Behind the business woman
About your career and the people who inspired you

When I entered medical school I wanted to be an internist and serve the underserved by treating hypertension, diabetes and cardiovascular disease. However during my fourth year in medical school, I fell in love with dermatology. I found that I was interested and passionate about every aspect of the specialty.  Since I was committed to go into internal medicine, I completed a 3 year residency in that specialty. However, half way through internal medicine, I said: “No, I’m not going to be happy or fulfilled practicing in this specialty”. I applied to dermatology residency and, here I am! I completed my dermatology residency at Colombia Presbyterian Medical Center in New York city and Professor Vincent DeLeo, who was one of my professors, really took me under his wings. He has been my biggest source of support, my best mentor and that relationship has lasted to this day. He is the one who called me and asked me many years later if I’d be interested in creating a center in New York to specially address the needs of individuals with skin of color.

INDUSTRY ZOOM: Skin of color is naturally protected : myth or reality?

Is Skin of Color naturally protected against the sun? First of all, in defining skin of color it is important to understand that it encompasses a range of skin types from Fitzpatrick Skin Type III to darker tones such as FST V and VI. For example, many women of Eastern Asian descent are considered to have skin of color but their skin can be very light and they can suffer the effects of sun burn or skin cancer. On the other hand, women of African descent are also considered as having skin of color and they infrequently or rarely burn. A study performed by Dr. Kaidbey at the University of Pennsylvania demonstrated that women of African American descent had an endogenous SPF of about 13.41. So this means that I can walk outside on any given day and I already have an SPF of about 15 present, but I’m still going to apply a sunscreen with an SPF of 30. Despite endogenous protection, skin of color still need additional sun protection, even the darker tones, for many reasons. We should not forget about the harmful negative effects of sun on the skin like skin cancer but even more importantly skin pigmentation is affected by sun exposure.What have been the most recent advances in understanding the effects of the sun on skin of color?I think one of the most significant advances is the understanding that Ultraviolet A, B and now visible light have significant impact on skin of color as it relates to pigmentary disorders such as melasma and post inflammatory hyperpigmentation. Besides, visible light especially the blue zone 450 nm can cause not only immediate pigment darkening but also long lasting pigmentation2, 3. That’s why sunscreens containing iron oxide that block visible light are very important. What are the challenges in skin protection for skin of color? The major challenge in sun protection for skin of color is educating the population about the importance of using sunscreen. Unfortunately, there are many reasons that keep women and men from using sunscreens and they are mostly related to not understanding the importance coupled with the aesthetic aspects of the sunscreens. Many sunscreens are very thick and greasy or leave a white appearance on the skin that is aesthetically unpleasing for people of color. What have been the most exciting skin care innovations in sun protection for skin of color patients? The most exciting thing to me is the emerging knowledge about the importance of iron oxide as an ingredient in sunscreen. There are now some tinted sunscreens formulated with iron oxide that people of color can obtain. Additionally, there is innovation in the aesthetic aspect of sunscreens overall. There are two sisters from Nigeria who formulated a sunscreen that does not leave that white appearance on the skin. Additionally, some of the mainstream sunscreen brands have done a lot better with either creating particles of physical blockers that are small enough so that the white tint is not apparent. Finally, there is a new and emerging approach that consists in adding adjunctive ingredients to sunscreen that have positive effects in the skin’s appearance from the sun damage such as Soy, Vitamin C and E and antioxidants4, 5. Have you seen any evidence-based studies demonstrating the benefits of photoprotection to improve cosmetic outcome in dark skin type? There are two important studies that I always highlight in my presentations on photoprotection. The first one is a prospective study by RANDHAWA6. The aim was to evaluate the efficacy of a facial sunscreen for the improvement of photo-damage. They used a broad spectrum photo-stable SPF 30 sunscreen for 52 weeks on 32 subjects. The clinical evaluation showed that all photo-aging parameters improved significantly by Week 52. Skin texture, clarity and pigmentation were the most improved parameters by the end of the study (40% to 52% improvement from baseline), with 100% of subjects showing improvement in skin clarity and texture. This study is very impressive because it showed that the daily use of a facial broad-spectrum photo-stable sunscreen may visibly reverse the signs of existing photo-damage, in addition to preventing additional sun damage. There is also another nice and interesting study3 that was conducted on women with melasma and darker skin tones, who were treated with 4% hydroquinone. In addition, one group was randomized to receive an SPF broad-spectrum 30 sunscreen and the other group a SPF broad-spectrum 30 with iron oxide. The second group had a 77% Improvement in their MASI score as compare the other group (61%). There was also a greater decrease histologically in the melanin content. All these studies are very important and compelling as they show the benefits of sunscreens (more improvement with iron oxides) and the dramatic effect that adjunctive ingredients can have.

What have you noticed about women of color and their skin care concerns over the years and across generations?

I think the major change regarding women of color is the rising awareness of their skin care concerns and the realization that in most cases something can be done to address their issues. It’s not a matter of just living with the concern or ignoring it.  For example, a large segment of my patient population wants to do some type of treatment for discoloration on their skin. So, it’s no longer, oh my mother has discolorations, I have them, I’m going to just live with them. Now, women seek solutions and treatments. And finally, like all women today, women with skin of color want treatments for their signs of aging such as sagging and prominent and nasolabial folds.

Should Doctors play a role on Social Media when it comes to skincare education on Skin of Color?

I think that is particularly important for physicians to participate in the dialogue on social media in regards to diagnosis and treatment of skin problems for women of color as well as addressing their cosmetic concerns. In the absence of professional advice, patients rely on the internet or “Dr. Google” to find answers that may be inaccurate or incorrect. I think that it is extremely important for physicians and especially dermatologists to impart information and dispel myths on social media.

I have seen women of color in my practice who have ordered, on the internet, chemical peel products that they administered in their home. Sometimes there are harmful ingredients when not used by a professional such high concentrations of trichloroacetic acid. When being used in this situation it can lead to catastrophic results and real skin damage. Same situation with women who buy the microneedling devices and administer it their own. So certain procedures may be exceedingly dangerous on skin of color which is unforgiving in terms of long-term pigmentation or scarring.

What is your secret for Healthy Skin?

My beauty daily routine varies based on the time of the year but it always include sunscreen, exfoliation and antiaging ingredients. After cleansing, the first step is applying sunscreen and that is really the foundation of my routine. I also regularly exfoliate my skin using mild moisturizing and exfoliating product that contains ingredients like glycolic acid or derivatives. Finally, I use products that contain peptides like pentapeptides for more overall anti-aging benefits.

What is driving you everyday?

My motivation and passion relates to my patients and answering each women’s skin and hair needs. I am committed to ensuring that my patients are satisfied with their skin and hair and that their life is improved through my care. If a solution is not readily available, I attempt to use the resources of Penn Medicine to  identify  how we can find some solutions. So that what keeps me going!

BIBLIOGRAPHY:

1. KAIDBEY, Kays H., AGIN, Patricia Poh, SAYRE, Robert M., et al.Photoprotection by melanin—a comparison of black and Caucasian skin. Journal of the American Academy of Dermatology, 1979, vol. 1, no 3, p. 249-260.
2. Mahmoud BH et al, JID 2010 Impact of Long-Wavelength UVA and Visible Light on Melanocompetent Skin
3. Catanedo and al. Photodermatol Photoimmunol Photomed 2014;30:35-42. Near-visible and UV photoprotection in the treatment of melasma: a double -blind randomized trial.
4. MATSUI, Mary S., HSIA, Andrew, MILLER, Janine D., et al.Non-sunscreen photoprotection: antioxidants add value to a sunscreen. In : Journal of Investigative Dermatology Symposium Proceedings. Elsevier, 2009. p. 56-59.
5. Poster JNJ on SOY – Nebus J, et al. Clinical improvement on photoaging using a facial moisturizer with total soy and SPF 30. Photoprotection; poster 64^th Annual AAD; San Francisco
6. RANDHAWA, Manpreet, WANG, Steven, LEYDEN, James J., et al. Daily use of a facial broad spectrum sunscreen over one-year significantly improves clinical evaluation of photoaging. Dermatologic Surgery, 2016, vol. 42, no 12, p. 1354-1361