Skincare is traditionally treated as a homogenous art. But we all have skin-tricacies that require special attention. The field of dermatology is finally starting to realize that skin of color needs to be considered in the devices made to care for skin, in the cultural training that physicians receive, and even the way that we value and appraise good skin.
Dr. Love (yes, you read that right, but we’re not talking about sex, ya filthy animal!) is a dermatology resident at NYU who is paving the way in the field of dermatology. Elyse is passionate about skin of color and as a black, female dermatologist she is really in a league of her own when it comes to caring for patients who don’t fit the beauty status quo. I sat down with her in a gentrifying Brooklyn coffee shop to talk about the field and learn more about what people of color can do to maintain a healthy glow. Sure, black don’t crack (exhibit A: Angela Bassett), but there’s work we need to do to make sure of it.
What are the main factors that people with skin of color should consider when creating a skincare routine?
The most important steps in establishing a productive skin care routine are to 1) understand and respect your skin type (oily, acne-prone, sensitive, dry, etc.) and to 2) have a goal to achieve optimum results. This is true for all skin tones.
The three biggest mistakes I see in skincare routines are using the same ingredient in multiple products, which in general is a waste of money, using good ingredients at the wrong time (ie. using retin-a in the morning), and over-exfoliating sensitive skin.
The biggest mistake I see with darker skin tones is not having a daily sunscreen in their regimen! The most important step to treat and prevent hyperpigmentation (darker areas of the face that can be caused by a number of reasons) is sun protection. I tell my patients that any dark spot will get darker in the sun. I don’t recommend starting treatment until they’re on a consistent sun protection regimen because without SPF, they’re just wasting their money on treatment.
What are the common problem areas that traditional dermatology doesn't cover regarding skin of color.
I don’t think there are any concerns that aren’t addressed by the field of dermatology, but in general, the skin conditions that have the least amount of research and effective treatments despite their high prevalence are conditions that only affect skin of color.
This includes keloids, hyperpigmentation, central centrifugal cicatricial alopecia (a type of scarring alopecia), traction alopecia (another type of hair loss), pseudofolliculitis barbae (ingrown hairs, razor bumps), and acne keloidalis nuchae (bumps that occur in the posterior scalp of men).
As the field of dermatology diversifies, these conditions will continue to receive more attention. There are a number of skin of color experts that are publishing great material every day.
Do individuals with skin of color need to worry as much about skin damage? Is there "hidden" that we should look out for?
Skin damage falls under two categories – the development of skin cancer and photoaging.
In terms of skin cancer – patients of color can absolutely develop skin cancer, particularly Asian and Hispanic patients. According to data published by the Skin Cancer Foundation, basal cell carcinoma (a type of skin cancer) is the most common cause of cancer in Caucasian, Hispanic, Chinese, and Japanese individuals. Although these cancers do occur in black patients (I have two patients I’ve taken care of this year), it is rare enough that I don’t particularly counsel my black patients on sun protection to prevent skin cancer.
Photoaging leads to decreased skin laxity, wrinkles, and hyperpigmentation, and occurs with chronic sun exposure. This isn’t just intense sun exposure that we associate with beach vacations, but the cumulative exposure of our daily commutes. For this reason, I counsel all of my patients to wear sun protection, no matter their skin color.
Currently, my recommendations for darker skin patients is to use a broad-spectrum sunscreen that’s at least SPF 30 and contains zinc oxide, titanium oxide, and/or iron oxide. These physical sun blockers protect from ultraviolet radiation and visible light. Ultraviolet radiation is known to contribute to skin cancer formation and photoaging. In new studies, visible light has been shown to cause hyperpigmentation in darker individuals.
Certain procedures, particularly those that use laser technology haven't always been safe to use on darker complexions. Are things changing? What are alternatives to these procedures that might have unfavorable side-effects?
It’s true that some lasers are not safe in darker skin tones. Each laser acts on a specific target within the skin – usually hemoglobin, melanin, or water.
Patients with darker skin tones are at increased risk of hyperpigmentation and scarring from lasers that target melanin. This is because darker skin tones have higher melanin concentrations and therefore absorb more of the laser’s thermal energy. However, lasers that target water are safe in darker skin tones. Lasers that target hemoglobin are typically avoided as there is some overlap in the hemoglobin and melanin spectrum. Depending on the patient’s specific concerns, chemical peels and microdermabrasion are additional options to treat acne scars and skin hyperpigmentation, however both of these procedures have the possible side effect of hyperpigmentation and scarring if not performed correctly. I recommend that individuals of color only have skin procedures performed by professionals who are familiar with performing that specific procedure on their skin complexion.
Tell us about your skincare routine!
My skincare routine is relatively simple. I work-out in the mornings before work, so my morning routine takes minutes. In the morning, I use a Kiehl’s gentle cleanser, 15% azaleic acid gel, Kiehl’s moisturizer, and 20% zinc oxide by Drunk Elephant. In the evening, I use a gentle cleanser, all three glossier serums (vitamin C+magnesium, hyaluronic acid+vitamin B5, nicatinade+zinc), 15% azaleic acid gel, 0.025% tretinoin cream, and glossier priming moisture rich. It’s simple, but effective.