Cosmetic Laser Procedures in Latin Skin

March 2019 | Volume 18 | Issue 3 | Supplement Individual Articles | 127 | Copyright © March 2019

Sheila Jalalat MDa and Eduardo Weiss MDa,b

aFlorida Hollywood Dermatology and Cosmetic Surgery Specialists, Hollywood, FL bDepartment of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL

Abstract
Hispanics/Latinos are one of the fastest growing segments in the skin of color population in the United States. Utilization of lasers especially in people with skin of color requires a thorough understanding of laser physics and laser tissue interactions. In this article, we will outline the different lasers used in our practice based on each chromophore. Pretreatment recommendations as well as management of complications will also be shortly discussed. Our goal is for the readers to grasp the importance of proper device selection, understand the concept of selective photothermolysis, and the various treatment parameters required for optimal safety and efficacy. J Drugs Dermatol. 2019;18(3 Suppl):s127-131.

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 historyFigure1Figure2