The use of lasers in persons with skin of color requires an understanding of laser physics and laser tissue interactions. Epidermal melanin in skin of color acts as a competing chromophore; this not only decreases the effect of laser treatment, but is also likely to cause nonselective thermal injury to the epidermis.
With the proper selection of device, wavelength, and parameters, cutaneous dermatologic lasers can be used safely on individuals with skin of color. To minimize unwanted side effects, the use of aggressive parameters is discouraged.
With the ideal candidate and the proper clinical setting, intense pulsed light (IPL) often treats numerous dermatologic conditions. However, IPL must be used with caution in patients with skin phototypes IV and is not the desired treatment for those with phototypes V or VI.
Fractional lasers show promise in the treatment of melasma, acne scarring, and skin rejuvenation in patients with darker phototypes.
Test spots are highly encouraged when treating people with darker skin phototypes.
Skin cooling and postoperative skin care are highly recommended for patients with skin of color.
The demographics of the United States is changing, as racial minority populations are steadily growing. From 2000 to 2010, the African American population increased by 12%, and the Hispanic and Asian populations both increased by 43%.1 As a result, dermatologists must embrace this growth by increasing their understanding of skin of color so as to deliver quality dermatologic care to patients of all skin phototypes.
In the subspecialty of dermatologic lasers, there are several factors to consider in order to optimize patient treatment. The choice of laser, appropriate parameters, an understanding of skin optics and tissue response, and the early treatment of untoward events are key to successfully treating patients with skin of color.
LASER–TISSUE INTERACTION FOR SKIN OF COLOR
A laser (light amplification by the stimulated emission of radiation) is made up of a pumping system, the lasing medium, and the optical cavity. The light that is emitted from the laser beam is monochromatic, coherent, collimated, and of high energy. Once the laser light reaches the skin, it can be reflected, scattered, transmitted, or absorbed. Laser light is absorbed by chromophores, which are ‘light-loving’ substances within the skin. There are three main endogenous chromophores in the skin: melanin, hemoglobin (oxyhemoglobin), and water [Figure 81-1]. Each chromophore has a specific peak absorption wavelength in the electromagnetic spectrum. Tattoo ink is considered an exogenous chromophore. Once absorbed, laser energy is transferred to other kinds of energy, for example heat, which may have various effects.
The absorption spectrum of hemoglobin and melanin with commonly used lasers. FD, frequency-doubled; LPDL, long-pulsed dye laser; Nd:YAG, neodymium-doped yttrium-aluminum-garnet.
Laser light can be delivered onto the skin in either a continuous, quasi-continuous, or pulsed ...