If a Caucasian patient comes to my practice they will be looking for treatment for sun damage, wrinkles and capillaries, whereas, if it is a person of color, they will be looking for treatment for dark spots — dark spots from hair, dark spots from melasma, dark spots from scars, says Eliot F. Battle, Jr., M.D., CEO and Co-Founder, Cultura Dermatology and Laser Center, Washington, D.C.
Not only do people of color have different cosmetic needs than Caucasian patients, they require different treatments than Caucasian patients seeking treatment for the same condition, he said during a presentation at the Skin of Color Seminar Series held last month in New York City.
In a session entitled “Updates on New Technologies for Treating Aesthetic Concerns in Skin of Color,” Dr. Battle outlined how best to treat skin of color cosmetic concerns.
Unfortunately, despite massive advances in laser technology, physicians are seeing more side effects than ever before on patients of skin of color. They are being treated by practitioners who have limited experience with lasers or skin of color.
“There is still a great need for education to help our practitioners understand the nuances of skin of color and the nuances of which laser procedures are appropriate,” Dr. Battle says.
The Cultura Dermatology & Laser Center, for example, has more than 40 lasers, some of which are used for patients of all skin colors, but usually one laser will be used to treat a particular condition in skin of color, and another type will be used for Caucasian skin. Lasers can be used on all skin colors for hair removal, skin tightening, body contouring, texture improvement and to treat pigmented lesions from acne, traumatic and surgical scars or melasma which are dark symmetrical patches on the face.
“What we are not good at, and what I don’t recommend practitioners doing, is treating vascular lesions on skin of color,” Dr. Battle says. “We are also not good at any invasive resurfacing where you take away the top layer of the skin and hope it will heal back better, and intense pulse light(IPL) treatment is not safe on skin of color, outside of very light Skin Type IV patients.”
Whenever a laser is used in skin of color it is important to minimize redness, inflammation and erythema, because in skin of color any form of irritation can transform into hyper pigmentation and dark spots, he emphasises. “Skin of color is more sensitive and reactive towards irritation. So in Caucasians, irritation and erythema from laser treatment usually resolves. In skin of color, we have a much higher incidence to turn irritation, inflammation and redness into dark spots. As a result, we are more conservative and adopt common sense parameters rather than those recommended by the manufacturer. We need to try and stay under the erythema and inflammation threshold,” he said.
HAIR REMOVAL LASERS
For hair removal, there are only two wavelengths that are FDA-approved for skin of color ― the diode and NdYAG. Diode lasers have evolved to treat skin of color more safely, whether from using suction, longer wavelengths (diodes now go up to 1060 nm), larger cooling plates that are often coupled with laser scanning or in-motion diodes which heat the dermis gradually through faster motion to offer greater protection of the epidermis. “Regardless of the advances in the diode wavelength, the NdYAG is by far the safest wave length. The diode lasers are definitely improving but they certainly do not touch the NdYAG lasers as being the gold standard in treating patients with skin of color, particularly Skin Type VI patients,” Dr. Battle said.
"Updates on New Technologies for Treating Aesthetic Concerns in Skin of Color,” Eliot Battle, M.D., Skin of Color Seminar Series. May 5-6, 2018, New York City