People of color are a very large group, which in South Africa includes people of African and Asian descent. It also includes patients of mixed backgrounds who have more darkly pigmented skin. Darker skin type people represent a significant and growing group of patients seeking aesthetic procedures. This is because of the increased awareness of safe, affordable aesthetic procedures. These procedures include amazing new lasers that are colour blind and are less invasive than previous generations of lasers. Yet special concerns have to be addressed when treating skin of color.
Acne vulgaris, the most common skin disorder, affects virtually all individuals in all nationalities at least once. Acne mainly affects the following areas: face, neck, upper trunk, shoulders and proximal arms. Incidence peaks in 18-year-olds, but substantial numbers of 20- to 40-year-olds also develop the disease.
In dark skin types, the biggest challenge is avoiding scars or marks from things such as acne and chicken pox that last for life as the pigment is so hyper-sensitive . When treating persons of color, post-inflammatory hyperpigmentation PIH (brown spots after the acne blemishes have healed) and active acne need to be differentiated. It is important to note that when one is treating acne, the brown spots that occur afterwards are only residual effects, not active acne.
Women are more likely to suffer from ongoing acne that commences or reappears during their early adult years. Around 8 % of women have acne persisting into their 30’s and in some it continues into their 40s and occasionally 50s. Why this occurs is poorly understood but may be related to hormones, childbirth, menopause, or stopping the pill. Adult women may be treated at the period and at ovulation when acne is especially severe, or throughout the entire cycle
There is also a subset of women with “true” hormonal acne who have abnormal levels of androgenic (male-type) hormones. These women often have accompanying excess facial hair (also hormonally regulated) and irregular menstrual cycles, although women who have normal hormone levels may also have excess hair. The sebaceous glands of patients with acne are likely to be hypersensitive to androgens (male-type) hormones.