There are both unique nuances and cultural considerations to rejuvenating the skin of East Asian patients, according to Annie Chiu, M.D., founder and owner of The Derm Institute in Hermosa Beach, Calif. Primary common concerns are more centered around skin texture, pore size and evenness of pigment, she says. While these patients can vary in presentation of pigment in their skin, they are generally skin type 3 or higher, making them more prone to hyperpigmentation than more fair-skinned individuals.
She notes that East Asian skin can be hyperreactive.
“These patients can look like lighter skin types, but can have a greater tendency then you expect for hyperpigmentation,” she says. The increased melanocytes in the skin can be easily activated with trauma, inflammation or heat, says Dr. Chiu who spoke on cosmetic dermatologic concerns among East Asians at the Skin of Color Seminar Series (SOCSS) in New York City in May.
“Therefore, you need to be careful when employing treatment modalities that may be irritating, whether it be topical medications or lasers,” Dr. Chiu says.
When treating with peel modalities, the use of less inflammatory peel ingredients such as salicylic acid or lactic acid, versus the more inflammatory glycolic acid, should be considered for more predictability.
Co-managing such patients with topical bleaching products containing hydroquinone is also an option, as a way to both prevent and pretreat possible unexpected postinflammatory changes.
In addition, “sun protection and proper broad-spectrum sunscreen is critical whenever you undertake any sort of resurfacing procedures on these patients,” Dr. Chiu says.
Because East Asian skin can be more sensitive, products like retinoids and hydroquinone to treat melasma and hyperpigmentation will cause excessive irritation.
“Consequently, I tend to start my patients on an every-other-day regimen, making sure they are not too irritated, using only tiny amounts, perhaps mixed with a moisturizer,” Dr. Chiu says. “If tolerated, I will then increase the amount of topical retinoids and hydroquinone.”
“When treating using lasers, you may want to consider a test area. This also holds true for deeper chemical peels,” Dr. Chiu says. You may also consider products that inhibit pigment, including vitamin C, hydroquinone and kojic acid, both pre- and post-procedure, she adds.
Laser procedures are not recommended for patients that are tanned or who are going to be in the sun, and should be used with great caution in melasma.
“These factors increase the likelihood of having an adverse effect, and I often see Asian patients who have worsened pigment because of incorrect treatment with intense pulsed light (IPL) by a medical spa,” Dr. Chiu says.