The Use of Lasers in Darker Skin Types

Abstract

The demographics of the US population continue to change at an extremely rapid pace. As of 2008, Asians, Hispanics, and African Americans accounted for 31% of the US population, and it is estimated that by the year 2050 half of the population of America will be represented by darker ethnic skin types. With the increase in the total number of individuals of skin of color, the demand for safe and effective laser therapy in darker skin types continues to increase. However, despite the increase in demand, the current literature regarding the use of lasers in darker skin remains limited. Most of the treatment parameters defined for laser platforms have been established primarily through extensive testing on skin phototypes I to III, and those studies that have been conducted on darker skin phototypes have been overwhelmingly conducted on Asian skin. Nevertheless, it has become clear that effective cutaneous laser surgery in darker skin types can be accomplished despite a relative overall greater risk for complications. Therefore, as the diversity of America continues to grow, the laser surgeon needs to maintain a clear understanding of the complexities associated with treating ethnic skin and remain mindful of the current, and ever-changing, therapeutic modalities available. This will allow the conscientious physician to maximize outcome and minimize risk when performing laser surgery on darker skin types.

Treatment of Nevus of Ota in Fitzpatrick skin type VI with the 1064‐nm QS Nd:YAG laser

“…With less epidermal disruption than other lasers, the 1,064‐nm QS Nd:YAG is often safer to use on darker skinned patients. Nevertheless, the increased amount of epidermal melanin in darker skinned patients may lead to nonspecific thermal damage following laser therapy 7. This may cause adverse side effects such as blisters, crusting, transient or permanent hyper‐ or hypo‐pigmentation, textural changes, and scarring 1.…”

“…On histological examination, elongated dendritic dermal melanocytes are seen in the upper dermis 1. Newer treatments with the Q‐switched (QS) lasers 2–7, include the QS ruby (QSRL), 1,064‐nm QS neodymium‐doped yttrium aluminium garnet (QS Nd:YAG), and QS alexandrite (QSAL). QS lasers are often used for the treatment of pigmented lesions since they create short pulses of energy, which match the thermal relaxation time of the small particles of melanin, minimizing damage to the surrounding skin.…”

Patient knowledge and attitudes on laser hair removal: a survey in people of color

“…LHR is now well established as a form of treatment for patients with unwanted hair 4 . It is widely accepted that the long‐pulsed diode (810 nm) and long‐pulsed Nd:Yag (1064 nm) are safe for hair removal in patients with dark skin 1 …”

“…It is widely accepted that not only light‐complexioned skin individuals are safely treated by LHR but dark‐skinned individuals are safely treated as well. The long‐pulsed diode (810 nm) and long‐pulsed Nd:Yag (1064 nm) are approved for hair removal in patients with dark skin 1 . However, some dark‐skinned patients are still concerned about the side effects, are simply not aware that this treatment can be performed on dark skin, or have been told by an uninformed medical provider that hair removal laser is not possible in darkly pigmented skin.…”

Efficacy and Safety of Combination Treatment for Oculodermal Melanocytosis

“…However, we resected less tissue than conventional treatments typically do, and the Q-switched lasers produce photomechanical effects that selectively target pigmented tissues. 17 Therefore, we speculate that there were no significant changes in scleral rigidity. Our previous study reported that the structure of collagen fibers is only damaged after high-energy fluence laser treatment (4 J/cm 2 ), and this damage was confined to the outer third of the sclera.…”