Treating Ethnic Skin
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Editor's note: This post was written by Kimberly A. Carlson, RN, MSN, ANP-C, DCNP, who practices at Arrowhead Dermatology in Arizona.
Remember those great tidbits you learned at the Dermatology Nurses' Association national conference in February? I will admit that if I haven't commited something I learned at the conference to my practice yet, the time of the year when I start forgetting what I learned will quickly approach! So, bear with me as I dust off my notes and review one of the most valuable lectures I attended, focusing on cosmetics for ethnic skin presented by Elliot Battle, MD.
Battle presented attendees with valuable information that we can each apply to our different pratices. I've highlighted some of the notable topics here. One of the most interesting - and prevalent- questions was "Why is the treatment of ethnic skin different from the treatment of Caucasian skin?"
- An important first step is to ask the patient about his or her ethnicity, rather than simply looking at their skin.
- Color is determined by different levels of melanin in the skin, not necessarily more of it.
- Ethnic skin is more active than Caucasin skin.
In addition to varying treatments, people with ethnic skin have different concerns. Ethnic skin concerns include dark spots, hair removal and texture. Caucasian skin concerns include dark spots, vascular changes and rhytids.
Battle also mentioned certain things that each dermatology provider should do for each skin type. The following procedures are okay to perform on ethic skin - or treatment "Do's": chemical peels, specific lasers, infrared treatments and radiofrequency treatments.
Not every treatment is recommended for all skin types. Battle pointed out the different remedies that are more or less conducive to each skin type:
-Erythema/inflammation (in white people, it resolves, but in ethinic skin, it hyperpigments and scars)
-Don't treat vascular lesions in ethnic skin.
-Don't "resurface" ethnic skin. Whether ablative or nonablative, resurfacing induces inflammation in both skin types.
-Be conservative when it comes to ethnic skin. Treatments may include:
- Microdermabrasion: perform light microdermabrasion only
- Chemical peels: perform mild chemical peels (i.e. Jessners, Melanage mask peel, TCA 35%)
- Lasers: Avoid IPL and CO2. The best lasers are the larger wavelength (mostly for hair removal) such as diode or Nd:Yag.
*If using a laser ...
1. Treat skin with a long pulse and low energy/influence.
2. Minimize epidermal heating and heat the epidermis slowly (not above 43 degrees Celcius. This can be measured with a piston temp gauge from an auto store!)
3. Maximize epidermal external cooling (use a refrigerated water-based coupling gel or slow passes with chiller tip and an ice pack afterward).
4. Do a test spot, then wait 48 hours to see how the skin reacts.
5. Be conservative.
6. Dispel unrealistic expectations. Don't be afraid to be honest! It's okay to turn a patient away if you are not able to treat or if you don't have experience in treating.
I hope this review helps you as much as it has helped me.