Issue link: https://www.ascpskindeepdigital.com/i/1278890
56 ascp skin deep september/october 2020 START WITH ENZYMES In-clinic treatment for darker skin tones should begin with the use of an enzyme to reduce the cornified cohesion. Enzymes are found in all living things and can be an alternative to chemical peels. They are vital in maintaining normal cellular activity, as well as assisting in the cell's repair process. In the exfoliating process, topical enzymes act as a catalyst to enhance the natural enzymes in the skin by breaking down and dissolving dead skin cells on the skin's surface. Using enzymes as an initial treatment helps to gauge the sensitivity of pigmented skin. Once the skin is healthier and the skin's pH is closer to its normal pH of 4.5–6, the more resistant issues (like skin conditions) can be addressed. CHEMICAL PEELS Darker skin conditions include hyperpigmentation, acne, pseudofolliculitis barbae, textural changes, and oily skin, and some of these conditions need the next level of resurfacing: chemical peels. Darker skin has its complexities, but chemical services can be employed as long as judicial protocols are in place. Chemical exfoliation is the ideal solution versus the use of laser resurfacing treatments, which can cause postinflammatory hypopigmentation, hyperpigmentation, or even scarring. Complications such as postinflammatory hyperpigmentation, hypopigmentation, and scarring are still valid concerns when peeling darker skins, especially when considering the use of a medium- to deep-depth chemical peel. Complications are increased if there is any dermal penetration or penetration at the site of an abrasion. It is wise to have a conservative approach and choose an agent formulated with a pH of 2.5 or above. Formulations lower than a 2.5 pH may cause "crusting," which leads to necrosis and potential melanocyte stimulation.