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Laser hair removal for patients of colour
Improvements in laser technology and understanding among providers have led to improved safety (1,300 words, 6 minutes)
Since the early days of laser hair removal, technological improvements have made a procedure once mostly limited to individuals with light skin and dark hair viable in a wider patient population.
In an article published in the lifestyle publication The Cut, New York dermatologist Dr. Michelle Henry notes that for patients with Black skin, the Nd:YAG laser is the safest device currently available for laser hair removal. However, there remain limitations to its use, she said.
“Even with all the articles that have come out, there is still a dearth of information when it comes to academic textbooks about skin of colour,” Dr. Henry said. “Successful laser hair removal and other procedures really come from not only studying skin of colour but knowing it well and doing a lot of volume.”
Early in the history of laser hair removal, patients with melanin-rich skin would be at risk of their skin absorbing a significant portion of the laser energy and excessively heat up, risking potential skin burns, Dr. Henry said. “But the Nd:YAG laser has numerous benefits, including its skin-type range and longer wavelength that targets the hair follicles while bypassing melanin
As well, there are conditions when laser hair removal is not safe for women of any skin colour, New York dermatologist Dr. Brendan Camp told The Cut. These include pregnancy, breastfeeding, the presence of an active skin infection, a tan from sun exposure, or if the patient is taking medications that can make the skin more sensitive to light.
Bottom line: Women with skin of colour pursuing laser hair removal should seek out a licensed medical professional with experience using an Nd:YAG laser to treat patients with darker skin types. These patients should avoid scheduling hair removal while they are pregnant or breastfeeding.
From the literature on energy treatments and skin of colour
Use of a 755/1064 nm long pulse laser equipped with pigment meter guidance in the treatment of pseudofolliculitis barbae, vascular lesions, and epidermal pigmented lesions
This study investigated combining dual-wavelength 755/1,064 nm laser with pigment meter guidance to optimize treatment outcomes for pseudofolliculitis barbae and benign vascular or pigmented lesions.
The authors note that the epidermal damage fluence threshold—the fluence at which moderate reddening or slight crusting is present one to two days after treatment—depends on the melanin content of the skin, among other factors. Yet most physicians estimate the melanin content of background normal skin, they write.
“Overestimation of melanin content results in unnecessarily conservative settings and disappointing results. Underestimation of the melanin content results in potential vesiculation and scarring.”
The study included 20 subjects. For pseudofolliculitis barbae (PFB), skin types were V and VI. For benign pigmented lesions, skin types ranged from II to IV. For blood vessels on the legs and abdomen, skin types ranged from II to III. In general, two to four treatments were applied four weeks apart.
Overall, the authors found the use of this laser, guided with the pigment meter, was effective in the reduction of hair, pigment dyschromia, and vascular lesions. They conclude the pigment meter adds an extra measure of security and confidence in setting selection.
Comparison of the efficacy and safety of a 730 nm picosecond titanium sapphire laser and a 755 nm picosecond alexandrite laser for the treatment of freckles in Asian patients: A two-centre randomized, split-face, controlled trial
This study investigated the efficacy and safety of the 730 nm picosecond titanium sapphire laser for treating freckles in Asian patients compared with those treated with the 755 nm picosecond alexandrite laser.
Researchers treated each half-face of 86 participants with either the 730 or 755 nm picosecond laser. They used a combination of blinded visual evaluations and self-reports at each follow-up visit to evaluate efficacy and safety.
The investigators found comparable treatment outcomes between the 730 nm picosecond laser and the 755 nm picosecond laser, with 68.99±7.42% and 69.27±7.75% clearance, respectively (p>0.05). Similar Global Aesthetic Improvement Scale scores (4.04±0.31 vs. 4.02±0.30, respectively [p>0.05]) were also seen between the two treatment approaches. Participants reported the 730 nm picosecond laser was perceived to be less painful than the 755 nm picosecond laser (4.69±1.63 vs. 5.65±1.80 nm, p<0.0001).
A review of treatment of port-wine stains with pulsed dye laser in Fitzpatrick skin type IV-VI
For this review, researchers searched the PubMed and Medline databases for English language literature published from database inception through Dec. 2022 using keywords including “PDL,” “pulse dye laser,” “skin of colour,” “Fitzpatrick skin types IV-VI,” “Fitzpatrick,” “pigmented skin,” “Port-wine stain,” “PWS,” and “pulsed dye laser.”
From an initial pool of 120 articles, nine met inclusion criteria with 241 patients that were considered Fitzpatrick skin type IV-VI. Patient ages ranged from one month to 74 years.
The authors found that patients treated at a younger age had better results than those treated at an older age. As well, darker-skinned individuals had better results when treated at a younger age compared to adults, sometimes experiencing complete resolution.
Adults who were treated saw a range of results, from improvements in appearance to hyper- or hypopigmentation or scarring of the treated area.
The authors write that patients with Fitzpatrick skin types IV-VI are at higher risk of adverse events when treated with PDL for PWS when compared to patients of other skin types.
Cosmetic treatments with energy-based devices in skin of colour
This article reviews various energy-based modalities that have shown positive outcomes for cosmetic indications in Fitzpatrick skin types IV to VI.
Treatments discussed include radiofrequency skin tightening devices, micro-focused ultrasound, fractional laser resurfacing, both ablative and nonablative, nonablative fractional lasers, broadband light, RF microneedling, and short-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG) laser devices.
The authors also mention how combining the short-pulse Nd:YAG laser with other treatments such as chemical peels or microneedling has shown synergistic effects and enhanced outcomes.
“Understanding these modalities and tailoring treatments to specific concerns is crucial for safe and effective solutions in patients with higher Fitzpatrick skin types,” the authors write.
VIDEO: Best lasers for skin of colour
Newport Beach, Calif.-based dermatologist Dr. Stefani Kappel discusses the best laser options for darker skin tones and treatments to avoid for these patients.
At the intersection of skin and society
Two documentary series exploring race and Canadian culture have been added to the Primetime program of the 2023 Toronto International Film Festival.
As reported by CP24 news, CBC’s “Black Life: Untold Stories,” directed by Leslie Norville, challenges problematic beliefs about Canada’s Black history. The series is a reframing of Black history with Black Lives Matter Canada co-founder Sandy Hudson and former pro hockey player P.K. Subban among those attached as producers.
The second, four-part CBC series, “Telling Our Story”, written and directed by Abenaki creator Kim O'Bomsawin, centres on the life experience of 11 First Nations in Quebec.
The CP24 article noted another Canadian series that will be in the Primetime program is the Crave comedy "Bria Mack Gets A Life,” about a 25-year-old Black woman navigating a white world, directed by Sasha Leigh Henry.
September is Healthy Ageing Month
September is National Childhood Cancer Awareness Month in the U.S.
Something to think about in the week ahead. . .
Henry Adams, U.S. historian, 1838 to 1918
Skin Spectrum Weekly will be away for Labour Day, but will return on Sept. 11 with Dr. Joyce Park, a dermatologist from Mountain View, Calif. Dr. Park explains how a popular “aged” filter on TikTok does not accurately model facial ageing in individuals with darker skin types.
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:
Drs. Lisa Kellett (Toronto), Michal Martinka (Calgary), and Jaggi Rao (Edmonton) discuss strategies for optimizing the management rosacea.
In a therapeutic update, Drs. Marcie Ulmer (Vancouver), Jen Lipson (Ottawa), and Sonya Cook (Toronto), detail current and upcoming advances in acne treatments.
An essay from Dr. Nickoo Merati (Montreal) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Merati wrote about the importance of people with skin of colour to “see” their community members represented at decision-making tables to rise to their full potentials. The essay also touches on efforts by Canadian medical students to improve the representation of skin of colour in dermatology education materials.
Plus regular features, including the popular column “Vender on Psoriasis” by Hamilton, Ont. dermatologist Dr. Ron Vender
Read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary* subscription or to receive a sample copy, please email firstname.lastname@example.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 eighth episode here, where Dr. Shear speaks with dermatologist Dr. Sonja Molin (Kingston, Ont.) about allergology, patch testing, and the growth of Queen’s University’s dermatology division.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.