Essentials for Aesthetic Dermatology in Ethnic Skin: Practice and Procedure

Description

This book focusses on creating awareness and detailing the nuances of aesthetic dermatology practice in skin of colour. It highlights practical considerations in pre/intra/post procedure care with emphasis on patient selection for aesthetic procedures and the associated challenges involved in real-time practice. It aims to cater to audiences of countries with both high and low dark skin patient population, as often the clinicians have limited experience in treating this group. Numerous topics are explored through case- based discussions and practical tips. This is a practical ready reference manual for a cosmetic dermatologist dealing with darker skin. Key Features: • Features the geo-ethnic skin types of Asians, South-east Asians, Africans and Hispanics. • Explores the topics through case-based discussions. • Provides comprehensive details about the use of machines on skin of color. Cover Half Title Title Copyright Dedication Contents Acknowledgments Editors Contributors Part I: Fundamentals in Understanding Ethnic Skin/Skin of Color 1 Introduction 2 Anatomy: Skin, Hair, Nails 3 Factors Affecting Skin Integrity 3.1 Introduction 3.2 Microbiome 3.3 Endocrine 3.4 Climate 3.4.1 Sunlight and Humidity 3.4.2 Cold and Dry 3.5 Allergens and Irritants 3.5.1 Skin 3.5.2 Hair 3.5.3 Genetic 3.5.4 Cultural Practices 3.5.5 Aging 3.6 Conclusion 4 Geo­Ethnic Variations in Skin 4.1 Introduction 4.2 The Origin of Humans 4.3 Differences in Skin Coloration 4.4 Racial Differences in Stratum Corneum Structure 4.5 Racial Differences in Epidermal­Dermal Function 4.6 Racial Differences in Cutaneous Appendages: Eccrine, Apocrine, and Apoeccrine Sweat Glands 4.7 Sebaceous Glands 4.8 Cutaneous Irritation in Different Racial Groups 4.9 Clinically Relevant Structural and Functional Differences 4.10 Complications Part II: Cases Encountered in Cosmetic Dermatology Practice 5 Sensitive Skin 5.1 Definition 5.2 Introduction 5.2.1 Key Considerations before Moving Forward with Cosmetic Procedures 5.3 Aesthetic Procedures and Considerations in Skin of Color 5.3.1 Chemical Peels 5.3.2 Lasers 5.3.3 Hair Removal 5.3.4 Injectables 5.3.5 Microdermabrasion (MDA) 5.3.6 Hair Transplantation 5.3.7 Other Considerations: Keloids and Hypertrophic Scars 5.4 Conclusion 6 Acne Vulgaris 6.1 Introduction 6.2 Classification 6.2.1 Mild Acne Vulgaris 6.2.2 Moderate to Severe Acne Vulgaris 6.3 Epidemiological and Etiological Aspects 6.3.1 Acne Grading System 6.4 Investigations 6.5 Management/Approach to Ethnic Skin 6.6 Clinical Pearls in Treating Skin of Color 6.7 Conclusion 7 Rosacea 7.1 Introduction 7.2 Epidemiology 7.3 Pathophysiology of Rosacea in Skin of Color 7.4 Clinical Features and Subtypes of Rosacea 7.5 Differential Diagnoses to Be Considered in Patients with Skin of Color 7.6 Treatment of Rosacea 7.7 General Measures/Non­Pharmacologic Treatments 7.7a Patient Education 7.7b Photoprotection/Sunscreens 7.7c Facial Cleansers 7.7d Facial Moisturizers 7.8 Conclusion 8 Pigmentary Disorders 8.1 Introduction 8.2 Hyperpigmentation 8.2a Acquired Diffuse Hyperpigmentation 8.2b Hyperpigmentation of Genetic/Nevoid Origin 8.2c Acquired Localized Hyperpigmentation 8.2d Drug­Induced Hyperpigmentation 8.2e Reticulate Pigmentary Disorders 8.2f Hyperpigmentation Affecting Flexures 8.2g Pigmented Lesions in Oral Mucosa 8.2h Pigmented Lesions of the Vulva 8.3 Hypopigmentation Disorders 8.3a Piebaldism 8.3b Waardenburg Syndrome 8.3c Albinism 8.3d Griscelli Syndrome 8.3e Ash Leaf Macules 8.3f Nevus Anemicus 8.3g Nevus Depigmentosus 8.3h Hypomelanosis of Ito 8.3i Idiopathic Guttate Hypomelanosis 8.3j Vitiligo 8.3k Other Hypopigmentation Disorders 8.4 Conclusion 9 Contact Dermatitis 9.1 Introduction 9.2 Allergic Contact Dermatitis 9.2.1 Epidemiology 9.3 Risk Factors 9.4 Ethnicity 9.5 Pathogenesis 9.6 Sensitization Phase 9.7 Elicitation Phase 9.8 Clinical Presentation 9.8.1 Localized ACD 9.8.2 Systemic/Generalized CD 9.8.3 Non­Eczematous ACD 9.8.4 Allergic Contact Urticaria (ACU) 9.8.5 Diagnosis 9.9 Patch Test 9.9.1 Types 9.10 Conclusion 10 Keloids and Hypertrophic Scars 10.1 Introduction 10.1.1 Etiology 10.1.2 Psychological Impact 10.1.3 Case 10.1.4 Standard Guidelines of Care for Keloids and Hypertrophic Scars 10.2 Conclusion 11 Hirsutism 11.1 Introduction 11.2 Epidemiology 11.3 Pathophysiology 11.3.1 Types of Hair 11.3.2 Normal Enzymatic Activity of the Skin 11.3.3 Androgens and Hair Growth 11.3.4 Insulin Resistance and Hirsutism 11.4 Etiology 11.5 Clinical Features 11.6 Classification of Severity 11.7 Approach to a Hirsute Patient 11.8 Management 11.9 Conclusion 12 Hair Loss and Hair Disorders 12.1 Introduction 12.2 Diffuse Non-Scarring Hair Loss 12.2a Androgenetic Alopecia 12.2b Telogen Effluvium 12.2c Loose Anagen Hair Syndrome 12.3 Patchy Non-Scarring Alopecia 12.3a Alopecia Areata 12.3b Traction Alopecia 12.3c Pressure Alopecia 12.3d Trichotillomania 12.3e Tinea Capitis 12.4 Cicatricial Alopecia 12.4a Central Centrifugal Cicatricial Alopecia 12.4b Lichen Planopilaris 12.4c Frontal Fibrosing Alopecia 12.4d Chronic Cutaneous Lupus Erythematosus 12.4e Folliculitis Decalvans 12.5 Hair Shaft Disorder 12.5a Chemotherapy-Induced Hair Loss 12.6 Conclusion 13 Periorbital Conditions in Ethnic Skin 13.1 Introduction 13.2 Functional Periorbital Anatomy 13.3 Periocular Wrinkles 13.3.1 Crow’s Feet 13.3.2 Horizontal Forehead Lines 13.3.3 Glabellar Frown Lines 13.3.4 Brow Contouring 13.4 Periocular Hills and Valleys 13.4.1 The Valleys 13.4.2 The Hills 13.5 The Dark Circles (Periocular Hyperpigmentation) 13.6 Dermatochalasis and Blepharochalasis 13.6.1 Preoperative Evaluation 13.6.2 Blepharoplasty Surgery 13.7 Transcutaneous Lower­Lid Blepharoplasty 13.8 Conclusion 14 Psychological Concerns in Ethnic Skin 14.1 Disorders of Pigmentation 14.1.1 Vitiligo 14.1.2 Melasma 14.1.3 Acne and Post­Inflammatory Hyperpigmentation 14.2 Hair/Scalp 14.2.1 Alopecia 14.2.2 Pseudofolliculitis Barbae (Razorbump) 14.2.3 Perifolliculitis Capitis Abscedens et Suffodiens (Dissecting Cellulitis) 14.3 Others 14.3.1 Keloids 14.3.2 Sarcoidosis 14.3.3 Eczema 14.3.4 Psoriasis 14.4 Conclusion Part III: Cosmeceuticals 15 Physical Photoprotection, Cosmetic Camouflage, and Sunscreens 15.1 Introduction 15.2 Sunlight 15.2.1 Physical Means of Photoprotection 15.2.2 The UPF of a Fabric Depends Upon 15.3 Sunscreens 15.3.1 Primary Photoprotection 15.3.2 Secondary Photoprotection 15.4 Characteristics of a Perfect Sunscreen 15.5 Sunscreen Labels 15.6 Application and Reapplication 15.7 Quantity 15.8 Shelf Life 15.9 Advice for Children 15.10 Safety 15.11 Adverse Reactions 15.12 Contraindications 15.13 Precautions 15.14 Sunscreen for Lips and Eyes 15.15 Sunscreen and Pollution 15.16 Controversies 15.17 Sunscreen and Its Effect on Vitamin D (“Sunshine Vitamin”) 15.18 Effect on Ecosystems 15.19 Oral Photoprotection 15.20 Sunscreen and Insect Repellents 15.21 Camouflage and Cosmetics 15.22 Skin of Color and Use of Sunscreen 15.23 Conclusion 16 Cleansers and Moisturizers 16.1 Introduction 16.2 Cleansers 16.3 Additional Considerations 16.3.1 Acid­Base Balance 16.3.2 Bar versus Liquid 16.3.3 Preservatives 16.3.4 Enhancers 16.3.5 Choosing a Product 16.4 Moisturizers 16.4.1 Occlusives 16.4.2 Humectants 16.4.3 Emollients 16.4.4 Preservatives 16.4.5 Enhancers 16.4.6 Choosing a Product 16.4.7 Clinical Pearls in Treating Skin of Color 16.5 Conclusion 17 Topical Anti­Acne Agents 17.1 Introduction 17.2 Treatment of Acne 17.2.1 Do Topicals Work in the Treatment of Acne? 17.3 Classification of Anti­Acne Agents 17.3.1 Antimicrobial Agents 17.3.2 How to Choose an Anti­Acne Agent 17.3.3 Side Effects of Antibacterials and Their Management 17.4 Hydroxyl Acid 17.5 Topical Retinoids 17.6 Combination Therapies 17.7 Anti­Acne Agents in Special Categories 17.7.1 Children 17.7.2 Pregnancy 17.8 Novel Approaches in the Treatment of Acne 17.8.1 Liposomal Formulation of Retinoids 17.8.2 Microsponges 17.8.3 Microspheres 17.8.4 Mechanical Treatments 17.9 Procedural Therapies in Acne 17.10 Newer/Emerging Topical Anti­Acne Agents 17.11 Conclusion 18 Lightening Formulations 18.1 Introduction 18.2 Indications 18.3 Classification 18.3.1 Lightening Formulations That Regulate Melanocyte Activation 18.3.2 Lightening Formulations That Reduce Melanogenesis 18.3.3 Lightening Formulations That Inhibit Melanosome Transfer to Keratinocytes 18.3.4 Lightening Formulations That Remove Epidermal Pigment 18.4 Clinical Pearls in Treating Ethnic Skin/Skin of Color 19 Anti­Aging Agents for Ethnic Skin 19.1 Introduction 19.2 Classification 19.2.1 Sunscreens 19.2.2 Retinoids 19.2.3 Alpha­ and Beta­Hydroxy Acids 19.2.4 Antioxidants 19.2.5 Polyphenol/Flavonoid Antioxidants 19.2.6 Hormonal Agents 19.2.7 Growth Factors 19.2.8 Peptides 19.2.9 Anti­Aging Minerals 19.2.10 Nutraceuticals Targeting Advanced Glycation End Products 19.3 Clinical Pearls in Treating Ethnic Skin 19.4 Indications for Agents 19.5 How to Use and Dosage 19.6 Side Effects 19.7 Choosing a Product 19.8 Conclusion 20 Cosmeceuticals in Hair Care 20.1 Background 20.2 How Do They Differ from Cosmetics and Drugs? 20.3 Other Cosmeceuticals Available for Hair Care 20.3.1 Decoding the Cosmeceuticals Available in the Market 20.4 Where Do Cosmeceuticals Score in Hair Care 20.4.1 Clinical Situations Frequently Encountered in Day­to­Day Practice 20.5 How to Increase the Efficiency of Peptide Penetration 20.6 Tests for Efficacy 20.6.1 Physical Examination of the Scalp 20.7 Conclusion 21 Lip, Nail, and Eye Care 21.1 Introduction 21.2 Lip Care 21.2.1 Specific Anatomical Considerations 21.2.2 Why Do Our Lips Need Separate Care? 21.2.3 Examination of the Lips 21.2.4 Lip­Licking Dermatitis 21.2.5 Lip Balms 21.2.6 Recent Advances and Lip Fillers 21.3 Nail Care 21.4 Nail Cosmetics 21.5 Eye Care 21.5.1 Eye Health 21.5.2 Special Eye Care Measures 21.6 Conclusion 22 Vitamins, Antioxidants, and Proteins 22.1 The Role of Nutrients in Skin Health 22.2 Vitamins 22.2.1 Vitamin A 22.2.2 Vitamin C 22.2.3 Vitamin E 22.2.4 Vitamin D 22.2.5 The B Vitamins 22.2.6 Vitamin K 22.3 Antioxidants 22.4 Proteins and Amino Acids 22.5 Oral Nutraceuticals 22.6 Conclusion 23 Cosmeceutical­Related Dermatitis and Allergies 23.1 Introduction 23.2 Classification 23.3 Epidemiology 23.4 Common Cosmeceutical Allergens 23.4.1 Fragrance 23.4.2 Preservatives 23.4.3 Vitamins 23.4.4 Hydroxy Acids 23.4.5 Botanicals 23.5 Investigation 23.5.1 History and Physical Exam 23.5.2 Patch Testing 23.6 Management 23.6.1 Post­Inflammatory Hyperpigmentation Part IV: Procedural Considerations for a Patient with Ethnic Skin 24 Evaluation and Assessment for Ethnic Skin 24.1 Introduction 24.2 What Are Consumers Looking For? 24.3 Differences in Intrinsic Aging across Ethnicities 24.3.1 Evaluation of Asian Skin 24.3.2 Evaluation of Southeast Asian Skin 24.3.3 Evaluation of Middle Eastern Skin 24.3.4 Evaluation of African Skin 24.3.5 Evaluation of Hispanic Skin 24.4 Conclusion 25 Aging in Middle Eastern Skin 25.1 Introduction 25.2 Stress and Aging Skin 25.3 Cutaneous Anatomical Features and Aging Skin 25.4 Pigmentary Disorders 25.5 Consultation for the Aging Face 25.6 Case 1 25.7 Cases 2 and 3 25.8 Case 4 25.9 Case 5 25.10 Case 6 25.11 Cases 7, 8, and 9 26 Minimizing Complications in Skin of Color 26.1 General Pre­Treatment Care for Chemical Peels, Microneedling, Microneedling Radiofrequency (MNRF), Platelet­Rich Plasma, and Laser and Light Devices 26.1.1 Pre­Treatment Priming 26.2 Special Considerations While Doing Chemical Peels: Step­by­Step, Shehnaz in Aesthetic Derm 26.3 Special Considerations While Doing Laser Treatments 26.4 Points to Remember before Any Laser Treatment 26.5 Points to Remember Pertaining to Specific Lasers 26.6 Hair Removal Lasers 26.7 Special Considerations While Doing Injectables 27 SOP for an Aesthetic Dermatology Clinic 27.1 Introduction 27.2 What Does Aesthetic Dermatology Comprise? 27.3 The State of Aesthetic Healthcare Practice 27.4 Infrastructure 27.5 Physician Qualifications and Staff Requirements 27.6 Equipment 27.7 Pre­Procedure Checklist 27.8 Procedures That Can Be Performed 27.9 Post­Procedure Care 27.10 Pharmacy and Dispensing 27.11 Telemedicine and Virtual Consultation 27.12 Publicity and Promotion 27.13 The Ethical Issues of Cosmetic Procedures 27.14 Conclusion Part V: Procedures 28 Chemical Peels 28.1 Introduction 28.2 Indications 28.2.1 Contraindications 28.3 Patient Workup and Counseling 28.3.1 History 28.3.2 Examination 28.3.3 Photographic Documents 28.3.4 Patient Selection 28.3.5 Test Spot Testing 28.4 Pre­Procedure Care 28.5 Procedure 28.5.1 Peeling Technique 28.5.2 Reagents 28.5.2a Tretinoin Peel 28.5.2b Salicylic Acid (SA) 28.5.2c Trichloroacetic Acid 28.5.2d Glycolic Peel 28.5.2e Jessner’s and Modified Jessner’s Solution 28.5.2f Phenol Peel 28.5.3 Procedure 28.6 Post­Procedure Care 28.7 Side Effects and Their Management 28.8 Clinical Pearls in Treating Ethnic Skin/Skin of Color 28.9 Conclusion 29 Microdermabrasion 29.1 Introduction 29.2 Type of Devices 29.2.1 Crystal­Containing MDA 29.2.2 Non­Crystal­Containing MDA 29.2.3 Oxygen MDA (Oxybrasion) 29.3 Mechanism of Action 29.4 Histological Evaluation 29.5 Transdermal Drug Delivery 29.6 The Effect of Skin Barrier Function 29.6.1 Sebum 29.6.2 Skin Hydration 29.6.3 Transepidermal Water Loss (TEWL) 29.6.4 Skin pH 29.6.5 The Effect of Skin Pigmentation 29.6.6 Indications 29.7 Patient Workup/Counseling 29.8 Pre­Procedure Care 29.9 Procedure 29.9.1 Patient Preparation 29.9.2 Device and Equipment Preparation 29.9.3 Operator Preparation 29.9.4 Steps of Treatment 29.10 Post­Procedure Care 29.11 Side Effects and Their Management 29.12 Clinical Pearls in Treating Ethnic Skin 29.13 Special Precautions—Do’s and Don’ts 30 Microneedling 30.1 Introduction 30.2 Mechanisms of Action 30.3 Devices 30.4 Roller MN 30.5 Stamp MN 30.6 Pen MN 30.7 Other Variations in MN Devices 30.8 Patient Considerations and Clinical Assessment 30.9 Operative Techniques 30.10 Post­Procedure Care 30.11 Number and Frequency of Treatments 30.12 Side Effects and Their Management 30.13 Special Precautions 30.14 Conclusion 31 Lasers and Lights 31.1 Introduction 31.2 Biological Characteristics and Classification of Skin of Color 31.3 Lasers in Skin of Color: General Considerations and Precautions 31.4 Laser Hair Removal 31.5 Skin Rejuvenation and Resurfacing 31.6 Endogenous Epidermal and Dermal Pigmented Lesions 31.6.1 Melasma 31.6.2 Ephelides, Lentigines, and Dermal Melanocytosis 31.7 Conclusion 32 Non­Light Energy-Based Devices 32.1 Introduction 32.2 Classification 32.3 Indications 32.4 Radiofrequency 32.5 Nonablative Radiofrequency Skin Tightening 32.6 Classification of Radiofrequency 32.7 Fractional Sublative Radiofrequency 32.8 Nano­Fractional Radiofrequency 32.9 Fractional Microneedling Radiofrequency 32.10 High­Intensity Focused Ultrasound 32.11 Cryolipolysis 32.12 Conclusion 33 Injectables: Toxins—Intrinsic Aspects and Special Precautions 33.1 Introduction 33.2 Botulinum Toxin for Glabella and Forehead 33.3 Treating Lateral Canthal Lines with Botulinum Toxin 33.4 Nasal Tip Elevation with Botulinum Toxin 33.5 Botulinum Toxin Treatment for Perioral Lines 33.6 Botulinum Toxin A Treatment of Masseter 33.7 Botulinum Toxin A for Parotid Gland 33.8 Botulinum Toxin for Chin (Mentalis) 33.9 Botulinum Toxin Treatment for the Neck and Jawline 33.10 Side Effects of Botulinum Toxin Treatment 33.11 Conclusion 33.12 The Future of Botulinum Toxin 33.13 Botulinum Toxin in Times of the Pandemic 34 Injectables: Fillers—Intrinsic Aspects and Special Precautions 34.1 Introduction 34.2 Structural and Functional Differences of Ethnic Skin 34.3 Skin Aging Assessment in Ethnic Skin 34.4 Indications 34.5 Patient Workup/Counseling 34.6 Pre­Procedure Care 34.7 Procedure 34.8 Post­Procedure Care for Ethnic Skin 34.9 Side Effects and Their Management 34.10 Clinical Pearls in Treating Ethnic Skin or Skin of Color 34.11 Special Precautions Do’s and Don’ts 34.12 Precautions during COVID­19 Times for Dermal Fillers, Especially in India 34.13 CK2 Point in Indian Men beyond 40 Years and Bony Resorption 34.14 Conclusion 35A Emerging Techniques: Platelet­Rich Plasma Therapy 35A.1 Introduction 35A.2 Indications 35A.3 Patient Workup/Counseling 35A.4 Pre­Procedure Care 35A.5 Procedure 35A.6 Post­Procedure Care 35A.7 Contraindications 35A.8 Side Effects and Their Management 35A.9 Clinical Pearls in Treating Ethnic Skin/Skin of Color 35A.10 Special Precautions 35B Non­FDA Skin­Lightening Procedures 35C Non­Surgical Thread Lifts 35C.1 Introduction 35C.2 Indications 35C.3 Types of Threads 35C.4 Mechanism of Action 35C.5 Patient Workup/Counseling 35C.6 Pre­Procedure Care 35C.7 Procedure 35C.8 Post­Procedure Care 35C.9 Contraindications 35C.10 Side Effects and Their Management 35C.11 Clinical Pearls in Treating Ethnic Skin/Skin of Color 35C.11.1 Combination Treatments 36 Home-Use Devices: An Overview and Regulatory Aspects 36.1 Introduction 36.2 Hair Reduction 36.2.1 Mode of Action 36.2.2 Clinical Efficacy and Safety 36.2.3 Side Effects and Adverse Incidents 36.3 Skin Rejuvenation 36.3.1 Mode of Action—Thermally Based Technology 36.3.2 Mode of Action—Non­Thermal Technology 36.3.3 Clinical Efficacy and Safety 36.3.4 Side Effects and Adverse Incidents 36.4 Hair Growth Stimulation 36.4.1 Mode of Action 36.4.2 Clinical Efficacy and Safety 36.4.3 Side Effects and Adverse Incidents 36.5 Medical Use of Huds 36.5.1 Mode of Action 36.5.2 Clinical Efficacy and Safety 36.5.3 Side Effects and Adverse Incidents 36.6 Standards 36.6.1 Embedded Lasers—Class 1C 36.7 Regulatory Aspects 36.7.1 General 36.7.2 Regulations outside the European Union and the United States 36.8 Where Does This Leave the Professional Practitioner and the Client? 36.9 Conclusion Part VI 37 Digital Marketing and Social Media Branding 37.1 Dermatology Trends on Social Media 37.2 More Dermatologists Turn to Social Media to Communicate with Patients 37.3 Increasing Your Brand Awareness 37.4 Five Core Benefits of Social Media Marketing for Dermatologists 37.5 Best Practices for Creating Compelling Content 37.6 Monitoring Your Online Reputation 37.7 Conclusion Part VII: The Future 38 Newer Cosmeceuticals 38.1 Introduction 38.2 Peptide­Containing Cosmeceuticals 38.2.1 Carrier Peptides 38.2.2 Signal Peptides 38.2.3 Neurotransmitter Peptides 38.3 Platelet­Rich Plasma Cosmeceuticals 38.4 Prebiotic, Probiotic, and Postbiotic Cosmeceuticals 38.5 Conclusion 39 New Devices for Treating Darker Skin Types 39.1 Introduction 39.2 Ethnic Population 39.3 Laser Tissue Interactions 39.4 Anti­Aging Treatments 39.5 Lasers 39.6 Radiofrequency 39.7 Microfocused Ultrasound 39.8 Toxins and Fillers 39.9 Skin Tone and Pigmentation Disorders 39.10 Acne and Other Scarring 39.11 Facial Photodamage and Rejuvenation 39.12 Benign Cutaneous Tumors 39.13 Hair Disorders 39.13.1 Acne Keloidalis Nuchae 39.13.2 Hypertrichosis 39.14 Conclusion Part VIII 40 Post­COVID­19: Where Are We Headed? Index