Exchanging Clinical Information and Treatment Protocols about Treating Skin of Color. Skin Types IV - VI. East Asian. African-American. South Asian (Indian). Middle East. Latin. South American. Mediteranean. How they differ from skin types I - III and how they differ from each other.

How do you treat African-Americans with PIH from Acne? Is anyone using the Laser Genesis 1064 from Cutera along with Hydroquinoine?

How are people treating Black Papules under the Eyes of African-Americans and Asians?

The actor Morgan Freeman has many of these. They are called _________.

A few doctors who I have spoken to treat them differently. The challenge is to remove the papule without causing PIH and scarring.

One doctor does it with a "gentle" curette and another does it with a laser. Let's discuss. I will post the name of the papules shortly (I have to look it up on Google).

Dermatosis papulosa nigra (DPN) is a benign cutaneous condition common among blacks. It is usually characterized by multiple, small, hyperpigmented, asymptomatic papules on the face of adult blacks. Histologically, DPN resembles seborrheic keratoses. The condition may be cosmetically undesirable to some patients.

I was just sent an article by MedSpaGuy. It talks about treating DPN with long pulsed 1064 ND:Yag. Single treatment. 3 mm spot size, 145-155 mj, 20 ms, double pulse. Clinical endpoint: popping sound and plumb of smoke.

Journel of Cosmetic and Laser Therapy. 2008. May. Eric Schweiger, et al

I have also heard that Q Switched Alex is a good way to treat.
Also heard about long pulsed 532 (KTP? Diode?)

Need to do test spots and be careful of PIH and scarring.

Is anyone treating DPN with laser? How is it working out? What laser do you use and what settings?

I have a very small black community where i am at but have talked to others that are using the Ellman Surgitron radiofrequency unit with excellent results.

Medscape: Are there any special concerns to take into consideration when using those nonsurgical products on persons of color?

Dr. Few: The main concern -- and this is the subject of a research project that I published -- centers around where the product is placed. In somebody who has darker skin, it's much more important to place, for example, hyaluronic acid products, such as Restylane and Juvéderm, in the mid layer of the dermis, as compared with somebody who has fairer skin, where you're trying to put the product more superficially in the dermis The study showed that the use of Restylane in people with darker skin was as safe and effective as in people with fair skin.[1] In addition, we showed the importance of minimizing the number of needle punctures to the skin, in order to limit the risk of hyperpigmentation. There were subtle points emphasized, such as the use of ice before and during treatment, the use of hydrogen peroxide instead of alcohol to clean the skin, and pretreating darker skin with skin-bleaching agents. Ultimately, the most critical point is placing the product in the mid-to-deep dermis.

Medscape: Why is that?

Dr. Few: If products are placed too shallowly in more darkly pigmented skin, the top surface of the skin can become irritated and actually even cause that skin to lift off. And then you get discoloration or hyperpigmentation.

Medical spa patients with non-Caucasian skin represent a largely untapped market for aesthetic treatments. Many potential patients are still being told that they cannot get laser or light-based treatments because of their skin type.

Over one half ofthe world is brown-skinned. Imagine turning someone away from your practice because you can’t treat that skin type, when we have safe lasers that can treat the darkest Indian and African skin safely. You will never become an expert if you can’t treat brown skin. Dr Fitzpatrickdevised his skin typing system of I-VI, with one (I) being your Scandinavian, blue-eyed person and six (VI) being as dark as you can get. Three or four through to six are the skin types that require attention and care. With the right technology and proper techniquewe can treat all skin typesas safely and effectively as we can Caucasian skin (I and II).

People with colored skin have a thicker stratum corneum, and their fibroblast cells are much more robust. That is why, with skin tightening, people with darker skin can get better results with less energy (fluence). It is important to understand the difference betweendark skin andethnicity.If youhad five peopleand one was anIndian (from India), one was African American, one Korean, one Japanese, and one was Brazilian, and they all had the same skin color, you wouldn’t be able totell the difference. But if you treated them with the samelasers, with the same settings, the same chemicals , and cosmeceuticals,you would get five totally different results.

It’s not skin color we treat, it is the ethnicity and all hereditary background that comes with it!

Intense pulsed light (IPL) and laser devices, which target epidermal melanin, work well on fair Caucasian skin. However, since darker skin has more melanin than light skin, the risk of epidermal damage is higher. The dermis houses the blood vessels, hair follicles, sebaceous glands and fibroblasts, so the ideal device is one that can deliver energy to the dermal layer without damaging the epidermis.

When traditional devices are used on non-Caucasian skin, post-inflammatory hyperpigmentation (PIH) in the epidermis is the most common adverse effect. If the PIH is deep enough, it may become permanent. Even now, patients with non-caucasian skin treated with less invasive and less aggressive fractional devices experience PIH and erythema. Scarring and keloids may result from more aggressive treatments. One solution is to modify treatment settings to minimise possible adverse effects. When we do this, however, we risk reducing efficacy and wasting patients’ time and money.

Heavily filtered IPL and Nd:YAG lasers can besafely used on darker skin types.In cases of low light tolerance lasers can be combined with abipolar radiofrequency (RF) energy for a more effective treatment of non-Caucasianskin.

Jeff B
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Jeff: I have always been curious about the reason WHY the darker skin types (i.e., Fitz IV and V) are more prone to PIH with laser skin resurfacing than the lighter skin types. I have heard that the reason is not because darker skin types have MORE melanocytes but rather has something to do with ACTIVATION or stimulation of their melanocytes. Has anyone seen any published articles addressing this issue? I am also curious about the difference between "permanent" skin color vs. sun tanned skin and the skin tolerance for various levels of photon application (taking into consideration wavelength, fluence and pulse duration). I have always found tan skin to be even more of a problem that a "natural" skin tone of approximately the same shade.

RON
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Great points, Ron.
At last year's ASLMS I attended the Skin of Color Course (4 hours). It was GREAT!
Anyone serious about Laser Skin Care needs to go to the ASLMS Meeting in April.
It is THE BEST way to learn and THE BEST CONFERENCE!
I will be there again this year and I will be at the Skin of Color Course hoping to learn more.
Just my opinion.

Jeff E.
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What a great topic. For years I have always asked the following questions without a decent response back

Why is it that a person that is a skin type two that tans to a skin type three has a much different reaction to laser than a person that is always a skin type three? Are the melanocytes more superficial in the tanned person and thus more prone to interaction with the laser energy?

Any feedback would be greatly appreciated

Mike
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I believe it is the quick and extreme "heat" delivered to the melanocytes that result in PIH. This is why it is safer to use longer pulse duration or lower fluency with pulse stacking in ethnic skin people. One more caveat is to use cortisone cream right after treatment to minimize heat-related inflammation.
One precaution in Asian women, their "outward skin appearance" might be "white" (mostly due to persistent and fanatic use of whitening cream thruout their life) their FST should always be considered at least IV or higher

Kevin
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In reply to the DPN question, in my opion the Q switched alex is the best alternative on the market. I use it daily for all skin types and rarely have any issue at all. Most popular setting 3mm 6-7joules, but can use a 2mm spot at higher setting as well. The Q switched Yag is not as effective.

Hello. I am hoping for medical advice and or a referral.

I am a 43yo African American female (Fitz chart 3-4, about the complexion of actress Nia Long) with facial hyperpigmentation developed in 1998. The spots are on the apples of my cheeks, each about the size of a silver dollar, and a strip across my forehead approx 1 1/2 inches by 3 inches. I believe the cause was a combination of doxycycline, anthrax vaccine, and a 6-week stint in Saudi Arabia during July-August.

Several years ago, I started trying to find a dermatologist in the Washington DC area, but gave up after several initially good phone consulations ended abruptly when I stated I was darker complected. The receptionists said the doctor's don't work on darker skin - period.

There have been a lot of advances since then I think. I have been reading medicalspamd regarding laser surgery and types of lasers to use on people of color (mostly on the page asking about comparisons between laser systems), but have seen precious few actual medical responses to the pleas for help. And I really haven't seen anyone with my "chemical photosensitivity phototoxic reaction" (terminology courtesy of internet research).

I would really appreciate some suggestions on (1) appropriate doctors in the Tampa area (2) who have experience with darker skin tones and (3) questions to ask when I find a doctor.

Finally, I would like to encourage doctors to get more familiar with darker pigmented skin and appropriately providing sound medical care. Thanks for your time, and any help you can provide.

P.S. Please contact me at giacromer@yahoo.com. Thank you.