Cosmetics and Skin Renewal

Chere Lucas, MD

Before and after removal of dermatosis papulosa nigra.

Cosmetic products and procedures are becoming increasingly popular and readily available. These services and products are designed to reduce signs of aging and sun damage. With so many options available, it can be confusing to determine which treatments will work best for you. Most cosmetic services are safe and effective in skin of color. However, there are several things to consider when choosing cosmetic services. The most common products and procedures will be discussed below as well as possible side effects.

Skin of color patients may present with specific concerns that are more relevant to this sub-population due to cultural beliefs and unique biological features which affect aging. Specifically, Asian patients are often concerned about hyperpigmented (brown) spots on the face that may develop over time. African American patients often present with concerns of deepening of facial lines and development of dermatosis papulosa nigra, a common condition in individuals with darkly pigmented skin. It consists of multiple tiny, non- cancerous, skin-colored or hyperpigmented (brown) papules on the face, neck, and cheeks. The lesions increase in number with age.

Cosmetic Products and Prescription Medications:

Skin care products that can improve signs of aging contain ingredients such as retinol, glycolic acid, antioxidants, peptides, growth factors and DNA repair enzymes. Some are available over the counter and others may be available through your dermatologist. Health experts advise everyone, regardless of skin color, to use a sunscreen with a SPF of at least 15. Although dark-skinned people won’t get sunburned as quickly, they will still burn and are still susceptible to sun-induced damage, such as brown spots, wrinkles and cancer.

Available as creams or gels, prescription medications, such as topical retinoids (tretinoin, adapalene and tazarotene) can help to reduce signs of aging by exfoliating, lightening brown spots and reducing fine lines and wrinkles. They can also help to reverse sun damage. Hydroquinone (bleaching cream) can be used alone or in combination with retinoids to lighten brown spots. A compounding pharmacy may be utilized to customize a prescription formulation tailor made to a patient’s skin care needs. Your dermatologist can suggest the right skin care routine for your skin.

Microdermabrasion:
Microdermabrasion uses small crystals to exfoliate (gently remove) the very top layers of skin. This helps to unclog pores and promote new skin cell growth. There is minimal down time after the procedure.

Chemical peels:
Chemical peels are used to resurface the skin to help with facial rejuvenation, treatment of acne and dark coloration on the skin. A chemical solution is applied to the skin, which removes the top layer of skin causing it to slough off. There are many different types of chemical peels. Superficial chemical peels are similar to microdermabrasion and remove only the very top layer of the skin. Not all chemical peels should be used in skin of color. Deeper peels (anything more than superficial) can cause dark (hyperpigmented) or light (hypopigmented) patches and can even lead to scarring. It is therefore important to be evaluated by a dermatologist ahead of time.

Lasers:
Lasers are available for hair removal, tattoo removal, treatment of birthmarks, redness, brown spots, and acne. Laser uses light at a specific wavelength to treat the skin. There are many different types of lasers depending on what is being treated. People with skin of color are more likely to get side effects with certain lasers such as lightening or darkening of the skin, burning and even scarring. Not all lasers can be used on darker skin types, so it may be necessary to test the area to be treated on a small part of the skin first. It is important to make sure that the provider treating you has experience with skin of color and the use of lasers.

Intense Pulsed Light (IPL):
Intense pulsed light is also known as a “photofacial” or “photorejuvenation”. It can be used to lighten brown spots, improve redness and improve fine lines. It uses high intensity visible light to treat the skin and is similar to laser. There is risk of scarring and permanent pigmentary changes if the IPL is used in tanned skin or darker skin types.

Botox and Dysport:
Botulinum toxin A is used to improve fine lines and wrinkles of the forehead, between the brows and around the eyes (crow’s feet). When someone squints or frowns, the skin forms lines. Over time, the lines can become permanently wrinkled. Botulinum can be injected into the muscles of the face that cause these wrinkles. This causes the muscles to relax and can soften or erase these lines and wrinkles.

Fillers:
Fillers are substances that are put into the skin to restore volume loss to create a more youthful appearance, plump lips and fill in lines. Fillers smooth the appearance of wrinkles. Most commonly, fillers are made of hyaluronic acid, which is a soft gel. Hyaluronic acid is a normal substance in the skin and is not permanent. For temporary fillers, the effects will typically resolve in about 6-9 months depending on the type of product used. Some longer lasting fillers, such as Sculptra, are also available and your dermatologist can discuss these with you.

Your doctor can decide which of the above treatments are best for your skin. In many cases, more than one treatment can be used to enhance the skin and create a more youthful appearance.

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Additional Resources
National Library of Medicine NIH MedLine: Dermabrasion, Botox
American Academy of Dermatology
US Food and Drug Administration