Safe and effective aesthetic treatments for patients with skin of colour.
Dr. Haneef Alibhai outlines the tools and techniques that produce good results and minimize risks for patients with darker skin tones (610 words, 3.5 mins.)
Using the correct tools and techniques for aesthetic dermatology in darker skin can produce good results while minimizing the risk of inducing unwanted pigment changes, explained Dr. Haneef Alibhai at Skin Spectrum Summit in Vancouver.
One technology Dr. Alibhai advocated for skin rejuvenation in Fitzpatrick skin types IV through VI was picosecond pulsed lasers.
“The beauty of the picosecond laser is it does not work photothermally, as other lasers do. Picosecond lasers work photoacoustically, creating a pressure wave to break down pigment,” he said.
Rather than heating a target point, these devices cause a phenomenon known as laser-induced optical breakdown, which causes a pressure wave that spreads through the tissue, reaching deeper into the dermis than the lasers could themselves, Dr. Alibhai said. The pressure waves temporarily alter the cell membranes' permeability, which increases the production of elastin and collagen.
This process leads to minimal downtime, “and there is no risk of hyperpigmentation because these laser-induced optical breakdowns are located below the dermal-epidermal junction,” he said.
“This is a very good device to lighten unwanted pigment. It has become my go-to to treat pigmentation on skin types IV, V, and VI, such as your typical solar lentigines, very safely.”
Of the picosecond lasers, Dr. Alibhai said he prefers a 755 nm device as energy at that wavelength is much more preferentially absorbed by melanin rather than oxyhemoglobin.
“If you compare it to 532 nm, where the melanin-to-blood ratio is about 2.5, or 1,064 nm, where melanin-to-blood absorption is about 16 times at 755 nm, the difference between melanin and oxyhemoglobin absorption is actually 50 times.”
This results in minimal risk of pinpoint bleeding, minimal side-effects and less downtime while lightening pigment and increasing collagen, he said.
Dr. Alibhai and his colleagues have begun pre-treating darker-skinned patients with hydroquinone compounds for the four weeks before their picosecond laser appointments, he said. “That is just for our comfort and safety so that we can sleep well at night. To minimize the risk of [post- inflammatory hyperpigmentation].
Many patients with darker skin have also asked about correcting dark circles under their eyes, he said. For those patients, particularly those with hollows under their eyes, Dr. Alibhai has been treating them with very fine, low-cohesivity, low-viscosity hyaluronic acid fillers, administered using a cannula.
The takeaway: “You have to choose the right patient,” he noted, saying that only three of every 10 patients are a candidate for treating this way. “If you have the right patient, the right product and the right technique, you get great results.”
FROM THE LITERATURE ON AESTHETIC TREATMENTS FOR PATIENTS WITH SKIN OF COLOUR
A prospective, split-face, randomized study comparing a 755-nm picosecond laser with and without diffractive lens array in the treatment of melasma in Asians
A recent study found that a 755 nm picosecond laser is a safe and effective treatment for melasma in patients with skin of colour. The researchers tested the laser in five monthly sessions on 18 subjects.
PrabotulinumtoxinA for the treatment of moderate-to-severe glabellar lines in adult patients with skin of colour: Post hoc analyses of the US phase III clinical study data
A recent study found that for treatment of glabellar lines in patients with skin types IV-VI, a dose of 20U prabotulinumtoxinA was well tolerated and effective when compared to patients with skin types I-III.
PrabotulinumtoxinA for the treatment of moderate-to-severe glabellar lines in adult patients with skin of colour: Post hoc analyses of the US phase III clinical study data
A recent study found that micro-needling for striae distensae for patients with skin types I-V was safe and effective. The researchers noted that striae distensae is notoriously difficult to treat for patients with darker skin tones since there is a high risk of thermal injury, which is not present with micro-needling therapy.
AT THE INTERSECTION OF SKIN AND SOCIETY
According to a report by CBC News, three medical students at Queen’s University in Kingston, Ont., and a team of 100 volunteers have devised a plan to diversify images in course materials. The team, which includes Iku Nwosu (pictured below), a third-year Queen’s University medical student, set to the task after noticing that the vast majority of images in their dermatology learning materials were of white skin, she said in the report.
"When I saw those slides, that didn't really include diverse skin tones, my first thought after was 'How would this [condition] look on me? How would this look on my family members, my community, my loved ones?'" said Nwosu to CBC Radio. After conducting research that found that of the 900 medical school lectures, one-fifth dealt with skin conditions. Within those, 90 per cent of images were of lighter skin tones, the team created a database of images of a variety of skin tones in hopes that the school will adopt the database. Read the full article here.
This Week
March 21 to 27 is National Poison Prevention Week
Tuesday, March 22 is World Water Day
Thursday, March 24 is World Tuberculosis Day
Something to think about during the week ahead…
Next Week
For acne patients with skin of colour, Dr. Catherine Maari talks about treating punch-out scares aggressively.
Thank you to our panellists and delegates for making the Indigenous Skin Spectrum Summit a great success. Conference highlights will soon be posted to the Skin Spectrum website. As always, we welcome your questions and comments on topics in Ethnodermatology.