In general, most believe that when we talk about “skin of color” we are talking about African American skin. That is not the case.
Skin types are classified in 6 different classes. Those that burn and do not tan, are a class I-II in the Fitzpatrick Scale. Type III is an intermediate class that sometimes burns, but can tan with prolonged sun exposure. Classes IV to VI don’t burn, they tan. Class VI does not typically tan, but they accumulate skin damage due to sun exposure, like all of us. Class VI through VI are prone to skin pigmentation disorders like melasma. We refer to Fitzpatrick Scale Class IV through Class VI as “skin of color”. That includes Hispanics, Middle Easterners, Africans, some European cultures and Asians, among other darker skinned cultures.
Most of our cosmetic products and skin rejuvenation light (IPL) and laser treatments are tailored to Classes I through III. However, people with skin of color need different approaches to get the results they want, avoiding hyper or hypo pigmentation complications.
Most skin of color experts, like Dr. Vanita Rattan have researched these cosmetic treatments extensively, but have little or no expertise in laser treatments for skin of color. In her book, Skin Revolution (2021), she recommends that skin of color patients should avoid laser treatments without discernment for those laser treatments that can work on skin of color.
Most of my patients are skin of color: I treat melasma with the most powerful and fastest pico laser in the world, the Fotona PQX. It works wonders, and I have very little issues with hypo- or hyperpigmentation. I follow protocols implemented and designed by melasma specialists and published experts that have tested hundreds of melasma patients successfully and kept most in remission for several years.
And, don’t take this wrong, I have read Dr. Rattan’s book and learned lots about skin of color, but I don’t agree with her opinion on the indications of lasers in skin of color. Just because 50% of a sample among her followers have had unfavorable experiences with laser treatments, one cannot issue a blank statement condemning laser treatments in all patients with skin of color.
Skin of color is challenging to treat whether you use lasers or not. However, light therapy or phototherapy using light has many different applications and before making a blanket statement we should know the different types of equipment and light/wavelength characteristic and recommend those that can be helpful and safe, avoiding those that can be problematic in skin of color. That is discernment. And that would be useful information for those skin of color patients.
