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!