Dr. DiAnne Davis discusses using lasers safely and effectively to revise scars in skin of color patients, including tips for improving patient outcomes.
DiAnne Davis, MD, FAAD, Dermatologist, North Dallas Dermatology Associates, Dallas, Texas
“I’m passionate about lasers and energy devices and how far that envelope can be pushed in terms of skin of color and melanin-rich skin,” said DiAnne Davis, MD, FAAD, who presented “Selecting the Most Appropriate Lasers for Scar Revision,” during the Skin of Color Update meeting in New York, New York.
According to Dr. Davis, that passion, or experience, is important to acknowledge before consulting with or treating scars in a patient with skin of color.
“If you, yourself, are not comfortable with treating skin of color, you should make sure to direct those patients to dermatologists that have that knowledge.”
Consult Considerations
One of the most important first steps is to look at the patient’s history of scars, said Dr. Davis.
“While interviewing a patient, I will look at cuts or scrapes that they had in their childhood that may be on their knees or elbows because I want to assess their degree of hyperpigmentation or, possibly, hypopigmentation. That lets me know which lasers I would recommend for their treatments and how to proceed with either pre- or posttreatment counsel.”
Dermatologists should also discuss the importance of sun protection with skin of color patients before using laser or energy-based devices on their skin no matter what the treatment, said Dr. Davis.
“That’s because, particularly in skin of color, the melanocytes are so much more fragile. I want them to know that there are potential risks with even minimal amounts of sun exposure.”
Some people believe darker skin types are not candidates for laser treatment, so it’s important to reassure patients that some lasers can be safely used to treat skin of color, said Dr. Davis.
“That is definitely a myth that I would like to debunk. It is still out there on social media platforms. I often hear that my patients are told that [lasers are not safe for skin of color] by different offices and practitioners.”
An Individualized Approach
The laser settings that Dr. Davis uses to treat scars in skin of color patients might be different than those used by her experienced colleagues in New York or on the West Coast, she said.
“… you definitely don’t want to memorize settings. We have parameters, but you always want to trust your gut and pay attention to that tissue-based interaction when the device comes in contact with the skin because that is very important in optimizing outcomes and minimizing adverse events.”
According to Dr. Davis, device selection is key to avoiding unfortunate pigmentary alterations that can happen when patients are treated with the wrong device.
“Often, I use non-ablative fractional laser therapy for my patients with skin of color because I can create the microchannels or columns that allow for that collagen remodeling but also the melanin shuttle that helps to eliminate that hyperpigmentation that we see on the skin when I’m addressing hyperpigmentation.”
Combination Therapy Benefits
Dr. Davis said she uses laser-assisted drug delivery to combine therapies, especially when it comes to treating scars.
“Oftentimes, I may use triamcinolone, or Kenalog, to apply on top of the skin after I have done the laser treatment. Another of my favorites is platelet-rich plasma. I think that helps accelerate the healing process and allows for some skin rejuvenation…. I also like poly-L-lactic acid, which is great for helping to stimulate those fibroblasts to help make new collagen.”
“As I explain it to my patients, that new collagen is going to be younger, fresher, and tighter, so it allows us to revise that scar and make the appearance less noticeable and refresh the skin, as well.”
More to Come
There are newer technologies that hold hope for scar treatment in the future, she said.
“One in particular is micro-coring. Right now, it is being utilized for skin rejuvenation, but I am hopeful in the future we can see what applications we can do with scars.”
Disclosure: Dr. Davis reports no relevant conflicts of interest.
