The OTC skincare market is large and growing. In-office dispensing remains popular, as aesthetic physicians recognize the benefits of offering patients high-quality skincare products. One area of increasing focus is on the needs of patients with skin of color. Many patients with darker skin types are concerned about avoiding irritating skincare products. Additionally, their aging skin concerns may differ somewhat from those of individuals with lighter skin. Ahead, Susan C. Taylor, MD answers questions about skincare for patients with skin of color (SOC).

The field of cosmeceuticals grew out of “wrinkle” creams, but there are many more signs of photoaging than wrinkles. Are there specific aging signs that seem more prevalent or of more concern in darker skin tones compared to lighter skin tones?

Susan C. Taylor, MD: There are several specific aging signs that seem more prevalent or of more concern in darker skin tones compared to lighter skin tones. In general, individuals with darker skin tones rarely develop fine lines or wrinkles. Rather, hyperpigmentation is a common sign of aging in this population. The discolorations may take several forms, including an overall darkening of sun exposed facial and neck skin or discrete smaller dark areas, again on sun exposed facial skin. Additionally, the skin often becomes dry and dull in appearance with a loss of radiance.

There is often a prominent loss of volume in the mid-face with sagging of the facial skin. This results in prominent nasolabial folds and oral commissures and a sunken appearance of the skin. Finally, prominent glabellar frown lines occur, but we rarely observe crow's lines. 

The field of cosmeceuticals continues to evolve, with recent advancements in antioxidants, retinols, hydroxy acids, etc. Are there any specific ingredients that may be particularly irritating or otherwise require caution in skin of color?

Dr. Taylor: Of course we want to avoid products that are irritating to the skin, particularly in skin of color patients. Irritation, which is often characterized by burning, itching, discomfort, and redness, can lead to post inflammatory hyperpigmentation in patients with darker skin tones. This discoloration may be long lasting and disfiguring. Retinoids and retinol as well as some hydroxy acids can cause this. Additionally, patients will identify and purchase various chemical peels on-line. I discourage this practice, as ingredients such as trichloroacetic acid (TCA) can harm the skin. 

“Brighteners and lighteners” may be especially appealing to patients with skin of color. Could you share some tips for effective use of such products? Any cautions? What about hair care products?

Dr. Taylor: There are a myriad of non-hydroquinone containing botanical brighteners and lighteners. Many of them are effective, but patients need to understand that the use of sunscreen really helps the efficacy of these products.

Brighteners and lighteners can be used on just about any body area. I would avoid use on the mucous membranes and on the upper eyelids. 

For tightly coiled hair that is common in many African Americans, it is important to have products that are moisturizing and do not strip the hair of the small amount of oil/sebum in this dry hair type. 

Sunscreens run the gamut from drug-store brands to high-priced office-dispensed varieties. Do you have any preferences in your recommendations to patients? Are there any special considerations for formulations you recommend? Is there patient reluctance to use SPF?

Dr. Taylor: There is reluctance for people with SOC to use SPF because they do not think that they are necessary (patients tend to have less burning and lower risk for non-melanoma skin cancer). Additionally, many SPF formulations leave an unpleasant and unsightly white film on the skin.

I find Neutrogena Ultra Sheer SPF 55 does not leave that white hue. Since SOC patients experience hyperpigmentation, which is worsened by the sun, it is important to wear SPF for that reason.

We have recently learned that sunscreens containing the ingredient iron oxide are particularly beneficial for patients with melasma, because the iron oxide blocks visible light. Visible light worsens melasma, as does UV light.