Laser Treatment for Darker Skin: Best Practices and Tips
While laser treatments are useful for hair removal, acne scarring and pigmentary disorders, there are considerations for use in patients with richly pigmented skin (Fitzpatrick skin types IV–VI).
A recent interview with a Cutis board member, Andrew F. Alexis, MD, MPH, points out some of the concerns, and offers tips for communicating with patients. First, these patients are at a higher risk for pigmentary alterations, specifically hyperpigmentation or hypopigmentation that can occur post-procedure. Pigment alterations are in most cases self-limited but can last for weeks to months. Lasers are still appropriate to use to treat many dermatological concerns including laser hair removal for pseudofolliculitis barbae or nonablative fractional laser resurfacing for acne scarring and pigmentary disorders.
The author offers these specific recommendations: long-pulsed 1064-nm Nd:YAG laser for hair removal in Fitzpatrick skin types V to VI, 808-nm diode laser with linear scanning of hair removal in Fitzpatrick skin type IV or less, 1550-nm erbium-doped nonablative fractional laser for acne scarring in Fitzpatrick skin types IV to VI, and low-power diode 1927-nm fractional laser for melasma and post inflammatory hyperpigmentation in Fitzpatrick skin types IV to VI. Dr. Alexis notes that these are all performed with conservative treatment settings such as low fluences and longer pulse durations for laser hair removal and low treatment densities for fractional laser procedures.
In addition, he recommends prior to laser resurfacing that the patient uses hydroquinone cream 4% twice daily starting 2 weeks before the first session and for 4 weeks posttreatment. One final recommendation to share with patients is that tanned skin increases risk of hyperpigmentation. Therefore, it is important to emphasize the need for broad-spectrum sunscreen and avoidance of intense sun exposure before and after laser treatments.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: November 21, 2016
Adapted from the original article.
[Image: Dermnet New Zealand]