Special considerations for darker-skinned patients.

Today, lasers are being used to treat an increasing number of medical and aesthetic challenges with great success. However, the effects of laser treatments upon darker-skinned patients differ from those on Caucasians in several aspects; this makes their use not without risk. First of all, skin of color has a greater epidermal melanin content than Caucasian skin, and this increase in epidermal pigmentation acts as a competing chromophore. Furthermore, with epidermal melanin acting as a competing chromophore, the light dosage that reaches the actual target is reduced, and higher fluence is necessary to produce a desirable effect. Although effective cooling and longer wavelengths with decreased melanin absorption have been used, the treatment of patients with Fitzpatrick skin types > IV remains associated with a significant risk of side effects. Thus, careful selection of laser and light source parameters in conjunction with skin cooling are important in obtaining desirable clinical outcomes in ethnic skin.