Editor's Note: The purpose of this column is to tap first-hand into a clinician's experience with the consumer, including chief complaints and treatments, to asses common concerns for women today in an effort to formulate better cosmetic products for those issues.
Caucasian women (Fitzpatrick Scale I–IV) comprise the majority of my clientele, and these women often express concerns about the unevenness of their skin tone. Since makeup is typically not in the scope of my consultancy, I advocate healthy and radiant facial skin to be the best possible canvas for a youthful appearance. Mechanical stimulation of the facial tissue and personalized skin care are two approaches I recommend to address skin color distribution issues.
Uneven Color Causes
Uneven skin tones including increased redness, a dull, ashy appearance with low luminosity, or pigmentation are due to different underlying biological causes. Redness can either be transient when due to stress, illness or travel; or of a more permanent nature when indicative of sensitive skin, mature skin with broken capillaries, mild rosacea, or acne with associated hyperpigmentation. Low hydration and impaired desquamation can contribute to an uneven, dull and ashy skin surface with low luminosity. Obviously the amount of melanin in skin dictates differences in skin pigmentation, which varies by ethnicity and can be exacerbated by lifestyle factors. Treatment goals related to skin color concerns are therefore multifactorial, and must be dealt with on an individual basis. However, in general they entail addressing skin hydration, regular desquamation and barrier function, and reducing skin redness and sensitivity.
Redness and Sensitivity
Sensitive skin has been defined as a skin type showing higher reactivity than normal skin. Non-invasive studies of sensitive skin have confirmed a trend for more redness and linked its higher reactivity to increased baseline vasodilation.1 Again, while personalized recommendations to address sensitive skin are made on a case-by-case basis, they typically involve treating skin with active ingredients that protect the barrier, hydrate and alleviate the hyper-reactivity of sensitive skin. In the absence of redness or broken capillaries, these approaches can also be combined with gentle, superficial facial massage.
Desquamation and Barrier Function
A dull facial complexion with ashy appearance and low luminosity is often caused by low hydration and impaired desquamation. Clinically, it can be the result of both internal factors, i.e., acute or chronic illness, dehydration and stress; as well as inadequate topical skin care routines involving cleansing, exfoliation and moisturization. The long-term treatment of a dull facial complexion involves the combination of basic skin moisturizing ingredients such as emollients, humectants and occlusive agents, as well as actives that induce the orthorhombic phase arrangement in skin. Keratolytic actives in appropriate concentrations are used as peels and recommended for at-home exfoliation, while mechanical stimulation to increase skin blood flow is important for regaining regular epidermal turnover.
Beyond the recommended daily use of sunscreen, treatment for uneven skin color related to hyperpigmentation can be offset by ingredients that block melanin production or transfer to keratinocytes over the long term; in the short term, keratolytic peels offer visible improvements. Melanin-reduction strategies are particularly useful during the winter season when sun exposure is low. However, the photoprotection skin gains from melanin influences its rate of aging. So although a tanned face is perceived to be more attractive, skin care with SPF is strongly recommended to be used all year around—and correct tanning behavior should accompany it.
Correcting the skin tone through topical means is only temporary unless any lifestyle elements affecting the complexion are also addressed. For example, transient viral infections are known to weaken the immune system, resulting in a pale and dull complexion. In larger cities, pollution can lead to free radical formation in the skin, which causes irregular pigmentation and other negative effects, identical to cigarette smoke. Unhealthy skin color also correlates with a diet inadequate in fruit and vegetable consumption; in fact, the positive visible effects of eating fruits and vegetables have been exploited to motivate a change in dietary habits.2 The yellow component of skin color contributes most to an attractive appearance. And while both diet-based carotenoid coloration and suntan-generated melanin coloration drive the perception of attractiveness, diet-based carotenoid coloration is consistently marked as more important.3 Last but not least, a change in hormonal status, i.e., during the menstrual cycle or menopause, is known to impact skin color, in particular the darkness of the lips.4
Skin coloration plays a pivotal role in facial attractiveness. This hard-wired preference for young and healthy-looking skin could explain why women place such an emphasis on the condition of their skin and its refinement through cosmetic products. Skin color is strongly linked to the perception of health,5 and its evenness garners more attention and positive statements about attractiveness.6
Research shows that only relatively small changes are required to correct uneven skin coloration and evoke a different perception of improved health.7 However, these changes must be addressed holistically with targeted interventions that are multifactorial and in line with consumers’ skin care and lifestyle habits. As noted above, these changes must address the cause of uneven skin tone, be it pigmentation, dull appearance or skin redness. This treatment, of course, must involve changing the lifestyle factors that contribute to the uneven skin tone.