Skin of color is differentiated by the amount and epidermal distribution of melanin. Although there is no difference in melanocyte density among different racial groups, previous studies indicate that darker skin has larger melanocytes producing more melanin and melanosomes are distributed individually in keratinocytes.1 This allows more effective absorption and deflection of ultraviolet light.
Because of the cultural and genetic differences, cosmetic dermatology in Asians differs from that in other racial groups of skin of color. In women from Far Eastern countries including Japan, Korea, China, and Singapore, light-colored complexion is widely considered to be beautiful. Asian females go to extreme measures of sun avoidance in order to have a lighter skin complexion. Such behavior is reflected by the nonmelanoma skin cancer prevalence among Japanese in Hawaii compared to Japanese in Japan, which differs by 45-fold. The use of sun protection, antioxidants, bleaching agents, and keratolytic preparations such as alpha-hydroxy acid forms an essential part of any skin care regimen.
The clinical presentation of photoaging differs between Asians and Caucasians in that pigmentary changes tend to occur with a greater incidence than skin wrinkling in Asians.2,3 Chung et al.4 more recently found both pigmentary changes and wrinkling to be major features of photoaging in Asians. However, moderate to severe wrinkling becomes apparent only at about 50 years, which is a decade or two later than in age-matched Caucasians.5
There are several acquired pigmentary conditions that are particularly common in Asians. Lentigines and seborrheic keratoses are frequent signs of photoaging among Asian. Melasma and Hori's macules are particularly common among Asian females. The use of appropriate laser or intense pulsed light (IPL) together with topical bleaching agents can significantly improve these conditions.
Laser or IPL sources for the treatment of these pigmentary conditions in Asians are not without risk given the fact that Asians have higher epidermal melanin content, which can lead to increased risk of postinflammatory hyperpigmentation (PIH). In addition, because epidermal melanin acts as a competing chromophobe, the light energy that reaches the targeted blood vessels or follicular melanocytes is reduced and higher fluences may be necessary to produce the desired effect. Besides sun avoidance and sun protection before and after laser/IPL treatment, topical bleaching agents are important as an adjunctive therapy. The appropriate use of laser/IPL parameters are also important including the use of skin cooling, longer laser pulse width to protect the epidermis, and longer laser/light source wavelength to reduce absorption by competing epidermal melanin.6 All these measures can further enhance clinical outcomes as well as reduce the adverse effect of laser/IPL treatment.
Another important genetic variation is the incidence of melanoma among Asians is found to be significantly lower than Caucasians. Incidences of melanoma have been reported to be between 0.2 to 2.2 per 100 000 in Asians. From a Singapore study, the incidence of melanoma ...