Skincare with Friends Episode 72- Skincare for People of Colour- Hyperpigmentation

Today we’re talking about skincare issues facing people of colour. I saw a post on Reddit (as I do) where a person of colour was bemoaning typical responses to  questions from darker skinned redditors on skincare addiction. Her post went like this- “Every time I look up body skincare tips for dark skin on this sub (not to bash this sub because this is an internet wide trend I’ve noticed), every other comment is “oh, that’s normal for poc/dark skin! Don’t worry about it babe. Just because something is common doesn’t mean that someone needs to be dissuaded from fixing it or offered no info at all about what to do. Acne is common. Wrinkles are common. People asking for advice need advice”.

Now my husband said that I shouldn’t be talking about brown skin because I’m not brown. Which is true. I can’t speak from personal experience but I’m sure we have listeners with darker skin and I bet they’d like to hear about what scientific research has to say about their skin. I’m going to try not to patronise anyone by telling them which skincare they should use when I have no experience of your skin type, but I WILL bore you all by reading out studies about TEWL and compact corneocytes.

When I did my Post Grad Diploma in Cosmetic Medicine, we talked about Fitzpatrick Skin Types. Fitzpatrick Skin typing is a way to categorise skin colour, it’s particularly useful when prescribing cosmetic treatments like chemical peels. For darker skin types, you have to use certain treatment with caution, we’ll get into that later. Here we have the chart-

The Fitzpatrick scale might be seen as reductive, it’s not a perfect way to describe skin colour, but it’s what most clinicians use.

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Dermatological/Medical Racial Disparity

We know there are issues with representation, Nat discussed this with her friend Nic, this is what she has to say to the question- 

“How well represented your skin is in general by brands offering treatments and products?Things were improving and I think post BLM they continue to do so at a faster pace, certainly in make up at least there has been a lot more choice for several years now and this continues to improve. However skin care specifically targeting darker skin was not on my radar, any knowledge I have of it is solely from you skin care posts . So personally I don’t know if this is a lack of products issue or a lack or marketing issue but lets just base this on Boots for example, I don’t see ANYTHING in Boots specifically for my skin and in 2022 that’s crazy. Also until seeing your posts I had no clue you could even get SPF for darker tones without the hideous white hue, so this definitely needs a HUGE marketing push. Winds me up tbh its like tights, a nude tight to you is not a nude pair to me, same with shoes , make up etc – In 2022 BAME people should not still be limited to generic white skin tone based product ranges….”

Nat’s Friend Nic

From Dija Ayodele’s book “Black Skin”“there is a misconception that black women prefer “natural”skincare, or tend to spend less money on skincare are untrue.  Black British women spend more than white women (£137 more per year). In addition, 70% of Black and Asian women feel left out of high street offerings and more than 35% felt that advice for their skin tones was lacking.”

Also, when I started researching this topic, the first thing I came across in a study which looked at how well dark skin is represented in dermatologist photography was this statement “Although the incidence of most skin cancers is lower in individuals with dark skin, these patients often have worse clinical outcomes, including disproportionately higher morbidity and mortality.” Which I found very shocking. 

The study found that skin conditions on black skin are poorly represented in medical imagery. Though there is better representation online. This is going to mean that doctors and dermatologists are going to be less familiar with the appearance of dermalogical conditions in darker skin. (Alvarado and Feng, 2021)

Delving a bit deeper into the disparity in the outcomes for those with darker skin-

“The 5-year melanoma survival is 74.1% for blacks compared with 92.9% for whites.” A 2012 study by Buster et al based in Alabama noted that people of colour were less likely to seek medical assistance for skin issues and outcomes were poorer (Buster et al, 2012)

This was a very American centric study and mentioned access to health and insurance as barriers which might not be the case in the uk. 

It was quite hard to find out the specific survival rates from melanoma in the uk comparing whites to non-white but it looks like non-white populations have a similar cancer survival rate. 

Saying that, I found this statement re medical disparity

“a recent UK study examining the uptake of healthcare services by children and young people from minority ethnic groups revealed that ethnic minorities received a poorer quality of healthcare compared to the Caucasian population,” and “(Black and South Asian women experienced longer delays than White women for breast cancer diagnosis”

(Lane and Beevers, 2007). 

Is Black Skin Actually Different to White Skin?

We’re speaking very broadly here. There is no one “black skin”. Skin will differ from person to person, depending on weather, time of year, time of month. We’re going to have to generalise a bit for simplicity’s sake. What we know-

• Unsurprisingly, dark skin tends to have more melanin and more melanosomes. Darker skin has more eumelanin as opposed to pheomelanin.
• Black skin has a lower average pH. One study of 1000 black Nigerians found the average pH to be 4.87. 
• Dark skin ages better than white skin (Warrier et al, 1996)
• Black skin has the same thickness but the upper layers of the skin are more compact (Rawlings, 2005)

There are a lot of studies and in trying to get information about the differences between skin in relation to colour/race/country of origin/ethnicity/country of dwelling there is a lot of contradictory evidence.   

Hyperpigmentation

There has been a history of people resorting to using “bleaching creams”, such as hydroquinone (in some regions, >4%), class 1 and 2 corticosteroids, mercury, phenolics, caustics, and other unknown plant and chemical derivatives. With unfortunate side effects such as skin atrophy and fragility, telangiectasias, dyschromias, exogenous ochronosis, acne, skin infections; may induce serious systemic complications such as Cushing’s syndrome, renal impairment, and neurological problems (Alam et al, 2008, p6). 

The gold standard for treating pigmentation is Hydroquinone for all skin colours, it should always be used under the supervision of a dermatologist for ultimate safety. There are lots of other ingredients that can help to a less reliable extent (tretinoin, kojic acid, tranexamic acid, Cyspera, Vit C.) and you can check these out in our other melasma episodes. There are also light based treatments like IPL and Laser as well as chemical peels, but you have to take care with these. On the pod, we interviewed my friend Cara, who is half Irish, half Guyanese and has had a melasma journey. Check out her Instagram- @makeup.in.maroochydore.

Cara’s top pick for treating melasma is Hydroquinone. She has tried IPL and chemical peels and didn’t get results. She has used Dermatica and is now using John Plunkett’s Superfade Treatment Cream and Accelerator, which is available in Australian chemists.

Post Inflammatory Hyperpigmentation

One of the most challenging things about treating skin disorders in darker skin is the propensity for dark skin to PIH. Post Inflammatory Hyperpigmentation happens in response to anything that causes irritation. It’s an issue which makes treating darker skin types more complicated. You have to be very careful using anything that heats up the skin (like laser or IPL) or exfoliating acids like glycolic.

You can tell if you are prone to PIH if things like spots or insect bites tend to heal leaving brown spots. If you’re going to get any treatments that chemically or thermally irritate the skin (like peels, IPL or laser), find a practitioner who is confident to treat people with your skin colour. I’m not going to really get into different types of lasers because that’s another episode on it’s own. The main thing is finding a practitioner competent and experienced in treating skin like yours. Have a good conversation with them about cases they have done before, to make sure they will know what energy and time settings to adjust to.

Something you can do to help prevent PIH before an irritating treatment is to prime the skin. This means using tretinoin or glycolic acid and hydroquinone for 6 weeks before the procedure to get the skin in good health and your melanocytes chill and lazy prior to the procedure. 

We’re going to continue our Skin of Colour series on our next episode on Acne.