INTRODUCTION
Defining Skin of ColorDefining skin of color in the Latino population can be particularly challenging as it encompasses several cultural and historical aspects. In general, skin of color identifies racial groups with darker skin hues other than that of white skin. The five racial categories defined by the U.S. Census Bureau are American Indian or Alaska Native; Asian; Black; Native Hawaiian or Pacific Islander; and White. The Hispanic population is estimated to rise from 55 million in 2014 to 119 million in 2060, an increase of 115 percent. By 2060, 29 percent of the United States is projected to be Hispanic—more than one-quarter of the total population.1 This increase in population becomes pertinent as it follows with an increase in demand by people with mixed color tones for dermatologic laser procedures. Most of the current medical literature on cosmetic laser procedures has been devoted to individuals with fair skin tones (Fitzpatrick skin phototypes <III). One study determined that the most common skin problems affecting this group are photoaging, facial melasma, hyperpigmentation, acne vulgaris, and eczema/contact dermatitis.2 The Latino population runs the gamut of Fitzpatrick phototypes and must be considered as a “one size does not fit all approach”. Several ways to define skin of color as well predict higher risk patients have been described. We will refer to the Fitzpatrick phototypes throughout the article. Although general skin tone color may provide a good prediction about the potential for hyperreaction to lasers, we also use a simple, yet effective additional screen in the office: palmar and digital crease pigmentation. First described by Hector G. Leal-Silva MD of the Institute of Dermatology and Cosmetic Surgery, Monterrey, Mexico, the screen divides patients into four groups, depending on the concentration of pigment present in their palmar creases (Figures 1 and 2). The palmar and digital crease color hue is a way to predict the propensity of various Fitzpatrick phototypes to experience post-inflammatory hyperpigmentation. The scale ranges from 0 to 3, with the highest number indicating a darker skin tissue response despite skin phototype.3 In general, a provider must be cognizant of their patients with mixed color tone in order to properly consult and discuss realistic expectations as well of potential risks.Pretreatment Safe treatment starts with a thorough pretreatment. We believe it is better to avoid laser procedures during the summer, when skin is at its darkest and there is a higher risk for sun exposure after treatment. A thorough history is obtained including history
