Skin Care

By Andrea Toochin

The other day I was out to dinner with my brother and two of his friends. Jumpy and slender both girls were theater majors and both part Asian. When one produced an identification card, the other exclaimed, “Oh my god! You look so Asian without your bangs.” I looked at the picture, noticing a strikingly different women, less punky, completely different vibe, and beautiful nonetheless. Her friend exclaimed, “Well, at least you don’t have those slanty eyes. I hate that!” This comment came 15 minutes after a description of a beautiful man they’d seen in a restaurant back in Boston. This man, as it turns out, was the product a mixed marriage. He had soft Asian features, which some describe as feminine, and the virile build of a tall, broad Italian man.

I was taken aback. I’m well aware of stereotypes and pressure to look a certain way. Any fan of Asian cinema knows most of the famous actresses embody what is considered traditional beauty-small eyes and lips, fair skin, and a petite figure. This is not just observation. One thing I remember from studying Mandarin was the direct translation of Chinese people from Chinese to English-the two characters mean ‘yellow people’. There’s no way something as concrete as a definition doesn’t impact cultural and societal norms. Just as you rarely see overweight stars in Hollywood, you rarely see dark Asians on the big screen.

My college roommate was a Jersey girl, half white, half Pakistani. She was the ultimate mix, technically both Jewish and Muslim because her mother was Jewish and her father was Muslim. Despite her mixed background, she could pass for 100 percent Pakistani. When she made her first trip to Pakistan, her aunt greeted her and gave her beautiful handmade silk Salwar Kameez to wear. However, one thing showed she wasn’t a native-her makeup matched her complexion. A picture of all the women in the family revealed that despite the fact that most of her cousins and aunts had similar complexions, she was the darkest in the photo. They had all become accustomed to norms-using makeup to look lighter. Similarly, I spent years working with kids at after-school programs and summer camps in predominantly black and Caribbean neighborhoods of Boston, and while I slathered on sunscreen in a attempt to avoid painful sunburns, my kids slathered it on too, but to avoid getting darker. God forbid they appear ebony.

Multiculturalism has been an obsession of mine since I was in elementary school. From a young age, I was drawn to those from different countries, upbringings and backgrounds. In essence, I was fascinated with the unknown. But, it seems most countries have a strict definition of what is beautiful. I believe that if everyone looked the same, spoke the same, and lived ‘normal’ lives, our world would be devoid of innovation and what some call the exotic-for example, the strikingly beautiful mixed man referenced above. Case in point.
In a world without appreciation for the beauty of color, Halle Berry would be abnormal, and Alex Wek wouldn’t be a model. How many of you have ever been in a situation where people ask you, “What are you?” You wonder, how do I respond, I’m American, I’m a writer, I’m a New Yorker, I’m Jewish, I’m a knitter, there are so many ways to answer. However, most people are either looking for an answer that describes the way you speak or how you look.

Though America is slowly expanding the notion of the beauty, we have a long way to go. We may be decades or even centuries away from a universe where color is seen simply as a descriptor rather than a defining factor, but we’re on our way. Though much of what is emerging in the marketplace is just clever marketing, there are some excellent products that work well for women of color. For some expert advice, we bring you tips from Dr. Fran Cook-Bolden, an assistant professor of dermatology at Columbia University and the director of the Skin Specialty Group and the Ethnic Skin Specialty Group in New York City.

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On average, how does black skin differ from white?

There are many differences in skin of color (aka pigmented skin, specifically black skin) and white skin. However, we are still working towards a clearer understanding of all of the differences. Known are as follows:

* There is a difference in the pigments (NOTE: white skin also has pigments. The types of pigments and the amounts of the specific pigments vary drastically in black and white skin, as well as between the different ethnic groups i.e. Asian skin vs. Native American skin vs. Pacific Islander skin vs. African skin vs Mexican skin. The pigment cells or melanocytes in pigmented skin are more reactive to internal and external injury, insults and stresses in general i.e. dark marks left after trauma such as cuts and scrapes, as a result of skin rashes or acne breakouts. It can also occur following aggressive laser procedures or because of diabetes or other internal medical problems.

* Healing properties. Pigmented skin particularly in African Americans and Asians are more prone to over aggressive and hyperactive healing which can lead to keloid (thick scars) formation, even as a result of the slightest injury or the most minor insult to the skin such as acne, piercing, surgical procedures, burns, insect bites, paper cut, or minor scrapes. The fibroblast, which is the backbone of the skin and healing, does not recognize the proper signal, which indicates when normal healing is complete, hence excessive healing and keloid formation ensue.

* Sebaceous or oil producing glands. There remain inconsistencies on the information available regarding whether there are actually fewer oil glands in pigmented skin, hence the propensity for “ashy skin” or if white skin is actually more devoid of these glands resulting in the same degree of dryness, but with less contrast in the white, flaking scales of dryness. It has been sited that Asian skin is the most sensitive and vulnerable to outside irritation and insults.

What are some common ailments or complaints you see in patients? What about Asian skin?

Pigmentation disorders are more common in pigmented skin than in white skin and probably the most common complaint is disorders of hyperpigmentation or excessive pigment production as noted above. This type of pigment that occurs in response to trauma or other stress, which turns on inflammation, is called postinflammatory hyperpigmentation. Even if this is not the primary complaint of a patient of color when they present to the dermatologist, plastic surgeon or other skin care specialist, on examination or during the conversation, a concern of unwanted or uneven pigment usually surfaces. Patterned pigmentation most common located symmetrically on the face, called Melasma, is very common in the pigmented population and is very sensitive to the sun and other ultraviolet radiation and hormonal stimulation. Acne and eczema are also very common in those with pigmented skin, with eczema being slightly more common in pigmented skin than in white skin.

Do you suggest different treatment options and topicals for black women than you would for white women, and why?

Topical treatment regimens for all skin types are based on the individual skin type, hydration and individual needs. It is often noted that skin of color is more sensitive to irritations. Certainly, in response to irritation, all pigmented skin is more prone to long-lasting unwanted pigmentation, hence one must be very careful to avoid skin care products or topical medications that are more likely to cause dryness and irritation.

In the case of acne, most treatments, if not all, can be drying and irritating. I will often prescribe treatments that are recommended for nightly use to be started only three times a week at or on alternate nights and then graduate to nightly use, as tolerated. If there is a history of dryness or sensitivity, I will recommend a formulation with a more hydrating base such as a cream or lotion base and steer away from gels or solutions that can be drying and irritating. This is the same for all skin types, again based upon the individuals needs.

Because pigmentation is such a prevalent issue in pigmented skin, a topical treatment for unwanted pigmentation is routinely included as part of the skin care regimen, definitely much more commonly than in white skin. Often patients of color will present for treatment of the resulting pigmentation without mention of the primary, initial problem. Sunscreen is a vital part of a skin care regimen for general health and skin cancer prevention and for optimal success in the treatment of unwanted pigment.

Eczema tends to be more common in black populations, right? How can people identify it? Are there over-the-counter (OTC) products that treat it?

There have been population-based studies conducted in England and the U. S. that suggest an increase in prevalence of atopic dermatitis (eczema) among black and/or Asian children. Of 570 million estimated visits for skin conditions, 7.9 million were for atopic dermatitis. The numbers of per capita visits for atopic dermatitis among blacks and Asian/Pacific Islanders were 2-fold and 6-fold higher, respectively, than among whites. The statistics tend to parallel in adults.

In children, atopic dermatitis most commonly appears in the folds of the arms and behind the knees, neck, wrists, and ankles. Areas of high perspiration are most often affected, especially when combined with form-fitting clothing. In older children and adults, it can appear anywhere. Affected areas are red, scaly (flaky), and often dry, but can be oozing if severe. Over time, affected areas can become thickened and sometimes hardened from repeated scratching. Severe itching is the hallmark of eczema and the itching can at times seem unbearable.

The first step in treating eczema is to keep the skin moisturized appropriately to help the skin heal. Most people with eczema suffer from extremely dry skin and skin can’t heal without the proper moisture balance. Even if you don’t have immediate access to medical treatment, you can possibly gain significant relief by adding the proper moisture. Recommended products are heavier creams and ointment-based moisturizers such as petrolateum, Aquaphor, Cetaphil cream, Eucerin cream, Aveeno cream, locoid lipocream, and Nivea Original formula lotions, and Vichy Lipidiose 2 Lipid Replenishing Body Cream.

Have you seen different reactions to laser treatments like the Titan among women of different races?

The Titan procedures, which focus on dermal heating and subsequent collagen production, which can result in skin tightening in areas where there is laxity is well tolerated by all skin types including pigmented and darker skin.

What are the most common places you see melanomas on black and Asian patients?

In skin of color, most melanomas are acral lentiginous (a brown or black spot that may resemble a blood blister) or on distal extremities, including the hands or feet.

There are many “lightening” products on the market. What do you think about women of color using products with ingredients like hydroquinone and licorice?

Hydroquinones (HQs) have been the mainstay of therapy in the treatment of hyperpigmentation for over 50 years. They are very helpful and effective in most cases, when used appropriately. Over use and abuse of hydroquinones can lead to adverse effects and problems. Prescription strength HQs should be used only under the supervision of a doctor and the continued use should only be with permission and guidance of your doctor. There has been a boom in the use of natural and botanical products for lightening such as licorice, bearberry extract, and kojic acid. There are varying levels of effectiveness amongst these ingredients in women of color and all skin types.

Do you have any favorite brands or those you don’t like? Any ingredients you recommend across the board, such as shea butter, green tea, avocado extract, stable vitamin C, and those you’d recommend avoiding, maybe acids over 10% percent or hydroquinone at prescription strength (4%)?

The preferred ingredients depend on the reason and where you are using them. Most of the ingredients listed above have antioxidant properties or moisturizing properties.

For antioxidants (and anti-aging), tried and true are vitamin C, glycolic acids, green tea extracts, retinoids, growth factors, coenzyme Q10, and lycopene.

Shea butter is a wonderful product to seal in moisture and help keep the skin barrier healthy.

What do you suggest for women whose men can’t get rid of their razor bumps?

Evaluate their tools for shaving (try different types of razors to see which you respond better to i.e. single vs. triple vs. other increased blades. Some individuals get fewer ingrown hairs with an electric razor vs. a disposable. Depilatories are also an option, as is waxing, electrolysis and hair removal laser.

When shaving, the skin should be moistened with a warm compress to soften the hairs and expand the pores and follicles for greater ease of hair removal. Avoid retracting or pulling the skin when shaving as this causes sharp tipped hairs to retract or bounce back and result in ingrown hairs. Always shave in the direction of hair growth. Removal of the individual hair is helpful as long as it can be done without nicking, pinching or piercing the skin.

A mild anti-inflammatory cream such as OTC hydrocortisone 1% can be used immediately after shaving and for a limited amount of time to ward off the development of inflammation from shaving and the development of ingrown hairs. Other anti-inflammatory or calming ingredients are tea tree oil, mild salicylic acids, and aloe.

TIDBITS

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If you buy any beauty book, please consider Beautiful Skin of Color. It covers everything you need to know about, including skin cancer, fillers and lasers, scars, Vitiligo, bumps and hair problems. Here are a few tidbits from the book.

* Chemical peels are safe for all skin types but the strength of the peel must be determined by the doctor’s analysis of the patient’s problems. The amount of acid in a professional peel ranges from 20 to 99 percent, but according to the book, most fall somewhere between 20 and 35 percent. It’s important to make sure that you know and trust the person applying the peel. Though many states allow aestheticians to apply peels, if your skin is at all sensitive or you are worried about pigment changes, find a doctor. Remember, a chemical peel differs from injections and microdermabrasion because of the recovery time; it will take at least a week to fully recover, so plan ahead.

* There are many skin conditions like Keratoderma, the thickening of skin around the feet and hands that can be treated with daily use of alpha and beta hydroxy acids. The book mentions OTC items that help, such as LactiCare, Lac-Hydrin and, Amlactin, lactic acid-based moisturizers; or Jergens Ash Relief Moisturizer, a mix of glycerin, petroleum, silicone, shea butter and cocoa butter. However, prescription strength items might be more effective, such as Tazorac, a retinoid, or Vanamide, a cream with a 40 percent concentration of the moisturizer urea.

* The doctors also mention their favorite cosmetic brands for women of color. Though popular brands like MAC, Avon, Bobbi Brown and Prescriptives have always offered makeup for women of color, a few of their latest favorites include Dermablend, I-Iman, and Shiseido and Shu Uemura for Asian skin.

If you take a moment to observe the trends, you’ll begin to see the irony. Many Asians use lightening products, most Caucasians use self-tanners, blacks are split down the middle, and Latinos, well, I have little to report. I have no sociological studies to back my observations. Maybe we all just want what we don’t have. We are a product of nature and nurture, and what we see most commonly on TV, in movies, and in magazines, are images of thin, white Americans. Some argue this is how our society has come to deem thin and white normal or ideal. However, in life, those of us who are lucky enough to live a life without fear of hunger, warfare, or catastrophe, all have something in common-a struggle to love ourselves in our natural form. Dr. Downie and Dr. Cook-Bolden provide real examples of such struggles. These passages are taken from their book.

“Danny is a teenager who asked us for a recommendation that we wouldn’t dream of making even if we could ‘I’m West Indian. People always mistake me for being African. What can I do to get rid of my dark skin.’” “We received the same request from Sita in an email: ‘We are Indian and my daughter has darker skin than the rest of the family. Is there anything that I can do to make it lighter?’”

“Please do nothing. Look in the mirror and love yourself for who you are. Dark skin is beautiful. There is no reason on earth to lighten it.”

To meet with Dr. Cook-Bolden at any of her three locations (Manhattan, Brooklyn or Westchester) visit her web site or contact her office at 212.249.8377

www.cookboldenskinandlaser.com

Beautiful Skin of Color is available in bookstores and online www.amazon.com/gp/product/0060521538/104-8660380-8930349?v=glance&n=283155

Aquaphor, Jergens, Cetaphil, Eucerin, Aveeno, and Nivea products are available at drugstores nationwide.

Locoid Lipocream, AmLactin and Lac-Hydrin creams are all available at www.drugstore.com

LactiCare lotion is available in the health and personal care section of Amazon

Vichy Lipidiose 2 Lipid Replenishing Body Cream is available at www.vichyusa.com

Dermablend items are available at Macy’s, Ulta & JC Pennery or online at www.dermablend.com

I-Iman products are available at Duane Reade, Walgreens and Target or at www.imancosmetics.com

Originally published August 2006
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