As humans, we all share the same genetic makeup. While this set of genes makes us human, it is the variations in our DNA sequences that give us our uniqueness. These unique qualities also give inclinations toward individual skin conditions.
In our modern times, skin must be described more completely than by color and shade. Although the Fitzpatrick typing is still important, so many individuals are a blend of ethnicities that genetic background must also be considered. Every individual is a blend of qualities. All of us have a range of ethnicities and backgrounds in our genetic history. With ethnic blending, people with very similar skin tones may originate from quite different backgrounds. These considerations are important when offering aesthetic consultations and treatments.
Let us explore some of the potential skin conditions and precautions for several ethnic backgrounds, and how to best consider the patient’s heritage when offering skin solutions.
African Descent and Skin Care
There is a wide range of possible pigmentation in African skin types. Some experience uneven skin tone or hyperpigmentation.
Individuals with skin of African descent may experience keloids and hypertrophic scarring. The packing between epidermal cells is tighter, the stratum corneum holds together with more force, and a heavy concentration of devitalized stratum corneum cells can cause an ashen appearance or the appearance of dryness when the skin is adequately moisturized.
In general, African skin tends to be resistant to wrinkling and maintains a more youthful look into old age. The skin’s important support structures, collagen and elastin, are much more resilient.
All individuals should use adequate sun protection. Even the darkest skin is not protected against sun damage. Skin cancer due to sun exposure occurs in all skin types and colors.
African Descent Skin Conditions
While African skin tends to age well, eye drooping (sagging skin along the outer canthus of the eye) can occur with aging. To prevent excessive drooping, these individuals can use topical products with growth factors and collagen stimulators that support the skin of the outer eye area.
Hypertrophic and Keloid Scarring
Those of African descent are susceptible to hypertrophic scarring (excessive scar tissue within the size of the lesion) and keloid scarring (excessive scar tissue that heaps up and enlarges beyond the original lesion). Unfortunately, keloids grow in response to any trauma (from a minor pinprick to a larger surgical wound). They are resistant to surgical removal and are best treated by a dermatologist.
Exogenous ochronosis is a dark blue-black pigmentation that occurs after using the skin lightening agent hydroquinone – usually purchased off-market and used without physician supervision. Exogenous ochronosis has been reported in all ethnicities but is most common in those of African descent. Once present, it is extremely resistant to treatment.
Asian Descent and Skin Care
There is a wide range of pigmentation among Asian skin types. PIH, or Post-Inflammatory Hyperpigmentation, readily occurs in Asian skin. A uniformly pigmented, and even paler skin is considered attractive in some Asian groups, so there is a strong market for brightening and lightening products or treatments.
Asian skin tends to have larger oil glands and tighter stratum corneum cellular packing. Sebaceous build-up is more likely to cause inflammatory acne, deep papules/pustules, and scarring. Large pores may be disturbing because a uniform, flawless complexion is valued.
Most Asian skin types age first with discoloration and pigment irregularities while wrinkles develop later in life.
Solar radiation is the strongest trigger for pigment production in the skin. It is especially important for Asian skin types to use sunscreen every day.
Asian Descent Skin Conditions
PIH is a condition that occurs in response to any kind of inflammation, such as from acne, sunburn, or even irritating products or treatments. After the inflammation or lesions have lessened, dark areas remain. Scarring and pigmented scars can result from severe inflammation. PIH is common in Asian skin types and often a very frustrating condition for the patient.
Many acne treatments are too harsh and irritating for Asian skin types. Rather than reduce the breakouts, they cause an inflammatory reaction and lead to PIH. Those with Asian skin should be cautious about using products containing benzoyl peroxide, large amounts of short-chain alcohols, citric acid, acetic acid, and other irritating or pro-inflammatory ingredients.
Exfoliation and Peels
The skin’s renewal process of exfoliation helps maintain skin health. Exfoliation can be increased with products and treatments, but the process should be gentle. Chemical peels and treatments may irritate Asian skin and contribute to PIH. Lactic acid is often better tolerated, is more hydrating, and should be chosen over treatments with citric acid or acetic acid.
Many with an Asian genetic background struggling with PIH may be interested in lightening agents to reverse the pigmentation. When using lightening products, hydroquinone should always be avoided. This chemical generates free radicals and can worsen inflammation and discoloration. Off-label products containing hydroquinone could also contain other harmful toxins like mercury.
Caucasian Descent and Skin Care
Hyperpigmentation is less likely to occur in Caucasian skin types until later years as a sign of excessive sun exposure. Excessive sun exposure, especially without adequate sun protection, can cause early photoaging with pigmentary irregularities.
Caucasian descent skin tends to be thinner in texture and have smaller, less active oil glands. This leads to dryness, especially in environmental extremes. Overall, Caucasian skin tends to heal well and does not produce large scars.
Caucasian skin wrinkles more readily than the skin of other ethnic groups, due to a smaller fibrous network within the skin’s structure. With aging, wrinkling tends to occur first and hyperpigmentation later.
Caucasian skin types are more likely to experience visible damage from sun exposure and are encouraged to use proper sun protection.
Caucasian Descent Skin Conditions
Caucasian skin is less fibrous and thinner than other skin types. Paired with less active oil glands, this results in a greater likelihood of dry skin, fine lines, and wrinkles in early age.
Latin Descent and Skin Care
The considerations for Latin descent skin are divided into those of Spanish and Portuguese descent and those of Caribbean descent. The skin of the former will react more like Caucasian skin, and the latter more like African skin.
The amount of overall pigmentation varies by geographical background. Some Latin skin is subject to the hypopigmentation of vitiligo.
Latin skin wrinkles more readily than those of many ethnicities and also develops stretch marks during pregnancy.
Latin skin tends to show its age by both wrinkling and pigmentary irregularities.
Those with Latin descent skin should always use sun protection as all skin types can develop skin cancer due to sun exposure.
Latin Descent Skin Conditions
Vitiligo is an autoimmune disorder with distinct, depigmented areas of skin. As an autoimmune condition, it occurs when the body fails to recognize the melanocytes as “self.” The immune system attacks them as if they were invaders, resulting in a loss of pigmentation in unpredictable areas. These patches can range from small spots to large patches of fully depigmented skin.
Vitiligo is more common among Latins from equatorial areas, such as Venezuela or Ecuador, but can occur in other regions and in individuals from other heritages. There are no known cures for vitiligo, but makeup can help the skin appearance.
Middle Eastern Descent and Skin Care
Those of Middle Eastern descent often experience a genetic tendency to hyperpigmentation around the eye area. PIH occurs readily from acne, irritating product use, and other inflammatory conditions.
Middle Eastern descent skin often has large sebaceous glands, resulting in prominent pores.
The large sebaceous glands of Middle Eastern skin bring antioxidants and hydration to the surface, preventing wrinkles as a sign of early aging.
Those with Middle Eastern descent skin are encouraged to wear sun protection as all skin types can develop skin cancer due to sun exposure.
Middle Eastern Descent Skin Conditions
Middle Eastern skin tends to have larger melanocytes, easily triggered for pigment production. PIH is likely to occur following acne, other inflammatory conditions, or early aging from sun exposure.
Diverse Skin Conditions in Aesthetics
Every patient’s skin is unique. To offer the best aesthetic support, it is crucial to understand the differences in each skin type, including genetic background. Treatments and products should be adapted to suit each person.
To learn more about ethnic variations in skin conditions and other topics, enroll in a professional course through iS University (www.isuniversity.org) or iS CLINICAL Education (www.isclinicaledu.com).