Photoaging a concern in all skin types
Symptoms of cumulative sun damage may appear later in darker skin but can still be avoided with good care, including sunscreen use. 1,300 words, 6 minutes, 30 seconds
The impact of photoaging will usually appear later in darker skin. Still, the effects are similar across skin types, said Dr. Jaggi Rao during a discussion at the Colloquium on Black and Brown Skin on Saturday, Aug. 21. As part of that discussion, Drs. Monica Li and Juthika Thakur had some recommendations for encouraging patients with darker skin to use sunscreens.
Darker skin is less likely to develop lentigines or freckling than lighter skin, and if those features do develop, they will likely occur later, Dr. Rao noted.
He said that the development of collagen degradation, wrinkle formation, and textural anomalies “seems to be the same across the board, if not a little bit more with the lighter skin types. Darker skin types will also become a bit thinner because of the effects of solar elastosis and collagen depletion. But I do not see it as quickly as with lighter skin types.”
Dr. Rao noted it is important to remember that while dermatologists clinically organize skin into six Fitzpatrick skin types, skin tone exists as a gradient. How skin ages can depend on where a patient is on that gradient, genetic factors and other issues such as smoking and the susceptibility of the constituents of their skin to ultraviolet light and weathering, he said. “But generally, I find that darker skin types will follow [photoaging patterns] a few years after the lighter skin types.”
Dr. Li and Dr. Thakur had these insights on sunscreen recommendations in dark skin:
Avoid products that would leave a white residue. Patients will be less likely to use them.
Patients may prefer sunscreens explicitly formulated for darker skin types, such as Black Girl or Colorscience.
Patients may try blending sunscreen with a foundation that better matches their skin tone.
Sunscreens containing iron oxide may more closely match darker skin tones and can block more blue-spectrum light.
Bottom line
Dark skin may show signs of photoaging later than lighter skin, but it still should be protected from the sun. Choosing more aesthetically preferable sunscreens may encourage patients with darker skin to use sunscreen more regularly.
From the literature on photoaging
Remodelling of fibrillin-rich microfibrils by solar-simulated radiation: Impact of skin ethnicity
This study compares the direct effect of ultraviolet radiation on fibrillin-rich microfibril (FRM) ultrastructure taken from buttock skin of individuals of black African or White Northern European ancestry. The study authors note that truncation and depletion of FRMs at the border of the dermis and epidermis in the skin is a sign of photoaging.
The investigators found differences in how FRMs from the lower, reticular dermis reacted to sunlight-simulating UV exposure compared to FRMs from the upper papillary dermis. FRMs from the papillary dermis from Black African subjects also experienced more damage than FRMs from Northern European individuals. They write that their data suggest that FRMs of the dermis should be considered two distinct populations that differentially accrue damage in response to this type of radiation. Papillary dermal FRMs derived from Black African subjects show more significant change following UVR challenge when extracted from the skin.
The study concludes that more studies are needed to understand the consequences of UVR exposure on FRMs in vivo, regardless of skin ethnicity, and how these changes may affect the role FRMs play in skin homeostasis.
Efficacy evaluation of a topical hyaluronic acid serum in facial photoaging
This study included 40 females aged 30-65 with Fitzpatrick skin types I-VI and who exhibited photoaging. Each used a hyaluronic acid (HA) facial serum twice daily with sunscreen. A dermatologist investigator evaluated smoothness, plumping, hydration, fine lines/wrinkles and global appearance issues. The participants also assessed the product for tolerability.
The tolerability was evaluated as excellent, and skin hydration improved. At week six, there was also a statistically significant improvement seen in all the evaluated attributes.
Photoaging reversibility in Asian patients with melasma treated using picosecond lasers with a diffractive lens array: A 1-Year prospective observational cohort study
To assess the ability of treatment with 755-nm picosecond alexandrite lasers with a diffractive lens array (DLA), the authors of this small pilot study recruited and treated 10 women with melasma and Fitzpatrick skin type IV. Each patient was assessed before treatment and at 12, 20 weeks, and one-year post-treatment.
The investigators observed a continual and significant improvement in average Melasma Area and Severity Index (MASI) scores until the one-year follow-up. The photoaging characteristics, such as wrinkles and red areas, improved simultaneously. They did notice the treatment improved texture, pores, ultraviolet spots, brown spots, and porphyrins, but this improvement relapsed by the one-year follow-up. No postinflammatory hyperpigmentation or hypopigmentation occurred.
Sun exposure and Black skin
This review looks at the clinical and experimental literature reporting sun-induced effects on Black skin. It also touches on current misconceptions expressed by many Black individuals regarding their resistance to sun-induced effects and how those misconceptions prevent engagement in sun-protective behaviours. The authors note there is a need for more research on the effectiveness of sun protection in the Black population to clarify the harmful effects of the sun in this population.
VIDEO: Affordable anti-ageing skincare routine—Dr. Alexis Stephens
At the intersection of skin and society
Toronto’s Harbourfront Centre hosts the UNMASK FEAR art exhibit, created by Toronto-born international artist Robert Young, until Nov. 30, 2021.
According to Harbourfront Centre’s website, the large-scale public art installation is a response to the global pandemic and the international outcry for racial justice. UNMASK FEAR combines photographic portraiture with filmed stories of Black Canadians who have made significant contributions to their community, culture, and country. “Those interviewed offer personal, detailed, and uncut expressions of triumph and success achieved by overcoming their fears and following their passions,” according to the site.
UNMASK FEAR can be viewed at the east side windows of Harbourfront Centre’s main building at 235 Queens Quay West, Toronto.
The portraits and accompanying videos can also be viewed on Harbourfront Centre’s website at https://www.harbourfrontcentre.com/sandbox/unmaskfear/
This week
November is American Diabetes Month
November 1-5 is International Stress Awareness Week
November 1-7 is National Pathology Week in the UK
Something to think about in the week ahead...
Skin Spectrum Summit, Nov. 4 & 6, 2021
There are only a few days left to register for this year’s Skin Spectrum Summit, which will be held virtually this Thursday, Nov. 4, from 6:30 p.m. to 9:30 p.m., and Saturday, Nov. 6 from 10:00 a.m. to 3:00 p.m. Readers of Skin Spectrum Weekly are encouraged to register for this event by clicking here.
The conference secretariat is pleased to confirm that the Summit has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 6.75 Group Learning credits.
Since last week more faculty have been confirmed for this year’s Summit. These additional faculty include:
Dr. Andrew F. Alexis—Vice-Chair for Diversity and Inclusion for the Department of Dermatology and dermatologist at the Center for Diverse Skin Complexions at Weill Cornell Medicine in New York City.
Dr. Jensen Yeung—dermatologist and Assistant Professor at the University of Toronto, and medical director of PERC (phototherapy education and research centre) at Women’s College Hospital in Toronto.
Dr. Alika Lafontaine—president-elect of the Canadian Medical Association.
Dr. Ncoza Dlova—Dean and Head of the University of KwaZulu-Natal’s (UKZN) School of Clinical Medicine in Durban, South Africa.
Dr. Jerry Tan—dermatologist in private practice in Windsor, Ont. and an adjunct professor in the Schulich School of Medicine and Surgery, Western University.
Dr. Yvette Miller-Monthrope—dermatologist and dermatopathologist and Assistant Professor, Dermatology, Department of Medicine, University of Toronto.
Drs. Alexis, Yeung, Lafontaine, Dlova, Tan, and Miller-Monthrope join curriculum chairs Drs. Gary Sibbald, Danielle Marcoux and Jason Rivers, moderator Dr. Shafiq Qaadri, and our other new and returning faculty members.