Managing Pigment in Ethnic Skin Types

We all deal with pigmentation issues at some point in our lives.
No getting around it, my friends. And it's NO FUN for ANY of us!

Today we are focusing on pigmentation in Ethnic skin types.
I have been writing and rewriting this Blog for a few weeks because this is a serious issue that effects millions of people.
I wanted to make sure I got this right for you.

Now, DON'T stop reading right here because you don't have ethnic skin and you think this Blog won't apply to you. It applies to all of us! (Thanks Ancestry websites for telling me just how much Native American heritage I have!)

There is oodles of great info coming up regarding pigmentation in ANY skin type.
Beyond that, here's why you should keep reading....

The face of America is evolving.

Courtesy National Geographic

The U.S. truly is a Melting Pot and these statistics from the US Census Bureau prove it!

"U.S. minorities now represent more than half of America's population under the age of 1, a historic demographic milestone with profound political, economic and social implications."

"Non Hispanic Whites are projected to no longer make up a majority of the population by 2042."
Just to give you some perspective, Non Hispanic Whites made up 85% of the population in 1960.

I'm super proud to see stats like this that prove how inclusive, accepting and progressive this young nation of ours, founded mostly of immigrants, has become in such a short time. Take a second and appreciate how amazing that is.
Okay, back to task at hand.

SO, WHAT ARE THE CLINICAL IMPLICATIONS OF MANAGING PIGMENTATION IN THE CHANGING FACE OF AMERICA?

Patients with ethnic heritage (African American, Spanish, Middle Eastern, Asian, Native American) inherently produce more melanin than Caucasians.
And while ethnic skin types have many benefits...managing pigmentation in ethnic skin presents a very specific and unique challenge.

Many of the tools in my expansive and cutting edge toolbox include Lasers, IPL, and other light based treatments. These treatments are awesome but can be problematic (or flat out contra indicated) for darker skin types. Thusly, limiting our options.

Here's why:
The mechanism of most of these modalities of treatment typically relies on a controlled injury to the skin to create a wound healing response, or they target pigmentation (which is hard to do when a laser cannot tell the difference between a freckle vs the natural pigment in the skin.)

For ethnic skin, many times, when skin or tissue is injured-the response of the body is to create MORE pigmentation. "HYPERPIGMENTATION"!

There is also a condition called Post Inflammatory Pigmentation (PIH). This is a direct response of trauma to the skin (lasers, peels, injuries, acne etc.).


One of the main concerns I hear daily from patients with ethnic skin types, is how to correct or manage pigmentation issues.

The short answer: YOU'RE DOING IT WRONG.  (But that doesn't give you much help, does it?)

The longer answer involves educating you, my readers, and my patients about the types of pigmentation, their causes and giving you the knowledge to become an advocate for yourself and your skin.

If you are ready...then get comfortable, grab yourself a cup of tea or glass of wine and settle in for a few minutes. I will condense this as much as I can but commit to reading for the next 10 minutes. You will thank yourself.

First, let's discuss the causes of pigmentation.

Melasma
This is a genetic predisposition and hormonally induced specific type of pigmentation. It presents differently than your run-of the-mill UV damage. Instead of scattered freckles-you will see patches/blocks of pigments that usually show up bilaterally on the face (temples, cheeks, jawline or upper lip).
See my Blog about Melasma for more detailed info.
We are getting away from calling this a "cosmetic issue" as it has been found to be a dysfunction of the skin.

Though this is a hormonal induced condition, it never presents in isolation. There are compounding factors in play.
Usually, pregnancy, birth control, hormone replacement therapy or UV exposure are the instigators.
FYI- certain Over the Counter supplements like Cohosh and St. Johns Wort have been found to mimic estrogen and make Melasma worse!!

The trick is to FIND YOUR TRIGGER!


Melanocytes (those pigment producing cells) are, in fact, immune cells. They respond when trauma or inflammation is present in the skin.

Certain traumas like cuts, scratches, acne, ingrown hairs, eczema or other dermatological conditions can lead to hyperpigmentation.

Acne Induced PIH

Some clinical causes include: lasers, IPL, microdermabrasion and chemical peels.

Certain medications- ranging from oral antibiotics to medications to treat heart disease and cancer-can create hyperpigmentation in the skin.

UV exposure. Don't make me say it again!!!
Even if you have darker skin, your skin can still over produce melanin when traumatized with UV radiation.

MANAGING YOUR PIGMENTATION
I'm not going to get into whether you are a candidate for laser treatment. This is very specific to your skin type and condition. You must be personally assessed by your Skin Care Professional to determine if this is right for you.

Lets talk about what you can do at home.

HYDROQUINONE (HQ)  4%-6% (prescription strength) has long been considered the Gold Standard for Melasma, pigmentation and PIH.
However, HQ is becoming more and more controversial due to long term effects like potential cytotoxity and contact dermatitis.

The other major issue with HQ is the potential for Exogenous Ochrinosis.

That's a lot of big words! Speak to me in plain English, you say? Here you go.

HQ IS A DRUG and you MUST take drug holidays.
The current thinking is you can only use this topical for 8 weeks (MAX 12 weeks) and then take 16 weeks off.
Otherwise, you may induce Ochrinosis which is a condition that results from an overuse of HQ.
The hyperpigmentation takes on a blue/black appearance and this...ugh...is irreversible.

I don't know about you...but I have too much going on between kids, work, house, pets, doctors/ortho appts etc to remember how to keep the HQ dosage straight. Was it 6 weeks on/8 weeks off? 8 weeks on/10 weeks off?
Who cares. I'll just use it all the time. Every day. For years. After all, MORE is BETTER, right?
It's easy to get lazy...AND I GET LAZY, TOO!  AND I'M THE PROFESSIONAL, Y'ALL!!!!

There's an easier way, folks.

1- Avoid UV radiation. And remember, this occurs insidiously and from an early age. Even incidental exposure can create irrevocable damage. Have you considered the ambient heat factor?
Living in Texas (as the saying goes, Texas has 2 seasons: Summer and August!) can cause major pigment issues. Dangit, enough already!

2-Wear SPF EVERY DAY! At least once in the AM. If you are going to be outdoors for any extended period of time, Reapply every 1-2 hours.

However, all you need is an SPF 30-45. Once the number of the SPF is increased higher than that...well, you really aren't getting more protection.
In fact, to get to those higher SPF #'s manufacturers must introduce more chemicals. More chemicals=more pro-inflammatory ingredients.
I like Elta MD SPF 46. It contains Niacinimide which inhibits melanin transfer.

3- Antioxidants are proven to augment the efficacy of SPF. Use a good one every morning. My fave is SkinMedica's C+E Complex or their TNS Essential Serum.

4-Use a good pigment inhibitor. There are lots of different ones on the market if you are looking for a non HQ option. Alternatives include:
Arbutin
Azelaic Acid
Kojic Acid
Licorice Extract
etc...

My fave right now is Lytera by SkinMedica.

It is a non-hydroquinone brightener that works on all skin types without a prescription.
This product has been scientifically proven to address all 4 stages of hyperpigmentation in the skin..
-Activation
-Production
-Transfer
-Migration

No breaks or drug holidays needed. I'm kind of obsessed with this product. Like, seriously obsessed.
Even though I don't have Melasma, I use this product twice per day. I have never gotten so many compliments on my "radiant, glowing skin" as did after 2 weeks on Lytera.

5-Retinol.
Retinoids (Vitamin A) have been clinically proven to down-regulate tyrosinase.
Tyrosinase refers to the enzyme in your body that controls and regulates melanin (pigment) production.
So, if you have overactive pigment production-i.e. Melasma, UV damage, PIH...Then Retinoids helps slow down and "police" that over production!!
I did a write up on the importance of Vitamin A ("The Best Thing You Aren't Using"). Read it.


Okayyyy. So, you feel like you just got spit out of a F5 tornado of information, right?

I know. It's a lot to take in.

But I want you familiar with this terminology and what these products do.
Education is the key to helping you manage your pigmentation.

Don't go blow your hard earned cash on some department store product that upcharges you to pay for their Prime Time commercial featuring a spotted Robin's egg that miraculously clears up within their 30 second time allotment. You won't get the results you are looking for.

There s a very specific and scientific regime to control and combat pigmentation issues, even in the most diverse skin types.

I'll break it down real simple for you.
Your basic skincare will look something like this:

AM:
Cleanse
Topical Antioxidant
Lytera
Elta SPF 46

PM:
Cleanse
Anti-Aging Serum
Lytera
Retinol Complex

This is the bare Nuts-N-Bolts of a skin care regime to aid in managing pigmentation (AND AGING!! It's a two-fer!!!).
Every case is specific. I'm here to educate you and make sure you walk into your doctor or skin care professional's office armed with as much knowledge as I can force down your gullet.

**Last Note***
Keep your eyeballs peeled for my write up on an Over The Counter Supplement called HelioCare (available at Walgreens, CVS etc).
It claims to reduce the absorption and negate the effects of UV by up to 400% when taken daily.

I have done a lot of research on this and I cannot find a single negative.
I have been using it myself for the last year. I had my daughters take it when we went to Mexico.
I was already convinced based on my personal experience.

Then, I went to a Plastic Surgical Skin Care Conference in San Francisco a few weeks ago and this product was brought up repeatedly in my lectures.
Not only for prevention of sun burns, but also in management of pigmentation/melasma in ethnic skin types.
I have begun my own personal study to test this theory and will let you know my findings in a few weeks.

Until then,
Buy the ticket, take the ride.

Michelle and Nancy
THE SKIN GURUS

How old you are is YOUR business, how old you LOOK is ours.
skin-gurus.com

Off topic...But On Point

I am back from hiatus and ready to blog!

So, over the last few weeks I have been gathering data and collecting my thoughts..should I tell y'all about the importance of retinols, or Managing Pigmentation in Ethnic Skin types, or the role Hormones play in skin throughout a lifespan (These Blogs are coming soon!!) ...but..

Something else kept coming to the forefront of my brain.

And it's not really related to skincare in the clinical sense, but more the 'WHY'  I got into this field in the first place.

Humanity lost one of its most treasured gifts last week.

So, I'm putting those Blogs on the back burner for a moment to pay a little tribute to Maya Angelou.

Ssshhhhh. Just keep reading. TRUST ME. It's not going where you think it's going.

I have always been inspired and captivated by this woman. As I started pinning and posting my favorite quotes from her and reading other peoples tributes... it started to dawn on me....just how many times in my life I have repeated her words in my head. Especially during rough times.

There are dozens of others of sayings that I put in a special little folder on my iPhone dedicated to inspirational quotes *nerd alert*
I've repeated them so often that I know them by heart and rarely think much anymore about the author. So, when I started reading all these posts, pins and tweets of Ms. Angelou's amazing insightful and graceful words...I realized how big of an influence she was to me.

I began to question whether I could ever be as influential as Maya Angelou.
I mean C'mon. I work in Plastic Surgical Skin Care. I'm a blonde from Texas! Can I make that kind of impact on the world?

I thought about this and started to remember why I was drawn to this field in the first place.
Then, I answered my own question. Yes, I can. And Yes, I do. One person at a time.

We all have baggage. Myself included. (Lawdyyyyy! Don't get me started! I don't have 'issues', I have SUBSRICPTIONS!)

Isn't funny how someone can say one thoughtless, cruel or careless remark in some crucial, pivotal moment in your life...and that seems to stick with you over the years, fuel insecurity and direct the course of your internal monologue for weeks or decades?
Especially for young women and men who have been teased about their appearance or body-shamed during those formative years, this can shape self and body image for a lifetime.

I was made fun of for my 'bologna-lips', my bad home perm, my chub... not to mention my snort-laugh and my innate clumsiness (which I never grew out of ;)

We all have issues and insecurities. If you tell me you don't, I call BS on that.

I have the absolute best job in the world. I get to make people feel better about themselves every. single. day.
I won't ever win a Pulitzer or Nobel or an Oscar (though some days I think I give Meryl Streep a real run for her money! And, I can legitimately tell you that I have a Best Actress Oscar winner as a patient. But that's the closest I will ever get to a golden statue.*sigh* all those hours wasted practicing my acceptance speeches in my bathroom mirror with a hairbrush-microphone ...C'est la vie.)
God knows, I don't do this job for money or lavish lifestyle.

I do it for you!

You, my lovely patients and online followers, let me into your life every single day. You open up to me about your fears and insecurities. You tell me about your loves, your aspirations, your families and your past. You put your faith and trust in me to guide in the right direction (and use lasers on your face! Talk about TRUST!)

What I love most about my profession is watching the transformation happen.
Because it's not just a physical.

Patients come to each appointment with a little more bounce in their step. And as their confidence grows, the narrative of their life starts to change.

For instance, that person, who, the first day I met her at our consult, had tears in her eyes. Her husband just left her. Now she is a 40 year old single mother of 3 and feeling low and beating herself up.
Or the nervous guy who had a hard time telling me why he came to see me. It took me 20 minutes to drag it out of him. Turns out, he wouldn't date or even be seen at the pool/lake or go to the gym due to his Gynecomastia.
It takes real courage to open up to a stranger like me about these personal insecurities. People probably tell me more about themselves than even their best friend in the world knows about them.
I don't take that lightly.

My greatest professional and personal (outside of my kids and loved ones) satisfaction comes on a daily basis when patients hug me and tell me how great they feel.
All of the sudden, their world is changing. They are happier. They have the confidence to take chances they otherwise would not have taken. I get to be your biggest cheerleader, high five and hug you and jump up and down and celebrate in your accomplishments!

Like a proud mama bird, my gratification comes by watching you take flight.
And when you leave my office, I look in the mirror and give myself some Shooter McGavin finger guns. Because, DAMN! I'm good at this!

Nancy and I also volunteer for the Phoenix Society for Burn Survivors annual World Burn Congress as part of the Image Enhancement Team for traumatic burn injury survivors.

If you know anyone who has suffered a traumatic burn injury, I highly recommend this organization.
They are a phenomenal support system.

As part of the Image Enhancement Team, we teach people how to camouflage scars, draw on lips and brows etc to help those who have suffered traumatic burn injuries re-enter society and cope with not only physical limitation but also the emotional trauma associated with disfigurement from traumatic burn injuries. It's not just changing faces, it's changing lives.

 

This is a wonderful profession and we are privileged to have y'alls continued trust and support.
This is our dedication and calling.
We promise to keep bringing you Blogs you find informative, useful and (hopefully) a little funny and sassy.

I leave you with this last quote because....well...Dammit. YES!

And now..back to your regularly scheduled programming.

Michelle and Nancy
The Skin Gurus

How old you are is your business, how old you look is ours!