Skin Classification for Culturally Diverse Clients
By Judith Culp
The population base in the United States is shifting as more cultures are merging. Did you know that in 1990 the US Census Bureau identified 6 races and 23 sub-types but just 10 years later, in 2000 they identified 6 races and 67 sub-types? The world and our client base is changing. So why would this be of concern to us as estheticians? Consider this scenario:
A client who appears to be a Fitzpatrick 3 with a nice summer tan comes into the clinic for an AHA or BHA treatment. We do the treatment following all of the manufacturer’s suggested guidelines and it seems to go well. The client gets a little pink, but nothing out of the norm. We do some extractions, a nice mask and check the client out when the service is complete. A few days later, the client comes back into the clinic complaining about skin discoloration. We note some brown areas – post-inflammatory hyperpigmentation. Why would this client who is only a Fitzpatrick 3 hyperpigment? The answer is in what we didn’t know – the client although fair, is of mixed heritage, part Puerto Rican, and her skin reacted like that of a higher Fitzpatrick.
The challenge to us as estheticians is in the field of skin analysis. The subtle blends of a client’s heritage may make their skin react in a manner we don’t expect when we are performing services. Using the Fitzpatrick scale, which was developed back in 1975 doesn’t take clients with heritage blends into consideration. It only describes how skin will respond to UV exposure – inflammation, or the lack of it, a tan. It does not take into consideration two new areas that medical and clinical professionals now need information on: insult and injury. While estheticians should not be causing injury, we certainly want to be aware of how a client heals. We also want to be aware how a client’s skin responds to what it perceives as insult. What is the risk of post-inflammatory hyperpigmentation?
The medical community is ahead of this on this as aesthetic procedures make it critical for dermatologists and plastic surgeons to be able to identify client risk factors. Since Asian skins can be very reactive, it isn’t surprising that a system called the Kawanda Skin Classification system was one of the first to advance on the Fitzpatrick Scale back in 1986. It was developed specifically developed to deal with Japanese patients. The next attempt and dealing with heritage related risk factors was the Lancer Ethnicity Scale developed in 1998. Lancer used the Fitzpatrick scale and added ethnicity to it. The Lancer scale has proven to be helpful to estheticians as it brought out the issues of heritage and better helped us identify how these clients might respond. Dr. Lancer’s research and development triggered a flurry of research and new scales to better attempt to deal with multiple cultures. Each had a different approach. The
Goldman World Classification system deals with burning, tanning and post-inflammatory pigmentation.
The Willis and Earles scale is for those of African only descent. It evaluates skin tone, UV response and pigmentation. Another scale, the Taylor Hyperpigmentation Scale, focuses on dyschromia. In 2006 the Roberts Skin Classification System was also released. It uses a complex 7 point evaluation system to determine how the client’s skin will probably respond to inflammation, insult or injury. It makes use of the Fitzpatrick Scale, the Glogau Scale of Photoaging, a scale to evaluate tendency to pigmentary issues, and a scale to evaluate risk of scaring.
While estheticians cannot do this in the same manner in which a physician would, we can make use of the techniques. We can take a complete client history including standard medical and lifestyle questions. We can establish their Fitzpatrick and add questions regarding ancestry to our questionnaire. We want to do a thorough evaluation of the skin through the magnifying light observing skin tone, texture and signs of photoaging. And we can ask the magic revealing question: When you have a skin injury does it go from pink to red and then fade away OR does it go from pink to red to brown. If they say it goes brown we know we have a client who is at risk for post-inflammatory pigmentation.
We can evaluate this information to determine if we think the client is appropriate for the treatment and if so do we need to do a more conservative approach. A good guideline for estheticians might be if the client has heritage that is in a higher Fitzpatrick range than his/her skin appears, treat her as the next higher level of Fitzpatrick. If she appears to be a Fitzpatrick IV but has African ancestry, treat her as a Fitzpatrick V. Using this approach, which is in essence what the medical community does, allows us to protect the client and minimize the risk of post-inflammatory pigmentation that can take months or longer to clear.
#skintyping #Fitzpatrick skins # Roberts skin classification #Lancer skin classification, #Rubin skin classification