: JAAD

“For example, rosacea can look quite different in skin of color, and many of those patients may not be aware they have it. This comes with seeing diverse patient populations, and also having the right textbooks and study materials. It has to go beyond just learning about treating skin of color—cultural competency is also critical.”

The bottom line: “Not all skin-care advice applies to every skin tone,” Dr. Houshmand explains. “This is important to understand. There are some fundamentals that we are taught during residency and training, but in general terms, we are aware in medicine that there are health disparities.”

“Plus, it is so vital to properly evaluate a patient’s skin, heritage and background. Why? A person’s skin color may be light or dark, but that is not the only factor to consider when discussing treatments. A fair-skinned patient of Hispanic, Mediterranean, Asian, African or American Indian descent will respond differently. A true expert in ethnic skin will know the nuances and proceed accordingly with not only procedures like peels, lasers and injectables, but also skin care.”

Sun Exposure

Dr. Houshmand says the number-one biggest misconception she wants to clear up as it relates to skin health is that “too much sun can cause some of the most common issues that people with darker skin types face,” including hyperpigmentation and melasma. “Dark skin can also develop skin cancer, and being unaware of that fact can be fatal. Melanoma, the most dangerous form of skin cancer, is less common among people of color, but they have a much higher mortality rate. Many patients of darker skin types are unaware that they can develop skin cancer.”

Miami dermatologist Annie Gonzalez, MD stresses that it is also imperative to accurately identify and treat cutaneous malignancies, and appropriately counsel these populations to ultimately improve disease-related outcomes. (One scary stat she shares: Latinos think that, because they most likely won’t get sunburned, they aren’t at risk for skin cancer; one recent study shows that 43 percent of Latinos never or rarely use sunscreen.) “Don’t procrastinate, get an exam and wear sunscreen daily!”

“Everyone needs to wear sunblock every day, rain or shine, January through December, regardless of ethnicity,” Dr. Downie says. “So many of my skin of color patients tell me that no physician has ever shared this with them. That information alone could help skin of color patients significantly.”

Color Corrector

There are so many skin myths about skin of color, in particular, says Brookline, MA dermatologist Papri Sarkar, MD. Here are some of the top ones she says the skin-care industry should help clarify:

+ All skin tones can get skin cancer, including people of color.

The five-year survival rate for people with melanoma is 67% for Black patients, compared to the 92% survival rate for white people.

SOURCE: Skin Cancer Foundation

+ You can prevent skin cancers, like basal cell cancer, in skin of color with sun protection.

+ There are sunscreens that don’t give a white cast or a “glow of death” to skin of color: “Tinted mineral sunscreens and clear chemical ones are my favorites, and I recommend putting on the clear first, and then a layer of tinted on top.”

+ Patients with skin of color need regular skin exams.

+ Patients with skin of color can get lasers, peels and other cosmetic treatments. “They just need to make sure they are seeing someone who treats skin of color often so their doctor can match the settings and the device to the patient for the best outcome.”

+ Aging is just as important in skin of color. “Although wrinkles may not be as prominent in some women of color, they are often more likely to get dyspigmentation, which is just as bothersome to them. In addition, they also lose plumpness and elasticity just like their white counterparts.”

+ It’s important not to think of all POC patients as one entity. “Right now, ‘POC’ is newsworthy, so I’m taking every chance I can to shape the narrative so people know to be inclusive, but also know that we’re not one monolithic group. It’s a true diaspora of skin tone, ethnicity, culture, religion, and more.”

Lasers + Chemical Peels

When using laser treatments, the machine needs to be FDA-cleared for darker skin types, or it should not be used on darker skin types, Dr. Downie notes. “If there is a question about something, do a test patch or do not use the treatment at all.”

Dr. Houshmand adds that, while there are many treatments that are effective and appropriate for skin of color, there are also some to stay away from: “It really depends on what we are treating and the patient’s goals. The same can be said for the use of lasers and light. Skin of color has an increased melanocyte, or melanin-producing, response. Therefore, you want to avoid the absorption of laser energy by the pigment in the epidermis. The safest technologies are long-pulse lasers or fractionated devices that protect the pigment in dark skin. I always start with very conservative settings for my treatments and do test spots.”

When it comes to chemical peels, the right compound applied to the skin for the correct amount of time can lead to great results. “However, not all chemical peels are appropriate for skin of color, although peels consisting of ingredients such as glycolic acid, lactic acid or salicylic acid can have excellent results when applied at low concentrations and slowly increase with each subsequent treatment,” Dr. Houshmand explains. “Trust your skin to a board-certified dermatologist, and remember that after any procedure for any skin type, education about sun avoidance and wearing sunscreen is key!”

Skin Care

According to celebrity aesthetician Shani Darden, skin of color patients must be cautious about product choices. Her advice: Always start with low concentrations of active ingredients and work your way up, and yes, always apply SPF.

“Darker skin types may be less prone to sunburns, but skin still needs to be protected with sunscreen,” she says. “Darker skin tones are still at risk for skin cancer, as well as aging. Looser, sagging skin, fine lines and wrinkles all happen as a result of sun damage, and wearing sunscreen every single day is still the most important thing you can do to keep your skin youthful and healthy.”

Plus, darker skin may be more prone to discoloration and dark marks after a blemish. “If you’re not wearing sunscreen daily, the dark spots will get darker and take that much longer to lighten because they’re constantly being exposed to the sun. Adding a retinol to your nightly routine can also help to minimize that discoloration and keep skin glowing.”

Another check on Darden’s list: An overall positive move in the right direction regarding inclusion in the beauty industry as a whole. “I think the industry is starting to get better in terms of inclusion, and I’m excited to support and be surrounded by more Black providers and Black-owned beauty brands today. There was not much representation for this when I was growing up, and it’s been amazing to see this change and see more representation across the board in beauty.”

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