Season 1 Episode 19: Most Common Skin Issues for People of Color
As discussed in prior episodes, the skincare industry has not appropriately addressed the skin concerns of all races and often excludes people of color from skin care studies. Unfortunately, the industry’s inherent racism has caused various consequences for people of color regarding their skincare products and the knowledge of how skin conditions affect these individuals differently.
The Skin Report is a podcast created to educate listeners on methods to improve skin health for people of all ethnicities and ages. On this episode, host Dr. Sethi continues her discussion on the skincare industry and how it approaches skin products and care methods for people of color. While many products and techniques exist to treat skin conditions in individuals with lighter skin tones, people of color receive fewer resources for appropriately treating their skin concerns. This episode covers the common skin issues faced by people of color, including dyschromia, atopic dermatitis, and adult acne. Furthermore, Dr. Sethi explains how to treat these conditions in ways that are safe for melanated skin.
This transcript was exported on September 13, 2022 -view latest version here.
Skin care can sometimes feel overwhelming, whether it’s finding the right products, ingredients, or treatments. There’s a lot out there, but not always for women of color. That’s why I set out to educate myself and others so that we can all feel beautifulin our skin. Hello and welcome to The Skin Report. I’m Dr. Simran Sethi, an internal medicine doctor, mom of three and CEO and founder of RenewMD Medical Spas and Skin by Dr. Sethi. We’re going to be doing something a little different. In fact, for the entire month of September, we’ll be doing a deep dive into the relationship between people of color and the skincare industry, the past, the present, and the future. This is our third episode in the September series. So far, we’ve discussed people of color and their skin, as well as the inherent racism in the skincare industry. As a result, there’s not always a product on the shelf for women of color.
I would highly recommend going back and listening to the first two episodes as they lay a foundation of knowledge for this episode, which brings us to today. We’ll be tackling the most common skin issues that people of color face and how to treat them by working with our melanin. You may recall from last week that people of color are often excluded from skincare studies. In 2020, the JAAD, or Journal of the American Academy of Dermatology, found that over the course of the past 20 years, 75% of participants in skin studies were white. I want to chat about something else that the JAAD discovered. The JAAD was unable to find any studies of large, peer-reviewed research on skin conditions for women of color, specifically. Of the 70,000 studies conducted on these complaints, only 1.6% included skin of color in clinical studies. Now, during this time, they also combinedseveral studies to discover that the top three most common dermatological complaints in women of color were dyschromia, atopic dermatitis and acne, all three conditions that I see again and again amongst women of color in my clinics.
Today, we’ll tackle each of these as well as other issues and their potential solutions. So what is dyschromia? Dyschromia is the term for irregular or patchy skin discoloration. Now, dyschromia is an umbrella term for types of melasma, hyperpigmentation, or just dark patches on the skin. Dyschromia can also refer to hypopigmentation or vitiligo, which are light patches on the skin. This type of hypopigmentation is an autoimmune disease, which is very rare compared to the hyperpigmentation in darker skin. Cases of dyschromia impact women more often than men and women of color, more than white women. The National Library of Medicine published a survey that examined how common dyschromia can be. It stated that between 1993 and 2010, there were almost 25 million physician visits that mentioned dyschromia. Granted, this is a recorded diagnosed number. The total number may actually be far greater. I also understand that this data is older than the studies we usually reference. However, like previously mentioned, there aren’t any studies on skin conditions that only impact women of color.
While this is not specific to non-white people, it does impact them more, as I said earlier. Each type of dyschromia may be caused by different things, but they tend to deal with variations in melanin density or vascular changes in blood vessels. For example, you may recall from our pregnancy episode that pregnant women of color are much more likely to experience melasma, particularly for South Asian women. Other causes can include autoimmune diseases or post-inflammatory hyperpigmentation. As this is a pigment issue, it would make sense that those with skin types four through six would experience it more. From my practice, I’ve noticed that dyschromia of some sort is the most common reason for women of color to seek medical attention. Women start looking for solutions for dyschromia pretty early, many in their mid to late twenties. One of the most frustrating types of dyschromia is melasma, which I see tons of in all three of my clinics. Dyschromia can truly be its own episode as pigmentation problems can occur for so many different reasons. Either way, how can we fix dyschromia? More on that, when we return.
Some dyschromia, such as melasma, may disappear on its own after certain changes occur, such as giving birth. However, other forms of hyperpigmentation and hypopigmentation can be more stubborn.For example, post-inflammatory hyperpigmentation develops after acne, eczema, or other [inaudible 00:05:29]. First, I always suggest making sure a patient’s skincare routine incorporates several different elements. A gentle cleanser with AHAs, for example, helps to slough off dead skin cells and boost a cell turnover rate so that there’s room for new layers of skin. Additionally, including serums with antioxidants like vitamin C, help to truly even out the skin tone. I also like to reiterate that sunscreen is a great way to prevent more hyperpigmentation. Even if you have more melanated skin, you should wear sunscreen every day, rain or shine, as UV race can trigger hyperpigmentation. However, dark spots can still occur and may resist topical treatments. This is when I would suggest trying a chemical peel to remove the top layer of the skin where the dark spots are.
Other approaches, such as laser therapy and microneedling, also work. I would highly recommend researching your aesthetician and physician to make sure they have experience with darker skin types to avoid further issues. These approaches can help to light stubborn dark patches, but always have to be paired with a skin nourishing routine to help generate new glowing skin. Hypopigmentation, light patches on the skin, is typically caused by some sort of injury or aggressive heat based treatment. Therefore, as your skin heals, your skin will start making melanin again, and the impacted areas should recover after a few weeks or months, depending on the severity of the skin injury. The next skin condition that impacts people of color is atopic dermatitis, otherwise known as eczema. Not all eczema is atopic dermatitis, but all atopic dermatitis is a form of eczema. Atopic dermatitis, or AD, is relatively common, as it impacts almost 10 million children and 16.5 million adults in the U.S., according to the National Eczema Association.
It can flare up and disappear at different times. Patients can be plagued with eczema as an infant and can continue throughout their entire lifetime if not properly addressed. While we are not quite sure what causes an individual to develop AD, we do know that it is a result of an overactive immune system. We also know that flareups can be triggered or worsened by stress, lack of sleep, unhealthy eating, and not moisturizing consistently. It can also be triggered by detergents, soaps, fragrances, dust, pet dander, and more. AD is morethan just a skin rash. It can greatly influence someone’s quality of life, if not treated and managed. It can be painful for some, especially children, and get in the way of participating in work, school, activities and more. This is a big topic that impacts people of all ages, ethnicities and skin tones. When we return, we’ll dive into the struggles of atopic dermatitis for people of color and what we can do about it.
When we hear about atopic dermatitis, or eczema, we often imagine dry, itchy, red skin. However, this picture only aligns with white patients who experience AD. For people of color, eczema can appear purple, brown, or grayish while still being itchy or dry. Unfortunately, people of color are often underdiagnosed, misdiagnosed, or never diagnosed, even though it is more common in people of color than it is in white people. Just because their eczema does not look red as described in medical textbooks, many providers fail to properly recognize it, and as a result, it remains untreated for a whilebefore it worsens. This is exactly why it’s important for providers to be educated on how different diseases present in different skin tones. As a patient, it’s also important to try and seek out providers who treat various skin tones.
Eczema and Skin of Color is a website sponsored by Pfizer that seeks to provide education for families, doctors, schools, and more. They’re a great resource for diagnosis and treatments, images of eczema in dark skin, publications and more. They have also combined and summarized the few studies that have been done in people of color with atopic dermatitis. Through this, they discovered in 2020 that Black and Hispanic children develop more severe cases of AD than white children and are more likely to miss school because of this. In people of color, a vicious cycle can develop. The AD causes itchiness, but when patients scratch themselves for relief, they aggravate the rash and also cause post-inflammatory hyperpigmentation, which we just discussed. A lack of diversity in medical training is not the only thing that leaves some children or adults more vulnerable to AD. Factors such as access to care, income, housing conditions and language barriers can lead to AD going unchecked and untreated.
However, there are some steps we can take to avoid and treat AD. First, I’d like to reiterate that AD is a reaction, a sign of an overactive immune system. This means that your skin is being triggered by some sort of allergen, such as dust, fragrances, food or more. Seeing an allergist is thebest course of action to try to identify what your triggers are and to avoid those triggers. I also recommend moisturizing daily. There are specific moisturizers that have the strength to better handle eczema, psoriasis, and more. Prioritizing your physical and mental health can also help reduce outbreaks as good sleep, a balanced diet and more can help to restore the skin. If you do experience hyperpigmentation as a result of atopic dermatitis, I can help treat those conditions at my medical spa once the AD has calmed down. There are a number of solutions, depending on the severity and areas of hyperpigmentation left behind by the ad flareups.
Acne is a common plight for many Americans, including adults. In our fourth episode, we took a look at adult acne,it’s prevalence, stubbornness and more. For example, JAMA Dermatology, a peer reviewed medical journal by the American Medical Association, revealed 54% of women and 40% of men older than 25 report some degree of acne. Several studies have shown that acneis the most common dermatological diagnosis in non-Caucasian patients. For people of color, acne needs to be treated in such a way that works with their melanin. And as we know from this series, most products are made without melanin on the mind. Harsh ingredients can further aggregate the issue and cause new ones in people of color, such as you know it, hyperpigmentation, as well as acne scars and more.
The Journal of Clinical and Aesthetic Dermatology examined adult acne in women of different races. Published in 2014, one set of data found that clinical acne appeared in Black American women at a rate of 37%, Hispanic Latina women at 32% and Asian women at 30%. This is more prevalent than what was found for white women at only 24%. So what can women of color do to prevent and treat acne? When it comes to active ingredients, I always recommend starting low and slow, especially for more melanated skin. Just because you have acne does not mean you should completely deplete your skin of moisture. Take a balanced approach to oil reduction so that the melanocytes are not inflamed and produce more melanin in response. We discussed this in our previous episode, but I also highly encourage women to incorporate retinol in their nighttime skin routine, starting with a low strength and only every couple of days a week.
Not only is retinol great at smoothing wrinkles, it also helps to clear pores and reduce inflammation, leading to clearer, brighter skin. Just remember to follow up with moisturizer as retinol does dry outskin, and this can result in increased pigmentation in darker skin. In fact, this issue with retinol is what made me develop the retinol lipid complex in the Skin By Dr. Sethi line. My retinol is a medium strength medical grade retinol that is combined with lipids to prevent overdrying and peeling of the skin, but instead nourishing it with skin barrier building lipids with the retinal formulation. Skin of color can also benefit from utilizing a low dosage of benzoyl peroxide, such as 2.5%. This can help kill a bacteria that causes acne. Like retinol, a higher dosage can cause dryness, flakiness, and irritation, worsening the acne. So like with retinol, follow up with moisturizer and be sure to start slowly. Also, remember, benzoyl peroxide will not bleach your skin, according to the American Academy of Dermatology Association. It will, however, bleach fabric such as sheets, towels, and clothing.
Acne and skin of color could be its own episode, but for now, I will say that more often than not, an aggressive approach to acne can worsen the condition and trigger scars in hyperpigmentation. So when choosing your skincare routine, opt for gentle cleansers and exfoliants, as well as acne products that have a low percentage of retinol, benzoyl peroxide, salicylic acid, and more. Monthly facials and other of 4medical spa services can also help to treat stubborn acne. If you do happen to develop hyperpigmentation and acne scars, we can help with that too, no matter how much melanin you do or do not have. I hope you can tune in next week to hear the conclusion of her September series, Skin Solutions for Skin of Color, and where the skincare industry is heading as a whole.
If you’d like to learn more about science backed skincare or medical aesthetic treatments, please subscribe to and turn on notifications for The Skin Report, so you always know when a new episode is up. We have a newsletter that you can sign up for on TheSkinReportbyDrSethi.com, so that you can stay up to date on all our new episodes, blogs, products, and more. Additionally, if you have a skincare question or want to make an episode topic recommendation, please message me at renewmdwellness.com, which is linked in my show notes, and I’ll be sure to answer your question in an episode soon. Thanks for listening in, until next time. Love the skin you’re in and celebrate your beauty.