Fitzpatrick Skin Type VI

People with skin type VI have a dark skin colour and usually of African decent. Their skin rarely burns and although skin cancer is not common among people with this skin type, they should still take the necessary precaution to protect their skin against skin cancer, namely wear sunscreen with a SPF higher than 15 and seek the shade between 10am and 4pm. Individuals with this skin type should still protect themselves from the sun as chronic sun exposure leads to uneven skin tone and pigmentation.

Acral lentiginous melanoma, a very virulent form of the disease, is more common among darker-skinned people. These melanomas tend to appear on parts of the body not often exposed to the sun, and often remain undetected until after the cancer has spread. Individuals should therefore check their skin regularly from head-to-toe and pay careful attention to any suspicious growths, especially on the palms, soles of the feet and on mucous membranes.

Skin type VI also reacts differently and at times more severely to common conditions such as acne, eczema, dermatitis, psoriasis and seborrheic dermatitis (dandruff) which can lead to potential problems with pigmentation, or uneven darkening or lightening of skin colour as he formation of melanin is a dynamic process and responds to various stimuli. Thus the the skin is more reactive to an insult which can lead to dark marks called Post Inflammatory Hyperpigmentation PIH. PIH may takes years to fade thus wearing a sunscreen dailyis essential to prevent PIH. This skin type can also produce less pigmentation called Hypopigmentation or lightened areas, after a burn or other injury.

There is a greater risk of keloid (raised, often large scars) development because darker skin has a better bed of collagen. Studies suggest that the fibroblasts which make collagen, are larger and more numerous and active. Damage to darker skin is therefore associated with a greater incidence of keloids and hypertrophic scars.

What are the best skin care practices for Fitzpatrick skin type VI?

• Minimise sun damage (Photoageing) - Individuals with this skin type should still protect themselves from the sun as chronic sun exposure leads to uneven skin tone and pigmentation. This is aggravated if there is any skin condition such as acne, eczema, dermatitis, psoriasis and seborrheic dermatitis (dandruff) or trauma to the skin. Individuals with this skin type should stay out of the sun during the peak hours of 10am - 4pm, and wear a SPF 15 to 30 sunscreen every day : Products with titanium dioxide or zinc oxide or Avobenzone provide protection against both UVA and UVB rays. Whenever you are out in the sun , wear a high SPF of 50 , wear protective clothing, wide brimmed hats, sunglasses, etc. and reapply a SPF of 50 every 90 minutes. For Internal Skin Protection oral supplements such as Polypodium leucotomas (Heliocare) and Pycnogenol ® (Ovelle) that offer sun protection and increase resistance against the pigmentation effects of the sun should be considered.
• Even out pigmentation. - Despite best efforts with bleaching agents and exfoliation treatments, pigment from PIH can be stubborn and long lasting. There is a ‘something’ missing in conventional fading creams. Most have side effects. For most people with skin type VI treating pigmentation is like taking one step forward and one step back. The challenge is to take care of pigmentation, fade the dark spots and heal it without scarring. At Skin Renewal , we are is pleased to be able to offer the “ something” missing in conventional fading creams such as Hydroquinone .These are recent advances in pigmentation technology such as the recently launched pigmentation peptides such as Oligopeptide-34, Oligopeptide-51, Oligopeptide-53, Pentapeptide-15 which can be safely used in all skin types and will not cause the sensitivity that is associated with traditional lightening/fading creams such as Retin A and Hydroquinone. If pigmentation fails to respond to topical depigmenting agents then it may be necessary to have in office treatment with appropriate chemical peels and the Laser genesis procedure with a long pulsed Nd YAG which is safe for skin type VI. Most cases of Melasma not responding to superficial peels and topical products is most likely due to the pigmentation of Melasma that is present in the dermis. Dermal melasma is more difficult to treat as the dermis does not exfoliate like the epidermis. This dermal Melasma in some cases responds to heating of the dermal pigment with Laser Genesis. This heating causes cavitation bubbles in the dermis and releases the trapped dermal pigment which then moves up to the epidermis where it can be exfoliated by the epidermis. At least 8 to 10 Laser Genesis treatments every 2 to 3 weeks are necessary to release the dermal pigment. The Laser Genesis procedure by Cutera gives new hope to Melasma sufferers if combined with topical sun protection, the new pigment lightening peptides and together with oral protection such as Ovelle - Pycnogenol ®, an inside out 3 D approach.
• Reverse some pre-existing age related changes such as wrinkles. - Once the signs of ageing such as wrinkles appear on the facial skin, it is time to initiate the most powerful corrective treatments such as growth factors , peptides , PHAs to improve collagen content and wrinkling.
• Special care when using laser / light therapies - Individuals with skin type VI are usually prone to an overactive production of melanin following laser skin or hair treatments. This can lead to permanent discoloration or scarring of the skin, and most experts agree that before people with skin type VI undertake any chemical peels treatment, their skins should be prepared with skin lightening peptides that down regulate the enzyme processes that stimulate melanin. Treatments should be preformed in a clinic that has experience in treating darker skin types and certain cosmetic procedures, such as IPL should not be performed on people with skin type VI. In these patients, the risks are weighed against potential benefits, and other treatments like nonablative laser rejuvenation with the long pulsed Nd YAG are preferable

In office aesthetic treatments for Fitzpatrick Skin Type V1

Most aesthetic skin treatments can safely be done in Skin Type V1 individuals without adverse side effects such as hyper or hypopigmentation occurring, provided that it is done by experienced professionals and that pretreatment precautions are followed. Most experts agree that people with this type of skin should receive pretreatment and preparations of their skin prior to aggressive lasers are used or chemical peels applied, to avoid hyper- or hypopigmentation.

Nonablative laser rejuvenation such as Laser Genesis can improve the texture and appearance of the skin and reduce uneven skin tone, without damaging the outer layer of the skin. These procedures can be used in patients with all skin types, and may be better choices for patients with skin type VI. Laser Genesis on skin type VI has no side effects and results in faster recovery times.

These nonablative lasers such as the long pulsed Nd YAG and infra red Titan bypass the epidermis and deliver energy to the underlying layers of skin (dermis), stimulating collagen growth and skin tightening.

The following treatments can be done in a clinic experienced in treating Skin Type V1 :

• Botox and fillers Microdermabrasion and superficial
• Chemical peels such as Glycolic, Alpha Hydroxy Acid , Beta HydroxyAcid and Nimue Chemibrasion can safely be done on Skin Type V1 : Fitzpatrick skin types VI are NOT candidates for medium and deep peels and are at greater risk for pigmentary dyschromia—hyper- or hypo-pigmentation after deep chemical peels
• Laser & Light such as Titan, Laser Genesis skin treatments can be safely used on skin type V with minimal pain and no downtime or side effects –
• IPL/ Lime Light skin rejuvenation treatments CANNOT BE done in Skin Type V1 :
• Radiofrequency such as Accent , TriPollar and Velashape radiofrequency procedures can be safely used on Skin Type V1 with no pain and no downtime or side effects
• Mesotherapy and transdermal mesotherapy can be safely used on Skin Type V1 with minimal pain and no downtime or side effects
• Carboxytherapy can be safely used on Skin Type V1 with minimal pain and no downtime or side effects
• Dermaroller skin needling can be safely used on Skin Type V1 with minimal downtime or side effects

Skin Care Regimen for Skin Type VI

1. CLEANSE AND EXFOLIATE
2. CORRECTIVES FOR SKIN PROBLEMS
3. FEED
4. HYDRATE
5. PROTECT

1. CLEANSE AND EXFOLIATE:

Cleanse your face daily to remove dirt, oil and makeup If you have dry or sensitive skin , use a gentle creamy cleanser that does not contain sulphate. Oily or acne prone skin should cleanse with a salicylic acid cleanser Do not overcleanse or use harsh ingredients or loofahs that can irritate the skin and cause inflammation which leads to blemishes and PIH . If your skin is dry, after cleansing, apply your moisturizer immediately so as to trap the moisture in which helps hydrate the skin. Exfoliate if you need to remove dull, dead skin cells by using gentle exfoliating acids found in skin products—do a test patch first on a small patch of skin

2. CORRECTIVES FOR SKIN PROBLEMS :

Pigmentation Most cases of Melasma not responding to superficial peels and topical products is most likely due to the pigmentation of Melasma that is present tin the dermis.. This dermal Melasma in some cases responds to heating of the dermal pigment with a long pulsed Nd YAG which is safe for black skin. This heating causes cavitation bubbles in the dermis and releases the trapped dermal pigment which then moves up to the epidermis where it can be exfoliated by the epidermis. At least 8 to 10 Laser Genesis treatments every 2 to 3 weeks are necessary to release the dermal pigment. .

Topical products with active ingredients to even out pigmentation Skin Type V1: The following is a list of skin care ingredients to USE if one has pigmentation. Oligopeptide-34, Oligopeptide-51, Oligopeptide-53, Pentapeptide-15, arbutin, bearberry, cucumber extract, hydroquinone, kojic acid, liquorice extract, magnesium ascorbyl phosphate, mulberry extract, niacinamide, retinol , beta hydroxyl acid, vitamin c The following is a list of skin care ingredients to AVOID if you have Skin Type VI because it might enhance dark spots. Oestradiol, oestrogen, genistein, black cohosh, chasteberry, hops, red clever, soy and wild yams.

Acne

Key Factors to treating acne in Skin Type VI

Skin Type skin type VI is prone to developing “dark spots.” or post inflammatory Hyperpigmentation PIH and thus acne should be dealt with as soon as the acne appears. The “dark spots ” can present a bigger problem than the acne itself and can diminish one’s self-esteem and affect a person’s ability to function confidently in society. Since acne management often takes at least 6 to 8 weeks before marked improvement is observed, it is imperative to address the patient’s PIH as the acne management process continues. Sunscreen that is not comedogenic ( not pimple forming or does not clog pores) must be worn daily to prevent the dark spots that result from the acne lesion. Acne treatments designed to dry the skin, such as toners should be use with caution as this skin dryness can lead to irritation with the resultant dark spots -PIH. Acne medications such as traditional Retin A and benzoyl peroxide can dry the skin out and should only be used under the supervision of a specialist doctor as these medications may irritate the skin and prolong dark spots –PIH in some cases. Benzoyl peroxide can also take the colour out of the skin leaving lighter spots Tetracycline antibiotics especially minocycline are photo sensitive and can cause skin pigmentation and thus should be used with caution. Patients should also be advised to avoid self-manipulation of lesions, which can exacerbate PIH and scarring. There are newer topical acne therapies available that treat acne from the inside- out such as Clarity by Lamelle and Acnevelle. These products treat the acne together with the side effects such as dark spots and scarring which occur later. In fact, Clarity contains encapsulated growth factors and peptides that treat the side effects of acne such as dark spots, scarring and dry skin. What makes this product unique is that the active ingredients are all encapsulated for enhanced stability and effect. This means that they can penetrate into the dermis where they are needed to exert their anti inflammatory and anti bacterial effects Topical products with active ingredients to avoid if you have acne in Skin Type V1: Cinnamon oil, Cocoa butter, Cocus nucifera, Isoprpopyl isostearate, Isopropyl myristate, Isopropyl myristate, Butyl stearate, Isostearyl neopentanoate, Myristyl myristate, Octyl palmitate, Isocetyl srearate, Propylene glycol 2, Myristyl propionate, Lanolin, Peppermint oil, Decyl Oleate, Octyl stearate.

3. FEED:

These are ingredients/nutrients that feed the skin which you may not get from your diet. These can be applied topically to fight free radicals damage and to calm, soothe and heal skin. Vitamin C can be used for pigmentation issues and healthier looking skin. Vitamin E protects against sun damage Alpha Lipoic Acid fights a range of free radicals, promotes energy in living ells and helps promote a healthy glow.

4. HYDRATE:

Keep skin well hydrated and moisturised as well hydrated cells are healthier and look and function better. Dehydrated skin cells are prone to sensitivity and infection.

• Humectants attract water to the skin cell and thus plump up fine lines and wrinkles giving your skin a smooth, youthful glow. These humectants include hyaluronic acid, sodium hyaluronate, glycerine, glycerides, propylene glycol, sorbitol urea, colloidal oatmeal.
• Occlusives bind water to your skin and slow the loss of water by forming a barrier on the skin’s surface . These include beeswax, lecithin, dimethicone, ceramides, cetyl alcohol and grapeseed oil Emollients are lipids that add lubrication to the surface of the skin by binding water and preventing evaporation and include hea butter, avocado, acai, passion fruit, mango, coconut, olive oil, rosehip oil, evening primrose oil, GLA and squalane
• Additional Skin Care ingredients to moisturise and hydrate Skin type IV:ajuga turkestanica, aloe vera, apricot kernel oil, borage seed oil, canola oil, , cholestrol, dexpanthenol, Jjojoba oil, macadamia nut oil, safflower oil,

5. PROTECT

• Minimise sun damage. Individuals with this Skin Type V1 should stay out of the sun during the peak hours of 10am - 4pm, wear an SPF of 15 to 30 sunscreen every day,
• External Skin Protection: Products with titanium dioxide or zinc oxide or Avobenzone provide protection against both UVA and UVB rays. Micronised Zinc oxide is recommended for sensitive skins and avoid avobenzone , PABA, Benzophenone, Butyl methoxydibenzoylmethane, Octyl methoxycinnamate, Methylbenzylidene camphor, Phenylbenzimidazole sulfonic acid if you have sensitive skin
• Internal Skin Protection: Oral supplements such as Polypodium leucotomas (Heliocare) and Pycnogenol ® (Ovelle) that offer sun protection and increase resistance against the damaging effects of the sun should be considered.