SummaryEthnic skin or 'skin of colour', which is characterized by increased epidermal melanin, labile melanocytes and reactive fibroblast responses, poses special challenges for the use of laser and light-based therapies. These therapies are associated with a greater risk of dyspigmentation and scarring in ethnic skin and therefore require careful selection of device and treatment parameters to minimize complications. Whereas early-generation lasers for hair removal and resurfacing were generally contraindicated for individuals with Fitzpatrick skin phototypes (SPT) IV-VI, advances in the past decade have given rise to a range of devices that can be safely used in ethnic skin. Longer wavelength lasers such as the 810 and 1064 nm Nd:YAG; intense pulsed light and monochromatic excimer light (308 nm); fractional lasers; and radiofrequency devices have all been used safely for hair removal, pigmentary abnormalities, resurfacing and skin tightening in ethnic skin, respectively. Notwithstanding these advances, nuances in the laser or light treatment of darker skin types remain and must be considered to ensure safe therapeutic outcomes. The vast majority of published data pertaining to lasers and light treatments in nonwhite skin involve patients of East Asian ethnicity (e.g. Korean, Japanese, Chinese, Thai). By contrast, there is a paucity of studies involving individuals of African ancestry or those with SPT V or VI. This article will review laser and light-based modalities that are considered safe and effective for individuals with richly pigmented skin.
What's already known about this topic?• Published data or recommendations on the safe and effective use of lasers in Fitzpatrick skin phototypes (SPT) V and VI are limited.
What does this study add?• This review addresses knowledge and practice gaps by summarizing available data on the use of lasers in patients with SPT V and VI, a subset of the population in which the risk of iatrogenic pigmentary and scarring complications is highest.• This provides clinicians with practical knowledge of which devices have been studied in SPT V and VI and offers treatment recommendations to improve outcomes.Traditionally, the literature on cosmetic procedures, especially laser and light-based therapies, has focused on the treatment of individuals of European ancestry with Fitzpatrick skin phototypes (SPT) I-III. Safety limitations of first-generation technologies as well as socioeconomic, demographic and cultural factors may contribute to the relative lack of studies involving the various racial/ethnic groups with constitutively darker skin. Shifts in the aforementioned contributing factors have led to considerable increases in the performance of cosmetic procedures in nonwhite racial/ethnic groups. According