Cosmetic laser treatments for skin of color: a focus on safety and efficacy

Although laser technology has been improved greatly, not all procedures or treatment categories are safe for treating patients with skin of color (Fitzpatrick IV-VI skin types, and not all lasers within a "safe" treatment category are sufficiently so. Cosmetic laser procedure categories that can be consistently, safely and effectively performed on patients, regardless of skin color or ethnicity (assuming the clinician have the right lasers and level of expertise) are laser hair removal, complexion blending (evening out skin tone) and skin rejuvenation (skin texture and laxity enhancement).

Ethnic Skin and the Laser

Skin of color is not simply made up of monolithic Fitzpatrick skin types. Genetic ancestry appears to have a significant impact on skin structure and function and the epidemiology of cosmetically sensitive cutaneous pathology. For example, skin of African decent, as compared to skin of Caucasian descent, evidences increased melanin, different melanosome dispersion patterns, a thicker stratum corneum, larger and more active fibroblasts and increased vascular reactivity, elasticity, dermal thickness, oil gland production and transepidermal water loss (TEWL). There are also differences in skin, and subsequently facial structure and morphology among ethnicities in response to photoaging. (2)

Ethnicity also plays a role in cosmetically relevant disease patterns. (3), (4) For example, African-American patients are more likely than are Caucasian patients to develop keloids, dyspigmentaton and erythema evolving into post-inflammatory hyperpigmentation. East and Southeast Asian patients are commonly afflicted with epidermal and dermal pigmentary disorders, such as lentigines, melasma, Hori nevus, nevus of Ota and acquired dermal melanocytosis. (5) South Asians and Pacific Islanders are at greater risk for acne scarring and trauma-induced dyspigmentation.