Care needed in laser Tx of pigment disorders in dark skin
Depth of lesions and whether the hyperpigmentation is melanotic or melanocytotic should inform treatment (1,300 words, 6 minutes)
Because of skin differences, being too aggressive while treating darker-skinned patients with lasers can result in burns or other damage, Dr. Jaggi Rao said during a presentation at the 8th annual Skin Spectrum Summit on September 17, 2022. He said that when treating hyperpigmentation, more commonly seen in darker-skinned patients; the essential guidelines are to prevent further pigment gain and promote existing pigment loss.
Dr. Rao is a clinical professor in the Faculty of Medicine and Dentistry at the University of Alberta in Edmonton and the founder and team lead of ConsultDerm, a national teledermatology project.
In his talk, Dr. Rao noted that the darker a patient’s skin, the more cautious a physician must be in how aggressively they approach treatment, including laser therapy.
He said that one factor to consider with laser treatment of pigment disorders is lesion depth. Hyperpigmentation can be divided into superficial (epidermal) vs. deep (dermal). When treating superficial hyperpigmentation such as lentiginous freckles or ephelides, dermatosis papulosa nigra, or shallow melasma most laser treatments should be considered safe if they are not too aggressive. With care, there should be no bleeding, decreased pain, quick recovery, and a lower risk of rebound hyperpigmentation, he said.
As an example of deep hyperpigmentation, Dr. Rao described a case of nevus of Ota with possible post-inflammatory hyperpigmentation in the dermis. In this case, laser therapy required caution because of the superficial vascular plexus. He said that in these cases, a physician must also be careful of the superficial papillary dermis and the large blood vessels deeper in the reticular dermis. Laser treatment at this depth may result in bruising or hemosiderin pigmentation, increased pain and tenderness, prolonged recovery, and hyperpigmentation. He said there is also a high risk of scarring because of collagen fibres in the area.
Dr. Rao said it is also important to consider the type of hyperpigmentation. Melanotic—hyperpigmentation due to excess melanosomes—can include conditions such as freckles, melasma, or post-inflammatory pigmentation. Melanocytotic—meaning too many melanocytes—can include nevoid lesions, lentigines, or seborrheic dermatoses.
He said simple lightening therapies such as creams, chemical peels, or microdermabrasion may work for melanotic conditions, as can fractionated laser treatments. Intense pulsed light therapy can reduce melanotic pigmentation by encouraging the skin’s natural exfoliation.
Dr. Rao said melanocytotic conditions require more aggressive methods to destroy the melanocytes. Q-switched or picosecond lasers, and perhaps ablative or vaporizing lasers, are required.
Bottom line: Identifying the depth and source of unwanted pigment in the skin are key factors in achieving good outcomes when treating hyperpigmentation with lasers in darker skin types.
From the literature on energy devices in skin of colour
Facial rejuvenation in Indonesian skin with a picosecond 755-nm laser
The authors of this paper note that while lasers for facial rejuvenation are popular in Asian patients, darker Asian skin types are more susceptible to pigmentary alterations.
To test the safety and efficacy of a picosecond 755 nm laser in facial rejuvenation in Indonesian skin, researchers recruited 20 healthy patients with Fitzpatrick skin types III-V with facial photoaging, aged 36 to 55.
Each patient received two treatment sessions four weeks apart. Patients were evaluated before therapy and four weeks after the second session, including a photographic analysis of the front and side of each cheek. Improvement was rated from mild to excellent.
Most (60%) of the patients had a good improvement, and 40% had a moderate improvement. Photographic analysis showed a significant improvement in wrinkles, pigments, and textures. Only mild anticipated adverse events were observed, and there was no post-inflammatory or hyperpigmentation.
Novel laser hair removal in all skin types
Researchers evaluated the safety and efficacy of a triple-wavelength diode laser module for hair removal treatment in all skin types (Fitzpatrick I-VI).
A total of 36 subjects were enrolled in the single-arm study: 16 with Fitzpatrick skin types I to IV and 20 with skin types V or VI. Participants received treatment to their axilla and bikini lines over four treatment sessions six weeks apart. Each was followed up three months after the last treatment session. Photographs were compared between baseline and follow-up with three blinded evaluators conducting a hair count.
Researchers observed a significant reduction in hair count between baseline and the three-month follow-up visit in both axilla and bikini lines for all skin types. The mean hair reduction was 41.5±19.4% and 48.1±20.9% in the axilla and bikini lines, respectively. Hair reduction was similar between the light and dark hair type groups. No serious adverse events were reported.
Review of laser treatments for post-inflammatory hyperpigmentation in skin of colour
This review examines the available literature on the optimal use of laser-based devices in treating post-inflammatory hyperpigmentation, particularly for Fitzpatrick skin phototypes III-VI.
The authors note that lasers remain a second-line treatment for this type of unwanted pigment change due to variable response, cost, and risk of complications with laser use.
However, they write that for post-inflammatory hyperpigmentation resistant to topical treatments, laser devices, particularly neodymium:yttrium-aluminum-garnet and fractional photothermolysis systems, can provide adjunctive therapy in skin of colour patients when appropriate parameters are used.
Safety and efficacy of superficial micro-focused ultrasound with visualization for melasma in Asians: An uncontrolled pilot study
In this study, 20 patients with mixed melasma on both cheeks received two treatments of superficial micro-focused ultrasound with visualization (MFU-V) one month apart. Researchers evaluated the safety and efficacy of the therapy over five monthly visits.
All cheeks had significantly reduced mean modified Melasma Area and Severity Index (mMASI) scores (13.2 at baseline to 2.4 at month four, and 2.8 at month five). Twenty-nine cheeks (72.5%) showed lightening of melasma at month four that persisted until month five, with improvements up to 75% compared to baseline.
Melasma area decreased overall, with sites containing >30% melasma involvement decreasing to 20% from 55% by month five, and there were no areas with 70%-89% involvement. Melasma lightening and area improved visibly in 40% and 20% of cheeks, respectively, as early as one month after the first MFU-V treatment. Improvements continued after the second treatment and persisted until study closure, correlating with patient global aesthetic improvement scale and satisfaction scores. The procedure was well tolerated, with only mild-to-moderate pain reported in 92.5% of treatments.
VIDEO: Before and after—Laser hair removal for Black skin. Face treatment
At the intersection of skin and society
Les Femmes Michif Otipemisiwak (LMFO), the national voice of Métis women in Canada, recently launched their Ready2Listen campaign, reports Canadian Geographic. This campaign includes short videos sharing the first-person accounts of Indigenous women and 2SLGBTQIA individuals fostering change within their communities. In total, 14 videos will be included.
The campaign began on International Women’s Day, March 8, at an event hosted by LMFO in partnership with the Royal Canadian Geographical Society, honouring five inspirational Métis matriarchs for their advocacy work.
The campaign also includes online resources for employing Indigenous methods of learning and conflict resolution to battle racism, bullying, and online hate.
“It’s something that has been a dream of mine—that we start to celebrate and honour the amazing women that I watch walk all around me,” said Melanie Omeniho, president of LMFO, is quoted saying at the event. “When we see the women that inspire us in the community and are mentors to others within our communities, we need to lift them up and celebrate them.”
This week
March 20 is National Native HIV/AIDS Awareness Day in the U.S.
March 22 is World Water Day
March 25 is the International Day of Remembrance of the Victims of Slavery and the Transatlantic Slave Trade
Something to think about in the week ahead. . .
Pliny the Elder, Roman author, 23-79
Next week
In a discussion hosted by the American Journal of Managed Care, Dr. Bruce Sherman, Medical Director of the U.S.-based National Alliance of Healthcare Purchaser Coalitions, and Dr. Maria Lopez, Chief Medical officer of the pharmacy benefit manager of Magellan Rx, offer their views on how health organizations address disparities in care for psoriasis among minority populations.
Free webinar: Teledermatology and remote and rural Indigenous communities
Edmonton-based dermatologist Dr. Jaggi Rao and Regina-based dermatologist Dr. Rachel Netahe Asiniwasis invite dermatologists and other medical professionals to attend a free virtual webinar on March 23, 2023 at 9:00 p.m. EST.
The one-hour webinar will cover the role of teledermatology in meeting the healthcare needs of rural and northern Indigenous populations. These topics will be explored through the lens of chronic spontaneous urticaria.
Free registration is available through this link.
Recordings of the webinar will be available to registrants after the event.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper print providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
The winning essay from Dr. Samantha Bizimungu (Montreal) was submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Bizimungu wrote on the issue of hair loss in women with skin of colour.
Dr. Nowell Solish (Toronto) discusses recent research on the use of daxibotulinumtoxinA for treating glabellar lines that found no significant difference in outcomes by race or age.
A review of new and upcoming treatments, featuring interviews with Dr. Ron Vender (Hamilton), Dr. Jeff Donovan (Whistler, BC), Dr. Sam Hanna (Toronto), and Dr. Mariusz Sapijaszko (Edmonton)
Plus regular features, including the popular column “Vender on Psoriasis” by Hamilton dermatologist Dr. Ron Vender
Read a recent online edition here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.
Season two of the Shear Listening Pleasure podcast with Dr. Neil Shear has launched. Listen to the sixth episode here, where Dr. Shear speaks with Dr. Samantha Bizimungu, a dermatology resident at the Centre Hospitalier de l’Université de Montréal (CHUM) about her winning essay for the DiTIDE essay competition, why she chose dermatology, and why ethnodermatology should matter to all physicians.
And if you’re looking for a web destination for all things derm, please visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.