Journal of Clinical and Aesthetic Dermatology

JUN 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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51 JCAD journal of clinical and aesthetic dermatology June 2017 • volume 10 • Number 6 N Background: Nonablative laser r esurfacing represents one of the major advances in procedural dermatology over the past decade. However, its use in darker skin types is l imited by safety concerns and a relative lack of available data. Aim: To provide evidence-based recommendations for the use of fractional lasers in darker skin types. Evidence review: 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. [abstract continued on next page] a B S T r a c T r E v I E w Nonablative Fractional Laser Resurfacing in Skin of Color: Evidence-based Review S H I VA NI B . K A U S H I K , M D ; A ND R EW F. A L E X I S , M D, M P H D e part m e n t o f D e r m a t o l o g y, Ic ah n S c h o o l o f M e d i c i n e a t M o u n t Si n ai , Ne w Yo r k , Ne w Yo r k NoNablative laser resurfacing represents one of the major advances in procedural dermatology over the past decade and has become the treatment of choice for a broad range of aesthetic indications. However, safety concerns related to their use in darker skin types remain. the vast majority of studies of fractional laser resurfacing in non-white patient populations involve asian skin types or are limited to Fitzpatrick skin photo types (sPts) iv. Published data related to the treatment sPts v and vi are limited. Herein, the authors review studies involving nonablative fractional lasers in the treatment of skin of color (sPt iv–vi) and suggest optimal parameters that can be used safely in these patients. FRAC TIONAL LASERS the concept of fractional lasers was introduced by Manstein et al in 2004. 1 since then, it has revolutionized the field of laser resurfacing. Fractional lasers create microscopic heat columns causing areas of thermal damage known as microscopic thermal zones (MtZs). these MtZs range from 100 to 400Jm in width and approximately 300 to 700Jm in depth. 2 the MtZs are separated by areas of normal skin, which acts as a reservoir for tissue regeneration and remodeling. these zones comprise up to 15 to 25 percent of the skin surface area per treatment session. 3,4 Fractional lasers can be further subdivided into ablative and nonablative depending on their impact on stratum corneum. ablative fractional lasers have longer wavelengths in the range of 2940 to 10600nm and lead to full thickness destruction of skin. Whereas, nonablative fractional lasers have wavelengths ranging from 1320 to 1927nm and leave a functionally and histologically intact stratum corneum compared to nonablative fractional lasers. ablative fractional lasers are usually associated with greater efficacy but longer recovery time and higher risk of complications in sPts iv to vi. 4–7 table 1 delineates the types of fractional devices currently used in Disclosure: The authors report no relevant conEicts of interest. Author correspondence: Shivani Bashiyan Kaushik, MD; E-mail:

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