Dr. Smita Ramanadham

Dr. Smita Ramanadham

April 8, 2020

This is so true, let me explain. Our skin type plays a big role is what laser or chemical-based treatments are safe for us. While there are many factors, the concentration of melanin and whether other skin conditions exist play a role. How do we determine this and why? We use a scale called the Fitzpatrick grading scale that essentially is based on how easily we tan but also is correlated with the concentration of melanin in our skin. The scale runs from Fitzpatrick type 1 (always burns) through 6 (never burns), with the amount of melanin increasing as you move up this scale. Want to use me an example? Sure, I’m an Indian female and my Fitzpatrick is a 5. I rarely burn and my skin is dark brown.

Okay, so why is this important for lasers. Lasers stand for light amplification by the stimulated emission of radiation (LASER). Laser use light energy. In order to have an effect, a laser has to target something within the skin. This can be hemoglobin which is in our blood and is what we target to treat vascular lesions. Melanin, gives us our skin color, and is targeted for sun spots or melasma. Water which is a large component of our skin and bodies, is targeted when we resurface the skin and aim to build collagen. Finally, hair is targeted for hair removal. These targets are all very close to each other and can be damaged if not protected or cooled sufficiently. This can be melanin which often “competes” for the energy or heat that is applied to the skin. When this occurs, it can be damaged and can change the skin color causing either hypopigmentation (lighter discoloration) or hyperpigmentation (darker discoloration). This can occur more often in people that have a higher concentration of pigment or melanin, like the higher Fitzpatrick skin types. For this reason, care must be taken when treating these patients, either by avoiding certain lasers or lowering the settings or cooling appropriately.

This applies to chemical peels, as well. Peels essentially create a controlled wound in the skin to cause rearrangement and strengthening of collagen as it heals. The peels vary in how deep they penetrate the skin. Superficial peels are generally safe as well as some medium depth peels. This is because they don’t go deep enough to where the melanin or pigment is located in the skin. Other peels that are deeper, can affect these molecules and again cause damage to them resulting in changes in color of the skin.

It’s for these reasons, that your doctors might not recommend certain lasers or peels given your skin type. We understand that damage might occur and also realize that for it to be safe, we would have to make the settings of the laser so low that you might not get the result you are seeking. We just all have to remember that these treatments are great, but they also have their limitations and we always have to weigh the risks with benefits to see if they are viable options for you!