With knowledge, laser Tx can be safe in darker skin
Lasers are a viable choice for patients with skin of colour, despite common misconceptions (6 minutes, 1,200 words)
Laser treatments have long been viewed as risky or off-limits for patients with darker skin tones. But Dr. Jonathan Shapero is working to change that narrative. At the 9th Skin Spectrum Summit last October, the Toronto dermatologist said that most patients can safely achieve successful outcomes with the latest laser technology and a nuanced understanding of diverse skin types. His assertions challenge long-held assumptions within the field and reflect a broader reckoning on equity issues in medicine.
Dr. Shapero is the vice president of the Canadian Laser and Aesthetics Specialists Society (CLASS) and moderator for the group’s laser safety course.
As an example of laser treatment that can be used in darker skin, Dr. Shapero noted a 1,064 nm laser can be used as an acne therapy to target hemoglobin to address the redness of the lesions, target water to destroy bacteria, and then melanin for the pigmentary response. He cautioned it is essential to counsel patients that laser treatment cannot eliminate acne or acne scars but can be helpful.
While lasers can be used to treat post-inflammatory dyspigmentation in darker skin by targeting melanin and the vascular supply of melasma, they should not be used as monotherapy, said Dr. Shapero. He said he always combines laser treatment with topical therapy, such as glycolic acid peels in these cases. He noted that lasers should not be a first-line treatment in this indication.
“You can use lasers on all skin types,” said Dr. Shapero. “Hopefully, the days are going to be done where we tell patients that there’s nothing we can offer them.”
Bottom Line: Laser treatment can be effective for patients of all skin tones. However, for some conditions, it should not be a first-line treatment and often achieves better results as part of a combination therapy with topical agents than as a monotherapy.
From the literature on lasers in skin of colour
Treatment of mild to severe acne with 1,726 nm laser: A safe alternative to traditional acne therapies
In this review, the authors discuss clinical challenges with present therapeutic options for acne treatment and the role of a 1,726 nm laser for acne. They review current acne treatment guidelines, trials of light-based acne therapy, and the selectivity of previous light-based therapies.
They note that studies of a 1,725 nm laser, supported by a contact cooling system, show it is effective in treating mild to severe acne. No pigment changes were seen in patients of any Fitzpatrick skin type. The authors note that melanin is not a clinically meaningful chromophore at the 1,726 nm wavelength, which explains this safety in darker skin tones.
Efficacy of a multimodal approach of laser therapy for earlobe keloid management in dark-skinned population
Researchers evaluated the efficacy and safety of CO2 laser therapy in managing earlobe and helix keloids in dark-skinned subjects.
They enrolled 21 patients with dark skin phototypes III to VI)—five men and 16 women—who presented with earlobe and ear helix keloids, with a mean age of 30.5 (±6.7) years. All patients underwent a single session of CO2 laser therapy immediately, followed by a pulsed dye laser procedure. The investigators followed up the patients for six months after the end of treatment.
Most of the patients treated showed complete remission of keloid lesions. Clinical photographs showed a visible aesthetic improvement of several types of keloids in dark subjects.
Clinical and optical coherence tomography correlation of vascular conditions treated with a novel, variable-sequenced, long-pulsed, 532 and 1,064 nm laser with cryogen spray cooling
This prospective clinical trial evaluated the safety and efficacy of a novel, variable-sequenced, long-pulsed, 532 and 1,064 nm laser with cryogen spray cooling as a treatment for vascular conditions.
Researchers enrolled 13 subjects with Fitzpatrick skin types I to IV, with a mean age of 51.3 years. Most (92.3%) were women. Their vascular conditions included blood vessels, rosacea, port-wine birthmark, and spider angioma.
Physician investigators graded all subjects as improved at both 30-day and 90-day follow-up. Optical coherence tomography imaging showed significant reductions in vessel density (p=0.018) and diameter (p=0.003) of the superficial vascular plexus. No serious adverse events occurred.
Post-inflammatory hyperpigmentation after carbon dioxide laser: Review of prevention and risk factors
This review analyzes the incidence of post-inflammatory hyperpigmentation PIH after CO2 laser therapy, identifies risk factors, and assesses the efficacy of several treatment modalities in preventing PIH.
When appropriate, researchers compared the incidence of PIH across each possible individual factor, such as skin type, gender, and type of intervention.
From 211 articles identified from the Pubmed and Embase databases, investigators included 14 relevant articles in this review.
Seventy percent of the subjects were females (n=219), and 30% were males (n=94), with a mean age of 30 years (SD=7.8). The most common skin types were type IV (59%) followed by type III (25%). In total, eight studies investigated the prevention of PIH.
Researchers found the incidence of PIH after CO2 laser significantly varies between studies and differs based on the type of intervention. The studies indicate that using clobetasol propionate 0.05% and fusidic acid cream effectively reduced PIH, recording an incidence rate of 39% and 53.3%, respectively. Fitzpatrick-skin phenotype did not appear to influence the risk of PIH. Other approaches, such as platelet-containing plasma, may be useful in reducing CO2 laser side effects.
The authors note there is a lack of high-powered clinical studies analyzing the incidence of PIH after CO2 laser treatment and the associated risk factors.
VIDEO: How I Treat Darker Skin Types—Dr Davin Lim
Dr. Davin Lim, a dermatologist in Brisbane, Australia, discusses his techniques in the clinic to achieve better, safer results with lasers when treating patients with darker skin types.
At the intersection of skin and society
In celebration of Black History Month, a “Unyielding Roots” concert series is premiering original compositions by two second-generation Canadians with Caribbean and African roots. Composers Rashaan Rory Allwood, pianist and instrumentalist, and Kathryn Patricia Cobbler, loop pedal violist, perform in the series along with soprano Nadine Anyan.
A press release describes the performance as “a musical journey with pieces that reflect upon elements of the Caribbean immigrant and African diaspora experience. A program of original ambient jazz, folk, and classical compositions performed against a background film of images and events from life in the Caribbean and Canada, exploring themes of being raised within multiple cultures and redefining beauty against a North American colonial landscape.”
Cobbler introduces herself and her work in this video:
Upcoming performances include Feb. 8, 2024, at the 10,000 HOURS Concert Hall in Vanier, Ont., and Feb. 11, 2024, at the Holy Blossom Temple in Toronto.
This week
February is Raynaud’s Awareness Month in the U.K.
Feb. 4 through Feb. 10 is Burn Awareness Week in the U.S.
Feb. 6 is International Day of Zero Tolerance for Female Genital Mutilation
Something to think about in the week ahead. . .
—Georg C. Lichtenberg, German scientist (1742 to 1799)
Next week
Dr. Danielle Marcoux discusses the prevalence of pediatric atopic dermatitis in Canada and some of the challenges faced by young Indigenous patients with this condition.
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. Lauren Lam (Calgary), Sam Hanna (Toronto), Benjamin Barankin (Toronto), and Renée A. Beach (Toronto) discuss many of the new therapeutic options that arrived in 2023.
Dr. Andrew F. Alexis (New York) details pigmentary disorders in patients with skin of colour.
An essay from Dr. Sheila Wang (Montreal) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Wang wrote about the development of new imaging technology to detect and assess ‘beneath-the-skin’ inflammation, perfusion, and tissue oxygenation in any skin phototype.
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 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 three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D impacts psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
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