All skin types need a balanced and carefully thought through approach. However, black skin needs even more consideration due to insufficient knowledge/expertise available for people with darker skin tones, particularly relating to post inflammatory hyperpigmentation, scarring and keloid. The physiology of dark skin is different and how melanin is distributed in the skin. The course of treatment is varied depending on the skin concern. With the recent increase in use of retinols, AHA’s, and electrotherapy facial and body treatments, it is important that people have a working knowledge not only on what these treatments can achieve but also potentially what harm they can do depending on skin tone.
The two most common skin conditions among deeper complexions or dark skin are hyperpigmentation and acne scarring, according to Dr. Carlos Charles based in New York. The main reason for this is due to melanocytes or pigment cells. In darker skin tones, the melanocytes are stronger, which means they can produce colour more easily leading to stubborn hyperpigmentation. This can occur as a response to external trauma, like squeezing a pimple too hard, from sun exposure or as a result of inflammation from rashes or acne. It could also be hormonal in some cases.
With the little bit of science background in the preceding paragraph on how these conditions occur, let’s discuss how to treat it generally with emphasis on a darker skin tone. Several myths suggest that to get rid of acne scars, one must exfoliate several times a week. This is not true as in doing that you will and may be causing more scarring as with repeated exfoliation, and if one is using micro beads, this can cause thickening of the skin thereby worsening the skin condition.
Scarring affects different levels in the skin and use of AHA’s with different molecular sizes can penetrate into deeper levels of the skin. However, acids with small molecular size like Glycolic, for instance, may not work well with someone who has a dark skin tone and has sensitive skin. Other acids can work better like lactic acid which has larger molecule. Aestheticians must ensure when working with dark skin tones that they don’t burn and fry the skin which will cause further pigmentation issues. We do want to go down to the deeper layers of the skin, but we don’t want to burn the skin. And good working knowledge of dark skin is important when using Alpha Hydroxy Acids (AHAs) and retinoids etc. Skin needs to heal i.e. tackle dehydration before extractions so as not to damage the skin. Trying to extract on a dark skin tone that needs hydration will bruise skin as the sebum trapped underneath will not come out easily and can exacerbate hyperpigmentation conditions and this can be very serious especially on a dark skin tone.
Skin care needs to be carefully planned and prioritised, especially with dark skin, to avoid pigmentation and uneven skin tone. For instance, you must not do a peel when the skin is not ready and main issues like surface dehydration and oiliness underneath have not yet been tackled. I always say to people:
“this may mean seeing the client a couple of times over a period of time.”
everything in one consultation. A healthy skin heals better and will absorb treatment products well. It’s a bit like building a house on a weak foundation; the foundation needs to be strong in order to achieve the overall aim. This is especially true when treating hyperpigmentation or acne scarring. This needs a step-by-step approach as the skin is prone to even more hyperpigmentation if not treated correctly. When possible conditions like surface dehydration with oiliness underneath have been treated, AHA’s can then be used and recommended in the home care regime. As skin heals, doing a peel can be considered.
Often, when there is infection in the skin, brown spots need to be treated before the scar can go away with appropriate products and treatments. To effectively treat hyperpigmentation, it is important to be able to identify the different types which could present, such as: post-inflammatory hyperpigmentation, melasma, sunspots, age spots, acne, bug bites, and hormonal changes. Unlike PIP, it is much easier to treat the lighter types like age and sun spots, but it does require consistency and maintenance. You can treat and lighten them significantly but if you neglect them, they will come back. Melasma appear as splotchy patches on the face and they have an almost map-like appearance and usually appear on the sides of the face, forehead and bridge of the nose. This is usually caused by combination of sun plus surges of hormones like pregnancy or starting birth control. This is the hardest form of hyperpigmentation to treat as it takes longer to fade and the worst part is that can come back so easily.
Watch out for hydroquinone, as it has been banned in some countries as continuous use has been known to cause cancer. It also cannot be used for more than 8 weeks as this upsets the melanin cycle and makes the skin prone to producing much more melanin. It is not to be used long-term.
Treating hyperpigmentation requires consistency and patience. If you don’t have patience and you want faster methods that may be available, like lasers and professional chemical peels, depending on the type of pigmentation issues these may not be easily accessible to everyone.
This article aims at going through what works. The good news is that these days, there are products and ingredients that work to provide effective treatment and I will go over which ones really work for each different type of hyperpigmentation.
What works?
- Sunscreen is a no brainer when we are talking about hyperpigmentation, as it is all about melanin and UV rays from the sun encourage melanin production. So one must use sunscreen of at least 30 SPF broad spectrum.
- Alpha Hydroxy Acids are also good at dealing with hyperpigmentation. They really help with sun damage by increasing cell turn over in our skin which in turn will end up fading dark spots.
- Retinoids are also good at reversing sun damage by encouraging cell turnover; but, when using retinols and AHA’s, you need to be very careful and protect your skin with a good sunscreen.
- Vitamin C protects against sun damage and lightens and brightens the dark spots. You will need to be using ascorbic acid of approximately between 10% and 20% for it to work effectively.
- Ingredients like kojic acid, alpha arbutin (used in many Asian whitening products), liquorice root extract and niacinamide also work well and are melanin inhibitors which work best together.
These ingredients will help treat hyperpigmentation no matter what form it comes in from the easiest to the most difficult to treat.
PIH-Post Inflammatory Hyperpigmentation can be effectively treated with some good acids and Vitamin C serums, and other melanin inhibiting solutions. You don’t actually need retinol to treat this type of hyperpigmentation.
When we talk about ageing and sun spots, retinols can make a big difference together with regular AHA treatments, Vitamin C and other melanin inhibiting solutions.
Melasma is probably the most resistant form of hyperpigmentation to treat as it can come back easily once neglected, so one has to be consistent. Chemical AHA treatments are good at treating melasma, as are Vitamin C and any combination of the melanin inhibiting ingredients mentioned above.
My own skincare range will be coming out soon; it was born from a lack of awareness and information of acne scarring and hyperpigmentation issues that are common on most skin types, but especially on darker skin tones. SB skincare range has a cleanser with glycolic acid, vitamin C and retinol, which are all amazing ingredients for pigmentation on most skin tones.
