Case Study:

A 24 year old male has been referred to you by one of your regular clients because of his concern about the inconsistent skin discoloration throughout his beard area. After reading his client intake form, you learn that he is of mixed decent, having both a Caucasian and African-American parent. Overall, his skin tone is clear and even, except for the lower half of his face. During your consultation, you learn that in the past he had a negative experience with ingrown hairs in his beard. When this problem arose, he did not use any product to combat the reoccurring ingrown hairs; he just continued to shave over them. Frustrated, this new client explains how he has not always had this problem. Recently, however, after he shaves it immediately looks as if he already has a five o’clock shadow, but his skin is smooth to the touch. After closely observing his cleanshaven face, you are able to see that there are no ingrown hairs under the skin’s surface and that the dark “shadow” on his skin is actually darkened skin pigment.

As a skin care professional, what solution do you propose to treat this case study?

Solutions:

Shelley Hancock, aesthetician and owner of Shelley Hancock Consulting

“I would combat this skin condition with LED Therapy. Although treatment of hyperpigmentation remains a challenge, much research has shown that near-infrared light (830nm to 850nm) delivered by LEDs may reduce melanin production and tyrosinase enzyme expression. This research indicates that LEDs could potentially be used to treat melaninoverproducing skin conditions. I have personally used LED at my center with much success for over 10 years now. This technology is fabulous because I can treat any skin type without issue. The treatment schedule needs to be fairly aggressive; one or two treatments are not going to do the job. I recommend 30 minute sessions at least twice a week for four weeks to begin, and then reevaluate the progress of the condition.”

Enrique Ramirez, owner of face to face nyc – day spa

“My recommendation for this gentleman would be a very specific facial that could combine microdermabrasion, deep pore cleansing, and a light chemical peel using TCA of 15 percent. This treatment would address the most stubborn skin conditions such as hyperpigmentation, very common among African-American men, who develop this after any form of trauma to the skin especially post acne or, in this case, folliculitis barbae. By doubling his exfoliation, using microdermabrasion and the gentle chemical peel, he is sure to start seeing evenly and lighter results after several treatments. I would certainly explain and educate this client on the benefits of this treatment and encourage him to sign up for a series of treatments, as with one treatment he may see little change.
As for at-home use, I would recommend a lightening moisturizer using vitamin C or licorice as well as a fruit acid peel to use once or twice a week. The key here is to talk about shaving strategies to keep at bay any recurrent ingrown hairs. Simple, easy steps like changing the blade often or applying pre-shaving oil can certainly reduce the chances of shaving related skin blemishes and discolorations.”

Ada Polla, CEO of Alchimie Forever

“The case presented is a challenging one, and one that is actually quite common in young patients that have an ethnic skin type. Indeed, it is a combination of the métissage skin color and the fact that post-inflammatory hyperpigmentation tends to be more visible than in lighter skin types.
It is unlikely that this concern will be 100 percent resolvable and the best case scenario will be treatment over a long period of time; there is certainly no quick fix. I would suggest a series of light AHA peels, as well as the use of lightening creams that contain hydroquinone (no more than a two percent concentration) or kogic acid. Such creams, while very effective, may be slightly irritating to the skin, so their use will need to be very carefully monitored by a skin care professional. I would absolutely not recommend any laser or IPL treatment as this may indeed aggravate the problem.”

Caroline Rushworth, director of education for Sothys USA, Inc.

“The client’s pigmentation issues have resulted from irritation and inflammation caused by the shaving and ingrown hairs he experienced in the past. The formation of pigmentation is a highly complex process with numerous factors affecting the melanin production, and hyperpigmentation is one of the most challenging skin conditions to treat. The hyperpigmentation did not appear overnight and it is important that the client understands that he will need to commit to a treatment program specifically geared to treat all forms of hyperpigmentation and/or uneven complexion problems. The aesthetician must ensure that the program utilizes the most potent and safest actives in order to produce the most satisfactory results.
Embarking on a series of professional treatments and targeted home care products, incorporating a complex of molecules recognized for their skin brightening properties, will effectively diminish the hyperpigmentation and even the complexion. Actives such as azelaïc acid and vectorized vitamin C and PP work together to regulate keratinization, inhibit tyrosinase, and reduce melanogenesis as well as provide powerful antioxidant and anti-inflammatory benefits.”

Heather Hickman, director of U.S. education for Dermalogica and The International Dermal Institute

“Pseudofolliculitus barbae is a common condition in up to 60 percent of African-American men. The problem results when curved hairs grow back into the skin causing inflammation and a foreign body reaction. This inflammation can, in turn, lead to postinflammatory hyperpigmentation.
I would recommend a course of treatments to reduce the hyperpigmentation, focusing on exfoliation with salicylic acid. This will slough off the surface pigmented cells and has the ability to penetrate the hair follicle and therefore reduce future issues with ingrowing hairs. Incorporating skin lighteners that inhibit melanogenesis, such as oligopeptide-34, to further eliminate the darkened skin pigment is also key to garnering positive results.
To prevent future issue, advising the client on how best to prepare the beard area prior to shaving will help to reduce further skin challenges. The aim of wet shaving is to soften and engorge the beard so that the hairs offer the least possible resistance to cutting and the risk of trauma to the skin is reduced. Incorporating a pre-shave product with ingredients such as clove flower oil will open pores, soften the beard and prevent ingrowing hairs and the resulting skin discoloration.”