Laser Therapy in Black Skin

Complications of dermatologic lasers in high Fitzpatrick phototypes and management: an updated narrative review

This article explores the intricacies of laser surgery, acknowledging inherent risks and complications. Patients with higher Fitzpatrick phototypes, characterized by unique biological traits, face heightened vulnerability during laser treatments. Limited experience with darker skin tones necessitates a higher level of laser expertise and a conservative approach. The study aims to comprehensively review laser therapy's side effects and complications, with a specific focus on Fitzpatrick phototypes IV through VI. We searched the MEDLINE database from 1972 to 2023 to consolidate knowledge. Results illuminate nuanced challenges associated with laser surgery in higher phototypes. In conclusion, this research emphasizes the need for enhanced expertise and caution in laser procedures for individuals with darker skin, offering valuable insights to optimize patient safety and outcomes.

An update on cosmetic procedures in people of color. Part 2: Neuromodulators, soft tissue augmentation, chemexfoliating agents, and laser hair reduction

Recent years have brought forth the undeniable practice gap in dermatology concerning knowledge and experience of cosmetic procedures in people of color (POC). A paucity in the literature regarding evidence-based recommendations for the management of POC undergoing cosmetic procedures and the rise of cosmetic procedures in dermatology serves as a call to action to provide education regarding differences in skin of color that may impact the cosmetic outcomes. To mitigate the current practice gap on the safety, use, and benefits of cosmetic procedures in POC, part 2 will discuss the authors' recommendations and clinical pearls, as well as evidence-based management for neuromodulators, soft tissue augmentation, chemexfoliating agents, and laser hair reduction in POC undergoing cosmetic procedures.

Laser Resurfacing for the Management of Periorbital Scarring

Laser (light amplification by the stimulated emission of radiation) skin resurfacing is currently one of the most widely adopted technologies in facial rejuvenation. While most often used for aesthetic purposes, lasers also have applications in the management of scars. Since the introduction of the CO₂ laser for skin rejuvenation in the 1990s, the last three decades have seen significant growth in the number of laser devices available to the physician. More recently, promising alternatives to light-based resurfacing technologies have emerged that include radiofrequency and intense focused ultrasound. To help the physician navigate the most current laser technologies as they apply to periocular scars, this review discusses the available treatment modalities, pre-treatment assessment of periorbital scars, treatment selection, and reported outcomes and complications. The recommendations described herein are based on published literature and the authors' experience in an academic oculoplastics practice.

Randomized, single-blinded, crossover study of a novel wound dressing vs current clinical practice after percutaneous collagen induction therapy

INTRODUCTION

Skin rejuvenation procedures have become common with sophisticated technologies with reduced downtime and related risks. Recently, microneedling has been paired with radiofrequency to create Fractional Radiofrequency Microneedling (FRFM) to induce neocollagenesis. Frequently, topical products are applied immediately after the needling. This procedure is known as percutaneous collagen induction therapy (PCIT). Postoperative topical wound care is critical for prompt rapid and safe healing, with moist wound healing deemed of primary importance for fast and correct scarring process. An ideal dressing enables a moist environment while reducing postprocedural inflammatory responses in the first stages of wound healing.

OBJECTIVE

To evaluate whether an innovative silicone-based wound dressing is superior than standard of care therapy in decreasing severity and duration of treatment-site acute inflammatory reactions post PCIT.

MATERIALS AND METHODS

Endymed PRO Intensif Handpiece (Endymed, Israel) was used for the full-face FRFM procedure. Subjects (n = 20) applied treatment (Stratacel^® -Stratpharma SG, Switzerland) and control (Aquaphor^® -Beiersdorf Inc, USA) immediately after the procedure and daily; they were evaluated immediately postprocedure (baseline assessment), at 2, 3 and 7 days postprocedure. Digital and 3D pictures (Antera 3D Camera for Skin Analysis-Miravex, Ireland) were taken at each assessment.

RESULTS

All patients healed properly without reporting adverse reactions to any of the studied products. Erythema at each study visit was significantly reduced with the use of the novel wound dressing (P < 0.001). A statistically significant difference in favor of the innovative wound dressing also emerged with respect to the patient-rated product properties (P = 0.008), such as feel on skin, drying time and stickiness.

CONCLUSIONS

The novel wound dressing reduced signs of acute inflammation following PCIT when compared to standard of care, without reporting adverse events and resulting in a more favorable outcome from a patient perspective.

Considerations When Treating Cosmetic Concerns in Men of Color

BACKGROUND

Men of color include a diverse population encompassing individuals with Fitzpatrick skin Types IV through VI. Yet, there is a paucity of data describing the cosmetic concerns of this population.

OBJECTIVE

To review the basic science of advantages and disadvantages of skin of color and pathophysiology, incidence, and treatment of disorders of cosmetic concern in men of color.

METHODS

A MEDLINE search was performed for publications on sex and racial differences in basic science of skin, common disorders in men of color, and evidence-based treatments.

RESULTS

There are intrinsic differences in skin and hair of darker-complexioned men, particularly in Hispanics, African Americans, Asians, and Afro-Caribbeans. Advantages of darker skin include increased photoprotection, slowed aging, and a lower incidence of skin cancer. However, the increased content of melanin is associated with myriad dyschromias including melasma and postinflammatory hyperpigmentation (PIH). Additional common skin conditions of concern in men of color include pseudofolliculitis barbae, acne keloidalis nuchae, and keloids.

CONCLUSION

A skin color conscious approach should be administered in caring for the cosmetic concerns of men of color that is cognizant of differences in biology of the skin and hair, associated PIH of disorders, and cultural/social practices among this population.

Laser skin treatment in non-Caucasian patients

The demand for facial rejuvenation and cosmetic procedures is rising among all ethnicities and skin types. The authors present a review of lasers and how to select a laser based on skin type and the treatment goals of laser resurfacing: skin laxity, dyschromia, hair removal, keloid, and hypertrophic scarring. In addition, they discuss preprocedural and postprocedural considerations, potential complications, and their management to maximize patient outcomes and minimize risk.

Lasers and light-based therapies in ethnic skin: treatment options and recommendations for Fitzpatrick skin types V and VI

Ethnic skin or 'skin of colour', which is characterized by increased epidermal melanin, labile melanocytes and reactive fibroblast responses, poses special challenges for the use of laser and light-based therapies. These therapies are associated with a greater risk of dyspigmentation and scarring in ethnic skin and therefore require careful selection of device and treatment parameters to minimize complications. Whereas early-generation lasers for hair removal and resurfacing were generally contraindicated for individuals with Fitzpatrick skin phototypes (SPT) IV-VI, advances in the past decade have given rise to a range of devices that can be safely used in ethnic skin. Longer wavelength lasers such as the 810 and 1064 nm Nd:YAG; intense pulsed light and monochromatic excimer light (308 nm); fractional lasers; and radiofrequency devices have all been used safely for hair removal, pigmentary abnormalities, resurfacing and skin tightening in ethnic skin, respectively. Notwithstanding these advances, nuances in the laser or light treatment of darker skin types remain and must be considered to ensure safe therapeutic outcomes. The vast majority of published data pertaining to lasers and light treatments in nonwhite skin involve patients of East Asian ethnicity (e.g. Korean, Japanese, Chinese, Thai). By contrast, there is a paucity of studies involving individuals of African ancestry or those with SPT V or VI. This article will review laser and light-based modalities that are considered safe and effective for individuals with richly pigmented skin.