Exchanging Clinical Information and Treatment Protocols about Treating Skin of Color. Skin Types IV - VI. East Asian. African-American. South Asian (Indian). Middle East. Latin. South American. Mediteranean. How they differ from skin types I - III and how they differ from each other.

When using the Fraxel 1500, what is the maximum treatment level you would use for an Eastern Asian patient (Korean)? I use TL 4-5. Can you go higher? What is the risk of PIH? Do the PIH risk get greater as you go to higher treatment levels?

How do you treat PIH from acne in an African-American? Can you use Laser Genesis (Cutera)? Can you use the MedLite? Should you just stick with topicals? Are peels and microdermabrasion safe? Can you use Fraxel 1500?

George,

1. Genesis does NOT treat pigment.

2. PIH in most cases will go away if left alone. If it has been there less than 6 months. leave it alone or use some topicals.

3. You can use the medlite but be very careful as you can depigment the area.

4. Depends on what peels you are talking about. I will do Blue peels an this class but always pretreat with the Obagi system.

5. Microderms are safe but make sure your aesthetician does not get overly aggressive as even aggressive microderms can cause PIH in some ethnic skin.

6. Yes, you can use the Fraxel 1500 but again be cautious. Type in Fraxel in the search area and you will see a lot of discussion for settings for a typical pt like yours.

MDJOHN:
In regards to Fraxel, I hace recently changed my protocol based on recommendation from a very experienced colleague from this blog. So far, I have had better success. In general, you want to use higher fluency (15 J/cm2), thus much less MTZ's (drilled holes) on the skin surface and keep the treatment level low (start with 4). Patients actually tolerate this better than fluency of 5-6 joules. Subsequently you can increase TL to 6-7.
George:
I agreed with what LH said since the risks of further AE's outweight any benefits from doing more such as IPL's or Q-switched or peels. I would tell them to be patient, use sun block at all time and wait out for the melanocytes to "even out" on their own over 6-12 month time.

Is anyone using medlite for melasma on skin type 4 and 5 and what settings are you using. We have Lumenis IPL, BBL and medlite (as well as fractional devices which we don't use as often due to downtime and expense). Which one do you guys recommend? Please help: struggling with melasma pts!