Laser management of hair follicle inflammatory conditions
Laser hair removal an option for pseudofolliculitis barbae, acne keloidalis nuchae in dark skin (1,500 words, 7 minutes)
Laser treatment with a 1,064 nm device can be a relatively safe, effective treatment for inflammatory issues related to hair follicles in patients with dark skin types. However, patients need to be counselled appropriately about permanent hair reduction.
This message was part of Dr. Jonathan Shapero’s presentation on laser treatments in skin of colour at the 9th annual Skin Spectrum Summit on Oct. 21, 2023.
“Generally speaking, if a physician is dealing with predominantly Fitzpatrick V or VI skin patients, they should be using 1,064 nm [devices],” he said, noting that wavelength has been established for many years as the safest in darker skin types. “I would emphasize safest. It's still not perfect, but it has the best safety profile.”
Dr. Shapero is a dermatologist in practice in North York, Ont. He is vice president of the Canadian Laser and Aesthetics Specialists Society (CLASS) and moderator for the Laser Safety Course for the Canadian Laser and Aesthetics Specialists Society. He is also a member of the Caribbean Dermatology Association.
Laser hair removal can be helpful for patients with pseudofolliculitis barbae, Dr. Shapero said. He noted that in his practice, in contrast to what he’s seen in textbooks that say this condition occurs predominantly in men, he has seen a roughly 50/50 ratio of men and women.
He noted that for men, he will talk with them about possibly not treating their beard area, as they may want to grow beards in the future.
Acne keloidalis nuchae
A physician can use laser treatment for acne keloidalis nuchae, but it should not be a first-line treatment, Dr. Shapero said.
“But for more advanced cases when other treatments aren't working [laser can be helpful]. But the counselling has to be very appropriate. The patient is going to have permanent hair reduction in these areas of the scalp that you treat. So generally reserve [laser treatment] for very advanced keloid formation when everything else hasn't worked.”
Bottom line: Laser treatments can help manage inflammatory conditions of the hair follicles in patients with dark skin. Patients should be counselled about permanent hair reduction.
From the literature on energy treatments in skin of colour
Periorbital skin rejuvenation of Asian skin using microneedle fractional radiofrequency
This study was conducted to evaluate the effect and safety of a novel fractional microneedle radio frequency (RF) device on periorbital wrinkles based on several objective indicators.
Researchers included 11 healthy Korean patients aged 30 to 75 years with periorbital wrinkles in this study. They evaluated wrinkle grades using the Fitzpatrick wrinkle assessment scale (WAS). Researchers also recorded melanin and erythema index, transepidermal water loss (TEWL), and three parameters for elasticity, and obtained skin biopsies from patients who consented. The treatment was performed in three sessions at four-week intervals.
All patients exhibited wrinkle improvement in the lateral periorbital area, and two patients also showed efficacy in the lower eyelid area. Investigators found a statistically significant decrease in WAS and a significant improvement in the melanin index at the fourth visit (12 weeks) and six months after the final treatment. There was also a considerable decline in TEWL at both time points, which the authors say suggests the water content of the skin increased with repeated treatment sessions. A peak increase in viscoelasticity and a decrease in retraction time following the first RF application were observed. In the histopathologic examination, the dermis had a denser collagen and elastin content.
Nonablative monopolar radiofrequency for the reduction of facial pores and sebum excretion in Thai patients: A novel approach
This study aimed to evaluate the long-term efficacy and safety of a nonablative monopolar radiofrequency (NMRF) for pore tightening and sebum output reduction in Thai patients.
A total of 19 patients with enlarged pores underwent two sessions of NMRF treatments at four-week intervals. Researchers quantified measurements of pore volume, skin texture, average pore size, sebum production, and skin elasticity using the Antera® 3D imaging system, dermoscopic image analysis with ImageJ software, Sebumeter® and Cutometer®. Two dermatologists also conducted a blinded clinical evaluation using photographs. Measurements were repeated at baseline, one month after the first treatment, and one, three, and six months after the last treatment.
Of the original 19 subjects, 17 completed the study protocol. The mean pore volume significantly reduced by 24% from the baseline one month after the first treatment (p<0.016). The pore volume continued to decrease by 34% and 38% one month (p<0.001) and six months (p<0.001) following the final treatment, respectively. Sebum excretion likewise significantly decreased from baseline by 39% (p=0.002) and 36% (p<0.001), three and six months after the second treatment, respectively. Skin texture and elasticity also significantly improved following two NMRF sessions. The objective assessments of the pore appearance corresponded to subjective clinical evaluations. The treatment was well-tolerated without significant side effects, such as dyspigmentation, textural alteration, and scarring.
A randomized, prospective, split-face pilot study to evaluate the safety and efficacy of 532-nm and 1,064-nm picosecond-domain neodymium:yttrium-aluminum-garnet lasers using a diffractive optical element for non-ablative skin rejuvenation: Clinical and histological evaluation
Researchers compared the efficacy and safety of diffractive optical element (DOE)-assisted picosecond neodymium: yttrium-aluminum-garnet (Nd:YAG) lasers with 532-nm and 1,064-nm wavelengths (532-nm and 1,064-nm Nd:YAG P-DOE) using a novel fractional handpiece for the treatment of photoaged skin.
The researchers initially evaluated histologic changes in ex vivo guinea pig skin samples after 532-nm Nd:YAG P-DOE irradiation. They then conducted a randomized, prospective, split-face study was performed on eight subjects with 532-nm and 1,064-nm Nd:YAG P-DOE. All of the subjects were Korean women aged 24 to 50 years. Four had Fitzpatrick skin type III, and four had skin type IV.
Based on the histological evaluation using ex vivo guinea pig skin, researchers observed a reasonable safety profile and the potential to generate effective skin rejuvenation using the 532-nm Nd:YAG P-DOE.
Results from the split-face study demonstrated that both 532- and 1,064-nm Nd:YAG P-DOE were similarly effective in improving skin texture and skin pores; however, 532-nm Nd:YAG P-DOE was more effective in treating dyspigmentation.
Partial unilateral lentiginosis successfully treated with the combination of 511 nm and 578 nm copper bromide laser in an Indonesian woman
This paper reports on the case of a 35-year-old woman who presented with multiple brown macules with a sharp demarcation from the midline of her forehead to the right cheek in a dermatomal distribution. Histopathological results showed increased melanin pigmentation in the basal layer with elongated rete ridges, supporting the diagnosis of partial unilateral lentiginosis. Following photoprotection and skin priming, the care team performed CuBr laser treatment in two steps using 511 nm and 578 nm wavelength as the first and second steps, respectively, with the second step delivered immediately after.
The authors report clinical improvement was achieved after two sessions of treatment at a one-month interval, as shown by an increasing lightness value (L*) in spectrophotometry. They observed no side effects, such as hyperpigmented macules. The patient also expressed satisfaction with her brighter facial skin. A sustainable favourable result persisted after six months of laser treatment.
In the conclusion, the authors write the combination of 511 nm and 578 nm CuBr laser showed favourable results, supporting its potential as an effective treatment choice for partial unilateral lentiginosis.
VIDEO: Can a Black person get laser hair removal?
Dr. Degha Fongod discusses laser hair removal, focusing on considerations for people with darker skin tones, particularly those of African and Indian descent. She is an internal medicine physician practicing aesthetic medicine in Northern Virginia with a focus on skin and health conditions affecting people with skin of colour.
At the intersection of skin and society
A new docuseries detailing little-told stories of Black Canadian experiences premiered Oct. 25, 2023, on the CBC Gem streaming service, reports The Toronto Star.
Titled ‘Black Life: Untold Stories,’ the series is as much about the present as it is about relearning the past, said the show’s executive producer Leslie Norville.
The show traces 400 years of contributions that helped shape the nation and underpin ongoing efforts toward racial justice, said Norville.
Through archival footage, recreations, and testimonies from Black Canadians, it also dispels common myths, such as Canada being a utopia for Black people during slavery.
“There’s still a lot of work that needs to be done here in Canada and the first step is grappling with our history,” said Norville.
“I didn’t know a lot of these stories myself. The process of doing this research unearthed a lot of information as a Black Canadian I should have known about and didn’t, so that was really shocking for me.”
The CBC series features eight hour-long episodes. Each instalment is dedicated to one overarching topic including Black empowerment, hip-hop, immigration, art and literature, sports, policing, and settlements.
November is Eczema Awareness Month in Canada
November is Native American Heritage Month in the U.S.
Nov. 1 is National Biologic Coordinators Day in the U.S.
Something to think about in the week ahead. . .
—Anne Wilson Schaef, U.S. author
In a presentation from the 9th annual Skin Spectrum Summit, Dr. Danielle Marcoux discusses treating atopic dermatitis in children with skin of colour.
Registration is open for the 2023 Indigenous Skin Spectrum Summit. First held in 2021, the Indigenous Skin Spectrum Summit is a special session of the Skin Spectrum Summit addressing specific challenges in treating Canada’s Indigenous community. This year’s virtual meeting will be held on November 25, 2023. Register at the following link:
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 providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Irina Turchin (Fredericton, N.B.), Ron Vender (Hamilton, Ont.), and Ashley O’Toole (Peterborough, Ont.) discuss advances in psoriasis treatment.
Dr. Joel DeKoven (Toronto) details the most common contact allergens based on North American Contact Dermatitis Group data.
An essay from Dr. Fabian Rodriguez-Bolanosi (Toronto) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Rodriguez-Bolanosi wrote about his experience working with Black women in the hair clinic.
Plus regular features, including the popular column “Vender on Psoriasis” by 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 Yadav on Acne podcast with Dr. Geeta Yadav has launched. Listen to the new season here. In episode four, Dr. Yadav gives insights into the correlation between vitamin D deficiency and acne, inflammatory factors, and whether the Western diet contributes to acne severity.
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.