Laser treatment for acne scarring in skin of color requires adequate parameters
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Key takeaways:
- Post-inflammatory hyperpigmentation is a concern when treating skin of color with lasers.
- Using high energy, low density parameters and proper counseling can reduce these risks.
CHICAGO — With proper counseling and parameters, aggressive acne scarring treatments can be used in patients with skin of color, according to a speaker at the American Society for Dermatologic Surgery Annual Meeting.
“It’s really important for us to remember the differences in the skin composition that exists within our skin of color patients,” DiAnne S. Davis, MD, FAAD, a board-certified dermatologist practicing in Dallas, said during her presentation. “You want to ensure that you’re assessing their overall skin quality, degree of oiliness that they have and also remembering the wide absorption spectrum that melanin has.”
The use of lasers to treat acne scarring can lead to dyschromia or post-inflammatory hyperpigmentation (PIH), which practitioners need to be extra mindful of in patients with skin of color.
Using the correct tools and fully counseling a patient about risks and aftercare, however, can help to reduce the risks for these effects.
“You want to make sure you’re having this full transparency with your patients, assessing how much this is affecting their quality of life so you can really guide your treatment options to what you think would be best tailored,” Davis said.
This counseling includes gathering a thorough genetic and scarring history, getting acne under control and following strict compliance with SPF use prior to care.
During treatment, the most important consideration is density, especially if using fractionated lasers.
Multiple studies have found that higher energy and lower density settings reduced the risk PIH patients with skin of color. However, there may still be some throughout the healing process of which the patient should be made aware.
“The lowest amount of density or a decreased amount of density is going to work best in minimizing the risk of PIH,” Davis said.
Additionally, the use of larger spot sizes, avoiding bulk heating and using pre- and post-cooling techniques will also help to reduce hyperpigmentation.
After treatment, complete sun avoidance is crucial and topical corticosteroids can be used.
“You can treat your skin of color patients,” Davis said.
“If they’re coming to you looking for options, you can do a lot of these aggressive procedures. ... You just have to be very mindful,” Davis continued. “You want to be mindful of the adequate parameters, you want to be very mindful of the counseling you can do ... and also making sure they’re following your post-procedure protocol.”
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Davis DS. Practical pearls and tips for treating acne scars in skin of color. Presented at: American Society for Dermatologic Surgery Annual Meeting; Nov 1-5, 2023; Chicago.
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