Laser surgery in dark skin

Tina S. Alster, MD and Elizabeth L. Tanzi, MD have just published a great overview of laser use on dark skin in Dermatology for the Clinician.

Abstract and Introduction

Although challenging, effective laser surgery in patients with darker skin tones can be achieved despite a higher inherent risk of untoward side effects. While the incidence of undesirable postoperative sequelae has decreased with the development of advanced laser technology and individualized treatment parameters, these risks may never be eliminated completely. Consequently, thorough patient preoperative preparation and education regarding the risks of cutaneous laser therapy will remain an essential component of treatment in darkly pigmented patients. In the future, as more refined laser techniques evolve, the ability to safely and effectively treat these patients will improve.

Selected quotations:

</font><blockquote><font size=“1” face=“Verdana, Helvetica, sans-serif”>quote:</font><hr /><font size=“2” face=“Verdana, Helvetica, sans-serif”> In 2000, the total number of individuals in the United States with skin of color was approximately 85 million.[1]

Nonspecific energy absorption by relatively large quantities of melanin in the basal layer of the epidermis can increase unintended nonspecific thermal injury and lead to a higher risk of untoward side effects including permanent dyspigmentation, textural changes, focal atrophy, and scarring in the darkly pigmented patient.

epidermal melanin absorbs approximately four times as much energy when irradiated by a 694 nm ruby laser as when exposed to the 1064 nm beam generated by the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, thus allowing greater penetration of the longer wavelength.[8]

For example, skin phototype VI may absorb as much as 40% more energy when irradiated by a visible light laser than does class I or II skin when fluence levels and exposure duration remain constant.[9]

The combination of longer wavelengths, active epidermal cooling, and longer pulse durations provided by the most advanced laser technology has decreased the side effects following laser-assisted hair removal in patients with darker skin tones.[15-23] Several pigment-specific laser systems with relatively long (millisecond) pulse durations have demonstrated safety and efficacy in darker skin phototypes, including the 755 nm alexandrite,[17-19] 810 nm diode,[20,21] and 1064 nm Nd:YAG.[23,24] Intense pulsed-light treatment of hirsutism in patients with darker skin phototypes may also be possible; however, studies have been limited.[22] One study[24] demonstrated significant long-term hair reduction after a series of 3 monthly long-pulsed 1064 Nd:YAG laser treatments in 20 women with skin phototypes IV-VI. (Figures 2 A & B) Adverse effects were limited to transient pigmentary alteration without fibrosis or scarring.[24] Pseudofolliculitis barbae, a condition with a high incidence in the African American population, has also been shown to respond favorably to laser-assisted hair removal with minimal untoward sequelae.[20,21]

  1. Taylor SC, Cook-Bolden F. Defining skin of color. Cutis. 2002;69:435-437.
  2. Chung JH, Koh WS, Lee DY, et al. Copper vapor laser treatment of port-wine stains in brown skin. Australas J Dermatol. 1997;38:15-21.
  3. Chung JH, Koh WS, Youn JL. Histological responses of port-wine stains in brown skin after 578 nm copper vapor laser treatment. Lasers Surg Med. 1996;18:358-366.
  4. Kim JW, Lee JO. Skin resurfacing with laser in Asians. Aesthetic Plast Surg. 1997;21:115-117.
  5. Ruiz-Esparza J, Gomez JMB, de la Torre OLG, et al. Ultrapulse laser skin resurfacing in Hispanic patients: a prospective study of 36 individuals. Dermatol Surg. 1998;24:123-129.
  6. Ho C, Nguyen Q, Lowe NJ, et al. Laser resurfacing in pigmented skin. Dermatol Surg. 1995;21:1035-1037.
  7. Baba T, Narumi H, Hanada K, et al. Successful treatment of dark-colored epidermal nevus with ruby laser. J Dermatol. 1995;22:567-570.
  8. Macedo O, Alster TS. Laser treatment of darker skin tones: a practical approach. Dermatol Ther. 2000;13:114-126.
  9. Anderson RR. Laser-tissue interactions in dermatology. In: Arndt KA, Dover JS, Olbricht SM, eds. Lasers in Cutaneous and Aesthetic Surgery. Philadelphia, PA: Lippincott-Raven; 1997:28.
  10. Alster TS. Laser treatment of darker skin phototypes: recent progress. Cosmetic Dermatol. 1999:13-16.
  11. Ueda S, Isoda M, Imayama S. Response of naevus of Ota to Q-switched ruby laser treatment according to lesion colour. Br J Dermatol. 2000;142:77-83.
  12. Chan HH, Ying SY, Ho WS, et al. An in vivo trial comparing the clinical efficacy and complications of Q-switched 755 nm alexandrite and Q-switched 1064 nm Nd:YAG lasers in the treatment of nevus of Ota. Dermatol Surg. 2000;26:919-922.
  13. Alster TS, Williams CM. Treatment of nevus of Ota by the Q-switched alexandrite laser. Dermatol Surg. 1995;21:592-596.
  14. Kilmer SL. Laser treatment of tattoos. In: Alster TS, Apfelberg DB, eds. Cosmetic Laser Surgery: A Practitioner’s Guide. 2nd ed. New York, NY: Wiley-Liss; 1999:289-303.
  15. Nanni CA, Alster TS. Complications of laser-assisted hair removal using Q-switched Nd:YAG, long-pulsed ruby, and long-pulsed alexandrite lasers. J Am Acad Dermatol. 1999;41:165-171.
  16. Chana JS, Grobbelaar AO. The long-term results of ruby laser depilation in a consecutive series of 346 patients. Plast Reconstr Surg. 2002;110:254-260.
  17. Lu SY, Lee CC, Wu YY. Hair removal by long-pulse alexandrite laser in oriental patients. Ann Plast Surg. 2001;47:404-411.
  18. Garcia C, Alamoudi H, Nakib M, et al. Alexandrite laser hair removal is safe for Fitzpatrick skin types IV-VI. Dermatol Surg. 2000;26:130-134.
  19. Handrick C, Alster TS. Comparison of long-pulsed diode and long-pulsed alexandrite lasers for hair removal: a long-term clinical and histologic study. Dermatol Surg. 2001;27:622-626.
  20. Yamauchi PS, Kelly PA, Lask GP. Treatment of pseudofolliculitis barbae with the diode laser. J Cutan Laser Ther. 1999;1:109-111.
  21. Greppi I. Diode laser hair removal of the black patient. Lasers Surg Med. 2001;28:150-155.
  22. Johnson F, Dovale M. Intense pulsed light treatment of hirsutism: case reports of skin phototypes V and VI. J Cutan Laser Ther. 1999;1:233-237.
  23. Goldberg DJ, Silapunt S. Histologic evaluation of a millisecond Nd:YAG laser for hair removal. Lasers Surg Med. 2001;28:159-161.
  24. Alster TS, Bryan H, Williams CM. Long-pulsed Nd:YAG laser-assisted hair removal in pigmented skin. Arch Dermatol. 2001;137:885-889.
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