Aging and Black Skin

As we age, our bodies begin to change. We begin to notice more wrinkles and fine lines. In our skin, collagen and elastin fibers that provide us with the firm, youthful look begin to weaken with time. The skin begins to lose its natural fat and that causes the skin to appear looser, more laxed, and less plump. Gravity also tends to pull the skin down further, worsening the skin sag. Skin can age more rapidly due to repeated sun exposure as well as smoking.

Many African Americans appear about 10 years younger than their stated age. This is due in large part to the extra melanin in the skin that protects the skin from the harmful UV sun rays. The more melanin one has, the more skin protection they receive. Thus, the lighter the complexion is, the greater the propensity is to age. Furthermore, less African Americans sun bathe or use tanning booths in comparison to Caucasians.

African American skin needs UV protection just as much as white skin does. You need to protect yourself from both UVA and UVB rays. UVB protection comes from SPF and UVA comes from a physical barrier such as zinc oxide and titanium dioxide. These now come micronized that they do not leave dark skin looking grey as in the past! What most people do not know is that UVA is very powerful and can penetrate through windows and is given off by fluorescent lighting, thus being indoors in your office, you are still exposed to UVA rays! Protect yourself daily and more frequently when you are out in the sun.

As African American skin ages, the biggest concerns are loss of volume (a more gaunt face), saggy skin, discoloration, and wrinkles. The loss of volume is seen because we lose our natural fat that is in our skin. Look at your pictures from your thirties and compare them to your pictures now in your fifties and sixties. The people who lose the most volume are the people who had thin faces to begin with. They treatment for this is fillers such as Juvaderm (the only filler approved for people of color) and sculptra to provide volume back to the face. It is very effective and can last 6-12 months.

The patient’s who have a more round face, may experience more sagging around the jaw line as gravity begins to pull the skin down. Using the laser tightening and resurfacing techniques can help if it is not bad, but if severe, surgery may be the only option.

Discoloration comes from sun damage that has occurred over the years. If you are lighter, you might have freckles which are a sign of sun damage, or if you are darker, you may just have patches or spots of unevenness. I tend to see more darker skin on the forehead and chin with lighter skin around the eyes and the cheek/nose area. This unevenness in skin color is also a sign of sun damage. Depending on how bad the discoloration is, treatments will vary. Topical treatments with hydroquinone 4%, a lightening gel and Retin-A, will work well for more superficial and milder forms of sun damage. For more severe sun damage, peels to lasers may be your answer. The best t thing is to see your expert and learn more about your skin and its specific needs.

Ethnic Skin: African/African American Skin

At Shanti Medical Spa & Wellness Center, we care for a variety of different people from around the US and the world. What I would like to discuss in this blog is the most common concerns that I see and hear from my African American/African patients. This does not cover the multitudes of skin conditions experienced in the world, but the most common ones seen in our clients. But before I go on to discuss this, I would like to say this category of skin, African American covers a very wide array of people. The skin hues can vary from very fair to very dark. What our clients experience, will vary depending on their genetics, their environmental exposures, and lifestyle.

In our African-American/African patients, their top three concerns are:
1. Acne
2. Discoloration or brown spots-acne scarring, melasma, freckles, etc
3. Unwanted Hair

Acne can occur in anyone and in any part of the body. Acne occurs due to inflammation in the sebaceous glands of the skin. Acne can look like brown bumps, pus bumps, large deep cyst or nodules. Inflammation occurs on the skin due to hormonal changes, friction, sweating, and stress. Taking care of the inside is just as important as taking care of the outside. So, first take a look at the common things we do: if you where hats, does your acne follow a pattern around your hat, does your hair or your hair products cause inflammation, do you see more acne where your cell phone touches your face?

Does what you eat cause acne? All the large studies in the US show no correlation to food, however what I find in my wellness program is how important nutrition or the lack of good nutrition can affect internal and external health. The majority of African Americans/Africans can not digest milk because they are lactose intolerant. Removing dairy from their diet can help clear the skin. I use elimination diets often in my clinic to help people improve well being. Processed foods cause inflammation within the body and I feel that it also causes inflammation on the face. Do your body good, and try to decrease the junk food and soda! Eating a well balanced diet rich in fruits, vegetables, whole grains, and good sources of protein and lots of water will take you far!

For African Americans, acne is sometimes related to hair follicles causing angry “hair bumps” anywhere on the body that experiences a hair removal process such as shaving, depilatories, or waxing. What aggravates my patients even more is that the scar that the acne leaves behind last even longer than the acne itself!

What I recommend for hair bumps, whether this occurs in men or women, is salicylic gel or solution. The area that is prone to hair bumps tends to be in need of greater exfoliation than other areas. Salicyclic gels/solution help the skin exfoliate faster and serve as a deterrent to new acne outbreaks in that area. I recommend to both men and women to use the gel if they get occasional break outs on the face, the neck, and even the bikini line. I like the solution if it is more severe. The side effects of salicylic acids is skin dryness, seen more with the solution. Also using Retinols in the area affected can reduce scarring over time.

What I like for treatments is chemical peels for mild acne and hair bumps. Chemical peels are natural fruit juices that have become acidic and cause the skin to exfoliate faster, reducing the outbreaks and scarring over time and can be used anywhere on the body. For more severe acne, I feel laser therapy is a better alternative. We offer two types of laser treatments: the blue light for just acne and the resurfacing laser for patients who have acne as well as scarring. Both can be used on all skin types and colors. I do recommend a lightening gel for two weeks prior to your laser treatment.

For discoloration or brown spots, we first have to understand what causes them. Most of my patients complain of discoloration from acne marks, scarring from bug bites, scratches, freckles from sun damage, as well as hormonal changes that cause sections of the skin to become dark, called melasma. Melasma typically occurs in pregnancy or after due to the hormonal changes. The treatment for discoloration really depends on how long it has been there and how extensive it is. The milder it is and the less time it has been there, the more likely it is to respond to topical medications/creams. The best treatments for this are Hydroquinone 4% and Retinols. Hydroquinone is a lightening gel that causes the skin to blend to its natural color. No, you will not look like Michael Jackson, but rather the inside color of your forearm. This is your natural skin color because very few people have exposed that area to sunlight intentionally. Retinols help the skin exfoliate faster lightening hyperpigmented areas. You must use these two for 12 weeks to notice a difference.

If the discoloration has been there for awhile, it will probably be more effectively treated with lasers or peels. I use peels for more milder and superficial pigmentation and lasers for discoloration that has been there for some time. Topical medications do not work well for brown spots that have been there for years. They may reduce some spots but not all the way. I like the fractional ablation or laser resurfacing treatment the best. It does have some down time of two-three days of redness and peeling, but penetrates deep within the skin to build new collagen and elastin over damaged areas. As with all lasers, it is best to be on a lightening agent for a few weeks before undergoing laser treatment.

Unwanted hair is another top concern. Like all people, very few of us want to be hairy and the thought of just not having to shave, appeals to all of us. Some specific concerns I have seen in my patients is that many people can not shave do to ingrown hairs, folliculitis or hair bumps. This can cause more scarring for them. Thus, laser hair removal is a great solution for people who have this problem. Another common medical condition I see that causes excess hair growth in women, is poly-cystic ovarian syndrome. Poly cystic ovarian syndrome causes irregular periods, weight gain, insulin resistance, acne and unwanted hair growth. I remove the unwanted hair with laser hair removal while modulating their hormones to permanently keep them hairless is very effective.

I will be talking about African American skin and aging. Aging and wrinkles are a whole new topic and the fastest growing segment of cosmetic medicine users are African Americans. We want to break the myth that “Blacks don’t Crack”. They can and do but usually never to the same extent as their lighter skin counterparts and usually about 10 years later. Stay tuned!

Ethnic Skin: South Asian

South Asians make up one quarter of the world’s population. The skin tones vary from very light to very dark, with many of us falling in the mid range, which we refer to as the color of “Wheat”. Being South Asian, I treat many other South Asians. What are the most common concerns I see in my patients at Shanti Medical Spa & Wellness center are unwanted hair, discoloration, and acne. This of course does not cover the wide array of skin conditions experienced in our community, but are the most common ones I see everyday.

For many South Asians, we have the genetic predisposition to have more hair than other people in the world. Our hair is thicker, coarser, and denser. There is no part of our bodies that is not affected by this! Almost 70% of the laser hair removal done today is done on South Asians even though we make up less than 2% of the population in the US. The love and desire to be hairless is insatiable in our community. It is best to start earlier rather than later. The reason is the hair that has been waxed, tweezed, and threaded responds slower to the laser than hair that is “virginal” to hair removing techniques. What hair removal techniques due to the hair follicle is it makes it crooked from the constant trauma and thus, when the laser light hits it, the whole hair follicle is not penetrated, which extends the hair removal process even longer. The earliest one can start is two years after a young teenage girl has had her period. For young teenage boys, they can start after 16, since most have started growing by then. If for whatever reason, one has not experienced pubertal changes, I do not recommend proceeding with hair removal. The body will go through a change during this time, and it is important to wait and see what happens.

When you choose a laser hair removal place, go to a reputable place that has had training working on South Asian skin. Many places literally train staff overnight and let them loose on unsuspecting clients. I think the hardest area to treat on my women patient’s is their lip area because it tends to be lighter and finer hair. It usually responds less than areas that have thick and coarser hair. Remember, because we have more hair than most people do, it will take us longer to respond to any hair removal technique than other people. Don’t worry, laser hair removal is great. I have done my whole body!

South Asians also suffer from acne just like the rest of the world. I do think that some of the acne is due to the excess hair we suffer from. I like to do a multi-faceted approach for my South Asian patients. I usually begin acne treatments along with hair removal to get the best treatments. Depending on the severity of acne, the treatments will vary. Please refer to the previous blog on what causes acne and acne treatments for more information.

For mild acne, topical treatments and peels work well. For more severe acne, laser treatments will probably help more. Talk to your local expert to see what a better treatment option is for you.

Discoloration is a common concern in the South Asian community. You can have discoloration from acne, bug bites, scratches, picking, hormonal changes, and just from aging. Treatment once again varies on how much discoloration one has and how long it has been there. For patients who just don’t want to do anything but use topical creams, I love the OBAGI line for South Asians. I use it and all the women in my family use it. It is an amazing line that helps with acne, brown spots, and slows down the aging process as well! Go to obagi.com to learn more!

For patients who have more severe discoloration, peels or lasers are better options. If the scarring has been there for years, the lasers will work better because they penetrate deeper and thus are more effective. I use the Pixel, our resurfacing laser on many South Asian patients. It is an amazing treatment that improves skin tone, texture, evenness and it even fills in soft lines and wrinkles! I love this laser for myself and my patients. To learn about South Asian skin and aging, stay tuned!