Women have been calling out the beauty industry for a long time for not offering makeup shades for multiple skin tones. While many companies have come quite a ways in the last few years, women with darker skin are still underserved, particularly when it comes to finding physicians who understand how different skin types and tones react to common dermatologic procedures and skincare products.
Dr. Carlos Charles, a dermatologist who's trained at Weill Cornell Medical College-New York Presbyterian Hospital, Memorial Sloan-Kettering Cancer Center and the University of Miami Miller School of Medicine, recently opened up a dermatology practice in the Chelsea neighborhood of New York City called Derma di Colore. According to Dr. Charles's website, his practice is "a comprehensive dermatology practice that addresses the treatment of dermatologic problems of all skin types with an interest in the treatment of darker skin tones," noting that he also "conducts national clinical research studies with the goal of finding answers to the toughest questions for dermatologic issues that commonly affect pigmented skin types." It's not a specialty I've seen very often, so I hopped on the phone to speak to him about his practice and where he thinks the skincare industry can step up efforts to improve product offerings for women of all skin types.
Why did you start this practice? I haven't seen many dermatologists who specialize in skin tone.
It’s kind of an emerging field in dermatology, and that’s why you probably haven’t come across a lot of dermatologists focusing on darker skin tones. I got interested because I feel like the behavior of darker skin or pigmented skin is very different in terms of how you approach it, especially when you’re using topical products, whether they’re medications or cosmetic products. And a lot of the disease processes can be different and can be very specific to dark skin tones. I thought there was a need. I thought that I could help out a lot, and New York City is, obviously for population reasons, a good place for it.
What are the biggest complaints you get from your patients, and the most common reason patients come to see you?
The number one complaint is hyperpigmentation or dark spots. Because with any darker-skinned individual, the pigment cells or the melanocytes are just more reactive. What I mean by that is that any injury or inflammation of any kind — a small pimple or bumping into something — leaves people with blemishes or dark marks. You don’t have to have pigmented skin to get that, but we see it more because the pigment cells are just able to harness and make pigment more easily. I get a lot of women who would like to even out their skin tone.
Is it harder to do that with darker skin tones?
Yes, it is harder because, again, the pigment cells are so robust — so they create blemishes that are just harder to fade, and they stick around longer. And we can’t be as aggressive with lightening products, whether topical products or procedural things like chemical peels or lasers, in darker skin tones because we can get more complications. If we’re really aggressively trying to treat a blemish or dark spot in someone with dark skin, we may end up creating more injury and end up with more complications and more dark marks.
What are some other common issues in your patient population?
This is more specific to black women, but there are a lot of hair loss issues. Not your common hair loss, but more like scarring. We call it scarring alopecia — thickening of the scalp, which kicks out hair follicles and causes hair thinning in the vertex of the scalp.
Is it related to chemical hair treatments?
We think it can be, but it’s unclear, because it’s also seen in women who are naive to any chemicals or procedures you think would cause damage. It’s seen in women who have worn their hair naturally throughout their lifetime. It’s not really that well understood, unfortunately.
So how do you end up treating it?
If it’s early in the disease process, we can do different anti-inflammatory medications, whether it’s injecting the scalp with steroid medications or using topical steroid medications. If it’s late in the disease process, it’s pretty hard to treat. We do more counseling.
How does aging manifest in darker skin tones?
The melanin or pigment helps protect somewhat from fine lines from ultraviolet light-associated aging like enlarged pores, fine lines and wrinkles. So we don’t get a lot of extrinsic aging, but in darker-skinned folks you still see the intrinsic aging, which means volume loss, loss of collagen over time, thicker wrinkles, sagging skin, volume depletion in the cheeks and jowls and things like that. That’s corrected with things like fillers. The hyperpigmentation thing plays into a bit of aging, too. As people age, we start seeing more uneven skin tones and blemishes. I should mention there are other things, too, like melasma, which we see in all skin tones, but we tend to see it a little more in Hispanic and Asian populations.
So do you recommend sunscreen for your patients, or is it not as important?
Absolutely! I said that UV light exposure isn’t such a big deal because melanin protects skin, but we still see textural changes and uneven skin tone. And I have to emphasize and be very specific and clear in saying that we still see a ton of skin cancer, especially in Hispanic populations. Where I did my residency in Miami, they did some really good research in looking at the Hispanic population, and we still see a lot of UV-induced basal cell and squamous cell skin cancers in Hispanics and blacks. So yes, it’s very important!
What kind of research are you doing in your practice?
We’re a new practice, so we’re looking to really build the research arm of the office. I did some work with Johnson & Johnson in helping to form a grading system for dark circles under the eyes [of people with] darker skin tones. We were doing it across all ethnicities. We were looking at Hispanic populations, black populations and Asian populations, and aging periorbital dark circles. Really, we just found that there’s a very distinct pattern among different ethnicities. It’s not a completely homogenous thing when we talk about dark circles under the eyes. And that’s a real big complaint that I get. Obviously it’s something we see in all skin types, but it’s something we see to a greater extent in darker-skinned people.
Right now we’re at the stage where we’re talking to a lot of cosmetics companies, because there’s more of an emphasis in looking at darker skin tones. The FDA is talking to these companies and asking them to increase the number of darker-skinned people into their studies so that we know how fillers — Botox and things like that — are going to behave on darker-skinned people. Historically, a lot of those companies would include a very small subset of skin-of-color patients, and it would be mostly Caucasian skin. So we’re trying to align ourselves with those companies so we can be the center that's doing that work.