Dr. Michele S. Green is a cosmetic dermatologist with a wealth of experience treating African American patients, male and female, at her private office in New York City. She uses the latest technology in dermatology treatments, including chemical peels, Cosmelan, and laser skin treatments, in order to find the best solution for your skin tone. Patients with darker skin tones are much more susceptible to hyperpigmentation and melasma, and need special laser treatments which are uniquely tailored to skin of color. From skin cancer, to hair loss, ethnic skin needs special care and there are many skin concerns. The following guide provides an overview on some of the more common issues surrounding darker skin tones and the treatments that Dr. Green utilizes at her Upper East Side NYC dermatology office.
Dermatologists and skin cancer exams
Dermatologists, like Dr. Michele Green in NYC, treat a myriad of skin diseases, from alopecia, melasma, dermatosis papulosis nigricans (DPNs), to skin cancer. Skin cancer is an important consideration that is often forgotten in patients with skin of color. Dr. Michele Green begins each new patient exam with a complete skin cancer examination, since all patients are susceptible to the serious effects of skin cancer. One of the most important health considerations in patients with darker skin tones, is that patients are often diagnosed with skin cancer in its later stages. According to the Skin Cancer Foundation, the 5-year survival for African american patients in the United States is 65% compared with 91% in Caucasian patients. In general, skin cancer among African Americans in the US account for 1-2 percent of all skin cancers, Hispanic patients 4-5 percent, and Asian patients 2-4 percent. Since it can be more difficult to diagnose skin cancer in darker skin patients, it is very important to consult an expert dermatologist since the delay in diagnosis can have such serious implications.
The most common area for patients with dark skin to develop a skin cancer is on the bottom, or plantar surface of the foot. Between 30 and 40 percent of all skin cancers in people of color occurs in the plantar area of the foot. The most common areas for skin cancer in African American patients are the:
- Plantar surface of feet
- Mucous membranes such as the mouth
- Lower legs
- Anogenital area
It is extremely important to have a complete skin cancer exam, especially for African American patients, since early diagnosis leads to prompt treatment and improved patient outcome.
Skin care in skin of color
Proper skin care in patients with darker skin tones, is extremely important since ethnic skin is very sensitive. There are unique considerations in treating dark skin, which one must be cognizant of, in order to treat skin of color effectively and safely. Darker skin tones are much more susceptible to discoloration and hyperpigmentation. Since darker skin tones are more prone to hyperpigmentation and sunspots, proper sunscreen is essential to use on a daily basis. Dr. Green recommends an SPF of 50 daily which has both UVA and UVB protection. Vitamin C serum is also a very effective antioxidant to help repair the daily damage from the sun and restore an uneven complexion. Gentle cleansers are also vital, as are daily moisturizers. In acne prone skin, it is very important to use non-comedogenic products. This is especially true in patients with darker skin, as they are more susceptible to hyperpigmentation and dark scars from acne breakouts. Hydrafacial is also a very effective way to maintain healthy and clean skin, and both prevent and treat discoloration and uneven skin tone.
Botox, Voluma 1 syringe and Juvederm 1 syringe
Acne Scarring and Hyperpigmentation
There are a number of different ways to treat the scarring that has resulted from a previous episode of acne, however not all the treatments on the market are necessarily suitable for darker skin tones. For example, African American patients respond differently to laser treatments than those with lighter skin types. The goal is to prevent acne breakouts, and provide the best acne treatment to avoid unwanted acne scarring. Since skin of color is prone to hyperpigmentation, careful laser selection and use of these lasers, is critical in having safe and effective cosmetic results.
One common issue that can affect darker skin is post-inflammatory hyperpigmentation (PIH), which results in the darkening of the skin from acne and acne scars. This discoloration is pigmentation can occur in Asian, Hispanic, & Native American skin tones, in addition to African American skin. The best treatment for this type of hyperpigmentation and dark scars are chemical peels combined with topical skin lightening agents. Dr. Green utilizes her unique MGSKINLABS line of skin care products which have powerful hydroquinone and retinoids to treat these problem areas. After a series of chemical peels, the discoloration will be reduced and your skin tone will be even and restored. Proper sunscreen and sun avoidance is essential in maintaining the best results.
In addition to chemical peels, acne scars can be treated with laser treatments and dermal fillers. The eMatrix laser is a “color blind” laser, and through radiofrequency heat, acne scars are improved and new collagen is stimulated. With a series of eMatrix laser treatments, acne scars can be minimized and your complexion restored. Dr. Green combines laser treatments with dermal fillers, such as Restylane, Sculptra, Bellafill, and Juvederm, to immediately restore lost collagen and volume in all types of acne scars. This immediate improvement in scars also has long term improvement in stimulating new collagen production. Dr. Green is an expert in treating acne scars, and combines multiple modalities, especially in patients with ethnic skin.
Keloid Scars and treatment options
A keloid is an overgrowth of scar tissue that develops around a wound, usually after the wound has healed. Approximately ten percent of individuals experience keloid scars. Keloids most commonly develop in patients with darker skin tones, especially in African American patients. Typically, keloids affect younger patients, between 15 and 30 years of age. Keloid scars can occur years after the initial scar is created, and tend to occur most often on the face, earlobes, neck, and chest areas. Studies have showed that there is a genetic predisposition to keloid scars, which may be related to the AHNAK gene. There are many skin injuries which predispose to keloid formation. The most common injuries which result in keloid scars are:
- Acne scars
- Surgical scars
- Ear piercing
- Vaccination sites
- Chicken pox scars
- Vaccination sites
Keloids can be a cosmetic issue since the keloid scar is often much larger than the original wound. Dr. Green has great success in treating these keloid scars with a combination of Vbeam laser treatments and intralesional cortisone injections. In recalcitrant cases, Dr. Green may recommend surgical removal of a very large keloid scar. Topical silicone gel pads also help reduce pressure on keloids and minimize their formation.
A common skin condition which Dr. Green treats in skin of color are razor bumps, or pseudofolliculitis barbae. Pseudofolliculitis is a common condition in which shaving causes inflammation and bumps to develop on the skin. This medical condition is more common in men than women, and commonly occurs on the face or neck. Clinically, one sees groups of red or dark bumps around each hair follicle, with characteristic inflammation. Treatment may consist of changing shaving habits, topical antibiotics, and in more bothersome cases, laser hair removal. Pseudofolliculitis also commonly occurs in patients who tweeze or pluck coarse hairs. Since the hairs tend to be more curved, the hair gets retracted below the skin surface, and pierces the follicular wall from the inside. The result can lead to these painful bumps which can scar, cause dark spots, and even keloids. Prompt medical attention by an experienced dermatologist, like Dr. Green, is essential to prevent these unwanted side effects and treat the underlying cause of this skin condition.
Tattoo Removal in skin of color
Dr. Green is an expert at tattoo removal for various skin tones and patients, including those with African American skin. For tattoo removals on darker skin, she uses the Alex TriVantage laser, which can remove tattoos after several sessions. The number of sessions depends on both the patient’s skin type and the various colors in the tattoo itself. A consultation with Dr. Green is the first step in formulating a treatment plan for your tattoo removal.
Any procedure including laser treatment has potential risks of hypopigmentation or hypertrophic scarring in darker skin tones. Because there is more melanin in darker skin, there is an increased potential of having the laser emit too much energy. This is why the laser tattoo removal process is a gradual one and requires multiple sessions.
The good news is that laser tattoo removal is relatively pain free. There will be some minor discomfort and generally the feeling reminds some of an elastic band snapping on the skin. It can take a series of laser treatments, spaced approximately two months apart, to clear the unwanted tattoo. The deeper the colors, such as pink and green, the more difficult it can be to remove the tattoo.
Dark Spots in Skin of Color
For darker skin tones there can be some issues with chemical peels and laser treatments. Traditionally, many of the techniques that may be suitable for lighter skin tones are not necessarily effective on darker skin and can even be potentially damaging. Due to the increased melanin in ethnic skin, the laser can potentially burn healthy skin.
Another potential serious side effect that can be caused by these treatments is an “over lightening” of the skin color along with hyperpigmentation issues. African Americans should opt for light chemical peel treatments and avoid strong chemical peels since these can potentially cause hypopigmentation or further scarring.
Female – Before and after Chemical Peel (2 treatments)
Skin Lightening in Skin of Color
Another treatment that Dr. Green is often asked about are skin lightening techniques in order to achieve a brighter and more even skin tone. Here the goal is to brighten the skin and improve the overall look and feel without overly lightening the skin. There are a number of methods available to lighten the skin such as Cosmelan, chemical peels and laser treatments. The best approach initially is to book a consultation with Dr. Green to discuss the results that you are looking to achieve and then a tailored course of treatments can be designed for you.
Hair Loss in African american patients
In addition to skin care, there are numerous hair conditions which dermatologists, like Dr. Green, specialize in treating. Many patients suffer from hair loss, or alopecia. For some individuals, hair loss may be genetic or hormonal. For others, there is an increased association of hair loss with autoimmune diseases such as Lupus and Hashimoto’s disease. Many women suffer a gradual hair loss from menopause. Still others, suffer from traction alopecia from hair styles such as braids which are too tight. Dr. Green is a specialist in hair loss, and will do a comprehensive examination and testing to identify the cause of your hair loss. Once the cause is identified, a comprehensive hair loss protocol will be designed for you. One of the most popular treatments for hair loss, for both men and women are PRP injections for hair loss. By utilizing your own blood, Dr. Green is able to utilize our own natural growth factors and encourage the re-growth of thinning hair.
Cosmelan and Melasma
Melasma (also known as the mask of pregnancy) manifests in facial pigmentation which can be caused by hormones, sun exposure and various other factors. Darker skin tones are prone to producing an excess of melanin, which can cause the skin to be even darker in certain areas. Since black skin is prone to this discoloration, and hyperpiguentaion, treating this issue is one of the most popular procedures in Dr. Green’s NYC office. Cosmelan is a type of chemical peel commonly used in Melasma treatment and can help treat this type of hyperpigmentation.
Cosmelan masks include a professional-grade cream that is applied in Dr. Green’s office. The mask is left in place for several hours and then can be easily removed by the patient. Three weeks later, a second Cosmelan mask is applied. Between both of these appointments, various creams will be prescribed in order to keep the skin clear of pigmentation. One must also avoid sunlight during this period to achieve maintain the best cosmetic results.
Cosmelan treatment – 8 months
Cosmetic Dermatology in African American skin
Dr. Green is an internationally renown expert in minimally invasive cosmetic procedures. Some of the most popular cosmetic procedures in her office are Botox, Juvederm, lip augmentation, Kybella, Thermage, and neck rejuvenation. The trend currently in cosmetic dermatology is for a more natural looking result. Dr. Green’s “less is more” philosophy extends to Botox where she believes in using “Baby Botox” or “Botox sprinkles” so that patients don’t look “frozen”. Similarly, with cheek augmentation and lip enhancement, the goal is to look younger, remove fine and deeper lines, and look refreshed. Through a combination of treatments, such as laser treatments, hydrafacaials, dermal fillers, and the right skin care, the goal is to both restore and maintain these rejuvenated results.
Laser Hair Removal
African American patients must be careful to select the appropriate laser for their skin tone. Laser hair removal procedures are highly sensitive to all color and melanin, which plays a critical role in the treatments of darker skin types. The laser is designed to target water, hemoglobin or brown melanin. If the proper wavelength or depth of penetration is not correctly set for darker skin patients, the skin can be easily damaged.
Dr. Michele Green utilizes the Candela Gentle Yag (ND:Yag laser) since this laser is equipped with long wavelengths and pulse width, which is most effective and safe for ethnic tones and all darker skin patients.
The reason the GentleYAG works so well is that it penetrates deeper than traditional laser treatments, which means the pigment in the skin is not affected in the same way. The GentleYAG laser can bypass the melanin in the surface of the skin and targets the hair root, providing safe and effective results. One of the risks with laser hair removal is hyperpigmentation or hypopigmentation (white spots) from the laser treatment. The Candela Gentle Yag was designed specifically for patients with darker skin tones, to avoid this unwanted side effect.
For more information about treating ethnic skin including chemical peels, acne scar treatments, Cosmelan, tattoo removal, laser hair removal, skin lightening and other dermatology treatments for African American skin, schedule a consultation with Dr. Michele Green at 212-535-3088 or contact us online. Dr. Green is based on the Upper East Side of NYC and is a Board Certified cosmetic dermatologist with experience treating male and female patients of all skin tones. She treats patients from Los Angeles to New York and with many international patients as well seeking her expertise in skin of color.