Cosmetic procedures viable in all skin types
Changes to approach and timing may be needed, but people with richly pigmented skin do not need to avoid any procedures (1,300 words, 6 minutes 30 seconds)
Individuals with very dark skin are at elevated risk of some complications from cosmetic procedures—particularly scarring and pigment changes—but that does not mean they should necessarily avoid these procedures, said Dr. Monica K. Li.
During a discussion at the Colloquium on Black Skin on Saturday, Aug. 21, Dr. Li said that patients and physicians could take additional precautions and achieve good outcomes. Dr. Li is a medical and cosmetic dermatologist in practice in Vancouver and Surrey, B.C.
“I think that with cosmetic procedures in skin types five and six, brown and black skin, it is important to have a good informed, thorough discussion. Inherently these patients will have an increased risk of post-inflammatory dyspigmentation and keloid scarring,” she said. “I do not think that patient populations in these groups should be restricted or limited necessarily regarding elective procedures. That informed consent process is important so that we can gauge and set expectations that are appropriate as the outcomes of the procedure.”
“I think it's too broad to say that there are procedures we need to avoid [in patients with darker skin],” Dr. Li said. “But having that discussion process and setting expectations is an important part to set us up for successful outcomes.”
In her practice, Dr. Li sees many patients with brown Asian skin types and some with Black skin types. These patients are seeking a full range of cosmetic dermatology procedures.
“Year-round, I would say that there is no one type of treatment that is more popular than another. All of us will show signs of ageing and signs of sun damage as we get older. So these are concerns that all patients across the skin spectrum may have,” she said.
Dr. Li listed a few steps she uses to avoid or minimize unwanted changes to the skin:
Not offering laser- and light-based interventions during the summer to reduce the risk of sunlight-induced pigment changes
Ensuring patients are cautious about sun exposure for a minimum of one month before laser- or light-based procedures
Choosing the right fluences and exposure times for energy devices for the patient's skin type
Silicone gel sheets can be used after procedures to reduce scar development
Bottom line:
While some additional care may be needed for some aesthetic procedures in patients with darker skin, there is no reason for these patients to avoid particular treatments.
From the literature on cosmetic dermatology
PrabotulinumtoxinA for the treatment of moderate-to-severe glabellar lines in adult patients with skin of colour: Post hoc analyses of the US phase III clinical study data
This post hoc analysis examined data from the pooled population of all 492 patients treated with 20U prabotulinumtoxinA in the two US single-dose Phase III glabellar line clinical studies. The post hoc study's authors grouped the patients by Fitzpatrick skin type into a skin of colour (SOC) group (skin types IV, V, and VI) and a without SOC group (skin types I, II, and III). Patients were grouped by Fitzpatrick skin Type: IV + V + VI (with SOC) versus I + II + III (without SOC).
Fewer patients in the SOC group responded to the treatment—measured as a one-point or more significant improvement in the 4-point Glabellar Line Scale—but the difference was not statistically significant. Rates of adverse events were similar between the two groups as well.
Treatment of rhinophyma with fractional CO₂ laser resurfacing in a woman of colour: Case report and review of the literature
This paper presents the first reported case of rhinophyma in a 62-year-old female patient with Fitzpatrick skin type V who was successfully treated with one session of fractional CO₂ laser resurfacing. The authors write that the case demonstrates the efficacy of this treatment approach to safely treat rhinophyma in patients of colour while improving their health, well-being, and cosmetic appearance.
The paper also includes a discussion of the literature on rhinophyma in different Fitzpatrick skin types. They note that the condition is considered exceptionally rare in skin types V and VI.
Combined treatment of rolling acne scars in ethnic skin using extensive subcision, trichloracetic acid peel, and fractional ablative erbium laser
This retrospective study included 56 patients with predominantly rolling acne scars and Fitzpatrick skin types IV-VI. The patients' scars were treated using a combination of tumescent anesthesia, extensive subcision, fractional ablative erbium laser, and a blending 20% trichloracetic acid (TCA) peel.
The study investigators found that a single treatment session with this approach resulted in an average 2.52 point improvement on a scar scale of 1 to 4. There were some temporary adverse effects, but the investigators noted these were considered acceptable.
Comparison of fractionated frequency-doubled 1,064/532 nm picosecond Nd:YAG lasers and non-ablative fractional 1,540 nm Er: glass in the treatment of facial atrophic scars: a randomized, split-face, double-blind trial
A total of 22 patients with Fitzpatrick skin type IV were included in this split-face study. Their average age was 29.68 years, and they had acne scars for an average of 8.8 years. The patient's scars were treated with either fractionated frequency-doubled 1,064/532 nm picosecond Nd:YAG laser or non-ablative fractional 1,540 nm Er:glass laser.
The investigators reported that the picosecond laser had an impact on all scar types, and in particular, resulted in a more pronounced effect on ECCA score (echelle d'evaluation clinique des cicatrices d'acne) in V- and U-shaped scars than the non-ablative laser did.
Erythema was reported more frequently on the facial sides treated with the picosecond laser, but edema, exudation, purpura, pain, and long-term adverse events were similar between the two treatments.
The paper's authors conclude that the fractionated frequency-doubled 1,064/532 nm Picosecond Nd: YAG laser showed better efficacy in treating acne atrophic scars than the alternative. They also note the picosecond laser provided satisfactory safety and improved pores and the skin's glossiness.
VIDEO: Is laser hair removal permanent, safe, worth it? Dark skin, side effects, cancer, home lasers, burns
At the intersection of skin and society
Work has started on a new eight-part documentary series to explore 400 years of the Black experience in Canada.
The series, titled Black Life: A Canadian History, will air on the CBC in 2023.
Involved in the development and production of the series are showrunner Leslie Norville of Studio 112 , Northwood Entertainment's Miranda de Pencier, former Governor General Michaëlle Jean and rapper-broadcaster Shad. The latter two are cultural consultants.
In a press release from the CBC, Norville said: “The docuseries will be an honest and nuanced look at Black Canadian history–and while some may find this uncomfortable, it’s critical to understand and grapple with the complexities of Canada's past.”
“I couldn’t ask for a more talented team to help bring this rich history to audiences and to explore and celebrate the stories and people whose contributions have shaped the country we know today. Miranda and I are delighted that Black Life: A Canadian History has found a home at CBC and value their support and enthusiasm for the project.”
This week:
Sept. 30 is National Day for Truth and Reconciliation in Canada
Oct. 1 is International Day of Older Persons
October is Healthy Workplace Month in Canada
Something to think about in the week ahead:
Looking ahead:
The 7th Annual Skin Spectrum Summit has confirmed the support of several new and returning dermatology partners.
The conference secretariat is delighted to be working with Pfizer Canada Inc., L’Oréal Canada and AbbVie, as well as Amgen Canada Inc., Arcutis Biotherapeutics, Leo Pharma Inc., Cipher Pharmaceuticals Inc., Proctor & Gamble Canada, Sanofi Genzyme Canada Inc., ERFA Canada 2012 Inc., Molnlycke Health Care, Perfuse Medtec Inc., Sun Pharma Canada Inc., and Vivier Therapeutics.
Skin Spectrum Weekly will continue to inform our readers as new partners are confirmed.
The Summit, Canada’s leading ethnodermatology medical conference for physicians, will be held on Nov. 4 and 6, 2021.
Skin Spectrum Weekly will bring you more news on faculty and topics for this year’s Summit as we get closer to the date.
Register today for the conference or find more information on the 2021 and prior Summits at SkinSpectrum.ca