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Beautiful Skin in All Colors

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The 67th annual meeting of the American Academy of Dermatology had countless sessions covering a broad range of skin diseases and conditions but one of the most packed sessions was titled "Aesthtetics and Cosmetic Surgical Procedures in Darker Racial Ethnic Groups." Although many remarked that they were concerned about seeing President Obama age right before our eyes, many people attended because of the need for our cosmetic practices to better reflect the changing ethnic and skin type demographics of America. According to a report from the Census Bureau "minorities" will make up 53% of the US population by 2050 with most of this growth coming from increases in the Hispanic population, which is expected to triple between 2008 and 2050. As the population changes, dermatologists need to learn to recognize age-related changes in darker skin types and develop the appropriate cosmetic tools for addressing these problems.

For years dermatologists have assessed skin color based on a skin typing system developed by my former mentor known as the Fitzpatrick scale, which categorizes one's skin based on its reactions to sun exposure. At one extreme are patients classified as Type I whose skin is fair white, never tans and always burns. At the other end are Type VI patients who are generally African American and whose skin always tans and never burns. This classification is useful in assessing risks for skin cancer and categorizing patients for clinical trials, but it's not useful for assessing darker skin patients (skin types IV, V and VI) prior to cosmetic procedures. A new scale, called the Roberts Scale, was developed for this purpose and was published last year in the Journal of Drugs in Dermatology. The Roberts scale categorizes skin based on its likely response to inflammation or injury, and is more useful for assessing likely outcomes of cosmetic procedures on darker skinned patients. This scale utilizes a person's ancestral history, personal history, appearance and test site reactions to determine whether they are more likely to develop pigmentation or scarring from cosmetic treatments. Patients at higher risk for pigmentation or scarring can be guided toward less invasive procedures to minimize these risks.

Once a patient's skin type is appropriately assessed, they can take advantage of the greatly expanding cosmetic tools for improving ethnic skin. Series of superficial topical peels with glycolic or salicylic acid continue to be the treatment of choice for uneven and darker skin complexions, which is one of the most common cosmetic concerns in darker skin types. In addition, advances in resurfacing lasers allow them to be used more safely to repair scars and wrinkles in darker skin types. Dr. Vic Narurkar echoed my own experience with the Fraxel re:store laser in a study where he showed that this laser can be safely used for all skin types without scarring and with minimal chances of transient skin darkening. Dr. Pearl Grimes discussed a study that showed that dermal filler injections into the smile lines around the mouth are safe and effective in darker skin patients. She suggested that these fillers might even last longer in patients with darker skin and that her patients generally do not need another treatment for over a year. She hypothesized that this may occur because the extra pigment in the skin prevents break down of the filler material by filtering the sun's harmful rays.

So don't worry, Mr. President. In 8 years we will have plenty of tools to fix those stress-induced wrinkles and skin aging safely and effectively, but it won't be covered by your insurance plan!

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