Cosmetic Considerations in Dark-Skinned Patients

Sarawin Harnchoowong,1 Vasanop Vachiramon,2 Natthachat Jurairattanaporn2 1Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand; 2Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Natthachat Jurairattanaporn, Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand, Tel +66 2201 1141, Fax +66 2201 1211 Ext 4, Email [email protected]: For dermatologists, diversities of human races result in an opportunity to encounter patients with various skin types. Cosmetic procedures have gained more popularity and become more accessible over the past decades. Thus, the selection of appropriate treatment protocol for each patient becomes inevitable. This review will focus on basic knowledge and key points in performing safe cosmetic-related procedures in patients with dark-complexioned skin. In terms of structure and function of the skin, people of color have equal epidermal thickness, corneocyte size and melanocyte number. However, they have more stratum corneum compaction, melanosome dispersion and melanocyte activity than fair skin individuals. Data regarding drug penetration and cutaneous irritation showed conflicting results. Superficial chemical peels and microdermabrasion can be done safely in dark-skinned patients. Medium-depth peel should be used with extreme caution. While deep-depth peel should be avoided at all times due to pigmentary and textural complications. Prolonged treatment interval, use of priming agents and sun protection are recommended. Injectable materials including botulinum toxin and soft tissue augmentation by hyaluronic acid filler can be done harmlessly in dark-skinned patients. Lasers and energy-based devices should be done with caution. Higher melanin dispersion and melanocyte activity acts as competitive chromophore. Pigmentary or textural changes can occur after aggressive treatment protocol. High energy setting, pulse stacking, short wavelength lasers and short treatment interval should be avoided in dark-skinned patients.Keywords: complications, dark skin, energy-based devices, injectables, laser, skin of colo

Evaluation of an Acne Severity Grading Self-Assessment System Suitable for the Thai Population – A Pilot Study

Kallapan Pakornphadungsit, Sarawin Harnchoowong, Penpun Wattanakrai Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Penpun Wattanakrai, Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand, Tel +66-2-2011141, Fax +66-2-201-1211 ext 4, Email [email protected]: Patient self-assessment is a potential tool in clinical practice to obtain subjective information of acne severity also in clinical trials to assess the general population in research and epidemiologic studies. The patient self-evaluation of acne severity has not yet been developed in Thailand.Objective: We aimed to validate an acne severity grading self-assessment suitable for the Thai population.Methods: A pilot study was conducted in 77 volunteers with acne lesions. We developed the Thai Global Evaluation Acne Scale (TGEA) and Thai Global Acne Grading System (TGAGS) by translating and adapting the original version. Patient self-assessment of acne severity was performed in two rounds. A training session about acne was provided to all participants lesions before starting the second round. Reliability between the self-assessment and clinician assessment of acne severity was statistically assessed.Results: For TGEA, 48.05% participants rated their acne severity corresponded with the clinicians (Cohen’s kappa coefficient, kappa = 0.26). After receiving the training, 79.22% subjects responded their acne severity corresponded with the clinicians (kappa = 0.66). For TGAGS, 77.92% patients who answered their acne severity corresponded with the clinicians (kappa = 0.52). After receiving the training, 94.80% participants responded their acne severity corresponded with the clinicians (kappa = 0.89). For raw score of the TGAGS, the intraclass correlation coefficient (ICC) during the self-assessment of acne severity compared to the clinician assessments was 0.54 and it increased to 0.79 after the training.Conclusion: Due to the almost perfect reliability, we suggested that TGAGS is a reliable subjective self-assessment of acne severity suitable for the Thai population. The training is essential in enhancing the reliability of this instrument. Our study’s findings can facilitate clinical practice and research studies.Keywords: subjective self-assessment, acne severity, trainin