Dr. Gilly Munavalli shares tips and tricks for using laser devices to safely treat skin of color.
Gilly Munavalli, MD, MHS, FACMS, Medical Director/Founder, Dermatology, Laser, & Vein Specialists of the Carolinas, Charlotte, North Carolina
“The whole session was centered around trying to be more comfortable with treating skin of color patients,” said Gilly Munavalli, MD, MHS, FACMS, who presented “Skin of Color Pearls” at this year’s ASLMS meeting.
“Obviously the demographic is changing for treated patients in this country. And so principally, we’re going to be seeing a lot more skin of color… So the point of the talk was to raise awareness for that and review some tips and procedures that you can do for treating skin of color.”
According to Dr. Munavalli, safety is key—and was his overriding message—when using laser and light devices on skin of color.
“You have to be careful with skin of color because of that pension for post inflammatory hyperpigmentation or PIH, as it’s commonly known.”
That means using devices that cause minimal thermal damage to the epidermis, he said.
“If we’re going to use devices for pigment, we want to use devices such as picosecond lasers or different things that are more photo mechanical than photo thermal.”
Using adjunctive cooling during treatment can also help to keep the surface of the skin cool, thereby minimizing the chance for hyperpigmentation, said Dr. Munavalli.
Performing test spots before treatment is another important step to safely treat darker skin types, said Dr. Munavalli.
“If you’ve got extensive issues, you might want to treat a couple [of spots first then] bring the patient back. It’s may not be something they want to do in terms of the inconvenience, but it’s the safest thing to do….”
Oral pretreatment with tranexamic acid can also be considered, said Dr. Munavalli.
“There’s some talk in the literature about using a medication called Lysteda, or tranexamic acid, orally prior to procedures. If I’m worried about post inflammatory pigment, and a patient’s extremely worried, we start that medicine several weeks prior.”
However, data on the use of oral tranexamic acid treatment is controversial, he said. It may or may not show a benefit.
Using topical steroids during the week after treatment can help to minimize inflammation, said Dr. Munavalli.
“That sounds counterintuitive in an area that’s healing, but the key is to get that inflammation and redness down as quickly as possible. The less likely we are to disrupt the melanocytes that way.”
Although there is some controversy over using potent topical steroids post treatment as well, some data show that using it as a burst for a couple days can prevent and suppress inflammation and subsequent hyperpigmentation, he said.
Other Treatment Tips
Match the treatment spot size to the lesion, said Dr. Munavalli.
“If you’re going to treat an area that’s, say, 2 mm, you don’t want to use a large spot size.”
Avoid over treating collateral areas around the lesion that don’t need it, he said.
“The tendency is to sort of try to over treat lesions and this is not the population to do it [in]… there are endpoints that you consider when you treat a lesion.”
According to Dr. Munavalli, change in color during treatment is important and something to be keenly aware of.
“You don’t want to dramatically over-whiten the lesion as an endpoint. You want to use the minimum energy to cause a mild grey-white color change for epidermal lesions.”
In terms of settings, every device is different, said Dr. Munavalli.
“…knowing your endpoints is really important. Finesse is critical here.”
Melanin-specific wavelengths can help to keep darker skin types safe, said Dr. Munavalli. The trend is to use picosecond lasers.
“You might need to use different wavelengths and ones that are a little bit more melanin specific, which is a big reason why we don’t use devices like IPLs commonly in darker skin because they can damage the skin.”
Finally, according to Dr. Munavalli, chemical peels are another option for treating skin of color safely.
“There’s a big resurgence in chemical peels especially amongst the younger dermatologists. Chemical peels can work very well in darker skin as long as you choose your type of peel wisely and observe the proper endpoints that signal a successful treatment.”
