Issue link: https://www.ascpskindeepdigital.com/i/1191176
type of hyperpigmentation that has a higher incidence in Asian skin, Latinx skin, and black skin of African descent.9 Melasma has a distinctive pattern of bilateral symmetry in large patches on the forehead, cheeks, upper lip, and chin. It should not be treated with intense pulsed light (IPL). Hyperpigmentation due to sun exposure will appear as small individual spots; IPL is a great treatment option for this condition. A nutritional deficiency in zinc can create dark spots on the skin that will not respond unless the deficiency is resolved. Some medications cause photosensitivity, which creates an overproduction of melanin to protect the skin from the inflammation. Long-term use of some anti- anxiety medications or even antibiotics, like minocycline, can cause hyperpigmentation. Be sure to observe the many aspects of your client's skin, including sebaceous gland activity, pore size, pigmentation, skin elasticity, and structural support of the epidermis and dermis. Is your client's barrier function compromised and is the skin sensitized by fragrances or the use of harsh ingredients? TREATMENT OPTIONS The way to have consistent success when treating skin of color is to proceed cautiously and in incremental steps. You need to condition the skin so the risk of developing PIH is minimized. Treatment options should include both professional treatments and home-care recommendations. Chemical peels, facials using devices, and lasers are three important options for your professional treatment plan. Chemical Peels Chemical peels need to be administered in a series. Start with an enzyme, and then progress to a high-pH, low-percentage chemical solution. Your client's skin will build a tolerance and be able to accept lower pH acid solutions with higher percentages of active ingredients over time. Mandelic and lactic acids are good peel agents to start your series. Lactic acid can pass through the cell membrane easily so your client will have uniform shedding. Lactic acid also increases microcirculation and increases collagen and ceramide production, so the skin will become more hydrated and develop a stronger barrier function. Mandelic acid is antibacterial and anti- inflammatory, so it's a nice option for sensitive skin, but you must consider your client's allergies. Don't use a lactic acid peel on someone with a lactose allergy. Similarly, mandelic acid is derived from bitter almonds, and would not be appropriate for someone with an almond allergy. Glycolic acid is the smallest molecule used in a peel and can penetrate the deepest. Don't start your series with a glycolic peel, since you risk causing rebound PIH in your client's skin. You can build your client's ability to accept glycolic with less risk after you have conditioned the skin with other peel solutions. Facials Using Devices Facials with devices, like microdermabrasion and nano chips, should be considered with the same deliberate approach. An aggressive microdermabrasion can lead to