Important laser therapy considerations in skin of color

The demand for dermatological treatments for those with skin of color is increasing simply because this patient demographic is growing rapidly. It’s essential for cosmetic dermatologists to know the nuances and differences presented by treating this group of patients. Skin of color has important biological, structural, and functional differences when compared to lightly pigmented skin. Therefore, it requires special considerations when it comes to laser treatments.

What’s Different About Skin of Color?

Increased epidermal melanin content offers protection against UV radiation, but also adds risk for hypopigmentation/hyperpigmentation—resulting in a tendency toward injury and inflammation from procedures. Singly dispersed larger melanosomes are widely distributed within epidermal keratinocytes. Skin of color increases the prevalence of pigmentary disorders resulting from labile melanocyte responses. Darker skin also has higher prevalence of keloids, which with increased fibroblast reactivity could lead to hypertrophic scarring.

These patients are more prone to conditions like melasma, café au lait marks, Hori’s nevus (also known as acquired bilateral nevus of Ota-like macules), lentigines, and post-inflammatory hyperpigmentation.

Laser Treatment Considerations

When treating patients with skin of color, several considerations should be weighed to provide laser treatments that accurately target the chromophore, a molecular area that provides pigment/coloration, and not the surrounding melanin found in deeper skin tones. These include:

• A wavelength specific to and well absorbed by the chromophore being treated, good skin penetration, and preferential absorption of melanin
• A laser that doesn’t overheat surrounding tissues
• A laser with highly customizable treatment parameters like adjustable power, spot size and fluence, and no compromise of spot size for fluence
• Ideally, a laser treatment that requires a small number of treatment sessions, relative to other laser treatment options, with minimal treatment time and low fluence

Why the PicoWay System Works

Picosecond lasers have revolutionized dermatological treatments, providing ideal characteristics and parameters required for treating patients of all Fitzpatrick skin types, including patients with skin of color.

Nanosecond pulse durations found in Q-switched lasers are measured in billionths of a second, the picosecond technology of the PicoWay laser system uses pulses measured in trillionths of a second. This is more efficient in breaking down melanin in benign pigmented lesions and particles of tattoo ink, so the body can easily rid itself of the debris as part of its natural biological elimination processes.

Picosecond lasers can be used in a broader range of skin types than nanosecond lasers due to reduced risk of hyperpigmentation or hypopigmentation and scarring with picosecond photoacoustic versus photothermal effect.

Proven Effective By the Experts

In 2018, a panel of 15 physicians discussed their experiences treating multiple conditions in patients with skin of color using the PicoWay laser system. The panel agreed that providing the best laser treatment for patients requires a balance of factors. These considerations include patient skin type and condition, and laser treatment factors such as fluence, diameter, pulse durations, treatment density, and output power. 

The group also determined general recommendations for treating benign pigmented lesions in patients with skin of color using the PicoWay laser system.

• Use the 1064nm wavelength with the Zoom handpiece for most patients, treating one to two times to address skin conditions such as CALMs and PIH. 
• In some patients, a 532nm or 785nm wavelength or handpiece may be more appropriate.
• A skin care regimen consisting of sunscreen and/or isotretinoin and/or azelaic acid and/or hydroquinone, in the appropriate clinical context, is recommended post treatment.
• Appropriate cooling techniques with either lower repetition rate or pausing between passes reduces heating, making patients more comfortable. A skin cooling system can also be used to prevent overheating during treatment.

Treating skin of color requires different considerations and approaches. Picosecond lasers make treating these patients easier and more effective. Find out more about the PicoWay laser system and learn from a sampling of case studies in Treatment Guidelines for the PicoWay Laser System in Skin of Color