In recent years, the beauty industry has made significant strides toward inclusivity, recognising the importance of representing diverse skin tones and ethnicities not only in its advertising but also in the products and services it offers. Campaigns like Cosmopolitan's Black Beauty Hub, launched across London Underground stations in early 2025, exemplify this movement by celebrating Black beauty and providing dedicated spaces for Black women to access tailored beauty content.
Despite these positive changes, many challenges persist, including those within the field of aesthetic medicine.
From clinical trials to medical training, the aesthetics industry has traditionally been very Caucasian-centric, and this lack of inclusivity has led to a knowledge gap among professionals who lack expertise in treating Black and Brown skin or knowing where to refer patients to if something is out of their remit. [SOURCE: Inclusivity for Skin of Colour – The Consulting Room]
In addition, treatments and products have been developed with a narrow focus, often overlooking the unique needs of patients with skin of colour. This oversight can lead to misdiagnoses, ineffective treatments, and a lack of trust between patients and practitioners.
This article explores key considerations for practitioners working with skin of colour and highlights the importance of knowledge, inclusive practices, and tailored approaches to provide effective and safe treatments.
Dr Ifeoma Ejikeme. Founder and Medical Director of Adonia Medical Clinic says, “Diversity and inclusion in aesthetics is a 360 issue, with every part of the industry needing to take responsibility for embedding inclusivity into every level of training, technology and treatment.
“Too often, treatment protocols aren’t designed with inclusivity in mind, leading to gaps in treatment access and outcomes. We need more standard operating procedures that prioritise equality at every step to ensure that all patients receive the highest levels of care.
“Manufacturers and device companies also play a vital role. Every patient should be able to access the same great technologies and treatments, yet we still see certain treatments that aren’t available or optimised for all skin tones.
“From a practice point of view, there are still some clinics that don’t offer treatments to different groups - such as those of melanin rich skin tones - and this is something that needs to change.
“The solution must be approached in stages. We need improved professional development opportunities for existing doctors, nurses, and therapists, as well as curriculum reform at the university, college, NVQ and BTEC levels to ensure everyone in the aesthetic industry is equipped to treat every patient. Diversity and inclusion should be core pillars of our practice, rather than qualities people pick up later on.”
In an article on understanding the needs of skin of colour in The Journal of Aesthetic Nursing, The Black Skin Directory founder Dija Ayodele wrote:
“The skin of colour population is rising globally, and practitioners are faced with an increasingly diverse footfall. Additionally, there are also increased demands for inclusivity in a vastly multi-cultural world. To satisfy these societal changes, it is important for practitioners to be competent in meeting the needs of all patient groups.
“From understanding the physiology of skin of colour to an appreciation of how culture, myths and expectations impact the conditions presented, as well as product and treatment selection, practitioners today need greater awareness to provide a superior and profitable service that meets the needs of all patients and stakeholders.”
In an ideal world, any patient should be able to walk through the door of any clinic and have their needs (where treatment is appropriate following a consultation) met. However, that is not always the case. But it’s not acceptable to say, “We don’t do Black skin” and turn a patient away. If you don’t offer certain treatments or are inexperienced in treating skin types IV-VI, make sure you have somewhere you can refer patients to.
“I’m well aware that, while we live in a very diverse country, not everywhere is diverse. So, if I went to a small English village, I don’t necessarily expect them to have the full ins and outs. What I do expect is that they know their limitations. They can say, as a practitioner, ‘I do not have enough experience in this, but I do know someone who does.’
“But in some cases, there is no basic knowledge. And it can be as cold as ‘We don’t do Black skin’. A client or patient will appreciate you saying, ‘I do not have that relevant experience. But I can recommend you to X instead’.”
- Speaking to The Consulting Room, Ayodele
Every patient’s skin is different and has individual needs. However, there are some commonalities and differences to be aware of. When treating skin of colour, you should also consider:
While most treatments are suitable for skin of colour patients, due to the increased risk of depigmentation and post-inflammatory hyperpigmentation, modifications to the preparation process, device settings, treatment potency, and duration may be necessary. [SOURCE: Journal of Aesthetic Nursing]
Research favours combination treatment modalities to achieve the best skin rejuvenation results.
In a recent article in Aesthetic Medicine on treating skin of colour, columnist Dr Sabika Karim
emphasises the unique challenges these skin types present in aesthetic medicine, particularly the increased susceptibility to post-inflammatory hyperpigmentation (PIH) and keloid formation. She explains that the heightened activity of melanocytes in darker skin leads to a more pronounced response to inflammation, resulting in persistent dark spots.
Additionally, the structural differences in the dermal-epidermal junction can exacerbate melanocyte activity, further intensifying hyperpigmentation. To address these challenges, Dr Karim advocates for tailored treatment approaches that minimise inflammation and potential skin injury, thereby reducing the risk of adverse effects such as PIH and keloid scars.
Skin conditions often present differently in skin of colour, which can lead to misdiagnosis or delayed treatment. For example:
Understanding these variations is crucial for offering accurate diagnoses and effective treatments. If you feel you have gaps in your knowledge when it comes to assessing and diagnosing skin of colour, additional training or having a referral partner is recommended to make sure you can meet patients’ needs.
The Fitzpatrick scale is a numerical classification system for human skin colour, developed by dermatologist Thomas B. Fitzpatrick in 1975, that categorises skin types based on their response to ultraviolet (UV) light, specifically their tendency to burn or tan.
The scale was designed to help dermatologists and other medical professionals understand how different skin types react to UV exposure, which is crucial for assessing skin cancer risk, determining appropriate skincare and treatment plans, and predicting the outcomes of aesthetic procedures.
The Fitzpatrick scale ranges from Type I (very fair skin that always burns and never tans) to Type VI (very dark skin that never burns and always tans).
While widely used, there are schools of thought now that the Fitzpatrick scale is outdated as it can be subjective and may not be fully representative of all skin types, particularly those with darker skin tones, where the terms "burn" and "tan" can be interpreted differently.
According to research, the use of this scale has been of limited utility because of different self-perceptions in different areas of the world, particularly among those with skin of colour.
According to a 2019 review of research, a number of participants in separate studies were unable to classify themselves by FSP as a result of the scale’s limitations. [SOURCE: HEALTHLINE]
In a 2015 study involving 556 people in South Africa with FSP types V and VI, 96.8% of participants reported that the sun affected their skin. Of 390 Black African participants in the study, 95.6% described themselves as photosensitive.
Factors beyond skin colour, such as a person's history of sun exposure, family history, and current medications, also play a role in determining skin cancer risk.
Despite the prevalent misconception that Black skin does not require sun protection, research indicates that UVA and UVB rays can still inflict significant damage, leading to premature ageing and an increased risk of skin cancer. While higher melanin levels in darker skin offer some natural defence, this protection is insufficient against prolonged sun exposure.
Historically, a lack of targeted education, inadequate health messaging, limited brand advertising, and suboptimal product formulations have perpetuated the belief that sunscreen is unnecessary for individuals with skin of colour. However, Black individuals often receive skin cancer diagnoses at more advanced stages, resulting in higher mortality rates.
To combat this issue, the Black Skin Directory (BSD) launched a campaign during Sun Awareness Week in 2019 to emphasise the importance of sunscreen for Black skin. This initiative addressed the underrepresentation of darker skin tones in sun care marketing, educated the community about skin cancer risks, and promoted proactive sun protection habits. The campaign featured the first sunscreen advertisement with a Black woman engaged in community outreach through on-street pop-ups and provided a comprehensive guide on sun protection for skin of colour.
Additionally, the Skin of Colour Training UK (SOCTUK) offers resources, including informative videos and fact sheets, to further educate both practitioners and the public on the necessity of sunscreen for darker skin tones. These combined efforts are crucial in dispelling harmful myths and fostering healthier skincare practices within the Black community.
Promoting inclusivity within aesthetic practices extends beyond treatment protocols. Inclusive marketing is vital in reflecting the diverse patient base served by aesthetic clinics.
Representation matters – using models of varying skin tones in promotional materials and showcasing real patient results can foster trust and accessibility.
Social media campaigns should highlight diversity and inclusivity, to make sure that patients with skin of colour feel seen and valued.
When writing about ethnicity, race or skin colour in any marketing or social media posts, make sure to educate yourself on the language to use.
The Law Society recently published an article on race and ethnicity terminology and language. It said:
“Language is continuously evolving. It's important to understand the meaning behind the terms we use to address people and to keep updated and willing to refresh our language so we use appropriate and respectful terms.
“It’s also imperative to remember that individuals will have their own particular preferences as to how they would describe themselves and how they would wish to be described. Identity is extremely personal. You should listen, educate yourself, learn, and politely ask about preferences if in doubt.”
The UK Government also has guidance on writing about ethnicity.
Your insurance will cover you for the treatments you provide, and it is your responsibility to make sure you are providing those treatments correctly and ethically to all patients, no matter what their skin type. If performing treatments like laser or IPL where there is an increased risk of burning in skin of colour patients, for example, make sure you have undergone adequate training and are using devices correctly and on the right settings to avoid burns.
Given the distinct approaches required, it's prudent to confirm that procedures, potential complications, and any necessary corrective actions are adequately covered. Engaging with your insurance providers to clarify coverage details can prevent unforeseen liabilities.
If you ever feel unsure about treating a patient or feel like treatment is out of your scope of practice, do not treat them. Be upfront about your limitations and offer them an alternative. For example, “I am afraid I am not able to help with this particular concern, but can I recommend XXX”. To take this a step further, you could facilitate an introduction for them. If patients feel seen and heard, they are less likely to make a complaint about you or give you a bad review, even if you are not able to treat them.
Do we have any statistics on laser burns claims specific to skin of colour or even generically?
Below are some key considerations for protecting yourself in the event of any claims.
There are resources out there that provide educational content, connect patients to practitioners experienced in treating skin of colour, and promote industry-wide knowledge sharing. Leveraging these resources can enhance a clinic's ability to cater to diverse patient needs.
One essential resource for practitioners is the annual Skin of Colour Training UK (SOCTUK) conference, held this year from January 22–24. This event, hosted by leading experts, offers invaluable insights into best practices for treating patients with skin of colour. Attendees can gain a deeper understanding of the nuances involved in managing skin conditions, selecting treatments, and addressing specific patient concerns.
Founded by skincare expert and aesthetician Dija Ayodele, The Black Skin Directory is a platform dedicated to bridging the gap in skincare services for people of colour. The directory connects individuals with qualified skincare professionals experienced in treating Black skin while also serving as a comprehensive knowledge hub offering educational articles on common skin conditions, effective treatments, and product recommendations. BSD also offers a BABTAC accredited course in Treating Skin of Colour.
This book, written by The Black Skin Directory founder Dija Ayodele, provides an in-depth exploration of Black skincare, combining practical advice with cultural and historical insights. The book addresses prevalent concerns such as hyperpigmentation and scarring, offers guidance on effective skincare routines, and debunks common myths – for instance, the misconception that darker skin tones do not require SPF protection. Ayodele also examines the beauty industry's relationship with Blackness and discusses the impact of systemic racism, advocating for a more equitable and inclusive approach to beauty. This comprehensive guide serves as an essential resource for Black women seeking to understand and care for their skin effectively, as well as being a useful resource for practitioners wanting to deepen their knowledge of Black skin.
Cosmopolitan’s Black Beauty Hub has been created to “spotlight, uplift, and celebrate Black beauty, culture, and self-expression”. This space is a culmination of all the work that the brand has done to create content that serves its Black British audience over the last decade.
To make sure you are meeting the diverse skin needs of patients in your aesthetic practice, you need to be committed to education and inclusivity. Attending events like the SOCTUK conference, utilising specialist resources, adopting inclusive marketing practices and being open and honest about your limitations can help position you as a trusted provider in this space. By prioritising patient safety and celebrating diversity, the aesthetic medicine community can make sure that all patients receive the care they deserve.
