April 2012

Lisa Kind - Editor

Esthetic Endeavors | by Judith Culp


A Multicultural Clientele

In our changing world, the people that are our clients are also changing.

At this time one-third of the US population are multicultural clients with skins that fall into the Fitzpatrick IV, V and VI categories (using the Fitzpatrick skin typing test). Type IV is beige with a brown tint; typical Mediterranean Caucasian skin; type V is dark brown and type VI is black skin.

Estheticians must be prepared to meet the needs of all of these potential clients and initially it can be intimidating.

The key to successful treatment of any skin color or type is the ability to do a good skin analysis and then to have a treatment protocol for the conditions we are most likely to encounter.

Global skins, those with higher Fitzpatrick numbers, have a little thicker stratum corneum. There may be more cell layers. The dermis is also structurally a little thicker with more sweat glands on the head and face. Also there are more superficial blood vessels although they may be difficult to observe.

A common mistake is to assume a darker skin that looks shiny is oily. It may be the reflection of moisture caused by the eccrine glands or it may be light reflecting off of the client's skin. Careful analysis using a magnifying lamp will reveal the difference.

The first step to treating a multicultural client is a thorough health and skin care history. We need to know what sort of things may be contributing to issues the client is facing, health and lifestyle, the products she/he is using, treatments they have been having both professionally and performing on themselves at home. Have the client tell you in their own words about their concerns and goals for treatment. Then do a visual observation looking for manifestations of these concerns.

Next we need to use our magnifying lamp and do a thorough skin assessment. Be sure to make notes on what you observe to guide you in determining a treatment that will offer the client the most benefit.

The last step is the treatment plan. This plan is generally two-fold. It includes determining what treatment will be offered that day and what series of treatments will best help the client achieve their goal.

If the client is concerned about acne, rosacea, hyperpigmentation, or general signs of aging, it's important to remind them these conditions did not happen overnight and will not be managed in a single facial treatment.

Liken it to going to the gym to get into shape. One time will make you feel good for a couple of days but it won't generate any lasting results. Lasting impact takes routine regular treatments to achieve the goal.

In the case of better skin, this means weekly visits to get the skin into shape, then monthly maintenance to keep it there. How many weekly visits? That will depend on the condition that is going to be treated. Some issues will improve in four treatments. Hyperpigmentation, acne or aging will take longer term work.

One condition that causes concern for some with darker skin tones is the tiny vellus hairs that are commonly found on the face. In a higher Fitzpatrick nimber, these hairs may also be dark in color. Sometimes the client will mistakenly think they are blackheads and want them extracted.

What they may need is another form of hair removal to minimize this issue. If the skin is too sensitive to wax and not suitable for laser or IPL removal, then occasional shaving may be the best choice. If done once every two to three weeks, moving the shaver with the direction of the hair growth it will not cause the hair to become stiffer.

This only works if the hair is straight. Curly hair may tend to become entrapped in the follicle creating a condition that may be mistaken for acne and worsened by over-treating with drying acne therapies.

A thorough knowledge of the products and equipment we have at our disposal is the next step so we can accurately select the treatment that will give the best results with no side effects. Every manufacturer provides protocols for using their products in effective treatments. Take training in them and get comfortable with matching the treatment to the client's needs based on skin type and skin condition. With our multicultural clients the biggest skin care concern must be the risk of hyperpigmentation from too aggressive a treatment or too harsh an exfoliation. Always follow manufacturer's recommendations for settings and frequencies for these and all clients. Treat the skin gently and learn how it responds. Many chemical exfoliants can trigger post inflammatory hyperpigmentation – the discoloration that can be caused by overworking the skin. Use a conservative approach and stay within manufacturer's guidelines.

Skin conditions are not treated that differently with regards to skin color. But the higher Fitzpatrick skins should be treated as "sensitive" skins and at higher risk of hyperpigmentation. Use a gentle touch and coax the skin toward the client's goals.

Judith Culp, has been in the esthetics industry since 1980. She is the owner of NW Institute of Esthetics, Inc. and contributing editor for Miladys Standard Esthetics: Advanced and lead author of Esthetician's Guide to Client Safety & Wellness. For more information visit www.estheticsnw.com.