New and standard therapies directed at common ethnic skin concerns

Here’s a primer on common ethnic skin concerns and therapies:

Keloids (KEY-loyd)

What they are: Overgrowths of scar tissue that follow ear or body piercing, acne, surgery and injury. Some grow from ingrown hair in neck folds. Dark-skinned individuals are more at risk.

How common: Very.

Cause: Unknown. One theory is that the healing process in the skin goes out of kilter, overproducing cells that create excess scar tissue.

Tips: Don’t wait until scars are too pronounced. The bigger they get, the harder they are to remove. After a few weeks, see a doctor if the skin is red and has a firmness to it.

Treatment: For a small keloid, doctors numb the area and cut it off surgically, a 10-minute procedure, followed by twice-a-month steroid injections into the site to avoid recurrence. Larger keloids, particularly flat, ribbon-like structures on the chest and back, or those that occur as a result of acne, are harder to treat. Typically, doctors inject a steroid drug, Kenalog, or triamcinolone, its generic name, into the scar. It may take months for even modest results.

Cost: Kenalog injections are $50 or more each; insurance coverage varies. Surgery to remove a small keloid is $100-$150 or more.

Post-inflammatory hyperpigmentation

What it is: Skin discoloration, often black or a slate-gray color. There are many types, including melasma, patches of brown or gray-brown spots; sun or liver spots; vitiligo (see below), and facial darkening during pregnancy, known as the mask of pregnancy.

How common: An estimated 5 million to 6 million American women have melasma. It occurs more often in Hispanics, Asians, Middle Easterners, Asian Indians and South, Central and African Americans.

Cause: Hereditary, hormonal changes, sun exposure, injury and diseases, such as acne, or injury. Using oral contraceptives or herbal medicines with sun exposure may cause discoloration, as can certain perfumes and exposure to cold or wind, saunas and ovens.

Tips: Protect yourself from the sun and use sunscreens faithfully.

Treatments: Hydroquinone is a bleaching agent available over the counter at 2 percent concentration or in stronger prescription doses up to 12 percent. But be careful: Strong products can cause skin blotches and weaker doses may be a waste of money. Dr. Lorna Thomas, a Detroit dermatologist, typically begins treatments at doses of 6 percent concentration.

In the past few years, other new products have been federally approved. Two are: TriLuma, a cream containing 4 percent hydroquinone; tretinoin, a vitamin A product; and a steroid solution. EpiQuin Micro is a cream that contains a 4 percent concentration of hydroquinone and retinal, a vitamin A derivative. Doctors are evaluating the effectiveness of the two products; early results show modest benefits.

Costs: TriLuma costs $80-$100 for a one-two month supply. Insurance may cover one-fourth of the cost, according to a spokesperson for Galderma Laboratories, its manufacturer, which offers a $25 rebate on its Web site, www.triluma.com.

EpiQuin is $55 for a one-two month supply; insurance may pay one-fourth of the cost.

Vitiligo (vit-il-EYE-go)

What it is: A common condition where pigment cells are destroyed and white patches on the skin appear, often in areas exposed to the sun or in body folds. It also may whiten hair, sometimes prematurely, in areas affected by the disease.

Cause: Unknown.

Incidence: Some 1 percent to 2 percent of the world’s population, about 40 million to 50 million people, are affected. Anyone of any race can get it, often before age 40, though it is more noticeable in people of color and may occur more in people with autoimmune diseases, leading to one theory that antibodies destroy the color-producing cells in the body, causing the disease.

The disease: The extent of color loss varies. It may be one-sided, cause a loss of color inside the mouth or be extensive. Although often progressive, the disease can advance slowly or rapidly.

Treatments: Steroid creams used for three months may help return pigmentation, particularly in younger children. Another approach combines psoralen, a medicine that reacts to ultraviolet A light, with that form of light or sunlight. Called PUVA therapy, it is time-consuming, requiring office visits two to four times a week, for 15-30 minutes, for as many as 300 treatments. Results vary and may be best in people without extensive spread of the disease. Side effects can include severe blistering and sunburn, and therapy may cause skin to blotch. Psoralen pills and natural sunlight may increase the risk of skin cancer, and cause sunburn, vomiting, nausea, itching, abnormal hair growth and hyperpigmentation.

Another approach, depigmentation, for people who have lost 80 percent or more of their pigment, uses drugs taken twice a day and bleaching agents every two weeks to depigment the skin, until it matches lighter areas. It may leave the skin dry, red, swollen and itchy. Surgery involves transplanting normal skin to small depigmented areas.

Costs: PUVA therapy costs about $60 per treatment. Insurance coverage varies.

Acne

What it is: An inflammatory skin problem causing pimples, blackheads or whiteheads on the face, back, neck, chest and shoulders. Acne in blacks tends to be the blackhead variety, and may be extensive and cause skin color changes.

How common: 17 million Americans, almost 85 percent of people 12-24 years of age.

Causes: Hormonal changes, which cause an overproduction of the male hormone androgen. Stress, steroid medicines and other factors also contribute to acne.

Tips: Don’t pick at acne. That may stimulate cells to grow more and leave a darker spot. Stay out of the sun or use sunscreens. Reapply sunscreens every two hours.

Treatments: Dozens. Doctors often use combination therapies with antibiotics, Tretinoin, a form of Retin A and hydroquanone. The drugs have a range of side effects, including dry skin, burning and irritation. Doctors often spot test products in the fold of the arms first. If there is redness or irritation, try somewhere else. Up to now, two other treatments, microdermabrasion, a skin-sanding process, and laser therapy, have not been recommended for dark-skinned people because they caused skin color changes. A new device, the ND Yag Laser, improves ethnic skin treatments.

Follicular diseases

Facial hair/women

What it is: Hirsutism is excess facial or body hair in women. It is a cosmetic issue, not a disease, in follicles, or hair cells, under the skin.

How common: An estimated 41 million in the United States. It may be more common in certain ethnic groups.

Causes: Hereditary and hormonal changes, during pregnancy or menopause, or certain diseases, such as ovary disorders, obesity and anorexia, may cause an overproduction of the male hormone androgen. Some drugs, including phenytoin sodium, an antiseizure medicine, also may cause unwanted facial hair.

Prevention: Weight loss may help.

Treatments: Oral contraceptives, electrolysis, waxing, tweezing and laser treatments. Vaniqa is a new prescription cream, applied twice a day, often to complement other hair-removal therapies. It takes as long as three months for results and must be taken for a lifetime. It blocks an enzyme that produces hair growth. “It doesn’t work on everyone,” Cook-Bolden says. “The general consensus is still out. More than 50 percent of patients are happy with it.” Vaniqa can irritate the skin if overused. Laser hair removal also works, but is costly, usually not covered by insurance and requires repeated treatments, for a lifetime.

Costs: $55, for a two-month supply of Vaniqa. Insurance may cover a portion of the cost. Laser hair removal typically costs $150 or more for each treatment.

Facial hair/men

What it is: Curly, ingrown facial or neck hair, known as shaving bumps or pseudofolliculitis barbae (SUE-dough fo-LIC-u-LIE-tis bar BE). The bumps, painful when shaved, also may discolor skin.

How common: Very common in African-American, Caribbean-American, Middle-Eastern and Latin-American men, and also can occur in women. The bumps develop anywhere hair is shaven, plucked or tweezed, mostly on the face and neck.

Tips: Grow the hair. Use barber scissors to shave. Shave with a moisturizing gel immediately after you shower. Don’t use a razor blade more than a few times. Shave the area just once; don’t go over it. Avoid fragrant aftershave lotions that may irritate the skin.

Treatments: The NG Yag laser, federally approved for dark skin types, is effective. A typical regimen requires five or six treatments, repeated every six months for a lifetime.

Costs: $200 a laser treatment; insurance usually does not cover.

Hair problems

Alopecia

What it is: Bald patches within the hair. Two types are more common in African Americans – traction alopecia, bald patches near the hairline, and scarring alopecia, over the center of the scalp. Doctors often perform a biopsy of an area to rule out lupus and other diseases.

Causes: Tight hair-pulling techniques, ponytails, braiding, sleeping in rollers, even soft ones, gluing hairpieces to the scalp and harsh chemical hair treatments.

Tips: Stop braiding hair; keep braids above shoulder length, and talk to your stylist about not braiding your hair too tightly. “If it hurts when you put them in, they are too tight,” says Dr. Diane Jackson-Richards, a Henry Ford Health System dermatologist.

Treatments: Antibiotics and steroids, creams or injections, may be prescribed to reduce inflammation and prevent infection. Surgery, as a last resort, includes hair transplants and scalp reduction, if the loss occurs where the scalp can be pulled together, to cover up the bald area.

Costs: Doctor visits vary, from $55 or more; insurance may cover if associated with acne.