Aesthetics investigates the challenges patients with higher Fitzpatrick skin types face in finding a suitable practitioner and explores how this can be improved
This month sees the launch of a new online resource dedicated to helping patients with skin of colour find a skincare professional who can address their concerns. Created by London-based aesthetician Dija Ayodele, who predominately treats women of colour, the Black Skin Directory is a website that aims to provide users with information on experienced skincare professionals, cosmeceutical treatments and products, as well as events and roadshows that users may be interested in.
According to the 2011 UK census, out of the 56.1 million people living in England and Wales in 2011, 4.2 million were Asian/ Asian British and 1.9 million were Black/ African/Caribbean/Black British. In addition, the White percentage of the population had decreased from 91.3% in 2001 to 86% in 2011, while the number of people from Pakistani and Indian heritage increased by around 0.4 million each in the 10 years since the 2001 census.1
So, with a rising population of people with higher Fitzpatrick Skin Types (FSTs), the demand for aesthetic treatments is only going to increase. Yet, after many conversations with her patients, Ayodele found that they all emphasised how difficult it was to find a practitioner able to treat their skin. As a result, she decided to conduct research into how many others felt this way. She conducted an online survey and spoke to women at the Afro Hair and Beauty Show 2017, which found that out of 125 women with skin of colour who have attempted to find a skincare professional, 92% said they found it challenging, very difficult or that they have never been able to find someone suitable to treat their skin.2
So, Aesthetics asks, why might it be difficult for men and women with skin of colour to find a suitable practitioner? And what can practitioners do to improve this?
Before an aesthetic practitioner can treat any patient, they must learn how to do so appropriately and safely. As there is no one route to becoming an aesthetic practitioner in the UK, each will learn skills based on their patient demographic and the type of training they undertake. Treating darker skin is widely acknowledged as more challenging due to the increased risk of hyper/hypopigmentation and potential for scarring,3 which may influence practitioners’ hesitation to focus their education on higher FSTs.
“There is a lot of study on treating ethnic skin, but I find that it’s not promoted in this country enough" - Dr Bhavjit Kaur
For aesthetic practitioner Dr Bhavjit Kaur who practises in Greenwich, however, 75% of her patients have a FST between IV-VI. As such, she has actively sought to learn more about treating darker skin. “It’s important that I am up-to-date with all the treatments and products available to my patients,” she says, explaining, “There is a lot of study on treating ethnic skin, but I find that it’s not promoted in this country enough. I get a lot of my education from reading articles and journals from the US, India and Korea.”
Ayodele agrees, noting, “I think skin of colour isn’t focused upon enough in education. In America, there are very specific textbooks on treating skin of colour but we don’t always see that here in the UK.” In addition, Ayodele argues that not enough clinical trials for new products and treatments are conducted on darker skin, saying that when she has asked companies for their results on higher FSTs, the usual response is that they haven’t been done or are US-based. While having results from abroad is better than no results, Ayodele suggests that it would be more marketable to have results from the UK.
In her role as a beauty writer for the black female beauty market, as well as an aesthetician, Ayodele says that not having data specific to her audience limits her enthusiasm to report on new products and treatments. “There’s no point in me harping on about something which I can’t give relevant details about,” she says. From a practitioner’s perspective, she suggests that more studies would get the attention of other clinicians and build their confidence in offering such treatments.
To help improve the data available on products and treatments for higher FSTs, Ayodele has established the Black Skin Directory Council, in which patients with skin of colour will test and review products. “The aim is to give brands the opportunity to have their product tested on a higher FST so they have more data to promote,” she explains.
Dr Kaur believes that the type of education and the way in which it is delivered could also be adjusted. She says, “When I go to talks on treating higher FSTs, they never seem to take place in the main conference room and they often only focus on laser treatments, however not all practitioners have a laser. If we are to educate people, we should start with skincare and chemical peels. Even with laser treatment, the skin needs to be prepared beforehand, so the appropriate options and protocols should be stressed upon more.”
Dentist, and aesthetic practitioner Dr Rikin Parekh is working with the Black Skin Directory to host educational events for practitioners to improve knowledge, awareness, patient care and safety on treating darker skin at his training base, The Avanti Aesthetics Academy. He says, “I don’t think it’s so much a lack of knowledge; practitioners know the differences in skin physiology, it’s more a lack of practical experience which then affects confidence. If you are not treating many people of colour, it becomes harder to treat them as you don’t have the hands-on experience to deal with the issues presented or if a complication develops.”
Ayodele adds, “There are practitioners who don’t have the experience in looking after darker skin tones because of where they’re based and because there is a lower population of people with skin of colour. However, in larger towns and cities there are so many people with higher FSTs that it shouldn’t be an issue.”
For practitioners to increase their confidence in treating these skin types, Dr Parekh advises, “Training and refresher courses together with specific education at conferences and journals can help.” Ayodele adds, “If you are hesitant, there’s lots of good training out there but, likewise, there’s lots of self-education you can do as well. If anything, the main thing to remember is not to rush and to ensure you administer treatment in a step-by-step process.” Dr Kaur emphasises that education is key and practitioners should understand the associated risks of treating darker skin and know what to do if any complications do occur.
The practitioners interviewed agree that if the clinician has the knowledge and experience to treat darker skin types, then they should ensure that this is being communicated effectively to potential patients. “After speaking to my patients, I have noticed that there seems to be misinformation, myths and misconceptions around what sort of treatments black skin can have – for a time it was regarded as dangerous to use certain products and peels on darker skin due to the risk of scarring. However, the technology is so much more advanced now,” says Ayodele.
To promote accurate and positive messages on treating higher FSTs, Ayodele suggests that as well as engaging more with black publications and bloggers, “Stronger web presence from clinics highlighting that they treat all skin colours would be a positive first step.” She adds that using more explicit key words in their online content for search engine optimisation purposes such as ‘black skin, dark skin, brown skin, women of colour, people of colour’ could also help. To further break down misconceptions around treating higher FSTs, Dr Parekh advises that even something as simple as providing treatment imagery of a person with skin of colour on your marketing, website and social media could make a difference.
Ayodele concludes, “In this day and age, no one should be able to walk away from a clinic feeling that they can’t be catered for. Having open and honest conversations is so important – if you don’t have the appropriate knowledge or feel you can treat them, then refer them to someone who can.”
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