Issue link: https://www.ascpskindeepdigital.com/i/70637
Peels and Hyperpigmentation How to avoid the risks when treating darker skin by Pamela Springer When chemical peeling with glycolic acid became popular in the 1980s, women flocked to dermatologists and estheticians for these "lunchtime peels." When performed correctly, a peel stimulates the production of collagen and healthy new skin cells, and diminishes signs of aging. Yet many estheticians have valid concerns about using them on darker skin, fearing possible complications, including postinflammatory hyperpigmentation (PIH), hypopigmentation, and scarring. Generally, peels and other exfoliating agents are used to resolve photodamage, fine lines and wrinkles, and dyschromias (the brown spots associated with aging). These conditions are most often seen in individuals with lighter skin coloring, Fitzpatrick I–III (see page 15 for a refresher on the Fitzpatrick scale). Those with pigmented skin, Fitzpatrick IV–VI, are more likely to have conditions such as dark postacne lesions, hyperkeratosis, pigmentary reactions, pseudofolliculitis barbae, or textural changes. But despite the disparities, dark skin is not as complex as one would imagine, and it will respond well to superficial chemical peeling as long as certain protocols are followed. The risk of complications is increased if the chemical is allowed to penetrate deeply (whether deliberately, or at the site of any abrasions). To limit the risk, professionals should seek specialized training prior to administering chemical peels on darker skin tones—and, of course, should never work outside their scope of practice. What is Hyperpigmentation? Hyperpigmentation—dark blotches on the skin—occurs equally in men and women, but more frequently in dark-skinned individuals. Some common causes are aging, allergic reactions, cosmetic irritants, excessive sun exposure, inflammation, insect bites, photosensitizing ingredients, shaving, skin abrasions, and skin disorders such as acne and eczema. Depending upon the depth of the pigmentation, the treatment of this skin disorder can be taxing, requiring three to six months to achieve the desired results. 12 ASCP Skin Deep July/August 2012 There are two types of hyperpigmentation. The first is epidermal melanosis, in which melanin production is increased in certain areas of the skin and pigment is subsequently transferred to surrounding keratinocytes. A variety of options have proven effective against this type. The second type is dermal melanosis, which occurs when inflammation causes melanin pigment to become trapped in the papillary dermis. There is no permanent solution for dermal melanosis, but the lesions can be lightened. Treatment for either type should begin with skin-lightening agents such as azelaic acid, hydroquinone, kojic acid, or retinoids, either alone or in combination. The use of a broad-spectrum sunscreen is most important to prevent further darkening of the lesions. Assessing Your Client Not every pigmented skin that is blotchy or has dark spots will be resolved with a chemical exfoliation. During the initial consultation, it is important to take an extensive history, especially noting any contraindications. Is the client prone to keloids? Is he or she on any medication? If you don't own a Physician's Desk Reference (PDR Network, 2011), which outlines contraindications for all prescription medications, check the online version at www.pdrhealth.com. For example, a client who is taking Tazorac or Accutane must avoid alpha hydroxy acids (AHAs). Some medications require the user to avoid aspirin, which means they would not be a candidate for any treatment or product containing salicylic acid.