LAS VEGAS The way Dr. Eliot F. Battle Jr. sees it, dermatologists should learn how to treat skin of color with cosmetic laser therapy for two reasons: to increase their revenue base as the world's population of brown-skinned individuals expands, and to improve their proficiency with operating lasers.
"You will never become an expert with lasers if you can't treat brown skin," Dr. Battle said at the annual meeting of the International Society for Dermatologic Surgery. "You have to embrace skin types IV-VI, for through this expertise we improved our ability to treat noninvasively and to treat tanned skin."
His Washington, D.C.-based practice is 37% African American, 27% white, 12% Hispanic, 8% Asian Pacific, 6% Asian, and 10% "other." Three of the top four nonsurgical procedures are laser hair removal, laser complexion blendingwhich he described as "evening out skin tone"and laser skin tightening. (Botulinum toxin type A rounds out the top four.)
"We are going through an exciting time to treat skin of color, for we have more ammunition than ever to safely and effectively treat people of color in all areas of skin care, including cosmeceuticals, prescription medicines, aesthetic spa treatments, cosmetic laser treatments, and plastic surgery procedures," said Dr. Battle, a cosmetic dermatologist and laser surgeon.
In light-skinned individuals, melano-somes are small, and are packaged together in membranes. They remain around the basal layer of the epidermis.
In skin of color, melanosomes are more numerous, and are individually dispersed throughout all layers of the epidermis. Skin type VI patients can have melanin even in the stratum corneum. Some dermatologists "don't understand the genetic influence on melanin" Dr. Battle said, and deem darker ethnic skin as more difficult to treat with laser therapy.
Treating skin of color requires mastery of wavelengths, fluence, pulse duration, and cooling, said Dr. Battle, who is also on the faculty of the department of dermatology at Howard University, Washington.
Laser hair removal is especially effective in skin of color because black, coarse hair is an optimal target for the laser beam. "In [whites], hair removal is vanity because conventional methods such as shaving, waxing, and plucking work," Dr. Battle said. "People of color get dark spots from all of those methods."
Thermal side effects after laser therapy occur in skin of color when the skin temperature exceeds 45° C, so Dr. Battle maximizes cooling by using cold gel, slow treatments, ice packs post treatment, and cold air flow. "Be afraid of erythema," he warned. "In [whites] erythema resolves, but people of color get hyperpigmentation and redness. If you are going to do test spots, wait 48 hours for results. You can get blisters up to the second and third day after treatment."
If side effects do occur, be compassionate and empathetic and employ meticulous wound care. "Always be available to the patient," he advised. "Provide them with your cell phone number."
Dr. Battle disclosed having no conflicts of interest relevant to his presentation.
A patient is shown before (above) and 2 years after (below)undergoing nine laser hair removal sessions.
Hair removal is very effective in darker skin because black, coarse hair is an optimal target for the laser beam. Photos courtesy Dr. Eliot F. Battle Jr.