Consensus and Misconceptions Regarding the Aesthetic Skin of Color Consumer

Each month the JDD Podcast discusses a current issue in dermatology. During the month of September, podcast host Dr. Adam Friedman sat down with Dr. Andrew Alexis, Chair of Dermatology at Mt. Sinai St. Lukes and Mount Sinai West to discuss misconceptions regarding the aesthetic skin of color consumer.

Dr. Angela Hou, PGY-3 dermatology resident at George Washington University School of Medicine and Health Sciences, shares key takeaways from Dr. Alexis’ JDD podcast titled ‘Capturing Consensus and Cutting Out misConceptions regarding the Aesthetic Skin of Color Consumer’.

Key Takeaways

  • There has been a rapid increase in the past 10 years in Fitzpatrick Skin Type IV-VI patient’s seeking aesthetic skin care, however the guidelines for skin of color is limited and more clarification and guidance is needed
  • This article helps reduce the gap in knowledge in regard to skin of color. This was difficult given the lack of evidence-based studies, therefore expert consensus was necessary for deciding on recommendations.
  • A common myth is that darker-skinned patients of African descent do not seek or need injectable fillers of the lips. Although lip enhancement is less common than in other populations, restoration of lip volume is still an important aesthetic concern, albeit at an older age than among Caucasian patients
  • Another knowledge gap is regarding skin of color patients with a history of keloids and the risks of developing keloids after filler injections. However, per the expert consensus, there are no known cases of keloids induced by soft tissue filler injections. Therefore, keloids should not be an absolute contraindication to fillers and should be evaluated on a case-by-case basis.
  • Although there is a risk of post-inflammatory hyperpigmentation (PIH) in skin of color, it is often mild and transient and should not preclude patients from undergoing aesthetic procedures. Ensuring that injectables are not too superficial and using linear threading technique to minimize epidermal injury can help minimize the risk of PIH.
  • More data and better enrollment of skin of color is necessary in US based studies to gain more information in regard to safety and efficacy of aesthetic procedures.
  • It is important to maintain an individualized approach to all patients. Allow patients the opportunity to discuss their concerns before identifying the solutions to their concerns.
  • Do not make assumptions in regard to patient’s ancestral background and Fitzpatrick skin type. Ask about a patient’s response to sun exposure.
  • Proceed with caution with chemical peels and laser treatments as there is an inherently higher risk of dyspigmentation.
  • Avoidance of dryness and irritation are high priorities for skincare, as irritation can lead to dyspigmentation. Sun protection is key, especially since the rate of sunscreen use is lower among skin of color patients.
  • When treating skin of color patients who have both acne and PIH, it is important to recognize that the PIH is as important if not more so than the acne. Therefore, a regimen that addresses both these issues is necessary, such as retinoids. Once the acne is well controlled adding therapies for PIH is the next step, such as a salicylic acid peels, azelaic acid, or hydroquinone
  • Psoriasis in skin of color can often be diagnostically challenging due to the lack of erythema and lesions can appear more violaceous or brown. It can also be therapeutically challenging as resolution of the plaques typically leaves dyspigmentation, though hydroquinone formulations or a strong retinoid can be helpful. Establishing realistic patient expectations is key.

Make sure to tune in and listen to the podcast here.

Purchase Skin of Color Update On-Demand:

Skin of Color Update On-Demand

Words from the Investigator

Dr. Angela Hou also had the chance to ask Dr. Alexis a few questions on his advice to residents and the one book he thinks everyone should read:

What is one piece of advice for current residents and young dermatologists?

Embrace new professional opportunities by saying ‘yes’ to offers to collaborate on projects (eg. publications, conferences, research efforts) or serve in organizational roles (eg. Dermatological societies) and then deliver. Collaborating with established dermatologists and giving back to the specialty through service is a wonderful way to learn from experts in the field and develop long-term mentorship relationships.

What is one book everyone should read?

Messy by Tim Harford

How can dermatologists maintain an up-to-date understanding of issues related to treating skin of color?

The AAD has multiple sessions that cover core topics in skin of color. The Skin of Color Society (SOCS) has an annual scientific symposium that takes place the day before the AAD Annual Meeting and is a great way to get updates on new advances. There are also CME meetings that focus on skin of color such as the annual Skin of Color Update which offers practical approaches to dermatologic disorders in skin of color.

Did you enjoy this JDD podcast recap? Find more here.

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