Laser Treatment of Skin of Color for Medical and Aesthetic Uses With a New 650-Microsecond Nd:YAG 1064nm Laser

April 2019 | Volume 18 | Issue 4 | Supplement Individual Articles | 135 | Copyright © April 2019


Wendy E. Roberts MD,a Michelle Henry MD,b Cheryl Burgess MD,c Nazanin Saedi MD,d Suneel Chilukuri MD,e Dr. Arusha Campbell-Chambers MBBS MScf

aGenerational and Cosmetic Dermatology, Rancho Mirage, CA bLaser & Skin Surgery Center of New York, New York, NY cCenter for Dermatology and Dermatologic Surgery, Washington, DC dDepartment of Dermatology, Thomas Jefferson University, Philadelphia, PA eRefresh Dermatology, Houston, TX fDermatology Solutions, Skin Body & Mind Clinic & Institute, Montego Bay, Jamaica

Abstract
Individuals with skin of color are a rapidly growing portion of the cosmetic procedures market. There are unique challenges to treating skin conditions in skin of color patients. This article and roundtable discussion focus on the use of energy-based modalities, particularly a 650-microsecond 1064nm laser that delivers energy in a collimated beam. Alone or in combination with other therapies, the 650-microsecond 1064nm laser has been used successfully to treat melasma, acne, postinflammatory hyperpigmentation, pseudofolliculitis barbae, hair removal, acne keloidalis nuchae, and aging skin in skin of color.

J Drugs Dermatol. 2019;18(4 Suppl 1):s135-137.

INTRODUCTION

Individuals with skin of color (SOC) are among the most rapidly growing portion of the cosmetic procedures market.1 In 2016, SOC individuals received 24.5% of total cosmetic procedures compared to 22% in 2014 and 15% in 1997.1,2 SOC denotes people of Fitzpatrick skin types IV through VI. Worldwide, these groups include Asians, Latinos, Africans, African-Americans, Afro-Caribbeans, Native Americans, Middle Easterners, Pacific Islanders, Alaskan natives, Native Hawaiians, and Mediterraneans.3

Lasers in Skin of Color

In SOC patients, medical and aesthetic skin conditions have been treated with limited success using topical or systemic therapies. These disorders are also difficult to treat with light-based therapy due to significant risks of treatment pain, epidermal burns, hypo- or hyper-pigmentation, and scarring. These complications have a higher risk in persons of mixed ethnicities such as the blond, blue eyed Native American or Latina. The Roberts Skin Type Classification System4 in the Table is a way to identify patients who are at risk and to document scarring and dyspigmentation risk in concert with Fitzpatrick and Glogau scales.5 Phys icians continue to search for a go-to device to safely and effectively treat skin conditions in SOC patients.Such a device is the 650-microsecond 1064nm laser (LightPod Neo®, Aerolase Corp., Tarrytown, NY) with a collimated beam of light. With this device, practitioners can safely treat important conditions such as acne, melasma, pseudofolliculitis barbae, and even psoriasis in SOC patients. They can also remove hair and rejuvenate skin. The procedure is rapid and sanitary because the handpiece does not touch the skin during treatment.

The 650-Microsecond 1064nm Laser

The 650-microsecond Nd:YAG 1064nm laser has been introduced for hair removal and the treatment of PFB in SOC.6 This laser is unique because (1) its 650-microsecond pulse duration permits pain-free treatment of SOC without skin cooling or anesthetic and (2) it delivers energy in a collimated beam, permitting the operator to vary handpiece-to-skin distance without altering the fluence, thus enhancing both efficacy and safety during treatment. With these features, the 650-microsecond 1064nm laser is more repeatable, safer, and less dependent on operator technique. Initially used primarily in hair removal with SOC, the technology proved to be as effective and safe as other hair removal modalities such as diode and alexandrite while achieving high patient satisfaction in a large survey of 298 hair removal patients.7,8 This laser device has since been used to treat onychomycosis,9 facial telangiectasias,10 acne vulgaris,11 and hyperpigmentation12 in SOC, all without cooling or anesthesia.The pulse duration of conventional 1064nm lasers is 5 to 30 milliseconds, much greater than the 700-microsecond thermal relaxation time of skin tissue.9,13 Pulse durations of this mag