Know the skin's culture
“Regardless of the color of our skin or ethnicity, we all have the same number of melanocytes in our skin. Melanin is packaged in organelles called melanosomes. The size of the melanosome, how they are packaged (individually or in membranes) and where they are dispersed in the epidermis help determine our skin color, which greatly impacts laser-skin interactions,” Dr. Battle says.
Ethnicity and sun exposure affect how melanin is dispersed in the skin. Lighter skin or “melanin-deprived” patients have smaller melanosomes which are packaged together in membranes around the basal layer of the epidermis. Darker skin, or melanin-enhanced patients, have larger and more numerous melanosomes that are dispersed throughout the layers of the epidermis.
What truly needs to be evaluated, though, is what Dr. Battle calls the “skin’s culture,” which includes ethnicity, health history and sun exposure. Patients with skin of color often have a diverse mix of ethnicities, and how this mix may affect cosmetic treatments is not yet fully understood.
“In other words, white is not white and brown is not brown,” he says.
Melanocytes are more susceptible to cold- and heat-induced injury making it more difficult to safely treat patients of color.
“Epidermal melanin competes for most laser wavelengths, resulting in an increased risk of thermal-induced side effects, like pigmentary changes and scarring,” Dr. Battle says.
He opts to treat these patients more conservatively than the manufacturer’s recommendations. Because of the frequency of inconsistent results, he does not use vascular lasers, intense pulsed light (IPL) or resurfacing lasers on patients with skin of color. Increasing safety is a priority, so Dr. Battle strives to minimize epidermal pigment absorption, minimize epidermal heating, and minimize epidermal erythema, edema and irritation
“Every patient you treat is a unique individual with unique DNA, so you need to be cautious,” he says.