Rather than simply dividing skin care into categories based on the traditional dry, normal and oily skin types, I evaluate my patients in terms of their skin and hair coloration. This allows me to develop skin care programs based on their individual potential for irritation and inflammation.
The palest complexions, especially in people of Irish and Nordic descent, are far more susceptible to sun damage. The lack of melanin pigment in their skin leads to early signs of photoaging. In fact, when exposed to sunlight, light-toned complexions experience much greater free radical development than what is produced in darker-toned skin.
The melanin pigment in the skin acts as an umbrella that absorbs ultraviolet rays. After just five minutes in direct sunlight, free radicals are activated, primarily in the cell plasma membrane, which releases arachidonic acid—and the damaging cascade begins. In lighter skin tones, the cascade and its consequences proceed rapidly, leading to early wrinkling and, occasionally, skin cancer lesions.
Deceased oil gland function has the positive effect of limiting acne breakouts and blemishes. Unfortunately, it also means that skin is dryer, making lines and wrinkles more visible. Although pale skin is more prone to oxidative stress from dehydration and sunlight, it is less likely to scar or develop patches of discoloration. This type of skin heals beautifully from cosmetic procedures such as facelift, dermabrasion or skin peel.
If you have pale skin, you should use cleansers for dry or sensitive skin. Your moisturizer should be rich in emollients. This type of skin needs a lifetime of protection from sun damage. A sunscreen with an SPF of 15 should be applied over the moisturizer and under your makeup each day. Be sure to use sunblock on your neck, chest and hands as well.
I was fortunate to do my residency at the Ford Medical Center in Detroit, Michigan, where 80 to 90 percent of my patients were African-Americans. My three-year residency gave me a unique opportunity to learn about the wide variety of skin types among this population, and my experience led me to question two widely held myths.
Many doctors believe that since African-American skin is thicker than Caucasian skin, it can withstand highly concentrated treatments. I have found that although the top layer of the skin, the stratum corneum, may be more compact, this type of skin does not respond well to aggressive therapy. In fact, I have found an increased inflammatory response that results in dark patches of discoloration from overly aggressive treatment. To avoid this problem, I recommend gentle, non-irritating cleansers and skin care products.
The second myth that I challenged was the idea that African-American skin is more resistant to drying because it is naturally richer in sebaceous oils. I have seen many patients develop ashy dryness when they use strong soaps and toners. To keep the skin soft yet clear, I prescribe mild liquid cleansers. Even if the skin seems oily, scrubbing grains and alcohol-based astringents will cause hyper-inflammatory darkening of the skin.
Moisturizers for African-American skin should be chosen on an individual basis. I usually start off with the lightest, non-greasy formulations. If dryness persists, I move up to a simple but richer product. Though Retin A can be too irritating, darker skin can respond beautifully to mild alpha hydroxy acids.
My research with African-American patients has demonstrated that because their skin is so sensitive, they develop an exaggerated inflammatory response to injuries. This exaggerated inflammatory response results in the breakdown of collagen and elastin, resulting in scarring. In addition to easy discoloration from inflammation, I also see greater incidence of scarring in this skin type. It is essential that inflammation be minimized before it can cause scarring to African-American skin.
If cared for correctly, your African-American skin can have a smooth, youthful glow that can last well past age seventy. Your melanin-rich skin offers wonderful protection from aging free-radical production. Over time, the anti-inflammatory effects of DMAE, alpha lipoic acid and vitamin C ester will reduce discoloration and scarring, and normalize oil gland activity.
This olive-toned complexion is intriguing for a number of reasons. First, it evolved within a population that had a naturally anti-inflammatory diet—large amounts of fish, very limited red meat, lots of olive oil and a constant supply of fresh fruits and vegetables. It included generous servings of cooked tomatoes, which contain high levels of lycopene, a powerful antioxidant.
Mediterranean skin has a bit more pigment than lighter Caucasian skin, and the pigment is slightly different. Possessing an olive rather than brown tone, this skin has more sun protection than Caucasian skin, but has less of an exaggerated hyperpigmentation response to inflammation. This skin will show hyperpigmentation, but not to the extent seen in African-American skin. In addition, Mediterranean skin seems to have a lower tendency for scar formation than what is seen in the darker skin tones. Mediterranean skin tends to be oilier, which means it avoids the oxidative stress inherent in dry skin. The oil, coupled with more melanin to provide protection from the sun, delays the appearance of lines, wrinkles and sagging skin.
On the downside, the active oil glands can increase the incidence and degree of acne. Fortunately, Mediterranean skin can tolerate aggressive anti-acne treatment without developing patches of discoloration.
If you have Mediterranean skin, you should use a liquid cleanser designed for oily skin. Alpha lipoic acid will do a wonderful job of shrinking pores that may have become enlarged from overactive oil glands. You should use only oil-free products, including the treatment products that contain sunscreens, DMAE and vitamin C ester. I also recommend a special eye product containing alpha lipoic acid, which greatly diminishes the dark under-eye circles that plague men and women with Mediterranean skin.
Asian skin has more melanin than Caucasian skin, but far less than African-American or Latino skin. This provides protection from accelerated photoaging. Asian skin is resistant to sunlight, but does not develop dark patches of pigmentation. The skin has just about the right level of sebaceous gland activity. There is neither a problem with chronic dryness nor is there significant acne.
The melanin content yields a skin tone that lacks radiance. I don’t believe this is due only to pigment but instead is another manifestation of low-grade inflammation. This inflammation leads to water retention and edema, which causes eye puffiness. Whenever there is underlying puffiness around the Asian eye, it is exaggerated by the natural bone structure. Alpha lipoic acid applied topically will resolve eye puffiness and also help normalize the microcirculation of the skin, resulting in increased radiance.
I have recently tested a new skin brightener and am delighted with the results. This product is now available.
The eye area puffiness and yellow skin tones of Asian skin respond beautifully to topical applications of alpha lipoic acid. Although sun protection is not as critical a factor as it is with Caucasian skin, a light moisturizer with a bit of sunscreen will be a value-added product.
The rich caramel-colored skin tones of my Latino patients have both strengths and drawbacks. On the plus side, the natural brown pigment provides a wonderful umbrella of sun protection. The inflammatory response in this skin isn’t as exaggerated as that of African-American skin, but it is still a problem.
I have found that acne problems are a frequent complaint. The overactive oil glands result in enlarged pores, blackheads and blemishes. You must wash the skin twice a day with a liquid cleanser formulated for oily skin. Antioxidants like alpha lipoic acid, DMAE and vitamin C esters in oil-free bases will shrink pores and refine your skin texture. It is particularly important that you select moisturizers and sunscreens that are non-greasy and oil free.
Antioxidant, anti-inflammatory skin care takes just a few minutes when you get up in the morning and when you go to sleep at night. Remarkably effective, it is quick, easy and painless. In an era of such expensive, high-tech anti-aging options as lasers and micro peels, this simple and affordable approach seems almost minimalist in its philosophy.
Many of my patients come to me as a last resort before a trip to the cosmetic surgeon. After a few months on the full program, they no longer feel the need for surgery. Ironically, after a few months of special attention to their skin, especially with products containing DMAE, friends or co-workers often assume my patients have had cosmetic surgery. The new radiance in their skin, the correction of sagging and the sense of health and energy they report are proof positive of the value of embracing the three-tiered anti-inflammatory program of diet, supplements and topicals.
As an active researcher, I welcome your comments and suggestions.