Skin of Color: Your Skincare Questions Answered (CFC Spotlight Thursdays)

1.       The doctor is in!

Michelle Henry M.D. is currently a 3rd year Dermatology resident at Mount Sinai School of Medicine. After finishing her residency this June, she will pursue a fellowship in Procedural Dermatology at Harvard Medical School, specializing in skin cancer and cosmetic surgery. Her areas of interest include: skin cancer surgery and prevention, skin of color and cosmetic dermatology.

2.       What made you decide to go into dermatology?

I am a visual learner, who pays obsessive attention to details. I think many dermatologists can describe themselves that way.  I have a long-standing interest in infectious diseases and I desired a career that would allow for versatility in terms of practice.  Dermatology is the perfect collision of medicine and surgery so, for me, it was the best choice of a specialty.

3.       Has learning about skin care from a dermatological perspective changed the way you treat your skin? In what way(s)?

It has definitely changed the way I protect my skin.  I always had the perception that I was immune to skin cancers and wrinkling because I have dark skin. Now, I am never outdoors without sun screen.  I also treat my acne quickly to avoid scarring and hyperpigmentation, which can both be long lasting. If I get a large cyst, I quickly inject it with a low concentration of steroid.  Works like magic!  In addition, I use the retinoid Tazorac religiously. Tazorac is like retin-A, which helps regulate skin turnover.  I strongly believe everyone should use a retinoid daily (if tolerated).  That, and regular gentle exfoliation are the most important aspects of my regimen.  However, I will admit to being a product junkie, and my newest obsession is Lancome’s  Advanced Night Repair serum. It’s like CPR for the skin. It has saved me from looking like a prune after a long work week.

4.       What are the THREE tips you’d give to someone struggling with adult acne?

  • Avoid the over-application of skincare products.  Acne is NOT a disease caused by lack of hygiene. It is a disease of the pilosebaceous unit (the follicle) .This means that over washing will actually cause more harm than help.  In addition, over-applying medications can cause drying. Many women, desperate for improvement, become mad scientists, making crazy concoctions and show up in our offices red, with worse acne than before. Keeping your skincare regimen simple is always a recommended strategy for most.   I use a good creamy wash with salicylic acid to start.  If your skin starts to feel too dry, stop using chemicals/medications for a week to allow your skin to return to its natural balance.
  • See a dermatologist. Often times, over the counter treatments are not enough. In particular, patients with darker skin often times should have a lower threshold for more aggressive treatments as permanent scarring and hyperpigmentation may occur more frequently.
  • Oral contraceptives can be helpful in maintaining a healthy hormonal balance. Adult acne in women is often a hormonal disease that requires oral treatments in the form of a pill. Oral contraceptives are frequently used to aid in hormonal regulation.

5.  What are your views on over-the-counter/online products like Neutrogena or Proactiv? Are some more helpful/less helpful than others? Which skin products do you recommend?

I think that Proactiv is okay for mild acne. Proactiv is micronized benzoyl peroxide. Benzoyl peroxide is available, cheaply, over the counter.  I think Procativ’s major benefit is that its texture allows it to serve as an exfoliant. There are many other tools that exfoliate well. I love the old fashioned “buff puff” and use it daily. Many of my patients love the Clarisonic brush for exfoliation. Both are excellent.   The Rolls Royce of exfoliation is microdermabrasion, which is safe for all skin types.  I love the Neutrogena line, in particular the sun screens.   However, my current and favorite sun screens are Aveeno Positively Radiant and Anthelios by La Roche-Posay. They are cosmetically elegant and don’t leave those of us with darker skin looking “ashen”.  I would also like to take a second to stress the importance of sun screen in all skin types. Although skin of color is less prone to skin cancer, the risk remains.  In addition, sun screen helps prevent uneven skin tone and wrinkles.

6. What skin challenges would you say are specific to people of color? What advice do you have for any readers who might be dealing with those challenges?

  • Hyperpigmentation:  One of the major concerns I find in my patients with darker skin, is that of hyperpigmentation or uneven skin tone. This is often a consequence of trauma, skin irritation or hormonal influences (conditions like melasma).  Your dermatologist can assess the type of hyperpigmentation you have, how deep or superficial it is, and create a treatment plan.  We have many topical skin lighteners that can help.  Chemical peels and lasers are very effective in more severe cases.  Using a good sun screen is very effective in maintaining an even skin tone. The over the counter fade cream by Ambi is effective as well. I would avoid fade creams without addressing them with a dermatologist, because they are often unregulated and may contain unsafe ingredients such as mercury.
  • Hair loss: Many women attribute hair to age or poor styling practices, but it may be an indicator of diseases like Lupus (which disproportionately affects African American women), thyroid disease, or  scarring alopecias like central centrifugal cicatricial alopecia ( thought to be cause by relaxers, hot combs etc).
  • Pseudofolliculitis barbae (razor bumps): Razor bumps plague both men and women of color.  Learning to avoid shaving against the direction of the hair, as well as exfoliating the area gently afterwards (manually or with creams), can help. Your dermatologist can also prescribe medications like topical steroids or retinoids which can be helpful.

7.  What advice do you have for readers who might want to get scars from cuts/bruises/burns removed?

We have a number of great modalities for scars. If the scar is flat and discolored we can use many different hydroquinone preparations to treat it. For depressed facial scars, such as those caused by acne, retinoids help somewhat, there are several effective chemical peels.  Chemical peels that are safe for darker skin types include salicylic acid or glycolic peels, which are gentle but effective.  For more severe cases of scarring, there is laser treatment. The Fraxel laser is great for scars and textural improvement.  I always tell patients not to worry, if we can’t make you perfect we have enough tools to make your scarring significantly better.

8.   Let’s talk about skin cancers/disease. Are any specific signs or markers to look for on your skin that might indicate a more serious skin condition? What are those signs and what advice do you have for readers?

  • Acanthosis Nigricans (AN): This is a dark velvety hyperpigmentation often found on the back of the neck or underarms. It can be an indication of insulin insensitivity which can lead to diabetes. Severe cases of AN can indicate an internal cancer warranting a thorough work up.
  • Nail pigmentation: Although over 70% of dark skinned patients (over the age of 20) have benign linear hyperpigmentation of the nails, called Melanonychia, patients must be aware that acral melanoma is the most common type of skin cancer in dark-skinned patients and is generally found on the nails, hands and feet.  As an interesting aside, Bob Marley died of acral melanoma.  If very dark lesions that grow rapidly or distort the nail arise, there is concern for melanoma.
  • Yellow skin or eyes:  May indicate liver disease caused by medications or infections such as hepatitis.

9. What is your view on Botox? Is it safe? What issues should someone consider before deciding to get Botox?

I love Botox. Few treatments work as well for reducing wrinkles. It works by directly targeting the facial muscles that are causing dynamic wrinkles to form. Dynamic wrinkles are those formed by animating the face.  The Botox protein blocks transmission from the nerve ending to the muscle. The muscles relax and the appearance of wrinkles is reduced. This effect lasts an average of three to six months. Botox celebrates its 10 year anniversary for aesthetic use this year (even though it has been used since the 1990’s). The initial indication for Botox was for treating crossed eyes and spasms in the eye muscle so it has been proven to be medically safe for many years.  However, there was one study in mice that showed Botox had migrated to the brain, but any safe medication might be harmful to a small animal in ridiculously high doses. Because of this, patients with certain neuromuscular diseases (such as multiple sclerosis) or autoimmune diseases (such as lupus) need clearance from their specialist before having Botox injections.

10. Is there anything else you’d like to add about skin care/health?

Proper hydration, vitamin supplements, getting enough sleep, exercise and reducing stress; these are things that are often overlooked in skincare.   Monitor your skin, its needs and condition will change. The weather plays a big role in how your skin behaves.  Your winter regimen will likely need to be different than your summer regimen.   Exercise can also be good for the skin. By increasing blood flow, exercise helps nourish skin cells and keep them healthy. With regards to diet, there is little evidence of any food being linked to acne; however, a recent article in the Journal of the American Academy of Dermatology, by  Di Landro  and colleagues, showed that milk may exacerbate (or even cause) acne, but one serving of fish a week might be preventative.  So drinking Almond milk and stocking up on salmon may help us all in our quest to be healthy, beautiful and acne free.

*What skin challenges do you face? Do you have any questions for Michelle?*

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About ChicFitChef

My "deserted island" checklist: a BCBG dress, a healthy & diabetic-friendly meal and a few workout DVDs. ;-)
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20 Responses to Skin of Color: Your Skincare Questions Answered (CFC Spotlight Thursdays)

  1. Elizabeth Whittington says:

    I was just thinking I needed some skin care advice!! I love this write-up on one of my oldest friends. She is so freakin AWESOME! Ok so I turned 30 and I am having adult acne and its annoying. I break out on one cheek and my forehead at least once a week and I have tried everything and it still happens.

    • Michelle Henry, MD says:

      Thanks, Liz! Adult acne is frustrating. It if often times associated with fluctuation hormones. If you don’t see a link with your menstrual cycle, birth control pills or medications could also be the cause. Sounds like your acne is minimal and localized. Discuss the usage of a retinoid, maybe Differin (adapalene), since it is gentle, and either a benzoyl peroxide or salicylic acid wash with your Dermatologist.

  2. James says:

    Great information! Any recommendation for practices/doctors specializing people of color?

    • Michelle Henry, MD says:

      Thanks, James! If you are in the NY/NJ area there are some excellent Dermatologist. I love Jeanine Downie (Monclair, NY), Rosemary Ingleton (NY) and Andrew Alexis. They are all well published leaders in the field. I know Drs. Downie and Ingleton, personally, and they are caring, super dedicated physicians.

  3. Great post! I definitely neglect my skin and there are some good tips in here. Thanks!

  4. Courtney Boyette says:

    Great information. Can you please go into more detail about some of the most common side effects a person can experience with Botox injections?

    • Michelle Henry, MD says:

      Glad you enjoyed it! The most common side effects that patients encounter include: transient swelling at the site of the injection that usually only lasts 20-30 minutes ( we affectionately call them “mosquito bites” ) and headaches, which are mild and occur infrequently. Also, there is the risk of bruising whenever you are injecting the skin, so I always make patients aware of this risk.

  5. Heatheresq says:

    Seriously, I hyperpigment w/ any trauma to the skin. Lasts on my legs for decades. My face seems to heal significantly faster (i.e. the skin tone becomes even much more quickly). What gives? I have used an OTC hydro-q lightener for years on and off and am pretty good about the suncreen over these discolorations. Help! My derm suggested Tri-Luma years ago but I didn’t bite because it was so expensive. Ugh. What is a girl to do.

    • Michelle Henry, MD says:

      Hi Heather! Hyperpigmentation is the bane of my existence as well. OTC lighteners contain no more than 2% hydroquinone. Your Dermatologist can prescribe much higher dosages. The standard is 4%, but I’ve used up to 6% for a short period in the right patient. Also, we can compound hydroquinone, a retinoid and a mild steroid, for much cheaper than the price of tri-luma with similar ingredients. My favorite combo only costs my patients $36. Maintenance after lightening is also important. Good sunscreens and creams with ingredients like kojic acid and melanozyme (Elure) will help maintain an even skin tone without the risks of longterm HQ.

  6. bbesq says:

    Michelle, which vitamins would you recommend for skin health, and what foods are rich in these? Also, I’ve heard of hormone therapy for acne in adults. What if they make you crazy?? 🙂 – bbesq, http://www.blackandbrownesq.com

    • Michelle Henry, MD says:

      Hi bb! Vitamin A is important in helping cells mature. It can be found in carrots, broccoli, spinach, and sweet potatoes. Sweet potatoes also have high levels of vitamin C which helps collagen growth and reduces wrinkles. Omega 3 fatty acids helps to make your cells more resistant to absorbing toxins. Also, Avocado is a food with “good fats” that helps your skin maintain it’s youthful elasticity. Almonds and peanut butter are also good for skin elasticity.

  7. Sheena Robinson says:

    Great information! Very informative. I have a question about men’s skin care. Every time my husband shaves he gets awful bumps under his chin. We’ve tried different products but nothing works. Is there anything that he can use OTC or does he need to see a dermatologist?

    • Michelle Henry, MD says:

      Hi Sheena! Pseudofolliculitis is awful. Things that will help are shaving in the same direction of the hair and not shaving too close. I like to give my patients a retinoid to start using a day or so after they shave. It helps to keep those pesky hairs from burrowing under the skin. Topical steroids and topical antibiotics also help with the “bumps” that form. As for over the counter treatments, Bliss ingrown eliminator pads are great. They are made for women’s bikini lines but work well for men. PFB Vanish is another product that works well. They can both be purchased online. Hope this helps!

  8. ChicFitChef says:

    Thanks SO much for doing this interview Michelle! I have a question!! What are your views on using natural oils on the skin? I use tea tree oil and grapeseed oil on my skin and have seen big improvements. Any thoughts on these oils or other oils to try?

    • Michelle Henry, MD says:

      It was my pleasure! Oils hydrates the skin in a similar way to our natural sebum, so they are great. Grape seed oil is full of antioxidants which may help protect against sun damage. Tea tree oil is great because has proven anti-inflammatory and anti-microbial properties, making it an effective treatment for acne and other inflammatory conditions. Another great oil is jojoba oil. It is the closest to our natural sebum and works as a great light moisturizer.

  9. Gavin Rhyan says:

    Retinoids are great specially if you want to remove skin wrinkles or exfoliate your skin. `

    My own blog
    http://www.melatoninfaq.com/liquid-melatonin/

  10. Pingback: 6 Steps to Looking Great on Your Wedding Day (From a Former Bride) | ChicFitChef™

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