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LASER AND LIGHT-BASED TREATMENTS IN SKIN OF COLOR

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SUMMARY

  • In treating patients with skin of color, an understanding of the clinical implications of variations in skin structure and function as well as an appreciation of different cultural perceptions of beauty are pivotal in reaching a successful clinical outcome.

  • Special consideration must be given to the appropriate use of laser parameters, including skin cooling and longer laser pulse width to protect the epidermis, longer laser/light source wavelength to reduce absorption by competing epidermal melanin, and higher fluences to achieve the desired clinical endpoint.

  • PDL with dynamic cooling is effective in the treatment of PWS in patients with skin of color. The long-pulsed Alexandrite and 1,064-nm Nd:YAG laser can be used for the treatment of resistant PWS. Proliferative hemangiomas can be treated with low-fluence, long-pulsed PDL.

image Beginner Pearls

  • Light-colored complexion with an even skin tone is widely considered to be beautiful in Asian societies, and for this reason pigmentary disorders are a common indication for laser therapy.

  • Preoperative measures to minimize PIH include sun avoidance for 2 weeks before and 4 weeks after laser treatment and avoidance of photosensitizing agents such as tetracyclines or oral contraceptives.

image Expert Pearls

  • LPDL with compression has been demonstrated to be an effective and safe modality to treat facial lentigines in Asian patients.

  • The lack of photomechanical effects compared with QS lasers gives IPL an advantage in the treatment of lentigines and freckles in Asian patients.

image Don’t Forget!

  • Factors that increase the risk of PIH include Fitzpatrick skin types IV to VI, recent sun exposure, and degree of inflammation at the dermal–epidermal junction.

  • For the QS laser, it is best to use the smallest spot size to avoid injury to the surrounding normal skin and the lowest fluence to achieve immediate whitening.

image Pitfalls and Cautions

  • The laser removal of melanocytic nevi is controversial, as there is a small but theoretical risk of delaying diagnosis of melanoma, and the risks of inducing neoplastic changes with sublethal laser damage are unclear.

  • Thus melanocytic lesions in patients with types IV to VI skin can be safely treated with laser therapy, provided that the lesion is not located in the acral area, the patient has no personal or family history of melanoma, and that the patient has been evaluated by a dermatologist.

image Patient Education Points

  • Sun protection is very important; the use of physical sunscreens with active ingredients such as titanium dioxide, zinc oxide, and iron oxide may be preferable to chemical sunscreens due to the lower risk of irritation.

  • In general, there is a tradeoff between rapidity of action and low number of treatments and an increased risk of PIH and postoperative downtime. Thus treatment should be tailored to each patient’s individual lifestyle and preferences.

image Billing Pearls

  • Almost all insurers in the United States exclude laser- and light-based treatments from ...

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