Laser Therapy Trials Lack Skin of Color Representation

Patients with darker skin tones, including phototypes 5 and 6, are often missing from trials studying light and laser therapies in dermatology, according to a recent study¹.

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“By 2044, more than 50% of the US population will have skin of color, denoted as skin phototypes 4–6,” study authors wrote. “Given these changes, there is significant concern across the medical field that clinical trials are not representative of this racial and ethnic diversity.”

Researchers said that despite laser and light therapies commonly being used in dermatology for skin conditions that often disproportionately impact patients with skin of color, there is a lack of information and evidence sufficient enough to support the use of these therapies in that patient demographic.

In order to improve patient outcomes and physician understanding, researchers sought to analyze the representation of skin phototypes 4 through 6 in dermatologic trials involving laser or light treatments through a systematic review.

Using sources such as PubMed and Web of Science, researchers collected and identified data from randomized, controlled trials involving the use of laser and light treatments in cosmetic dermatology. All trials were sourced from January 1, 2010, to October 14, 2021.

Researchers used search terms such as “lasers,” “erbium laser,” “pulsed dye laser,” and “intense pulsed light” to develop a comprehensive accumulation of controlled and clinical trials. The exhaustive list of search terminology included more than 40 relevant and similar light and laser terms.

All articles included in the study (n=461) were published in English, centered around human data, involved light or laser treatments, involved the treatment of cosmetic dermatologic conditions, and were randomized controlled trials.

Researchers collected data from each article, including:

• Journal of publication
• Condition of study
• Laser or light treatment(s) studied
• Funding type
• Location of study
• Total number of participants
• Reporting of participant gender
• Reporting of participant racial/ethnic composition
• Reporting of skin phototype

In total, the trials included in the review amassed 14,763 participants. The most common dermatologic conditions involved in the trials were scarring, melasma, and port-wine stains. The most commonly-used devices included the CO2 laser, Nd:YAG laser, pulsed dye laser, intense pulsed light, diode laser, or multiple lasers.

Of this data, 81.7% involved skin phototypes 4 through 6, and 27.5% involved skin phototypes 5 through 6.

“Although it is important for darker skin types to be represented in trials studying skin of color conditions, it is equally important for darker skin types to be represented in trials studying conditions without skin type predispositions,” study authors wrote. “It is important that all journals consider the skin of color composition of dermatology trial participants to ensure published datasets that are representative of the dermatology patient population.”

Study limitations included lack of reporting participant skin phototypes, race, or ethnicity; and a lack of trial reporting on skin tone of participants.

“Trials studying lasers and lights for the treatment of cosmetic dermatologic conditions need improved representation of skin phototypes 5 and 6,” study authors wrote. “Limited data on the skin type of trial participants affects dermatologists' ability to recommend treatments for cosmetic conditions.”

Reference

1. Manjaly P, Xia E, Allan A, et al. Skin phototype of participants in laser and light treatments of cosmetic dermatologic conditions: A systematic review. Jour of Cosm Dermatol. 2023. doi:10.1111/jocd.15739