JUST SEE ME! PIGMENTATION SOLUTIONS FOR HIGHER FITZPATRICKS

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1 1 2 3 JUST SEE ME! PIGMENTATION SOLUTIONS FOR HIGHER FITZPATRICKS Just See Me! Diversity AESTHETICS Training! 20+ years! Advanced Aesthetics Diversity Consultant and Trainer! Professional Speaker! Aesthetic Medicine Conferences! Aesthetics Trade Shows! Author! Natural Radiance A Guide to Ethnic Skin PIGMENTATION SOLUTIONS FOR HIGHER FITZPATRICKS " The intent of this presentation is for learners to:! Explore the influences of cultural practices and beliefs and how they impact treatment modalities! Science related to the process of melanogenesis! Explore the classifications of pigmentary disorders! Summarize best practices based on current research findings 4 5 WHAT IS ETHNICITY? " A social construct based on nation origin and phenotypic pigmentation (or skin of color) " Darker-skinned populations (tan, olive, brown and black) constitute the majority of the global population. " Hispanics, Latinos, Africans, African Americans, Caribbeans, Native Americans, Pacific Islanders, East Indians, Pakistanis, Eskimos, Koreans, Chinese, Vietnamese, Filipinos, Japanese, Thai, Cambodians, Malysians, Indonesians and Aleuts. 6! Hispanics buying power has reached $1.7 trillion dollars! 19% of U.S. buying power "African American spending over $1 trillion dollars on beauty 1&

2 " African American spending over $1 trillion dollars on beauty products. 5 times more than the general public " Asian Americans are the most affluent ethnic group, spending their fair share of the income on skin care products. There median income is over $91,000. " Past 10 years ethnic patient has become a contributing factor in the growth of aesthetic medicine " According to American Society for Aesthetic Plastic Surgery 25% of the 15.9 million surgical and non surgical esthetic procedures were provided to ethnic patients " Understanding cultural beliefs are critical to gaining the patient s trust and respect establishing a relationship ultimately benefiting the patient " Little has been published on how cultural influences affect response to treatment modalities " Physicians should ask about the use of home remedies " Home remedies and folk medicines may interact with prescription drugs. African American Home Remedies " Dry Skin! Cocoa butter! Shea butter! Vaseline African American Home Remedies " Acne! Vicks Vapor Rub! Worsens acne " Alcohol To dry out darkly colored necks, dark pimples and razor 2&

3 " Alcohol! To dry out darkly colored necks, dark pimples and razor bumps " BenGay! Firm sagging neck and treats cellulite African American Home Remedies " Milk of Magnesia! Facial mask to treat acne and smooth texture of skin " Urine from babies! Clear fungus and treat acne ASIAN HOME REMEDIES " Traditional Chinese Medicine! Employs herbs! May cause allergic reaction Hispanic/Latino Home Remedies " Physicians have limited knowledge of botanicals and their interaction to pharmacologic agents " Understanding the structure and function of a higher Fitzpatrick opens up a wide variety of treatment options tailored for this patient MELANOGENESIS " Skin color begins with a process called melanogenesis " Melanocytes, melanosomes and keratinocytes are the key players of skin color. " Melanocyte are stem cells, which are responsible for regeneration of melanocytes, a type of pigment cell. " Every skin type has the same amount of melanocyte cells. MELANOGENESIS " The pigment cell, melanosomes, are produced within melanocytes. "Having darker skin means a larger concentration of pigment 3&

4 melanocytes. " Having darker skin means a larger concentration of pigment cells. " Skin continually renews and repairs itself. " Keratinocytes are stem cells that constantly regenerates skin with regeneration beginning in the basal layer of the epidermis MELANOGENESIS Global Skin Type 3-6 vs. Global Skin Type 1-2 MELANOGENESIS Global Skin Type 3-6 vs. Global Skin Type 1-2 CAUSES OF INCREASED MELANIN PRODUCTION " Hyperpigmentation! Ultraviolet exposure! Melasma! Solar lentigines! Ephelides! Photosensitizing agents! Medications and supplements! Tetracycline, Ibuprofen, St. John s Wort CAUSES OF INCREASED MELANIN PRODUCTION " Hyperpigmentation! Skin diseases and conditions! Actopic dermatitis! Melasma! Systemic disorders! Cancer TOOLS OF THE TRADE " Locations! Epidermal! Dermal! Compound! Epidermal! Dermal 4&

5 ! Dermal SKIN ASSESSMENT " Epidermal type (70-90%)! Deposits in the basal and suprabasal layer through the stratum corneum! Pigment is intensified. SKIN ASSESSMENT " Dermal type Discoid Lupus Erythematous! Melanin within the superficial dermis and mid dermis! Blue-gray color! Pigment is not intensified under black light SKIN ASSESSMENT " Compound (mixed) type! Features are both epidermal and dermal! 24% PIGMENT DISORDER " Melasma! Challenging acquired hypermelanosis usually occurring symmetrically on the face! Commonly affects Hispanic, Asian and black women! Etiopathogenesis of melasma is unknown, multiple factors have been implicated! Genetic influences, sunlight exposure, pregnancy, oral contraceptives use, hormone replacement therapy, cosmetics and medications (phototoxic and antiseizure) MELASMA " Pathogenesis! Strongly associated with! Hormonal influences! 50-70% in pregnant women! HRT hormone replacement therapy includes progestational hormones MELASMA " Pathogenesis 5&

6 " Pathogenesis! Strongly associated with! Ultraviolet (UV) radiation! More prevalent to exposure to UV radiation is observed in geographic areas with high levels of UV light! Improvement or nearly resolved lesion, may relapse completely or develop darkening from one episode of exposure 34 MELASMA " Pathogenesis! Strongly associated with! Genetic predisposition! A hereditary component following exposure to UV radiation.! Consequence of DNA repair PIGMENT DISORDER " Post Inflammatory Hyperpigmentation (PIH)! An acquired increased cutaneous pigmentation secondary to inflammation.! Excess pigment deposits may occur in the epidermis or both the epidermis and dermis PIGMENT DISORDER " Lentigines! Common light brown to brown lesions! Seen on sun-exposed areas! Face, arms, chest and back! Induced by natural or artificial ultraviolet light sources! Commonly see in Asians and Hispanics PIGMENT DISORDER " Medication-Induced! Minocycline! Tricyclic antidepressants! Bismuth! Clofazamine 6&

7 ! Clofazamine THERAPEUTIC MODALITIES TOPICAL AGENTS " Pre melanin synthesis act before melanin synthesis blocking tyrosinase! Tretinoin " During melanin synthesis blocking tyrosinase or scavenging reactive oxygen species! Hydroquinone " Post melanin synthesis! Linoleic acid! Niacinamide THERAPEUTIC MODALITIES LASER THERAPIES " Laser and light source therapies are limited by their potential to cause postinflammatory dyspigmentation THERAPEUTIC MODALITIES LASER THERAPY " Safely used! Intense pulsed light! Various Q-switched lasers! 532-nm Nd:Yag! 694-nm Ruby! 755-nm Alexandrite! 1064-nm Nd:Yag! Use of longer wavelength perferred in darker skinned patients. THERAPEUTIC MODALITIES LASER THERAPY RISKS " Ablative lasers! 2940-nm Erbium YAG! nm CO2 " Fractional photothermolysis! May prove positive between ablative and nonablative techniques PRE & POST CHEMICAL PEELS & LASER THERAPY 7&

8 CHEMICAL PEELS & LASER THERAPY " Pre! Reduce retinoic acid causes irritation and is phototoxic! Topical bleaching agents and sun-protective measures optimizes outcome.! Lower risk of post inflammatory hyperpigmentation (PIH) " Post! Non acid skin care products! Sun protective measures 43 YOUR ATTENDANCE IS GREATLY APPRECIATED! Our training is the key in unlocking the mystery of ethnic skin Contact Us! globalskinmd.com 8&