Pigmentation Disorders

In the November issue of Journal of Drugs in Dermatology (2011;10:1235-9), Dr. Eliot F. Battle Jr., gives an excellent review of "Advances in Laser Hair Removal in Skin of Color."

Dr. Battle summarizes that "Laser hair removal, previously contraindicated in patients with ethnically dark (phototypes IV-VI) or sun-tanned skin, is now recognized as a safe and effective method of permanent hair reduction in all patients. Longer wavelengths, conservative fluences, longer pulse durations and appropriate cooling methods are necessary to minimize untoward side effects and maximize efficacy. The longer wavelength Nd:YAG laser is considered safest in treating darker skin of color. An added benefit of laser epilation is that side effects of conventional hair removal such as pseudo-folliculitis barbae and post inflammatory dyspigmentation, more commonly seen in skin of color, may also respond favorably to the laser, thus increasing the potential for patient satisfaction."

The mechanism of laser hair reduction (LHR) is based on the theory of selective photothermolysis, whereby thermal injury to a desired chromophore can be achieved with the appropriate wavelength, pulse duration, and fluence.

In LHR, the target chromophore is the pigment in the hair follicle and bulb. However, Dr. Battle notes that destruction of the non-pigmented progenitor stem cells is also required to achieve permanent hair reduction. Therefore, a modified theory of selective photothermolysis has been proposed for the mechanism of LHR where appropriate wavelengths, as well as longer pulse durations, must be used to allow heat to effectively destroy the melanocytic hair follicle and bulb, as well as the amelanotic hair follicle and stem cell. 

In darker skin types, longer wavelength lasers must be used to bypass absorption of epidermal pigment to prevent untoward side effects of dyspigmentation.

Currently the 810-nm diode and 1064-nm Nd:YAG lasers are Food and Drug Administration approved for skin types IV-VI. The Nd:YAG is inherently the safer of the two devices because of the longer wavelength; however,  long pulse durations with the diode laser with appropriate cooling have been shown to increase its safety profile.

Epidermal damage from lasers occurs when the epidermal temperature equals or exceeds 45 degrees Celsius, thus appropriate cooling mechanisms are essential for safe and effective LHR. Excessive cooling, however, can lead to dyspigmentation in darker skin.

Initiating LHR in darker skin should be done conservatively with longer wavelengths, lower fluences, and longer pulse durations. If test spots are performed, it is recommended to wait 48 hours before proceeding with therapy as patients with darker skin may manifest delayed dyspigmentation.

Patients with skin types IV-VI may also be at increased risk for paradoxical hypertrichosis. While it has been reported in most ethnic origins, those of Mediterranean and Pacific Asian descent may be particularly affected. Paradoxical hypertrichosis mainly occurs on the face and neck, and has been reported both within and outside the treatment area. While the exact cause is unknown, possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Current treatment for paradoxical hypertrichosis is laser therapy of the affected area.

The only contraindications for LHR are gold therapy and St. John’s Wort, which should be discontinued for 3 months prior to therapy. While not contraindicated, LHR is not recommended in pregnant women. 

There is no evidence supporting increased LHR side effects in patients recently receiving Accutane; however, until there is more data, it is recommended to wait 3 months after discontinuing Accutane before initiating LHR. Anti-viral prophylaxis may be taken 2-3 days prior to LHR and for 5-7 days after treatment for patients with a history of recurrent herpetic infections in the treatment area.

With each treatment, patients may expect a 10%-20% decrease in hair count, color, and diameter of the hair. In patients of darker color, a minimum of eight treatments may be required to achieve results, with treatments typically scheduled 4-8 weeks apart. 

Dr. Battle also noted that LHR not only treats unwanted hair, but also effectively diminishes inflammation and dyspigmentation from pseudofolliculitis barbae and acne keloidalis nuchae, as these conditions are due to ingrown and/or tufted coarse curled hairs in darker skin types.

In the November issue of Journal of Drugs in Dermatology (2011;10:1235-9), Dr. Eliot F. Battle Jr., gives an excellent review of "Advances in Laser Hair Removal in Skin of Color."

Dr. Battle summarizes that "Laser hair removal, previously contraindicated in patients with ethnically dark (phototypes IV-VI) or sun-tanned skin, is now recognized as a safe and effective method of permanent hair reduction in all patients. Longer wavelengths, conservative fluences, longer pulse durations and appropriate cooling methods are necessary to minimize untoward side effects and maximize efficacy. The longer wavelength Nd:YAG laser is considered safest in treating darker skin of color. An added benefit of laser epilation is that side effects of conventional hair removal such as pseudo-folliculitis barbae and post inflammatory dyspigmentation, more commonly seen in skin of color, may also respond favorably to the laser, thus increasing the potential for patient satisfaction."

The mechanism of laser hair reduction (LHR) is based on the theory of selective photothermolysis, whereby thermal injury to a desired chromophore can be achieved with the appropriate wavelength, pulse duration, and fluence.

In LHR, the target chromophore is the pigment in the hair follicle and bulb. However, Dr. Battle notes that destruction of the non-pigmented progenitor stem cells is also required to achieve permanent hair reduction. Therefore, a modified theory of selective photothermolysis has been proposed for the mechanism of LHR where appropriate wavelengths, as well as longer pulse durations, must be used to allow heat to effectively destroy the melanocytic hair follicle and bulb, as well as the amelanotic hair follicle and stem cell. 

In darker skin types, longer wavelength lasers must be used to bypass absorption of epidermal pigment to prevent untoward side effects of dyspigmentation.

Currently the 810-nm diode and 1064-nm Nd:YAG lasers are Food and Drug Administration approved for skin types IV-VI. The Nd:YAG is inherently the safer of the two devices because of the longer wavelength; however,  long pulse durations with the diode laser with appropriate cooling have been shown to increase its safety profile.

Epidermal damage from lasers occurs when the epidermal temperature equals or exceeds 45 degrees Celsius, thus appropriate cooling mechanisms are essential for safe and effective LHR. Excessive cooling, however, can lead to dyspigmentation in darker skin.

Initiating LHR in darker skin should be done conservatively with longer wavelengths, lower fluences, and longer pulse durations. If test spots are performed, it is recommended to wait 48 hours before proceeding with therapy as patients with darker skin may manifest delayed dyspigmentation.

Patients with skin types IV-VI may also be at increased risk for paradoxical hypertrichosis. While it has been reported in most ethnic origins, those of Mediterranean and Pacific Asian descent may be particularly affected. Paradoxical hypertrichosis mainly occurs on the face and neck, and has been reported both within and outside the treatment area. While the exact cause is unknown, possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Current treatment for paradoxical hypertrichosis is laser therapy of the affected area.

The only contraindications for LHR are gold therapy and St. John’s Wort, which should be discontinued for 3 months prior to therapy. While not contraindicated, LHR is not recommended in pregnant women. 

There is no evidence supporting increased LHR side effects in patients recently receiving Accutane; however, until there is more data, it is recommended to wait 3 months after discontinuing Accutane before initiating LHR. Anti-viral prophylaxis may be taken 2-3 days prior to LHR and for 5-7 days after treatment for patients with a history of recurrent herpetic infections in the treatment area.

With each treatment, patients may expect a 10%-20% decrease in hair count, color, and diameter of the hair. In patients of darker color, a minimum of eight treatments may be required to achieve results, with treatments typically scheduled 4-8 weeks apart. 

Dr. Battle also noted that LHR not only treats unwanted hair, but also effectively diminishes inflammation and dyspigmentation from pseudofolliculitis barbae and acne keloidalis nuchae, as these conditions are due to ingrown and/or tufted coarse curled hairs in darker skin types.

In the November issue of Journal of Drugs in Dermatology (2011;10:1235-9), Dr. Eliot F. Battle Jr., gives an excellent review of "Advances in Laser Hair Removal in Skin of Color."

Dr. Battle summarizes that "Laser hair removal, previously contraindicated in patients with ethnically dark (phototypes IV-VI) or sun-tanned skin, is now recognized as a safe and effective method of permanent hair reduction in all patients. Longer wavelengths, conservative fluences, longer pulse durations and appropriate cooling methods are necessary to minimize untoward side effects and maximize efficacy. The longer wavelength Nd:YAG laser is considered safest in treating darker skin of color. An added benefit of laser epilation is that side effects of conventional hair removal such as pseudo-folliculitis barbae and post inflammatory dyspigmentation, more commonly seen in skin of color, may also respond favorably to the laser, thus increasing the potential for patient satisfaction."

The mechanism of laser hair reduction (LHR) is based on the theory of selective photothermolysis, whereby thermal injury to a desired chromophore can be achieved with the appropriate wavelength, pulse duration, and fluence.

In LHR, the target chromophore is the pigment in the hair follicle and bulb. However, Dr. Battle notes that destruction of the non-pigmented progenitor stem cells is also required to achieve permanent hair reduction. Therefore, a modified theory of selective photothermolysis has been proposed for the mechanism of LHR where appropriate wavelengths, as well as longer pulse durations, must be used to allow heat to effectively destroy the melanocytic hair follicle and bulb, as well as the amelanotic hair follicle and stem cell. 

In darker skin types, longer wavelength lasers must be used to bypass absorption of epidermal pigment to prevent untoward side effects of dyspigmentation.

Currently the 810-nm diode and 1064-nm Nd:YAG lasers are Food and Drug Administration approved for skin types IV-VI. The Nd:YAG is inherently the safer of the two devices because of the longer wavelength; however,  long pulse durations with the diode laser with appropriate cooling have been shown to increase its safety profile.

Epidermal damage from lasers occurs when the epidermal temperature equals or exceeds 45 degrees Celsius, thus appropriate cooling mechanisms are essential for safe and effective LHR. Excessive cooling, however, can lead to dyspigmentation in darker skin.

Initiating LHR in darker skin should be done conservatively with longer wavelengths, lower fluences, and longer pulse durations. If test spots are performed, it is recommended to wait 48 hours before proceeding with therapy as patients with darker skin may manifest delayed dyspigmentation.

Patients with skin types IV-VI may also be at increased risk for paradoxical hypertrichosis. While it has been reported in most ethnic origins, those of Mediterranean and Pacific Asian descent may be particularly affected. Paradoxical hypertrichosis mainly occurs on the face and neck, and has been reported both within and outside the treatment area. While the exact cause is unknown, possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Current treatment for paradoxical hypertrichosis is laser therapy of the affected area.

The only contraindications for LHR are gold therapy and St. John’s Wort, which should be discontinued for 3 months prior to therapy. While not contraindicated, LHR is not recommended in pregnant women. 

There is no evidence supporting increased LHR side effects in patients recently receiving Accutane; however, until there is more data, it is recommended to wait 3 months after discontinuing Accutane before initiating LHR. Anti-viral prophylaxis may be taken 2-3 days prior to LHR and for 5-7 days after treatment for patients with a history of recurrent herpetic infections in the treatment area.

With each treatment, patients may expect a 10%-20% decrease in hair count, color, and diameter of the hair. In patients of darker color, a minimum of eight treatments may be required to achieve results, with treatments typically scheduled 4-8 weeks apart. 

Dr. Battle also noted that LHR not only treats unwanted hair, but also effectively diminishes inflammation and dyspigmentation from pseudofolliculitis barbae and acne keloidalis nuchae, as these conditions are due to ingrown and/or tufted coarse curled hairs in darker skin types.

While the growing field of nanotechnology holds promise, particularly for darker skinned patients, it comes with its fair share of controversy.

Nanotechnology is the study of manipulating matter on a molecular scale by structuring ingredients into nanometer sized particles versus micrometer particles that are considerably larger.

The technology is currently being used in sunscreens, cosmetics, moisturizers, and anti-aging products because of properties that cannot­­ be obtained using larger sized particles. In skin of color, nanotechnology has provided considerable benefit in the elegance of products, particularly sunscreens.

Chemical blockers in sunscreens, such as avobenzone, are greasy and difficult to blend. In addition, titanium dioxide leaves a white residue when applied to darker skin. When the ingredients are converted to nanoparticles, however, they are less greasy and leave the skin residue free while retaining their broad spectrum properties.

Because sunscreen use is much less prevalent in skin of color, particularly in black and Hispanic populations, skin cancer rates and photo-aging are on the rise in these populations. Although more educational and preventative health measures need to be undertaken, improvements in sunscreens may help drive use.

The safety of nanotechnology, however, has received considerable debate. Because the skin is the first line of defense, many dermatologists have concerns about the potential risk of nanotechnology.  

Studies have shown that nanoparticles can enter skin with an altered integrity. Thus, products containing nanoparticles should never be used on damaged skin, burns, infants, and those with an inadequate skin barrier.

Considerable research on nanoparticles has shown that healthy, undamaged skin is an effective barrier for preventing the entry of nanoparticles into the deep layers of the dermis. And, the Food and Drug Administration’s Nanotechnology Task Force is currently investigating the safety of nanoparticles for skin care products because materials in the nano-scale dimension may have different chemical, physical, and biologic properties. The FDA has proposed guidelines for the use and development of nanotechnology to ensure patient safety and product efficacy.

Sunscreens are used to protect us from a known carcinogen: UV radiation. Nanoparticles have not been proven to be carcinogenic. In fact, sunscreens with nanoparticles have been shown to last longer, apply better to the skin, and provide better UVA and UVB protection than other products on the market.

We should encourage our skin of color patients that these products are safe and are more transparent than traditional products. This technology is providing more appealing products for us to offer our patients.

While the growing field of nanotechnology holds promise, particularly for darker skinned patients, it comes with its fair share of controversy.

Nanotechnology is the study of manipulating matter on a molecular scale by structuring ingredients into nanometer sized particles versus micrometer particles that are considerably larger.

The technology is currently being used in sunscreens, cosmetics, moisturizers, and anti-aging products because of properties that cannot­­ be obtained using larger sized particles. In skin of color, nanotechnology has provided considerable benefit in the elegance of products, particularly sunscreens.

Chemical blockers in sunscreens, such as avobenzone, are greasy and difficult to blend. In addition, titanium dioxide leaves a white residue when applied to darker skin. When the ingredients are converted to nanoparticles, however, they are less greasy and leave the skin residue free while retaining their broad spectrum properties.

Because sunscreen use is much less prevalent in skin of color, particularly in black and Hispanic populations, skin cancer rates and photo-aging are on the rise in these populations. Although more educational and preventative health measures need to be undertaken, improvements in sunscreens may help drive use.

The safety of nanotechnology, however, has received considerable debate. Because the skin is the first line of defense, many dermatologists have concerns about the potential risk of nanotechnology.  

Studies have shown that nanoparticles can enter skin with an altered integrity. Thus, products containing nanoparticles should never be used on damaged skin, burns, infants, and those with an inadequate skin barrier.

Considerable research on nanoparticles has shown that healthy, undamaged skin is an effective barrier for preventing the entry of nanoparticles into the deep layers of the dermis. And, the Food and Drug Administration’s Nanotechnology Task Force is currently investigating the safety of nanoparticles for skin care products because materials in the nano-scale dimension may have different chemical, physical, and biologic properties. The FDA has proposed guidelines for the use and development of nanotechnology to ensure patient safety and product efficacy.

Sunscreens are used to protect us from a known carcinogen: UV radiation. Nanoparticles have not been proven to be carcinogenic. In fact, sunscreens with nanoparticles have been shown to last longer, apply better to the skin, and provide better UVA and UVB protection than other products on the market.

We should encourage our skin of color patients that these products are safe and are more transparent than traditional products. This technology is providing more appealing products for us to offer our patients.

While the growing field of nanotechnology holds promise, particularly for darker skinned patients, it comes with its fair share of controversy.

Nanotechnology is the study of manipulating matter on a molecular scale by structuring ingredients into nanometer sized particles versus micrometer particles that are considerably larger.

The technology is currently being used in sunscreens, cosmetics, moisturizers, and anti-aging products because of properties that cannot­­ be obtained using larger sized particles. In skin of color, nanotechnology has provided considerable benefit in the elegance of products, particularly sunscreens.

Chemical blockers in sunscreens, such as avobenzone, are greasy and difficult to blend. In addition, titanium dioxide leaves a white residue when applied to darker skin. When the ingredients are converted to nanoparticles, however, they are less greasy and leave the skin residue free while retaining their broad spectrum properties.

Because sunscreen use is much less prevalent in skin of color, particularly in black and Hispanic populations, skin cancer rates and photo-aging are on the rise in these populations. Although more educational and preventative health measures need to be undertaken, improvements in sunscreens may help drive use.

The safety of nanotechnology, however, has received considerable debate. Because the skin is the first line of defense, many dermatologists have concerns about the potential risk of nanotechnology.  

Studies have shown that nanoparticles can enter skin with an altered integrity. Thus, products containing nanoparticles should never be used on damaged skin, burns, infants, and those with an inadequate skin barrier.

Considerable research on nanoparticles has shown that healthy, undamaged skin is an effective barrier for preventing the entry of nanoparticles into the deep layers of the dermis. And, the Food and Drug Administration’s Nanotechnology Task Force is currently investigating the safety of nanoparticles for skin care products because materials in the nano-scale dimension may have different chemical, physical, and biologic properties. The FDA has proposed guidelines for the use and development of nanotechnology to ensure patient safety and product efficacy.

Sunscreens are used to protect us from a known carcinogen: UV radiation. Nanoparticles have not been proven to be carcinogenic. In fact, sunscreens with nanoparticles have been shown to last longer, apply better to the skin, and provide better UVA and UVB protection than other products on the market.

We should encourage our skin of color patients that these products are safe and are more transparent than traditional products. This technology is providing more appealing products for us to offer our patients.