How to offer a diverse treatment range for people of colour

In a recent survey by Black Skin Directory, 92% of black women said it was challenging to find a skincare professional who could meet their needs. Therefore, knowing how to treat skin of colour is essential for your salon to be more inclusive.

“As a world we are changing. In 1990, the US census said that there were six different races and just 23 sub races,” says Dr Ifeoma Ejikeme, medical director of Adonia Medical Clinic. “In 2000, this was massively expanded to 67, and now there are even more.” In fact, approximately a third of the population in the US and 14% in the UK now consider themselves to have skin of colour. Additonally, research from the University of Nottingham shows that by 2051, the segment in the UK who consider themselves mixed-race is expected to grow by 200%.

However, many beauty therapists admit that they feel nervous treating skin of colour, which includes African, Caribbean, South Asian, East Asian, South East Asian, Pacific Islander, Native American, Australoid, Middle Eastern, and Latino or Hispanic skin. 

Scale up

“There are more people who may have reactions that we don’t expect if we just used our eyes to guess what their heritage was,” says Dr Ejikeme. Therefore, it’s important to investigate this in the initial consultation to know what would happen to a client’s skin if you were to do a peel or microneedling treatment. The following scales can help you plan the best course of treatment.

Fitzpatrick Scale

The Fitzpatrick scale classifies skin into six categories. It tells you which skin types are most likely to burn (I being the fairest and most likely to burn, to VI being the darkest and least likely to burn) when exposed to UV light. However, “it does not tell you how the skin would react when exposed to laser hair removal or chemical peels,” says Dr Ejikeme.

Additionally, it classifies skin type VI as “never burns”, which Dr Ejikeme says is incorrect. “I don’t know of a single person of colour who doesn’t burn,” she adds. Those with darker skin tones still need to wear an SPF, so make sure you can recommend one that will not leave a white cast on darker skin. Mineral sunscreens tend to be less ashy on darker complexions.

Obagi Skin Typing system

Developed by dermatologist Dr Zein Obagi, this system categorises skin into white, black and Asian. While clients’ skin is far more complex and diverse than these three distinct groups, it’s good to have the system in the back of your mind to predict how your client’s skin may react to certain treatments, says Dr Ejikeme.

“Imagine a fair Japanese woman whose skin is light. If you treated her skin inappropriately, it would pigment darker,” she says, explaining that the skin is more likely to pigment to the client’s underlying heritage.

Roberts Skin Type Classification System

“This system helps you predict injury and it specifically looks at inflammation,” says Dr Ejikeme. It observes both the Fitzpatrick scale (observing skin tone) and Glogau scale (observing severity of wrinkles), but it also considers pigmentation and scarring, which is useful when planning a course of treatments.

“The Roberts scarring scale looks at the different scarring patterns,” she adds. “Does the person have atropic scarring? Do they scar flat? Do they scar with cysts? Do they scar with keloids, or with large keloids?” This will tell you how your client’s skin may react adversely to treatments.

Similarly, the Roberts hyperpigmentation scale can predict the hyperpigmentation, or the hypopigmentation, a client may experience. “How long does that dark spot last for? Two weeks on average? Or do they tend to always scar with a permanent scar that lasts for years? These sorts of questions are really helpful,” says Dr Ejikeme.

For example, clients with black, South Asian or Indian skin respond better to chemical peels, whereas those with East Asian skin respond better to microneedling treatments.

Attract a diverse client base

Dija Ayodele, founder of The Black Skin Directory (BSD), reveals that 90% of respondents in a recent BSD survey said that the experience and knowledge of treating skin of colour was the primary reason they chose a particular clinician. One way to demonstrate this is by stocking product houses that show clinical trials on darker skin tones.

“Some will do a clinical trial with skin tones up to Fitzpatrick scale four, but five and six are missing,” says Ayodele. Therefore, showing that the brands you use are effective on all skin tones will help to build trust with all your clients. Contact your product houses and ask if they can provide evidence of clinical trials for darker skin tones.

Also, use diverse model imagery and showcase beforeand- after pictures from a range of clients in your marketing materials. “If you have a potential skin-of-colour client searching for these treatments and you haven’t got those images on your website, then you’re losing out on clients because they don’t see someone that looks like them,” says Ayodele. You may have the knowledge to treat a wide range of skin tones, but a client won’t know that unless it’s implicit on the first touch-point with your business.

Additionally, using terms on your website such as black skin or Asian skin to caption the corresponding images will help your website to rank higher in Google searches, helping you to reach a broader audience.

It’s often regarded that those with darker skin tones do not need to use a daily SPF. However, if they are concerned about ageing and pigmentation, then it is a must, especially if they’re receiving a treatment that will make their skin more sensitive to UV rays. “There is also evidence that those with darker skin tones can still develop skin cancer,” says Ayodele, so it’s important to reiterate this when treating clients.

Dispel myths

Another myth is that darker skin is thicker and can tolerate more aggressive treatment. This is untrue. Skin thickness is the same across all races, so it’s important to treat all your clients on a case-by-case basis when recommending treatments or retailing products. In fact, in Fitzpatrick skin types four to six, a higher level of inflammation is present in acne, as well as the likelihood of post-inflammatory pigmentation (PIH), says facialist and aesthetician Andy Millward: “A skin-of-colour client will have higher levels of inflammation at every single grade of acne compared to your Caucasian clients.”

Skin of colour can be particularly prone to hypertrophic scarring (a scar contained to the area of trauma) and keloid scarring (a scar that grows past the initial area of injury), and this can be caused by trauma to the skin, such as acne. “As a non-medic, I can treat hypertrophic scarring, but I would have to refer for keloid scarring,” says Millward. “If in doubt, always refer to a medic for assessment.”