Much of the world’s population consists of people of color. The non-Caucasian population is currently 29.4% with large estimated growth rates ranging from 8% to 36% in many ethnic groups. By contrast, the estimated Caucasian growth rate is 1.5%. If these estimates are correct, by the year 2050, more than 50% of the U.S. population will be of non-European descent.
Clinical And Histological Differences Between Caucasian And Ethnic Skin
Contrary to what some may believe ethnic skin is not darker because it holds more melanocytes (which produce the melanin that creates pigment). There are actually the same amount of melanocytes present in white and dark skin. There are approximately 2,000 melanocytes per millimeter of skin.
The difference in darker skin is that the cells are larger, not more numerous. This produces more pigment. With Caucasian skin, as skin cells migrate toward the skin surface, the melanin is broken down more rapidly than in darker skin.
The stratum corneum is equally thick in white and darker skin. There is evidence, however, that the stratum corneum in black skin contains more cell layers due to greater cellular cohesion and will require more effort to remove.
There are also significant differences among racial groups when it comes to the amount of ceramides within the stratum corneum. The lowest levels are in black skin, followed by white skin, Hispanic, and Asian skin, respectively. It is evident that the lower the ceramide level is, the lower the water content of the skin will be. Knowing this will aid professionals in recognizing which skin types will require more hydration support.
A third difference is in the inflammatory responses of Caucasian and non-white skin. A darker skin affected by acne will often show significant inflammation below the skin’s surface in what appears to be non-inflammatory lesions on the skin’s surface. This is not so with Caucasian skin. This explains why acne in darker skin, no matter how mild, will almost always result in PIHP.
In addition, ethnic skin responds differently than white skin to comedogenic ingredients. When exposed to pore-clogging substances, the response in white skin is predominantly clinical inflammation with papules and pustules developing in 2 to 3 weeks. In black skin, the clinical inflammation does not usually occur, but multiple small, open comedones will appear after 2 weeks.
White skin responds to comedogenic products by the follicular wall rupturing early in the process, while black skin responds initially with hypertension keratosis, which leads to open comedo early in the process.
Common Skin Disorders Seen In Ethnic Clients
Post-Inflammatory Hyperpigmentation is one of the most common skin disorders for SOC (skin of color). It is estimated that 65% of black patients and 53% of Hispanic and Asian patients experience some form of hyperpigmentation. This may occur from skin inflammation due to acne conditions, other skin eruptions and irritations, misuse and overuse of certain skin products, over-stimulation from peelings and microdermabrasion, and many more. There are definitely certain precautions that must be taken when treating PIH, whether it is a home-care regimen or a professional treatment.
Pseudofolliculitis Barbae – PFB (the common layman’s term is razor bumps) is a condition that occurs generally from shaving, waxing and irritation causing coarse ingrown hairs to burrow back into the skin – leading to a blockage, inflammation and eventually infection. This is more prevalent in African American men due to the coarser hair, although it may be seen in skins of all nationality and color; women may develop this on the cheek or chin area. PFB is generally easy to resolve if you have a compliant client. The use of certain AHAs, beta acid, melanin suppressants, buffing grains and a nutrient-based healing topical (epidermal growth factor) will usually eliminate the problem. The most important thing is to address it before it gets to the stage in which the skin has become inflamed and then hyperpigmented.
Acne or Folliculitis Keloidalis is a condition that occurs on the back of the neck and is primarily due to irritation from haircuts (often from cutting tools that have not been properly sanitized) and the rubbing of shirt collars (certain detergents and starches will irritate the skin). Skins from many ethnic backgrounds have the potential to form keloids and hypertrophic scars. Keloid, which is an overgrowth of scar tissue, is seen more frequently in clients of African, Asian and Hispanic descent. Hypertrophic scars are different from keloids in that they remain within the border of the original wound. The aesthetician’s role in this condition would be to support the care of the skin after the dermatologist has removed them or begin the appropriate care to prevent them from occurring in the first place. This is especially difficult to do with men unless they are seeing you early for professional skin care.
Dermatosis Papulosa Nigra, or “flesh moles,” are almost exclusive to black skin and are considered to be hereditary. The brown or black raised spots are not cancerous and usually appear on the cheeks and just below the eye area.
Keratosis Pilaris is a condition that normally appears on the backs of the arms and is not limited to any skin of color; it can appear in the fairest of skin to the darkest. However, the outcomes can be very different. Keratosis Pilaris generally shows itself as either red, irritated patches with a rough texture or small, pinpoint-size white papules that look like very small milia. In skin of color, the end result can be irritated, raised black dots.
Complications That May Occur
Once again, the most common complication among people of color is hyper-pigmentation (PIHP). This can be treated with Brightening Cream Enhanced or Skin Brightening Gel, Skin Smoothing Gel and Epidermal Growth Factor. Professionally, doing a mild glycolic or lactic treatment with the Melanin Suppressant Solution or Melanin Suppressant Solution and Vitamin A Peel will begin to suppress the melanin and brighten skin.
Surface hypopigmentation may also occur, and unless you have discussed the possibility with your patient/client, he or she will be very upset. They need to understand that this is temporary and normally within 10 days to as long as two months, the pigment will return. It is not a complication one likes to deal with, but it is treatable and only temporary.
Acne conditions may sometimes worsen, but this is part of the healing process and will usually abate within a week. Blemish Serum or Fruit Acid Botanical may be recommended for lesions as well as the use of Epidermal Growth Factor.
Edema, pruritis, rash, milia, or extreme discomfort are considered complications and must be noted in the patient/client chart. Be careful with an SOC that is using certain medications, such as Tazarac, which will cause the skin to be much more sensitive and thinner. This should be discussed in the initial consultation and any medication that you are not familiar with needs to be approved by the attending physician before proceeding with a peeling treatment.