Proceedings of the Fifth SKIN SPECTRUM SUMMIT

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SSS-2019 02-10-20_Layout 1 2/12/2020 5:17 PM Page 16AESTHETICS& HAIR16 • Proceedings of 2019 SKIN SPECTRUM SUMMITSafe, effective aesthetic Tx in skin of colourDr. Haneef AlibhaiUsing the correct tools and techniques for aestheticdermatology in darker skin can producegood results while minimizing the risk of inducingunwanted pigment changes, explained Dr. HaneefAlibhai at Skin Spectrum Summit in Vancouver.One technology Dr. Alibhai advocated for skin rejuvenationin Fitzpatrick skin types IV through VI was picosecondpulsed lasers.“The beauty of the picosecond laser is it does not workphotothermally, as other lasers do. Picosecond lasers workphotoacoustically, creating a pressure wave to break downpigment,” he said.Rather than heating a target point, these devices causea phenomenon known as laser-induced optical breakdown,which causes a pressure wave that spreads through the tissue,reaching deeper into the dermis than the lasers couldthemselves, Dr. Alibhai said. The pressure waves temporarilyalter the permeability of the cell membranes, which increasesproduction of elastin and collagen.This process leads to very little downtime, “and there isno risk of hyperpigmentation because these laser-inducedoptical breakdowns are located below the dermal-epidermaljunction,” he said.“This is a very good device to lighten unwanted pigment.It has become my go-to to treat pigmentation on skintypes IV, V, and VI, such as your typical solar lentigines, verysafely.”Dr. Marissa Joseph began hertalk at Skin Spectrum Summitin Toronto by examiningthe belief that there is adifference in how individuals ofdifferent races age.“Is that really true?” she asked beforegoing on to contrast the featuresof aging seen in different skin types.Thinking about mechanisms ofOf the picosecond lasers, Dr. Alibhai said he prefers a755 nm device as energy at that wavelength is much morepreferentially absorbed by melanin rather than oxyhemoglobin.“If you compare it to 532 nm, where the melanin-tobloodratio is about 2.5, or 1,064 nm, wheremelanin-to-blood absorption is about 16 times, at 755 nm,the difference between melanin and oxyhemoglobin absorptionis actually 50 times.”This results in very limited risk of pinpoint bleeding,minimal side-effects and less downtime while lightening pigmentand increasing collagen, he said.Dr. Alibhai and his colleagues have begun pre-treatingdarker-skinned patients with hydroquinone compounds forthe four weeks prior to their picosecond laser appointments,he said. “That is just for our comfort and safety, sowe can sleep well at night. Just to minimize the risk of [postinflammatoryhyperpigmentation].Many patients with darker skin have also asked aboutcorrecting dark circles under their eyes, he said. For thosepatients, particularly those with hollows under their eyes,Dr. Alibhai has been treating them with very fine, low-cohesivity,low-viscosity hyaluronic acid fillers, administered usinga cannula.“You have to choose the right patient,” he noted, sayingthat only three of every 10 patients are a candidate fortreating this way. “If you have the right patient, the rightproduct and the right technique, you get great results.”How does skin aging differ among races?Dr. Marissa Josephaging is important across all skintypes, she said.She spoke about intrinsic agingand extrinsic aging, making note of theextrinsic causes of aging, such as UV
SSS-2019 02-10-20_Layout 1 2/12/2020 5:17 PM Page 17Dr. Marissa Josephexposure and smoking.But, she said, when comparingFitzpatrick skin types, darker skin typestend to experience facial aging at a decreasedrate due to intrinsic factors.Grooming practices for Afro-textured hairDr. Renée A. BeachWhen it comes to groomingpractices for those withAfro-textured hair, youare considering another type ofnormal, according to Dr. RenéeBeach, who presented on hair andscalp disorders at Skin SpectrumSummit in Montreal.Whereas non-Afro-textured hairtypes may require washing two tothree times a week, with Afro-texturedhair, weekly washing is generallyadequate enough.“The hair can be quite fragile formanipulation, so you really want toAccording to a survey of womenaged 18 to 75, “African-Americanwomen reported advanced signs of facialaging on average 10 to 20 yearslater than their Caucasian counterparts,”she said.Forehead lines in African-Americanwomen were reported in their50s, tear troughs did not appear untiltheir 60s and crow’s feet finally appearedin their 70s, she said.Approximately 70% of African-American women aged 70 to 79 reportedthat they still had not observedlines around their mouths.“There really is a delayed onset ofthings like wrinkles,” she said.Dr. Joseph went on to rank therate of wrinkle onset by race: black patientsexperienced the slowest onset,followed by Hispanic patients, Asianpatients and, finally, white patients.The reason that darker-skinned patientsexperience a decreased rate ofonset may be due to “a protective effectof increased fibroblast activity,” she said.This may also explain the increasedrisk of keloids in darkerskinnedpatients, she said.This does not mean that patientswith darker skin tones don’t seek orrequire treatments or improvementsfor anti-aging, she said.Dermatosis papulosa nigra, smalldark keratoses that appear on theface and neck, was one of the examplesshe gave of an aging conditionspecific to people with darker skin.“There are nuances to addressingtheir specific aging concerns,” she said.have patients [be] careful with regardsto styling practices,” explainedDr. Beach. “The hair growth is generallyless than other hair types, andthis can be approximately half orthree-quarters of the rate of otherhair types.”Patients in this cohort prefer touse conditioners over shampoosmainly because some of the slippingagents in conditioners helpAfro-textured hair be more manageableafter it is shampooed.As a result of the decreasedgrowth rate in patients with Afrotexturedhair, trimming frequencyshould be reduced to twice a yearon average, according to Dr.Beach.Additionally, the bedtime routinefor patients with Afro-texturedhair is significant for two reasons:first, to preserve a certain hairstyle,and second, to minimize trauma tothe existing hair. Some patients willapply moisturizing products but willalso protect the hair with somethingsilky or satiny, such as a bonnetor particular wrap, to minimizefriction.Tractionalopecia in menwith turbansDr. Renée A. BeachTraction alopecia is a scalpdisorder that occurs commonlyin women. But as Dr.Renée A. Beach discussed duringher presentation on hair andscalp disorders at Skin SpectrumSummit in Vancouver, a minorityof men, particularly men whowear turbans, report symptomsof the condition.“As a dermatologist, we oftenlook before we ask, and when welook, we see that there is loss of thefrontal hairline, with a fringe pattern[of hair] remaining at the edge of thefront,” Dr. Beach said, describing thesymptoms of traction alopecia.Female patients will show signsof gradual hair loss as a result of ahistory of wearing swept-back hairstyles,sleek ponytails and top knots.According to Dr. Beach, when youquestion these patients, they willadmit that when the hairstyles go in,they are painful. But both femaleand male patients often accept thepain as part of the styling process.Signs of traction alopecia includethe fringe hair loss along theedge of the frontal scalp. There is retainedvellus or small terminal hairsthat simply do not get swept up intoin cooperation with JOURNAL OF ETHNODERMATOLOGY • 17
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Proceedings of the Fifth SKIN SPECTRUM SUMMIT

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