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Delicate darker skin Sensitivity, hyperpigmentation key concerns

Article-Delicate darker skin Sensitivity, hyperpigmentation key concerns

National report — When treating patients with darker skin types, cosmetic surgeons and dermatologists should keep in mind a broad range of variables and unique challenges pertaining to medical as well as cosmetic issues, Manjula Jegasothy, M.D. tells Cosmetic Surgery Times.

An increased level of skin sensitivity, for instance, can be an unexpected challenge in patients with darker skin.

"Many people do not realize that darker skin types can be more sensitive than lighter skin types in many ways," says Dr. Jegasothy, director of the Miami Skin Institute and assistant clinical professor at the University of Miami Department of Dermatology.

"Topical regimens need to be tailored to accommodate this fact," she says.

For example, when treating darker-skinned patients with acne, the hyperpigmentation that acne papules leave behind can last much longer than the inflammation itself and cause more frustration than the actual condition for some patients.

"Care should therefore be taken to address the issue as quickly as possible in order to enhance patient satisfaction," Dr. Jegasothy advises.

Handle with care

Eczema is not only more of a problem in patients with darker skin types, but it is more common among these patients as well. In addition to being more difficult to treat, the condition can cause more hyperpigmentation and skin sensitivity.

Particular care should be taken when using lasers and other treatments that cause bruising, as inherent differences in melanin content and distribution may lead to problems such as increased hyperpigmentation.

"Darker skin types are well known to be more sensitive to lasers and have a myriad of more adverse events associated with laser and other treatments that can induce bruising," Dr. Jegasothy says. "So adjustments need to be made when performing these procedures on darker skin types to accommodate this."

Testing imperative

Doctors may assume that darker skin will respond in the same way as lighter skin to identical treatments, when, in fact, there could be big differences. Dr. Jegasothy recommends performing tests more frequently on darker skin types before performing an entire treatment.

"It is a good idea to be less aggressive with therapy at the outset with darker skin, and then increase treatment as time goes on and there has been a greater opportunity to evaluate the individual skin type tolerance level," Dr. Jegasothy says.

To manufacturers' credit, lasers and light-based therapies have begun to take into consideration the wide variety of skin types, and newer techniques such as fractional resurfacing with Fraxel and radiofrequency tissue-tightening with Thermaget continue that progress.

"The interesting thing about many of the newer lasers is that manufacturers have finally seen the need to make the devices safer for darker skin types," Dr. Jegasothy says.

False security

Darker skin is known to have a greater skin protection factor due to the increased epidermal melanin, and very dark skin can filter about twice as much UV radiation as white skin. But the protection can give patients with darker skin a false sense of security. A study released last summer found that, while skin cancer is less common in blacks and Hispanics than among Caucasians, those with darker skin are more likely to be diagnosed with melanoma at a later stage (Arch Dermatol. 2006;142:704-708).

A key factor believed to explain the later diagnoses among darker-skinned individuals is simply that many preventive and early detection efforts are geared to fair-skinned people, who are at a higher risk for melanoma than those with darker skin.

The take-home message from the study is that darker-skinned patients should be urged to self-check for skin cancers, and doctors themselves should also use more diligence in screening such patients.

"Evidence suggests that secondary prevention efforts such as skin cancer examination are suboptimal in Hispanic and black populations," conclude the authors.

"Although varying cultural values may account for some differences in healthcare use, public education regarding melanoma risk in black and Hispanic persons and delivery of skin cancer screening and examinations represent the main potential areas of intervention to improve the stage at diagnosis of melanoma in these populations," they wrote.

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