When people hear that I go to the East to advise on skin-care, they usually say: "but the Japanese have such perfect skins". They don’t need any special creams and treatments. They look much younger than their age compared to westerners, and especially compared to the sun worshippers in Australia, New Zealand, South Africa and the USA. They don’t get wrinkles as easily as we do and if you look at fashion photos then it is easy to believe that their skins are flawless.

When I am in Japan I catch the public transport every day and so I see thousands of Japanese every time I visit. Two important features strike one’s eyes very quickly: many Japanese have awfully ugly dark brown splodges on their faces that they call "shimi." The other important difference is that many Japanese have pink or scaly patches on the faces and body. They have atopy of their skin and while this may seem to be a medical condition, the skin care therapist can do a great deal to help. I’ll leave that problem for another time.

I believe that an important reason why the Japanese do not tend to wrinkle like Caucasians is that first of all they have a slightly denser degree of melanin than westerners – but that is not the full explanation. Some Japanese are very pale but have a yellowish tint to their skin that is due to having more beta-carotene in their skin. The Japanese diet consists of much more vegetables than the average Caucasian diet, but that is not the reason for their skin colour. They must have some inherent tendency to extract beta-carotene from the blood stream and deposit it in the skin.

Beta-carotene is an extremely powerful antioxidant that can scavenge free radicals very effectively. Their diet is also very rich in vitamin C, vitamin E, and polyphenols that are powerful antioxidants. They drink green tea that adds more protection. This rich antioxidant brigade shields collagen and elastin. That, I believe, is why their skin tends not to wrinkle as much as Caucasian skin.

However, nothing gives complete protection and some soft UV-A rays (and maybe even violet and blue rays) penetrate the skin and do damage to the melanocytes that are just at the junction of the dermis and the epidermis. Probably the antioxidant brigade is not as rich there as in the dermis because the constant exposure to light means that the surface layers of the skin are attacked more by free radicals. The melanocytes are induced to make more melanin.

I believe that the Japanese carry a significant degree of phaeomelanin in their skin. Amongst Caucasians we know that very black hair is often associated with the gene for red hair and that means that these people make phaeomelanin, which is not the same as eumelanin. Eumelanin protects us from the sun whereas phaeomelanin is a photosensitiser that actually aggravates the effects of free radicals. Because the Japanese have very black hair that often betrays a reddish tint, they may well carry the genes for phaeomelanin as well as eumelanin. Phaeomelanin may well be a reason why the Japanese and Chinese tend to make awfully ugly brown marks on their faces. The marks tend to be in the areas that are most sun-exposed.

The Japanese do not have a culture of wearing hats, though they do use umbrellas which are pretty translucent to light. In winter they fail to recognise that their skins are still prone to UV-A damage and, of course, UV-A is the group of rays that is responsible for pigmentation problems. Although they take less holidays than Europeans do, they do get the opportunity to travel to special destinations like Hawaii where the younger Japanese like to develop a dark tan. As a result of this, I have noticed that more and more young Japanese people develop large pigmented marks.

The damage that we see on people’s skin actually starts many years before we notice the marks. It may be that the person was badly burned at some stage and DNA (deoxyribonucleic acid) in a single melanocyte was damaged. If by chance the DNA controlling the production of melanin is affected then the melanocyte just makes an excessive amount of melanin. The cell has in fact lost control of melanin formation. Over time this single cell multiplies and gradually grows into a visible patch of cells that are making more melanin than the surrounding skin. Each melanocyte deposits its melanin into about 30 to 36 other cells so the pigmented area can be much larger than the actual number of malfunctioning cells.

The treatment of melasma in Oriental skin is difficult. What surprises me is that so many reputable skin care therapists immediately think of peeling or hydroquinone. Neither of these two treatments is safe, and nor are they physiological. We have to be extremely cautious when treating Oriental skin because these individuals tend to have a very sensitive skin and pigmentation changes can be very obvious. Most people recommend using hydroquinone, which they may mix with hydrocortisone and retinoic acid (vitamin A acid).

Hydroquinone is, no doubt, one of the most effective depigmenting agents that we have – when it works well - but it is a cytotoxic and inhibits tyrosine but can kill the melanocyte. It is a cellular toxin and if it does not kill the cell, then it permanently affects the production of melanin. These cells become rogue melanocytes that respond to tiny amounts of light and make more melanin than usual. These rogue cells are also more resistant to treatment with other chemicals after they have been damaged by exposure to hydroquinone.

Prolonged use of hydroquinone may eventually lead to a condition called ochronosis. Ochronosis is a disease caused by an abnormality of tyrosine metabolism and since hydroquinone affects tyrosine, this is not altogether surprising that a topical agent can cause a systemic disease. I believe hydroquinone is a malicious chemical that should not be used on skin. Many people use hydroquinone in conjunction with peeling and I believe that the success of peeling is largely due to the hydroquinone.

If a deep peel is done then the skin colour in Orientals may become blotchy and uneven. Another fact is that many melanocytes are in the deeper dermis so peeling cannot kill them. I have seen Oriental patients who have been peeled for pigment marks and while the initial result is good, later on the mark is darker and larger than before the treatment. I believe that peeling acts on the dark melanin which is changed to a lighter colour and that makes for immediate success. Peeling may destroy superficial melanocytes because they are immediately below the epidermis. However, some melanocytes may lie deeper than the acid can penetrate and after a short while they will find other cells to attach to and transfer pigment so eventually the mark will return.

In the meantime, the skin is more sensitive to UV rays and if the person has not protected themselves thoroughly from UV rays, then the rays will penetrate deeply into the skin and damage and stimulate the melanocyte even more than normally, so eventually the number of affected melanocytes is even greater than before and the mark becomes larger. So in summary, heavy peeling is not a good way to treat Oriental skin.

Hydroquinone is also dangerous to use on their skin because of the complications. Many years ago a large Japanese cosmetic company introduced a skin lightening range and after a short while they had to remove the product from the market. So many Japanese women had used the product and experienced the pleasure of the initial lightening and then the dreadful darkening of the skin when the product was stopped. As a result, the Japanese government passed a law that forbids the use of hydroquinone in cosmetics in Japan. Take my advice and do not treat any of your Oriental clients with heavy peeling or with hydroquinone.

When you have an Oriental client then remember that their skin is fragile and betrays all mistakes. They need to be treated with a physiologically based treatment that protects their skin at the same time as treating it. This invariably will mean that the treatment will take longer to manifest results, but the client should be informed that the treatment will take time and be made aware that safe treatment is the best for them.