Considerations for cosmetic appliances for colored skin

Technologies ranging from microneedling to picosecond domain lasers provide new solutions for treating dermatoses of colored skin, said Monica Li, MD, in her presentation on Aesthetic Considerations in Patients of Color at the American Academy of Dermatology (AAD) Virtual Meeting Experience (VMX).1

“This is an important topic as patient and population demographics in North America change,” said Li, clinical instructor in dermatology and skin sciences at the University of British Columbia in Vancouver, in Canada.

The AAD recently released statistics advocating proper skin care for all skin colors, based on the US Census Bureau’s prediction that by 2044, no racial group will dominate the population.2.3

“This trend in real-world clinical practice calls for greater knowledge, skill and management by dermatologists to better meet the aesthetic dermatological needs of those with darker skin phototypes,” Li said. As increasing numbers of patients of color come to our dermatology practices, clinicians must also appreciate the differences in patient needs, outcomes, and management approaches compared to lighter skin types. This recognition requires awareness and education. “

These pigmentary skin conditions include melasma, benign epidermal and pigmented skin lesions, as well as common conditions such as post-inflammatory hyperpigmentation (PIH) and stretch marks.

As with any patient, regardless of skin tone, a thorough and complete history is necessary. “This includes a history of PIH or keloid scarring due to other treatments or skin conditions,” Li said. “By being aware of these complications, clinicians can implement strategies to try to prevent them by first place.”

Li does not believe that there is a specific device for preferential use in colored skin; however, awareness of an increased risk of certain adverse events (AEs) in this population, such as HIP, is crucial. “Patients who [are at] the risk of PIH must be very strict regarding sun protection and avoidance at least 1 month before treatment, ”she said.

Microneedling is relatively safer to use on darker skin tones. “This collagen induction therapy has been shown to be safe and effective for all skin types for scars and streaks,” Li said.

According to Li, picosecond domain lasers have achieved positive results in safety in colored skin. “These lasers produce more of a photomechanical effect than a photothermal effect that is traditionally provided by previous generations of lasers,” she said. “A more photoacoustic effect reduces heat energy input to the target site and surrounding skin, potentially reducing the risk of dyspigmentation.”

In addition, radiofrequency (RF) technologies and high intensity focused ultrasound (HIFU) can benefit patients of color when used under the right circumstances. “But these two treatment modalities used in isolation often don’t necessarily target pigment problems or scarring because of their different mechanisms of action,” Li said. “There can also be different treatment techniques when it comes to it. to treat colored skin. ”

Recent technological advances show that fractional lasers could also be safe for this population, if used with care. “However, this requires more advanced knowledge and experience, as fractional lasers provide thermal energy,” Li said. “Overly assertive contexts can lead to undesirable results.”

Most lasers and other light-based devices require longer intervals between treatments for colored skin than those with lighter skin phototypes: every 6 to 8 weeks vs. 3 to 4 weeks, respectively. “This ensures that there is no residual inflammation that can lead to unwanted effects like PIH,” Li said.

To increase the safety of various cosmetic modalities, Li recommends testing for potential AEs using small spot treatments before proceeding with the entire face, neck, or chest.

“You should also be more careful with the treatment settings,” she said. “It’s always okay to start low and go slow, to hopefully prevent or at least curb some of the unwanted events. If they do occur, they may be less intense. “

For laser systems, larger dot sizes and lower fluences are generally recommended.

Recognizing AEs early is important, “so if they do occur, management is started as soon as possible,” Li said. “For example, we know that PIH usually occurs between week 3 and week 4 afterwards. a treatment. Therefore, timely follow-up is necessary. “

Treating immediate post-treatment inflammation with topical medications can reduce HIP, as well as topical skin lightening agents.

“In the future, I hope for more clinical trials and more research and development into evolving technologies and devices that can be used safely and effectively across the skin spectrum,” Li said. . “More importantly, increased knowledge and experience among colleagues will ultimately improve aesthetic skin care for patients with light and dark skin.”


Li is a consultant and speaker for Candela Medical.

The references:

1. Li M. Let There Be Light: Aesthetic Considerations in Ethnic Skin Using Lasers and Devices. Presented at the 2021 American Academy of Dermatology Virtual Meeting Experience (AAD VMX) Annual Meeting; April 23-25, 2021 (virtual).

2. Taylor, SC. Boot Camp Colored Skin: What Every Dermatologist Should Know About the Dark Skin Patient. Presented at the 2018 American Academy of Dermatology 2018 Annual Meeting; February 16-20, 2018, San Diego, California.

3. Colby S, Ortman J. US Census Bureau Report No. P24-1143. US Population Size and Composition Projections: 2014 to 2060. March 3, 2015. Accessed April 12, 2020. / p25-1143.pdf

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