Nonablative Fractional Laser Resurfacing in Skin of Color: Evidence-based Review.

Nonablative laser resurfacing represents one of the major advances in procedural dermatology over the past decade. However, its use in darker skin types is limited by safety concerns and a relative lack of available data. To provide evidence-based recommendations for the use of fractional lasers in darker skin types. A broad literature search of PubMed/Medline database was conducted in April 2016 using the term fractional lasers. A free text search of keywords including fractional resurfacing, nonablative lasers, skin type, skin of color, ethnic skin, Fitzpatrick skin type, Asian skin, African Americans, Afro-Caribbean, and Hispanics was also executed. An in-depth review of all the relevant articles fitting the authors' inclusion/exclusion criteria was performed. Thereafter, each study was assigned levels of evidence per the Modified Criteria by Oxford Center of Evidence Based Medicine. A recommendation was made for a specific treatment based on the presence of at least one Level 1 study or more than three Level 2 or 3 studies that had concordant results. The available evidence strongly suggests that fractional lasers are a favorable treatment option for a variety of dermatological diseases in Fitzpatrick skin phototypes IV to VI. Level 1 evidence was found for the use of fractional lasers for treating acne, striae and skin rejuvenation. Level 2 evidence was found for their use in acne scars, melasma, and surgical/traumatic scars. Fractional resurfacing is a safe and efficacious treatment option for various dermatological disorders in darker skin types; however, there is a paucity of high-quality studies involving skin types V and VI.