Tailored Laser and Light-Based Therapies for Acne, Skin of Color, and Inflammatory Conditions

Sophia Reed, MD, FAAD

In a recent Dermatology Times Expert Perspectives custom video series, “Advancing Care With Laser and Light-Based Technology in Dermatology,” Sophia Reid, MD, FAAD; Cheri Frey, MD; Cheryl Burgess, MD, FAAD; Karan Lal, DO, MS, FAAD; and Corey Hartman, MD, FAAD, discussed the role of these therapies in managing various skin conditions, highlighting customized treatment protocols and combination approaches for optimal patient outcomes.

Integrating Therapies for Comprehensive Acne Care

Reid, founder of Skin Secrets Dermatology in Park Ridge, New Jersey, emphasized the value of integrating laser and light-based therapies into acne management. According to Reid, these technologies cater to increasingly informed patients seeking alternatives to antibiotics and topical treatments.

“We know that they’re safe and effective for patients, and it doesn’t compromise or make them concerned about any potential side effects down the road,” she said, adding that such therapies alleviate concerns about long-term adverse effects from traditional medications.

Reid highlighted the versatility of laser treatments by companies such as Aerolase for addressing acne of various severities and forms. “Any stage of acne can actually be treated with a laser or light therapy,” she explained.

Aerolase devices, in particular, suit all skin types and minimize pretreatment restrictions, Reid noted. Patients often see improvements in acne, scarring, and hyperpigmentation by the second or third session, with noticeable boosts in confidence as their skin clears. The devices’ compatibility with chemical peels and topical regimens enhances outcomes further, making them integral in Reid’s practice.

Customized Consultations and Skin Care Planning

Frey, a dermatologist in Washington, DC, emphasized the importance of personalized consultations for patients with chronic skin conditions such as rosacea.

“We do have to be worried about sensitivity or rebound erythema in any treatment, whether it’s a laser treatment or a topical treatment, because conditions like rosacea are chronic,” she explained. To achieve successful outcomes, Frey prioritizes thorough consultations that address patients’ goals, expectations, and skin care routines. This includes evaluating their history while considering treatments, upcoming events, and current photoprotection measures.

For patients undergoing laser procedures, Frey focuses on minimizing complications through education and careful preparation. “We want to make sure that patients don’t have tan skin when they come in for their laser procedures,” she noted.

Optimizing Care for Skin of Color

Burgess, a dermatologist in Washington, DC, emphasized the importance of tailoring laser and energy device treatments for patients with skin of color. As unique parameters and fluences are required for Fitzpatrick skin types IV to VI, standard manufacturer protocols often fall short. She stressed the value of test spots to assess skin response and minimize adverse events, particularly for hyperpigmentation and acne scars.

When addressing scarring, including acne and surgical scars, Burgess combines advanced techniques such as microneedling, fractional lasers, and resurfacing to achieve optimal results. Acknowledging the complex mix of scar types in most patients, she tailors treatments to the depth and texture of the scars. For stretch marks, she advises realistic expectations, as no treatment fully removes them.

Burgess also champions combining multiple procedures in 1 session to enhance outcomes, such as using a 650-microsecond laser alongside chemical peels or microneedling. These techniques not only treat specific conditions such as acne but also stimulate collagen and improve skin clarity and texture.

Hartman, a dermatologist based in Birmingham, Alabama, emphasized the importance of laser therapy for patients with skin of color. As the founder and medical director of Skin Wellness Dermatology, Hartman explained that although topical therapies and chemical peels can be useful for managing pigment, advanced lasers, such as the Nd:YAG lasers, are essential for treating deeper pigmentation issues in melanated skin.

In his practice, the Aerolase Neo Derm device has become a go-to tool due to its ability to safely and effectively address conditions such as melasma and postinflammatory hyperpigmentation, which are prevalent in patients with darker skin. This device’s ability to differentiate between epidermal and dermal pigment, combined with its minimal downtime and patient comfort, sets it apart from other treatments, he said.

Hartman also discussed the importance of adjusting laser settings for patients with more melanated skin, stressing the need to be cautious with energy delivery to avoid overheating the skin, which can lead to unwanted adverse effects such as hyperpigmentation or hypopigmentation.

“If we rush to treatment and rush the energy, that can cause outcomes that are not what any of us want to happen,” he said.

Insights on Eczema, Psoriasis, Vitiligo, and Beyond

Lal, an adult, pediatric, and cosmetic dermatologist based in Scottsdale, Arizona, highlighted the utility of phototherapy, particularly narrowband UV-B devices, in managing inflammatory skin diseases such as psoriasis, eczema, and vitiligo.

Narrowband UV-B, with its specific wavelength range of 308 to 311 nm, is effective in reducing skin inflammation while minimizing skin cancer risks. This makes it suitable for patients taking photosensitizing medications or those who have higher cancer susceptibility, Lal noted.

Lal emphasized the tailored approach required for different conditions, from determining the minimal erythema dose in patients with psoriasis to leveraging repigmentation benefits in those with vitiligo.

“If you’re seeing redness 24 hours after, you know you’re at a good dose, and you stay on that dose until the redness goes away and is not as prevalent at 24 hours. Then you increase your threshold,” Lal said.

He noted the importance of patient access, motivation, and financial considerations in phototherapy, as devices are increasingly less available outside academic centers.

Conclusion

Incorporating laser and light-based technologies into dermatologic care offers versatile, effective options for managing diverse skin conditions across all skin types. By tailoring treatments to individual patient needs, clinicians can optimize outcomes and enhance confidence.