Melasma, Hyperpigmentation, or Uneven Skin Tones
Skin Peels,Lasers,Creams,and Sunscreens For Sensitive Ethnic Skin
May 13, 2009
Fitzpatrick classification of skin color ranges from the palest blue-eyed red head, type I, to deep brown-black skin with brown eyes, type VI. “Ethnic skin” ranges from IV to VI. This includes many of African, Asian, Latin, and some Mediterranean backgrounds.
Collagen and Melanin Work Synergistically Creating Hyperpigmentation
Darker skin has some inbuilt sun protection. The active production of melanin coupled with keratinocytes increases the likelihood of developing post inflammatory pigmentation after scratches, insect bites, pimples, or rubbing the skin.
Successful Treatment is Provider Dependent
Skin analysis is important in treating darker skin. Asian brown-eyed brown haired indiduals have a different response to products than do Caucasian brown-eyed brown haired individuals.
Equally important is the “mix” of skin backgrounds. A light skinned individual from an Irish father and Mexican mother may have undertones of “ethnic skin” and should be treated with the same cautions until determined otherwise. Similar precautions are needed with, for example, a blue-eyed individual from India.
Sun Screens are Necessary Regardless of Skin Color
Mottled skin color can come from hormones, medication, and trauma. Sun exposure intensifies the damage. A sunscreen in must be augmented by a topical with UVA and UVB protection. Dark skin should use precautions whenever using a product that claims anti-aging compounds since this may refer to retinal or other exfoliating material that may cause pigmentation by friction.
Chemical Peels Should Not Be Aggressive
Spot peeling can be done. Phenol peels are contraindicated in dark skin but Trichlorocetic (TCA) acid is recommended for skin tightening and lightening. Physicians Choice of Arizona has an array of animal friendly non-damaging peel formulations for skin of color.
Kojic acid, resorcinol, and citric acid can be combined with lactic and salicylic acid (jessner peel) to create an effective tightening and lightening peel. Depending on skin sensitivity, hydroquinone may be used with the peel.
Additional peel combinations utilize arbutin, TCA, kojic, and alzelaic acids. Experiment with mild glycolic peels. Non-aggressive controlled superficial and medium depth peels are the key to not causing more pigmentation.
Lasers for Skin of Color
IPL (intense pulsed light) is not practical for dark skin. The light is attracted to dark melanin and will scatter over the skin in this case. CO2 lasers are also not recommended since they destroy pigment and will permanently lighten the skin and possibly cause scarring due to their aggressive nature. Fraxel, a non-ablative laser, on low settings with multiple treatments can resolve pigment issues and minor scars. Often a hydroquinone product such as Obagi is recommended to prepare the skin prior to lasering.
Bleaching Products for Ethnic Skin
- Hydroquinone is banned in many countries but available in US by prescription. There are questions about its cancer inducing abilities when used in large amounts. In the US it is felt that using it to spot treat or pretreat prior to peeling is not harmful when used under a licensed practitioner’s guidance.
- Azelaic acid claims to be as effective as hydroquinone without any inherent contraindications. Some products used as peels such as kojic acid, glycolic and citric acid are in over-the-counter creams, makeup, soaps, and lotions. Spot test these products prior to use.
- Glutathione is popular in Asian for lightening skin.
- Porcelana is a bleaching product that has been sold in US for decades. It contains hydroquinone 2%. Many other products sold over the counter are a combination of ingredients discussed here.
- Treatment should not be started if pregnant or breast feeding.
Inhibitors of Melanin Production
These products may not lighten skin but can help reduce the chances of inflammatory hyper pigmentation by controlling the output of melanin.
- Arbutin, a product of bearberry, cranberry, mulberry, and blueberry extracts
- Alpha Hydroxy Acid (AHA) lactic and glycolic acids
- Ascorbic acid has gained popularity in this category.
The goal should be making skin a smooth even color, i.e. removing hyper pigmentation not changing it to another shade. If doing the treatment oneself, spot test in a hidden area to be sure hypo-pigmentation wont occur. If using a professional, be sure the person is experienced in skin of color.
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