Patients should protect themselves
Kauvar further discussed this issue at the meeting during her presentation,
“Navigating Laser and Device Therapies in Skin of Color: Prevention and Management of Complications.”
This transcript has been slightly edited. subtitles were generated automatically.
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What are the most common complications you see when using lasers on patients of color?
The most common complications are probably hair removal because hair removal is such a common procedure. Could be related to poor laser selection. Certain wavelengths of light, those that are most strongly absorbed by melanin, such as an alexandrite laser, are not suitable for treating pigmented skin because the absorption is too great.
Another factor would be using the wrong parameters, so high energy. anything that increases the absorption of laser light can cause not only damage to the hair follicle but also damage to the epidermis and surrounding tissue. In particular, with hair removal lasers, your target is melanin or pigment. There is pigment in the hair follicle, but there is also pigment in the background skin. To protect this pigment, you want to use skin cooling.
Most of these lasers have some kind of cooling device, some that spray ice on the surface of the skin, called a cryogen, at the same time as a laser pulse. Others have what we call contact cooling. It is a cold tip and cools the skin as you heal.
When complications occur, what are your management strategies?
It depends on the complication. Most of the complications, fortunately, are temporary hyperpigmentation or hypopigmentation. In these cases, with hyperpigmentation, we usually give the patient a corticosteroid cream as well as hydroquinone or another bleach to even out the skin color. If there is scarring from a procedure, which is after the fact because you’ve damaged the tissue to the point where you have blisters or ulceration in an area, then you want to go to a resurfacing or resurfacing laser. Lasers that are very safe for skin of color are fractional non-ablative lasers.
Fractional non-ablative lasers, such as 1550 nm or 1565 nm, are lasers that create hundreds or thousands of small microscopic wounds in the epidermis and dermis. As the tissue heals itself, it replaces the damaged epidermis as well as the damaged dermis, so there is new collagen and a new epidermis. In this way, you can improve the scars. We use these lasers for all kinds of scars, not just to treat complications.
There is also another type of fractional, non-ablative laser with a wavelength of 1927 nm that is especially useful for staining. It’s a great option for all skin types, but what’s important when using these fractional lasers is to use a much lower density than you might on lighter skin types and increase the number of treatments. You want to cause less heating of the tissue because heat can stimulate melanin production or new pigment production and hyperpigmentation.
What role does patient education play in minimizing risks and setting expectations?
Patients need to know that the sun is their enemy, for all patients, not just those with skin color. When you have inflamed skin, it is much more prone to hyperpigmentation, so it is important for the patient to go through the procedure in their base skin color. In some cases, if they are at high risk, we will pre-treat them with skin bleaches such as hydroquinone or others and, in some cases, adding topical corticosteroid cream to minimize inflammation. We will also deal with them after the process for some time for the same reason.
Wearing sunscreen all the time and a natural sunscreen is best, before the procedure and afterwards, to protect against the ongoing effects of both visible and UV light. It turns out that it’s not just UV light that can stimulate pigmentation, but visible light as well. The only sunscreens that actually filter visible light are tinted sunscreens. Your best sunscreen to protect against hyperpigmentation or complications during a laser procedure is to use a tinted sunscreen.
