The shrinking world: skin considerations in a global community

Each year that passes the world becomes smaller and smaller, not physically, but socially. It is now possible in the span of 30 min to e-mail people from Tokyo to Berlin to Portland to San Francisco to Montreal to London to Buenos Aires to Moscow to High Point, North Carolina, my home. As I sit at my desk in my small corner of the world, I can share thoughts and knowledge with dermatologists of many different skin types, genders, and backgrounds. This ability enriches me personally and enhances my skills as a dermatologist. This is one of the major goals of the Journal, to bring the best new ideas and research in cosmetic dermatology from a global community to a global community; in short, to understand what makes our skin the same and at the same time different. What really are the skin considerations in a global community? The key to understanding skin considerations in a global community is the recognition that not all skins are the same. The same skin disease can look very different in Caucasian vs. African American skin. The pigmentation problems common in Asian skin are not seen in Northern Europeans. The effects of aging are much different in men vs. women. Adolescents are more likely to develop acne with product use than mature individuals. Persons who easily flush experience stinging and burning in response to product application more frequently. Thus, issues of ethnicity, skin color, age, gender, and skin sensitivity must be considered when developing skin care products for a global community. Gender issues are some of the most basic global differences. Male skin is visually much different than female skin and has a unique response to aging and adverse product reactions. Probably the most important difference between male and female skin is the skin thickness. Male skin is thicker than female skin, in part because of the presence of terminal hair follicles over much of the body. This difference is most pronounced on the face where women have only vellus hairs, whereas men have fully developed terminal hairs. The presence of male facial hair is partially responsible for the more favorable appearance of mature men over mature women. As UV radiation activates collagenase to destroy dermal collagen, the male beard allows the skin to resist wrinkling. Thus, photoaged men do not exhibit the pronounced redundant facial skin seen in photoaged women. The thicker male skin is also superior for diffusing UV radiation, especially in the UVA range, which penetrates more deeply, causing greater damage in female skin. Thus, the global media prefers images of younger women and older men, which further magnifies gender differences in photoaging. Skin sensitivity is another global consideration that has some gender predilection. Women experience adverse reactions more commonly than men. The thinner skin may allow irritants and allergens to penetrate deeper in female skin, but the increased incidence may also be resulting from greater product usage. Women globally use more skin care products and cosmetics than men. This increased usage magnifies the chances of contacting an irritant or an allergen. Globally, women are also more likely to undergo procedures that destroy the skin barrier, such as facial peels, microdermabrasion, spa treatments, etc. Furthermore, women are more likely to engage in anti-aging topical products that can create barrier damage, such as topical tretinoin, glycolic acid, lactic acid, etc. This damage to the stratum corneum further increases the chance for magnification of a mild adverse reaction into a more serious dermatologic problem. This artificially created increase in skin sensitivity has been termed “polypharmacy” by some who wish to impart the concept of overusage of prescription and over-the-counter products. Lastly, skin color is an important global consideration. All colors of skin possess melanin, but the differences arise from unique melanin distribution. This difference in melanin distribution gives rise to light and dark skin and also to sunburn characteristics. Very light skin that does not tan typically does not respond to injury with pigmentation changes. This is in contrast to persons with darker skin, to include Asian, Mediterranean, African American, and Hispanic skin, who experience frequent postinflammatory hyperpigmentation, which is a larger cosmetic concern than wrinkling in these ethnic groups. Darker skin will sunburn and tan just like fair skin, but deepening of the skin color is generally considered undesirable. This is not the case in fair complected individuals who try to achieve a tan by natural sun exposure, the use of artificial UVA radiation in a tanning booth, or dyeing of the skin with self-tanning products containing dihydroxyacetone. Melanin is basically an unstable radical that can absorb an electron from highly energetic unstable oxygen species, preventing the activation of collagenase and the resulting dermal damage. This is why darker-complected peoples of the world typically do not demonstrate photoaging to the same degree as their fairer-complected age-matched counterparts. A global view of cosmetic dermatology is important for both the dermatologist and the cosmetic formulator. Many companies are now developing multilingual packaging, consistent global formulations, and expanding distribution to all continents. This is the shrinking world of the future. We are a global community similar in many ways with unique differences all looking to achieve the same goal of lifelong health and beauty.

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