Abstract
The growing diversification of the patient population coupled with the increasing demand for cosmetic laser rejuvenation has highlighted the need to develop cutaneous laser systems and establish treatment protocols for patients with a wide range of skin conditions and phototypes. Recent technologic advancements have provided viable treatment options to achieve clinical outcomes that were previously only attainable in patients with lighter skin tones. This review provides an updated discussion of the range of laser treatments available for pigmented skin and sets the stage for further advancements.
Pigment-specific laser technology with green, red, or near-infrared light targets a variety of pigmented lesions such as lentigines, ephelides, café-au-lait macules, and melanocytic nevi as well as tattoos and unwanted hair. Short-pulsed alexandrite, ruby, and neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers are used for pigmented lesions and tattoos, whereas their longer pulse-width laser counterparts are used for laser-assisted hair removal. Vascular lesions and hypertrophic scars can be treated with a variety of vascular-specific lasers, but it is the pulsed dye laser (PDL) that has long been the gold standard treatment for these lesions due to its high specificity for hemoglobin and its ability to improve skin surface texture in children and adults.
Laser skin resurfacing techniques for photodamaged skin and atrophic scars have been optimized with fractional technology to produce excellent clinical outcomes and minimal complication risks. Radiofrequency and nonablative lasers are also used to provide skin tightening and collagen remodeling with virtually no postoperative recovery.
Similar content being viewed by others
References
American Society for Aesthetic Plastic Surgery. Survey data 2008 [online]. Available from URL: (http://www.plasticsurgery.org/Media/PressReleases/CosmeticProceduresUpInAllEthnicGroupsExceptCaucasiansIn2008.html) [Accessed 2010 Feb]
American Society for Dermatologic Surgery. Procedure survey data 2007 [online]. Available from URL: (http://www.asds.net/TheAmericanSocietyforDermatologicSurgeryReleasesNewProcedureSurveyData.aspx [Accessed 2010 Feb]
2008 US Census Bureau. An older and more diverse nation by mid-century [online]. Available from URL: (http://www.census.gov/Press-Release/www/releases/archives/population/012496.html) [Accessed 2010 Feb]
Macedo O, Alster TS. Laser treatment of darker skin tones: a practical approach. Dermatol Ther 2000; 13: 114–26
Alster TS, Tanzi EL. Laser surgery in dark skin. Skin Med 2003; 2: 80–5
Tanzi EL, Alster TS. Cutaneous laser surgery in darker skin phototypes. Cutis 2004; 73: 21–30
Bhatt N, Alster TS. Laser surgery in dark skin. Dermatol Surg 2008; 34: 184–95
Anderson RR. Laser-tissue interactions in dermatology. In: Arndt KA, Dover JS, Olbricht SM, editors. Lasers in cutaneous and aesthetic surgery. Philadelphia (PA): Lippincott-Raven, 1997: 28
Tanzi EL, Lupton JR, Alster TS. Review of lasers in dermatology: four decades of progress. J Am Acad Dermatol 2003; 49: 1–31
Tse Y, Levine VJ, McClain SA, et al. The removal of cutaneous pigmented lesions with the Q-switched ruby laser and the Q-switched neodymium: yttrium-aluminum-garnet: a comparative study. J Dermatol Surg Oncol 1994; 20: 795–800
Kono T, Manstein D, Chan HH, et al. Q-switched ruby versus long-pulsed dye laser delivered with compression for treatment of facial lentigines in Asians. Lasers Surg Med 2006; 38: 94–7
Chan HHL, Kono T. The use of lasers and intense pulsed light sources for the treatment of pigmentary lesions. Skin Ther Lett 2004; 9: 5–7
Sadighha A, Saatee S, Muhaghegh-Zahed G. Efficacy and adverse effects of Q switched ruby laser on solar lentigines: a prospective study of 91 patients with Fitzpatrick skin type II, III and IV. Dermatol Surg 2008; 34: 1465–8
Ueda S, Isoda M, Imayama S. Response of naevus of Ota to Q-switched ruby laser treatment according to lesion colour. Br J Dermatol 2000; 142: 77–83
Chan HH, Ying SY, Ho WS, et al. An in vivo trial comparing the clinical efficacy and complications of Q-switched 755-nm alexandrite and Q-switched 1064-nm Nd:YAG lasers in the treatment of nevus of Ota. Dermatol Surg 2000; 26: 919–22
Alster TS, Williams CM. Treatment of nevus of Ota by the Q-switched alexandrite laser. Dermatol Surg 1995; 21: 592–6
Kono T, Nozaki M, Chan HH, et al.Aretrospective study looking at the longterm complication of Q-switched ruby laser in the treatment of nevus of Ota. Lasers Surg Med 2001; 29: 156–9
Kunachak S, Leelaudomlipi P, Sirikulchayanonta V. Q-switched ruby laser therapy of acquired bilateral nevus of Ota-like macules. Dermatol Surg 1999; 15: 938–41
Lam AY, Wong DS, Lam LK, et al. A retrospective study on the efficacy and complications of Q-switched alexandrite laser in the treatment of acquired bilateral nevus of Ota-like macules. Dermatol Surg 2001; 27: 937–42
Kunachak S, Leelaudomlipi P. Q-switched Nd:YAG laser treatment for acquired bilateral nevus of Ota-like maculae: a long-term follow-up. Lasers Surg Med 2000; 26: 376–9
Polnikorn N, Tanrattanakorn S, Goldberg DJ. Treatment of Hori’s nevus with the Q-switched Nd:YAG laser. Dermatol Surg 2000; 26: 477–80
Ee HL, Goh CL, Chan ES, et al. Treatment of acquired bilateral nevus ofOtalike macules (Hori’s nevus) with a combination of the 532-nm Q-switched Nd:YAG laser followed by the 1064-nm Q-switched Nd:YAG laser is more effective: prospective study. Dermatol Surg 2006; 32: 34–40
Chan HH, Leung RS, Yng SY, et al. Recurrence of nevus of Ota after successful treatment with Q-switched lasers. Arch Dermatol 2000; 136: 1175–6
Park MJ, Tsao H, Tsao S. Acquired bilateral nevus of Ota-like macules (Hori nevus): etiologic and therapeutic considerations. J Am Acad Dermatol 2009; 6: 88–93
Salem A, Gamil H, Ramadan A, et al. Melasma: treatment evaluation. J Cosmet Laser Ther 2009; 11: 146–50
Lee HS, Won CH, Lee DH, et al. Treatment of melasma in Asian skin using fractional 1550-nmlaser: an open clinical study. Dermatol Surg 2009; 35: 1499–504
Kundu RV, Joshi SS, Suh KY, et al. Comparison of electrodesiccation and potassium titanyl-phosphate laser for treatment of dermatosis papulosa nigra. Dermatol Surg 2009; 35: 1079–83
Kilmer SL. Laser treatment of tattoos. In: Alster TS, Apfelberg DB, editors. Cosmetic laser surgery: a practitioner’s guide. 2nd ed. New York: Wiley- Liss, 1999: 289–303
Alster TS. Q-switched alexandrite (755-nm) laser treatment of professional and amateur tattoos. J Am Acad Dermatol 1995; 33: 69–73
Grevelink JM, Duke D, van Leeuwen RL, et al. Laser treatment of tattoos in darkly pigmented patients: efficacy and side effects. J Am Acad Dermatol 1996; 34: 653–6
Jones A, Roddey P, Orengo I, et al. The Q-switched Nd:YAG laser effectively treats tattoos in darkly pigmented skin. Dermatol Surg 1996; 22: 999–1001
Chang SE, Choi JH, Moon KC, et al. Successful removal of traumatic tattoos in Asian skin with a Q-switched alexandrite laser. Dermatol Surg 1998; 24: 1308–11
Nanni CA, Alster TS. Complications of laser-assisted hair removal using Q-switched Nd:YAG, long-pulsed ruby, and long-pulsed alexandrite lasers. J Am Acad Dermatol 1999; 41: 165–71
Chana JS, Grobbelaar AO. The long-term results of ruby laser depilation in a consecutive series of 346 patients. Plast Reconstr Surg 2002; 110: 254–60
Lu SY, Lee CC, Wu YY. Hair removal by long-pulse alexandrite laser in Oriental patients. Ann Plast Surg 2001; 47: 404–11
Garcia C, Alamoudi H, Nakib M, et al. Alexandrite laser hair removal is safe for Fitzpatrick skin types IV-VI. Dermatol Surg 2006; 26: 130–4
Handrick C, Alster TS. Comparison of long-pulsed diode and long-pulsed alexandrite lasers for hair removal: a long-term clinical and histologic study. Dermatol Surg 2001; 27: 622–6
Chan HH, Ying SY, Ho WS, et al. An in vivo study comparing the efficacy and complications of diode laser and long-pulsed neodymium:yttriumaluminum- garnet (Nd:YAG) laser in hair removal among Chinese patients. Dermatol Surg 2001; 27: 950–4
Yamauchi PS, Kelly PA, Lask GP. Treatment of pseudofolliculitis barbae with the diode laser. J Cutan Laser Ther 1999; 1: 109–11
Greppi I.Diode laser hair removal of the black patient. Lasers Surg Med 2001; 28: 150–5
Alster TS, Bryan H, Williams CM. Long-pulsed Nd:YAG laser-assisted hair removal in pigmented skin. Arch Dermatol 2001; 137: 885–9
Trelles MA, Urdiales F, Al-Zarouni M. Hair structures are effectively altered during 810nm diode laser hair epilation at low fluences. J Dermatol Treat 2009; 1: 1–4
Nanni CA, Alster TS. Laser-assisted hair removal: optimizing treatment parameters to improve clinical results. Arch Dermatol 1997; 133: 1546–9
Tanzi EL, Alster TS. Long-pulsed 1064-nm Nd:YAG laser-assisted hair removal in all skin types. Dermatol Surg 2004; 30: 13–7
Lanigan GW. Incidence of side effects after laser hair removal. J Am Acad Dermatol 2003; 49: 882–6
Ross EV, Crooke LM, Timko AL, et al. Treatment of pseudofolliculitis barbae in skin types IV, V, and VI with a long-pulsed neodymium: yttrium aluminum garnet laser. J Am Acad Dermatol 2002; 47: 263–70
Fournier N. Hair removal on dark-skinned patients with pneumatic skin flattening and a high energyNd-YAGlaser. J Cosmet Laser Ther 2008; 10: 210–2
Bewdewi AF. Hair removal with intense pulsed light.LasersMed Sci 2004; 19: 48–51
Gold MH. Lasers and light sources for the removal of unwanted hair. Clin Dermatol 2007; 25: 443–53
Gold MH, Foster TD, Adair M, et al. The treatment of dark skin (types V and VI) with the intense pulsed light source for hair removal. Int J Cosmet Surg Aesthet Dermatol 2000; 2: 35–9
Weir VM, Woo TY. Photo-assisted epilation: review and personal observations. J Cutan Laser Ther 1999; 1: 135–43
Breadon JY, Barnes CA. Comparison of adverse events of laser and light-assisted hair removal systems in skin types IV-VI. J Drugs Dermatol 2007; 6: 40–6
Goh CL. Comparative study on a single treatment response to long pulse Nd:YAG lasers and intense pulse light therapy for hair removal on skin type IV to VI: is longer wavelengths lasers preferred over shorter wavelengths lights for assisted hair removal. J Dermatol Treat 2003; 14: 243–7
Sadick NS, Krespi Y. Hair removal for Fitzpatrick skin types V and VI using light and heat energy technology. J Drugs Dermatol 2006; 5: 597–9
Alster TS, Tanzi EL. The effect of a novel, low-energy, pulsed-light device for home-use hair removal. Dermatol Surg 2009; 35: 483–9
Alster TS, Railan D. Laser treatment of vascular birthmarks. J Craniofac Surg 2006; 4: 720–3
Garden JM, Bakus AD. Clinical efficacy of the pulsed dye laser in the treatment of vascular lesions. J Dermatol Surg Oncol 1993; 19: 321–6
Anderson RR, Parrish JA.Microvasculature can be selectively damaged using dye lasers: a basic theory and experimental evidence in human skin. Lasers Surg Med 1981; 1: 263–76
Morelli JG, Tan OT, Garden J, et al. Tunable dye laser (577 nm) treatment of port wine stains. Lasers Surg Med 1986; 6: 94–9
Alster TS, Wilson F. Treatment of port-wine stains with the flashlamppumped pulsed dye laser: extended clinical experience in children and adults. Ann Plast Surg 1994; 32: 478–84
Sharma VK, Shandpur S. Efficacy of pulsed dye laser in facial port-wine stains in Indian patients. Dermatol Surg 2007; 33: 560–6
Asahina A, Watanabe T, Kishi A, et al. Evaluation of the treatment of portwine stains with the 595nm long pulsed dye laser: a large prospective study in adult Japanese patients. J Am Acad Dermatol 2006; 54: 487–93
Sommer S, Sheehan-Dare RA. Pulsed dye laser treatment of port-wine stains in pigmented skin. J Am Acad Dermatol 2000; 42: 667–71
Ho WS, Chan HH, Ying SY, et al. Laser treatment of congenital facial portwine stains: long-term efficacy and complication in Chinese patients. Lasers Surg Med 2002; 30: 44–7
Chang CJ, Nelson JS. Cryogen spray cooling and higher fluence pulsed dye laser treatment improve port-wine stain clearance while minimizing epidermal damage. Dermatol Surg 1999; 25: 767–72
Chiu CH, Chan HH, Ho WS, et al. Prospective study of pulsed dye laser in conjunction with cryogen spray cooling for treatment of port wine stains in Chinese patients. Dermatol Surg 2003; 29: 909–15
Weiss RA, Dover JS. Laser surgery of leg veins. Dermatol Clin 2002; 1: 19–36
Dover JS, Arndt KA. New approaches to the treatment of vascular lesions. Lasers Surg Med 2000; 26: 158–63
Yang MU, Yaroslavsky AN, Farinelli WA, et al. Long-pulsed neodymium: yttrium-aluminum-garnet laser treatment for port-wine stains. J Am Acad Dermatol 2005; 52: 480–90
Alster TS, Tanzi EL. Combined 595nm and 1064nm laser irradiation of recalcitrant and hypertrophic port-wine stains in children and adults. Dermatol Surg 2009; 35: 914–9
Kauvar AN, Loud WW. Pulsed alexandrite laser for the treatment of leg telangiectasia and reticular veins. Arch Dermatol 2000; 136: 1371–5
Alster TS, Tanzi EL. Hypertrophic scars and keloids: etiology and management. Am J Clin Dermatol 2003; 4: 235–43
Alster TS, Zaulyanov-Scanlon L. Laser scar revision: a review.Dermatol Surg 2007; 33: 131–40
Alster TS, Nanni CA. Pulsed dye laser treatment of hypertrophic burn scars. Plast Reconstr Surg 1998; 102: 2190–5
Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585nm flashlamp-pumped pulsed dye laser. Lancet 1995; 345: 1198–200
Reiken SR, Wolfort SF, Berthiamume F, et al. Control of hypertrophic scar growth using selective photothermolysis. Lasers Surg Med 1997; 21: 7–12
Kuo YR, Jeng SR, Wang FS, et al. Flashlamp pulsed dye laser (PDL) suppression of keloid proliferation through down-regulation of TGF-beta, expression of extracellular matrix expression. Lasers Surg Med 2004; 34: 104–8
Alster TS, Tanzi EL. Laser skin resurfacing: ablative and nonablative. In: Robinson J, Sengelman R, Siegal DM, et al. editors. Surgery of the skin. Philadelphia (PA): Elsevier, 2005: 611–24
Alster TS. Cutaneous resurfacing with CO2 and erbium:YAG lasers: preoperative, intraoperative, and postoperative considerations. Plast Reconstr Surg 1999; 103: 619–32
Ho C, Nguyen Q, Lowe NJ, et al. Laser resurfacing in pigmented skin.Dermatol Surg 1995; 21: 1035–7
Kim JW, Lee JO. Skin resurfacing with laser in Asians. Aesth Plast Surg 1997; 21: 115–7
Ruiz-Espara J, Gomez JM, de la Torre OL, et al. Ultrapulse laser skin resurfacing in Hispanic patients: a prospective study of 36 individuals. Dermatol Surg 1998; 24: 59–62
Alster TS, Hirsch RJ. Single-pass CO2 laser skin resurfacing of light and dark skin: extended experience with 52 patients. J Cosmetic Laser Ther 2003; 5: 39–42
Tanzi EL, Alster TS. Complications of ablative and nonablative lasers and light sources. In:Gloster Jr HM, editor. Complications in cutaneous surgery. New York: Springer, 2008: 167–82
Munavalli GS, Weiss RA, Halder R. Photoaging and nonablative photorejuvenation in ethnic skin. Dermatol Surg 2005; 31: 1250–61
Alster TS, Lupton JR.Are all infrared lasers equally effective in skin rejuvenation. Semin Cutan Med Surg 2002; 21: 274–9
Hardaway CA, Ross EV. Non-ablative laser skin remodeling. Dermatol Clin 2002; 20: 97–111
Alam M, Hsu T, Dover JS, et al. Nonablative laser and light treatments: histology and tissue effects: a review. Lasers Surg Med 2003; 33: 30–9
Fitzpatrick R, Geronemus R, Goldberg D, et al. Multicenter study of noninvasive radiofrequency for periorbital tissue tightening. Lasers Surg Med 2003; 33: 232–4
Alster TS, Tanzi EL. Improvement of neck and cheek laxity with a non-ablative radiofrequency device: a lifting experience. Dermatol Surg 2004; 30: 503–7
Alster TS, Lupton JR. Nonablative cutaneous remodeling using radiofrequency devices. Clin Dermatol 2007; 25: 487–91
Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing. J Am Acad Dermatol 2008; 58: 719–37
Manstein D, Herron GS, Sink RV, et al. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med 2004; 34: 426–38
Hantash BM, Bedi VP, Kapadia B, et al. In vivo histological evaluation of a novel ablative fractional resurfacing device. Lasers Surg Med 2007; 39: 96–107
Wanner M, Tanzi EL, Alster TS. Fractional photothermolysis: treatment of facial and nonfacial cutaneous photodamage with a 1500-nm erbium-doped fiber laser. Dermatol Surg 2007; 33: 23–8
Alster TS, Tanzi EL, Lazarus M. The use of fractional laser photothermolysis for the treatment of atrophic scars. Dermatol Surg 2007; 33: 295–9
Kono T, Chan HH, Groff WF, et al. Prospective direct comparison study of fractional resurfacing using different fluences and densities for skin rejuvenation in Asians. Lasers Surg Med 2007; 39: 311–4
Lee HS, Lee JH, Ahn GY, et al. Fractional photothermolysis for the treatment of acne scars: a report of 27 Korean patients. J Dermatol Treat 2008; 19: 45–9
Hu S, Chen MC, Lee MC, et al. Fractional resurfacing for the treatment of atrophic facial acne scars in Asian skin. Dermatol Surg 2009; 35: 826–32
Taub AF. Fractionated delivery systems for difficult to treat clinical applications: acne scarring, melasma, atrophic scarring, striae distensae, and deep rhytides. J Drugs Dermatol 2007; 6: 1120–8
Kim BJ, Lee DH, Kim MN, et al. Fractional photothermolysis for the treatment of striae distensae in Asian skin. Am J Clin Dermatol 2008; 9: 33–7
Tierney EP, Kouba DJ, Hanke CW. Review of fractional photothermolysis: treatment indications and efficacy. Dermatol Surg 2009; 35: 1445–61
Tanzi EL, Wanitphakdeedecha R, Alster TS. Fraxel laser indications and long-term follow-up. Aesth Surg J 2008; 28 (6): 1–4
Chapas AM, Brightman L, Sukal S, et al. Successful treatment of acneiform scarring withCO2 ablative fractional resurfacing.Lasers Surg Med 2008; 40: 381–6
Waibel J, Beer K, Narurkar V, et al.Preliminary observations on fractional ablative resurfacing devices: clinical impressions. J Drugs Dermatol 2009; 8: 481–5
Kim S, Cho KH. Clinical trial of dual treatment with an ablative fractional laser and a nonablative laser for the treatment of acne scars in Asian patients. Dermatol Surg 2009; 35: 1089–98
Cho SB, Lee SJ, Kang JM, et al. The efficacy and safety of 10 600-nm carbon dioxide fractional laser for acne scars in Asian patients. Dermatol Surg 2009; 35: 1955–61
Graber EM, Tanzi EL, Alster TS. Side effects and complications of fractional laser photothermolysis: experience with 961 treatments. Dermatol Surg 2008; 34: 301–7
Chan HH, Manstein D, Yu CS, et al. The prevalence and risk factors of postinflammatory hyperpigmentation after fractional resurfacing in Asians. Lasers Surg Med 2007; 39: 381–5
Tan KL, Kurniawati C, Gold MH. Low risk of postinflammatory hyperpigmentation in skin types 4 and 5 after treatment with fractional CO2 laser device. J Drugs Dermatol 2008; 7: 774–7
Metelitsa AI, Alster TS. Fractionated laser skin resurfacing treatment complications: a review. Dermatol Surg 2010; 36: 299–306
Acknowledgments
No sources of funding were used to prepare this review. The authors have no conflicts of interest that are directly relevant to the content of this review.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shah, S., Alster, T.S. Laser Treatment of Dark Skin. Am J Clin Dermatol 11, 389–397 (2010). https://doi.org/10.2165/11538940-000000000-00000
Published:
Issue Date:
DOI: https://doi.org/10.2165/11538940-000000000-00000