Diversity and dermatologic surgery

Key Points

For Eliot Battle, M.D., this trend signals that dermatologic surgeons must educate themselves about the nature of skin of color in order to more effectively treat their patients.

Double whammy

First, and most obviously, know the procedures thoroughly, and second, understand the differences and various nuances of ethnic skin.

"This will become even more crucial as years go by, because no longer are surgical procedures almost exclusively being done on Caucasian patients," he tells Dermatology Times.

"In addition, as the population has become more diverse and produced offspring with mixed skin characteristics, we are having to adjust and learn about what those characteristics are so we can more effectively do our job."

Dr. Battle cites the most obvious example of this lack of knowledge: the entertainer Michael Jackson.

"What happened to him is the perfect example of what I'm talking about," Dr. Battle says. "The best surgeons, both plastic and dermatologic, worked on him in original and corrective procedures - they were highly skilled in the procedures but obviously had little knowledge of ethnic skin."

Surgeons' knowledge must be more than skin deep, Dr. Battle adds.

"Not only do we need to look at the differences in skin textures among ethnic patients, but to internal supporting structures," he says. "For example, people of African ancestry have thicker skin, larger and more numerous sebaceous glands, thicker stratum corneum, more and larger fibroblast cells and larger macrophages."

Post-surgical hyperpigmentation also can be a major problem .

"With my Caucasian patients, I'm not concerned with redness of the skin with laser treatment, for instance, because I know it will resolve," Dr. Battle says. "In skin of color, this can turn into hypertrophic scarring or hyperpigmentation. I often remove sutures sooner with ethnic patients to avoid infections that can lead to scarring."

Seeing the light

Thanks to improving technology and dermatologists' increasing awareness of ethnic skin types, laser treatment has become more appropriate for patients of color.

"Skin-rejuvenation laser treatments for complexion blending, collagen enhancement and improved skin laxity have become more popular among people of color," Dr. Battle says, "and lasers are also very effective for treating pseudofolliculitis barbae, which is so common among African American men. Traditional methods for removing unwanted hair, such as plucking, waxing, shaving and electrolysis often create dark spots or scarring. Laser-assisted hair removal minimizes those problems, and people of color frequently experience dramatic improvement in skin texture and tone following laser hair removal procedures."

Dr. Battle says lasers also are appropriate for psoriasis, vitiligo, acne, scar and leukoderma therapy and tattoo removal in patients of color.

Sharing the wealth

"Other dermatologists will refer patients of color to me, and I'm honored that they do, but I think it would be better if once they referred, they'd come and watch and learn about the treatments," he says. "I'd be honored even more if they did that."