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
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