Exclusive Interview - Dermatologist Dr. Neil Persadsingh

Dr. Neil Persadsingh is a world-renowned dermatologist and the author of ‘Acne In Black Women’ and ‘The Hair in Black Women’.

In an interview with Makeup and Mane, Dr. Persadsingh gives readers professional skincare advice and tips on how to tackle some of the most common skin conditions affecting women of colour.

When a white person’s skin is damaged it tends to turn red. When a black person’s skin is damaged it tends to turn black. So a lot of girls who suffer from acne get these black spots. Because we didn’t, until recently, have good medicines to treat them, they would try to treat it on their own with the bleaching creams and the steroid creams. As a result, a lot of them would end up with problems.

Not only that, a lot of women don’t use sun block and it is imperative to use sun block. A lot of them don’t use adequate moisturizers. A lot of our people use harsh soaps on their face, carbolic soaps and soaps like that.

MM: What are the main causes of acne in women?

Dr. P: Acne is caused by the hormones in your body. You don’t get acne until you see menarche, which is your first menstrual period. Acne is usually worse just before the period. Acne might get worse in pregnancy or it might get better. A lot of women find that they get acne at the time of menopause, when the hormones become unstable. So it is definitely hormonal.

Acne in Black Women

MM: I have heard many black women comment that over the counter acne medications such as OXY and Clearacil don’t work well on their skin. Does the treatment of acne in Black skin differ from that in Caucasians?

Dr. P: When we see acne in a black person although it may look very similar to acne in white person, if you cut out the lesion and analysed it under the microscope, you will find that there is much more inflammation in the acne in a black person.

This why you get more hyperpigmentation, more black spots and more scarring, because there is more of an inflammatory reaction there than in white skin. Now what that means is, we ought to treat the acne very aggressively in black people. So from day one you go out with your guns blazing.

Number two, you are always thinking about the side effects. For example, the holes they get in their face, the scars etc. In addition, some things like Benzyl-peroxide might tend to stain the clothes and stain the skin. Some things like Tetracycline can induce phototoxic dermatitis, which is a rash some people get when they go out into the sun that makes them look darker. Some preparations, like Retin-A, might in be intolerable in some black people in higher concentrations. So with a lot of medicines, I start at a very low concentration and then move up. Where as with a white person, you could probably start treatment using the strongest medication.

MM: Are there any over the counter medications available that are effective in the treatment of acne and hyperpigmentation in dark skin? Should hydroquinnone be avoided?

Dr. P: What I am saying is not that you have to avoid hydroquinnone. I am saying that you have to be careful with it. Now what happened is that a lot of hydroquinnone came out over the years and a lot of people used it and they developed ochronosis, which is the deposition of pigment deep into the dermis and it gives you an ugly colour and it is very difficult to treat.

Now in the past we have noticed that a lot of people developed this because they used high concentrations of hydroxiquinnone. Now if you are going to use this thing, it shouldn’t be more than two percent. Recently, they have come out with some four percent preparations. I’ve seen patients using six and eight percent concentrations for a prolonged period of time, without medical supervision.

This is what I am against. Potent steroids begin used on the face for a long period of time. This happens frequently within the black community. In Nigeria we had this problem, in Nassau we had this problem and also in some of the other Caribbean countries.

The came out with a gel called Reggae Gel which has clobetasol, the strongest form of steroid and we shut that down. So Reggae Gel went off the market and then they came out with Yellow Gel. The product was made by the same people, in the same tube but with a different box and they are selling it. So, we face that problem.

MM: Many  women suffer from the occasional outbreak. How does a person determine if a case of acne is severe enough to seek medical treatment or consult a dermatologist?

Dr. P: I think the paradigm has to shift and it is our responsibility, you in media and me in medicine, to educate the public. From the beginning we want to see the patient. I think that we have the resources now that if a person goes to the dermatologist early, the disease can be stopped completely.

Very often the dermatologist can put you on Accutane or use a suppression therapy. If you are in good hands you won’t end up with the ’sick wheel’. I have seen so many people carrying the burden, I mean a life-long burden, with the spots and scars when if they had been treated earlier, they wouldn’t have it. I also think that is the cheapest way to go, to treat it earlier.

MM:  When person is suffering from acne or has oily skin, the first reaction is to automatically stop moisturizing their skin. How important is moisturizing? What should a client look for when selecting a moisturizer?

Dr. P: You must understand the function of moisturizers. In the skin you have two layers, the epidermis and the dermis. The uppermost layer, the dermis, the outer part is the stratem corneum. Now, our skin naturally produces something called sebum. If you squeeze between your nostril and the side of your cheek, the white stuff that comes up is sebum. This is what keeps the skin soft and supple and smooth.

Now I tell my patients, if you bake a chicken and took a wing, put it in a plate and put it in the refrigerator and took the other wing, wrapped it in cling film and put in the fridge, after 24hrs one piece would be hard, the other would be soft.

The one that was wrapped had the moisture trapped in. This is what sebum is supposed to do. Now because of the weather conditions, we are loosing the sebum so we use the moisturizers and the creams to replace the sebum and keep the skin supple and young looking. It is absolutely important to moisturize, for men and for women.

MM: Aside from the use of hydroquinone, what other methods are available to help lighten hyperpigmented areas?

Dr. P: If you go to the dermatologist, he will probably recommend micro-dermabrasion and chemical peels, even laser treatment to get rid of the dark spots. We have technology to get rid of it. It’s just that the patients don’t come to us. They treat it themselves.

MM: Many doctors prescribe oral contraceptives for the prevention and cure of acne. In your opinion how affective is this?

Dr. P: In the UK and in Jamaica, we use Diane-35, which is a progesterone compound that gives you birth control protection and helps the acne as well. A few of the other pills like Alesse and Femiane also contain things that help with acne but once you stop taking the birth control pill, ‘BAM! , the acne comes back. So it is not really curative, it’s just suppressing it until you have to stop it. Either the woman reaches 35 and she wants to stop the birth control pill or she gets pregnant. So that is really suppression therapy again.

MM: I have often read that acne is more of an internal condition and has very little to do with eating greasy foods or how often the area is washed. Is this true and if so why is such and emphasis placed on skin care products?

Dr. P: None of the products will cure acne. They only have one drug that cures acne and that is Accutane. All the other things are supportive and they suppress the acne and they wait for the patient’s acne to get better in the natural course of events. All the antibiotics etc, only suppress it for a while but they don’t get to the root of the acne. The only thing that gets to the root and stops the acne is Accutane.

MM: When a woman is suffering from acne, normally her first reaction is to cover the problem with cosmetics. Does this make the problem worse? Which types of cosmetics are safe and which ones should be avoided?

Dr. P: In the past we had a lot of cosmetics which were comedogenic, that means that they caused acne. But nowadays most, if not all cosmetics, are tested on a model, a rabbit-hair model. And what the found is that if you took a rabbit hair and you applied compounds onto it, if those compounds would cause acne, you get severe acne on the rabbit hair within a couple of days. So this is done to all products now.

A lot of women find that when they have acne, they try to cover it. I tell them that it is important for their feelings of self-worth, self-esteem, sense of pride that they use something to cover it. So what happens is, we use medications that you tend to apply at night so they can use their makeup in the day. If they have to use the medication in the day I tell them to put on the medicine, wait 10 minutes and then apply the makeup.

For more information on black skincare check out Dr. Neil Persadsingh’s book ‘Acne In Black Women’.