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More education needed in laser treatment of skin of color


National report ? As the American population becomes more diverse and includes a higher percentage of people of color, cosmetic physicians will have to adjust their approaches to various treatments, but perhaps, most obviously, those treatments using lasers.

That is the central message presented by Eliot F. Battle Jr., M.D., assistant clinical professor at the department of dermatology, Howard University, Washington.

"More than 40 percent of the world's population is non-white, and by the year 2010, 35 percent of the U.S. population will be comprised of non-whites with darker skin types," Dr. Battle says. "There already is a large untapped patient population out there made up of people of color, and it's only going to get larger."


Dr. Battle says that non-Caucasian patients are increasingly coming to dermatologists wanting help with two problems seen more frequently in darker skin types: hypertrichosis and hirsutism and pseudofolliculitis barbae.

"Skin rejuvenation laser treatments, which include lasers that are used for complexion blending, collagen enhancement and improved skin laxity are also becoming popular among people of color," Dr. Battle says.

To treat these disorders and to better serve the growing non-Caucasian patient population, Dr. Battle says physicians and patients alike need to be better educated about the safe and effective use of lasers for people of color.

"Lasers are an excellent option for treating many conditions in people of color, such as pseudofolliculitis barbae," he says.

"In people of color, conventional methods for removing unwanted hair, such as plucking, waxing, shaving and electrolysis can create dark spots or scarring. With laser-assisted hair removal, people of color frequently experience dramatic improvement in skin texture and tone - with less discoloration - once the hair is removed."


But, he adds, many patients with darker skin have been harmed by users who either don't have the proper training or experience, or who weren't aware of the special approaches needed when treating darker skin with lasers.

For example, there appears to be a higher incidence of side effects with laser hair-removal therapy on darker ethnic skin.

"The epidermal melanin competes for the same light that's targeted for the hair," Dr. Battle says, "and the melanin is absorbed across most of the photobiological spectrum."

Dr. Battle suggests that for hair removal on darker skin types practitioners need to use either an 810 nanometer diode laser with very long pulse duration (100-400 ms) or a long-pulsed Nd:Yag (1064 nm). Regardless of the laser used, he says, skin cooling should be very aggressive. He suggests that before treatment the doctor should instruct the patient not to pluck or wax, that the treatment area should be shaved and free of make-up, that non-pigmented cooled gel should be applied and that adjunct cooling might be a possibility to consider.

"And as a rule of thumb, you should not treat around the bony eye socket, including inferior eyebrows, and you should always angle the laser pulse away from the eye." Dr. Battle says. "Also, don't 'stack' pulses and don't treat over suspicious-looking moles.

"Finally, it's important to monitor treatment speed - the faster you treat, remember, the less you cool, and it's essential to maximize cooling."

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