WebMD Live Events Transcript
Event Date: Wednesday, March 17, 2004.
By Susan C. Taylor, MD
WebMD Weight Loss Clinic - Live Events Transcript
Women of color have special concerns when it comes to protecting the health and beauty of skin and hair. We learned what makes skin of color beautiful, yet vulnerable, and got healthy help for hair during our Q&A with Susan Taylor, MD, author of Brown Skin and director of the Skin of Color Center in New York City.
The opinions expressed herein are those of the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome to WebMD Live, Dr. Taylor. What makes skin of color beautiful, yet so vulnerable?
Taylor: It is the melanin in the skin of color that protects it from the sun. Often women of color will look 10 years younger when compared to their counterparts with white skin. The melanin in the skin absorbs the ultraviolet light and prevents many of the changes that we associate with aging. Unfortunately, that melanin can create problems, specifically the increased melanin can cause dark marks on the skin. Those dark marks, often called blemishes, are very difficult to eradicate.
Moderator: Uneven skin tone is problem many women of color face. What are some of the causes and what are your recommendations for dealing with it?
Taylor: There are many causes of discolorations on the skin. For women in particular acne bumps cause dark marks. When the acne bump goes away a woman of color is often left with a dark blemish. In addition, any type of rash on the skin, for example eczema, can resolve with a dark mark. Cuts, scrapes, burns, and abrasions may all heal with a dark area on the skin. So as you can see, there are many causes of dark marks. Unfortunately, despite the exact cause, it can require several months, if not years, for the dark mark to fade.
Fortunately, there are treatments that can hasten the fading of the dark mark. The first and most important treatment is the use of sunscreens. The sunscreens should be applied on a daily basis, and I recommend a sunscreen with an SPF of 15 or 30.
There are both over-the-counter and prescription items that can lighten the dark marks faster. The ingredient that dermatologists recommend most often is hydroquinone. Hydroquinone comes in both prescription and over-the-counter concentrations. Typically, this cream is applied twice a day to the dark mark. There are other agents, namely glycolic acid, kojic acid, azeleic acid, and soy, which can lighten discolorations.
Finally, chemical peels or even microdermabrasion are procedures that can lighten the discolorations.
Member question: My skin is relatively clear, except for dark circles under my eyes. My mother suffers from the same problem. She tells me it's hereditary and there is nothing I can do about getting rid of them. I have tried different products costing up to $25 and it has not helped with eliminating my dark circles. So, I am beginning to believe my mom. Are these products made for Caucasian women, and are our skin types so different it would not work for African American women? If so, do you know of a product made specifically for us?
Taylor: Dark circles under the eyes are a very difficult problem to treat for people of any skin type or color. Often, dark circles are caused by poor drainage of blood from around the eyes. This poor drainage occurs often with people with allergies. If that is the case, then there is not a good treatment for the disorder.
However, there are times when the discoloration is due to excessive pigmentation in the skin of the lower eyelids. In that case, bleaching creams that contain hydroquinone may be helpful.
Member question: Can my birth control pills be causing the dark patches I'm getting on my face? If so, is there anything I can do besides changing birth control methods? Even if I do that, will the patches go away on their own?
Taylor: Birth control pills may cause a condition called melasma. With melasma, dark patches typically develop on the cheeks, lower forehead, and chin. Also of note is the fact that melasma can occur during pregnancy. In some individuals, discontinuing the birth control pill can result in lightening of the melasma. However, medication to lighten the dark marks is often required.
Member question: I'm getting light patches! What is causing this? What can I do to even out my skin tone?
Taylor: There are many causes of light patches on the skin:
- The most common cause is a condition called postinflammatory hypopigmentation. This is a condition where light patches develop after some type of inflammation in the skin. The inflammation may be itching, redness, a rash, or even a pimple. When the inflammation resolves it may leave a light spot.
- Alternatively, a form of eczema, called pityriasis can produce light spots on the skin.
- Finally, vitiligo may result in the complete loss of pigmentation in the skin, with very prominent white spots developing.
So that gives you a range of some of the possibilities. The treatment for each problem is a little different, so it is very important that you consult with your dermatologist so that the proper diagnosis may be made.
Member question: I am a light-skin African American female. For about four years, I have begun to develop these cyst-like pimples on my face. I am very compulsive with picking or digging or popping pimples and the like; therefore I have developed these very dark spots along the jaws and the jaw line. I'm afraid to use an over-the counter bleach to lighten these spots, unless you can suggest something.
Taylor: It is extremely important for women of color to keep their hands away from their faces. Picking and squeezing and popping bumps will cause very dramatic dark spots on the skin, as well as scars. So it is very important not to pick, squeeze, or pop, particularly if you are of color.
To heal the damage that has been done you may consider using some of the gentle exfoliating products that contain glycolic acids. Hydroquinone bleaching creams may also be helpful.
Member question: I have some hairs that grow on my chin and I've been tweezing them and it's been leaving dark spots. Is there any way to get rid of them?
Taylor: The most important thing that you can do is to address the excessive growth of hair. You may consider exploring electrolysis, laser hair removal, or even a prescription cream that in some women blocks the growth of hair.
You do not want to pluck the hairs. Plucking will cause an ingrown hair, which, in turn, will cause a bump that will then cause a dark mark. Instead of plucking consider clipping the hair with a pair of scissors.
To answer the question of how to address the dark mark, again, exfoliation or bleaching can help restore the natural color of the skin.
Member question: Does laser hair removal work on women of color?
Taylor: That is a very important question. I have many women of color in my practice, who range from a cafe au lait color to a chocolate brown color, who successfully undergo laser therapy.
There are lasers specifically designed to remove hair in women of color. It is important that your dermatologist use such a laser. Typically the diode of the 1064 YAG laser is suited for skin of color. Laser hair removal often requires four to seven treatments, performed monthly, before one observes a permanent reduction in the growth of hair.
Member question: Every once and a while I will wear makeup, and by the middle of the day my face is so oily. What can I do to combat that?
Taylor: There are several suggestions that I have for you to combat your oily skin:
- Select a makeup that is oil-free. In fact, there are some foundations that contain an ingredient called salicylic acid that will help to control the oil.
- Make sure that you use a cleanser designed for oily skin.
- You should probably pass on using moisturizer on your face in the morning.
- Blotting paper may be purchased from several cosmetic counters, and that paper will absorb excessive oil on the face throughout the day.
Member question: I would like to know the best facial cleanser, toner, and moisturizer to buy at any local retail store and or drug store without spending too much for products that do not work. I am looking for a very soft and smooth feeling for my face and cannot seem to achieve it.
Taylor: There is no one best product for everyone. There are many very good skin care products that one can purchase in a drug store. In general, you want to select a cleanser and moisturizer, and perhaps a toner, for your skin type. Your skin type may be dry, oily, or normal. In general, the Cetaphil, Aveeno, Nutrogena, and Purpose products are gentle products to use on skin that tends to be sensitive. Each of these product lines has cleansers, moisturizers, sunscreens, etc.
Member question: I am 36 years old and I have always had very dry skin. My hands are wrinkled and dry with lots of lines. My skin looks like an old woman. It's so embarrassing when shaking someone's hand. What can you recommend for my problem skin?
Taylor: The key is to keep your hands out of water and apply moisturizer throughout the day. Dry hands are a particular problem during the cold weather, especially if your hands are in water a great deal. So try to minimize the number of times a day you wash your hands. When doing wet work wear cotton gloves topped with rubber gloves. The gloves will protect your hands from the water.
In addition, applying a good moisturizer many times throughout the day is a must. There are many hand creams on the market, and they can range from Neutrogena hand cream to Lubriderm to Vaseline.
Member question: I have a very dry skin type and I try to moisturize as often as possible, but my scalp is just out of control. It flakes constantly. I wash, condition, and moisturize my hair as often as I should but it just flakes so much whether I itch or not. When I scratch it this dead skin just falls all over me, and it's pretty embarrassing.
Taylor: Dry, flaky, itchy scalp is a problem caused by seborrheic dermatitis, psoriasis, or even a fungal infection. If your flaking has not improved after using over-the-counter dandruff shampoos, then it's time to see a doctor. Prescription medication is often required to treat the conditions that I named. Also, if one suspects a fungal infection, a culture would need to be performed.
Member question: Is there any harm in keeping your hair braided or cornrowed constantly, or wearing weaves? I'm a swimmer and felt the constant heat to dry and curl my hair daily was causing it to break off.
Taylor: I have no problem with the use of cornrows or braids with extensions, as long as they are not braided too tightly. If the braids or cornrows are very tight a type of hair loss may develop called traction alopecia. Make sure that when your hair is braided, it is done very loosely. If you notice thinning along the hairline it is time to stop braiding the hair.
Also, do not forget to wash your hair on a regular basis, even with the braids in. Condition the hair, as well.
Member question: I had acne when I was in high school. My skin got clear. Now that I've turned 40 I'm getting acne and/or blackheads again. What is the best way to treat this problem? Also, does water help with skin?
Taylor: Acne is not just a disease of teenagers; it commonly occurs in adult women in their 20s, 30s, and 40s. Usually by 55 the acne will resolve. Acne is not caused by dirt; it is caused by bacteria, excessive oil, and plugging of the pores. Our treatments are designed to kill the bacteria, decrease the oil, and unplug the pores. Washing vigorously and scrubbing can worsen acne, so cleanse and moisturize very gently. Antibiotics and retinoids are often used for the treatment of adult acne.
Member question: What causes one to have large deep pimples under the armpits, breast, and/or pubic area?
Taylor: The problem that you are describing is called hidradenititis suprativa. The cause of hidradentitis suprativa is unclear; however, we know there is a large inflammatory and infectious component. In this condition large cysts and abscesses develop under the arms, in the groin area, and on the buttocks. The condition can be very painful and uncomfortable.
Often dermatologists will treat the condition with antibiotics, although other prescription medications may be used. I encourage you to see your doctor.
Member question: I seem to have a great deal of skin tags. How does one get them and what is the best treatment to have them removed (some of them snag on my clothing)?
Taylor: Skin tags are benign, noncanerous growths that commonly occur on the neck and under the arms and bra line as we mature. These growths are very annoying, but can be removed quite easily by your doctor. Often, the lesions are snipped or burned.
Member question: Are there any other drugs for women other than spirnolactone for hereditary hair loss? Can Propecia be given if postmenopausal?
Taylor: The most commonly recommended medication for the treatment of female pattern hair loss is Rogaine. Propecia, which is prescribed for men, has not been approved for use in women. Spirnolactone, which is a diuretic, or water pill, has been used by some dermatologists for the treatment of female pattern hair loss. Unfortunately, to date, additional therapies are needed for this troubling disorder.
Member question: I have your book on my bedside table and I often use it as a reference. The advice has helped me to improve my skin greatly after a recent bout with adult acne. I do, however, have three concerns. I have been experiencing what to me seems like a large amount of shedding hair. My hair is thick and there does not appear to be breakage, but how much shedding is normal? I am sweeping my bathroom floor on a daily basis.
Second, I go to a professional hair care technician on a weekly basis. She takes time to oil my scalp during each service and I do so at home, however I still have a dry scalp. Do you have any recommendations for how often to use oil or a type that should be used in this case?
Lastly, I was on a course of antibiotics for acne. The acne has almost completely cleared up but I do have four small areas of hyperpigmentation. Is there some product I can safely use on my sensitive skin? I do have a prescription (a mixed formula) from my dermatologist, but it was a little too harsh.
Taylor: It is normal to shed up to 100 hairs a day. Anything more than that is considered abnormal. If you are unsure if the amount of shedding that you have is abnormal, collect the hairs for a 24-hour period and count them. Less than 100 is normal, greater than 100 is abnormal and should send you off to the dermatologist for evaluation.
In general, I do not recommend that women of color oil their scalps. If you have a dry scalp that is flaky and itchy, that may be due to a problem called seborrheic dermatitis. Seborrheic dermatitis may be successfully treated with prescription shampoos. It is perfectly acceptable to apply oil to hair that is dry, but not to the scalp.
I would suggest that you call and discuss the reaction that your skin had from the prescription medication that your doctor gave you. Often, altering the amount that is applied or the frequency with which it is applied to the skin will result in improved tolerability of the product.
Member question: I'm 19 years old, and I've been suffering from acne for five years. I've used different products containing benzoyl peroxide, and now I'm using medication that contains clindamycin phosphate. What's your best advice to get rid of acne? What's the best home treatment (eating habits, sleeping, exercising, etc.)?
Taylor: Healthy living with adequate intake of water, exercise, and nutrition go a long way into improving the health of our skin. Drinking six to eight glasses of water and including fruits and vegetables and including a multivitamin in your diet will lead to healthy skin.
Unfortunately, there are some people who will, nonetheless, require prescription medications to treat their acne. Many women will try over-the-counter acne products containing the ingredients benzoyl peroxide or salicylic acid. These products will control mild acne in some women. If that is not the case with you, you should consider seeing your dermatologist.
Moderator: Do you have any final words for us, Dr. Taylor?
Taylor: In my book, Brown Skin, I discuss a wide range of skin, hair, and nail disorders that affect women of color. So if we were unable to answer your question today, you might utilize the book as a good resource. You may also visit my web site, which is www.drsusantaylor.net.
Moderator: Thanks to Susan Taylor, MD, for sharing her expertise with us today. For more information please read her book, Brown Skin: Dr. Susan Taylor's Prescription for Flawless Skin, Hair, and Nails!
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