Skin of color is complex

Although many lasers have earned Food and Drug Administration (FDA) approval for treating patients of color, an expert says that physicians' expertise has yet to catch up with the technology available.

"About eight years ago," Eliot F. Battle Jr., M.D., says, "I realized there was a significant difference between what I could offer Caucasian patients and what I could offer people of color."

Since that time, he tells Dermatology Times, "We now have wonderful FDA-approved lasers that are colorblind for hair removal, collagen enhancement, skin rejuvenation, tattoo removal, acne and other treatments."

TECHNOLOGY DOES NOT EQUAL EXPERTISE

But in recent years, Dr. Battle says, many dermatologists have recognized a potential problem.

"Technology makes everybody think they can do it easily, but this technology must be combined with equal expertise," he explains.

For this reason, he says that for the past four years, he's delivered approximately 100 presentations annually on this topic.

Dr. Battle says that by the beginning of 2006's third quarter, he plans to start a "Cosmetic Therapy on Skin of Color" quarterly seminar series to help practitioners learn how to more safely and efficaciously treat their patients of color.

"Treating people of color requires not just knowledge of lasers and cosmetic therapies. It's also about learning the differences of brown skin, which reacts differently," Dr. Battle explains.

When one treats Caucasian skin, he says, there is no pigment competing for the laser's light. Therefore, he says, "For hair removal we can choose a wavelength of light that loves pigment. We choose as high a fluence as possible and set the pulse duration as short as possible because we're not worried about the skin color competing."

Treating skin of color demands the opposite approach, Dr. Battle says.

"We must choose a wavelength of light that likes - but doesn't love - pigment. This gives us the ability to change other parameters such as pulse duration to treat more safely." By applying the energy more slowly, he says, "Skin pigment still absorbs it, but it absorbs it more slowly."

This causes the skin to heat up more slowly, thereby making it easier and more efficient to remove heat from the skin, he adds.

Regardless of skin color, Dr. Battle says, "Side effects (including blistering and color changes) occur when the skin heats up past 45 degrees Celsius. So the key to treating pigmented skin and all skin colors safely is knowing how to keep the skin under 45 degrees Celsius."

In this regard, tools include lasers' built-in cooling systems, adjunctive coolers (such as blowers) and refrigerated gel. Similarly, he says that treating slowly helps maximize a laser's cooling capability, which one must supplement with post-treatment ice packs.

For hair removal in Caucasians, Dr. Battle recommends alexandrite (755 nm) and diode (800 nm to 810 nm) lasers.

"For patients of color," he says, "we use wavelengths that don't like pigment as much, such as the Nd:YAG (1,064 nm). The longer the wavelength, the less pigment absorption occurs."