SABIKA Says

Columnist Sabika Karim gives her guide to treating skin of colour

In this month’s edition of Sabika Says, I’m focusing on the unique needs of treating darker skin tones, specifically Fitzpatrick skin types IV-VI, in the context of medical aesthetics. The growing trend of proactive ageing is not just about restoring lost volume but about prioritising healthy, youthful skin. While this shift can be attributed to years of patient education, social media, and advancements in aesthetic treatments, it’s essential to recognise the specific concerns and considerations that arise when working with darker skin tones.

CHALLENGES WITH SKIN OF COLOUR

Darker skin types are inherently more prone to post-inflammatory hyperpigmentation (PIH) due to distinct structural and functional differences. PIH occurs when inflammation triggers the skin’s melanocytes to produce excess melanin, leading to persistent dark spots. In darker skin, the melanocytes and melanosomes are larger and more active, leading to a heightened response to inflammation. The dermal-epidermal junction (DEJ), which plays a crucial role in skin integrity, can be disrupted by inflammation, causing further melanocyte activity and melanin transfer to keratinocytes. As a result, hyperpigmentation becomes more severe. Additionally, darker skin types face a heightened risk of keloid formation after skin injury or inflammation, which leads to raised, thickened scars. This makes it critical to adopt tailored treatment approaches to prevent adverse effects. Therefore, when treating darker skin, it is vital to manage inflammation effectively, reduce the risk of hyperpigmentation, and ensure treatments are safe and effective for the unique characteristics of these skin types.

KEY TIPS FOR TREATING SKIN OF COLOUR

Here are my top tips for successfully treating skin of colour, especially Fitzpatrick skin types IV-VI, using both preventative and treatment measures:

1. Photoprotection: Proper sun protection is essential when treating darker skin, especially for those with hyperpigmentation concerns. Always recommend SPF 50 or higher for the face, neck, and back of the hands. I recommend sunscreens with both physical and chemical blocks. Physical sunscreens provide immediate protection and are less likely to irritate the skin, while chemical filters can fill in any protection gaps. One favourite product is SmartSkincare NEOVA SPF 50, which combines physical and chemical filters with antioxidants and DNA repair enzymes.

2. Antioxidants: Antioxidants play a crucial role in minimising hyperpigmentation by neutralising reactive oxygen species (ROS). ROS, produced by UV and visible light exposure, trigger melanocyte activation and melanin production. Antioxidants reduce oxidative stress and inhibit melanocyte stimulation. vitamin C is a powerful antioxidant, and C E Ferulic by Skinceuticals is a top recommendation for this. The serum combines vitamin C with vitamin E and ferulic acid to enhance the stability and effectiveness of both vitamins.

3. Melanogenic pathway inhibitors: Tyrosinase is the enzyme responsible for melanin production. By inhibiting tyrosinase, we can reduce melanocyte activity. The gold standard for inhibiting this enzyme is hydroquinone, which is available by prescription in the UK. For over-the-counter options, alpha-arbutin and kojic acid are great alternatives, although they are less potent. Tranexamic acid is also a strong depigmenting agent that works by reducing inflammation and inhibiting melanocyte-stimulating factors. Obagi C-Rx C-Clarifying Serum is one of my go-to products and contains hydroquinone and vitamin C, and Mesoestetic Melan Tran3x Concentrate combines tranexamic acid with niacinamide, another anti-inflammatory agent. They are great used in combination.

4. Pre-treatment preparation: Prior to undertaking skin rejuvenation treatments such as microneedling, RF microneedling, lasers, or chemical peels (all of which can cause inflammation), it’s essential to prepare the skin to reduce the risk of PIH. In my experience, the Obagi Nu-Derm System is an excellent pre-treatment protocol for darker skin types. This comprehensive skincare system helps control patient outcomes and improve skin quality by incorporating exfoliators, tyrosinase inhibitors, moisturisers, and sunscreens, preparing the skin for more advanced treatments.

5. Pigmentation and anti-inflammatory treatments: In-clinic treatments can complement at-home skincare and are designed to address pigmentation and inflammation. Chemical peels, like the Mesoestetic Mesopeel MD melanostop tranex, contain ingredients such as salicylic acid, kojic acid, and tranexamic acid, which target pigmentation while also reducing inflammation.

Phototherapy with LED light is another excellent non-invasive treatment. The Dermalux Tri-wave MD utilises a combination of wavelengths to treat pigmentation with red light (633nm) and inflammation with near-infrared light (830nm). I use this as a standalone treatment or in conjunction with other treatments like RF microneedling or peels to reduce post-treatment inflammation and hyperpigmentation.

Picosecond lasers, like the Candela Picoway, effectively treat pigmentation by delivering energy in picoseconds (less than a millionth of a second). Unlike traditional lasers, which use heat to target pigmentation, picosecond lasers work on a photoacoustic basis, shattering pigmentation with sound energy for instant results. To prevent rebound pigmentation, patients should continue maintenance therapy with tyrosinase inhibitors.

6. Skin resurfacing: For skin resurfacing and collagen stimulation, radiofrequency microneedling (RFMN) is my preferred option for darker skin types. RF energy is “colour-blind”, meaning it doesn’t target pigment and can be safely used across all skin types when appropriately controlled. Devices like Cutera Secret RF offer precise depth control, and the use of insulated needle tips ensures energy is focused on the dermis, preventing heat from damaging the epidermis and reducing the risk of PIH. This minimises heat exposure to melanin-rich epidermis, making it safer for individuals with darker skin tones.

7. Dark circle treatment: Dark circles are more pronounced in darker skin types due to increased melanin production, genetic predisposition, and external factors such as inflammation. One of the most effective treatments for periorbital pigmentation is the use of polynucleotides (PNs), such as Croma PhilArt Eye. These are formulated with lower concentrations to prevent excessive swelling and downtime. Polynucleotides help reduce inflammation and stimulate collagen production in the delicate eye area, offering an improvement in dark circle pigmentation.

CONCLUSION

Treating darker skin tones requires a customised approach, considering their unique structural and functional characteristics. These skin types are more prone to PIH and keloid formation, which necessitate careful pre-treatment preparation and post-treatment care. By focusing on photoprotection, antioxidant use, melanogenic pathway inhibitors, and specific in-clinic treatments like RF microneedling, chemical peels, and phototherapy, we can ensure optimal results without triggering pigmentation concerns.

Through my years of experience, these methods have proven successful in treating darker skin types and achieving beautiful, even toned, and healthy skin. Every skin type is unique, and with the right approach, we can address the aesthetic needs of all skin tones with care and precision.

DR SABIKA KARIM

Dr Sabika Karim, founder of Skin Medical, is a multiaward-winning international educator who combines her NHS GP background with 19 years of aesthetic medical practice to deliver gold standard treatments to her patients at the clinic whilst raising industry standards by teaching and training her peers.

Conflict of Interest Statement – The views expressed are solely my own and have not been influenced or sponsored by any external parties. For full transparency, I am a key opinion leader (KOL) for Sinclair Pharma, Cellese, Evolus, Dermalux, and Erchonia.